Our Publications

By Arjun Teotia, Brent D. Fulton, Dan R. Arnold, Richard M. Scheffler | Published July 2025 in Journal of Hospital Management and Health Policy| Link to article

“The increasing trend of hospital affiliations raises significant questions about the factors
that drive these decisions and their implications for hospital performance, particularly in terms of pricing
and quality. This study contributes important insights into how affiliations—a less formal consolidation than full mergers—affect hospital performance. This study aims to assess the effects of hospital affiliations on the discharge charges and quality of care provided by affiliated hospital.”

By Daniel R. Arnold, Brent D. Fulton, Ola A. Abdelhadi, et al | Published June 20, 2025 in JAMA Health Forum  | Link to Full Article

“Physician practices in the US are rapidly being acquired by private equity (PE) firms. A recent study found a 6-fold increase in the number of PE acquisitions of physician practices between 2012 and 2021. These acquisitions are occurring in many specialties, with the highest share of physicians working in practices owned by PE firms occurring in gastroenterology (13.1%). This acquisition activity has also been reported in studies published in gastroenterology specialty journals. While the influx of capital from PE has the potential to create technological and operational efficiencies, many have feared that PE’s short-term financial incentives may negatively impact health care prices, quality, or access.”

By Brent D. Fulton, Daniel R. Arnold, Jordan M. Wolf, and Richard M. Scheffler | Published May 26, 2025 in Milbank Quarterly  | Link to Full Article

States are becoming increasingly concerned about rising health care spending because it crowds out budgets for education and other obligations and it burdens consumers, exposing them to medical debt and bankruptcies. This study identifies states that have established health care cost commissions (HCCCs), examines state-level political and economic factors associated with their establishment, and reports which of these states have also enacted health care competition-related laws that further equip these commissions. As of August 2024, 17 states had established HCCCs that aim to reduce the growth of health care costs using a variety of methods, such as collecting health care use and spending data and setting spending growth targets. States that lean politically Democratic were more likely to establish these commissions, particularly those states with higher commercial hospital prices or higher Medicaid spending as a share of the state budget, or both. States with HCCCs have also enacted competition-related laws but to varying degrees. Because health care reform is difficult to enact at the federal level, many states are enacting their own reforms, tailored to their needs and political feasibility with many establishing HCCCs to limit health care spending increases. Future research should study the impact of these commissions on health care spending that increases short-term spending yet moderates long-term spending, including the feasibility and impact of increased spending on primary care services as well as the impact of spending on new health care technologies.

By Katherine Gudiksen, Andréa E. Caballero, Paul Ginsburg, Bruce Allain, Thomas Greaney, Brent D. Fulton | Published April 2025 in Journal of Health Politics, Policy and Law | Link to article.

“Consolidation among health systems has resulted in increased prices and caused the cost of employer-sponsored health benefits to increase much faster than inflation over the past few decades. Prior quantitative research demonstrates small, but significant price increases resulting from transactions that expand the geographic footprint of health systems, but the mechanisms by which these cross-market acquisitions raise prices is not completely resolved.“

By Daniel R. Arnold, Jaime S. King, Brent D. Fulton, Alexandra D. Montague, Katherine L. Gudiksen, Thomas L. Greaney, Richard M. Scheffler| Published in Health Services Research in April 2024 | Link to full report.

“As hospital systems have expanded, they’ve extended into regions where they previously had no presence. A recent study found 55% of the 1500 hospitals targeted for a merger or acquisition from 2009 to 2019 operated in a commuting zone that the acquirer did not previously operate in. The price and quality effects of these “cross-market” hospital mergers and acquisitions (M&A) are the focus of this paper.”

What this study adds: 

• Serial acquirers are significant contributors to estimated cross-market price effects.
• We find no discernible impact of cross-market mergers on mortality and readmission rates for heart failure, heart attacks and pneumonia.
• Overall, this study provides further evidence that cross-market hospital mergers lead to price increases and novel findings of no quality effect and the impact of serial acquirers on the price effect. More antitrust scrutiny of these mergers—particularly those of serial acquirers—appears prudent given the current state of highly concentrated hospital markets in the United States.

Questions should be addressed to Daniel Arnold, [email protected]

By Ola Abdelhadi, Brent D. Fulton, Laura Alexander, Richard M. Scheffler | Published March 2024 in Health Affairs | Link to full report.

“Private equity (PE) firms have been acquiring physician practices at an increasing rate, raising concerns about such firms’ penetration at the physician level into local markets and the impact on health care quality and prices. However, limited knowledge exists about the extent of PE firms’ control in local markets. By linking data on PE acquisitions to physician data and using full-time-equivalent physicians as the base of assessment, we estimated the local market share of each PE firm within ten physician specialties at the Metropolitan Statistical Area (MSA) level.”

“The addendums provide additional data and more detailed information regarding metropolitan statistical areas (MSAs) that had a private equity (PE) firm with 30+% or 50+% market share in 2021 for one or more of the ten physician specialties analyzed in the report. Addendum 1 provides the physician specialty, the name of the physician practice, and the PE firm with the 30+% or 50+% market share for most of the MSAs mentioned in the original report. Addendum 2 presents the MSA-level three year post-PE price increase for the affected specialty.”

Addendums authored by Richard M. Scheffler and Daniel R. Arnold | Link to the addenda and full report.

Check out the Petris Center’s recent report on the rise of private equity firms in acquiring physician practices, in collaboration with AAI and the Washington Center for Equitable Growth. The study covers ten medical specialties across the United States, offering insights into private equity’s impact on market concentration and healthcare expenditure. Lead author Richard Scheffler expresses concerns over shifts towards prioritizing profits over patient care, with far-reaching implications in the practice of medicine.

By Richard M. Scheffler, Laura Alexander, Brent D. Fulton, Daniel R. Arnold, Ola A. Abdelhadi | Link to the full report here.