This study noted that the number of optometrists per practice increased by nearly one OD (89%) per practice after PE acquisition, while the number of ophthalmologists per practice increased by 52%. Photo: Getty Images.

An increasing number of physician practices have been acquired by private equity (PE) firms over the last decade, mainly due to the appeal of profitability and efficiency. Optometrists practicing in PE-acquired ophthalmology clinics are among the specialists benefiting from the switch, demonstrated by a recently published study in Ophthalmology. The analysis compared service usage and Medicare spending between ophthalmology practices that have been acquired by PE firms vs. those that have not. While the researchers reported little to no overall effect on utilization or total spending, they did find that both the number of unique patients seen by optometrists, as well as the use of top-shelf Lucentis over Avastin, was greater in PE-acquired practices.

The study analyzed Medicare fee-for-service claims from 2012 to 2019 alongside a national database of PE acquisitions of ophthalmology practices. An event study framework was used to compare changes at a practice before and after PE acquisition to changes in practices that were never acquired. The main outcome measures included the number of beneficiaries seen, intravitreal injections and medications used for injections, along with spending on ophthalmologist and optometrist services, ancillary services and intravitreal injections.

By 2019, the analysis showed that the number of optometrists per practice increased by nearly one OD (89%) per practice after PE acquisition, while the number of ophthalmologists per practice increased by 52%. On average, optometrists in PE-acquired practices saw roughly 24% more beneficiaries per quarter than optometrists in non-acquired practices. For ophthalmologists, on the other hand, no increase was observed in the number of beneficiaries seen.

While total spending did not differ significantly between PE-acquired and non-acquired practices, the researchers did note a slight decrease of 1.6% in spending on clinician services in acquired practices. They also reported a 5.5% increase in per-beneficiary per-quarter spending on ophthalmologist services and a 4.6% decrease for optometrists. Additionally, ancillary services spending decreased by 7.6%, and spending on intravitreal injections increased by 25%.

Roughly 5% more intravitreal injections were performed in PE-acquired practices, including a 74.1% increase in the use of Lucentis—an expensive medication—and a 12.9% decrease for Avastin, an inexpensive injection. The researchers noted in their paper that “the event study showed consistent and often statistically significant increases in ranibizumab injections and decreases in bevacizumab injections after acquisition.”

Overall, the data collected in this analysis validate the crucial role that optometrists play in the efficiency of eyecare services, the demand for which is growing as the population ages. The researchers commented in their paper that although “the absolute numbers are small, these findings are consistent with the commonly stated hypothesis and empirical evidence that PE firms increase their use of non-physician clinicians, who are paid at lower rates.” They added, “The impact of substituting optometrists for ophthalmologists on the quality and overall cost of care is controversial.”

It’s important to note that not every finding in this study reached statistical significance, and its authors suggest that further research should include information on prices, quality, sales of acquired practices by PE firms and changes over additional years post-acquisition.

Braun RT, Lelli GJ, Pandey A, et al. Association of private equity firm acquisition of ophthalmology practices with Medicare spending and utilization of ophthalmology services. Ophthalmology. September 28, 2023. [Epub ahead of print].