Our Publications

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. 

By Thomas L. Greaney, Richard M. Scheffler, Katherine L. Gudiksen, Jaime S. King, Amy Y. Gu, Brent D. Fulton, Paul B. Ginsburg, and Daniel R. Arnold | Link to Full Comment

The Draft Merger Guidelines (DMGs) constitute a major step forward in providing economically sound guidance to practitioners and courts for evaluating the potential competitive impact of mergers and acquisitions. These comments are offered by a group of law professors, economists, and policy experts who have devoted most of their professional careers to issues concerning market and regulatory issues involving health care providers and payors. The comment focus on several proposed changes that are of particular importance to improving oversight of consolidation in the health care sector.