Private Equity Health Care Acquisitions – May 2022

In light of the growing investor interest in healthcare and therisks associated with private equity ownership of healthcare companies, the Private Equity Stakeholder Project will be tracking private equity-backed healthcare acquisitions. Below is a list of private equity healthcare buyouts and add-on acquisitions completed or announced during May 2022. We will continue to track acquisitions on a monthly basis.

See April 2022 acquisitions here.

Waud Capital-owned GI Alliance (GIA) has acquired two gastroenterology practices in May, marking further inroads by private equity firms into the digestive health industry.

Last month GIA partnered with Digestive Health Specialists, the largest independent practice in Missouri, with 19 gastroenterologists and nine advanced practice providers in five locations.[1] GIA also partnered with Houston-based Gastroenterology Consultants, which has nine physicians and six advanced practice providers in six Texas locations.[2]

Since Waud acquired GIA in 2018[3] it has become the biggest private-equity-owned gastroenterology platform in the US, [4] growing from having 159 affiliated gastroenterologists to over 670 operating in Texas, Arkansas, Arizona, Colorado, Florida, Illinois, Indiana, Kansas, Louisiana, Mississippi, Missouri, Oklahoma, Utah, and Washington.[5]

The company is still growing rapidly; in December 2021 alone it acquired six other gastroenterology practices in Arizona, Mississippi, Louisiana, Washington, Illinois, and Colorado.[6]

Waud’s expansion of GIA is reflective of private equity’s growing interest in the broader digestive health market. According to a 2021 report by Physician Growth Partners, nearly 10% of the 14,000 gastroenterologists in the United States were partners or employed by a private-equity-owned company.[7]

Several forces appear to be driving investor interest in gastroenterology. An aging population means more people are getting colonoscopies to screen for colorectal cancer, and for patients age 65 and older these screenings are covered entirely by Medicare. In 2021 the CDC lowered the recommended age for colorectal cancer screening from age 50 to 45, [8] in part due to increasing incidence of early-onset colorectal cancer in younger adults.[9]

Read: Kaiser Health News, “Betting on ‘Golden Age’ of Colonoscopies, Private Equity Invests in Gastro Docs”

These factors have increased demand for gastroenterology services, aggravating a shortage of gastroenterology providers. The Health Resources and Services Administration (HRSA) estimates that by 2025, the US will face a shortage of more than 1,600 gastroenterologists nationwide.[10]

Finally, the gastroenterology industry has historically been fragmented, creating opportunities for private equity firms to use platform companies to buy up and consolidate providers, as Waud Capital has done over the four years since it acquired GIA.[11]

Private equity ownership of physicians’ practices has garnered scrutiny for appearing to increase the rate of surprise medical billing, whereby providers charge insured patients out-of-network rates for services patients believed to be in-network.[12] A 2020 study published in the Annals of Internal Medicine found that nearly 1 in 8 patients receive out-of-network bills for routine screening colonoscopies where both the endoscopists and hospital facilities were in-network.[13]

Colonoscopies can result in surprise medical bills for a few reasons. The Affordable Care Act made screening colonoscopies free of charge to patients without cost sharing, but if precancerous polyps are discovered and removed during a procedure then the procedure is retroactively reclassified as a diagnostic colonoscopy, which is not required to be covered. In other words, patients are essentially punished with higher bills if their colonoscopy reveals that they are at risk for developing cancer.[14] 

Additionally, while the colonoscopies may be covered by insurance, related services like anesthesia used in the procedures or pathology services used conduct biopsies may be out-of-network. This increases the likelihood that a patient will receive a surprise medical bill.[15]

May 2022 Buyouts

May 2022 Add-On Acquisitions

[1]https://www.beckersasc.com/gastroenterology-and-endoscopy/gi-alliance-acquisition-spree-2-deals-in-1-week.html

[2]https://www.beckersasc.com/gastroenterology-and-endoscopy/gi-alliance-acquisition-spree-2-deals-in-1-week.html

[3]https://tddctx.com/texas-digestive-disease-consultants-partners-waud-capital-forms-gi-alliance/

[4]https://www.beckersasc.com/gastroenterology-and-endoscopy/the-rise-of-gi-alliance.html

[5]https://www.prnewswire.com/news-releases/provident-healthcare-partners-advises-gastroenterology-consultants-in-its-partnership-with-gi-alliance-301544549.html

[6] Pitchbook, accessed June 2022.

[7]https://physiciangrowthpartners.com/gastroenterology-private-equity/#:~:text=While%20private%20equity’s%20presence%20in,a%20private%20equity%20backed%20platform.

[8]https://blogs.cdc.gov/cancer/2021/06/08/45-is-the-new-50-for-colorectal-cancer-screening/

[9]https://www.nejm.org/doi/full/10.1056/NEJMra2200869#:~:text=In%20the%20United%20States%2C%20the,2015%2C%20a%2063%25%20increase.

[10]https://bhw.hrsa.gov/sites/default/files/bureau-health-workforce/data-research/internal-medicine-subspecialty-report.pdf pg. 5.

[11]https://www.beckersasc.com/asc-transactions-and-valuation-issues/gastroenterology-an-emerging-trend-in-private-equity-healthcare-transactions.html

[12]https://www.nber.org/system/files/working_papers/w23623/w23623.pdf

[13]https://ihpi.umich.edu/news/many-colonoscopy-patients-could-get-surprise-bills-new-study-finds

[14]https://khn.org/news/article/surprise-medical-bill-colonoscopy-screening-versus-diagnosis/

[15]https://ihpi.umich.edu/news/many-colonoscopy-patients-could-get-surprise-bills-new-study-finds