# Private Equity Hospital Rollup A **private equity hospital rollup** is the acquisition of hospitals by a [[Private Equity]] firm using substantial borrowed money, with returns extracted through debt, real-estate **sale-leasebacks**, management fees, and operating cuts before the firm exits — typically within a 3–7 year horizon. It is the most financialized variant of the [[For-Profit Hospital]] model. ## Scale Per the [[Private Equity Stakeholder Project]] tracker (updated April 2025), roughly **488 U.S. hospitals are PE-owned** — about **8.5% of all private hospitals** and **22.6% of for-profit hospitals**. Texas has the most; New Mexico the highest concentration; over a quarter serve rural populations. Major owners include [[Apollo Global Management]] ([[Lifepoint Health]]) and [[Bain Capital]]. ## The Critique and the Evidence A landmark JAMA study (Kannan, Bruch, and Song, 2023) found PE acquisition was associated with a **25% increase in hospital-acquired adverse events** — including a 27% rise in falls and a 38% rise in central-line infections — even as such events fell nationally. The mechanism critics cite: debt service and return targets crowd out staffing and safety investment. The collapse of [[Steward Health Care]], loaded with debt by [[Cerberus Capital Management]] before its 2024 bankruptcy, became the emblematic failure that drove state-level regulation. See [[Healthcare Industry Ecosystem]].