The immediate effects of private equity acquisition of urology practices on the management of newly diagnosed prostate cancer.

Some worry that physician practices acquired by private equity may increase the use of services to maximize revenue. We assessed the effects of private equity acquisition on spending, use of treatment, and diagnostic testing in men with prostate cancer. We used a 20% sample of national Medicare claims to perform a retrospective cohort study of men with prostate cancer diagnosed from 2014 through 2019. The primary outcome was prostate cancer spending in the first 12 months after diagnosis. Secondary outcomes included the use of treatment and a composite measure of diagnostic testing (e.g., imaging, genomics) in the first 12 months after diagnosis. Multilevel modeling was used to adjust for differences in patient and market characteristics. The effect of practice acquisition on each outcome was assessed using a difference‐in‐differences design. There were 409 and 4021 men with prostate cancer managed by urologists in acquired and nonacquired practices, respectively. After acquisition, prostate cancer spending was comparable between acquired and nonacquired practices (difference‐in‐differences estimate $1182, p = 0.36). Acquisition did not affect the use of treatment (difference‐in‐differences estimate 3.7%, p = 0.30) or the use of diagnostic testing in men who were treated (difference‐in‐differences −5.5%, p = 0.12) and those managed conservatively (difference‐in‐differences −2.0%, p = 0.82). In the year following acquisition of urology practices, private equity did not increase prostate cancer spending, the use of treatment or diagnostic testing in men with prostate cancer. Future work should evaluate the effects of private equity acquisition on practice patterns and quality over a longer time horizon.

一些人担心被私募股权收购的医生诊所可能会增加服务的使用以实现收入最大化。我们评估了私募股权收购对前列腺癌男性患者的支出、治疗使用和诊断检测的影响。 我们使用了20%的全国医疗保险索赔样本，对2014年至2019年确诊的前列腺癌男性患者进行了一项回顾性队列研究。主要结局是诊断后前12个月的前列腺癌支出。次要结局包括治疗的使用以及诊断检测（例如成像、基因组学）在诊断后前12个月的综合指标。采用多层模型对患者和市场特征的差异进行调整。使用双重差分设计评估诊所收购对每个结局的影响。 在被收购和未被收购的诊所中，分别有409名和4021名由泌尿科医生治疗的前列腺癌男性患者。收购后，被收购诊所和未被收购诊所之间的前列腺癌支出相当（双重差分估计值为1182美元，p = 0.36）。收购不影响治疗的使用（双重差分估计值为3.7%，p = 0.30），也不影响接受治疗的男性（双重差分 -5.5%，p = 0.12）和保守治疗的男性（双重差分 -2.0%，p = 0.82）的诊断检测使用。 在泌尿科诊所被收购后的一年里，私募股权没有增加前列腺癌男性患者的前列腺癌支出、治疗使用或诊断检测。未来的工作应该在更长的时间范围内评估私募股权收购对诊疗模式和质量的影响。