Access to Urological Care for Medicaid-Insured Patients at Urology Practices Acquired by Private Equity Firms

Nie, James; Hsiang, Walter; Marks, Victoria; Laditi, Folawiyo; Varghese, Adarsh; Umer, Waez; Haleem, Afash; Mothy, David; Wang, Hannah; Patel, Riya; Pan, William L.; Shah, Rishi; Khan, Sophia; Singh, Rohan; Golla, Vishnukamal; Cavallo, Jaime A.; Breyer, Benjamin N.; Leapman, Michael

doi:10.1016/j.urology.2022.01.055

Cited by 15 publications

(30 citation statements)

References 14 publications

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“…These findings can likely be attributed to known difficulties that community healthcare providers have in finding care referrals to appropriate specialists that are covered under Medicaid 45 . Furthermore, the disparity in access to urologic care has been specifically demonstrated for patients with Medicaid coverage seeking treatment at practices acquired by private equity firms 46 . Improvements in access to RARP may lead to improvements in morbidity and mortality in this population 19,47 …”

Section: Discussionmentioning

confidence: 99%

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Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

Logan

Mahenthiran

Siddiqui

et al. 2023

Journal of Surgical Oncology

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Background Most radical prostatectomies are completed with robotic assistance. While studies have previously evaluated perioperative outcomes of robot‐assisted radical prostatectomy (RARP), this study investigates disparities in access and clinical outcomes of RARP. Study Design The National Cancer Database (NCDB) was used to identify patients who received radical prostatectomy for cancer between 2010 and 2017 with outcomes through 2018. RARP was compared to open radical prostatectomy (ORP). Odds of receiving RARP were evaluated while adjusting for covariates. Overall survival was evaluated using a propensity‐score matched cohort. Results Overall, 354 752 patients were included with 297 676 (83.9%) receiving RARP. Patients who were non‐Hispanic Black (82.8%) or Hispanic (81.3%) had lower rates of RARP than non‐Hispanic White (84.0%) or Asian patients (87.7%, p < 0.001). Medicaid or uninsured patients were less likely to receive RARP (75.5%) compared to patients with Medicare or private insurance (84.4%, p < 0.001). Medicaid or uninsured status was associated with decreased odds of RARP in adjusted multivariable analysis (OR 0.61, 95% CI 0.49–0.76). RARP was associated with decreased perioperative mortality and improved overall survival compared to ORP. Conclusion Patients who were underinsured were less likely to receive RARP. Improved access to RARP may lead to decreased disparities in perioperative outcomes for prostate cancer.

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Section: Discussionmentioning

confidence: 99%

“…45 Furthermore, the disparity in access to urologic care has been specifically demonstrated for patients with Medicaid coverage seeking treatment at practices acquired by private equity firms. 46 Improvements in access to RARP may lead to improvements in morbidity and mortality in this population. 19,47…”

Section: Limitationsmentioning

confidence: 99%

Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

Logan

Mahenthiran

Siddiqui

et al. 2023

Journal of Surgical Oncology

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“…Reduced access for patients with Medicaid potentially reflects practice strategies to limit exposure to the lower reimbursement and increased administrative burdens associated with Medicaid. Medicaid appointment availability at private equity-affiliated urology practices was three times higher than private equity-backed dermatology practices [38 ▪ ], which may be an indication of future trends in other specialties with a shorter track record of private equity investment. Moving forward, it will be important to monitor healthcare access for increased disparities for Medicaid-insured patients in larger healthcare organizations, especially private equity-backed practices.…”

Section: Medical Specialtiesmentioning

confidence: 92%

“…In a 2021 study assessing all urology specialties, Medicaid acceptance was higher at nonprivate equity-backed practices (66.8%) than at private equity-backed practices (52.1%, P < 0.01) [38 ▪ ]. Private equity-backed practices had shorter mean patient wait times for an appointment than at nonprivate equity-affiliated offices (17.5 vs. 21.4 days, P = 0.17) [38 ▪ ]. Reduced access for patients with Medicaid potentially reflects practice strategies to limit exposure to the lower reimbursement and increased administrative burdens associated with Medicaid.…”

Section: Medical Specialtiesmentioning

confidence: 98%

Section: Medical Specialtiesmentioning

confidence: 99%

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Private equity in ophthalmology: lessons from other specialties

Brill

Luo

Sridhar

et al. 2022

Current Opinion in Ophthalmology

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Purpose of reviewIn the absence of long-term data of the effects of private equity in ophthalmology, this article reviews the role of private equity in other medical specialties as a guide to the future for ophthalmology. Recent findingsAcross an array of medical specialties, including anesthesiology, dermatology, emergency medicine, ophthalmology/optometry, radiology, and urology, medical practices are being consolidated into a few larger platform groups. Although there has been a short-term financial success for both private equity firms and senior medical practice partners, there exists broad skepticism from peer-reviewed publications and the national media.

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The immediate effects of private equity acquisition of urology practices on the management of newly diagnosed prostate cancer

Faraj,

Kaufman,

Herrel

et al. 2023

Cancer Medicine

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IntroductionSome worry that physician practices acquired by private equity may increase the use of services to maximize revenue. We assessed the effects of private equity acquisition on spending, use of treatment, and diagnostic testing in men with prostate cancer.MethodsWe used a 20% sample of national Medicare claims to perform a retrospective cohort study of men with prostate cancer diagnosed from 2014 through 2019. The primary outcome was prostate cancer spending in the first 12 months after diagnosis. Secondary outcomes included the use of treatment and a composite measure of diagnostic testing (e.g., imaging, genomics) in the first 12 months after diagnosis. Multilevel modeling was used to adjust for differences in patient and market characteristics. The effect of practice acquisition on each outcome was assessed using a difference‐in‐differences design.ResultsThere were 409 and 4021 men with prostate cancer managed by urologists in acquired and nonacquired practices, respectively. After acquisition, prostate cancer spending was comparable between acquired and nonacquired practices (difference‐in‐differences estimate $1182, p = 0.36). Acquisition did not affect the use of treatment (difference‐in‐differences estimate 3.7%, p = 0.30) or the use of diagnostic testing in men who were treated (difference‐in‐differences −5.5%, p = 0.12) and those managed conservatively (difference‐in‐differences −2.0%, p = 0.82).ConclusionsIn the year following acquisition of urology practices, private equity did not increase prostate cancer spending, the use of treatment or diagnostic testing in men with prostate cancer. Future work should evaluate the effects of private equity acquisition on practice patterns and quality over a longer time horizon.

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Access to Urological Care for Medicaid-Insured Patients at Urology Practices Acquired by Private Equity Firms

Cited by 15 publications

References 14 publications

Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

Disparities in access to robotic technology and perioperative outcomes among patients treated with radical prostatectomy

Private equity in ophthalmology: lessons from other specialties

The immediate effects of private equity acquisition of urology practices on the management of newly diagnosed prostate cancer

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