Health Aff
Medicare payments fuel private equity in primary care
Clinical Takeaway: PE ownership in primary care may expand short-term access and preventive care delivery, though the productivity pressures behind those gains and their longer-term toll on clinicians remain unclear.
Private equity (PE) investment in physician practices has accelerated in recent years, with prior research linking acquisitions to higher commercial prices and staffing cuts in specialty and hospital settings. Traditional Medicare pays clinicians per service under fee-for-service, and preventive visits such as the annual wellness visit reimburse at higher rates than routine office visits, so volume and service mix directly shape practice revenue.
Whether the patterns seen in other sectors hold in primary care, where the work centers on continuity and preventive care rather than procedures, had not been clearly established and this study works to address that gap.
After acquisition, physicians at PE-owned practices billed roughly 30% more services and saw about 11% more patients than those at independently owned practices. Patients in PE-acquired practices received about 13% more services, driven mainly by laboratory testing and preventive care. Medicare annual wellness visit billing rose by 21%, a service Medicare has long encouraged but that independent practices often struggle to complete because of documentation demands.
Workforce changes ran counter to patterns seen in other PE-acquired health care settings. PE-owned primary care practices expanded their clinical teams, hiring about 17% more primary care physicians and 40% more nurse practitioners and physician assistants relative to controls.
Medicare spending per physician rose by about 15%, but spending per patient was unchanged, suggesting that higher revenue came from volume rather than costlier services per patient. The added staff appears to have absorbed some of the heavier caseload, but the day-to-day intensity of practice clearly rose.
Researchers linked PitchBook data on 225 PE acquisitions from 2016 to 2022 with national Medicare Part B claims. Each acquired practice was matched to five non-PE controls in the same state with a similar share of primary care physicians. Outcomes were measured over five quarters before and after acquisition.
"The relationship between private equity and patient care is more complicated than it first appears, and financial incentives shaped by payment policy play an outsized role in how private equity operates," said lead author Yashaswini Singh, an assistant professor of health services, policy, and practice at the Brown University School of Public Health.
Source: Singh Y. Health Aff. 2026 May 20. Private Equity Acquisitions in Primary Care: Changes in Utilization, Spending, and Workforce