The Impact of Private Equity on the Therapy Industry: A Focus on Applied Behavior Analysis

Introduction to Industry Changes

The therapy industry, notably sectors focused on autism and behavioral disorders, has undergone significant transformations over the past decade. Applied Behavior Analysis (ABA) therapy, a critical intervention for autism spectrum disorders, has seen particularly intense change. This transformation has been fueled largely by the influx of private equity investment. While the industry grows, the essential focus on patient care is often overshadowed by profit motives. This blog post examines the consequences of these changes, particularly how they affect service quality and accessibility in ABA therapy.

Rise of ABA Therapy

ABA therapy is rooted in a methodical approach that encourages positive behaviors in individuals with autism through reinforcement strategies. As autism diagnoses have increased—current data suggests 1 in 36 children in the U.S. are diagnosed—the demand for specialized services like ABA has surged. This therapy is not only popular but also expensive, with costs potentially reaching $60,000 per year for intensive interventions, which are often covered by insurance and Medicaid.

The Attraction of Private Equity

Private equity firms are attracted to the therapy industry by the promise of steady, insurance-funded revenue streams. Their typical strategy involves buying companies, optimizing operations for cost-efficiency, and selling them at a profit. However, this often results in cost-cutting measures that can compromise the quality of patient care.

The Case of CARD

A poignant example is the Center for Autism and Related Disorders (CARD), which was acquired by Blackstone in 2018. CARD, once a thriving network with 265 locations, filed for bankruptcy by 2023 after closing 100 centers. This dramatic shift left many families without services, disrupting the care of vulnerable children like Javier Bautista, whose story of disrupted therapy highlights the human cost of these corporate strategies.

Financial Strategies and Their Impacts

Private equity’s model typically loads acquired companies with debt, betting on aggressive growth strategies. For CARD, this meant expanding services without a proportionate investment in staff training or retention, which diluted the quality of care. When revenues did not meet expectations, especially during the COVID-19 pandemic, the financial structure became unsustainable, leading to cutbacks and closures.

Effects on Staff and Service Quality

The influx of private equity has also affected the workforce within the therapy industry. There is often a push to increase the caseloads on staff while reducing supervision and ongoing training, which can lead to burnout and turnover. This diminishes the quality of care and undermines the therapeutic outcomes for patients.

Regulatory and Ethical Concerns

The operational changes driven by private equity raise significant ethical and regulatory concerns. Instances of inappropriate treatment strategies, as reported in J.J.’s case, where techniques used were deemed provocative rather than therapeutic, highlight the potential harm to patients. Such practices have led to legal actions and calls for tighter industry regulation.

The Broader Impact on the Healthcare System

The strategy of maximizing short-term profits is not isolated to autism services. Studies across healthcare sectors have shown that private equity-owned facilities often see worse patient outcomes. This is attributed to understaffing, reduced spending on patient care, and an emphasis on financial metrics at the expense of service quality.

Pushback and Reform

There is growing scrutiny of private equity’s role in healthcare. Recent investigations by federal agencies and academic studies suggest that these investments might prioritize profits over patients, prompting calls for regulatory reform. Proposals include setting minimum staff-to-patient ratios and enhancing transparency in ownership and financial operations.

Advocacy and the Role of Families

Families and advocates are becoming increasingly vocal about their experiences and challenges. The story of J.J. and his mother withdrawing him from CARD following poor treatment practices is just one example of the increasing pushback against the perceived commodification of care.

Rebuilding Trust and Quality

In response to widespread criticism, some original founders, like Doreen Granpeesheh of CARD, have stepped in to buy back and stabilize their organizations. Their focus is on restoring trust and prioritizing clinical quality over financial gains. This shift back to a more care-focused model is seen as critical in rebuilding patient and community trust.

The Future of ABA Therapy

Looking ahead, the therapy industry, particularly ABA, stands at a crossroads. Will it continue to be driven by investment firms looking for high returns, or can it return to its roots of patient-centered care? The answer will depend largely on the actions of policymakers, the advocacy of families, and the ethical stance of the industry’s leaders.

Conclusion: A Call for Balanced Approaches

The need for a balanced approach that respects the financial realities of running large-scale operations without compromising on the quality of care is essential. The therapy industry must navigate these complex waters with an eye toward ethical practices, regulatory compliance, and, above all, the welfare of its patients. As stakeholders reassess their strategies, the hope is that they will prioritize long-term sustainability over short-term gains, ensuring that services like ABA remain available, effective, and patient-focused.