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Who employs your doctor? Increasingly, a private equity firm

nytimes.com

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

#241

Post by verteu »

starcraft2wol wrote: post #135
verteu wrote: post #117

Earlier quoted context omitted.

By this standard, should we not believe that smoking causes lung cancer? After all, a controlled experiment on humans has never been done.

Those studies aren't similar in methodology or subject at all. Can you acknowledge there are unmeasured social factors at play in this simple survey analysis, or not? If so, I'm happy to speculate about the epistemology of tobacco studies.

> Those studies aren't similar in methodology or subject at all.

They both used observational health data to create a causal conclusion on mortality. How is that not a similarity in methodology?

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

#242

Post by [deleted] »

wpietri wrote: post #194
starcraft2wol wrote: post #105

Earlier quoted context omitted.

That's nice of you to list where you work. On HN there are many qualified and intelligent people, so we generally prefer to talk about the issues directly. > half a dozen standard robustness checks My original comment isn't arguing they used tools improperly, it's an epistemology argument. It's about the limitations of what information could even be gathered from this kind of study.

I think it's hilarious that somebody who has been here for all of 11 days wants to tell somebody who is coming up on their 10-year HNiversary what "we generally prefer".

[deleted]

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

#243

Post by fiprofessor »

tpmoney wrote: post #221
vkou wrote: post #178

Earlier quoted context omitted.

> This doesn't explain why doctors are selling though Retiring doctors are selling because this lets them cash out their practice for way more than they'd otherwise get for closing it and auctioning off the equipment. > Why aren't doctors just not selling their practices and taking a more relaxing job running things themselves? The ones that are selling are the ones exiting the rat race, the downsides aren't affectin…

So why aren't new doctors opening their own practices? What has changed in the last 20/30/40 years that are leading up and coming doctors to choose working for someone else instead of opening their own practice?

I think they will over time if PE deals start to implode or reveal themselves to be as bad as people claim. But the reaction will take a while to happen.

With partnership-based models, it's not necessarily the case that most of the doctors who owned their practices were necessarily that entrepreneurial. Many probably joined the practice and then became partners after a few years with buy-in and sweat equity. There's some risk and business management involved, but not the same as really doing your own thing. The path was laid out. (Kind of like lawyers at big law firms.)

The real entrepreneurs were the ones who initially founded a practice from scratch. But for some specialties where PE has taken hold, you need a group of people with enough capital to do that, negotiate contracts with hospitals for admitting privileges, wait-out a non-compete from a prior practice, etc. That takes time, and meanwhile, the net share of PE held firms may still increase for a while as other firms continue to sell out.

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

#244

Post by elishah »

poorbutdebtfree wrote: post #143
recursivedoubts wrote: post #9

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.

Metabolic health is responsible for at least 3/5 of healthcare costs. 4/5 of SNAP recipients have at least one underlying metabolic health issue. Big food wins. Big medicine wins. Big pharma wins.

> Metabolic health is responsible for at least 3/5 of healthcare costs.

I would love to see a source for that, as it is strongly at odds with all data that I've ever seen. For example:

"Medical cost of overweight and obesity combined is approximately 5.0% to 10% of US healthcare spending." https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-789X....

"Costs attributable to overweight and obesity in Canada were $6.0 billion in 2006, with 66% attributable to obesity. This corresponds to 4.1% of the total health expenditures in Canada in 2006. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-789X....

"Costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care)." https://journals.plos.org/plosone/article?id=10.1371/journal...

This is a notoriously difficult thing to estimate, and highly influenced by exact definitions of any given study, so some variance is to be expected. But going from around 6% to >60% seems like quite a jump.

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

#245

Post by darrin »

tryptophan wrote: post #35
alach11 wrote: 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.

A bonus based on risk-adjusted outcomes would put pay in alignment with patient care. This would require much better outcome analysis and reporting though (also a good thing).

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

#246

Post by mediascreen »

lapcat wrote: post #114
lordnacho wrote: post #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 machin…

> To me it seems like PE has simply discovered a loophole in the system. The fundamental loophole is that "the free market" is practically a religion in the United States (the so-called Invisible Hand taking the role of a god doling out rewards and punishments), and a significant portion of the population is vehemently opposed to any regulation of capital. You can even see this attitude in some of the comments here,…

People often see the United States as the ultimate free market, but compared to other countries it can be seen as pretty heavily regulated.

According to the Heritage Foundation's Economic Freedom ranking, it ranks 25th, well below "socialist" states like Denmark (in 9th place) and Sweden (in 10th place).

https://www.heritage.org/index/ranking

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

#247

Post by darth_avocado »

rcme wrote: post #69
darth_avocado wrote: post #55

Earlier quoted context omitted.

Capital is the barrier and the requirement is not low in the areas PE takes over.

It seems like a vet would be about as expensive as opening a restaurant, maybe 1-3x as much. That doesn't seem like the most capital intensive thing ever.

It is more expensive to open a clinic than a restaurant, with the costs being anywhere from $500k-$1M. The main difference between the two is that the vet clinic has higher running costs aka salaries in the early years before the practice takes off. For restaurants, it’s relatively lower (staff salaries and produce) if the demand is lower.

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

#248

Post by ars »

lordnacho wrote: post #213
ars wrote: post #198

Earlier quoted context omitted.

Your question is wrong. Voluntary means that the person giving you the choice is not the one creating the choices. So your choice is "work", or "starve and die" - the person offering the job is not creating the "starve and die" choice, therefor it is voluntary. Your choice is "work", "I will beat you" - this in involuntary. Your choice is "work for $1,000,000", or "work for a bar of gold" - this is involuntary becaus…

Does this mean that as long as there are two people making offers, anything you do is voluntary?

Your sentence is not written carefully.

Rephrasing: As long as there are two independent people making offers, your choice between the two offers is voluntary. (Do not forget the 3rd option: accept neither offer.)

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

#249

Post by lapcat »

mediascreen wrote: post #246
lapcat wrote: post #114

Earlier quoted context omitted.

> To me it seems like PE has simply discovered a loophole in the system. The fundamental loophole is that "the free market" is practically a religion in the United States (the so-called Invisible Hand taking the role of a god doling out rewards and punishments), and a significant portion of the population is vehemently opposed to any regulation of capital. You can even see this attitude in some of the comments here,…

People often see the United States as the ultimate free market, but compared to other countries it can be seen as pretty heavily regulated. According to the Heritage Foundation's Economic Freedom ranking, it ranks 25th, well below "socialist" states like Denmark (in 9th place) and Sweden (in 10th place). https://www.heritage.org/index/ranking

That's a political propaganda piece by a notorious right-wing think tank.

"The Heritage Foundation (abbreviated to Heritage) is an American conservative think tank based in Washington, D.C. The foundation took a leading role in the conservative movement during the presidency of Ronald Reagan, whose policies were taken from Heritage's policy study Mandate for Leadership." https://en.wikipedia.org/wiki/The_Heritage_Foundation

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

#250

Post by BSEdlMMldESB »

horsawlarway wrote: post #200
YPCrumble wrote: post #188

Earlier quoted context omitted.

It feels like most answers to “who is at the losing end of any transaction” is pension funds, which are guaranteed by the government. So by your theory PE firms are sucking in taxpayer money by fleecing pension funds run by financiers who aren’t smart enough to get into PE. Basically until pension funds aren’t bailed out by the government this will continue.

You don't stop making blood to get rid of leeches. You pull the leech off.

you do if/when you have such a case of leeches that you die.
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