Impacts of private-equity acquisition of ophthalmology practices remain elusive

With private equity (PE) firm acquisition of practices on the rise, this retrospective study sought to uncover the influence of this change on ophthalmology practices, particularly regarding utilization and spending over time. Several striking trends were seen, though few reached statistical significance.

Study design

This retrospective cohort study used 2012–2019 Medicare fee-for-service claims to compare 123 PE-acquired practices vs 20,549 practices that had never been acquired by PE. The investigation was particularly focused on the longitudinal effect of PE acquisition on the number of beneficiaries, number of intravitreal injections (IVI), type of drug used for IVI, cost of IVIs, and cost of clinic visits to optometrists and ophthalmologists.

Outcomes

The most potentially important clinical findings included a 74% increase in the use of ranibizumab (a relatively expensive IVI) and a 13% decrease in the use of bevacizumab (a relatively less expensive IVI) in PE-acquired practices vs non-PE practices, though these differences were not statistically significant. The primary significant difference was an increase of about 25% in the number of beneficiaries seen per quarter by optometrists after PE acquisition; no change was seen in ophthalmologist beneficiaries. Other trends included a 5% increase in spending per PE beneficiary and 5% increase in the number of intravitreal injections in PE-acquired practices, but these results were also nonsignificant.

Limitations

The study attempted to use an event-study framework to look at difference-in-differences pre- and post-PE acquisition. Two difficulties with this model of comparison are that practice patterns vary widely and they are not necessarily consistent before and after PE acquisition, as assumed by the model. This is likely why the confidence intervals were so wide. There are also so many factors that affect choice of IVI agent, including changing reimbursements and the varying ability of PE vs non-PE groups to negotiate rebates for these medications.

Clinical significance

These results, while interesting, should be cautiously interpreted. While we often think of PE-practice profitability as hinging on increased patient volume, increased IVI volume, and increased ratio of expensive IVI drug, this study does not necessarily confirm this hypothesis. Perhaps the variability in practice patterns in both types of practices is more difficult to characterize than this modelling allows.

Financial Disclosures: Dr. Rebecca Soares discloses no financial relationships.