Private Equity Acquisition Effect on the Most Common Urologic Procedures

To examine the impact of private equity (PE) acquisition on the volume of common outpatient urologic procedures.

PE acquisitions of urology practices in 2016 and 2018 were identified through use of financial databases cataloguing both public and private transactions. Yearly office visit and procedure volume by provider were extracted from the publicly available Medicare Physician & Other Practitioners by Provider and Service database from 2013 to 2022. We chose the most commonly billed procedures and visits for analysis: cystoscopy, post-void residual (PVR), prostate biopsy, complex cystometrogram (CMG), complex uroflow, extracorporeal shock-wave lithotripsy, ureteroscopy, 30- and 45-minute new patient visits, and 15-, 25-, and 40-minute follow-up patient visits. We used comparative interrupted time series analysis to analyze yearly procedure and visit volumes before and after the acquisition.

We identified 199 and 196 physicians acquired by PE and not acquired, respectively. The volumes of complex CMG increased at the time of acquisition in 2018 by 10.2 per physician-year, more than the control physicians. For some procedures (cystoscopy, PVR, prostate biopsy, complex CMG, complex uroflow), the post-acquisition trends in volume were different for those acquired in 2018 compared to the control groups. The number of new patient and follow-up office visits were largely unaffected by PE acquisition in 2016 and 2018.

We observed variability in procedure volumes after PE acquisition, depending on the procedure type. The full impact of the changing ownership model in urology is yet to be determined.