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Brief/Case: Competing with Private Equity in Physician Alignment

Updated: Feb 4



As almost everyone knows, there is an enormous amount of private equity activity in the healthcare industry, with particular focus being placed on large physician practices. These PE firms are able to provide physicians with an immediate, and often a secondary down-stream, liquidity event that can be quite substantial – a financial windfall that can be extremely appealing.


Unfortunately, part of the strategy of many PE firms is to strip ancillary services from hospitals, resulting in material decreases in utilization and correspondent shortfalls in reimbursement.

Case in point: A rural hospital in central North Carolina was facing the prospect of its only oncology practice being purchased by a PE firm. If the transaction were consummated, the hospital would lose all of its oncology infusion therapy business. HMR was brought in to work with senior administration and the oncologists, in hopes that a solution could be developed that would prevent the PE transaction from occurring.

Through close and rather intense collaboration with both constituencies, HMR was able to devise a business solution that addressed practice valuation and terms of purchase, physician compensation planning, deferred compensation arrangements, and governance structure.


In the end, the physicians chose to partner with the hospital and to forgo the private equity opportunity. Of almost equal importance, the practice suffered no physician attrition, it continues to operate with virtually no financial subsidy from the hospital, and the business model is expected by all parties to be sustainable very long term.


The bottom line: When physician groups agree to be acquired by private equity, hospital revenues can face a severe blow. There are ways to compete, however. PE firms may have deep pockets, but they typically offer terms that many physicians find unattractive. By listening to physician concerns and creating flexible, responsive alignment opportunities, rural hospitals can stave off the threat of private equity.


Brief/Case is a series of short case studies drawn from the real-world experience of RHI partners. Follow RHI on LinkedIn to be sure you never miss a post.

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