"Doctors’ spat with Atrium Health spills into rare public view"

[skypilot]

Mecklenburg Medical Group doctors sue Atrium Health to break away from hospital system

Monday, April 2nd 2018, 11:07 am EDTMonday, April 2nd 2018, 12:40 pm EDT

Mecklenburg Medical Group doctors sue Atrium Health to break away from hospital system

Wow, in both cases it seems like physicians banding together and saying "enough!" Usually we are led like sheep to the slaughter by these AMCs and corporate executives. We are too busy trying to keep our heads above water practicing medicine to put up much of a fight.

Don't forget this all started with a sellout to an AMC. Now doctors in Charlotte are going to have to fight like hell to get their autonomy and respect back. Seems like a losing battle almost everywhere else in the country.

And 4:1 already sucks. Thank you Mednax and Southeast. It is just a question of going from awful to more awful.

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[GA8314]

"Though purporting to be a non-profit institution, Atrium — with its bloated management bureaucracy — has repeatedly complained and contended that it 'loses' millions of dollars on the MMG physicians each year," the suit says, adding that Atrium has refused to release the doctors from their restrictions.

Those are fighting words..... Oh boy...

 

[gasdoc77]

Finally! Doctors uniting in response to the oppressive, anti-competitive divide-and-conquer approach of their "managers". It's about d*&n time. The best and brightest have had enough with being told when, where, and how to practice by the c-students that went on to be administrators because they were the best at beer pong in their frat house (or the AMC chiefs who climbed the ladder simply by being the most unscrupulous doc out of the bunch).
On that note, take the latter part of the last sentence into consideration during negotiations if a head AMC doc says “approximately, about, or trust me”.

 

[ncdoc1974]

 

[Noyac]

In case someone wants to read the entire article:

Atrium Health punches back, countersues as fight over lost medical contract escalates

 

[jwk]

Gonna be fascinating to watch this unfold over the next few months.

 

[ERRES2288]

So what do the docs actually want? For their non compete to be waived and work for Scope? To continue working for Mednax with the contract at Atrium? Or to contract directly as Southeast again ?

 

[zero0]

Well poop.

I grew up in Charlotte, strong roots there, was kinda hoping to go back eventually. Hope this doesn't kill the anesthesia job market there.

 

[VA Hopeful Dr]

Well poop.

I grew up in Charlotte, strong roots there, was kinda hoping to go back eventually. Hope this doesn't kill the anesthesia job market there.

Lots of jobs in the surrounding area if you don't mind being an hour or two away.

 

[Scotty_G]

It's hard to feel bad for any of them.

 

[Dr.whom]

Perhaps a bright side to this fiasco is that hospital administrators around the country will look at this and think twice about partnering with AMCs based on their promises.

 

[Mman]

Perhaps a bright side to this fiasco is that hospital administrators around the country will look at this and think twice about partnering with AMCs based on their promises.

the CEO of our main hospital personally spoke with us about this exact situation and why he was happy to not have to deal with that sort of thing

 

[Man o War]

Hospital says 50 anesthesiologists who worked for southeast anesthesia filed complaints with the state based on medical ethics, and the hospital was concerned about interruption of services over pay disputes between Mednax and the anesthesiologists.
What a mess. Not a good look for the AMC at all.

 

[Consigliere]

Perhaps a bright side to this fiasco is that hospital administrators around the country will look at this and think twice about partnering with AMCs based on their promises.

HAHAHAHAHAHA! Thanks for the laugh; I needed that.

 

[aneftp]

I’ve been saying this all along. Because we keep pushing the limits and keep stretching staffing models. As long as the ship stays afloat. All these consultants will keep preaching about “efficency”

What needs to happen is for all the docs to just walk. (Likely not possible since many people got bills to pay) Let the whole hospital operation room system sink. Yes. Let it sink. Before the public realizes how much greed there is. Mednax. Atrium etc.

We all know it’s 99% BS when they say “in the best interest of patient care”. It’s not. It’s about money. Always has been.

Bottom line. We have to let the system fail before administrations wake up and realize hospital based health care cannot be run like a normal business. U can fudge and cherry pick outpatient surgery but not hospital based practices.

 

[deleted126335]

It's hard to feel bad for any of them.

Don't know anything about the players there, but, I don't think that's fair. I am sure that there are plenty of docs there that were always worker bees who never got to be owners. I am rooting for them, but they are least likely to come out on top. The issues for them will be: Who will be signing their paycheck? Do they have to relocate due to an enforced noncompete? Will things get uglier for them when this gets resolved?

 

[Dr.whom]

HAHAHAHAHAHA! Thanks for the laugh; I needed that.

Is it so farfetched to think that hospital administrators would look out for their own self-interest?

If this battle gets messy and national news outlets start reporting on it, all eyes will be on AMCs' business models. If its true that AMCs are billing out of network to increase revenue (they do have to pay their administrators and CEOs and their stocks must increase somehow), then a big public battle like this could be the beginning of the end of them.

 

[nimbus]

Is it so farfetched to think that hospital administrators would look out for their own self-interest?

If this battle gets messy and national news outlets start reporting on it, all eyes will be on AMCs' business models. If its true that AMCs are billing out of network to increase revenue (they do have to pay their administrators and CEOs and their stocks must increase somehow), then a big public battle like this could be the beginning of the end of them.

Out of network billing has been going on since PPOs were invented. Doubt this will change anything.

 

[deleted162650]

Out of network billing has been going on since PPOs were invented. Doubt this will change anything.

This is true, but the game has changed with today's crazy high deductibles and co-pays. When patients get hit with large outta network bills from specialists which they had no say in selecting they get pissed. When they get pissed they complain to the hospital. The hospital then puts pressure on the docs to stop it 'cuz they don't wanna lose business to the hospital across town.

 

[Dr.whom]

Exactly.

Occasional out of network billing is normal in this business. But if their model is to deliberately stay out of network so that they can bill the patient more, it will piss off the patients and the hospital.

If I was a patient and I go to a hospital that takes my insurance, but then gets hit by a large out of network bill from a specialist working in that hospital, I'd be very pissed off.

 

[Man o War]

The out of network thing is problematic now post ACA in cases of things that are covered as preventive and not subject to out of pocket costs. In this case, I saw a patient they interviewed who said she had a colonoscopy at Atrium, owed zero because it was considered preventive, but Mednax charged her $600 something bucks for the sedation. So zero out of pocket from everyone except anesthesia.
That’s going to generate complaints for sure.

 

[Noyac]

This is true, but the game has changed with today's crazy high deductibles and co-pays. When patients get hit with large outta network bills from specialists which they had no say in selecting they get pissed. When they get pissed they complain to the hospital. The hospital then puts pressure on the docs to stop it 'cuz they don't wanna lose business to the hospital across town.

This is very true but not all OON docs are bad. Frequently, the group or docs are OON because the insurance co wouldn’t negotiate fairly with them. This was an effective way of getting the ins co and the docs to come to the table. But as time went on, many greedy docs realized that they could just remain OON and make bank. This is where the system fell apart and the docs that were OON got a bad name. Now this has spoiled it for the rest. Now the ins co’s are lobbying for OON legislation. In my state (Colorado) there was a great push to eliminate OON billing and to just make the ins co pay a little over CMS rates. That was nuts. That would have put all of the control in the hands of the ins co’s and rates would have dropped across the board. We managed to halt the legislation. Now the docs still have some negotiating power. But there will need to be some sort of common sense legislation (I know that’s an oxymoron). Something like 3X CMS rates for OON bills.

 

[Man o War]

This is very true but not all OON docs are bad. Frequently, the group or docs are OON because the insurance co wouldn’t negotiate fairly with them. This was an effective way of getting the ins co and the docs to come to the table. But as time went on, many greedy docs realized that they could just remain OON and make bank. This is where the system fell apart and the docs that were OON got a bad name. Now this has spoiled it for the rest. Now the ins co’s are lobbying for OON legislation. In my state (Colorado) there was a great push to eliminate OON billing and to just make the ins co pay a little over CMS rates. That was nuts. That would have put all of the control in the hands of the ins co’s and rates would have dropped across the board. We managed to halt the legislation. Now the docs still have some negotiating power. But there will need to be some sort of common sense legislation (I know that’s an oxymoron). Something like 3X CMS rates for OON bills.

I agree with this. Given the abysmal CMS reimbursement for anesthesia, I get it. My understanding is, this is standard operating procedure for many AMCs, not sure how much they even try to negotiate for lower rates with insurance companies anymore.

 

[BLADEMDA]

This is very true but not all OON docs are bad. Frequently, the group or docs are OON because the insurance co wouldn’t negotiate fairly with them. This was an effective way of getting the ins co and the docs to come to the table. But as time went on, many greedy docs realized that they could just remain OON and make bank. This is where the system fell apart and the docs that were OON got a bad name. Now this has spoiled it for the rest. Now the ins co’s are lobbying for OON legislation. In my state (Colorado) there was a great push to eliminate OON billing and to just make the ins co pay a little over CMS rates. That was nuts. That would have put all of the control in the hands of the ins co’s and rates would have dropped across the board. We managed to halt the legislation. Now the docs still have some negotiating power. But there will need to be some sort of common sense legislation (I know that’s an oxymoron). Something like 3X CMS rates for OON bills.

The common sense solution is that if you are OON the physician should be allowed to collect 120 percent of their highest in network payer. If the physician doesn't have any in network payers then the insurance company must pay the highest rate they allow in network based in that State.

 

[nimbus]

This is true, but the game has changed with today's crazy high deductibles and co-pays. When patients get hit with large outta network bills from specialists which they had no say in selecting they get pissed. When they get pissed they complain to the hospital. The hospital then puts pressure on the docs to stop it 'cuz they don't wanna lose business to the hospital across town.

Exactly.

Occasional out of network billing is normal in this business. But if their model is to deliberately stay out of network so that they can bill the patient more, it will piss off the patients and the hospital.

If I was a patient and I go to a hospital that takes my insurance, but then gets hit by a large out of network bill from a specialist working in that hospital, I'd be very pissed off.

You are both correct in this day and age.

Back in the late 90s I considered a small 7 person practice in a mountain resort town on the Ca-Nv border. A significant proportion of their practice was out of town, out of network tourists. They were paying 2-3x the other offers I got at that time. Their business model was based on OON billing.

Unlike Colorado, California has passed AB72 which limits OON billing to 125% of Medicare. If it is upheld against multiple challenges in the courts, it will have severe consequences for both in network contracting and out of network payments. At least it will keep the AMCs away if that is indeed their business model.

 

[Mman]

The common sense solution is that if you are OON the physician should be allowed to collect 120 percent of their highest in network payer. If the physician doesn't have any in network payers then the insurance company must pay the highest rate they allow in network based in that State.

While that'd be nice for us, I wouldn't say it's common sense because then the physician will never agree to a contract for less than 20% higher than their best contract rate. That's not exactly fair either.

 

[skypilot]

you can lure in the scabs with good Locums pay, but that will only be sustainable for the short term. i would bet that this won't go very well for any of the parties involved. we'll see how it all plays out.

If you were a big corporation and you wanted to break an Anesthesiologist strike with scabs, what new law would you be promoting?

Thats right, the "Interstate Medical Licensure Compact" would make it easy for an AMC or Hospital Medical Mega Group to bring in lots of doctors from out of state to break a strike quickly. That is just one more reason to vote against it, if you can. See the thread below.

More MOC Garbage

 

[Hiram Coggin]

The deal is sealed.

Mednax is out, Scope is in.

ATRIUM HEALTH COURT RULING:Court agrees with Atrium rejecting attempt to disrupt transition to new partner

 

[IMGASMD]

The deal is sealed.

Mednax is out, Scope is in.

ATRIUM HEALTH COURT RULING:Court agrees with Atrium rejecting attempt to disrupt transition to new partner

Is Scope part of Atrium Health?

 

[Mman]

Is Scope part of Atrium Health?

no.

Scope is 1 guy. He got hired to consult for Atrium Health about their anesthesia services because they were considering getting rid of Mednax. They said, hey let's just give you the job. So he created a company to hire a bunch of docs to work for him at Atrium's locations. I believe that Atrium is paying him $x per doc and then he gets to keep the savings if he can hire them cheaper than what he is being paid by Atrium (i'm about 95% sure that's the model).

 

[IMGASMD]

Thanks. I thought I heard somewhere along the thread that Scope is basically hospital (Atrium) owned company. Maybe I am mistaken. I guess job openings in NC either way.....

 

[ERRES2288]

Wow looks like they aren’t hiring any of the Mednax folks either. I wonder how they recruited so many physicians there so fast? Must have been some good $$

 

[Hiram Coggin]

no.

Scope is 1 guy. He got hired to consult for Atrium Health about their anesthesia services because they were considering getting rid of Mednax. They said, hey let's just give you the job. So he created a company to hire a bunch of docs to work for him at Atrium's locations. I believe that Atrium is paying him $x per doc and then he gets to keep the savings if he can hire them cheaper than what he is being paid by Atrium (i'm about 95% sure that's the model).

Thanks. I thought I heard somewhere along the thread that Scope is basically hospital (Atrium) owned company. Maybe I am mistaken. I guess job openings in NC either way.....

Scope is a puppet for Atrium.

Scope is purported to be "physician" owned. I guess it is, but it is one guy who is picked by Atrium.

 

[Mman]

Wow looks like they aren’t hiring any of the Mednax folks either. I wonder how they recruited so many physicians there so fast? Must have been some good $$

aren't the Mednax docs still under a noncompete that prevents them from working there? I mean I know they are and I'm not aware of any legal resolution to that which would allow them to get hired by the new entity.

And how do you recruit so many physicians? I'm guessing by being less than truthful with what their compensation and/or call schedules will be.

 

[IMGASMD]

aren't the Mednax docs still under a noncompete that prevents them from working there? I mean I know they are and I'm not aware of any legal resolution to that which would allow them to get hired by the new entity.

And how do you recruit so many physicians? I'm guessing by being less than truthful with what their compensation and/or call schedules will be.

Locum opportunities? Hire someone who has the balls to take on 1:8 in this chaotic situation? Is this the first fall out of AMC on this scale 100+ anesthesiologists?

 

[caligas]

I’m sure someone else can chime in that knows more but there are still issues being worked out in court including enforcement of the non compete. I believe many of the “hires” are current Southeast docs. A recent similar case in Greensboro resulted in a judge ruling non compete can’t be enforced due to needs of the community, not a lawyer but I’m guessing that helps their case in CLT.

 

[AdmiralChz]

Don’t feel bad for mednax who played their hand (actually very well in the PR arena) but lost. I would feel bad for the docs who worked for them though - many have been in the area for years and if the non-compete isn’t negated they will have to move away or seek locums for 2-3 years... Even the press release says the non-compete is being enforced and they won’t be hired by Atrium.

 

[Shimmy8]

I’d be willing go work a couple weeks locum...wonder how much pay is?

 

[Man o War]

I’d be willing go work a couple weeks locum...wonder how much pay is?

Make sure you add the “dumpster fire” upcharge to your asking price. That place will be a mess for a while I predict.

 

[Mman]

Make sure you add the “dumpster fire” upcharge to your asking price. That place will be a mess for a while I predict.

it's also a massive level 1 trauma center that does things like liver transplants and has 3 pediatric heart surgeons. I'm sure that change over will go well on day 1.

 

[deleted126335]

I’ll bet that they cut a deal for the pediatric cardiac anesthesiologists who are currently there.

 

[Man o War]

it's also a massive level 1 trauma center that does things like liver transplants and has 3 pediatric heart surgeons. I'm sure that change over will go well on day 1.

Nuts.

 

[Man o War]

If any of you go there, take it from the guy who did a short locums stint with an AMC- get it in writing what your max supervision ratio is and refuse to deviate from that. There is no worse feeling than having a bunch of incompetent, dangerous CRNAs you don’t know at all running wild on your license.

 

[nimbus]

The deal is sealed.

Mednax is out, Scope is in.

ATRIUM HEALTH COURT RULING:Court agrees with Atrium rejecting attempt to disrupt transition to new partner

I’m sure someone else can chime in that knows more but there are still issues being worked out in court including enforcement of the non compete. I believe many of the “hires” are current Southeast docs. A recent similar case in Greensboro resulted in a judge ruling non compete can’t be enforced due to needs of the community, not a lawyer but I’m guessing that helps their case in CLT.

“We respect the court’s decision that prevents Scope and Atrium Health from hiring Southeast Anesthesiology Consultants’ physicians for a temporary period. We have consistently expressed our interest in providing an opportunity for these valued doctors to remain a part of our community and continue practicing at Atrium Health. We regret that Mednax refused to consider releasing Southeast Anesthesiology Consultants’ anesthesiologists from Mednax’s agreements. Nonetheless, this requirement of the court will have no impact on Atrium Health and the transition to Scope Anesthesia on July 1, since Scope has filled its roster with eminently talented physicians. Given the caliber and experience of anesthesiologists we have been able to recruit, Atrium Health and Scope made clear at the hearing there are no current plans to try to hire Southeast Anesthesiology Consultant physicians.”

 

[WholeLottaGame7]

I’ll bet that they cut a deal for the pediatric cardiac anesthesiologists who are currently there.

Nope.

 

[AdmiralChz]

I’ll bet that they cut a deal for the pediatric cardiac anesthesiologists who are currently there.

It’s somewhat rare that Peds cardiac people work for AMCs (more children’s hospital employees or academics), but they are here and are getting the same no-deal as the others.

 

[Noyac]

I’d be willing go work a couple weeks locum...wonder how much pay is?

Don’t be stupid.
Let this dog rest a while.
It won’t matter one bit how much they pay you in the end but the repercussions could.
One lawsuit, that’s all it takes.
In situations like this people are angry. If something goes less than planned then who knows what the surgeons, other OR staff and anyone else might do.
Stay clear of this situation.

 

[pgg]

Don’t be stupid.
Let this dog rest a while.
It won’t matter one bit how much they pay you in the end but the repercussions could.
One lawsuit, that’s all it takes.
In situations like this people are angry. If something goes less than planned then who knows what the surgeons, other OR staff and anyone else might do.
Stay clear of this situation.

That's an interesting point. Thanks.

 

[anbuitachi]

it sure must be easy to hire anesthesiologists these days. they sure filled those positions quickly

 

[deleted126335]

Don’t be stupid.
Let this dog rest a while.
It won’t matter one bit how much they pay you in the end but the repercussions could.
One lawsuit, that’s all it takes.
In situations like this people are angry. If something goes less than planned then who knows what the surgeons, other OR staff and anyone else might do.
Stay clear of this situation.

All true. But great risks sometimes entail great rewards.
https://www.annemergmed.com/article/S0196-0644(17)30196-8/pdf?code=ymem-site

Word on the street that locum/scab/mercenary/under employed/exploited docs were getting $1,000/hr for a while. I have no idea if true. Just what I was told. No idea what July 1 will look like in Charlotte and what rate for what work in what subspecialty will be available. When younger, I would have at least taken a look.