Private Equity Acquisitions in Oncology: Impact on Market Share and Prices

Private equity (PE) acquisitions of physician practices have seen a significant increase in recent years. The surge in PE acquisitions raises concerns about market consolidation, affordability, and quality of care, particularly for disadvantaged patients. The Purpose of this study is to examines the trend of PE acquisitions in oncology from 2013 to 2022, quantify market shares, analyze changes in price and spending with particular focus on radiation oncology, and describe the influence on sociodemographic disparities in health outcomes.

This is a cross-sectional study of PE acquisition data in oncology from PitchBook and Irving Levin databases, linked to physician data from the OneKey data set, from 2013 to 2022. We compared characteristics of PE-acquired practices and non-PE-acquired practices. We estimated the PE firm's market share of full-time equivalent oncologists in 384 metropolitan statistical areas (MSAs) and illustrated the geographic distribution and concentration of PE-acquired oncology practices. Finally, we linked these data to Health Care Cost Institute data and used difference-in-difference within event study to estimate PE impact on radiation oncology prices and spending.

Between 2013 and 2022, 423 oncology practices in 111 MSAs were acquired by 82 PE firms, with a compound annual growth rate in acquisition volume of 27% during the study period. Disproportionately, almost half (44.5%) of PE acquisitions occurred in the South. MSAs with over 50% PE market share exhibit higher market concentration than MSAs with over 50% non-PE market share (Herfindahl-Hirschman Index for concentration: 6204 vs 4629). After acquisition, PE-acquired oncology practices had 5.3% higher office visit prices, and higher radiation therapy spending (50.1% increase) compared to non-PE-acquired oncology practices.

The increase in PE acquisition was more likely to be associated with an increase in local market share, raising competitive concerns impacting prices and spending and exacerbating healthcare disparities. Findings are relevant to antitrust policy makers interested in PE's impact on oncology physician market competition.