Looks like Envision lost the lucrative contract at John Muir Medical Center in Walnut Creek CA.
Envision loses John Muir WC CA contract
- Thread starter tdub878
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Were they unable to staff?
Who’s replacing them?
Who’s replacing them?
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Lost or dropped?
My guess is someone came in and offered to do it for less money...they won't be able to staff it and survive on locums for a few months until it all blows up.
Happening all over as the market adjusts
My guess is someone came in and offered to do it for less money...they won't be able to staff it and survive on locums for a few months until it all blows up.
Happening all over as the market adjusts
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In VHCOL areas, it cannot be done for less. Unlike ski lift operators, anesthesiologists and CRNAs are not willing to live in worker dorms.
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Seems like they’re struggling to staff the sites they already have but good luck to them.
Labor is very expensive. Envison is like a deadbeat landlord (circa 2008 housing collapse) which huge mortgage they have no intention of paying
As long as the rents are good. They will stick around
But if the rents (labor costs) are too much. They will just bail
Simple business model.
As long as the rents are good. They will stick around
But if the rents (labor costs) are too much. They will just bail
Simple business model.
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Are you kidding me? Vituity can't even staff its own sites, lol
Many of the current anesthesiologists will choose to stay. Envision has no work for them. It is a desirable area and recruiting will not be as challenging. Vituity has a good reputation.
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Non competes are not enforceable in California, thankfully.
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How do you know the cut is 35%? Just curious the source of this information
The courts have struck that down.
Attorney General Bonta Reminds Employers and Workers That Noncompete Agreements Are Not Enforceable Under California Law
Noncompete agreements are widespread, affecting an estimated 20-25% of the nation’s labor force OAKLAND – California Attorney General Rob Bonta today issued an alert reminding employers and workers that noncompete agreements are not enforceable in California. Noncompete agreements generally...
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Who didn't see this coming. After Envision took its cut they were the lowest paid Anesthesiologists in the area. Pure W2, only 19k 401k and if I remember correctly they said most were taking home 20k a month or something like that. Should make more now with a different contract hopefully or more will leave.
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Wasn't this the place where that young kid died from liver resection case?
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20k pre or post tax? 20k post tax take home pay seems pretty decent to me.
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It's a big group, productivity based. Covered a lot of sites. There's folks who made 400k, there's folks who made in the 700s. Depends on the work
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I'm not sure, but I assume you are joking, correct?
Vituity had such a terrible reputation as CEP that they had to change their name.
Vituity's reputation might not be as bad as Envision's (emphasis on *might*), but it's terrible, all the same.
I really do not understand how AMCs can make money in urban California areas.
They can’t strong arm a lot of private insurers like they do in the south. They got less negotiating power with fragmented hospitals systems in bigger cities. In the south there maybe only 2-3 major players in each city so if an amc controls the southern city. They can strong arm United etc.
Obviously they can’t do anything with medi-cal and Medicare.
So outside of extraction subsidies from hospitals. It’s hard to make a 30% profit.
The only major guarantee profit/savings is from the 6-7% savings from the billing company that the own.
They can’t strong arm a lot of private insurers like they do in the south. They got less negotiating power with fragmented hospitals systems in bigger cities. In the south there maybe only 2-3 major players in each city so if an amc controls the southern city. They can strong arm United etc.
Obviously they can’t do anything with medi-cal and Medicare.
So outside of extraction subsidies from hospitals. It’s hard to make a 30% profit.
The only major guarantee profit/savings is from the 6-7% savings from the billing company that the own.
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Sounds like Envision is no longer in the Bay Area. Good riddance.
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That's like 600k pretax
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Does that mean MAC is returning to independence, getting swallowed up by Vituity, or ??
MAC/Envision is done w John Muir, San Ramon and Pleasanton Valley Care hospital.
They have several ascs with good payor mix in the Bay Area But John Muir was the big cash cow. Envision corporate overhear will need to shrink to account for that.
I think their days are outnumbered in that region. Fancy business talk and cool powepoints can only take you so far.
Vituity/CEP has had a long relationship with John Muir and dozens of other regional hospitals. Hospital Administration and Physicians are happy. Physician owned and led. They are intrenched as major inpatient player in this area.
They have several ascs with good payor mix in the Bay Area But John Muir was the big cash cow. Envision corporate overhear will need to shrink to account for that.
I think their days are outnumbered in that region. Fancy business talk and cool powepoints can only take you so far.
Vituity/CEP has had a long relationship with John Muir and dozens of other regional hospitals. Hospital Administration and Physicians are happy. Physician owned and led. They are intrenched as major inpatient player in this area.
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several years ago when i was in between jobs, i had the opportunity to go work at an envision site on a PRN locums basis. a recruiter i'd been working with and who'd been good to me set me up. told me that he was in a pinch and that they really needed someone and if i had the availabilty, etc. so, i said okay. he'd been loyal to me so i was trying to pay him back.
anyway, part of the process was being called by the site liaison for envision. i call this yokel back after he left me a message, and the first thing out of his mouth was, "i'm new at anesthesia services so bear with me..."
first thing he asks me is if i had ever been arrested or fired. after that, he tells me that i will need to have someone send an attestation letter that i know how to handle myself in an emergency in the OR. i'm just about ready to hang up because i don't really need the work that badly, but i persisted because i'm trying to keep a good line with this outside recruiter who's hooked me up in the past.
finally, we get through a lot of the b.s., i send in more documentation than i've ever had to send in for any position ever in my life, and it gets down to wire where i think i'm ready to go. this is like a thursday and i'm supposed to show-up at the site on monday. suddenly they email me at the very last minute wanting me to fill out a w-4 form. hold on a second. i call the yokel back and i tell him, "dude, i'm not your employee. i'm an independent contractor. you pay me and submit a 1099."
he says, "i really need you to fill out the w-4 or we can't have you come work for us. we can't put you on payroll." i respond, "i'm not signing a w-4 for you. i am in no way shape or form one of your employees or otherwise willing to create the appearance of employment arrangement directly with envision." that was that.
called the recruiter back, told him what was going on, and said, "i jumped through all those hoops for what? no way in hell will i ever work with or for that organization." he just said i'm sorry.
never again. i will go work checkout at Target before i ever work with those guys.
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If envisions cut off the top is 30% (as suggested) plus costs they really are in trouble.
They covered a few hospitals in indiana back when I worked there and they were always chronically understaffed and couldn’t make anything work…. But then were weirdly picky about who they hired or made the whole interview process extremely difficult… for permanent or locums. (We used some locums people that had tried them and had similar experiences to that above).
With phymed out, envision next, Napa limping along for now - USAP seems to be in a pretty good spot right now. I know people like to bash USAP but I can’t get any first hand knowledge or anything concrete out of anyone about USAP really “going down” in any place.
They covered a few hospitals in indiana back when I worked there and they were always chronically understaffed and couldn’t make anything work…. But then were weirdly picky about who they hired or made the whole interview process extremely difficult… for permanent or locums. (We used some locums people that had tried them and had similar experiences to that above).
With phymed out, envision next, Napa limping along for now - USAP seems to be in a pretty good spot right now. I know people like to bash USAP but I can’t get any first hand knowledge or anything concrete out of anyone about USAP really “going down” in any place.
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I was told that in the original deal envision was getting 50% of the MAC hospital stipends too.
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I wonder what kind of payout the original partners received to give up so much to Envision so easily.
Wow Amyl selling the pyramid scheme of USAP. Hey don’t blame her -her stock will go up. Of all of these PE groups USAP was most intelligent in the groups they selected -strong economies, strong groups….but with those strong economies now comes insane cost of living increases and inflation for any non MD or non partner MD. Add no increases in rates per the NSA (rumor is USAP accepted a decrease in rate with United in some markets to pad the books for a stock sale). Also, as another person pointed out-USAP is in keep things good for as long as possible mode with #1>>>>#2
1. PE
2. mD partners
Rest of corporation taking a bath. USAP will be last man standing but they’ll lose some of their sites sooner than later and eventually fail (unless they find away to beat the no surprises act-which never say never, private equity are smart folks).
1. PE
2. mD partners
Rest of corporation taking a bath. USAP will be last man standing but they’ll lose some of their sites sooner than later and eventually fail (unless they find away to beat the no surprises act-which never say never, private equity are smart folks).
There are a lot of failing AMC throughout California. There is a turnover of one AMC to the next and the problems in the underlying hospital ORs are not addressed. There is high acuity trauma with brand new or traveling nurses and no body knows anything where equipment is located and are getting burnt. The only way to survive this situation is to only do elective cases and get to know all the players before venturing into night calls. A lot of them are desperate and want warm bodies to do calls with no relief
Original partners sold to Sheridan. Payouts varied on seniority. Low to low mid 7 figures. Yes, part of stipends were deducted by Envision.
Current negotiations broke down bc Envision wanted mor hospital support. RFP came out to address this.
Hopefully most docs will stay and won’t have lives disrupted.
Current negotiations broke down bc Envision wanted mor hospital support. RFP came out to address this.
Hopefully most docs will stay and won’t have lives disrupted.
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Ahhh my mistake. Original sale was to Sheridan, not envision. Nonpartner who left MAC shortly after the sale told me the 50% of hospital stipend number and there were heavy stipends even then.
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Have a buddy involved in this. Some/many have already signed on with vituity to stay.
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False. I highly doubt anesthesiologists are signing contracts within one day of an announcement being made of a new group winning a bid. Contracts don't even exist at that point.
I’d be careful to promote usap. Like I stated several times. Most of usap contracts originally were cherry picking the top payor mixes from 2015-forward. This is how mednax (American anesthesiology) grew from 2007-2014. They stopped growing shortly after 2014 cause usap formed and took the remaking nicer contracts.
So usap is falling right into almost the same time line as mednax’s American anesthesiology.
Usap is taking over scraps of contracts these days. There is little or zero room for growth. Most of their “new” contracts aren’t that desirable. My friends 30 year private contract in north east. My friend group actually abandoned the contract cause of hospital demands. Usap is learning the hard way with that contract. They tried to low ball remaining former partners but had to increase their initial pay. So the former partners are getting within 5% GUARANTEED of what they would normally make as private group.
Extremely little cost savings for usap. Add to usap having to pay the junior associates the same (100k) MORE than what they would have made in partnership track. I see very little or zero cost savings.
The numbers make no sense. Of course usap has got to have some side 3 year deal with hospital admin to subsidize any costs. Cause hospital admin fall for all that talk.
Usap is a well oil machine. But only so much you can do when the payor mix is less than 30% true non Medicare advantage commercial.
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I’m not really selling USAP…. All I hear is rumors and conjecture.
USAP had some crap business here in dallas- hard sites to fill when the market wasn’t this good for candidates, hospital administrators okay with Mia anesthesiologist and firefighter models…. It’s not a sign of weakness to cut that business… it’s a good business decision.
In this labor market especially not all business is good.
I hear Colorado is fixed - Denver has hired tons of drs…. They changed the track to production and a two year track and that worked. I heard things weren’t great up there awhile back but I hear it’s fixed. Would love to hear from someone (pm me if you want) who actually knows what’s going on up there… not info from last year.
I don’t know if there’s anything to the rumors about the nsa deals. I do know that USAP had the power and money and know how to go against United health care and win. No one else has. We will definitely have the resources to do well in arbitration if necessary.
Denver?
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Denver is fixed and out of trouble
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What is now happening at some of the USAP divisions is that they are trying to negotiate revenue guarantee stipends with hospitals to bridge the gap in pay for their associates and partners. With the NSA, I think the writing is on the wall: the hospital will have to absorb the cost of anesthesia services and bring it in-house.
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Not all states allow anesthesiologists to be employed directly by the hospital.
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Feel free to blow off my post, this is the internet. But if you want to believe me, like I said, I have a friend in the group who told me months ago about Envision losing the contract and many of their coworkers were going to stay at Muir working for vituity when the switch happened. As someone above pointed out, there are no non-competes enforceable in California. And if you think that someone working in said group was surprised by the change in management, you probably haven't been doing this very long.
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And this is why ownership of a contract is worthless. Hospital can change the deal whenever they want.
All that matters is what the market will bear. The great physician owned groups in So Cal used to be extremely predatory, 7year partner tracks, huge buy one, etc. They did that because they could and the market allowed the senior partners to be just as greedy as the corporate folks.
Now the market has shifted and those groups have to adjust. The AMCs adjust or they bail. The hospitals will adjust and increase stipends or they will lose staff and ORs will shutdown.
Do you think it really matters who the boss is at John Muir? All the docs there will care about is pay, lifestyle, call, etc. Who they call their boss is just a formality.
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which states are those? I know texas is one... just curious of the others. and who says these laws cant change going forward
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not necessarily... as stated some states dont allow this as they think (rightly so) that it may compromise patient care and doctor objectivity. I have never ever had such pressure put on me to do an unsafe case as when I was a hospital employee. I was flatly told "we dont cancel cases here." surgeons bring money in and hospital admin sees nothing but $... they want anesthesiologist that keep the surgeons happy and that they don't hear about.
The value of good arbitration is yet to be seen with the NSA... maybe it will matter... maybe it won't. It may be worth it to the hospital to have a large group with some leverage -like USAP - to handle this for them.
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California has laws against the corporate practice of medicine too.
In theory, this prohibits unlicensed corporations from making medical decisions and overruling doctors. That’s why insurance companies have hired an army of licensed hired gun “medical directors” to reject prior authorizations and torture surgeons and other doctors with “peer to peer” reviews. We are relatively shielded from this in anesthesia.
This is also part of the reason why Kaiser doctors in the state operate under the umbrella of TPMG and SCPMG. Those organizations are ostensibly independent of Kaiser.
Addressing the Prohibition on the Corporate Practice of Medicine
Many states prohibit the “corporate practice of medicine.” In general, this doctrine bans corporations from practicing medicine or employing a physician to provide professional medical services. It is based on a number of public policy concerns, including the commercialization of the practice of...
www.homecaremag.com
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The problem with arbitration is that the current prevailing rates in the community are the baseline and considered reasonable. The commercial insurance rates will never go up. Insurance company payment for anesthesia services have suddenly become nonnegotiable and hospitals have to recognize that the cost of anesthesia will increasingly come directly from their pockets.
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Arch Guillotti
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The corporate practice of medicine laws just seem so ridiculous and useless now.
