Private Equity Hospitals: Top Firms in 2026

Key Facts

• As of March 2025, 488 US hospitals are owned or operated by private equity firms, representing 8.5% of all private hospitals and 22.6% of all for-profit hospitals.
• PE firms have deployed an estimated $1 trillion into US healthcare over the past decade, with $104 billion invested in 2024 alone, up from $5 billion in 2000.
• Texas leads all states with 108 PE-owned hospitals; New Mexico has the highest penetration at 36.2% of all private hospitals in the state.
• Apollo Global Management is the largest PE hospital owner, controlling 235 facilities through Lifepoint Health and ScionHealth.
• Rehabilitation (29.2%) and psychiatric hospitals (22.6%) together account for more than half of all PE-owned hospital facilities.
• PE-owned hospitals average a CMS star rating of 2.5; 25% hold 1-star ratings versus the 9.7% national average.
• High-profile bankruptcies at Steward Health Care (2024) and Prospect Medical Holdings (2025) have triggered legislation in 19 states and a bipartisan Senate investigation.

The PE Hospital Sector: Scale, Geography, and Structure

Private equity firms now own or operate 488 hospitals across the United States, making private equity hospitals one of the most concentrated and scrutinized categories in US healthcare investment. Annual PE investment in healthcare reached $104 billion in 2024, up from $5 billion in 2000. PE-owned facilities account for 22.6% of all for-profit hospitals nationally, meaning nearly one in four for-profit hospitals carries a PE fund as its controlling owner.

The geography of PE hospital ownership skews heavily toward the South and rural markets. Texas hosts 108 PE-owned facilities, more than any other state, representing 19.6% of the state's private hospitals. New Mexico leads on penetration at 36.2%, followed by Wyoming at 33.3% and Idaho at 24.4%. At least 27.7% of PE-owned hospitals serve rural populations, concentrated in lower-income zip codes where entry valuations are lower and nonprofit competition is limited.

A small number of fund managers control the majority of facilities. Apollo Global Management alone owns 235 hospitals through Lifepoint Health and ScionHealth, more than four times the next largest PE hospital owner. One Equity Partners (34 facilities via Ernest Health), Equity Group Investments (32 via Ardent Health Services), and Webster Equity Partners (29 via Oceans Healthcare) form the second tier. Dozens of smaller fund managers account for the remaining portfolio across behavioral health, rehabilitation, and rural acute care.

PE hospital ownership spans four facility types: non-specialty acute care (32.6%, 159 facilities), rehabilitation hospitals (29.2%, 142 facilities), psychiatric facilities (22.6%, 110 facilities), and long-term acute care hospitals (LTACHs, 15.6%, 76 facilities). Behavioral health has attracted disproportionate PE capital, reflecting relatively predictable Medicare and commercial reimbursement and the consolidation potential in a fragmented ownership landscape.

Private Equity Hospital Firms: Comparison

Most PE firms active in the hospital sector do not publicly disclose AUM data. The table below reflects strategy, sector depth, and notable attributes drawn from deal history and facility data.

The distressed acquisition category occupied by Cerberus, GoldenTree, and Davidson Kempner represents a separate investment thesis: acquiring failing or bankrupt hospital systems at discounted valuations and attempting operational turnarounds. Results have been inconsistent. Cerberus generated $800 million in profit on its Steward exit, but Steward's subsequent bankruptcy in 2024 closed hospitals in multiple states. GoldenTree and Davidson Kempner acquired Quorum Health post-bankruptcy and continue selling assets to satisfy creditor obligations.

Top Picks by Investment Strategy

Largest Portfolio: Apollo Global Management controls 235 hospital locations through sequential acquisitions including Lifepoint (2018), the RegionalCare merger (2018), and Kindred Healthcare (2021), which created the ScionHealth subsidiary.

Rehabilitation Network Leader: One Equity Partners' Ernest Health operates 34 acute rehabilitation and LTACH facilities across 11 states, making it the most geographically distributed pure-rehabilitation PE operator in the country.

Rural Acute Care Operator: Equity Group Investments took Ardent Health Services public via IPO in 2024 while retaining four board seats and controlling ownership, a rare successful PE hospital exit that avoided the bankruptcy path taken by several peers.

Behavioral Health Consolidator: Webster Equity Partners added Haven Behavioral Healthcare to Oceans Healthcare in January 2025, reaching 29 psychiatric and behavioral health hospitals across nine states. The firm now holds the dominant position in PE psychiatric hospital consolidation.

Surgical Facilities Specialist: Bain Capital holds approximately 40% of Surgery Partners, the largest publicly traded surgical facility company with 161 locations in 31 states. Bain submitted a non-binding proposal to take Surgery Partners fully private in January 2025.

Strongest Deal Returns, Highest Controversy: Cerberus Capital Management's acquisition of the Caritas Christi Catholic system for approximately $250 million in 2010 (rebranded as Steward Health Care) generated $800 million in profit on exit. The subsequent Steward bankruptcy is the most-cited case in current PE hospital policy debates.

Distressed Buyout Specialists: GoldenTree Asset Management and Davidson Kempner Capital Management acquired Quorum Health out of a 2020 bankruptcy and have since reduced the portfolio from 21 to 12 hospitals by selling facilities to meet lender obligations, including two former Steward hospitals acquired in 2024-2025.

Leading PE Hospital Operators: Firm-by-Firm Analysis

Apollo Global Management — The Mega-Fund Consolidator

Apollo commands the largest PE hospital portfolio in the United States by an order of magnitude, with 235 facilities through Lifepoint Health and ScionHealth. The firm built this position through a buy-and-build strategy spanning three major transactions: the Lifepoint Health acquisition in 2018, an immediate merger with RegionalCare Hospital Partners, and the December 2021 Kindred Healthcare acquisition. That final deal created ScionHealth as a separate specialty-focused entity. Lifepoint now operates 78-plus hospitals under joint venture arrangements with 26 health systems, including a 14-hospital partnership with Duke Health covering North Carolina, Virginia, and Pennsylvania.

Apollo's scale makes it the reference point for any analysis of PE hospital consolidation, but quality metrics have deteriorated. Three of Lifepoint's North Carolina hospitals saw CMS star rating declines in 2024-2025, and Wilson Medical Center holds the lowest possible 1-star rating.

Bain Capital — The Deal Architect

Bain Capital co-engineered the $33 billion leveraged buyout of HCA Healthcare with KKR in 2006, the largest hospital LBO in PE history at the time. Those 161 HCA hospitals alone represented 57% of all PE hospital acquisitions documented in studies covering 2003 to 2017. Bain's current hospital exposure sits primarily in Surgery Partners, where a roughly 40% stake gives the firm significant influence over a network of 161 surgical facilities in 31 states, despite Surgery Partners' public Nasdaq listing.

The firm's January 2025 non-binding proposal to take Surgery Partners fully private signals a move toward tighter operational control. Hospital executives evaluating PE buyout proposals should study Bain's HCA exit closely: the successful IPO in 2010 generated up to $4.6 billion for investors, though the full cycle spanned nearly a decade.

Cerberus Capital Management — The Exit Paradox

Cerberus generated $800 million in profit on its Steward Health Care exit while leaving behind one of the most consequential hospital bankruptcies in recent US history. The firm acquired the Caritas Christi Catholic health system in Massachusetts for approximately $250 million in 2010, converted it to for-profit status as Steward Health Care, and grew the system to more than 30 hospitals across eight states. Its 2016 sale of Steward's real estate to Medical Properties Trust raised $1.25 billion for investors while saddling the hospitals with fixed rent obligations that proved unsustainable.

Steward filed one of the largest hospital bankruptcies in decades in 2024, permanently closing Carney Hospital in Boston and Nashoba Valley Medical Center in Massachusetts. This sequence (profitable PE exit followed by portfolio company bankruptcy) is now the primary reference case in federal and state PE hospital oversight proposals.

Leonard Green & Partners — The Dividend Extraction Model

Leonard Green & Partners extracted more than $500 million from Prospect Medical Holdings through dividend recapitalizations while driving the system toward insolvency, making it the clearest documented case of financial engineering overriding operational priorities in PE hospital ownership. The firm acquired Prospect for $363 million in 2010 and used debt-funded cash distributions to PE investors to boost returns over the following decade. Prospect's total liabilities grew from $451 million in 2015 to $1.6 billion in 2019. The firm exited in 2021, leaving Prospect carrying $2.3 billion in debt.

Prospect filed Chapter 11 bankruptcy in January 2025. Its Crozer Health system closed in April 2025 with more than 2,600 layoffs. The Rhode Island attorney general found that Leonard Green "realized hundreds of millions" while leaving behind a heavily indebted system. At least 11 states now cite the Prospect case in advance-notice legislation for PE healthcare transactions.

One Equity Partners — The Rehabilitation Network Builder

One Equity Partners' Ernest Health network, spanning 34 acute rehabilitation and long-term acute care facilities across 11 states, represents the most geographically distributed pure-rehabilitation PE operation in the country. The 11-state footprint covers Arizona, California, Colorado, Idaho, Indiana, Montana, New Mexico, Ohio, South Carolina, Texas, Utah, Wisconsin, and Wyoming. One Equity's investment thesis reflects the appeal of rehabilitation hospital consolidation: relatively stable Medicare reimbursement, limited competition from large acute care systems, and operational synergies across a portfolio of similarly sized facilities.

The rehabilitation model (representing 29.2% of all PE hospital facilities nationally) has attracted multiple fund managers precisely because it avoids the safety-net reimbursement risks that burdened Steward and Prospect.

Equity Group Investments (EGI) — The IPO Path

EGI took Ardent Health Services public via IPO in 2024 while retaining controlling ownership and four board seats, demonstrating that PE hospital operators can access public capital markets without fully relinquishing governance authority. EGI controls Ardent's 32-hospital system operating in Texas, Oklahoma, Idaho, Kansas, New Mexico, and New Jersey. Ardent's rural and mid-market hospital concentration mirrors the broader PE trend toward smaller regional markets where dominant insurer relationships and limited nonprofit competition improve operating economics.

For fund managers evaluating exit options, Ardent's IPO demonstrates a viable path to liquidity that avoids the bankruptcy exits seen elsewhere in the PE hospital landscape.

Webster Equity Partners — The Psychiatric Consolidator

Webster Equity Partners built Oceans Healthcare into the dominant PE-owned psychiatric hospital operator through a deliberate acquisition-led growth strategy. The purchase of Haven Behavioral Healthcare in January 2025 (previously owned by Thoma Bravo and Brentwood Capital Advisors) brought Oceans to 29 behavioral health hospitals in nine states. Webster's sector thesis rests on structural undersupply: psychiatric bed counts per capita have declined for decades, and rising mental health utilization creates reimbursement pricing power for well-positioned operators.

Behavioral health now represents 22.6% of all PE-owned hospital facilities, the second-largest category after acute care, reflecting widespread fund manager conviction in the subsector's reimbursement stability.

GoldenTree and Davidson Kempner — The Distressed Specialists

GoldenTree Asset Management and Davidson Kempner Capital Management specialize in distressed hospital acquisitions, a strategy they deployed jointly in 2020 by acquiring Quorum Health Corporation out of bankruptcy at discounted valuations. Their investment thesis centered on operational improvement combined with selective asset sales to satisfy lender credit obligations. As of March 2025, Quorum operates 12 hospitals across nine states, down from 21 at acquisition.

Recent deal activity includes the purchase of two former Steward Health Care hospitals in 2024-2025, illustrating how distressed hospital portfolio sales generate secondary deal flow within the PE ecosystem. Quorum's credit rating has reflected ongoing financial pressure, with the portfolio still actively divesting to meet obligations.

Investment Trends Reshaping PE Hospital Markets

Behavioral Health Consolidation Accelerates

Behavioral health remains the most active hospital subsector for PE investment, with psychiatric facilities comprising 22.6% of the total PE hospital portfolio. Webster Equity Partners' acquisition of Haven Behavioral Healthcare in January 2025 added 29 combined inpatient and outpatient locations to Oceans Healthcare's network. Patient Square Capital operates Summit Behavioral Healthcare's 14 facilities in a parallel consolidation strategy. Chronic psychiatric bed shortages and rising behavioral health utilization provide the underlying investment rationale, with relatively predictable Medicare and commercial reimbursement reducing revenue volatility compared to acute care.

Sale-Leaseback Transactions Face Legislative Barriers

Sale-leaseback agreements let PE owners sell hospital real estate to a REIT and lease it back, generating immediate cash for investors. This technique raised $1.25 billion at Steward in 2016 while creating fixed rent obligations that contributed to the 2024 bankruptcy. Massachusetts enacted legislation in January 2025 explicitly banning sale-leaseback agreements in healthcare, the first state-level prohibition of this specific technique. Nineteen states have introduced related legislation in 2025. PE fund managers structuring new hospital acquisitions must now assess the regulatory durability of sale-leaseback economics, given that Massachusetts, Oregon, and Indiana have each enacted restrictions within the past two years.

Joint Ventures With Nonprofits Extend PE Reach

Apollo's Lifepoint Health operates 78-plus hospitals under joint venture structures with 26 nonprofit and academic health systems, including Duke Health's 14-hospital network across North Carolina, Virginia, and Pennsylvania. These arrangements give PE-backed operators access to trusted regional brands and new geographies while offering a partial antitrust shield relative to direct acquisitions. Joint ventures with nonprofits represent the fastest-growing structural feature in PE hospital expansion and remain a relatively under-regulated area, a gap that several state attorneys general have begun examining.

Antitrust and Congressional Oversight Escalates

The FTC settled with Welsh Carson Anderson & Stowe in January 2025 over its anesthesia roll-up strategy, which gave US Anesthesia Partners 50-70% market share in Houston and drove reimbursement rates 95% above in-network medians. The Senate Budget Committee released bipartisan findings in January 2025 documenting harms at Prospect Medical Holdings and Lifepoint Health. Updated FTC premerger notification rules, effective February 2025, now require parties to disclose prior acquisitions from the past five years. These rules target serial roll-up strategies that historically fell below the $126.4 million Hart-Scott-Rodino reporting threshold. Oregon's SB 951, enacted June 2025, restricts PE control of physician practices through management services organizations (MSOs), establishing the strongest state-level constraint on PE healthcare control structures to date.

CMS Quality Ratings Deteriorate Across the Portfolio

Of the 92 PE-owned hospitals with CMS star ratings available, the average is 2.5 stars. Thirty facilities saw ratings decline between 2024 and 2025 updates while only 17 improved. The number of 1-star PE hospitals more than doubled from 10 to 23. Three Lifepoint Health hospitals dropped from 3 stars to 1 star in the most recent CMS update cycle. PE hospitals are overrepresented at the 1-star and 2-star levels (25.0% and 29.4% respectively) and underrepresented at 4 and 5 stars (5.4% at 5 stars versus 13.4% nationally).

How to Assess PE Hospital Investments

Start with CMS overall star ratings and their direction over time. PE-owned hospitals average 2.5 stars nationally, and the trend matters as much as the current number. A facility declining from 3 stars to 1 star across consecutive CMS updates signals accelerating quality degradation, as seen at several Lifepoint hospitals in North Carolina in 2024-2025. The CMS Hospital General Information dataset provides free access to star ratings, readmission rates, and patient safety measures for all Medicare-enrolled facilities.

Debt structure is the highest-order financial risk factor in hospital PE due diligence. Assess the debt-to-earnings ratio and verify whether the firm has executed sale-leaseback transactions or dividend recapitalizations since acquisition. Steward's $1.25 billion real estate sale to a REIT and Leonard Green's $500 million-plus in dividend extractions from Prospect Medical are the documented reference cases. Firms generating returns primarily through financial engineering rather than operational improvement present heightened bankruptcy risk for communities, workers, and downstream creditors.

Staffing ratios and capital expenditure trends reveal operational intent most directly. A 2025 study in Annals of Internal Medicine found 13% higher emergency department deaths, 16-18% reductions in ICU and ED salary expenditure, and an 11.6% workforce reduction at PE-acquired hospitals post-acquisition. Requesting CMS cost reports (which document full-time equivalent employees per occupied bed and capital investment by year) provides an evidence-based basis for comparison against peer facilities and against the same facility's pre-acquisition baseline.

Prior bankruptcy history across a firm's full portfolio is a leading indicator that single-deal narratives often obscure. Seven of the eight largest healthcare bankruptcies in 2023 involved PE-backed providers. Evaluating a PE firm's complete portfolio history (not just its current or most recent holdings) reveals whether the Steward and Prospect patterns are outliers or reflect a repeating investment approach.

Which Firm Fits Your Needs?

Hospital executives and board members evaluating PE acquisition proposals should study the contrast between Apollo's joint venture model and EGI's IPO path as alternative frameworks. Lifepoint's joint venture structures offer capital access and operational scale while nominally preserving local brand identity. Ardent's IPO demonstrates that PE hospital operators can access public capital markets without full ownership transfer, though EGI retains governance control through board seats and a controlling stake. In both cases, the critical negotiating terms involve board seat allocations, service line protection provisions, and the conditions under which real estate can be separated from operations.

LPs building diversified alternatives portfolios with healthcare exposure should distinguish between the mega-fund generalists and the sub-sector specialists. Apollo, Bain Capital, and KKR offer scale and deal history but carry documented quality deterioration risk and rising regulatory exposure in their hospital portfolios. One Equity Partners' rehabilitation concentration and Webster Equity Partners' behavioral health focus provide cleaner sector theses with more predictable Medicare reimbursement and lower correlation to the safety-net hospital bankruptcy risks that have generated the most damaging headline outcomes.

Policymakers, advocacy organizations, and healthcare workers tracking PE hospital ownership should use a public hospital ownership tracker alongside CMS Hospital General Information data to identify ownership and star rating trends for specific facilities. WARN Act filings (required notices for planned mass layoffs) provide the earliest available signal of operational changes following PE acquisitions. Oregon's SB 951 and Massachusetts Chapter 343 represent the current legislative benchmarks for state-level oversight frameworks.

Methodology

This overview of private equity hospitals draws on ownership, quality, and financial data from the CMS Hospital General Information dataset, a public PE hospital ownership tracker (updated April 2025), and SEC filings for publicly traded portfolio companies including Surgery Partners and Ardent Health Partners. Patient outcome data references peer-reviewed studies published in JAMA (2023, 2024) and Annals of Internal Medicine (2021, 2025). Regulatory information reflects enacted legislation as of mid-2025 and federal enforcement actions through January 2025. Firms appear in detailed profiles based on facility count, deal significance, or strategic distinctiveness within the PE hospital landscape. All facility counts reflect CMS-enrolled hospitals; ambulatory surgery centers and outpatient locations are excluded unless carrying a CMS hospital designation. Financial engineering examples draw from documented bankruptcy filings, state attorney general findings, and corporate SEC disclosures.