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Introduction: Private equity firms have recently acquired several large urology practices in the United States. As little is known about these acquisitions, we sought to characterize trends in urology practice consolidation. Methods:We compiled urology practice acquisition data via financial databases, news outlets, practice websites, and Internet keyword search for the time period January 1, 2011 through March 15, 2021. For each acquisition, we determined the acquiring group, number of employed urologists, practice locations, and status of ancillary services (pathology, radiology, or surgery centers). We estimated workforce effects based on the 2019 American Urological Association workforce census.Results: We identified 69 independent practice acquisitions in the study period, including 19 (28.4%) by hospital systems, 7 (10.4%) by multispecialty physician groups, 23 (34.3%) by urology practices, and 20 (29.9%) by private equity-backed platforms. Private equity firms initially targeted large urology practices (mean of 60.8AE32.6 urologists) with ownership of ancillary services and consolidated local market share through acquisitions of smaller practices (mean of 15.9AE14.5 urologists). As of March 2021, we estimate that 7.2% of private practice urologists in the U.S. were employed by one of 5 private equity-backed platforms; over 25% of all urologists practicing in New Jersey and Maryland are employed by a private equity-backed platform.Conclusions: Private equity acquisitions have accelerated to become a dominant form of urology practice consolidation in recent years and have achieved significant market influence in certain regions. Future research should assess the impact of private equity investment on practice patterns, health outcomes, and expenditures.

Key Points Question Can individuals insured by Medicaid access cancer care services at high-performing cancer-designated hospitals? Findings In this cross-sectional study of 334 facilities recognized for cancer care, 95.5% accepted new patients with Medicaid for breast cancer, 90.4% for colorectal cancer, 86.8% for kidney cancer, and 79.6% for skin cancer (melanoma) care. Medicaid was accepted for all 4 surveyed cancers at 67.7% of facilities. Meaning Despite increases in the number of US residents insured through Medicaid, these findings suggest that barriers to accessing cancer care exist at high-quality centers.

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6535 Background: The COVID-19 pandemic has dramatically accelerated the availability of telehealth services for patients with cancer. However, little national cross-sectional data is available to inform potential gaps in access. We aimed to characterize overall access to and trends in telehealth availability for new cancer care patients at hospitals across the United States. Methods: We performed a cross sectional secret-shopper study to evaluate the availability of telehealth services for new patients for three major cancer types—colorectal, breast, and skin cancer—at Commission on Cancer accredited hospitals during the period of April to November 2020. American Hospital Association and Center for Medicare and Medicaid Service databases were queried to determine hospital characteristics. We described hospital variation in access to telehealth services using descriptive statistics. Univariable and multivariable logistic regression were used to identify factors associated with telehealth availability. Results: Of 334 successfully contacted facilities, 248 (74%) offered new patient telehealth services for at least one cancer type. However, access differed by cancer site: telehealth availability for new patients with skin, colorectal, and breast cancer was 47%, 42%, and 38%, respectively. Of the facilities sampled, 47% offered telehealth for one cancer type, 40% for two cancer types, and 14% for all three cancer types. Rates of any telehealth access among the cancer types ranged from 61% at Community Cancer Programs to 100% at NCI Designated Programs. In multivariable logistic regression, facility type was significantly associated with telehealth access while factors such as bed size, ownership, and volume were not significantly associated. Conclusions: Although access to telehealth services for patients with cancer has increased, overall gaps in access remain. Within facility differences in telehealth access imply opportunities to better align services within institutions, though further investigation is warranted as these offerings mature.[Table: see text]