In the most recent issue of Harvard Magazine, Walsh raises an interesting question in the first line of the article, “Is private equity monetizing medicine at patients’ expense?”1 There are an increasing number of reports in the literature noting that hospitals owned by private equity firms are associated with more hospital-acquired adverse events compared to matched control hospitals. These data have motivated investigators to search for causes of increased complication rates in patients: could these rates be explained by cost cutting measures that are financially motivated? Kannan and Song2 recently reported the results of an analysis of 4.8 million Medicare claims from 2009-2019. Patients in private equity owned hospitals experienced 25.4% more hospital-acquired complications. Specifically, central line associated infections in private equity hospitals were 37.7% higher than those reported in control hospitals; the increase in falls in private equity hospitals was reported as being 27.3% higher as well. Additionally, surgical site infections doubled (10.8-21.6 per 10,000 hospitalizations) in private equity hospitals in spite of the fact that they reported an 8.1% reduction in surgical volume. While associated with shorter length of stay, patients from private equity hospitals were more likely to be transferred to other acute care hospitals post discharge. There was no difference between private equity and control groups in terms of post discharge 30-day mortality.2 This is not insignificant. Currently there are about 460 hospitals in the United States owned by private equity firms. Overall the private equity industry manages $7.5 trillion in assets and owns companies that employ more than 11 million American workers.3 In what they referred to his “the Private Equity Phenomenon”, Scheffler and Blumenthal note that over the last decades private equity firms have purchased 6,000 physician practices. This translated to one-third of all metropolitan areas in United States having a private equity footprint of at least 30% market share. Price increases of 10-20% have been reported with harmful impacts on quality.4 Several studies have also noted increased pressure on physicians to increase cash flow by increasing patient and procedure volume. Additionally, the use of ancillary revenue streams in concert with this may conflict with high-quality patient centered care and threaten professional autonomy. As consolidation of competing markets by private equity transforms medical corporations, concern that profit margins may influence national health care policies and prices has been voiced as well. Such a consolidation may increase costs for patients and insurers and exacerbate health care inequalities.5-9 Significant benefits, however, have been reported particularly in those institutions that are struggling financially. Strategic acquisition and consolidation certainly may result in a competitive advantage with increased operational efficiency, and diversification and improvement of revenue streams.6,7 Cerullo et al surveyed the financial performance of 176 hospitals acquired between 2005 and 2014 and compared them to matched control hospitals. In the private equity acquired institutions, there was a $432 decrease in cost per adjusted discharge and a 1.78% increase in operating margin. The majority of acquisitions (134 members of the Hospital Corporation of America (HCA) acquired in 2006) were found to have a 3.27% increase in operating margin but without a change in cost per adjusted discharge. Overall private equity acquisition was associated with decrease in total beds, ratio of outpatient to inpatient charges and staffing. The authors concluded that financial performance improved after acquisition while patient throughput and inpatient utilization increased with decreased staffing metrics. They noted the need for future research to identify any “unintended trade-offs” with safety and quality.10 Clearly, the business of medicine is here to stay. Operational efficiency, and cost control are key metrics to ensure long-term institutional survival. If however we continue to believe that our primary duty as practitioners is to provide the highest quality and compassionate care to our patients, predominantly financially motivated change needs to be scrutinized very closely. Otherwise, our humanitarian mission will fail. I would be very interested to hear from any members who have experience with private equity health care institutions. Please cast your vote in the poll question below.