Private Equity Stakeholder Project: “Behind nonprofit partnerships, private equity firms are building a growing footprint across hospitals, hospice, rehabilitation, and outpatient care. Over the past decade, private equity has dramatically expanded its presence across the healthcare system. While much of the public attention has focused on traditional acquisitions of hospitals, physician practices, nursing homes, and other providers, private equity firms are increasingly pursuing another strategy: joint ventures with nonprofit health systems. PESP’s new report examines how these partnerships have become an increasingly important avenue for private equity-backed healthcare companies to expand across hospitals, rehabilitation facilities, ambulatory surgery centers, hospice, home health, behavioral health, and other sectors. The report documents more than 500 healthcare facilities operated through nonprofit-private equity joint ventures—an undercount based only on publicly identifiable arrangements—and examines how these partnerships may introduce financial practices more commonly associated with traditional private equity ownership, including sale-leasebacks, management agreements, and related-party transactions, into nonprofit health systems. The report also explores whether existing federal and state oversight frameworks have kept pace with these increasingly complex ownership structures. Much of the IRS guidance governing nonprofit-for-profit joint ventures dates to 1998 and 2004, before private equity invested more than $1 trillion in U.S. healthcare over the past decade and before today’s large private equity-backed healthcare platforms became so prevalent…”