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Wrote Hacking Healthcare, operated/managed hospital systems, blah blah. The study being referenced here is https://doi.org/10.1001/jama.2023.23147 https://doi.o

Wrote Hacking Healthcare, operated/managed hospital systems, blah blah. The study being referenced here is https://doi.org/10.1001/jama.2023.23147 https://doi.org/10.1001/jama.2023.23147. The conclusion of the study is that the identified set of hospitals performed worse on some key metrics, hospital acquired infections are in my opinion a pretty good bellweather of other problems. However, what they are defining as "private equity" seems to be pretty amourphous. Most of the studied hospitals were in private ownership that a lot of people would call "private equity" and then bought by different "private equity". I previously was involved in ownership and management through my company ClearHealth, of some of the facilities studied. Most people would identify that ownership as "private equity". I don't dispute that the hospitals seem to be performing worse after the ownership change (after our interests were divested in 2017-2020). As "private equity" we took over operations and management of many facilities of both public and private ownership and made them run really a lot better for both patients and owners, we were very very good at doing that. Bottom line there are a lot of very incompetently run facilities out there, of both private, "private equity" and various form of public ownership/management. It makes a great headline to say that a hospital can be "bought" but ownership and management of hospital systems takes a book to explain. Outside entirely vertical systems like Kaiser and even that has some complexity, hospitals are much more like medical malls than anything else. An ownership and or management company does not dictate what happens under their roofs in anything like the manner a private corporation like Coke, GE or Google would. 29 states make it outright illegal for non-licensed persons to own or manage an entity that engages in the practice or medicine. Most hospitals of any size over 100 beds involve at least dozens of seperately controled and managed entities. See "corporate practice of medicine (CPOM)" laws. Finally I would add that measuring outcomes on an apples to apples basis is more or less an impossible thing to do. Lots of people don't like to hear that. Again something like HAI I think can be a useful general indicator as well as other measurements of preventable complications, but comparing outcomes at different facilities especially across size and location is more or less useless.

Madmallard 3y ago
Overworking doctors and understaffing to save money and any cutting corners being done is something that should be outlawed, rigorously inspected and investigated constantly. At every single hospital system I've been at in the last 10 years, which is several due to chronic health issues, there definitely needed to be at a minimum 2x as many working staff as there are. There's really not excuse other than corporate greed going on here. Profit margins should not be the bottom line in a life saving institution. It is destroying society from the inside out.
csdreamer7 3y ago
There is quite a bit of ambiguity in your wording and questions as others have mentioned. With that said, would you talk about your experience in the PE hospitals handling insurance? As far as I know, one of the biggest drivers of consolation in hospitals and clinics is smaller operators struggling to deal with insurance. The second is the rising cost of equipment and specialties as far as I know. > 29 states make it outright illegal for non-licensed persons to own or manage an entity that engages in the practice or medicine. What is your point? Almost half of the states allow non-licensed persons to own or manage an entity. A semi-rural hospital in California saw it's doctors unionizing because of the performance metrics it's management imposed on the doctors that threatened their licenses after they were bought out. Do not know if California is one of those states, but it shows the short sighted profit seeking nature that people do not want to find out about the place they had or going to have their surgeries at.
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yborg 3y ago
Ownership driving a hospital group for increasing profitability as their main goal will cause optimization for things other than patient care, they don't need to try and micromanage the internals.
worik 3y ago
> However, what they are defining as "private equity" seems to be pretty amourphous It is an English anguage report, not an engineering document. In that context it is crystal clear what is meant by "private equity". It is completely different from "private ownership" It is not a problem at all. There is a similar issue with objecting to comparing out comes. The effects are not able to be finely measured,but the scale of the effects makes that a pointless quibble. The entry of private equity into health businesses, rolling them up into large groupings then squeezing them for profit has been documented in many places. Objecting because the measurements and descriptions are not perfectly precise is not very good. (It is in the "squeezing for profit" that the problem lies - incase you need some help)
bruce511 3y ago
One set of owners will see a hospital as a community good, there to provide quality health care first and return a reasonable long-term sustainable profit. Another set of owners sees it as a short-term exercise in maximising profit at the expense of everything else. Both may technically be "private equity". But when Private Equity is mentioned as a category, its typically the latter. Of course comparing hospital results is hard, and no doubt you can cherry-pick metrics, and find anecdotes to support any position. So the story is whatever will get the most clicks. But it's not hard to postulate, or support the idea, that when owners maximise for profit, health care comes second. That is the capitalism way. Of course not all hospital owners are bad. A hospital may change hands multiple times via good owners. Sooner or later though an owner comes along with the goal of extracting the maximum value out of thd business, in the shortest possible time, regardless of the long-term consequences. Value likely accumulated over decades. At which point destruction is inevitable.

Madmallard 3y ago

Overworking doctors and understaffing to save money and any cutting corners being done is something that should be outlawed, rigorously inspected and investigated constantly. At every single hospital system I've been at in the last 10 years, which is several due to chronic health issues, there definitely needed to be at a minimum 2x as many working staff as there are. There's really not excuse other than corporate greed going on here. Profit margins should not be the bottom line in a life saving institution. It is destroying society from the inside out.

csdreamer7 3y ago

There is quite a bit of ambiguity in your wording and questions as others have mentioned. With that said, would you talk about your experience in the PE hospitals handling insurance? As far as I know, one of the biggest drivers of consolation in hospitals and clinics is smaller operators struggling to deal with insurance. The second is the rising cost of equipment and specialties as far as I know. > 29 states make it outright illegal for non-licensed persons to own or manage an entity that engages in the practice or medicine. What is your point? Almost half of the states allow non-licensed persons to own or manage an entity. A semi-rural hospital in California saw it's doctors unionizing because of the performance metrics it's management imposed on the doctors that threatened their licenses after they were bought out. Do not know if California is one of those states, but it shows the short sighted profit seeking nature that people do not want to find out about the place they had or going to have their surgeries at.

deleted 3y ago

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yborg 3y ago

Ownership driving a hospital group for increasing profitability as their main goal will cause optimization for things other than patient care, they don't need to try and micromanage the internals.

worik 3y ago

> However, what they are defining as "private equity" seems to be pretty amourphous It is an English anguage report, not an engineering document. In that context it is crystal clear what is meant by "private equity". It is completely different from "private ownership" It is not a problem at all. There is a similar issue with objecting to comparing out comes. The effects are not able to be finely measured,but the scale of the effects makes that a pointless quibble. The entry of private equity into health businesses, rolling them up into large groupings then squeezing them for profit has been documented in many places. Objecting because the measurements and descriptions are not perfectly precise is not very good. (It is in the "squeezing for profit" that the problem lies - incase you need some help)

bruce511 3y ago

One set of owners will see a hospital as a community good, there to provide quality health care first and return a reasonable long-term sustainable profit. Another set of owners sees it as a short-term exercise in maximising profit at the expense of everything else. Both may technically be "private equity". But when Private Equity is mentioned as a category, its typically the latter. Of course comparing hospital results is hard, and no doubt you can cherry-pick metrics, and find anecdotes to support any position. So the story is whatever will get the most clicks. But it's not hard to postulate, or support the idea, that when owners maximise for profit, health care comes second. That is the capitalism way. Of course not all hospital owners are bad. A hospital may change hands multiple times via good owners. Sooner or later though an owner comes along with the goal of extracting the maximum value out of thd business, in the shortest possible time, regardless of the long-term consequences. Value likely accumulated over decades. At which point destruction is inevitable.