Re: Braun et al.: Association of private equity firm acquisition of ophthalmology practices with Medicare spending and use of ophthalmology services (Ophthalmology. 2024;131:360369) Reply

Purpose: Private equity (PE) firms increasingly are acquiring ophthalmology practices; little is known of their influence on care use and spending. We studied changes in use and Medicare spending after PE acquisition. Design: Retrospective cohort study. Participants: Seven hundred sixty-two clinicians in 123 practices acquired by PE between 2017 and 2018 and 34 807 clinicians in 20 549 never-acquired practices. Methods: We analyzed Medicare fee-for-service claims (2012–2019) combined with a novel national database of PE acquisitions of ophthalmology practices using a difference-in-differences method within an event study framework to compare changes after a practice was acquired with changes in practices that were not acquired. Main Outcome Measures: Numbers of beneficiaries seen; intravitreal injections and medications used for injections; and spending on ophthalmologist and optometrist services, ancillary services, and intravitreal injections. Results: Comparing PE-acquired with nonacquired practices showed a 23.92% increase (n = 4.20 beneficiaries; 95% confidence interval [CI], 1.73–6.67) in beneficiaries seen per PE optometrist per quarter and no change for ophthalmologists, while spending per beneficiary increased 5.06% ($9.66; 95% CI, –2.82 to 22.14). Spending on clinician services decreased 1.62% (–$2.37; 95% CI, –5.78 to 1.04), with ophthalmologist services increasing 5.46% ($17.70; 95% CI, –2.73 to 38.15) and optometrists decreasing 4.60% (–$5.76; 95% CI, –9.17 to –2.34) per beneficiary per quarter. Ancillary services decreased 7.56% (–$2.19; 95% CI, 4.19 to –0.22). Intravitreal injection costs increased 25.0% ($20.02; 95% CI, –1.38 to 41.41) with the number increasing 5.10% (1.83; 95% CI, –0.1 to 3.80). There was a 74.09% increase (8.38 injections; 95% CI, 0.01–16.74) in ranibizumab and a 12.91% decrease (–3.40 injections; 95% CI, –6.86 to 0.07) in bevacizumab after acquisition. The event study showed consistent and often statistically significant increases in ranibizumab injections and decreases in bevacizumab injections after acquisition. Conclusions: Although not all results reached statistical significance, this study suggested that PE acquisition of practices showed little or no overall effect on use or total spending, but increased the number of unique patients seen per optometrist and the use of expensive intravitreal injections. Financial Disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article. © 2023 American Academy of Ophthalmology