A nationwide study has found a measurable increase in emergency department (ED) deaths at hospitals acquired by private equity firms, raising fresh concerns about the impact of investor-led ownership on patient outcomes.

Published September 23 in Annals of Internal Medicine, the study analyzed more than 7 million emergency visits and over 880,000 intensive care unit (ICU) hospitalizations across 342 hospitals. It compared data from 49 private equity-owned hospitals to 293 similar hospitals that had not changed ownership. All data was drawn from Medicare Part A and B claims between 2009 and 2019.

Researchers from Harvard Medical School, the University of Pittsburgh, and the University of Chicago found that mortality rates rose by 13% — from 52 to 59 deaths per 10,000 ED visits — after a hospital was acquired by a private equity firm. ICU stays shortened, patient transfers increased, and staffing expenditures dropped significantly in both ED and ICU settings.
The authors link these outcomes to cost-cutting strategies commonly employed by private equity owners, including reduced staffing and lower salaries.

“Staffing cuts are one of the common strategies used to generate financial returns for the firm and its investors,” said Dr. Zirui Song, senior author and associate professor of health care policy at Harvard Medical School. “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.”

Following acquisition, private equity hospitals cut ED salary spending by 18% and ICU salary spending by 16% relative to controls. Hospital-wide, full-time employee counts declined by 11.6%, with overall salary expenditures falling 16.6%.

Private equity firms often claim to improve hospital operations through capital investment. However, the study notes that these firms have disproportionately acquired financially stable hospitals, which are better suited to handle debt obligations while remaining profitable.

The findings build on previous research that linked private equity ownership to increases in preventable adverse events in inpatient settings.

Policy responses at the state and federal level have started to emerge, focusing on increased transparency and oversight of private equity transactions in health care.

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