Use of low-value cancer care after practice acquisition by private equity.

59 Background: Private equity (PE) acquisition of medical practices has been associated with increased prices, increased service intensity, and staff reductions. In some medical specialties, private equity ownership has led to an increase in services that are revenue-generating but are not clinically beneficial for patients. PE investment in medical oncology practices has grown in recent years, but whether this has impacted cancer care quality is unknown. The goal of this study was to compare the prevalence of low-value, high-revenue cancer treatments for patients treated at PE-owned and non-PE-owned practices. Methods: This was a retrospective cohort study using fee-for-service Medicare claims and Medicare Advantage encounter data, 2015-2021. We included Medicare beneficiaries with an incident cancer diagnosis from 2016-2020, who were at risk of receiving one of five low-value treatments: 1) granulocyte colony stimulating factors (GCSF) for patients receiving low-risk chemotherapy; 2) denosumab for castration sensitive prostate cancer; 3) nab-paclitaxel instead of paclitaxel for breast or lung cancer; 4) addition of bevacizumab to carboplatin + paclitaxel for ovarian cancer; and 5) biologic drugs for which biosimilar versions existed. We used Pitchbook data to identify practices that had been acquired by PE firms, and the acquisition dates. We used National Plan and Provider Enumeration System data to identify oncologists who ever practiced at a PE-acquired location, and the time intervals during which they were and were not at that location. The primary exposure of interest was whether, on a patient’s diagnosis date, their primary oncologist’s practice location had previously been acquired by a PE firm. The primary outcome was whether a patient received the low-value treatment for which they were at risk. We estimated the adjusted prevalence of low-value treatment for PE-exposed patients, vs. non-PE-exposed patients treated by the same clinicians. Results: The sample included 201,348 patient observations across the five low-value services, of which 5,246 were treated by oncologists in PE-acquired practices. Comparing patients diagnosed when their oncologist was vs. was not practicing at a PE-acquired address, adjusted prevalence differences of low-value treatments were: -3.2%-points (-5.5 to -0.8) for GCSF; -4.5%-points (-14.2 to 5.1) for denosumab; -1.2%-points (-3.2 to 0.8) for nab-paclitaxel; -7.0%-points (-12.1 to -2.0) for bevacizumab; and +2.8%-points (-0.3 to 5.9) for biologics. Conclusions: In this observational study of Medicare beneficiaries, PE ownership was not associated with increased prevalence of profitable but low-value cancer treatments. These results suggest PE firms may focus on other strategies to generate positive return in the context of medical oncology practices.