New research published in Ophthalmology explored the impact on practicing optometrists via an analysis comparing ophthalmology practices acquired by private equity (PE) firms compared to practice not acquired.
Give me some background first.
According to researchers, the number of PE-acquired physician practices has dramatically increased over the last 10 years—and ophthalmology practices are not excluded from this phenomenon.
However, the effects of these acquisitions on physicians, staff, patients, as well as the overarching cost and quality of health care, is still murky; these can vary on a practice-by-practice basis.
So why target ophthalmology?
Previous research identified three reasons:
- A defined referral path where the scope and role of an ophthalmologist is clear.
- High procedure volume of patients/aging population with heavy demand for ophthalmic care
- Clinics have lucrative cash-pay procedures (including subspecialities)
Now this research.
Researchers conducted a retrospective cohort study by analyzing Medicare fee-for-service claims (from 2012 to 2019) incorporated with a national database of ophthalmology practices acquired by PEs.
Per the study, they used a differences-in-differences method with an event framework to compare “changes after a practice was acquired to changes in practices that were not acquired.”
How many practices were identified?
Based on data from 2017 to 2018:
- PE-acquired: 123 practices (762 clinicians)
- Not-acquired: 20,549 practices (34,807 clinicians)
What was measured?
Outcome measures included:
- Number of beneficiaries seen
- Intravitreal (IV) injections
- Medications for injections
- Spending on:
- Ophthalmology/Optometry services
- Ancillary services
- IV injections
And the findings?
Based on changes over time, a relative increase was noted in beneficiaries seen per quarter per PE-acquired optometrist (23.9%; 4.20 beneficiaries, 95% Confidence Interval [CI], 1.73 to 6.67).
Of interest: no change in the number of beneficiaries seen was noted among ophthalmologists.
A relative increase in overall spending per beneficiary was also noted (5.06%; CI, -2.82 to 22.14).
What about spending on clinician services?
These services saw an overall 1.62% decrease: ($-2.37, 95% CI, -5.78 to 1.04).
Broken down, however, spending for ophthalmology services increased 5.46% and decreased 4.0% for optometrists.
And ancillary services spending also saw an even larger decrease: 7.56% (-$2.19, 95% CI, 4.19 to -0.22).
Now IV injections.
Overall, injection spending increased 25% ($20.02, 95% CI, -1.38 to 41.41).
Meanwhile, the number of injections increased by 5.10% (1.83, 95% CI, -0.1 to 3.80), with expensive medication (ranibizumab) increasing 74.09% compared to a 12.91% decrease for the less expensive injection alternative (bevacizumab)..
To note, consistent and periodically statistically significant increases (ranibizumab) and decreases (bevacizumab) were observed following PE acquisition.
Any limiting factors to consider?
Per the authors, not every finding in the study reached statistical significance.
They recommend that additional research should include the following:
- Information on prices
- Quality
- Sales of acquired practices by PE firms
- Changes over additional years post-acquisition
Expert opinion?
According to the study authors, the data further supported the critical role of optometrists in the efficiency of eyecare services.
However, they also noted that the “impact of substituting optometrists for ophthalmologists on the quality and overall cost of care is controversial.”
Take home.
This study suggests that, while PE-acquired practices have little or no overall impact on the utilization or total spending of a practice, such practices do result in an increase in the number of unique patients seen per optometrists as well as the apparent preferential use of expensive IV injections.