Association of Private Equity Firm Acquisition of Ophthalmology Practices with Medicare Spending and Utilization of Ophthalmology Services.
Academic Article
Overview
abstract
PURPOSE: Private equity (PE) firms are increasingly acquiring ophthalmology practices; little is known of their influence on care utilization and spending. We studied changes in utilization and Medicare spending after PE acquisition. DESIGN: Retrospective cohort study. PARTICIPANTS: 762 clinicians in 123 practices acquired by PE between 2017 and 2018; 34,807 clinicians in 20,549 never-acquired practices. METHODS: We analyzed Medicare fee-for-service claims (2012-2019) combined with a novel national database of PE acquisitions of ophthalmology practices using a difference-in-differences method within an event study framework to compare changes after a practice was acquired to changes in practices that were not acquired. MAIN OUTCOME MEASURES: Numbers of beneficiaries seen; intravitreal injections and medications used for injections; spending on ophthalmologist and optometrist services, ancillary services, and intravitreal injections. RESULTS: Comparing changes over time for PE-acquired to non-acquired practices, there was a relative increase in beneficiaries seen per quarter per PE optometrist of 23.92% (4.20 beneficiaries, 95% CI, 1.73 to 6.67); no change for ophthalmologists; and a relative increase in spending per beneficiary of 5.06% ($9.66, 95% CI, -2.82 to 22.14). Spending on clinician services decreased 1.62% ($-2.37, 95% CI, -5.78 to 1.04), including a 5.46% ($17.70, 95% CI, -2.73 to 38.15) increase in per beneficiary per quarter spending on ophthalmologist services and a 4.60% ($-5.76, 95% CI, -9.17 to -2.34) decrease for optometrists. Ancillary services spending decreased 7.56% (-$2.19, 95% CI 4.19 to -0.22); intravitreal injections spending increased 25.0% ($20.02, 95% CI, -1.38 to 41.41). The number of intravitreal injections increased 5.10% (1.83, 95% CI, -0.1 to 3.80), including a 74.09% (8.38 injections, 95% CI, 0.01 to 16.74) in use of an expensive medication (ranibizumab) and a 12.91% decrease (-3.40 injections, 95% CI -6.86 to 0.07) for an inexpensive injection (bevacizumab). The event study showed consistent and often statistically significant increases in ranibizumab injections and decreases in bevacizumab injections after acquisition. CONCLUSIONS: Though not all results reached statistical significance, this study suggests that PE-acquired practices had little or no overall effect on utilization or total spending, but increased the number of unique patients seen per optometrist and the use of expensive intravitreal injections.
