The death of PE in anesthesia.

[sleepdoc2u]

NAPA out of Long Island. Makes me cry crocodile tears. PE business model is doomed.

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[dabears505]

There's no money to be made in Anesthesia, hence the death of PE

 

[GassYous]

So they are all out? Employed by northwell?

 

[midazzoler]

PE failing doesn’t equal success for other models.

 

[Fpg1245]

NAPA out of Long Island. Makes me cry crocodile tears. PE business model is doomed.

Do go on please

 

[secants]

Out of Northshore in Manhasset?!

 

[brominator]

Yes this happens a few weeks ago , have until early 2023 to accept final Northwell offer

 

[brominator]

Lot of the old
Timers are pissed off

 

[brominator]

Out of Northshore in Manhasset?!

Yes all
Of Northwell is Napa free

 

[amyl]

Lot of the old
Timers are pissed off

Why? I’m not familiar with this hospital or issue

 

[Dr. Rude]

There's no money to be made in Anesthesia, hence the death of PE

The PE Vampire may rise again if/when there is an excess of anesthesia personnel seeking jobs. Tough creature to kill.

 

[IMGASMD]

The PE Vampire may rise again if/when there is an excess of anesthesia personnel seeking jobs. Tough creature to kill.

That may not happen for a few more years (?) with the way it has been going. At least I hope.

 

[IMGASMD]

Yes this happens a few weeks ago , have until early 2023 to accept final Northwell offer

Are they offer for them to stay?
Are we saying that napa won’t/can’t do anything if they jump ship?

 

[amyl]

Everyone says Napa and envision are dying… but they are recruiting like crazy. They don’t really seem to be dying- just saying

 

[linkin06]

Everyone says Napa and envision are dying… but they are recruiting like crazy. They don’t really seem to be dying- just saying

Well they need to minimally fulfill contractual obligations. Are they recruiting just to scrap by?

 

[IMGASMD]

Everyone says Napa and envision are dying… but they are recruiting like crazy. They don’t really seem to be dying- just saying

Must agree with @linkin06 the plenty of them were “recruiting” like madmen up to the day they were kicked out.

 

[Fpg1245]

Must agree with @linkin06 the plenty of them were “recruiting” like madmen up to the day they were kicked out.

I noticed those salaries rose really quickly. 500K a pop even in desirable cities. They were desperate and anyone who took the bait would be renegotiating their contract in a year or 2 with a totally different employer

 

[IMGASMD]

I noticed those salaries rose really quickly. 500K a pop even in desirable cities. They were desperate and anyone who took the bait would be renegotiating their contract in a year or 2 with a totally different employer

It’s a weird time. You can get “there”. But just feels very unstable, unsustainable at this time. That’s why the other thread was talking about future employer will be hospital systems…. No one will be able to pay other than the big boys.

 

[Howard888]

Only a matter of time before a USAP site fails. My guess Denver or Austin. I know someone who interviewed at Austin-working precall, post call, longer days-can’t hire CRNAs or MDs, stipend for an academic hospital. I know folks at Kaiser in Denver-USAP still struggling staffing, cut some facilities, lost other ASCs.

Model doesn’t work with increased costs. Facilities do not want to pay a stipend just to pay non clinical private equity. Years still before it all falls apart of course, but I expect to see dominos every few months

 

[dannyboy1]

Are they offer for them to stay?
Are we saying that napa won’t/can’t do anything if they jump ship?

Most likely northwell will indemnify the physicians and litigate with NAPA. just like at all the other sites where this happened. These non competes are almost always nonenforcable. Just need an organization with deep pockets to pay the attorneys. Pennies to an organization like northwell.

 

[IMGASMD]

Are they out of LIJ? That’s where the strong hold was, right? A few years ago, Northwell started their buying spree, while which Napa at their flagship hospital.

 

[Dr. Stable-Genius]

The PE Vampire may rise again if/when there is an excess of anesthesia personnel seeking jobs. Tough creature to kill.

Trainee here, not sure I totally understand the scenario but trying to follow along. Can you clarify for me what precisely is happening and what you mean? It was my impression that PE was only growing into more and more medical sectors, not weakening

 

[nimbus]

Everyone says Napa and envision are dying… but they are recruiting like crazy. They don’t really seem to be dying- just saying

Envision was recruiting for John Muir in Walnut Creek until the week they were replaced. I think NAPA was actively recruiting in Reno until they were abruptly replaced too. Recruiting doesn’t seem like an indicator for the health of a practice. Practices can be recruiting one week and be gone the next.

 

[GravelRider]

Most likely northwell will indemnify the physicians and litigate with NAPA. just like at all the other sites where this happened. These non competes are almost always nonenforcable. Just need an organization with deep pockets to pay the attorneys. Pennies to an organization like northwell.

Last rumor I heard was Northwell was buying out NAPA non-competes. Who knows, though? The rumors change weekly.

 

[GravelRider]

Everyone says Napa and envision are dying… but they are recruiting like crazy. They don’t really seem to be dying- just saying

The Northwell NAPA rumor is Northwell is offering NAPA a buy out of non-competes. Every person NAPA hires is another potential non-compete buy out.

But, I agree, I don’t think they are dying. I think they are shedding less profitable sites and cutting their losses against aggressive hospital systems.

 

[CubsDynasty]

Envision et al. will continue to hire until the last day of their contract. 1) They need to demonstrate everything is okay 2) They need to fulfill their minimal contractual obligations 3) the more docs they have with noncompetes the more control and buyout power the obtain. Hence why now you're seeing Envision offering 100k sign on bonuses. Not a good omen.

 

[dannyboy1]

Last rumor I heard was Northwell was buying out NAPA non-competes. Who knows, though? The rumors change weekly.

If Napa refuses to play ball they will certainly hire and indemnify. Northwell is not gonna back down if Napa refuses to sell or wants a ridiculous price for the non compete.

 

[nimbus]

The Northwell NAPA rumor is Northwell is offering NAPA a buy out of non-competes. Every person NAPA hires is another potential non-compete buy out.

But, I agree, I don’t think they are dying. I think they are shedding less profitable sites and cutting their losses against aggressive hospital systems.

But are NSUH and LIJ considered less profitable sites?

 

[Dr. Rude]

Trainee here, not sure I totally understand the scenario but trying to follow along. Can you clarify for me what precisely is happening and what you mean? It was my impression that PE was only growing into more and more medical sectors, not weakening

PE does well when there are more docs and CRNAs than there are jobs. The situation is now the reverse.

 

[GassYous]

But are NSUH and LIJ considered less profitable sites?

Best payor mix in the state probably

 

[GravelRider]

But are NSUH and LIJ considered less profitable sites?

So the Northwell NAPA rumors apply to some of their smaller sites. I don’t know if NAPA being out of NSLIJ is imminent. I hear different things every week. The writing has been on the wall for years now. Northwell is very aggressive about taking control of all physicians at their hospitals. They want total alignment with their system.

NSLIJ probably has one of the best payer mixes in the country, I would guess.

 

[Fpg1245]

So the Northwell NAPA rumors apply to some of their smaller sites. I don’t know if NAPA being out of NSLIJ is imminent. I hear different things every week. The writing has been on the wall for years now. Northwell is very aggressive about taking control of all physicians at their hospitals. They want total alignment with their system.

NSLIJ probably has one of the best payer mixes in the country, I would guess.

For anesthesia in general their comm. rates tend to be pretty solid. And in a massive system like that based on LI. They probably get a good deal I would imagine

But yes, when there is excess labor PE does well but then again so to employers when labor is too plentiful

 

[nimbus]

So the Northwell NAPA rumors apply to some of their smaller sites. I don’t know if NAPA being out of NSLIJ is imminent. I hear different things every week. The writing has been on the wall for years now. Northwell is very aggressive about taking control of all physicians at their hospitals. They want total alignment with their system.

NSLIJ probably has one of the best payer mixes in the country, I would guess.

Some of the posts above made it seem like NAPA exit from all Northwell sites is imminent. Guess we’ll all see soon enough.

 

[drccw]

Any word on Lenox Hill?

 

[Status Sciaticus]

Everyone says Napa and envision are dying… but they are recruiting like crazy. They don’t really seem to be dying- just saying

Must agree with @linkin06 the plenty of them were “recruiting” like madmen up to the day they were kicked out.

Thats because they want to recruit you to sign the contract, thus coming under their non-compete clause. Win-Win for AMCs because they can sell your contract or renegotiate from a stronger leverage point.

Envision et al. will continue to hire until the last day of their contract. 1) They need to demonstrate everything is okay 2) They need to fulfill their minimal contractual obligations 3) the more docs they have with noncompetes the more control and buyout power the obtain. Hence why now you're seeing Envision offering 100k sign on bonuses. Not a good omen.

This is the answer. A few buddies of mine in the NY/NJ area mentioned exactly this situation.

Any word on Lenox Hill?

Its been northwell for a while

 

[nimbus]

Envision et al. will continue to hire until the last day of their contract. 1) They need to demonstrate everything is okay 2) They need to fulfill their minimal contractual obligations 3) the more docs they have with noncompetes the more control and buyout power the obtain. Hence why now you're seeing Envision offering 100k sign on bonuses. Not a good omen.

Anybody know if you need to return the signon bonus if envision loses the site?

 

[epidural man]

PE does well when there are more docs and CRNAs than there are jobs. The situation is now the reverse.

Curve of aging population going up.

Curve of available anesthesiologists - going down.

I think the low of anesthesia residents was about 30 years ago - so we are seeing this low now.

I don’t think this trend will reverse any time soon. Economy and ASC money, and all that - likely will have a small roll. Lack of anesthesia bodies is the driving factor.

 

[GravelRider]

Envision et al. will continue to hire until the last day of their contract. 1) They need to demonstrate everything is okay 2) They need to fulfill their minimal contractual obligations 3) the more docs they have with noncompetes the more control and buyout power the obtain. Hence why now you're seeing Envision offering 100k sign on bonuses. Not a good omen.

What is the going rate for a non-compete buyout? Is it more than $100k per person?

 

[CubsDynasty]

I’d love to hear the answer to this too. I’ve heard speculative numbers but nothing firm. If you think about it most jobs now offer 50-100k sign on anyway, so an overtaking buyout of that amount is essentially a wash in their books. Same thing from the selling perspective, that figure probably doesn’t move the needle for them. Man this noncompete clause is absurd for anesthesia.

Any envision folks here? Does your contract have the following: “when we inevitably go bankrupt you must return bonuses for time not worked?”

 

[UscGhost]

I’d love to hear the answer to this too. I’ve heard speculative numbers but nothing firm. If you think about it most jobs now offer 50-100k sign on anyway, so an overtaking buyout of that amount is essentially a wash in their books. Same thing from the selling perspective, that figure probably doesn’t move the needle for them. Man this noncompete clause is absurd for anesthesia.

Any envision folks here? Does your contract have the following: “when we inevitably go bankrupt you must return bonuses for time not worked?”

I haven't seen that. But it probably depends on what state you're in

 

[gasdoc77]

TRUE partner-owned private practices need to jump through a few hoops to organize as nonprofits (since they inevitably provide some uncompensated/emergency care). The hoops vary state to state, but most practices clear their books at the end of the year anyhow (bonus out remaining funds to partners). It might be a VERY useful recruiting tool (PSLF) and provide a further advantage against PE or unequitable groups that are owned by a precious few. Drain the swamp.

 

[Dr. Rude]

Curve of aging population going up.

Curve of available anesthesiologists - going down.

I think the low of anesthesia residents was about 30 years ago - so we are seeing this low now.

I don’t think this trend will reverse any time soon. Economy and ASC money, and all that - likely will have a small roll. Lack of anesthesia bodies is the driving factor.

Counter arguments:
Hospitals closing or consolidating.
CRNAs making progress in their agenda. Supervision requirements eliminated or ratios increasing.
Care being less accessible due to limited resources.

 

[Fpg1245]

Counter arguments:
Hospitals closing or consolidating.
CRNAs making progress in their agenda. Supervision requirements eliminated or ratios increasing.
Care being less accessible due to limited resources.

CMS absolute refusal to reasonably reimburse for anesthesia services.

 

[vm26]

CMS absolute refusal to reasonably reimburse for anesthesia services.

Current Medicare payment system on unsustainable path: Contact Congress

The Medicare payment system is on an unsustainable path. Find materials to contact members of Congress to let them know the Medicare physician payment system needs reform.

www.ama-assn.org

 

[nimbus]

About AIM — Association for Independent Medicine

www.associationforindependentmedicine.org

 

[sevoflurane]

About AIM — Association for Independent Medicine

www.associationforindependentmedicine.org

Is this a nonprofit entity? Is your group involved?

 

[nimbus]

Is this a nonprofit entity? Is your group involved?

It’s an organization just founded by 4 independent groups in the Midwest. My group is not involved. It says it would be open to other specialties too.

 

[nimbus]

Look or sound familiar?

Private Equity Firms Tried to Shoplift a Supermarket Chain Before Selling It. A Judge Just Stopped Them.

The Albertsons/Kroger merger tells you a lot about our cash-extractive economy.

slate.com

“But even if $4 billion cash grab isn’t part of a diabolical conspiracy to circumvent antitrust law to force an illegal merger, the D.C. lawsuit maintains, it still, in itself, constitutes an unlawful restraint of trade under Section 1 of the Sherman Act:

But whatever the motivation, the antitrust laws do not care: Defendants have an agreement that, as detailed herein, will have an anticompetitive effect on competition among supermarkets in the District of Columbia, California, and Illinois, and that is sufficient basis for this Court to stop the Special Dividend from being paid, and protect consumers and workers in all the States… By stripping Albertsons of necessary cash at a time when its deteriorating bond ratings will make access to capital harder for Albertsons, this agreement between Kroger and Albertsons curtails Albertsons’ ability to compete on price, services, other quality metrics, and innovation. Because it increases Albertsons’ leverage, empirical economics suggests this reduction in Albertsons’ competitiveness will reduce the intensity of price competition market-wide.

“And that there is the real showstopper. Because the devolution described above, wherein the current norm that views every realm of commercial activity as first and foremost a vehicle for shareholder cash extraction, ultimately strips our workplaces and vital infrastructure of their ability to function normally—well, welcome to America, where everything from thehospitals to the airlines to the dental clinicsto the railroads to Boeing has been brought to its knees by the same predictable cycle of gratuitous junk debt imposed to fund gratuitous shareholder payouts that must then be paid off through round after round of gratuitous layoffs and price hikes. Our ruling class spent $882 billion on stock buybacks in 2021—but couldn’t be bothered to fix the leaky roof of the plant that produces a quarter of the nation’s infant formula. Private equity is a misleading euphemism for the malign force responsible for this great ponzification of our institutions; in the 1980s everyone just called it “corporate raiding” because that’s what it was.

For years a sad community of union activists and finance geeks has been laboring tirelessly to outlaw its worst abuses. They’ve taken road trips to New York to rally outside the headquarters of KKR and Apollo and gotten arrested outside BlackRock; testified at congressional hearings and galvanized around a robust law, the Stop Wall Street Looting Act, that would actually target the problem at its root in the systemic abuse of the bankruptcy code.

And for years the struggle to essentially “make stealing illegal again” has culminated in just about nothing. Private equity is more powerful than ever; the Stop Wall Street Looting Act will never make it out of committee, and that’s with Democrats in control of both houses of Congress. What I’ve learned in years of interviewing workers in private equity–controlled companies is that, no matter how rock-bottom bad things seem, they can always get worse. (Just take it from residents of the KKR-owned chain of nursing homes where health inspectors repeatedly found no staffers at all during their visits to the facilities after the famous private equity firm immortalized in Barbarians at the Gate added an extra $2 billion in debt to the balance sheet.)

But what if, as the state AGs are now contending, “Wall Street looting” is already illegal? Because it chokes off the resources necessary for institutions to meaningfully “compete” in the marketplace, thereby violating a whole host of long-neglected prohibitions on anticompetitive restraints of trade?”

 

[Dr. Rude]

Look or sound familiar?

Private Equity Firms Tried to Shoplift a Supermarket Chain Before Selling It. A Judge Just Stopped Them.

The Albertsons/Kroger merger tells you a lot about our cash-extractive economy.

slate.com

But even if $4 billion cash grab isn’t part of a diabolical conspiracy to circumvent antitrust law to force an illegal merger, the D.C. lawsuit maintains, it still, in itself, constitutes an unlawful restraint of trade under Section 1 of the Sherman Act:






“And that there is the real showstopper. Because the devolution described above, wherein the current norm that views every realm of commercial activity as first and foremost a vehicle for shareholder cash extraction, ultimately strips our workplaces and vital infrastructure of their ability to function normally—well, welcome to America, where everything from thehospitals to the airlines to the dental clinicsto the railroads to Boeing has been brought to its knees by the same predictable cycle of gratuitous junk debt imposed to fund gratuitous shareholder payouts that must then be paid off through round after round of gratuitous layoffs and price hikes. Our ruling class spent $882 billion on stock buybacks in 2021—but couldn’t be bothered to fix the leaky roof of the plant that produces a quarter of the nation’s infant formula. Private equity is a misleading euphemism for the malign force responsible for this great ponzification of our institutions; in the 1980s everyone just called it “corporate raiding” because that’s what it was.

For years a sad community of union activists and finance geeks has been laboring tirelessly to outlaw its worst abuses. They’ve taken road trips to New York to rally outside the headquarters of KKR and Apollo and gotten arrested outside BlackRock; testified at congressional hearings and galvanized around a robust law, the Stop Wall Street Looting Act, that would actually target the problem at its root in the systemic abuse of the bankruptcy code.

And for years the struggle to essentially “make stealing illegal again” has culminated in just about nothing. Private equity is more powerful than ever; the Stop Wall Street Looting Act will never make it out of committee, and that’s with Democrats in control of both houses of Congress. What I’ve learned in years of interviewing workers in private equity–controlled companies is that, no matter how rock-bottom bad things seem, they can always get worse. (Just take it from residents of the KKR-owned chain of nursing homes where health inspectors repeatedly found no staffers at all during their visits to the facilities after the famous private equity firm immortalized in Barbarians at the Gate added an extra $2 billion in debt to the balance sheet.)

But what if, as the state AGs are now contending, “Wall Street looting” is already illegal? Because it chokes off the resources necessary for institutions to meaningfully “compete” in the marketplace, thereby violating a whole host of long-neglected prohibitions on anticompetitive restraints of trade?”

"If you can take advantage of a situation in some way, it's your duty as an American to do it. Why should the race always be to the swift, or the Jumble to the quick-witted? Should they be allowed to win merely because of the gifts God gave them? Well I say, "Cheating is the gift man gives himself."

-Momtgomery Burns.

 

[nimbus]

For an immigrant coming from a corrupt developing country, it's always disappointing to discover how corrupt the US Congress and government are, too.

I immigrated from a developing country too. It is a fully developed 1st world economy now. The corruption was rampant in the old days and still rampant now. Everything depends on connections and bribery. One of the recent presidents was impeached and imprisoned when she was caught taking bribes from oligarchs.