Private equity (PE) firms are increasingly acquiring ophthalmology practices; little is known of their influence on care utilization and spending. We studied changes in utilization and Medicare spending after PE acquisition.
Retrospective cohort study.
762 clinicians in 123 practices acquired by PE between 2017 and 2018; 34,807 clinicians in 20,549 never-acquired practices.
We analyzed Medicare fee-for-service claims (2012-2019) combined with a novel national database of PE acquisitions of ophthalmology practices using a difference-in-differences method within an event study framework to compare changes after a practice was acquired to changes in practices that were not acquired.
Numbers of beneficiaries seen; intravitreal injections and medications used for injections; spending on ophthalmologist and optometrist services, ancillary services, and intravitreal injections.
Comparing changes over time for PE-acquired to non-acquired practices, there was a relative increase in beneficiaries seen per quarter per PE optometrist of 23.92% (4.20 beneficiaries, 95% CI, 1.73 to 6.67); no change for ophthalmologists; and a relative increase in spending per beneficiary of 5.06% ($9.66, 95% CI, -2.82 to 22.14). Spending on clinician services decreased 1.62% ($-2.37, 95% CI, -5.78 to 1.04), including a 5.46% ($17.70, 95% CI, -2.73 to 38.15) increase in per beneficiary per quarter spending on ophthalmologist services and a 4.60% ($-5.76, 95% CI, -9.17 to -2.34) decrease for optometrists. Ancillary services spending decreased 7.56% (-$2.19, 95% CI 4.19 to -0.22); intravitreal injections spending increased 25.0% ($20.02, 95% CI, -1.38 to 41.41). The number of intravitreal injections increased 5.10% (1.83, 95% CI, -0.1 to 3.80), including a 74.09% (8.38 injections, 95% CI, 0.01 to 16.74) in use of an expensive medication (ranibizumab) and a 12.91% decrease (-3.40 injections, 95% CI -6.86 to 0.07) for an inexpensive injection (bevacizumab). The event study showed consistent and often statistically significant increases in ranibizumab injections and decreases in bevacizumab injections after acquisition.
Though not all results reached statistical significance, this study suggests that PE-acquired practices had little or no overall effect on utilization or total spending, but increased the number of unique patients seen per optometrist and the use of expensive intravitreal injections.

Copyright © 2023. Published by Elsevier Inc.