Hospital Ownership Status Affects Pulmonary Outcomes

Patients treated for chronic obstructive pulmonary disease (COPD) or pneumonia experienced worse outcomes when treated at hospitals acquired by private equity firms, based on data from a new study presented at the American Thoracic Society (ATS) 2026 International Conference.

“Previous studies have linked private equity acquisition of hospitals to worse patient experiences and higher rates of hospital-acquired adverse events, such as falls, although findings for specific medical conditions have been more variable,” according to lead author Stephen Mein, MD, a pulmonologist at Beth Israel Deaconess Medical Center in Boston.

“We wanted to understand whether private equity acquisitions impacted outcomes for patients hospitalized with COPD and pneumonia because these conditions are among the most common reasons for hospitalization and they are widely included in measures of hospital care quality,” he said.

Mein and colleagues reviewed data from Medicare fee-for-service claims data from 41 private equity hospitals and 192 matched control hospitals between 2010 and 2019, including 146,904 COPD visits and 194,993 pneumonia visits.

The study population was Medicare beneficiaries aged 65 years or older who had at least one hospital encounter (defined as observation stay or inpatient admission) for asthma, COPD, or pneumonia. The clinical outcomes were in-hospital mortality, 30-day mortality, and 30-day hospital revisit rates. The researchers compared changes in outcomes across 3 years before and after acquisition in a linear regression analysis. Models adjusted for patient age, sex, race and ethnicity, clinical risk score, and dual eligibility status.

Overall, no changes in patient age, sex, clinical risk scores or dual-eligibility status across all conditions at private equity hospitals were noted compared with control hospitals. However, 30-day hospital revisits among patients with asthma increased significantly at private equity hospitals compared to control hospitals (difference-in-differences, + 8.3 percentage points; 95% CI, 4.0-12.7). No significant changes were noted for in-hospital mortality or 30-day mortality.

Similarly, 30-day hospital revisits were significantly higher for patients with COPD at private equity hospitals than at control hospitals (+ 0.9 percentage points; 95% CI, 0.1-1.6). Patients with pneumonia had an increased in-hospital mortality at private equity hospitals compared with control hospitals (+ 0.7 percentage points; 95% CI, 0.2-1.2), with no differences in 30-day mortality or revisits.

The findings that patients treated for COPD at private equity-acquired hospitals more often returned to the hospital within 30 days after hospital discharge and that patients with pneumonia were more likely to die during their hospital stay were surprising, Mein noted. “The 1-percentage-point increase in deaths among patients with pneumonia is especially concerning as the baseline in-hospital mortality rate for this condition was only 3%-4%,” he said.

“Our findings add to growing concerns around the potential negative effects of private equity ownership in healthcare and highlight the need for stronger oversight of these acquisitions to help protect our patients, and the results have implications for many patients as private equity acquisitions of US hospitals are becoming more common,” Mein said.

The findings were limited by the focus on older adults with Medicare insurance, and may not be generalizable to other patient populations, said Mein. “In addition, we were unable to account for differences in private equity firm practices or identify potential heterogeneity in outcomes across hospitals acquired by different private equity firms,” he said. More research is needed to understand the factors contributing to worse outcomes at private equity-acquired hospitals in the current study and other published work, Mein added.

Vigilance is Needed to Optimize Outcomes

“Given the rapid increase in acquisitions of US hospitals by private equity firms, it is important to evaluate how these acquisitions affect patient health outcomes,” said Arianne K. Baldomero, MD, MS, a pulmonologist, critical care physician, and assistant professor of medicine at the University of Minnesota, Minneapolis.

“The worse outcomes observed among patients hospitalized in privately acquired hospitals were not entirely unexpected,” said Baldomero, who was not involved in the study. “Although not explicitly stated in the abstract, these acquisitions may involve cost-containment strategies, such as potential reductions in staffing. particularly nursing and support staff, changes in supply chain management, or the scaling back of less profitable services, which likely contribute to worse patient outcomes,” she said.

More research is needed to identify the potential etiologies driving these differences in outcomes, which would help inform strategies for improvement, said Baldomero. However, the results of the new study suggest that clinicians managing patients discharged from acquired hospitals should be vigilant about discharge planning, transitions, and follow-up to mitigate poor health outcomes, she said.

The study received no outside funding. The researchers and Baldomero had no financial conflicts to disclose.

A version of this article first appeared on Medscape.com.