Ann Intern Med
ACP pushes for stronger regulation of private equity in medicine
Clinical takeaway: ACP is asking for more transparency from PE-owned practices, with consolidation now concentrated in primary care, dermatology, ophthalmology, and gastroenterology. Physicians in or near these markets should expect continued scrutiny of cost, staffing, and referral patterns.
Private equity investment in US health care has grown rapidly over the past decade, and a body of research on its effects has emerged. The American College of Physicians has published a position paper synthesizing that evidence and laying out where it believes regulators, lawmakers, and antitrust enforcers should act.
Private equity deal values in health care nearly tripled to $119.9 billion in 2019 from $41.5 billion in 2010, with primary care and multispecialty practices increasingly targeted. Acquisitions of physician practices rose more than six-fold between 2012 and 2021. Four specialties (dermatology, ophthalmology, gastroenterology, and primary care) accounted for 81% of those deals. In 28% of metropolitan markets, a single PE firm now holds more than 30% market share within at least one specialty.
ACP cites evidence to argue that this trend deserves more oversight. A systematic review linked PE ownership to cost increases of up to 32% without consistent quality gains. Research on PE-acquired hospitals found increased hospital-acquired conditions and adverse events, and no improvement in 30-day post-discharge mortality, despite a tendency to treat younger, healthier patients. PE acquisitions have also been associated with workforce shifts toward advanced practitioners, and nearly 60% of physicians in a 2022 survey cited reduced autonomy as a primary downside of corporate ownership.
The 11 recommendations cluster around four themes: clinical autonomy (strengthening state corporate-practice-of-medicine doctrines, restricting noncompetes), transparency (pre- and post-acquisition disclosure of prices, outcomes, adverse events, and workforce metrics), antitrust enforcement (lowering reporting thresholds below the current $111.4 million Hart-Scott-Rodino cutoff and scrutinizing roll-up strategies that evade review), and federal program integrity (tightening False Claims Act enforcement against PE firms and oversight of PE entities benefiting from rural payment designations or Medicare Advantage).
The paper was developed by ACP's Medical Practice and Quality Committee with input from the Coding and Payment Policy Subcommittee, drawing on peer-reviewed studies, government reports, and policy literature. The Board of Regents approved the position paper in June 2025.
The position paper signals organized medicine's view that PE's growth has outpaced the regulatory tools designed to monitor it. Most acquisitions fall below federal reporting thresholds, corporate-practice-of-medicine doctrines vary widely by state, and FCA enforcement has reached only a small fraction of PE-owned entities. ACP frames the practical bottleneck as transparency: without disclosure, neither regulators nor referring physicians can assess effects on patients.
“ACP calls on lawmakers and regulators to enforce existing laws more strictly, increase funding and oversight for regulatory agencies, and establish policies that protect physicians and patients from the adverse effects of growing corporate interests,” the authors conclude.
Source: Johnson D. Ann Intern Med. 2026 May 26. Regulatory Framework for Private Equity and Corporatization in Health Care: A Position Paper From the American College of Physicians