Private Equity Health Care Acquisitions – November 2023

In light of the growing investor interest in healthcare and the risks associated with private equity ownership of healthcare companies, the Private Equity Stakeholder Project is tracking private equity-backed healthcare acquisitions. Below is a list of private equity healthcare buyouts, growth investments, and add-on acquisitions completed or announced during November 2023. We will continue to track acquisitions on a monthly basis.

See October 2023 acquisitions here.

See all our 2022 acquisitions updates here.

CD&R-backed Gentiva acquires ProMedica Hospice
Gentiva, a hospice chain owned by private equity firm Clayton, Dubilier & Rice (CD&R), has acquired non-profit health system ProMedica’s home health and hospice business. The deal adds 4,000 employees of ProMedica’s, bringing Gentiva’s total employee number to 35,000.[1]  The combined company now operates more than 615 facilities across 38 states and is the largest U.S. hospice company by revenue and number of patients.[2]

This is the first purchase Gentiva has made since CD&R acquired it (then known as a segment of Kindred at Home) from insurer Humana in 2022 for $2.8 billion.[3]

Private equity firms increasingly make up a disproportionate share of the hospice industry, particular through acquisitions of non-profit providers in recent years. In 2019, approximately 113,000 (8%) of the nation’s 1.46 million Medicare hospice beneficiaries were cared for by PE-owned hospices – a 327% increase from 2012.[4]

In 2020, private equity acquisitions of hospice agencies surged, according to a report by the Center for Economic and Policy Research. By the end of 2021, private equity accounted for 18 out of a total of 23 deals involving hospice providers. While the hospice industry in 2022 saw a relative lull in dealmaking compared to previous years, “PE firms continue to be leading players in the market” wrote the report’s authors.[5]

2023 has seen at least 18 PE-backed hospice acquisitions so far.[6]

Research comparing patient outcomes and other indicators at for-profit vs non-profit hospice companies raises red flags about the growing presence of private equity in the hospice industry. For example, a 2019 report from the Government Accountability Office (GAO) found that hospices with the lowest quality ratings were most likely to be for-profit, although average quality remained similar.[7] For example, for-profit hospices were more likely than their non-profit counterparts to have low rates of home visits in the last days of life by health professionals and high rates of live discharge from hospice.[8]

A 2023 study by RAND Corporation published in JAMA Internal Medicine found that “family members reported worse care experiences on average from for-profit hospices across all of the domains assessed, including help for pain and other symptoms and getting timely care.”

Private equity, with its characteristic focus increasing short term profits sometimes at the cost of patient care, may amplify the concerns raised about for-profit ownership of hospice providers. See, for example, PESP’s report on private equity ownership of hospice and home health providers: Private Equity at Home: Wall Street’s Incursion into the Home Healthcare and Hospice Industries (March 2022).

November 2023 Add-on Acquisitions

November 2023 Buyouts

November 2023 Growth Investments

[1]https://www.gentivahs.com/articles/news-and-press/gentiva-completes-acquisition-of-promedicas-home-health-and-hospice-business/

[2]https://www.beckershospitalreview.com/finance/promedica-sells-home-health-hospice-business.html

[3]https://www.cdr-inc.com/news/press-release/cdr-acquire-humana-home-hospice-and-personal-care-divisions

[4] Pg. 26; Appelbaum, Eileen, Rosemary Batt, and Emma Curchin. “Preying on the Dying: Private Equity Gets Rich in Hospice Care.” Center for Economic and Policy Research, April 25, 2023. https://cepr.net/wp-content/uploads/2023/04/2023-05-Preying-on-the-Dying-Appelbaum-Batt-and-Curchin.pdf.

[5] Pg. 23; Appelbaum, Eileen, Rosemary Batt, and Emma Curchin. “Preying on the Dying: Private Equity Gets Rich in Hospice Care.” Center for Economic and Policy Research, April 25, 2023. https://cepr.net/wp-content/uploads/2023/04/2023-05-Preying-on-the-Dying-Appelbaum-Batt-and-Curchin.pdf.

[6] Pitchbook, accessed December 2023.

[7] MEDICARE HOSPICE CARE: Opportunities Exist to Strengthen CMS Oversight of Hospice Providers, United States Government Accountability Office, Oct. 2019. https://www.gao.gov/assets/gao-20-10.pdf. Pg. 15.

[8]MEDICARE HOSPICE CARE: Opportunities Exist to Strengthen CMS Oversight of Hospice Providers, United States Government Accountability Office, Oct. 2019. https://www.gao.gov/assets/gao-20-10.pdf. Pg. 18-19.