Table 2.

Unadjusted Changes in Spending and Utilization After Private Equity Acquisition Compared to Practices Never Acquired

	2012 [Pre-Acquisition]			2019 [Post-Acquisition]			Unadjusted Differences Pre- and Post-Acquisition Periods
Outcomes	PE-acquired practices	Non-PE-acquired practices	Unadjusted difference [95% CI]	PE-acquired practices	Non-PE-acquired practices	Unadjusted difference [95% CI]	Unadjusted differencee [95% CI]	P Value
Total spending per beneficiary a	324.86	187.43	137.43 [127.61 to 147.25]	400.69	221.35	179.34 [171.01 to 187.65]	41.91 [29.39 to 54.42]	<.001
Spending on clinician services	198.73	143.30	55.43 [51.68 to 59.17]	188.39	146.79	41.60 [38.43 to 44.77]	−13.82 [−18.60 to −9.06]	<.001
Spending on ancillary services	46.54	28.51	18.03 [16.66 to 19.39]	37.93	26.03	11.90 [10.74 to 13.07]	−6.13 [−7.86 to - 4.37]	<.001
Spending on intravitreal injectionsb	115.32	30.85	84.47 [69.10 to 99.85]	273.26	126.66	146.60 [113.11 to 160.09]	62.13 [42.86 to 81.39]	<.001
Number of unique patients per clinician a
Number of unique patients for ophthalmologists	109.57	80.66	28.91 [24.74 to 33.10]	160.29	132.34	27.95 [24.24 to 31.66]	−0.96 [−6.21 to 4.29]	0.72
Number of unique patients for optometrists	30.87	17.36	13.51 [11.40 to 15.62]	61.63	30.36	31.27 [29.54 to 33.0]	17.76 [15.09 to 20.44]	<.001
Number of intravitreal injections c
Number of Injections Per 100 Beneficiaries	48.79	35.85	12.94 [9.24 to 16.63]	63.44	48.91	14.53 [11.68 to 17.78]	1.59 [−2.41 to 6.00]	0.403
Aflibercept Injectiond	17.58	11.67	5.91 [2.28 to 9.54]	55.11	40.83	14.28 [11.06 to 17.49]	8.37 [4.15 to 12.59]	<.001
Ranibizumab Injection	22.45	10.60	11.85 [8.41 to 15.27]	41.49	20.18	21.31 [18.48 to 24.14]	9.46 [5.56 to 13.37]	<.001
Bevacizumab Injection	31.64	25.99	5.65 [2.04 to 9.23]	26.37	28.50	−2.13 [−5.09 to 0.83]	−7.78 [−11.86 to - 3.68]	<.001

^aAll results are per clinician per quarter. The sample consists of 748,796 clinician-quarter (ophthalmologist and optometrists) observations, containing 762 PE clinicians and 32,807 non-PE clinicians. Spending measures are geographically adjusted using Medicare’s Geographic Variation Public Use File – by National, State, and County to adjust spending for geographic differences in input costs, such as rent and labor.

^bIncludes spending for the medication used and for the ophthalmologist service [that is, giving the injection]. Includes only ophthalmologists.

^cIncludes only ophthalmologists who gave at least one intravitreal injection [Afliberecpt, Ranibizumab, or Bevacizumab] in that quarter. Intravitreal injection sample consists of 58,749 ophthalmologist-quarter observations, containing 144 PE ophthalmologists and 2,345 non-PE ophthalmologists who provided at least one intravitreal injection in a given quarter.

^dAfliberecpt was approved for use on November 11, 2011. Therefore, we use the observations from the year 2013 to calculate the pre-acquisition period mean.

^eSample consists of clinicians who were present for at least 4 quarters before and after PE acquisition