Private Equity Acquisitions in Primary Care: Effects on the Medicare Program

项目摘要 私募股权收购在初级保健领域加速，包括数千名医生 美国各地数十万人的生命。尽管有这种增长，这些收购对临床的影响 经济结果仍不得而知。运送系统其他部分的证据有限，包括 疗养院、医院和程序专家表明，获得PE与更高的 价格和支出，以及对质量的潜在负面影响。PE如何拥有初级保健 做法影响到医疗保险受益人的健康和医疗保健是一个根本问题，因为医疗保险 覆盖近6000万慢性病受益人的初级保健--这是AHRQ的优先人口。 本提案侧重于私募股权投资公司可能在以下条件下影响提供商行为的具体机制 传统Medicare(TM)和Medicare Advantage(MA)中的不同财务激励，并估计影响 关于护理质量和患者结果。我们建议将初级保健获取数据与TM索赔和MA联系起来 遇到2016-2024年的数据；使用准实验性事件研究框架，比较变化 在与非PE的匹配对照受益人的PE获得的初级保健实践中的受益人中 获得性初级保健实践。在TM中，我们假设PE增加了服务的利用率，并且 特别是低价值的服务，如不必要的或浪费的测试、成像或程序。在并购方面，增加了 在放弃预算的情况下，利用率可能会适得其反，因此我们假设PE最大化 通过对临床诊断进行更密集的差异化编码来获得收入，以获得更高的风险调整 联邦政府的付款。我们的目标是：1)检查相关提供商行为的变化 通过PE获得初级保健做法，包括利用低价值服务和诊断编码 强度；2)评估护理质量和患者结果的变化；以及3)了解治疗效果 异质性，包括患者的种族/民族和地理构成，以及提供者和 实践特色。我们应用了许多创新，包括开发一种新的PE数据集 在初级保健方面的收购，将公开提供，供未来使用。为了更好地接近 在因果推断方面，我们还应用了统计创新，包括在差异中的识别策略。 差异分析、风险集匹配和基数匹配以将接受治疗的个体与可比者进行匹配 控制和最小方差平衡权重的应用。调查结果将提供新颖、及时和 全面定量评估与以下因素相关的关键临床和经济结果变化 初级保健中私人股本所有权的增长趋势，并将与联邦和州的政策高度相关 各国政府考虑如何维护和支持获得高价值初级保健的机会。 1

Project Summary Private equity acquisitions have accelerated in primary care, comprising thousands of physicians covering hundreds of thousands of lives across the U.S. Despite this growth, the effects of these acquisitions on clinical and economic outcomes remains unknown. Limited evidence in other parts of the delivery system, including nursing homes, hospitals, and procedural specialists, shows that PE acquisition is associated with higher prices and spending, as well as potential negative effects on quality. How PE ownership of primary care practices affects the health and health care of Medicare beneficiaries is a fundamental question, as Medicare covers primary care for nearly 60 million beneficiaries with chronic diseases - an AHRQ priority population. This proposal focuses on the specific mechanisms by which PE firms may affect provider behavior under different financial incentives in Traditional Medicare (TM) and Medicare Advantage (MA), and estimates effects on quality of care and patient outcomes. We propose to link primary care acquisition data to TM claims and MA encounter data from 2016-2024; using a quasi-experimental event study framework, we compare changes among beneficiaries in PE-acquired primary care practices with matched control beneficiaries of non-PE acquired primary care practices. In TM, we hypothesize that PE increases the utilization of services, and specifically low-value services like unnecessary or wasteful tests, imaging, or procedures. In MA, increased utilization can be counterproductive under a capitated budget, and we thus hypothesize that PE maximizes revenue through differentially more intensive coding of clinical diagnoses to garner higher risk-adjusted payments from the federal government. Our aims are to: 1) examine changes in provider behavior associated with PE acquisition of primary care practices, including utilization of low-value services and diagnostic coding intensity; 2) estimate changes in quality of care and patient outcomes; and 3) understand treatment effect heterogeneity, including by patient racial/ethnic and geographic composition, as well as by provider and practice characteristics. We apply a number of innovations, including the development of a novel dataset of PE acquisitions in primary care, which will be made publicly available for future use. In order to better approach causal inference, we also apply statistical innovations, including identification strategies in difference-in- differences analyses, risk set matching and cardinality matching to match a treated individual to comparable controls, and application of minimum variance balance weights. Findings will provide novel, timely, and comprehensive quantitative assessments of changes in key clinical and economic outcomes associated with a growing trend of PE ownership in primary care, and will be highly policy relevant as federal and state governments consider ways to preserve and support access to high-value primary care. 1