Joseph A. Rodriguez’s Post

This is a problem. And increasingly providers recognize the rising conflict between these trends and the purpose of the profession. Luckily, many are focused on developing a better system, including many physician groups we’re meeting this week at the #APGSpringCon24. The remaining physician-owned practices across the country need to know there is a better solution than a PE sale to succession planning and growth. An #ESOP transaction unlocks the capital necessary to pay retiring physicians for their equity, provides a path to operating tax-free, and sustains a COMPLETELY physician-led practice, independent of private equity and payor influence.

The Impact of Private Equity on Healthcare By Paul Pender, MD The message[1] from WSJ reporter David Wainer is that healthcare costs increase when private equity enters the picture.  The examples given include an anesthesia group in Texas and the Chapter 11 filing of Steward Health that owns failing hospitals in Massachusetts and other states.  The Federal Trade Commission and state and federal legislators are scrutinizing roll-ups of physician practices.  Gaining market power through acquisitions and mergers is common in American business.  However, in healthcare, a dominant player that has collected physicians and hospitals can have an adverse effect on prices. “The U.S. commercial market relies on negotiations between insurers and medical providers to deliver the best possible quality and price for patients. Increasingly, though, it is becoming less competitive by design.” Nearly 75% of all physicians work for either a hospital system or a corporate entity.  Prices for essential items, whether for prescription drugs or for anesthesia services, are often obscured.  When there is little competition, costs tend to increase. Deals have resulted in billions of dollars invested by private equity in the last decade to create consolidation in healthcare with the promise to improve efficiency and quality.  However, the opposite appears to result from such consolidation.  For example, nursing staff have been assigned more patients to cover per capita once private equity owns a hospital.  Emergency rooms of hospitals owned by private equity are often staffed with nurse practitioners rather than physicians who specialize in emergency care.  Physicians who work for large, consolidated hospital systems bemoan having more patients to see in shorter appointment times without adequate breaks.  Doing more with less is the demand of administrators beholden to private equity owners of hospitals.  Harvard researchers have recently described how quality care suffers when private equity controls a hospital, using criteria such as re-admission rates and hospital-acquired infections. Where is this trend going?  Until a new model of care develops that pays for health outcomes rather than for units of work, the consolidation trend will continue. Fortunately, a new healthcare model is launching, whereby partnerships between physicians and self-insured employers bypass the big players and reduce costs through price transparency and by minimizing the financial drain of middlemen.  Such a model removes friction along the health journey for all stakeholders.  Details to follow. [1] https://lnkd.in/gn9TtJVt

David Wainer wraps up his excellent 3-part The Wall Street Journal series today, a refreshingly candid look at costs and compromises of the health care business model in the US. Physicians, regulators, and the public are always sold on boosts in efficiencies and services but patients get dropped from the equation and costs and profits, not care quality, are what reliably go up. 1. You Can Thank Private Equity for That Enormous Doctor’s Bill https://lnkd.in/gbB8FzVn 2. As Hospitals Grow, So Does Your Bill https://lnkd.in/ggj5RA2Q 3. What Happens When Your Insurer Is Also Your Doctor and Your Pharmacist https://lnkd.in/gpjjz9YH #medicine #healthcare #physicians #insurers #healthpolicy #healtheconomics (see also Will Flanary’s “Private Equity Goes to Therapy”! https://lnkd.in/gD_diciN)

The latest on private equity-backed healthcare services: WSJ's initial article in a three-part series delves into the Steward Healthcare bankruptcy and the United States v. U.S. Anesthesia Partners antitrust case in Texas. Stay informed on the evolving landscape. #foleyandlardner #privateequity #healthcaretransformation #antitrust #bankruptcy #hospitals #healthsystems #healthcareprivateequity.

The involvement of private equity firms in healthcare has raised concerns about the hidden costs that impact patients and providers. A recent Wall Street Journal article sheds light on the repercussions of prioritizing profit over patient care. From increased healthcare costs to the erosion of trust and quality, the consequences are profound. Private equity's short-term focus on financial gains can compromise long-term care quality and operational efficiency. Vulnerable populations, in particular, bear the brunt of these challenges, facing cost-cutting measures and decreased care quality. In this complex landscape, advocating for patient-centered care is crucial. Collaboration among policymakers, healthcare leaders, and communities is essential to ensure transparency, accountability, and sustainable solutions. Let's work towards a healthcare system that prioritizes everyone's needs, especially the most vulnerable. Grateful for the insights of colleagues like Tisha Titus, MD, MPH, and Brian Koehn in our shared mission to uphold healthcare quality and equity. Read more about this critical issue:

"Private-equity investors have poured billions into healthcare but often game the system, hurting both doctors and patients"... AND EMPLOYERS! So much of the downstream impact of vertical integration of both payers and providers has hurt employers - the ones paying the claims for the ~100m of Americans covered by a self-insured plan. It's work to unbundle, set up centers of excellence, institute hard steerage, and "disrupt" the patient experience. But there are savings, better patient experiences, and better outcomes out there to be had. https://lnkd.in/eYK7498J

“As this three-part Heard on the Street series will show, the rich rewards and lax oversight ultimately create pain for both patients and the doctors who treat them.” In 2024, 75% of doctors work for hospitals or corporations. Gone are the days of physicians working for themselves or physician-owned practices. #privateequity #doctors #physicians #hospitals #physicianowned #corporations #patients #patientadvocacy #verticalintegration #patientsfirst #rheumatology #medicalschool #wallstreetjournal #healthinsurance

Powerful article from the WSJ: https://lnkd.in/gr6ckxQR "Such so-called rent-seeking behavior is a unique feature of the American healthcare system. Nowhere else in the world do so many healthcare dollars encounter so few mechanisms to limit profiteering. The U.S. commercial market relies on negotiations between insurers and medical providers to deliver the best possible quality and price for patients. Increasingly, though, it is becoming less competitive by design." I believe that employers need to navigate the waters of healthcare like they would shark-infested-waters in a rowboat. You can be frustrated about the sharks, but the most important thing to do is keep you and your employees safe. ✳️Are you auditing/reviewing the work of your ASO? ✳️Have you put in place direct primary care that can remove expensive inpatient costs? ✳️Do you have an independent PBM that does not use spread? ✳️Are you paying your broker directly, with a signed commitment that they make no other money than yours -OR- do you check on everything they do, knowing that that are deeply influenced by BUCA carrier dollars? None of us can despair and give up on healthcare--it is too important. We have to work together to fix the business of healthcare, and we will. Until then, be safe out there, and don't put your hands in the water. #brokenhealthcare #employeebenefits

I just read this article published today in the WSJ. It raises more questions and points than the author addresses. First of all pricing for goods and services are typically set by the market so in this case CMS and commercial payors establish the lions share of acceptable reimbursement. As a practical manner supply and demand drive pricing. Historically consolidation in most any industry helps gain economies of scale while improving access and quality. A significant point not addressed here is that demand v supply imbalance is very much at work while putting the blame on PE or other acquirers of medical practices misses the mark by a mile. There is no question that healthcare spend is out of control and many markets go underserved. In all likelyhood capital, management expertise and capacity will come into play. Guess who has the capital, PE amongst other large capitalists. If you want change and expect better stop pointing blame and casting aspersions. By the way it doesn’t help matters on the supply and capacity side if more providers are retiring or exiting the system. America it’s time for you to decide how you want it, in this case it’s a really tough pill to swallow but it has side affects that you can eventually get over!

Interesting read from the WSJ on Private Equity's influence on healthcare costs. The article explores the parallels between the consolidation of medical practices, shedding light on the impact on end buyers. On the other hand, having firsthand experience with privately-held companies backed by PE investment, I've witnessed how such setups can positively benefit clients, employees, and shareholders. Thoughts? #Healthcare #PrivateEquity #WSJ