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"After a hospital was acquired by private equity, admitted Medicare patients had a 25% increase in hospital-acquired complications, compared with patients admit

"After a hospital was acquired by private equity, admitted Medicare patients had a 25% increase in hospital-acquired complications, compared with patients admitted before acquisition. Patients also had 27% more falls and 38% more bloodstream infections caused by central lines, which are temporary surgically inserted ports that allow easy intravenous access for patients receiving repeated drug infusions or other treatments. The increase was seen despite private equity hospitals' placing 16% fewer central lines than before the buyout." I am not sure who the private equity firms are, but I thought it was alarming when insurers started purchasing hospitals, urgent care facilities and even your standard family med doc, as they would be negotiating with themselves on how much profit they could make off each appointment. But I didn't consider lower standards when it comes to patient care, this adds a whole different dimension.

Voultapher 3y ago
You know, it's maybe a bad idea to privatize some things https://www.economist.com/by-invitation/2023/07/10/mathew-lawrence-on-why-privatisation-has-been-a-costly-failure-in-britain https://www.economist.com/by-invitation/2023/07/10/mathew-la... water in the U.K got more expensive and the service worse. A terrible deal for everyone but a handful of private equity investors.
- giantrobot 3y ago
  No one wants to learn the lesson that while government administration of some things might be "inefficient", any efficiencies brought about by privatization will be turned into margins by the private entity rather than savings to the end customers. Private entities need to maintain margins and will cut service to maintain them.
  - JumpCrisscross 3y ago
    > Private entities need to maintain margins and will cut service to maintain them This is a false dichotomy. Public v private is so often framed as a political agency versus free-market bonanza. In reality, we have independent agencies and public-private partnerships. But on the private side, we also co-operatives, a model which seems well-suited for community hospitals.
    - phkahler 3y ago
      Or how about just non-profit? Regardless of the options, private equity seems like the worst one and should probably be illegal. Taking "profit" from keeping people "not dead" seems as close to extortion as you can get without actually being so.
      - JumpCrisscross 3y ago
        > how about just non-profit? “If the public health goal is to improve hospital care, then focusing on things like for-profit or nonprofit status is a distraction” [1]. > Taking "profit" from keeping people "not dead" seems as close to extortion Modern medicine is expensive. For profit or not, expenses must be covered. We’re better off incentivising people to become doctors and nurses and pharmaceutical researchers. The problem is all the nonsense being eaten up in administration, administration largely paid for by price obfuscation. [1] https://www.hsph.harvard.edu/news/press-releases/hospitals-converting-to-for-profit-status-show-better-financial-health-no-loss-in-quality-of-care/ https://www.hsph.harvard.edu/news/press-releases/hospitals-c...
        phkahler 3y ago
        >> “If the public health goal is to improve hospital care, then focusing on things like for-profit or nonprofit status is a distraction” Fair enough. So let's just ban for-profit healthcare so we can stop being distracted by that whole thing.
        albert180 3y ago
        Still you manage to waste 10% on Administrative Expenses and have the worst health outcomes in G7 but the highest expenses. Maybe learn a thing or two from northern Europe which has 100% public healthcare delivery
        giantrobot 3y ago
        > Modern medicine is expensive. For profit or not, expenses must be covered. There's a ton of bullshit that goes into "medical expenses" in the US. Not the least of which is the inability for people to pay for care and end up in the ER for urgent non-emergency services because ER services are required to be provided. Hospitals need to foot the costs of those people that literally can't pay. Those costs get amortized over every other service (plus plain old margin and gauging) increasing the overall costs. Besides eliminating unpaid emergency service public health coverage would let people get regular medical care without plunging into debt so they'd go sooner before conditions become acute. Private insurance could even still exist, but as a premium add-on to statutory coverage. More doctors and nurses is just supply side economics applied to healthcare. Those jobs will appear naturally with the entire population completely covered. Rural hospitals could even open back up since they'd be serving people with actual coverage.
  - Frost1x 3y ago
    Yea the argument that efficiency gains are passed to consumers is a tired old and often false argument. The only time efficiencies are passed to consumers are when there is real healthy competition and consumers are supporting that diversity. That's when in order to remain competitive, efficiency needs to be passed to the consumer. Even in those situations it's not guaranteed. Markets seem to arise at or duplicate similar solutions and even if it's inefficient it's not worth he risk to find better alternatives for consumers because the competitive edge vs risk vs reward just isn't a winning mix worth pursing. I'm increasingly convinced that most forms of free market systems work best once we have commoditization of a solution and it's just a matter of reproducing that solution, and doing so isn't too capital intensive. As you start to move away from these parameters, markets get more and more consumer hostile and self focused making the argument for them increasingly weak.
    - JumpCrisscross 3y ago
      > most forms of free market systems work best once we have commoditization It’s almost the opposite. Free markets didn’t work in the pre-industrial era because everything was commoditised. That made returns on capital paltry, which in turn made it more “profitable” to conquer capital than build it. After industrialisation, we repeatedly saw innovation—though not necessarily creativity—in market economies outperform that in centralised ones.
    - lelandfe 3y ago
      Not to mention that the private companies will work to avoid said competition. Little wonder why ISPs refer to creating networks where one already exists as “overbuilding”
      - lotsofpulp 3y ago
        When I look around, there are multiple businesses usually near each other that compete. Home Depot and Lowes, Walmart and Target, Burger King and McDonald’s. ATT/Verizon/Tmobile. But it is possible that if you pay to build out an entirely new network to a place where Comcast has a monopoly, and the customers would rather pay Comcast $5 less than whatever the lowest price you can charge is, then you would see negative returns by paying to build that network (since the cost of building out a network like that is so astronomical, and Comcast obviously does not have to pay it so their COGS is much lower).
- klipt 3y ago
  Water is a monopoly right? Seems obvious that privatizing a monopoly doesn't help, because there's no competition incentive to keep prices down and service up.
  - Sharlin 3y ago
    Oh, but it does help. Just not the general population.
  - AnotherGoodName 3y ago
    I sometimes think the "anti-government run anything" mantra is just people who are easily swayed by propaganda reciting a line. It's easy to take singular examples of government failure and write articles claiming that everything must be owned by private equity because government is dysfunctional. But do you know what? I used to pay 1/4 the price for electricity when i lived in an area with a local county run power company compared to my new nearby location that has PG&E as the only option. As in government run utilities were literally 1/4 the price per kwh and yet i'm supposed to buy into this "GOVERNMENT IS INEFFICIENT LOL COMMUNISM" propaganda that just doesn't appear true in the slightest. I mean this is consistent across the board. I know the baby boomer generation were vulnerable to this anti-socialism propaganda but can we please start looking at things objectively and push back against this privatization that is almost always a way for politicians to enrich themselves. Sigh.
    - deleted 3y ago
      [deleted]
    - skfingngihg 3y ago
      The government is less efficient at serving its stake holders than for-profit corporations. The government creates the conditions for PGE to be so bad. I’m defecting from the grid this year, PGE’s high prices mean my s system will pay for itself in less than a year and will likely be more reliable. battery and solar companies saved me from PGE and they can save you. The government perhaps can but likely won’t. Extrapolate for yourself what this means about the world and what organizations should command the most resources.
Fomite 3y ago
One of the big problems is that infection control and antibiotic stewardship don't have billable procedures most of the time, and are thus viewed as cost centers by hospital leadership.
- ublomate 3y ago
  And therein lies the most significant problem with unbounded capitalism. Capitalism is a very, very powerful tool, because it redefines everything in terms of money. This enables the magic of specialization and trade, but it also causes situations like this where greedy and/or thoughtless people chip away at the margins of things like safety and let other people suffer the consequences.
  - JumpCrisscross 3y ago
    > Capitalism is a very, very powerful tool, because it redefines everything in terms of money Well, in terms of capital. For the segments of the economy we put into the market. Also, this is more a feature of industrialisation than capitalism—socialist economies still consider resource allocation in generalisable terms.
  - amelius 3y ago
    > Capitalism is a very, very powerful tool, because it redefines everything in terms of money. But only when it is convenient. For example school teachers or police officers can work their brains out but cannot profit from it like entrepreneurs do. For many people unbounded capitalism is a very shitty proposition.
    - deleted 3y ago
      [deleted]
    - saulpw 3y ago
      Teachers and police officers don't benefit by definition because they do not have capital. Capitalism benefits the people who start private schools and private jails. Capitalists take advantage of labor in order to increase their own profits.
chiefalchemist 3y ago
> After a hospital *A* hospital. Single. I'm certainly not going to defend private equity. But if we're going to do a takedown, let's do it correctly. Cherry picking what is likely an outlier is not doing it correctly.
- chiefalchemist 3y ago
  Some things never change. So typical of HN. A comment lacking in critical thinking is added. The punters jump on to further the false narrative. And...the correction to that misguided affair is down voted. Y'all are funny. Ignorant, but funny.
  - orwin 3y ago
    Sorry, I avoid saying that on HN, but if you read the article and not just skimmed through it, you could have clicked on the link to the study here: https://jamanetwork.com/journals/jama/fullarticle/2813379?guestAccessKey=e0cef9be-d55c-4bcf-8892-412af8f24355 https://jamanetwork.com/journals/jama/fullarticle/2813379?gu... And discover why your comment was downvoted. I apologize I did not leave a comment to explain why I was down voting, I just did not want to say 'look, this person can't read', it's tacky (sorry for still doing it btw)
    - chiefalchemist 3y ago
      The *pulled quote* says "A hospital" (read: cherry picked) and then uses that outlier to sway the assuming and the naive. If I wanted to speak to the whole study I would have. However, the paragraph pulled specifically says "*a* hospital*. Now who did the skimming?? FFS
- arcaen 3y ago
  Not sure where you got the idea that the study was only of a singular hospital, seeing as the study outline details claims for 600k hospitalizations in 51 private-equity hospitals are compared to 4m comparable hospitalizations in 259 non-private-equity hospitals.
rootusrootus 3y ago
> I thought it was alarming when insurers started purchasing hospitals, urgent care facilities and even your standard family med doc I am skeptical of that conclusion. Kaiser Permanente gets good results, and they are an HMO: the very definition of an insurer owning the hospital/urgent care/family doc.

Voultapher 3y ago

You know, it's maybe a bad idea to privatize some things https://www.economist.com/by-invitation/2023/07/10/mathew-lawrence-on-why-privatisation-has-been-a-costly-failure-in-britain https://www.economist.com/by-invitation/2023/07/10/mathew-la... water in the U.K got more expensive and the service worse. A terrible deal for everyone but a handful of private equity investors.

giantrobot 3y ago
No one wants to learn the lesson that while government administration of some things might be "inefficient", any efficiencies brought about by privatization will be turned into margins by the private entity rather than savings to the end customers. Private entities need to maintain margins and will cut service to maintain them.
- JumpCrisscross 3y ago
  > Private entities need to maintain margins and will cut service to maintain them This is a false dichotomy. Public v private is so often framed as a political agency versus free-market bonanza. In reality, we have independent agencies and public-private partnerships. But on the private side, we also co-operatives, a model which seems well-suited for community hospitals.
  - phkahler 3y ago
    Or how about just non-profit? Regardless of the options, private equity seems like the worst one and should probably be illegal. Taking "profit" from keeping people "not dead" seems as close to extortion as you can get without actually being so.
    - JumpCrisscross 3y ago
      > how about just non-profit? “If the public health goal is to improve hospital care, then focusing on things like for-profit or nonprofit status is a distraction” [1]. > Taking "profit" from keeping people "not dead" seems as close to extortion Modern medicine is expensive. For profit or not, expenses must be covered. We’re better off incentivising people to become doctors and nurses and pharmaceutical researchers. The problem is all the nonsense being eaten up in administration, administration largely paid for by price obfuscation. [1] https://www.hsph.harvard.edu/news/press-releases/hospitals-converting-to-for-profit-status-show-better-financial-health-no-loss-in-quality-of-care/ https://www.hsph.harvard.edu/news/press-releases/hospitals-c...
      - phkahler 3y ago
        >> “If the public health goal is to improve hospital care, then focusing on things like for-profit or nonprofit status is a distraction” Fair enough. So let's just ban for-profit healthcare so we can stop being distracted by that whole thing.
      - albert180 3y ago
        Still you manage to waste 10% on Administrative Expenses and have the worst health outcomes in G7 but the highest expenses. Maybe learn a thing or two from northern Europe which has 100% public healthcare delivery
      - giantrobot 3y ago
        > Modern medicine is expensive. For profit or not, expenses must be covered. There's a ton of bullshit that goes into "medical expenses" in the US. Not the least of which is the inability for people to pay for care and end up in the ER for urgent non-emergency services because ER services are required to be provided. Hospitals need to foot the costs of those people that literally can't pay. Those costs get amortized over every other service (plus plain old margin and gauging) increasing the overall costs. Besides eliminating unpaid emergency service public health coverage would let people get regular medical care without plunging into debt so they'd go sooner before conditions become acute. Private insurance could even still exist, but as a premium add-on to statutory coverage. More doctors and nurses is just supply side economics applied to healthcare. Those jobs will appear naturally with the entire population completely covered. Rural hospitals could even open back up since they'd be serving people with actual coverage.
- Frost1x 3y ago
  Yea the argument that efficiency gains are passed to consumers is a tired old and often false argument. The only time efficiencies are passed to consumers are when there is real healthy competition and consumers are supporting that diversity. That's when in order to remain competitive, efficiency needs to be passed to the consumer. Even in those situations it's not guaranteed. Markets seem to arise at or duplicate similar solutions and even if it's inefficient it's not worth he risk to find better alternatives for consumers because the competitive edge vs risk vs reward just isn't a winning mix worth pursing. I'm increasingly convinced that most forms of free market systems work best once we have commoditization of a solution and it's just a matter of reproducing that solution, and doing so isn't too capital intensive. As you start to move away from these parameters, markets get more and more consumer hostile and self focused making the argument for them increasingly weak.
  - JumpCrisscross 3y ago
    > most forms of free market systems work best once we have commoditization It’s almost the opposite. Free markets didn’t work in the pre-industrial era because everything was commoditised. That made returns on capital paltry, which in turn made it more “profitable” to conquer capital than build it. After industrialisation, we repeatedly saw innovation—though not necessarily creativity—in market economies outperform that in centralised ones.
  - lelandfe 3y ago
    Not to mention that the private companies will work to avoid said competition. Little wonder why ISPs refer to creating networks where one already exists as “overbuilding”
    - lotsofpulp 3y ago
      When I look around, there are multiple businesses usually near each other that compete. Home Depot and Lowes, Walmart and Target, Burger King and McDonald’s. ATT/Verizon/Tmobile. But it is possible that if you pay to build out an entirely new network to a place where Comcast has a monopoly, and the customers would rather pay Comcast $5 less than whatever the lowest price you can charge is, then you would see negative returns by paying to build that network (since the cost of building out a network like that is so astronomical, and Comcast obviously does not have to pay it so their COGS is much lower).
klipt 3y ago
Water is a monopoly right? Seems obvious that privatizing a monopoly doesn't help, because there's no competition incentive to keep prices down and service up.
- Sharlin 3y ago
  Oh, but it does help. Just not the general population.
- AnotherGoodName 3y ago
  I sometimes think the "anti-government run anything" mantra is just people who are easily swayed by propaganda reciting a line. It's easy to take singular examples of government failure and write articles claiming that everything must be owned by private equity because government is dysfunctional. But do you know what? I used to pay 1/4 the price for electricity when i lived in an area with a local county run power company compared to my new nearby location that has PG&E as the only option. As in government run utilities were literally 1/4 the price per kwh and yet i'm supposed to buy into this "GOVERNMENT IS INEFFICIENT LOL COMMUNISM" propaganda that just doesn't appear true in the slightest. I mean this is consistent across the board. I know the baby boomer generation were vulnerable to this anti-socialism propaganda but can we please start looking at things objectively and push back against this privatization that is almost always a way for politicians to enrich themselves. Sigh.
  - deleted 3y ago
    [deleted]
  - skfingngihg 3y ago
    The government is less efficient at serving its stake holders than for-profit corporations. The government creates the conditions for PGE to be so bad. I’m defecting from the grid this year, PGE’s high prices mean my s system will pay for itself in less than a year and will likely be more reliable. battery and solar companies saved me from PGE and they can save you. The government perhaps can but likely won’t. Extrapolate for yourself what this means about the world and what organizations should command the most resources.

Fomite 3y ago

One of the big problems is that infection control and antibiotic stewardship don't have billable procedures most of the time, and are thus viewed as cost centers by hospital leadership.

ublomate 3y ago
And therein lies the most significant problem with unbounded capitalism. Capitalism is a very, very powerful tool, because it redefines everything in terms of money. This enables the magic of specialization and trade, but it also causes situations like this where greedy and/or thoughtless people chip away at the margins of things like safety and let other people suffer the consequences.
- JumpCrisscross 3y ago
  > Capitalism is a very, very powerful tool, because it redefines everything in terms of money Well, in terms of capital. For the segments of the economy we put into the market. Also, this is more a feature of industrialisation than capitalism—socialist economies still consider resource allocation in generalisable terms.
- amelius 3y ago
  > Capitalism is a very, very powerful tool, because it redefines everything in terms of money. But only when it is convenient. For example school teachers or police officers can work their brains out but cannot profit from it like entrepreneurs do. For many people unbounded capitalism is a very shitty proposition.
  - deleted 3y ago
    [deleted]
  - saulpw 3y ago
    Teachers and police officers don't benefit by definition because they do not have capital. Capitalism benefits the people who start private schools and private jails. Capitalists take advantage of labor in order to increase their own profits.

chiefalchemist 3y ago

> After a hospital *A* hospital. Single. I'm certainly not going to defend private equity. But if we're going to do a takedown, let's do it correctly. Cherry picking what is likely an outlier is not doing it correctly.

chiefalchemist 3y ago
Some things never change. So typical of HN. A comment lacking in critical thinking is added. The punters jump on to further the false narrative. And...the correction to that misguided affair is down voted. Y'all are funny. Ignorant, but funny.
- orwin 3y ago
  Sorry, I avoid saying that on HN, but if you read the article and not just skimmed through it, you could have clicked on the link to the study here: https://jamanetwork.com/journals/jama/fullarticle/2813379?guestAccessKey=e0cef9be-d55c-4bcf-8892-412af8f24355 https://jamanetwork.com/journals/jama/fullarticle/2813379?gu... And discover why your comment was downvoted. I apologize I did not leave a comment to explain why I was down voting, I just did not want to say 'look, this person can't read', it's tacky (sorry for still doing it btw)
  - chiefalchemist 3y ago
    The *pulled quote* says "A hospital" (read: cherry picked) and then uses that outlier to sway the assuming and the naive. If I wanted to speak to the whole study I would have. However, the paragraph pulled specifically says "*a* hospital*. Now who did the skimming?? FFS
arcaen 3y ago
Not sure where you got the idea that the study was only of a singular hospital, seeing as the study outline details claims for 600k hospitalizations in 51 private-equity hospitals are compared to 4m comparable hospitalizations in 259 non-private-equity hospitals.

rootusrootus 3y ago

> I thought it was alarming when insurers started purchasing hospitals, urgent care facilities and even your standard family med doc I am skeptical of that conclusion. Kaiser Permanente gets good results, and they are an HMO: the very definition of an insurer owning the hospital/urgent care/family doc.