Sunita Somvanshi
Tejal Somvanshi
A new nationwide study shows Medicare patients are more likely to die in emergency departments after hospitals are bought by private equity firms. The research, published September 23 in Annals of Internal Medicine, found a 13% increase in emergency department deaths following private equity acquisitions.
The Harvard Medical School study revealed that Medicare patients experienced seven additional deaths per 10,000 emergency department visits compared to similar hospitals not under private equity ownership. Researchers linked these deaths directly to significant cuts in staffing and salaries at the acquired hospitals.
After private equity takeovers, hospitals slashed emergency department salary expenditures by 18% and intensive care unit salaries by 16%. Overall, these hospitals reduced their full-time staff by an average of 11.6% and cut total salary spending by 16.6%.
“Staffing cuts are one of the common strategies used to generate financial returns for the firm and its investors,” said Dr. Zirui Song, the study’s senior author and associate professor at Harvard Medical School. “Among Medicare patients, who are often older and more vulnerable, these financial strategies may lead to potentially dangerous, even deadly consequences.”
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The research also found that private equity hospitals increasingly transferred their sickest patients to other facilities. Emergency department transfers rose by 4.2% and ICU transfers jumped by 10.2% after acquisition. Meanwhile, length of stay for patients who remained in intensive care units decreased by 4.7%.
Dr. Song noted that emergency departments and ICUs rely heavily on human staff providing direct bedside care. “These are places where cutting staffing often means cutting the capacity to take care of people,” he said.
The study compared more than 1 million emergency department visits and 121,000 ICU hospitalizations at 49 private equity hospitals with over 6 million ED visits and 760,000 ICU stays at 293 control hospitals. Researchers analyzed Medicare claims and cost report data spanning 2009 through 2019.
This research builds on previous findings published in JAMA showing a 25% increase in preventable adverse events in hospital inpatient wards after private equity acquisition, including more patient falls and infections.
While private equity acquisitions are often marketed as efforts to rescue struggling hospitals, a 2024 study by the same researchers found that private equity firms typically target financially healthier hospitals that can better manage new debt while still generating revenue.
State and federal policymakers have begun exploring increased regulation of private equity in healthcare. Early efforts focus on greater transparency, oversight of acquisitions, separating corporate influence from clinical decisions, and protecting patients while still allowing private capital investment in hospitals.
The federally funded study was conducted by researchers from Harvard Medical School, the University of Pittsburgh, and the University of Chicago, with support from the National Institutes of Health and the Agency for Healthcare Research and Quality.
