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Who employs your doctor? Increasingly, a private equity firm

nytimes.com

41–50 of 415 posts

Re: Who employs your doctor? Increasingly, a private equity firm

#41
post #3

Reminds me of "Does Private Equity Investment in Healthcare Benefit Patients?" [1]. > Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases…

That is a "working paper" and has not been peer reviewed.

Re: Who employs your doctor? Increasingly, a private equity firm

#42
post #4

When possible, I prefer people who work for me to have incentives that are aligned with mine. PE-owned medical practices and even many private practices throw that out the window, with financial incentives to do procedures or run tests. I was talking to my wife’s obstetrician about this last week and he also feels strongly about it. He’s paid a flat salary and gets no financial benefit for a c-section vs. an inductio…

Flat salary is an incentive to do the easiest option or least work. You can’t win with the incentive game. One nasty way that can manifest is to under test because if you don’t find anything you don’t have to do anything.

That seems infinitely better than the status quo. Having unnecessary procedures is much worse. With the former you can go to another doctor, with the latter they'll just run up your bill until you're broke or dead unless you're one of the exceedingly rare few who gets medical advice from multiple doctors (most can't afford that or do not have alternative in-network doctors).

Re: Who employs your doctor? Increasingly, a private equity firm

#43

PE is essentially buying all needs of a first world human. Medicine, homes, essential services, farmland, in an attempt to extract margin from the last possible places they can. It feels like we’ve re entered the 80s again but worse where now we have 100 billionaires buying up farmland under the guise of it being better that they own it rather than the farmers for… reasons. I think this is essentially late stage capi…

I wonder if public co-ops can rival the influence / power of PE firms?

Re: Who employs your doctor? Increasingly, a private equity firm

#44
post #4

When possible, I prefer people who work for me to have incentives that are aligned with mine. PE-owned medical practices and even many private practices throw that out the window, with financial incentives to do procedures or run tests. I was talking to my wife’s obstetrician about this last week and he also feels strongly about it. He’s paid a flat salary and gets no financial benefit for a c-section vs. an inductio…

Flat salary is an incentive to do the easiest option or least work. You can’t win with the incentive game. One nasty way that can manifest is to under test because if you don’t find anything you don’t have to do anything.

> You can’t win with the incentive game.

I agree that incentives are frequently and perhaps typically exploited, especially when crafted carelessly or not iterated upon, as most incentives seem to be.

I would be eager to contemplate a clinical outcome based incentive scheme.

Re: Who employs your doctor? Increasingly, a private equity firm

#45
post #4

When possible, I prefer people who work for me to have incentives that are aligned with mine. PE-owned medical practices and even many private practices throw that out the window, with financial incentives to do procedures or run tests. I was talking to my wife’s obstetrician about this last week and he also feels strongly about it. He’s paid a flat salary and gets no financial benefit for a c-section vs. an inductio…

The supposedly not for profit hospital systems conglomerates are as rapacious as any robber baron. Nominal form is no guarantee.

Re: Who employs your doctor? Increasingly, a private equity firm

#46
To me it seems like PE has simply discovered a loophole in the system. We want a system where creating value for people is rewarded, but PE has found a way to legally get the rewards without improving society. Normally this is called a scam or a fraud, and there are laws for standard stuff like taking people's money without giving them what you promised.

For PE however, they've found a way around it, using the machinery available in the economy. For instance, once you are able to pay out a dividend that covers your cost of purchase, whatever comes next doesn't matter a whole lot from an investment point of view. You may have saddled the target with a huge debt, but that's a heads-I-win-tails-you-lose situation. If the firm does ok, PE actually win more. If it goes bankrupt, oh well. PE firm is still doing fine.

The risk is entirely on all the other interested parties: employees and customers.

But because we only have one side of the "created value" balance, all we can really see is some PE guys get paid. We don't see the other side, which is pretty hard to untangle. You can make an argument that everyone is better off with society organized this way, but you can't really ignore that many people seem to think they're worse off in this world.

Re: Who employs your doctor? Increasingly, a private equity firm

#47

This is the kind of economic distortion that should be expected when onerous government-imposed regulation of practitioners, medication, and medical devices creates barriers to entry that reduce competition. While such regulation may have been imposed to try to increase safety, quality, and consistency, for example, it also ends up interfering with the incentives of the participants. The lack of real competition, com…

Patient options and choices such as "go to the doctor" vs "go into crippling debt while trying to navigate a labyrinthine billing nightmare"?

Just as an alternative point of view - you describe these regulations as "government-imposed". Would it not be equally (if not more) likely that these regulations are being created and supported by the industry players themselves?

This lack of real competition that you mention sounds like a dream if you have few scruples and a captive market. And telling someone that they'll die unless they pay for your services seems to be about as captive of a market as you can get.

Re: Who employs your doctor? Increasingly, a private equity firm

#48
post #3

Reminds me of "Does Private Equity Investment in Healthcare Benefit Patients?" [1]. > Our estimates show that PE ownership increases the short-term mortality of Medicare patients by 10%, implying 20,150 lives lost due to PE ownership over our twelve-year sample period. This is accompanied by declines in other measures of patient well-being, such as lower mobility, while taxpayer spending per patient episode increases…

Capitalism at its best! America! Fk yeah!

[deleted]

Re: Who employs your doctor? Increasingly, a private equity firm

#49
post #25

Earlier quoted context omitted.

>It feels like we’ve re entered the 80s again but worse where now we have 100 billionaires buying up farmland under the guise of it being better that they own it rather than the farmers for… reasons. I don't get it. Are the billionaires buying the land from the farmers at gunpoint? If it's so disastrous for the farmers to sell, why did they sell in the first place?

It's not disastrous for the farmers. It's just bad news for people who require food at any point in their lives. I'm sure it'll be fine as long as your account doesn't get cancelled.

Yea it’s a classic, aggregate individual leverage of simple players by sophisticated players to gain monopoly over the system.

Oh it’s fine now farmers can sell, until it’s not.

Re: Who employs your doctor? Increasingly, a private equity firm

#50
post #13

america, unsatisfied with spending vastly more privately on healthcare than the rest of the world, while also spending more publicly on healthcare than the rest of the world, continues to find ways to make healthcare yet more expensive and ruinous for its citizens.

Maybe true but, for the rest of the world, you're still the 'go-to' place where medical miracles can happen. Money had something to do with this.

I don't think it's true. In fact, I'm pretty sure each year 14 millions Americans are going to Canada for medical treatment, and richer American are going to Singapore/Uk.
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