Private equity takeover of hospitals led to rise in Medicare emergency patient deaths, says study

Private equity acquisition of hospitals have led to an increase in deaths among emergency department patients receiving Medicare, according to a recent study published in Annals of Internal Medicine.

It’s the latest in a series of recent studies illustrating that private equity acquisition of health facilities leads to worsening patient outcomes, including death.

“Each of them sort of comes up with the same result,” said Martin Kenney, distinguished professor in the department of human ecology at the University of California, Davis and author of Private Equity and the Demise of the Local. “Private equity takes over things in the medical field, quality goes down, prices go up,” Kenney explained.

Researchers found that private equity acquisition leads to increased deaths in nursing homes, increased post-operative complications for common inpatient surgeries and even an increase in medical conditions acquired in the hospital, such as bloodstream infections and injuries from falls.

Notably, the Department of Health and Human Services condemned private equity’s role in worsening patient outcomes toward the end of the Biden administration.

The latest study compared staff levels, wages and patient mortality in 49 private equity acquired hospitals with 293 non-private equity control hospitals – and found the private equity hospitals had smaller staff numbers and smaller salaries, and that there were seven more deaths per 10,000 patients in the private equity hospitals’ emergency departments. That’s around 700 excess deaths among the million emergency department visits the researchers investigated.

All of the patients whose records were included in the study were Medicare recipients.

Zirui Song, associate professor of health care policy and medicine at Harvard Medical School and one of the study’s authors, said that cutting staff in emergency departments that serve Medicare patients can be especially problematic.

“Some patients in emergency departments come in critically ill, requiring all hands on deck to care for them. Trauma, respiratory failure, sepsis, heart attack and stroke are a few examples of such conditions often seen in emergency departments,” Song said.

Medicare patients also may require special attention, Song said, as they are “on average older, with more health conditions, and are more vulnerable relative to commercially insured patients”. The study notes that private equity hospitals cut emergency department salaries by 18.2% on average, and reduced the number of full-time hospital employees by 11.6%.

Private equity owned health facilities are also known for rejecting higher risk patients in order to keep down the cost of care. Something similar is happening in emergency departments, according to Song’s study. Private equity owned hospitals transfer 12% more emergency patients out to other hospitals, and those patients were more likely to have multiple conditions.

“Sicker patients are transferred out to other hospitals, often because the first hospital lacks the bandwidth, capacity or resources to take care of them,” Song said, adding that this should mean that the patients that remain in the original hospital get more attention overall and have better outcomes.

Despite the increase in transfers at private equity owned hospitals, more patients were still dying, which Song says is “concerning”.

Song added that policymakers should consider the implications of cost cutting in hospitals after reading this study.

“Some cuts in expenditures may improve the efficiency of hospital operations, but other cuts may be harmful to patient care,” he said.

Policy changes that will actually hold private equity firms accountable for declines in patient care are unlikely, according to Kenney. As it stands now, “you don’t sue the private equity firm, because the private equity firm is insulated,” he said.

In order to sue a private equity firm for the actions of its portfolio health companies, plaintiffs must meet a very high bar to show that the private equity firm was directly involved in the health company’s day to day operations – even if that firm directly profited from the cost cutting that resulted in harm. Instead, Kenney says, plaintiffs must sue the hospital or other health company.

“And then, if worse comes to worse, they just go bankrupt and leave the patient who’s been harmed, holding the bag.” Kenney said.

In order for that to change, “Congress would have to pass a law saying that a private equity firm is responsible for the activities of the firm in its portfolio,” Kenney said, but he doesn’t see that happening anytime soon.

“Look at who owns our Congress and the executive branch too,” he said.

Both Republican and Democratic members of congress have billions of dollars invested in private equity firms. Secretary of treasury, Scott Bessent, also is connected to private equity, and did not immediately divest from those assets upon joining the executive branch.

While in other industries, consumers may be able to vote with their wallets and choose to avoid companies that mistreat their customers, when it comes to where to go to the emergency room, there isn’t always a choice.