Practice Acquisitions in Home-Based Medical Care in the United States

Home-based medical care (HBMC) is an important care model for older adults with complex health conditions and functional limitations that can potentially prevent institutionalization. Historically, HBMC has comprised small, independent provider organizations. It is unknown whether consolidation observed in other health care sectors has similarly affected HBMC.

We used the American Academy of Home Care Medicine's national provider directory to identify a cohort of practices billing traditional, fee-for-service Medicare for HMBC in 2022. Using Pitchbook Inc., we identified whether an acquisition occurred for each of these practices and categorized acquisition types as private equity (PE) firm buyouts, health system acquisitions, and other corporate acquisitions. We described most recent acquisition timing from 2012 to 2024 for this cohort of practices and compared 2022 practice characteristics by most recent acquisition status and type as of 2022, using this as a proxy to describe current practice ownership.

The majority of HBMC practices in our cohort with any acquisition were acquired in 2022, with the greatest number of recent private equity firm buyouts in 2021. Among 2308 HBMC practices serving 476,088 Medicare fee-for-service patients in 2022, 12.6% of patients received care from PE-acquired practices, 2.4% from health system-acquired practices, and 5.0% from other corporate-acquired practices. Acquired practices were generally larger and cared for patients with slightly higher hierarchical condition category (HCC) scores who were less often high-needs qualified. Performance measures did not differ meaningfully between acquired and non-acquired practices.

A significant share of HBMC patients is cared for by practices that have been acquired, with further investigation warranted to understand potential effects on patient selection and care quality.