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， 尽管这种增长，这些收购对临床的影响， 经济结果仍然未知。输送系统其他部分的证据有限，包括 养老院，医院和程序专家，表明PE收购与更高的 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 实践影响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 为近6 000万慢性病受益人提供初级保健-这是亚洲人权质量组织的优先人群。 该提案重点关注私募股权公司可能影响供应商行为的具体机制， 传统医疗保险（TM）和医疗保险优势（MA）中的不同财务激励措施，并估计影响 医疗质量和病人的治疗效果。我们建议将初级保健收购数据与TM索赔和MA联系起来 2016-2024年的遭遇数据;使用准实验性事件研究框架，我们比较了 在PE获得的初级保健实践的受益人与非PE的匹配对照受益人中， 获得初级保健的做法。在TM中，我们假设PE增加了服务的利用率， 特别是低价值服务，如不必要或浪费的测试，成像或程序。在MA，增加 在资本预算下，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差异化更密集的编码，以获得更高的风险调整后收入 来自联邦政府的付款。我们的目标是：1）检查与供应商行为相关的变化 PE获得初级保健实践，包括利用低价值服务和诊断编码 强度; 2）估计护理质量和患者结局的变化;以及3）了解治疗效果 异质性，包括患者种族/民族和地理组成，以及提供者和 实践特点我们应用了一些创新，包括开发一个新的PE数据集， 在初级保健方面的采购，将公开提供，供今后使用。为了更好地接近 因果推理，我们还应用统计创新，包括识别策略的差异， 差异分析、风险集匹配和基数匹配，以匹配治疗个体与可比个体 控制和应用最小方差平衡权重。调查结果将提供新颖，及时， 对与药物治疗相关的关键临床和经济结局变化进行全面定量评估， 初级保健中PE所有权的增长趋势，并且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的初级保健。 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