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

[deleted171991]

And what hard lesson is that? That it's ok to have immeasurable patient harm during Corporate warfare? Or that there are no consequences to replacing several dozens of Physicians in one fell swoop?

When the last AMC rolled into town and took our contract we had 15 PDPH and 5 Endo codes in less than two weeks as they sicced their hoards of Mercenary CRNA and Assasin sRNAs during the "Transition".

It's not in the interest of the Hospital or Scope to advertise complications. Those of us that are involved in Staffing know that it takes several years to safely turn over that many Docs. The Lawyers will do the rest now (LOTS of Settlements).

And did that result in even one newspaper article? Five endo patients almost dying is a huge deal. Did anybody have the guts to blow the whistle and go on TV about it? Did patients protest and refuse to go to the hospital? Did the hospital lose millions because of it? I assume no.

It's all about money. Unless you make them bleed money, by having them lose business, you can bark all you want, you little puppy. Welcome to crony capitalism. You ain't seen nothing yet.

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[Notascab]

That would be pure speculation...... but my best guess is that most of the partners wherein mid 50's.... Obamacare was a significant threat to future reimbursements and income, the buyout was probably in the form of selling stock instead of ordinary income so there was a tax benefit and the partners may/maynot have looked at all the "future" partners in the pipeline that were going to dilute their future earnings...... got tired of the constant threats by the hospital and thought they were better protected. Pure speculation on my part. Could be all or one of the above or none.

 

[Mman]

I have heard 4th hand rumors that Mednax is going to get out of the anesthesia business. Not all at once, but they are going to stop supporting their locations and just gradually let their contracts not be renewed when the hospitals get tired of them.

 

[deleted162650]

I have heard 4th hand rumors that Mednax is going to get out of the anesthesia business. Not all at once, but they are going to stop supporting their locations and just gradually let their contracts not be renewed when the hospitals get tired of them.

Making way for the 2nd golden age of PP Anesthesia.

The more things change, the more they stay the same.

 

[GravelRider]

Back up plans and FI are important..... I guess the argument would be to homeschool your kids, don't get involved in your community, don't buy a house, and don't contribute to the local economy wherever you live.

Yes. That is the prevailing wisdom today. Mobility is probably one of the most important traits in the economy today...not just anesthesiology. We used to think medicine was immune to “corporate restructuring” and massive layoffs. Guess what, it’s not. My engineer friend was laid off not too long ago during a similar event. He collected unemployment for 6 months while he put his house up for sale and moved his family 2 states away for a new job. He’s already getting scares about it happening again. He’s a smart dude with a Master’s degree. No one is immune, not even doctors. The best you can do is insulate yourself well enough so it doesn’t hit as hard when it happens to you. Stop contributing to the consumer economy and start hoarding like Ebenezer Scrooge. We can whine and philosophize about the demise of medicine as we know it or we can be a realist and prepare for the worst. Quality of care metrics will always take a backseat to dollar metrics. It is what it is. Whatever happened at this place (I haven’t followed too closely) is just a good reminder at what can happen anywhere.

 

[BLADEMDA]

Making way for the 2nd golden age of PP Anesthesia.

The more things change, the more they stay the same.

Or, Envision, Team health, Northstar or countless other AMCs "low ball" the contract then work the existing staff like indentured servants. I don't see the other players going quietly into the night but rather increasing market share. As long as AMCs can BILL private insurance carriers at double what my old group was able to these players aren't going anywhere.

Ironically, the Medicare Option is the only thing I see putting these companies out of business. I doubt the politicians will pass a law stating private groups must be allowed to collect 80% of the reimbursement of national companies.

The playing field isn't level as the insurance companies only respect economies of scale.

 

[GravelRider]

Making way for the 2nd golden age of PP Anesthesia.

The more things change, the more they stay the same.

Nope. Hospital employment or some bastardized version of it is what comes next. Hospitals...especially large systems...are sick of dealing with outside contractors, whether that be AMCs or private practices. We will continue to see small private hospitals integrated into larger regional systems. As the consolidation continues, every aspect of care will be kept within the system. Everything from primary to referral care to ancillary services like labs. They will tout greater efficiency and costs savings while they dominate the local market and charge higher rates to insurance companies (and patients). There is no more golden age of medicine.

 

[nimbus]

There are people on this board who say they and their friends will fight the AMCs and take contracts away from AMCs. This is what it looks like.

Remember Scope wanted to retain the existing doctors and CRNAs and offered work to them. There is no doubt their preference was to keep the vast majority of the existing staff from Mednax. It is Mednax that refused to release them from their noncompete. Really that was the only leverage that Mednax had; it was that or rolling over. If Mednax had the best interests of their employees in mind, they would have released them. But they don’t. They are not blameless. Neither are the old SEA doctors who invited Mednax into their community. This outcome was very predictable.

It’s always tough to be the new guy. You don’t know local routines, practices and customs. You don’t know the surgeons and staff you are working with. A brand new anesthesiologist should not be expected to perform as smoothly as someone who has been part of the same team for 10, 15, or 20 years. Anyway, in a year or 2, it will be business as usual. The old Mednax crew will be forgotten and life will go on.

 

[nimbus]

And did that result in even one newspaper article? Five endo patients almost dying is a huge deal. Did anybody have the guts to blow the whistle and go on TV about it? Did patients protest and refuse to go to the hospital? Did the hospital lose millions because of it? I assume no.

It's all about money. Unless you make them bleed money, by having them lose business, you can bark all you want, you little puppy. Welcome to crony capitalism. You ain't seen nothing yet.

Even if it made the papers, it wouldn’t make a difference. The deal is done, people will forget, and life will go on.

 

[Mman]

Or, Envision, Team health, Northstar or countless other AMCs "low ball" the contract then work the existing staff like indentured servants. I don't see the other players going quietly into the night but rather increasing market share. As long as AMCs can BILL private insurance carriers at double what my old group was able to these players aren't going anywhere.

Ironically, the Medicare Option is the only thing I see putting these companies out of business. I doubt the politicians will pass a law stating private groups must be allowed to collect 80% of the reimbursement of national companies.

The playing field isn't level as the insurance companies only respect economies of scale.

Those AMCs might not go quietly into the night, but the hospitals themselves will be getting rid of them over time. I'd bet within 20 years that 80+% of jobs will be hospital employees or private groups.

 

[narcotics999]

Or, Envision, Team health, Northstar or countless other AMCs "low ball" the contract then work the existing staff like indentured servants. I don't see the other players going quietly into the night but rather increasing market share. As long as AMCs can BILL private insurance carriers at double what my old group was able to these players aren't going anywhere.

Ironically, the Medicare Option is the only thing I see putting these companies out of business. I doubt the politicians will pass a law stating private groups must be allowed to collect 80% of the reimbursement of national companies.

The playing field isn't level as the insurance companies only respect economies of scale.

If hospitals get tired of Mednax for its aggressive billing, why will they accept another predatory AMC?

Your words sound a bit like we should just surrender without a flight.

 

[BLADEMDA]

If hospitals get tired of Mednax for its aggressive billing, why will they accept another predatory AMC?

Your words sound a bit like we should just surrender without a flight.

No. I'm just pointing out the playing field isn't level. I think that is why USAP has done so well recruiting new groups. Yes, they take 20% off the top but they also collect substantially more money from their private insurance contracts. I know one group who "sold" out to USAP where the partners got buyout money and stock but are still taking home the same income as pre-buyout.

If you can find a good group where true partnership is possible and that group doesn't get a hospital subsidy (or a small subsidy) then I encourage new grads to go that route.

 

[BLADEMDA]

Those AMCs might not go quietly into the night, but the hospitals themselves will be getting rid of them over time. I'd bet within 20 years that 80+% of jobs will be hospital employees or private groups.

I bet that within 20 years the Medicare Option or Medicare for all is now the law of the land. Hence, the AMCs will no longer serve any function.

 

[nimbus]

I bet that within 20 years the Medicare Option or Medicare for all is now the law of the land. Hence, the AMCs will no longer serve any function.

They already serve no function except to siphon scarce healthcare dollars to their investors.

 

[deleted941485]

That would be pure speculation...... but my best guess is that most of the partners wherein mid 50's.... Obamacare was a significant threat to future reimbursements and income, the buyout was probably in the form of selling stock instead of ordinary income so there was a tax benefit and the partners may/maynot have looked at all the "future" partners in the pipeline that were going to dilute their future earnings...... got tired of the constant threats by the hospital and thought they were better protected. Pure speculation on my part. Could be all or one of the above or none.

I think that’s probably spot on...hospitals wanted coverage EVRYWHERE in every setting. Reimbursements we’re slowly turning into garbage partly due to Obamacare and even before that. The practice that had been built had a choice they could ride it all the way to 0 ending with hospital employment or extract what ever value they still had left in the organization. They chose mednax likely because if the hospital ever got a hold of them they’d be getting dick.

 

[ryanjmy]

Remember Scope wanted to retain the existing doctors and CRNAs and offered work to them. There is no doubt their preference was to keep the vast majority of the existing staff from Mednax. It is Mednax that refused to release them from their noncompete. Really that was the only leverage that Mednax had; it was that or rolling over. If Mednax had the best interests of their employees in mind, they would have released them. But they don’t. They are not blameless. Neither are the old SEA doctors who invited Mednax into their community.

I think Mednax has learned their lesson with playing hardball with non compete buyout negotiations. It’s better to get something than nothing.

 

[Noyac]

Interestingly Atrium is listed in the top 150 healthcare facilities to work for.

150 top places to work in healthcare | 2019

Becker's Healthcare is pleased to release the '150 Top Places to Work in Healthcare | 2019' list, which highlights hospitals, health systems and healthcare companies that promote diversity within the workforce, employee engagement and professional growth.

www.beckershospitalreview.com

Which only reenforces the notion that these lists are crap. They focus on a few things like services and lecture series and diversity training etc. But not on employee retention obviously.

 

[nimbus]

Interestingly Atrium is listed in the top 150 healthcare facilities to work for.

150 top places to work in healthcare | 2019

Becker's Healthcare is pleased to release the '150 Top Places to Work in Healthcare | 2019' list, which highlights hospitals, health systems and healthcare companies that promote diversity within the workforce, employee engagement and professional growth.

www.beckershospitalreview.com

Which only reenforces the notion that these lists are crap. They focus on a few things like services and lecture series and diversity training etc. But not on employee retention obviously.

Hmmmm...top 150. That’s like a list of the top 150 anesthesia programs. Is there a major health system that is not on that list?

 

[Notascab]

As we speak the Atrium search engine optimizers are busy making this the first web site you see when you search Atrium Health.... my bet is the Independent Tribune a small throw away newspaper from a town of 15000 people will magically be at the top of the search in a city with over 1 million plus catchment area....

 

[Noyac]

Hmmmm...top 150. That’s like a list of the top 150 anesthesia programs. Is there a major health system that is not on that list?

My healthcare system didn’t make the cut.
We are working on that front however. I used this list to help generate some ideas as well.

 

[deleted162650]

My healthcare system didn’t make the cut.
We are working on that front however. I used this list to help generate some ideas as well.

Anesthesia department holding them back?

 

[nimbus]

My healthcare system didn’t make the cut.
We are working on that front however. I used this list to help generate some ideas as well.

You guys need a better publicist.

 

[deleted126335]

They need to lie more effectively.

 

[nimbus]

Mednax stock is up like 8% since that article was written on June 25

Now trading in the 20’s, down 50% since June 2018. Probably not great news for AMCs in general.

 

[Status Sciaticus]

Now trading in the 20’s, down 50% since June 2018. Probably not great news for AMCs in general.

Lets hope this is the start. Those parasites can bug off.

 

[narcotics999]

Now trading in the 20’s, down 50% since June 2018. Probably not great news for AMCs in general.

It was 80s in mid 2015. When groups sold out, did they get $$$ or stocks?

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[deleted941485]

All those honeymoon sweetheart deals they set up in the last decade are starting to come apart

 

[Mman]

It was 80s in mid 2015. When groups sold out, did they get $$$ or stocks?

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the Mednax model was pure cash

 

[IMGASMD]

the Mednax model was pure cash

Ma-ney......

 

[B-Bone]

the Mednax model was pure cash

every mednax buyout I've ever heard the details about was 100% stock (including the recent one in my market). I ended up skiing with a mednax bigwig a few years ago and he said they did not do cash acquisitions at all. Doesn't mean they never have, but just wanted to provide a different perspective.

 

[Mman]

every mednax buyout I've ever heard the details about was 100% stock (including the recent one in my market). I ended up skiing with a mednax bigwig a few years ago and he said they did not do cash acquisitions at all. Doesn't mean they never have, but just wanted to provide a different perspective.

we were offered straight cash and everyone near us that sold got all cash, the sweetener of their deal was the upfront cash got taxed as long term capital gains.

 

[B-Bone]

we were offered straight cash and everyone near us that sold got all cash, the sweetener of their deal was the upfront cash got taxed as long term capital gains.

Yeah that's the ideal situation. Just wanted to point out that it's not the situation everywhere with Mednax. Just curious, what year was your deal? My conversation with the mednax suit was in 2017 and am wondering if the disparity is more geographic or if it represents a change in tactics.

 

[Mman]

Yeah that's the ideal situation. Just wanted to point out that it's not the situation everywhere with Mednax. Just curious, what year was your deal? My conversation with the mednax suit was in 2017 and am wondering if the disparity is more geographic or if it represents a change in tactics.

this was a while ago. I actually don't know of any practices they acquired in the last 2 or 3 years. Straight cash was their standard practice 6-12 years ago. It was basically a math formula asking how much of present income you'd like to drop down to for annual salary and then pick a length of time for to sign on for and they give you the difference as a lump sum capital gain. Example, if your income was $800K per year and you were willing to sign on for 7 years at $400K, then you get the difference (800-400)= 400 multiplied for those 7 years as a $2.8M lump sum. The math got even crazier in pyramid schemes where only a few partners got paid to get all the docs for a lower salary which is how you ended up with guys getting $5-10M cash as a capital gain to sell out.

 

[pgg]

Lets hope this is the start. Those parasites can bug off.

May their trophy wives divorce them, their children shun them, and their dogs run away in the wake of their stock market woes.

 

[AdmiralChz]

this was a while ago. I actually don't know of any practices they acquired in the last 2 or 3 years. Straight cash was their standard practice 6-12 years ago. It was basically a math formula asking how much of present income you'd like to drop down to for annual salary and then pick a length of time for to sign on for and they give you the difference as a lump sum capital gain. Example, if your income was $800K per year and you were willing to sign on for 7 years at $400K, then you get the difference (800-400)= 400 multiplied for those 7 years as a $2.8M lump sum. The math got even crazier in pyramid schemes where only a few partners got paid to get all the docs for a lower salary which is how you ended up with guys getting $5-10M cash as a capital gain to sell out.

This was the Sheridan formula in Florida - multi-tiered PPs with older partners close to retirement got 5-10x more than junior partners (sometimes the latter got basically nothing) and the older folks laughed off into the sunset. Thankfully, this model has largely all sold out and doesn’t exist much anymore.

Mednax and Sheridan (or whatever name is it now) have both apparently approached my group in the last decade or so with offers. Mostly stock which we laughed away, and since we are a totally equal partnership splitting a buyout so many ways didn’t make it as inticing.

 

[Noyac]

The environment may be changing. I am hearing of insurance companies refusing to pay AMC numbers.
ie: Cigna in Colorado. Maybe it was another co.

 

[deleted941485]

The environment may be changing. I am hearing of insurance companies refusing to pay AMC numbers.
ie: Cigna in Colorado. Maybe it was another co.

AMC bussiness model is garbage. It is a sharade that the admin bought into and greedy PP super partners fostered. I’ve witnessed several AM. Takeovers which take good groups that got greedy and turn them into CRnA meat mills with high turnover, stingy benefits, and MBA types on a power trip.

All this trouble because hospitals thought they could skimp on a stipend.

 

[nimbus]

More free market capitalism.....

A Private Equity-Owned Doctors' Group Sued Poor Patients Until It Came Under Scrutiny

After the Blackstone Group acquired a large national physician staffing firm in 2017, low-income patients faced far more debt collection lawsuits. They stopped only after news media investigated.

www.npr.org

 

[VA Hopeful Dr]

More free market capitalism.....

A Private Equity-Owned Doctors' Group Sued Poor Patients Until It Came Under Scrutiny

After the Blackstone Group acquired a large national physician staffing firm in 2017, low-income patients faced far more debt collection lawsuits. They stopped only after news media investigated.

www.npr.org

Medicine is not free market at all though.

These groups wouldn't be able to pull that off if charges were public and there were plenty of choices as to where to seek care.

 

[nimbus]

Medicine is not free market at all though.

These groups wouldn't be able to pull that off if charges were public and there were plenty of choices as to where to seek care.

To me “free market” means little to no government intervention, no antitrust enforcement, no government mandate for price transparency, runaway consolidation, and control of the health care system by capitalists i.e. those with access to the most capital-bankers and financiers. Free market means letting the market decide who wins and who loses without engineering controls to get a desired outcome. These PE groups are pulling their shenanigans because our government has not stepped up to regulate them. Healthcare should not be at the mercy of bankers who’s only objective is to squeeze as much money out of the system as quickly as possible.

That’s also why our cell phone bills are 5x what they are in Europe and Asia. Runaway consolidation in telecom with a few winners controlling the entire market and the little guys put out of business.

I realize government regulation is a dirty word for the die hard capitalists on this board but corporations cannot be trusted and they need to be regulated to protect the public.

The irony in all this is that even though these companies charge more to patients and insurance companies, they pay their employed doctors less. They are rent seekers pure and simple, raising costs without adding any value. Ask any doctor who works for one of these outfits what they think of their boss.

 

[vector2]

Medicine is not free market at all though.

These groups wouldn't be able to pull that off if charges were public and there were plenty of choices as to where to seek care.

What makes you think various institutions in the same zip code would have wildly varying prices? My guess is they'll all do enough legwork to avoid the appearance of price fixing and then go ahead and price fix, just like somehow all the major cell phone carriers can get away with a ~ $100 unlimited plan.

 

[VA Hopeful Dr]

What makes you think various institutions in the same zip code would have wildly varying prices? My guess is they'll all do enough legwork to avoid the appearance of price fixing and then go ahead and price fix, just like somehow all the major cell phone carriers can get away with a ~ $100 unlimited plan.

Because we know they don't

Prices at Zuckerberg hospital’s emergency room are higher than anywhere else in San Francisco

Under the city’s watch, the public hospital’s prices have doubled since 2010.

www.vox.com

 

[VA Hopeful Dr]

To me “free market” means little to no government intervention, no antitrust enforcement, no government mandate for price transparency, runaway consolidation, and control of the health care system by capitalists i.e. those with access to the most capital-bankers and financiers. Free market means letting the market decide who wins and who loses without engineering controls to get a desired outcome. These PE groups are pulling their shenanigans because our government has not stepped up to regulate them. Healthcare should not be at the mercy of bankers who’s only objective is to squeeze as much money out of the system as quickly as possible.

That’s also why our cell phone bills are 5x what they are in Europe and Asia. Runaway consolidation in telecom with a few winners controlling the entire market and the little guys put out of business.

I realize government regulation is a dirty word for the die hard capitalists on this board but corporations cannot be trusted and they need to be regulated to protect the public.

The irony in all this is that even though these companies charge more to patients and insurance companies, they pay their employed doctors less. They are rent seekers pure and simple, raising costs without adding any value. Ask any doctor who works for one of these outfits what they think of their boss.

You're taking the hard-core libertarian approach which is fine, but most of the free-market people in medicine don't agree to all of that.

Private equity groups wouldn't be a problem if we were allowed more competition as there would be less money involved. I'm sure many of y'all here work in physician-owned surgery centers. As a general trend, they charge way less money than hospital-owned ORs. With ever increasing deductibles, patients are more cost-conscious than they used to be (as are employers who provide insurance). As a PCP I'm starting to have patients ask me where the surgeons I refer them to operate as they want the lowest cost locations available. Problem is, under the ACA you can't open new physician-owned surgery centers. Private equity firms can, but they have no reason to minimize costs.

 

[psychbender]

It's also not free market when organizations can band together and petition the government to impose some regulations which don't improve anything for the consumers, but actually just serve to increase barriers to entry and lock out new companies from the market, thus allowing the older/larger corporations to charge whatever they want for inferior service. Cronyism with "regulation" is not a free market.

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[Mikkel]

You're taking the hard-core libertarian approach which is fine, but most of the free-market people in medicine don't agree to all of that.

Private equity groups wouldn't be a problem if we were allowed more competition as there would be less money involved. I'm sure many of y'all here work in physician-owned surgery centers. As a general trend, they charge way less money than hospital-owned ORs. With ever increasing deductibles, patients are more cost-conscious than they used to be (as are employers who provide insurance). As a PCP I'm starting to have patients ask me where the surgeons I refer them to operate as they want the lowest cost locations available. Problem is, under the ACA you can't open new physician-owned surgery centers. Private equity firms can, but they have no reason to minimize costs.

Hospitals claim it's because they're subsidizing lower profit procedures/inpatient care, but really it's about supporting a massive administration bureaucracy.

 

[VA Hopeful Dr]

Hospitals claim it's because they're subsidizing lower profit procedures/inpatient care, but really it's about supporting a massive administration bureaucracy.

It's actually both

 

[Noyac]

”There is the concept of the "free market." Here, the concept of a total free market and free market alternatives is somewhat illusory. In reality nearly 30 to 50 percent of most providers' revenue comes from Medicare and Medicaid. Thus, you are never really dealing with a free market in healthcare. There are free market incentives — like health savings plans and transparency — that can help, but one is not in total dealing with a free market“ Quote from Becker’s.

 

[PieOHmy]

I realize government regulation is a dirty word for the die hard capitalists on this board but corporations cannot be trusted and they need to be regulated to protect the public.

Its not illegal to lobby. It is the politicians who are dirty not the corporations. Everyone wants an edge on the other guy and would pay A LOt to get that edge. Who do you think gives them that edge.. The government does.

 

[dannyboy1]

It's also not free market when organizations can band together and petition the government to impose some regulations which don't improve anything for the consumers, but actually just serve to increase barriers to entry and lock out new companies from the market, thus allowing the older/larger corporations to charge whatever they want for inferior service. Cronyism with "regulation" is not a free market.

Sent from my SM-G930V using SDN mobile

In a true free market anyone off the street would be able to set up shop as a “doctor” (I.e no medical license needed) some regulations work well for us.....

 

[Mikkel]

In a true free market anyone off the street would be able to set up shop as a “doctor” (I.e no medical license needed) some regulations work well for us.....

Why would that be a bad thing? At least the fake doctors would be exposed for being the charlatans they are, unlike the DNPs who successfully pass themselves off as "Doctor" to their patients with the benefit of the doubt because of a diploma from Springfield Upstairs College of Nursing Doctors.