Private-equity hospital acquisitions were associated with a 13% increase in emergency department deaths among Medicare patients—7 additional deaths per 10,000 ED visits—compared with matched nonacquired hospitals
Following acquisition, salary expenditures decreased by 18% in emergency departments (EDs) and 16% in intensive care units (ICUs) compared with nonacquired hospitals. Hospital‑wide, full‑time employees decreased by 12% and salary spending by 17%. ICU mortality did not change; ICU length of stay shortened by about 0.2 days. Transfers to other acute care hospitals increased by 4% from EDs and 11% from ICUs.
The study included more than 1 million ED visits and 121,000 ICU hospitalizations at 49 private equity hospitals compared with nearly 6.2 million ED visits and 760,000 ICU hospitalizations at 293 matched control hospitals from 2009 to 2019.
“Staffing cuts may trigger capacity constraints, resulting in less bandwidth for direct patient care,” wrote Sneha Kannan, MD, MS, of the University of Pittsburgh, and colleagues. “The increased ED mortality at private equity hospitals occurred without changes in the mix of ED beneficiaries (based on observable characteristics). One possible mechanism that may explain this is reductions in staffing, as EDs can be particularly sensitive to staffing levels and clinician labor mix. Notably, staffing levels at private equity hospitals were already slightly lower than at control hospitals before acquisition. Thus, further staffing cuts may contribute to increased ED deaths and transfers, particularly as control hospitals (and hospitals nationwide) increased their ED staffing.”
The study was limited to Medicare beneficiaries and measured staffing through expenditures rather than direct employee counts. The clinical appropriateness of transfers could not be assessed, and follow-up was limited to 3 years.
The findings suggest private equity acquisitions may compromise patient safety in high-acuity hospital areas, where adequate staffing is critical for managing complex, time-sensitive medical emergencies.
Disclosures: See the study for author disclosures; NIH and AHRQ funding noted in the paper.
Source: Annals of Internal Medicine