Hospital Staffing and Patient Outcomes After Private Equity Acquisition

After private equity acquisition, hospitals may experience changes in staffing with implications for patients.

To examine hospital staffing and patient outcomes in emergency departments (EDs) and intensive care units (ICUs) before and after hospitals were acquired by private equity.

Matched difference-in-differences analysis.

100% Medicare Part A and B claims and Cost Report data from 2009 to 2019.

1 007 529 ED visits and 121 080 ICU hospitalizations across 49 private equity hospitals were compared with 6 179 854 ED visits and 760 377 ICU hospitalizations across 293 matched control hospitals.

Hospital ED and ICU salary expenditures, patient mortality, length of stay, and transfers. Secondary outcomes included hospital-wide salary expenditures and full-time employees.

After acquisition, private equity hospitals reduced ED salary expenditures by 18.2% (-$12.63 per inpatient bed day; 95% CI, -$22.74 to -$2.52; P = 0.015) and ICU salary expenditures by 15.9% (-$8.46 per inpatient bed day, CI, -$13.21 to -$3.72; P < 0.001) relative to control. This occurred alongside average hospital-wide reductions in full-time employees by 11.6% and salary expenditures by 16.6%, relative to control. Beneficiaries in EDs of private equity hospitals experienced 7.0 additional deaths per 10 000 visits after acquisition relative to control (13.4% increase from a raw baseline of 52.4 deaths per 10 000; P = 0.009). No differential change in ICU mortality was observed. However, patients in private equity EDs and ICUs experienced a 4.2% and 10.6% increase in transfers, respectively, to other acute care hospitals after acquisition relative to control. On average, ICU length of stay shortened by 0.2 days. Sensitivity analyses produced qualitatively similar findings.

Potential unmeasured confounding; lack of generalizability to other acquisitions or patient populations.

After private equity acquisition, hospitals on average reduced salaries and staffing relative to nonacquired hospitals, notably in the EDs and ICUs, which are higher-acuity and staffing-sensitive areas. This decreased capacity to deliver care may explain the increased patient transfers to other hospitals, shortened ICU lengths of stay, and increased ED mortality.

National Institutes of Health and Agency for Healthcare Research and Quality.