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Private equity investors hold an ever-growing financial stake in dermatology practices across the U.S., researchers found, a trend that may have implications for patients and the care they receive.

Seventeen dermatology management groups acquired 184 dermatology practices nationwide from May 2012 to May 2018, including 34 practices bought in just the last 5 months of the study period, reported Arash Mostaghimi, MD, MPA, MPH, of Brigham and Women's Hospital in Boston, and colleagues in .

As of mid-2018, the researchers counted 381 individual dermatology clinics coming under management-group ownership during the 6-year period. One such group -- Advanced Dermatology & Cosmetic Surgery, Inc. -- acquired 47 practices with 92 individual clinics from 2012 onward, Mostaghimi and colleagues found, and now runs a total of 193 clinics in 14 states around the country.

Notably, the rate of acquisitions increased nearly 12-fold from only five in 2012 to 59 in 2017, the authors wrote.

Private equity involvement in the number of acquired practices and amount of financial deals has increased over the last several years, and this requires being vigilant and doing further research, noted Mostaghimi.

"I think the jury's out. I think the reason we have to be vigilant is because anytime you introduce a potential profit motive in dermatology or in medicine, you have to be very thoughtful to make sure it doesn't lead to negative impacts for patients," Mostaghimi told MedPage Today.

There is limited empirical information concerning the effect of private equity on dermatology, but further oversight and research could be valuable, agreed Joshua Sharfstein, MD, and Jamar Slocum, MD, both of Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, in an . The House of Delegates of the American Medical Association last year requested research into the use of unsupervised non-physicians in these practices, the speed of these private equity takeovers, and the effect on patient access and physician independence, they added.

With the rapid expansion of these acquisitions and the time needed to carry out this research, it might be too late, so "efforts to protect the field of dermatology and the American public from the potential adverse consequences should begin now," the editorialists emphasized.

All dermatology practices should be transparent by providing the American Academy of Dermatology with basic information about their ownership, along with core measures related to access to emergency and essential care, revenue growth, their use of non-physicians, and the provision of uncompensated care, the editorialists continued. The academy should then make that information public, they urged.

"Until meaningful data are available on what happens to the quality of care and affordability for patients and payers, dermatologists should stop selling their practices to private equity firms, and legislators should prohibit such transactions," wrote Sharfstein and Slocum.

Mostaghimi and colleagues used five financial databases to gather investment and acquisition information regarding dermatology practices. Transaction information was supplemented with publicly accessible data from dermatology management groups' press releases, other financial databases, and financial news outlets. Acquisitions were confirmed to be dermatology practices offering cosmetic, surgical, and medical clinical care. Using spatial analytics software, the locations of clinics linked with acquired practices were mapped out.

Limitations of the study included that publicly available information on private-equity transactions is inherently limited, making it challenging to determine the extent of missing information. Mostaghimi and colleagues wrote that one venture capital database listed 15 dermatology management groups not identified in the researchers' own search, supporting their suspicion that the study underestimated the extent of clinic acquisitions. In particular, they likely missed small physician-owned practices directly acquired by small private equity firms.

Mostaghimi and colleagues also noted that their estimates of the number of clinic locations were approximate because the clinic addresses linked with each practice acquisition came from internet searches.

"Further research is needed to assess whether and how private equity-backed ownership influences clinical decision-making, health care expenditures, and patient outcomes," the investigators concluded.

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