ACEP Statement on Private Equity and Corporate Investment in Emergency Medicine

Profit Motives Influencing Health Care Decisions Warrant Scrutiny

As part of how ACEP is Fighting for Emergency Physician Autonomy in a Changing Health Care Landscape, the ACEP Board of Directors approved this statement at their April 2022 meeting:

The American College of Emergency Physicians (ACEP) is increasingly concerned about the expanding presence of private equity¹ and corporate investment in health care, including emergency medicine. Emergency medical care is an essential and vital service, and the profit potential of expanding and commercializing emergency medicine practice is attracting attention from emergency physicians and non-physician investors. Emergency physicians may practice under a variety of compensation arrangements and quality emergency care is provided by physicians under different methods of compensation. However, consolidation is rapidly changing the health care landscape and may threaten the emergency physician’s autonomy and ability to provide the highest quality emergency care, protect patient safety and maintain their own wellness.

ACEP reaffirms our core beliefs, including:

• The physician-patient relationship is the moral center of medicine. The integrity of this relationship must never be compromised. The physician must have the ability to do what they believe in good faith is in the patient's best interest.
   
• Medical decisions must be made by physicians and any practice structure that threatens physician autonomy, the patient physician relationship, or the ability of the physician to place the needs of patients over profits should be opposed.
   
• An emergency physician, as defined by ACEP, must serve as the chief medical officer, medical director, or equivalent for an emergency medicine practice. The ED medical director should have oversight over all aspects of the practice of emergency medicine in the ED and make decisions based on best practices and evidence-based medicine.
   
• Decisions regarding clinical staffing model(s) and emergency physician staffing number(s) should be made by emergency physicians to ensure the health and safety of both patients and physicians.
   
• Full transparency regarding private equity and corporate investment is essential in the health care industry.
   
• Objective data is critically needed to measure the impact of private equity and corporate investment in emergency medicine on patient care and outcomes, as well as on emergency physician well-being.
   
• Financial motives should never supersede an emergency physician’s autonomy to make bedside decisions in the best interest of the patient.

¹As per MedPAC, “ private equity” refers broadly to any activity where investors buy an ownership, or equity, stake in companies or other financial assets that are not traded on public stock or bond exchanges.” This statement refers in particular to the type of private equity in which “investment firms that purchase companies and then try to improve their operational and financial performance so they can later be sold for a profit.”

Reference List of ACEP Policy Statements

Code of Ethics for Emergency Physicians
Revised January 2017, June 2016 and June 2008. Reaffirmed October 2001. Revised June 1997 with current title. Originally approved January 1991, titled “Ethics Manual”

Emergency Physician Rights and Responsibilities
Revised April 2021, October 2015, April 2008, July 2001 Originally approved September 2000

Emergency Department Planning and Resource Guidelines
Revised April 2021, April 2014, October 2007, and June 2004, June 2001 with current title. Reaffirmed September 1996. Revised June 1991. Originally approved December 1985, titled "Emergency Care Guidelines"

Staffing Models and the Role of the Emergency Department Medical Director
Originally approved April 2020

Definition of an Emergency Physician
Reaffirmed April 2017. Originally approved June 2011

Compensation Arrangements for Emergency Physicians
Revised April 2021, April 2015, April 2002, June 1997. Reaffirmed October 2008, April 1992. Originally approved June 1988

Emergency Physician Compensation Transparency
Originally approved October 2020

Emergency Physician Contractual Relationships
Revised April 2021, June 2018, October 2012, January 2006, March 1999, August 1993 with current title. Originally approved October 1984, titled "Contractual Relationships between Emergency Physicians and Hospitals"

As an adjunct to this policy statement, ACEP has prepared a policy resource and education paper (PREP) titled "Emergency Physician Contractual Relationships"