GENERAL MEDICAL LITERATURE: More on Private Equity in medicine
A large group of colleagues from Boston, most employed by and/or past owners of the Boston IVF enterprise, one of the largest IVF clinic chains in the country, which since it was initially sold by its founders has changed hands two or three times (it is hard not to lose track) and is now part of IVI-RMA, likely the largest private equity-owned worldwide IVF franchise, published a study which claimed to have examined “the effect of one of their a large-scale mergers on in vitro fertilization outcomes and patient satisfaction.
They concluded that clinical outcomes even after big mergers can be maintained. Patient response to the merger was, however, different and quite clearly demonstrated concerns (even though details were not given).
In general, we perceived this paper (which appeared in the format of a Research Letter) as overall rather unsophisticated, insufficiently transparent about how this retrospective study was performed and, to a degree, as rather obviously (and for several reasons) self-serving.
Our principal criticism of this paper is, however, the basic premise that the desirable goal of a merger should be no change. We would argue that this premise alone demonstrates the real conscious or subconscious concerns of the authors that their merger may have had adverse outcome consequences (indeed at least partially met in the perception of the newly formed enterprise by its patients). And – even more importantly – it in our opinion is an absolutely wrong target for a merger because – of course aside from financial gains – the goal of any merger is, at least theoretically, to do better on all fronts: better product, better service, better client perception, etc.
What this paper, therefore, instead projects, is deep pessimism, which (considering its results) indeed appears warranted: IVF outcomes appeared to have remained the same, though even that was not universal, as Clinic A lost some clinical pregnancy rate but appeared to have caught up by live births (1). Does that mean Clinic A got worse in managing IVF cycles and better in preventing miscarriages?
Considering the small differences, this is likely a silly question to ask; but telling, in how whimsical this study really is, especially considering that Boston IVF apparently treats an unusually young patient population with mean ages of 34 to 35, when the mean age for all U.S. clinics for years has been over 36 years (The CHR’s in 2024, of course, was 45 years!).
But what is then the correct question to ask? Of course not only in reproductive medicine but, by now, in many (usually cash-flow rich) medical specialty areas, the real basic questions to ask is why are we allowing non-medical interests – and especially Private Equity – to take over medicine (2). As PitchBook recently noted, private equity between 2018 and 2022 invested over $350 billion in U.S. health care assets, whether by purchasing physician practices, hospitals, or long-term care facilities, and there exist now already an abundance of studies demonstrating two typical changes once an enterprise is purchased by Private Equity: quality of care goes down and prices go up.
In a way, the here described study confirmed this as well, at least when it comes to quality because if patient dissatisfaction increases, this is, of course, per-se, a quality issue. Another example from the infertility field is one of the two recently newly published papers by authors at the Center for Human Reproduction which reported that Equity-owned IVF clinics in the U.S. utilize PGT-A in IVF cycles significantly more heavily than clinics owned by physicians and/or hospitals/universities (3). Suffice it to say, here presented paper from our Boston colleagues made no mention of any of this.
And then – just before this was published – a paper was published in JAMA that reported on a quite large investigation of patient care experiences after Private Equity acquisitions of U.S. hospitals (4), and the results were anything but reassuring and, by no means surprising considering similar previously reported results. In comparison to control hospitals: Patient care experience in hospitals principle significantly worsened after acquisition by Private Equity in comparison to control hospitals, though we must acknowledge, the difference was much smaller than we would have anticipated.
Since Private Equity usually works on a tight time schedule of five to seven years before resale, one would expect increasing patient complaints over time and that was, indeed, the case, with peaks of patient unhappiness (considering above-noted time schedule) unsurprisingly reached at three years.
References
1. Heyward et al., Fertil Steril 2025;123(1)179-181
2. Singh et al., N Engl J Med 2025;392(7):627-629
3. Patrizio et al., J Assist Reprod Genet 2025;42:81-84
4. Bhatla et al., JAMA 2025;333(6):490-497