Association Between Market-Level Characteristics and Cardiologists Acquired by Private Equity in the United States.

"Barbarians at the Ticket Gate": Private Equity's Arrival in American Sports Leagues

Private equity (PE) investments have expanded rapidly in procedural specialties such as orthopaedics. Physical therapy (PT) has become a newer target for PE investment because of reliable reimbursement, scalable operations, and recent policy reforms enhancing access. This study examines national trends in PE acquisitions of PT clinics, their geographic distribution, and PE exit trajectories. This cross-sectional study analyzed PE acquisitions of PT practices in the United States between January 1, 2010, and December 31, 2024. Acquisition data were drawn from PitchBook and supplemented through public verification. State and nationwide PT practice counts were estimated using the 2024 Medicare Care Compare database. PE acquistions in physical therapy expanded rapidly, from four deals in 2010 to 175 deals in 2023. By 2024, these acquisitions accounted for 2,591 PE-affiliated physical therpay clinics in the US, with 91.1% of the deals comprising of add-on acquisitions. PE penetration varied widely geographically, with Rhode Island (69.8%), Massachusetts (61.2%), and Tennessee (52.8%) having the highest proportions. Ten platform companies operated 59.3% of PE-affiliated PT locations in the United States, with notable regional concentration. The majority (63%) of acquisitions remained with the original PE firm, while 33.3% were sold to another PE firm with the average holding period being 3.3 years. PE investment in PT is marked by rapid growth, regional consolidation, and short-term investment cycles. Recent federal and state policy changes-including direct access laws and expanded referral authority-may have further facilitated PE entry into PT practices and contributed to the sector's investment appeal. Additional research is needed to evaluate the effect of PE ownership on care quality, access, and workforce stability.

Taking Private Equity Public: The Blackstone Group

Objectives: Private Equity (PE) involvement in healthcare has been evident in the United States (US) for some time, with questionable benefits reported. There are significant differences in funding, health insurance and regulation in the US, when compared to Australia and New Zealand (NZ), so it is not clear whether existing US research can be generalised to these settings. This study aims to examine published information regarding PE involvement in the private-for-profit (PFP) healthcare sector in Australia and NZ, including evidence of PE shareholdings and its impacts. Design: This scoping review considers academic and grey literature, including academic research and commentary papers, media reports, corporate reports, PFP healthcare websites and government submissions. Main Outcome & Results: Thirty three relevant sources were identified, but no specific information on the impacts of PE investment were discovered. The academic papers highlight an ongoing debate (but limited research evidence) about PFP healthcare, including the quality of clinical care, practice consolidation and a downward trend on clinician ownership. The grey literature offered more information on PE investment and growth of the PFP sector, but limited detail about shareholdings. Conclusion: With little research on PE investment in Australia and NZ, it is difficult to know if continued PE growth will have a positive or negative affect on operational performance and outcomes, such as clinician engagement and clinical care. The authors conclude that there is a shifting landscape of PFP healthcare in Australia and NZ, to less clinician and greater PE ownership. Given the reports of negative impacts of PE involvement in the US, these trends pose significant immediate and long-term implications. This paper sets the agenda for further research to explore the organisational and system-level impacts of PE growth in Australia and NZ.

The Determinants of Investment in Private Equity and Venture Capital: Evidence from American and Canadian Pension Funds

We show that cross-border leveraged buyout investments involving U.S. rather than non-U.S. private equity (PE) investors are more likely to have a successful exit (initial public offering or acquisition). Exogenous increases in effective proximity following the signing of “open sky agreements” between the United States and target firms’ home countries increases both the propensity of U.S. PE firms to invest in these firms and the value addition by these investors. We show that such increases in value addition by U.S. PE investors following proximity increases are at least partially due to better monitoring, facilitated by the more efficient allocation of experienced U.S. PE managers to cross-border deals.

Private equity (PE) investment in healthcare has expanded rapidly, particularly in plastic surgery, where rising demand for aesthetic procedures presents attractive financial opportunities. Although PE backing may enhance operational efficiencies, concerns exist regarding its potential impact on care quality, patient outcomes, and healthcare costs. The authors of this study examine PE acquisitions of US plastic surgery practices, identifying trends in investment growth, geographic distribution, and the financial models adopted by PE-backed practices. In this cross-sectional study, the authors analyzed PE acquisitions of US plastic surgery practices from January 1, 2000 to July 1, 2024. Data were obtained from PitchBook, verified through practice websites and follow-up inquiries. The analysis focused on acquisition trends, insurance acceptance policies, and the geographic distribution of PE-backed practices. Between 2000 and 2023, PE-backed acquisitions in plastic surgery grew by 4300% in practice volume and 7630% in capital investment. Acquisitions were concentrated in states, such as Texas, Florida, and New York. PE investment was prominent in general, facial, and oculoplastic surgery practices, with a preference for cash-only models, particularly in specialized fields. Many practices employed few plastic surgeons, relying instead on aesthetic clinicians. PE consolidation in plastic surgery is expanding rapidly, driven by demand for elective procedures. Although PE investment brings financial and operational advantages, it raises concerns about healthcare quality and equity. Further research comparing PE and non-PE-owned practices is necessary to guide policies ensuring patient care quality and access.

Private Equity in Ophthalmology and Optometry: Analysis of Acquisitions from 2012 through 2019 in the United States

Unicorns, Guardians, and the Concentration of the U.S. Equity Markets

The Dodd-Frank Wall Street Reform and Consumer Protection Act drastically changed the financial regulatory landscape in the United States. One noteworthy change was a near-elimination of the so-called “private adviser” exemption to the Investment Advisors Act of 1940. The biggest beneficiaries of this exemption were private equity sponsors and hedge fund managers. A result of this change is that most private equity fund advisers and hedge fund managers must now register as investment advisers with the Securities and Exchange Commission (the “SEC”) under the Investment Advisers Act and are subject to a myriad of rules and regulations. The focus of this Note is the application of the fiduciary duties governing advisers required to register under the Investment Advisers Act to private equity sponsors. Problematically, these fiduciary duties do not emanate from the Act itself, but are the result of judicial interpretation. Largely because of this genesis, the substance of advisers’ fiduciary duties remains unclear. Importantly for private equity advisers, the bounds of their fiduciary duties were developed in the context of industries vastly different from modern private equity. This Note argues that the existing “one-size-fits-all” scheme of fiduciary regulation under the Investment Advisers Act is inappropriate for the private equity industry. It examines three recent SEC orders against major industry players for violations of their fiduciary duties under the Investment Advisers Act and notes both their inconsistency and lack of guidance. Instead of this byzantine system of fiduciary regulation, a contractarian model would better serve both private equity sponsors and investors by allowing the parties themselves to define the bounds of the fiduciary relationship. This approach best reflects the bargaining power and financial sophistication of the parties and encourages the continued growth of the private equity industry.

Adapting Private Equity to Company Law or Vice Versa? Understanding Some Key Determinants of a Strong Private Equity Market in the China Context

The authors’ survey suggests that general partners anticipate a slow and steady recovery for private equity in 2013. To take the pulse of the industry and identify the key challenges and opportunities that will impact private equity in 2013, the private equity practice at BDO USA, LLP, conducted its fourth annual Perspective Private Equity Study from November through December 2012. This year’s study, which examined the opinions of more than 100 senior professionals at private equity firms throughout the United States, found that despite a disappointing year in 2012, private equity professionals remain confident in the industry’s sustained recovery. <b>TOPICS:</b>Private equity, quantitative methods, equity portfolio management, emerging

This article provides a comparative analysis of pension plan allocations to private equity and to venture capital in the United States and in Canada. Although the assets of American funds in our data are worth 10 times those of Canadian funds, their investment in private equity is about 20 times larger. Asset size is an important determinant of the decision to invest in private equity in both countries, but it is only a determinant of how much to invest in Canada. Asset size appears to be an important factor in explaining the difference in private equity investment, but it is not sufficient to explain it in its entirety. We examine other possible explanatory factors, such as fund types and location, the institutional environment, and regulatory constraints.

Earlier, the United States was the first country to set up private equity funds. By setting up investment institutions to raise funds from the rich for investment in high-tech small and medium-sized enterprises, with the gradual development, private equity funds became one of the financing channels for small and medium-sized enterprises, and gradually became an important part of the American financial system. The introduction of private equity funds in China was in the early stage of reform and opening up. With decades of changes, the private equity fund industry has gradually developed in China. However, there are still some legal problems to be solved in the supervision of foreign private equity funds. At present, the loss of foreign private equity fund institutions and irresponsible fund managers still occur from time to time, which is not conducive to promoting China’s economic reform and enterprise innovation and management. It will even have a certain impact on China's economic development order. The supervision of foreign private equity funds is an important way to raise funds in China. It is necessary to strengthen the effective supervision of foreign private equity funds and increase legal research.

11 - The private equity legal framework in the United States