ApolloMD

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.

EctopicFetus

Keeping it funky enough
15+ Year Member
20+ Year Member
Joined
May 3, 2004
Messages
12,248
Reaction score
2,860
Unsure if you guys saw the Reddit thread about Apollo.. TLDR they are having their 1099 docs pay for the MLPs at their site in Patterson NJ. Someone mentioned this was the site that the old acep prez Rosenberg was part of.. Anyone know what happened with that contract? Did Apollo throw out a sdg or did the SDG sell?

Members don't see this ad.
 
I mean... technically money is fungible and that money has to come from someplace.

However making anything a line item is basically shoving it into people's face. People don't like that.
 
I mean... technically money is fungible and that money has to come from someplace.

However making anything a line item is basically shoving it into people's face. People don't like that.
Could have come from their fat profits. Idk.

Does anyone know the history of that site? When did Apollo take over?
 
Members don't see this ad :)
Could have come from their fat profits. Idk.
Those fat profits comes out of the pay check as well... but there's a reason that "admin profit" isn't a line item deduction.
 
  • Like
Reactions: 1 users
Ring Of Fire Robbery GIF by Outside Watch
 
  • Like
Reactions: 1 user
Apollo did the same thing to us during COVID. The APCs had their hours reduced to like 25% and the docs started getting these negative returns on their paychecks which turned out to be subsidized pay to cover the 75% missing APC compensation. I’m not actually sure if the director knew about it or not but the docs were absolutely not told about it until we brought it up. A lot of the shady, constantly changing RVU compensation with Wizard of Oz presentations to the docs from corporate with these bizarre algorithmic formulas to explain the pay model is what turned me off that particular CMG.
 
Last edited:
  • Like
  • Wow
Reactions: 3 users
Apollo did the same thing to us during COVID. The APCs had their hours reduced to like 25% and the docs started getting these negative returns on their paychecks which turned out to be subsidized pay to cover the 75% missing APC compensation. I’m not actually sure if the director knew about it or not but the docs were absolutely not told about it until we brought it up. A lot of the shady, constantly changing RVU compensation with Wizard of Oz presentations to the docs from corporate with these bizarre algorithmic formulas to explain the pay model is what turned me off that particular CMG.

Same I won’t work for Apollo at least other CMGs the pay is consistent
 
  • Like
Reactions: 1 users
That lawyer guy needs his cut. Their website it so shady. They talk about no outside ownership. Freakin hilarious. It’s accurate cause they leave out some very important and specific language to cover up their shadiness.

Valorbridge partners for the win.

Seemingly the founder is a lawyer from a rich family who was gifted some contracts and figured out multiple ways to screw em docs.

This Patterson NJ site is just the latest.
 
A couple of clarifications:

1. Each shop is run individually. So I can't comment on the Patterson NJ shop. What I've heard are the docs are very happy.

2. Do you think PA/NPs come for free? I've never had a negative return on APPs. In fact, I usually have a couple thousand generated each month from their patients. ApolloMD says they eat the cost of the screeners, but they have to be paid from somewhere.

3. The "administrative cost" is minimal when compared to other CMGs.

4. That lawyer that you're referring to was one of the founders of ApolloMD (he and an ER physician). ValorBridge was formed by him. The difference is that private equity didn't form ApolloMD or buy it out. He started branching out to other ventures and created ValorBridge. He rolled his shares of ApolloMD into ValorBridge.

I would ask that if you're going to comment, please make sure you have the facts straight before you post things.
 
  • Dislike
Reactions: 1 user
A couple of clarifications:

1. Each shop is run individually. So I can't comment on the Patterson NJ shop. What I've heard are the docs are very happy.

2. Do you think PA/NPs come for free? I've never had a negative return on APPs. In fact, I usually have a couple thousand generated each month from their patients. ApolloMD says they eat the cost of the screeners, but they have to be paid from somewhere.

3. The "administrative cost" is minimal when compared to other CMGs.

4. That lawyer that you're referring to was one of the founders of ApolloMD (he and an ER physician). ValorBridge was formed by him. The difference is that private equity didn't form ApolloMD or buy it out. He started branching out to other ventures and created ValorBridge. He rolled his shares of ApolloMD into ValorBridge.

I would ask that if you're going to comment, please make sure you have the facts straight before you post things.
Who Is this post pointed to? If me please let me know what I said wrong.
 
Apollo did the same thing to us during COVID. The APCs had their hours reduced to like 25% and the docs started getting these negative returns on their paychecks which turned out to be subsidized pay to cover the 75% missing APC compensation. I’m not actually sure if the director knew about it or not but the docs were absolutely not told about it until we brought it up. A lot of the shady, constantly changing RVU compensation with Wizard of Oz presentations to the docs from corporate with these bizarre algorithmic formulas to explain the pay model is what turned me off that particular CMG.

Did they ever recoup that money? Or did the docs have to subsidize the MLPs?
 
Unsure if you guys saw the Reddit thread about Apollo.. TLDR they are having their 1099 docs pay for the MLPs at their site in Patterson NJ. Someone mentioned this was the site that the old acep prez Rosenberg was part of.. Anyone know what happened with that contract? Did Apollo throw out a sdg or did the SDG sell?

Pretty sure they were hospital employed immediately prior to Apollo taking over. Rosenberg did used to be the Chair. I know people who worked there a few years ago and they were happy back then. It was a favorable RVU compensation model and some docs could make upwards of $270+/hour which is unheard of in NJ, especially with residents.

When Apollo took over it was something like $215/hour base and an RVU bonus. About 50% of docs get the RVU bonus afaik.

The company on all the contracts for the docs appears to be called Passaic River Physicians, LLC based in Georgia. Not sure why this has to be done but it’s probably not for the most pure reasons.
 
Last edited:
Often this is done for the contracts with insurers. I cant speak to them specifically in this instance. Do you know @GatorCHOMPions why the former private group lost their contract. Looks like Rosenberg left in 2021 and is doing palliative care.
 
Members don't see this ad :)
Sites have different company names/corporations for both malpractice risk as well as contract negotiations with insurers.

I'm not sure why people are up in arms about having to pay for APPs to do screening shifts or see patients. Does an SDG pull this off without having to pay for them? No, it comes out of doc's pockets with an SDG as well.

If you read that Reddit thread, there is a post about docs making up to $370/hr.
 
Sites have different company names/corporations for both malpractice risk as well as contract negotiations with insurers.

I'm not sure why people are up in arms about having to pay for APPs to do screening shifts or see patients. Does an SDG pull this off without having to pay for them? No, it comes out of doc's pockets with an SDG as well.

If you read that Reddit thread, there is a post about docs making up to $370/hr.

SDG keeps the books open if you have to pay for an APP from the group sure but then I need to know all the costs. And why are we comparing what does SDG does?

You can pay for a doc in triage? Why doesn’t the money come from the hospital?
 
SDG keeps the books open if you have to pay for an APP from the group sure but then I need to know all the costs. And why are we comparing what does SDG does?

You can pay for a doc in triage? Why doesn’t the money come from the hospital?
It does to a degree. Hospital subsidizes the SDG/CMG. Physicians pay the salaries of the APPs. Reading from that Reddit thread, it appears that the APPs in triage ordering stuff has increased throughput and physician productivity causing the docs to make more money.

There is all this CMG hate as if SDGs have this magical unicorn to allow things to happen without physicians needing to pay for it. The only contract reimbursement is from payers (insurance, self, etc.) or hospital subsidies. It all has to come from there whether you're an SDG or a CMG. The SDG reference came about because someone mentioned they were previously an SDG (either here or on Reddit).

For the record, ApolloMD has been very transparent with me with what costs go where. I can't speak for every contract, but the one where I work is very open and I cannot for one bit complain about my income, the amount taken off the top for administration/malpractice, etc.
 
Did they ever recoup that money? Or did the docs have to subsidize the MLPs?

Nope. In fact, now that recollection serves, I think this was a decision that the FMD made and didn’t inform the group, so it just showed up in our paychecks and we were never given an option. I think CMG told him he could lay off some MLPs or subsidize their salary with the physician pay so he/she went with the latter.

Super lame. It was about $5K taken out of my paycheck every month.
 
  • Wow
Reactions: 1 user
Nope. In fact, now that recollection serves, I think this was a decision that the FMD made and didn’t inform the group, so it just showed up in our paychecks and we were never given an option. I think CMG told him he could lay off some MLPs or subsidize their salary with the physician pay so he/she went with the latter.

Super lame. It was about $5K taken out of my paycheck every month.
So this wasn't a corporate decision but the facility medical director's decision instead of asking the group to vote on it?
 
So this wasn't a corporate decision but the facility medical director's decision instead of asking the group to vote on it?
Correct. At least that was the impression when the FMD explained everything. We def were not informed or asked to vote on the issue. I was the AFMD and didn’t even know about it. I think the reason it flew so easily is that COVID introduced so many unknowns into everything and we were very new into the pandemic and nobody knew what to expect. None of us wanted to mass fire the MLPs because of sudden volume loss 2/2 COVID. I don’t have a moral problem with what went down but I’m still very pissed that the decision was made without our input.
 
Often this is done for the contracts with insurers. I cant speak to them specifically in this instance. Do you know @GatorCHOMPions why the former private group lost their contract. Looks like Rosenberg left in 2021 and is doing palliative care.

I’m fairly certain it wasn’t a private group within the last handful of years, but instead hospital employment directly by St. Joe’s. I’m not sure why they’d get Apollo to manage the ER recently. There is probably an interesting reason and/or backstory, though.
 
  • Like
Reactions: 1 user
Sites have different company names/corporations for both malpractice risk as well as contract negotiations with insurers.

I'm not sure why people are up in arms about having to pay for APPs to do screening shifts or see patients. Does an SDG pull this off without having to pay for them? No, it comes out of doc's pockets with an SDG as well.

If you read that Reddit thread, there is a post about docs making up to $370/hr.
I think the fact that per the post none of the docs knew this was happening is the issue. Also, you are real smart. You can’t compare the 2. Apollomd could take a smaller profit or they could shove it in the doctors face.

The income thread makes me happy. I’m happy that there are em docs making $300+. I think we should be at $400 at a minimum if at a busy shop. I get economics don’t always work but that’s what I think we are worth.
 
  • Like
Reactions: 1 users
I'm not sure why people are up in arms about having to pay for APPs to do screening shifts or see patients. Does an SDG pull this off without having to pay for them? No, it comes out of doc's pockets with an SDG as well.
Not sure, is this even a serious question? Your starting to sound like a variable life salesman trying to justify his high commission that was never told to the buyer.

These line docs are not owners. You think Ford can buy a new fandango gadget to make line worker's job more efficient and just deduct this from their hourly rate? The UAW would be in arms if there was a never discussed $5/hr deduction for "efficient" machine.

I can't speak for the legalities b/c the contracts are written always in employers favor, but this opens things up for serious abuse of power.

Whats next? Deduction for a new EMR, scribe, overhead paging system, scheduling program?
 
  • Like
Reactions: 5 users
There is all this CMG hate as if SDGs have this magical unicorn to allow things to happen without physicians needing to pay for it
The magic unicorn is the fact that as a SDG, we know/voted/discussed before having the unicorn show up as a surprise on my paycheck.
 
  • Like
Reactions: 6 users
Nope. In fact, now that recollection serves, I think this was a decision that the FMD made and didn’t inform the group, so it just showed up in our paychecks and we were never given an option. I think CMG told him he could lay off some MLPs or subsidize their salary with the physician pay so he/she went with the latter.

Super lame. It was about $5K taken out of my paycheck every month.

This is something that USACS wouldn't even dare doing.
 
  • Like
Reactions: 1 user
The argument that some of these assets don’t pay for themselves is kind of laughable with a CMG. We’ve seen the open books with the APP implosion and docs were generating on average $165/pt. I work in a 2.5 PPH shop. So, I earn about $412.5/hr yet I’m paid ~$250/hr. Now, you can argue that there’s malpractice insurance, coding/billing, all the usual corporate expenses to keep the company afloat. But seriously….you can’t pay the APCs? You can’t pay for my scribes? You can’t pay for my state medical licenses? After taking 40% of my income…you’re suddenly so strapped that zero percent of this money can come out of the corporate coffers and it absolutely must be taken out of the local physician group revenue? Give me a break. The cost of the APC screening shifts is hilarious considering most of these shifts are minimal compared to their usual productivity shifts. These are healthcare providers who are billing for gobs of money and probably having over 80% of their revenue taken by the corporation. My wife works in FM/IM and gets these RVU bonuses and it will say how many millions of dollars have been charged per year. I think hers was 2 million+ revenue captured and yet this is a NP making 200K/yr. EM can’t be too different.
 
  • Like
Reactions: 5 users
yes open books is the answer to this.

We elected, during the darkest Covid doldrums to keep our PAs (mostly hourly) in stead of firing them, understanding the lack of volume will make them a cost sink and thus cut bonuses/ salaries of the physicians. Of course we canned OT and cut hours back to bare bone baseline. But we met and agreed we didn’t want to fire a Pa who’d worked with us for years and braved a horrid first wave of Covid for 1-2mo of minimal salary reduction to the docs.

But we did this with wide open eyes and discussion, which is key. Volume came back, and we went back to normal.
 
  • Like
Reactions: 1 users
The argument that some of these assets don’t pay for themselves is kind of laughable with a CMG. We’ve seen the open books with the APP implosion and docs were generating on average $165/pt. I work in a 2.5 PPH shop. So, I earn about $412.5/hr yet I’m paid ~$250/hr. Now, you can argue that there’s malpractice insurance, coding/billing, all the usual corporate expenses to keep the company afloat. But seriously….you can’t pay the APCs? You can’t pay for my scribes? You can’t pay for my state medical licenses? After taking 40% of my income…you’re suddenly so strapped that zero percent of this money can come out of the corporate coffers and it absolutely must be taken out of the local physician group revenue? Give me a break. The cost of the APC screening shifts is hilarious considering most of these shifts are minimal compared to their usual productivity shifts. These are healthcare providers who are billing for gobs of money and probably having over 80% of their revenue taken by the corporation. My wife works in FM/IM and gets these RVU bonuses and it will say how many millions of dollars have been charged per year. I think hers was 2 million+ revenue captured and yet this is a NP making 200K/yr. EM can’t be too different.

This should be stickied.

From everything I've read on this message board for the last several years...it shouldn't cost more than ~15% of revenue to run an ER group...this includes malpractice, contracts, admin, scheduling, coding/billing, scribes, legal, definitely not more than 20%.

When I was at a TH site, they were taking 10% right out for their profit. Then they took another 25-30% for all the services above.
 
  • Like
Reactions: 3 users
This should be stickied.

From everything I've read on this message board for the last several years...it shouldn't cost more than ~15% of revenue to run an ER group...this includes malpractice, contracts, admin, scheduling, coding/billing, scribes, legal, definitely not more than 20%.

When I was at a TH site, they were taking 10% right out for their profit. Then they took another 25-30% for all the services above.
In some ways this is just the business of medicine and capitalism in general. On the Pain Med side of things in private practice where it's purely money in and money out via collections the typical offers in desirable areas are something like 30-35% collections (with a base salary the first couple of years) with no mention of eventual partnership. Some especially "aggressive" owners were offering even lower than that. In less desirable areas you get 40-50% collections and maybe a promise of partnership down the road. It's all supply and demand. The overhead I hear quoted for most practices is something like 40% on average, maybe even 35% if you are super lean. Sometimes it is higher if you're marketing hard or special circumstances like part of an orthopedic group.

I'm a hospital employed pain doc and I know for a fact they are making huge $$$ off my back with the facility fees for procedures and downstream revenue for all the MRI and PT I order. I am paid below average RVUs because I am in a highly desirable and saturated area. In the end it is again supply and demand and I had to just take it because I have to/want to live here.

Everyone wants their pound of flesh, and to an extent I get it. As ER docs we are not bringing the patients in. They are coming because of the brand and/or location of the hospital. The hospitals *should* get some piece of the profit pie for this aspect. They will give doctors what supply and demand dictates. It sucks but this is just the way it is.

One argument can be made that if only the contracts from CMGs were given back to the doctors pay would be fairer. To that I'll point out an example of the SDG I do per diem at. They are literally the only one in a hugely population dense area. Pay for pre-partners is LOWER BY A MILE than any surrounding CMG, and yet they just hired a couple new grads (fortunately pay for per diem is fine). And the partnership is FIVE YEARS. And only a handful of the couple dozen docs are actual voting rights partners, the rest are "junior partners" that get some profit sharing and extra retirement benefits. The super partners do this because they can. If magically all CMGs disappeared and were replaced by SDG's my bet is the pay would rise but marginally, and you'd have the situation I described above with the super partners/junior partners/pre-partners pyramid in the population dense areas. Why offer everyone equal (above average) pay when you don't necessarily have to. I can't speak to other regions of the country but around where I am medicine is a dog-eat-dog world. You'd still have the natural drift back to supply and demand, and human instinct to get yours by the ones lucky enough to inherit the power.
 
  • Like
Reactions: 1 user
This should be stickied.

From everything I've read on this message board for the last several years...it shouldn't cost more than ~15% of revenue to run an ER group...this includes malpractice, contracts, admin, scheduling, coding/billing, scribes, legal, definitely not more than 20%.

When I was at a TH site, they were taking 10% right out for their profit. Then they took another 25-30% for all the services above.
You can do contracts, admin, scheduling, coding/billing / legal, HR, and admin your retirement accounts for 15% or less. Probably 12%.

If you employee the PAs, but also take the profit they make… its going to “cost” more (this can be 5-10% of revenue depending how many PAs you have) but of course unlike scheduling this cost feeds you $ right back. As such I like to separate it in my mind when I think about “overhead”.

As well, if your group is letting you throw money in a 403b and 457b, I don’t count this as “overhead” since it is going to you… it could be a significant % of your revenue.

The only one that messes up your math is malpractice. In certain parts of the country this can easily be 30k/yr per doc. Which could easily be 5% of the revenue. So YMMV, very dependent on location and nature of insurance.
 
  • Like
Reactions: 1 users
In some ways this is just the business of medicine and capitalism in general. On the Pain Med side of things in private practice where it's purely money in and money out via collections the typical offers in desirable areas are something like 30-35% collections (with a base salary the first couple of years) with no mention of ...

yea I ... sure. I think every employee should learn how much they contribute to a business and how much they are paid.
It's quite hard to do for most employees in businesses (e.g. software engineers, assistants, etc).
It is particularly easy for ER where revenues and costs can be easily calculated and apportioned to the docs within a practice.
 
  • Like
Reactions: 1 users
You can do contracts, admin, scheduling, coding/billing / legal, HR, and admin your retirement accounts for 15% or less. Probably 12%.

If you employee the PAs, but also take the profit they make… its going to “cost” more (this can be 5-10% of revenue depending how many PAs you have) but of course unlike scheduling this cost feeds you $ right back. As such I like to separate it in my mind when I think about “overhead”.

As well, if your group is letting you throw money in a 403b and 457b, I don’t count this as “overhead” since it is going to you… it could be a significant % of your revenue.

The only one that messes up your math is malpractice. In certain parts of the country this can easily be 30k/yr per doc. Which could easily be 5% of the revenue. So YMMV, very dependent on location and nature of insurance.

Yea this is basically what I said. 15%. I think for inefficient groups it might be more than 15%, and for really efficient groups it might be less than 10%, but not by much.

The fact is that these CMGs that take 30-40% of revenue when it can be done for 1/2 it speaks to just how much docs are duped.

The hardest part I reckon is getting contracts with private insurers.
 
  • Like
Reactions: 1 user
Yea this is basically what I said. 15%. I think for inefficient groups it might be more than 15%, and for really efficient groups it might be less than 10%, but not by much.

The fact is that these CMGs that take 30-40% of revenue when it can be done for 1/2 it speaks to just how much docs are duped.

The hardest part I reckon is getting contracts with private insurers.
Janders was agreeing with the general cost being 15% or less, NOT including malpractice. As he said, in some parts of the country it's 30k/doc/yr. In that scenario, assume you bring in 600k raw revenue a year. You pay your 15% for costs, and then pay your 30k malpractice, which at 600k revenue amounts to another 5% for a grand total of 20% in costs.

To be clear, I agree that CMGs are clearly taking way more than necessary simply to line their own pockets. That said, having a realistic understanding of the underlying costs is important. Including malpractice costs, many practices, even efficiently run ones, are looking at something closer to 20% for the aforementioned costs.
 
  • Like
Reactions: 2 users
Generally speaking as a rule of thumb its about 20% overhead for all the administrative costs.

So for those that see 3 PPH at 150 PP that still comes to about 350/hr rate left over for the docs.
 
  • Like
Reactions: 2 users
Top