Private Equity Investment in Surgical Care.

Objective

To characterize the extent of private equity (PE) investment affecting surgical care.

Background

Over the last decade, investor-backed, for-profit PE groups have invested in health care at an unprecedented rate, but the breadth of these investments affecting surgical practice remains largely unknown.

Methods

Four nationally representative databases were used to identify all merger/acquisitions involving surgical practices between 2015 and 2019, determine PE investment in those transactions, and link the acquisitions with a physician data set.

Results

A total of 1542 unique transactions were identified, of which 539 were financed by PE. Fifty-eight transactions were then classified into their respective categories within surgical care: digestive disease, orthopedics, urology, vascular surgery, and plastic/cosmetic surgery. These transactions accounted for 199 practice sites and 1405 physicians, averaging 24.2 physicians per transaction. Acquisition activity peaked in 2017, with a total of 63 practices involved. Digestive disease, urology, and orthopedic surgery accounted for the most activity. General surgeons were involved in a small share of the digestive disease practice acquisitions. Three "surgery-adjacent" categories were also identified: anesthesiology, ambulatory surgery centers, and surgical staffing firms. Among these, anesthesia was the largest category in terms of practices (194) and physicians (2660) involved in transactions across the study period. Medical Service Organizations were a key mechanism through which PE firms invested in surgical care.

Conclusions

PE has engaged in substantial investment within surgical specialties, creating increased practice consolidation. These investments affect all levels of medical care and have notable implications for patients, practitioners, and policymakers.

COI Statement

D.B. is a past board member and equity owner of BioStar Ventures, LLC and Assembly Ventures, LLC (venture capital firms). J.B.D. is a co-founder and equity owner of ArborMetrix Inc. K.R.C. receives consulting fees from GI Windows Inc., a surgical device company unrelated to the submitted work. The remaining authors report no conflicts of interest.

References:

• Zhu JM, Hua LM, Polsky D. Private equity acquisitions of Physician Medical Groups across specialties, 2013-2016. JAMA. 2020;323:663–665.
• Patel SN, Groth S, Sternberg P Jr. The emergence of private equity in ophthalmology. JAMA Ophthalmol. 2019;137:601–602.
• Billig JI, Kotsis SV, Chung KC. Trends in funding and acquisition of surgical practices by private equity firms in the US from 2000 to 2020. JAMA Surg. 2021;156:1066–1068.
• Casalino LP, Saiani R, Bhidya S, et al. Private equity acquisition of physician practices. Ann Intern Med. 2019;170:114–115.
• Tan S, Seiger K, Renehan P, et al. Trends in private equity acquisition of sermatology practices in the United States. JAMA Dermatol. 2019;155:1013–1021.