Over the past decade, 342 cardiology clinics have been acquired by private equity firms, with over 94% of acquisitions occurring between 2021 and 2023, according to study presented at the AcademyHealth 2024 Annual Research Meeting in Baltimore, MD, and simultaneously published on June 30 in JACC.

"Although cardiology is an attractive target for private equity firms, little is known about the number and types of practices that are being acquired," said senior author Rishi K. Wadhera, MD, MPP, Mphil. "Private equity acquisitions in other specialties have been shown to decrease quality and increase costs, so it is critical to understand the impact on cardiology."

Victoria Liu Bartlett, MD, Michael Liu, MPhil, et al., sought to identify the number of private equity acquisitions of cardiology practices from January 2013 to September 2023 and the community characteristics associated with acquisition of cardiology clinics, using data from the Irving Associates Health Care M&A and PitchBook databases. The 2023 Centers for Medicare and Medicaid Services National Downloadable File was used to determine the total number of outpatient cardiology practices and clinic sites in the U.S. The authors also used the American Community Survey to examine community characteristics by zip code, including the proportion of people age ≥65 years, identifying as Black or Hispanic, living below the Federal Poverty Level, and without a high school level of education, along with evaluating rurality and U.S. Census Bureau region.

They identified 41 acquisitions of outpatient cardiology practices by private equity firms within the study period, corresponding to 342 clinic sites. The majority of acquisitions – 94.7% – occurred between 2021 and 2023 (n=324). There were 278 unique cardiology clinic sites acquired, since 64 were acquired twice, representing 2.9% of all cardiology clinics (n=9,576) in the country.

Of note, cardiology clinics located in the highest poverty communities were less likely to be acquired by private equity firms as opposed to clinics located in the wealthiest communities (top vs. bottom poverty quartile: 2.0% vs. 2.9%; adjusted rate ratio [aRR] 0.61; 95% CI, 0.40-0.94). In addition, clinics located in the South were more likely to be acquired than those in the Northeast (4.3% vs. 1.5%; aRR 3.17). A similar pattern was observed for clinics in the West (3.8%; aRR 2.60).

No significant associations were found when investigating community-level proportion of adults ≥65 years, proportion of racial and ethnic minorities, levels of educational attainment and rurality.

In an accompanying editorial comment, ACC Past President Edward T.A. Fry, MD, MACC, adds: "Clinicians, health system administrators, policymakers and the public need to define the elements of clinical practice that encourage a growing number of cardiologists to seek out alternative employment models. Addressing them will be necessary to truly transform care and promote equity and value."

Keywords: United States, Delivery of Health Care, Poverty, Cardiologists, Centers for Medicare and Medicaid Services, U.S.