ACEP is pleased that federal policymakers and expert healthcare economics researchers continue to analyze the effects of various business practices across health care. The ongoing efforts to increase transparency related to consolidation of healthcare entities and the role of private equity are critical to identifying future strategies for improvements to the healthcare delivery system.
| ACEP remains concerned about the lack of definitive data available to better assess the specific impacts of these practices on quality of care within complex healthcare systems. |
The U.S. Government Accountability Office (GAO) has released a new report on health care consolidation—developed with input from ACEP—that underscores how little is definitively known about the impact different types of consolidation have on quality of care.
Titled “Health Care Consolidation: Published Estimates of the Extent and Effects of Physician Consolidation,” the report was commissioned by Congress and tasked the GAO with studying the extent health care consolidation is taking place across Medicare and Medicaid markets, and how private equity could be contributing.
The report distinguished among several forms of consolidation, including hospital-physician integration, and physician consolidation with health insurers, corporate entities, and private equity firms, respectively. It found that at least in the available research, hospital-physician consolidation has not been shown to decrease quality of care overall.
However, GAO noted a striking gap: it could not identify sufficient studies assessing the quality effects of physician consolidation with insurers, corporate entities, or private equity.
New Evidence: Private Equity Hospital Acquisitions Linked to Higher ED Mortality
Just after the GAO report’s release, new research published in Annals of Internal Medicine has filled part of this evidence gap.
| The Annals analysis did not examine physician practice acquisitions by private equity, but it provides the strongest evidence to date that private equity consolidation at the hospital level may adversely affect patient safety, particularly in emergency departments. |
A Harvard-led team examined outcomes in 49 hospitals acquired by private equity between 2010–2017, comparing them with nearly 300 control hospitals, finding that after acquisition, private equity hospitals cut emergency department (ED) and ICU staffing expenditures by 16–18%. These cuts were associated with a 13% relative increase in ED deaths—seven additional deaths per 10,000 visits—compared to controls.
Troubling Insurer Trends
The GAO report found that vertical consolidation of physician practices by insurers, which ACEP has long sounded the alarm on, continues to grow and underscores what emergency physicians are experiencing every day.
Insurer-driven consolidation can alter referral networks, restrict patient access, and change contracting dynamics in ways that are far less transparent than hospital mergers, creating risks and challenges for physicians and patients alike.
The accelerating rate of such vertical consolidation should be troubling to policymakers and anyone who relies on timely access to the highest quality emergency care.
ACEP Believes in Transparency, Oversight, and Patient-Centered Care
Both reports underscore an urgent need for greater transparency and stronger oversight of consolidation across the health system. Policymakers must require more robust reporting on ownership structures and their impacts on patient outcomes.
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Regardless of whether the consolidating entity is a hospital, insurer, corporate chain, or private equity firm, ACEP believes emergency physicians must have medical autonomy and adequate resources and staffing levels that prioritize patient care over profits. Consolidation must never come at the expense of quality, access, or physician-led medical decision-making. |
ACEP continues to advocate for reforms that protect patients, support emergency physicians, and ensure that financial incentives never override clinical judgment.
