Private Equity–Acquired Residential Treatment Facilities vs Other For-Profit Facilities

Importance: Amid an ongoing addiction crisis, private equity (PE) firms have acquired large numbers of residential substance use disorder (SUD) treatment facilities in the US. How PE ownership affects SUD care prices and facility characteristics is not well understood. Objective: To evaluate prices and facility characteristics of residential substance use treatment facilities owned by PE firms compared with other for-profit facilities. Design, Setting, and Participants: This cross-sectional study using a secret shopper framework was conducted from June 2024 to April 2025. PE-acquired residential SUD treatment facilities were matched to non-PE-acquired, for-profit control facilities by geographic proximity. Trained callers posed as individuals seeking residential SUD care for a family member with pending Medicaid insurance. Exposures: Ownership by PE vs non-PE for-profit entities. Main Outcomes and Measures: The primary outcome was daily rate. Secondary outcomes included bed availability and wait times, admission requirements, services, staffing, amenities, and facility-initiated contact. Results: This study included 341 residential facilities with completed call data (127 PE-acquired, 214 geographically matched non-PE for-profit). Mean (SD) daily rates were 15.6% higher at PE facilities ($910.73 [$463.16]; median, $854.29 [IQR, $589.29-$1071.43]) compared with non-PE facilities ($779.87 [$501.92]; median, $750.56 [IQR, $480.64-$952.38]; Benjamini-Hochberg-adjusted P = .04). This significantly higher daily rate was also found after adjustment for geographic cluster-matched fixed effects (β = $127.73; 95% CI, $29.57-$225.87; adjusted P = .03). Compared with non-PE-acquired control facilities, PE-acquired facilities were less likely to offer detox services (74.8% vs 88.8%; adjusted P = .02) and private rooms (12.1% vs 25.7%; adjusted P = .02), and more likely to make postcall contact attempts (mean [SD], 0.68 [1.39] vs 0.18 [0.47]; adjusted P < .001). Conclusions and Relevance: In this national secret shopper study, PE-acquired residential SUD treatment facilities reported higher daily prices than geographically matched non-PE for-profit facilities. Price differences persisted after accounting for local market factors, suggesting systematic cost differences associated with ownership structure. This study provides facility-level evidence on pricing differences by ownership type in residential SUD treatment and highlights the need for further research to understand the mechanisms underlying these differences and their implications for patients and payers.