Key Takeaways
- • Private equity firms own 447 U.S. hospitals, equal to 9.5 percent of all private hospitals and 26.8 percent of for-profit hospitals, according to the 2026 update of the Private Equity Stakeholder Project (PESP) hospital tracker.
- • Apollo Global Management is the largest owner, controlling 200 hospitals through Lifepoint Health and ScionHealth; New Mexico has the highest concentration, with 42.1 percent of its private hospitals under PE ownership.
- • On July 6, CMS published a proposed rule that would extend PE and REIT ownership disclosure requirements beyond home health agencies to hospitals, physician organizations and other Medicare participants.
- • A September 2025 Annals of Internal Medicine study of Medicare claims found newly acquired hospitals cut staffing by nearly 12 percent and hospital-wide salaries by nearly 17 percent, with cuts concentrated in emergency departments and ICUs, and emergency department mortality rising.
- • Lawmakers have proposed a bicameral bill, introduced in March, that would bar PE-owned hospitals and nursing homes from Medicare certification; industry groups oppose an outright ban.
Summary
Private equity firms own 447 U.S. hospitals, according to the 2026 update of the hospital tracker published by the Private Equity Stakeholder Project, a watchdog group that monitors these deals. That share represents 9.5 percent of all private hospitals and 26.8 percent of for-profit hospitals. Apollo Global Management is the largest single owner, running 200 hospitals through Lifepoint Health and ScionHealth. New Mexico has the densest concentration, with 42.1 percent of its private hospitals under private equity ownership.
Federal regulators are moving to increase visibility into who owns the facilities Medicare pays for. On July 6, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would extend ownership disclosure requirements for private equity firms and real estate investment trusts (REITs) well beyond home health agencies, reaching hospitals, physician organizations and other Medicare participants, according to Holland & Knight. REITs often buy hospital property and lease it back to operators, a common feature of private equity deals. Nursing homes were the first test case: since January 2024, Medicare- and Medicaid-billing nursing facilities have had to report whether each direct or indirect owner is a private equity company or a REIT. CMS typically finalizes its annual home health payment rule in the fall, according to Learningsignal.
The investment thesis rests on steady, recession-resistant demand, an aging population and a fragmented provider base that offers room to consolidate. Buyers typically use heavy debt, often carried by the acquired provider, and aim to sell within several years. Research points to tradeoffs. A Medicare claims study published in the Annals of Internal Medicine in September 2025 found that newly acquired hospitals reduced staffing by nearly 12 percent and hospital-wide salaries by nearly 17 percent, as reported by HealthDay. The cuts were concentrated in emergency departments and ICUs, and emergency department mortality rose.
Lawmakers have advanced stronger measures. A bicameral bill introduced in March would bar private equity-owned hospitals and nursing homes from Medicare certification, according to LeadingAge, although industry groups have opposed an outright ban. For government contractors, the expanded disclosure regime means more ownership data flowing through provider enrollment and more analytics linking ownership to cost and quality outcomes.
The Pentagon has a direct stake in the civilian hospital market, purchasing more than 65 percent of TRICARE care from civilian providers, according to Military.com. The Defense Health Agency's fiscal 2026 plan made care reattraction, which seeks to bring patients back to military treatment facilities, one of three lines of effort. A December 2023 directive set a goal of recapturing at least 7 percent of available private sector care for military treatment facilities by Dec. 31, 2026.
Federal regulators are moving to increase visibility into who owns the facilities Medicare pays for. On July 6, the Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would extend ownership disclosure requirements for private equity firms and real estate investment trusts (REITs) well beyond home health agencies, reaching hospitals, physician organizations and other Medicare participants, according to Holland & Knight. REITs often buy hospital property and lease it back to operators, a common feature of private equity deals. Nursing homes were the first test case: since January 2024, Medicare- and Medicaid-billing nursing facilities have had to report whether each direct or indirect owner is a private equity company or a REIT. CMS typically finalizes its annual home health payment rule in the fall, according to Learningsignal.
The investment thesis rests on steady, recession-resistant demand, an aging population and a fragmented provider base that offers room to consolidate. Buyers typically use heavy debt, often carried by the acquired provider, and aim to sell within several years. Research points to tradeoffs. A Medicare claims study published in the Annals of Internal Medicine in September 2025 found that newly acquired hospitals reduced staffing by nearly 12 percent and hospital-wide salaries by nearly 17 percent, as reported by HealthDay. The cuts were concentrated in emergency departments and ICUs, and emergency department mortality rose.
Lawmakers have advanced stronger measures. A bicameral bill introduced in March would bar private equity-owned hospitals and nursing homes from Medicare certification, according to LeadingAge, although industry groups have opposed an outright ban. For government contractors, the expanded disclosure regime means more ownership data flowing through provider enrollment and more analytics linking ownership to cost and quality outcomes.
The Pentagon has a direct stake in the civilian hospital market, purchasing more than 65 percent of TRICARE care from civilian providers, according to Military.com. The Defense Health Agency's fiscal 2026 plan made care reattraction, which seeks to bring patients back to military treatment facilities, one of three lines of effort. A December 2023 directive set a goal of recapturing at least 7 percent of available private sector care for military treatment facilities by Dec. 31, 2026.
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