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Shining a light on PE ownership.

Industry Playbook

The
Healthcare
Playbook

Understanding how private equity typically operates in the healthcare sector.

10companies tracked
7common tactics

Common PE Tactics in Healthcare

Tactics
01

Staffing Reduction

Cut nursing staff and replace RNs with LPNs or aides to reduce labor costs

Consumer Impact

Higher mortality rates, worse patient outcomes, longer wait times

VERY COMMON
02

Real Estate Sale-Leaseback

Sell hospital real estate and lease it back, extracting equity for investors

Consumer Impact

Hospital becomes financially fragile, may close if lease costs increase

VERY COMMON
03

Billing Upcoding

Aggressively code for higher-reimbursement procedures and diagnoses

Consumer Impact

Higher insurance costs, unnecessary procedures, billing disputes

COMMON
04

Service Line Cuts

Eliminate unprofitable but essential services like maternity, psychiatric, or rural care

Consumer Impact

Community loses access to essential healthcare services

COMMON
05

Management Fee Extraction

Charge acquired hospitals large management and consulting fees

Consumer Impact

Money leaves patient care budget, goes directly to PE firm

VERY COMMON
06

Supply Chain Changes

Switch to cheaper suppliers and equipment to cut costs

Consumer Impact

Lower quality equipment, potential supply shortages

COMMON
07

Physician Practice Acquisition

Buy up physician practices to control referrals and billing

Consumer Impact

Reduced physician independence, potential conflicts of interest

COMMON

Warning Signs to Watch

Red Flags

Sudden executive departures or leadership changes

Warning sign #1 that may indicate PE involvement or upcoming changes.

Hiring freezes or layoffs announced

Warning sign #2 that may indicate PE involvement or upcoming changes.

Complaints about increasing wait times

Warning sign #3 that may indicate PE involvement or upcoming changes.

News about equipment issues or deferred maintenance

Warning sign #4 that may indicate PE involvement or upcoming changes.

Insurance network changes or coverage restrictions

Warning sign #5 that may indicate PE involvement or upcoming changes.

Quality rating declines in CMS reports

Warning sign #6 that may indicate PE involvement or upcoming changes.

Closure of specific departments or services

Warning sign #7 that may indicate PE involvement or upcoming changes.

Staff complaints about understaffing

Warning sign #8 that may indicate PE involvement or upcoming changes.

Increased patient complaints on review sites

Warning sign #9 that may indicate PE involvement or upcoming changes.

Financial distress reports in local news

Warning sign #10 that may indicate PE involvement or upcoming changes.

Typical Timeline

Phases
0-6 monthsCompleted

“0 to 6 months”

Cosmetic changes, 'optimization' announcements, leadership shuffle

6-12 monthsYOU ARE HERE

“6 to 12 months”

Staffing cuts begin under 'efficiency' programs, service reviews

12-24 months

“12 to 24 months”

Service quality noticeably declines, wait times increase

24-36 months

“24 to 36 months”

Major issues emerge (department closures, quality scandals)

36+ months

“36+ months”

Potential bankruptcy, hospital closures, or fire sale to another operator

Consumer Impacts

Effects
EMPLOYEES

Longer wait times for appointments and procedures

Longer wait times for appointments and procedures

CUSTOMERS

Less time with doctors and nurses during visits

Less time with doctors and nurses during visits

QUALITY

Higher infection rates and adverse events

Higher infection rates and adverse events

HEALTH & SAFETY

Emergency room closures or reduced hours

Emergency room closures or reduced hours

EMPLOYEES

Loss of specialized services (maternity, psych, cardiac)

Loss of specialized services (maternity, psych, cardiac)

CUSTOMERS

Increased surprise billing and out-of-network charges

Increased surprise billing and out-of-network charges

QUALITY

Travel required for services previously available locally

Travel required for services previously available locally

HEALTH & SAFETY

Potential loss of entire healthcare facility

Potential loss of entire healthcare facility

Historical Examples

Case Studies

Steward Health Care

See details

PE Firm · N/A

Steward Health Care (Cerberus) - Multiple hospital closures across MA, FL, TX in 2024, bankruptcy filing

Hahnemann Hospital

See details

PE Firm · N/A

Hahnemann Hospital (Paladin Healthcare) - Philadelphia hospital closed in 2019 after PE stripped assets

Envision Healthcare

See details

PE Firm · N/A

Envision Healthcare (KKR) - Major emergency room staffing company, bankruptcy in 2023

ManorCare

See details

PE Firm · N/A

ManorCare (Carlyle) - Nursing home chain faced quality issues, bankruptcy in 2018

Prospect Medical

See details

PE Firm · N/A

Prospect Medical (Leonard Green) - Multiple hospital closures, quality concerns

PE-Owned Healthcare Companies

10 companies in our database

ST

Steward Health Care

healthcare
ACTIVE
EN

Envision Healthcare

healthcare
ACTIVE
US

US Dermatology Partners

healthcare
ACTIVE
HA

Hahnemann University Hospital

healthcare
ACTIVE
SO

Sound Physicians

healthcare
ACTIVE
EM

Emergency Physician Partners

healthcare
ACTIVE
BR

BrightSpring Health Services

healthcare
ACTIVE
HE

Heartland Dental

healthcare
ACTIVE
AS

Aspen Dental

healthcare
ACTIVE
VE

VetCor

healthcare
ACTIVE

What to Watch For

1

Check hospital's financial filings and credit ratings

2

Monitor CMS quality star ratings and inspection reports

3

Watch for news about staff complaints or union activity

4

Note any changes to accepted insurance networks

5

Follow state health department enforcement actions

6

Track patient reviews and satisfaction scores

7

Research the PE firm's track record with other healthcare facilities