For-profit insurance companies have long been regarded as the ultimate offenders in medical profiteering. However, they distract from the unscrupulous involvement of private equity (PE) in medicine, a similarly culpable and even more insidious economic titan.
PE is a unique, unregulated investment platform with the objective of aggressively generating short-term revenue for the firm and its investors without regard for long-term value to society, including public health.
PE firms typically operate on a 3- to- 7-year cycle during which a company is acquired by an investment manager with funds from “limited partners” who are frequently institutional investors. The company is often acquired in a leveraged buyout in which the company is saddled with high-interest debt and bears the full risk of failure to become more profitable — typically resulting in shameless cost-cutting and layoffs.
The PE firm and manager become significantly wealthier regardless of the outcome due to exorbitant fees, such as assets under management.
In May 2021, an American Antitrust Institute white paper found that PE investment accelerates consolidation and “is fundamentally incompatible with a stable, competitive healthcare system that serves patients and promotes the well-being of the population.”
The rise of PE in medicine has resulted in a proxy war against insurance companies exclusively for the benefit of clandestine shareholders and investment fund managers rather than patients or clinicians.
In 2019, for instance, the New York Times exposed the financial backers of Doctor Patient Unity, a secretive organization that created a $28 million ad campaign demonizing insurance companies for “surprise bills” and opposing legislation to eliminate out-of-network bills. Those backers were revealed to be two of the largest PE-backed emergency medicine staffing firms — contract management groups (CMGs) Envision and TeamHealth, which are owned by PE firms KKR and Blackstone, respectively.
Here’s one example of the chilling effect of PE ownership: During the early days of the COVID-19 pandemic, Ming Lin, MD, a board-certified emergency physician, was fired for speaking out against the lack of PPE and protection for frontline staff at PeaceHealth in Washington state. Lin was directly employed by a PE-backed CMG, TeamHealth, which was contracted by the hospital system.
This arrangement eliminated any right to due process for Lin, as it does for an estimated 50% of American emergency physicians employed by CMGs.
Envision attempted the same with Cleavon Gilman, MD, who tweeted that no more ICU beds were available in Arizona at the height of the pandemic and was subsequently fired without due process. [MedPage Today had the details here.]
While Gilman leveraged his large social media following to illuminate his unjust termination, Lin is now backed by the ACLU and is suing TeamHealth and PeaceHealth for violating due process rights.
Unfortunately, countless physicians never make the news, suffering moral injury as a condition of gainful employment, and they are intimidated out of advocating for patients and healthcare workers.
Despite the obvious incompatibility between shareholder primacy and care that puts patients first, the largest emergency medicine society, the American College of Emergency Physicians (ACEP), has deep ties to private equity.
For instance, immediate past president William Jacquis, MD, and past president Rebecca Parker, MD, are now senior vice presidents at Envision, owned by PE firm KKR. Current board members Anthony Cirillo, MD, and Arvind Venkat, MD, are directors for US Acute Care Solutions, which recently had a $470 million investment from PE firm Apollo.
Emergency medicine may only be the “canary in the coal mine” of healthcare consolidation and PE influence. Dermatology groups have been a recent target of PE buyouts. Hospitalist, radiology, and anesthesia groups are following suit. Indeed, all anesthesiologists were recently replaced with certified registered nurse anesthetists at a hospital staffed by Envision in Watertown, Wisconsin. The reach of PE in medicine extends well beyond physician staffing groups.
Organizations such as Restoring Medicine, Practicing Physicians of America, Free2Care, DPC Alliance, and the American Academy of Emergency Medicine actively support physician autonomy and independent practice in order to restore the rapidly eroding integrity of the physician-patient relationship.
The specialty of emergency medicine was a pioneer in selling out to contract management groups and private equity. That’s why the #TakeEMBack campaign will be front-and-center in this movement, starting with the TakeEMBack Summit this September in Chicago.
It’s time for medicine, including individuals and professional societies, to restore the integrity of the physician-patient relationship by taking a strong stand against all forms of corporate greed. It’s time to take medicine back.
Mitchell Louis Judge Li, MD, is the founder of Thrive Direct Care in Chicago, and the chief medical officer of the AAEM-Locum Group. He recently launched the advocacy group, Take Medicine Back.