Study Links Private Equity Hospital Acquisitions to Higher Emergency Department Mortality
New national research is raising concerns about the impact of private equity ownership on patient care in U.S. hospitals. A study led by investigators at Harvard Medical School, the University of Pittsburgh, and the University of Chicago has found that mortality rates among Medicare patients increased after hospitals were acquired by private equity firms. The findings, published Sept. 23 in Annals of Internal Medicine, point to staffing cuts as a likely driver of the rise in deaths.
The research analyzed more than one million emergency department visits and over 121,000 ICU hospitalizations across 49 hospitals acquired by private equity, comparing them with more than six million emergency visits and 760,000 ICU hospitalizations at 293 matched control hospitals. The dataset spanned 2009 to 2019 and included all traditional Medicare Part A and B claims nationwide.
The analysis revealed that, following acquisition, Medicare patients treated in emergency departments of private equity hospitals experienced seven additional deaths per 10,000 visits compared with similar hospitals that were not acquired. This equates to a 13% increase over a baseline of 52 deaths per 10,000 visits.
Researchers also documented broad reductions in hospital staffing and compensation. Salary expenditures fell by 18% in emergency departments and 16% in ICUs, while overall hospital staffing levels dropped by an average of 11.6%. Across all departments, salary spending decreased by 16.6% compared with non-private-equity hospitals. According to the study team, these reductions directly undermine the capacity of hospitals to care for medically complex patients.
“Staffing cuts are one of the common strategies used to generate financial returns for the firm and its investors,” said senior author Zirui Song, MD, PhD, associate professor of health care policy at Harvard Medical School and a physician at Massachusetts General Hospital. “Among Medicare patients, who are often older and more vulnerable, this study shows that those financial strategies may lead to potentially dangerous, even deadly consequences.”
Beyond mortality, the study observed shorter ICU stays and more frequent transfers to other hospitals after private equity acquisition—patterns consistent with reduced in-house capacity to care for critically ill patients.
These findings build on earlier work. In a prior JAMA study, Song and colleagues documented a 25% increase in preventable adverse events, including hospital-acquired infections, in inpatient wards following private equity buyouts. Together, the evidence suggests that changes to staffing and clinical operations are central to the risks introduced by investor-driven ownership.
Proponents of private equity argue that such acquisitions bring much-needed capital to hospitals, especially those facing financial strain. But evidence suggests otherwise. A 2024 study in JAMA Internal Medicine found that private equity firms more often acquire financially stable hospitals, raising doubts about whether the primary goal is revitalization or revenue generation.
The results come at a time of increasing scrutiny from policymakers. Several state and federal initiatives are exploring regulatory measures, such as increased transparency in transactions, restrictions on corporate influence over clinical decision-making, and oversight mechanisms to ensure patient safety is not compromised.
As the debate continues, the study provides new empirical evidence that the business strategies of private equity firms may have measurable consequences for patient outcomes—particularly in emergency and critical care, where bedside staffing is indispensable.