The rate of serious medical complications rose at hospitals after they were bought by private equity investment firms, according to a large study of the effects of such acquisitions on patient care in recent years.
the study, published in JAMA on Tuesday, found that in the three years after a private equity fund bought a hospital, adverse events including surgical infections and bed sores rose by 25 percent among Medicare patients compared with similar hospitals that those investors did not buy. . The researchers reported a roughly 38% increase in central line infections, a serious type of infection that medical authorities say should never happen, and a 27% increase in falls by patients during their hospital stay.
“We were not surprised that there was a signal,” said Dr. Sneha Kannan, a healthcare researcher and physician in the Division of Pulmonary and Critical Care at Massachusetts General Hospital, who was the study's lead author. “I will say we were surprised by how strong it was.”
Although the researchers found a significant increase in medical errors, they also noted a slight decrease (nearly 5 percent) in the rate of patients who died during their hospital stay. Researchers believe that other changes, such as a shift toward healthier patients being admitted to hospitals, could explain this decline. At 30 days after patients were discharged, there was no significant difference in mortality rates between hospitals.
Other researchers who reviewed the study said that while it did not provide a complete picture of the effects of private equity, it raised important questions about the quality of care at hospitals acquired by private equity owners.
“This is a big deal because it is the first piece of data that I think strongly suggests there is a quality problem when private equity takes over,” said Dr. Ashish Jha, dean of the Brown University School of Public Health, who led the private equity affairs. He has also studied hospital safety extensively.
Over the past two decades, private equity firms have become major players in the health care space, buying not only hospitals but also an increasing number of nursing homes, physician practices and home health care companies. Companies raise money from institutional and individual investors to form investment funds, often purchasing hospitals and other entities with high levels of debt, with the goal of reselling them within a few years. A separate recent study indicated that companies are consolidating physician groups in some local markets, which could lead to higher prices.
So far, these companies own a small share of hospitals in the United States, although numbers are difficult to measure because transactions are not always public.
Numerous media reports showed that some acquired hospitals were forced to do so Closing due to financial distressSome people fell under Regulatory audit For quality problems. But such examples are not necessarily typical.
“The private equity industry plays an essential role in providing local hospitals with the capital they need to improve patient care, expand access, and drive innovation,” said Drew Maloney, CEO of the American Investment Council, an industry trade group. “This research does not reflect the full track record of private equity in advancing health care across the country.”
The industry has recently come under scrutiny. This month the Senate Budget Committee He launched a bipartisan investigation In private equity ownership of hospitals. Bills introduced by several Democrats in Congress have pushed for more public reporting on private equity deals in health care, and for broader reforms on the ways companies can acquire companies and make profits.
Several studies have examined the financial impacts of private equity firms on hospitals. The new study, which examined 51 hospitals between 2009 and 2019, provides new evidence that those changes may lead to more serious conditions for patients. The researchers, who also include Dr. Zhirui Song of Harvard University and Joseph Dov Bruch of the University of Chicago, received funding from Arnold Ventures, a group that supports a wide range of health care research and research. It was decisive From the private equity industry.
former research It found that patients were less likely to die after visiting a private equity-backed hospital. But the researchers said they wanted to focus their study on specific measures such as medical errors that directly reflect hospital care rather than patient deaths, which are more likely to be influenced by the health status of patients admitted to the hospital.
The researchers examined a set of errors that Medicare tracks and that Medicare encourages hospitals to reduce. Hospitals with high levels of some of these problems — such as central line infections — must pay fines to the government. Although not all errors occurred sufficiently to be accurately measured, and complications generally rarely occurred, all eight individual measures studied worsened in hospitals purchased by private equity funds.
Rates of these complications have generally been declining for about 15 years, as hospitals have worked to reduce them and as best practices to avoid them have spread.
“These are preventable adverse events that everyone believes should not happen in hospitals,” said Dr. David Blumenthal, former president of the Commonwealth Fund, a nonprofit health care research group, who reviewed the study.
Some private equity owners may be overly eager to cut costs, leading to lower quality of care, he said. “It's about investment style,” he said. “It's about strength, short-term profits and the required investment returns.” In cases where they don't follow this strategy, private equity can be a positive, Dr. Blumenthal added: “It brings in capital. “It brings innovation.”
The most likely explanation for the increase in errors is a reduction in hospital staffing, an effect that has been measured in other studies of private equity, the researchers said. “Post-acquisition staff reductions could explain all of these results,” Dr. Song said.
But this paper did not directly measure staffing levels in the hospitals it examined.
Dr. Song has He called for more government oversight Private equity firms in healthcare. But several researchers who have studied the companies said that while the new study raises serious concerns, it still leaves some important questions unanswered for policymakers.
“This should make us lean forward and pay attention to what’s going on,” said Zach Cooper, a professor of public health and economics at Yale University, who has studied the industry. “That shouldn't prompt us to offer wholesale policies yet.”
Vivian Hu, a professor of economics at Rice University, was a co-author of the book paper that documented reductions in staffing after companies bought hospitals, including small reductions in nursing staff. Professor Ho noted that it was difficult to ascertain whether the cuts were the result of a change in leadership, or ownership by a private equity firm specifically, but she said the findings were worrying enough that she was keen to see more evidence.
“I'm willing to believe it's because of staffing issues,” she said. “Just combine that with anecdotal reports of what's happening in some of these hospitals, and it's a consistent story.”
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