Patient-reported care experience declined significantly at hospitals acquired by private equity firms, with key measures such as overall hospital ratings and willingness to recommend showing measurable declines compared to control hospitals, according to a recent study analyzing data from 73 private equity-acquired hospitals and 293 matched control hospitals across the U.S. between 2008 and 2019.
This analysis was conducted using a difference-in-differences design to assess changes in patient-reported outcomes, as detailed in the study published in JAMA Network. The authors stated, “First, did global measures of patient care experience change after hospitals were acquired by private equity firms compared with matched control (nonacquired) hospitals between 2008 and 2019? Second, were there changes in patient-reported measures of hospital communication, clinical processes, and environment?”
Researchers utilized data from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey, a CMS-endorsed national survey that evaluates patient care experiences through standardized questions administered after discharge. Primary measures included overall hospital ratings and willingness to recommend, while secondary measures assessed staff responsiveness, cleanliness, and communication with nurses and doctors.
From pre-acquisition to three years post-acquisition, the percentage of patients rating hospitals 9 or 10 out of 10 declined slightly, from 65.0% to 65.2%, at private equity-acquired hospitals. This finding underscores a measurable decline in global patient care ratings, a key outcome of the study. In contrast, this measure increased at control hospitals from 66.2% to 69.2%. The difference-in-differences estimate was −2.4 percentage points. Similarly, patient willingness to recommend private equity-acquired hospitals fell from 66.9% to 65.5%, while it rose at control hospitals from 68.2% to 69.3%. The difference-in-differences estimate was −2.1 percentage points.
The disparity between private equity-acquired and control hospitals grew with each subsequent year, reaching its largest in the third year post-acquisition. Hospital ratings dropped by −5.2 percentage points compared to controls, and willingness-to-recommend ratings decreased by −4.4 percentage points.
Secondary findings indicated a decline in staff responsiveness at private equity-acquired hospitals. Patient-reported responsiveness dropped by −1.3 percentage points relative to control hospitals. Other secondary measures, such as communication and environmental factors, did not show significant changes.
The study’s authors noted limitations, including the observational nature of the analysis, the potential for unmeasured confounding factors, and the use of self-reported HCAHPS data. Sensitivity analyses supported the robustness of the findings, even after excluding the year of acquisition and hospitals with incomplete data.
The researchers reported that patient-centered care measures declined following private equity acquisitions and noted the increasing prevalence of private equity ownership in healthcare. They suggested that these findings may inform policymakers about the potential impacts of such acquisitions.
Full disclosures can be found in the study.
