Private Equity Acquisition in Ophthalmology and Optometry: A Time Series Analysis of the Pre-COVID, COVID Pre-Vaccine, and COVID Post-Vaccine Eras

  1. Sachi A. Patil
  2. Daniel G. Vail
  3. Jacob T. Cox
  4. Evan M. Chen
  5. Prithvi Mruthyunjaya
  6. James C. Tsai
  7. Ravi Parikh

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

Objective

To identify temporal and geographic trends in private equity (PE) backed acquisitions of ophthalmology and optometry practices in the United States from 2012 to 2021.

Design

Cross-sectional time series analysis using acquisition data from 10/21/2019 to 9/1/2021 compared to previously published data from 1/1/2012-10/20/2019. Acquisition data was compiled from 6 financial databases, 5 industry news outlets, and publicly available press releases. Linear regression models were used to compare rates of acquisition.

Subjects

245 PE acquisitions of ophthalmology and optometry practices in the United States between 10/21/2019 and 9/1/2021.

Measures

Number of total acquisitions, practice type, locations, provider details, and geographic footprint.

Results

245 practices associated with 614 clinical locations and 948 ophthalmologists or optometrists were acquired by 30 PE-backed platform companies. 18 of 30 platform companies were new compared to our prior study. Of these acquisitions from 10/21/2019 - 9/1/2021, 127, 29, and 89 were comprehensive, retina, and optometry practices, respectively. From 2012 to 2021, monthly acquisitions increased by 0.947 acquisitions per year (p<0.001*). Texas, Florida, Michigan, and New Jersey were the states with the greatest number of PE acquisitions with 55, 48, 29, 28 clinic acquisitions, respectively. Average monthly PE acquisitions were 5.71 per month from 1/1/2019 - 2/29/2020 (pre-COVID), 5.30 per month 3/1/2020-12/31/2020 (COVID pre-vaccine, p=0.8072), and were 8.78/month 1/1/2021-9/1/2021 (COVID post-vaccine, p=0.1971).

Conclusion

PE acquisitions increased from 2012-2021 as companies continue to utilize both regionally focused and multi-state models of add-on acquisitions.

Article activity feed

  1. ScreenIT

    SciScore for 10.1101/2022.02.03.22270390: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: This study received approval from the Institutional Review Board of Yale University and is compliant with the tenets of the Declaration of Helsinki.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Addresses were utilized to create a geographic map in GraphPad Prism software version 8 (GraphPad Software, San Diego, CA).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    There are limitations to this study. Two acquisitions were very large and impossible to add to our geographic depiction of acquisitions. This was Keplr Visions acquisition of 43 optometry practices and AEG visions’ acquisition of 50 comprehensive or multi-specialty practices. We anticipate that these large, multi-practice acquisitions would further support our finding that private equity acquisitions are growing with add-on practices in certain geographic strongholds. Further, for some practices, if information was not available on the nature of the practice or staff through web archives at the time of acquisition, thus we opted to utilize information from the date closest to the acquisition. Acquisitions via private equity decreased during the initial phases of the COVID-19 pandemic but overall remained stable in the COVID pre-vaccine era and continued during the COVID post-vaccine era. Ophthalmology has experienced an increased and sustained continuation of PE acquisitions despite the economic ramifications of COVID-19. The continual growth of private equity during times of hardship to ophthalmology practices raises concerns of patient outcomes, healthcare costs, physician referral choice, and physician employment choice.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2022.02.03.22270390v1 on medRxiv