The Sad Story of VC taking over EM

[DoctwoB]

I am questioning if anything short of a national Wuhan style lockdown can substantiatively flatten the curve for this disease, given asymptomatic spread and fact that we missed the boat on testing (for which one of our own had a role) Half measures may give you the worst of both worlds- not flatten the curve much but still create a lot of economic damage. Shelter in place has been a joke in many places with gun stores and golf courses being deemed essential businesses. I am seriously concerned it just creates economic hardship but does little to flatten curve.
It also obvious that China is completely untrustworthy with their figures so hard to learn lessons from them. They dropped ball for a few months but only saw 3000 deaths wtf? Think we are going to be up the creek until widespread antibody testing available, and am hearing that supply chain for this may be a real issue because all reagents are manufactured in guess where and every country will be trying to get their hands on them.

Will soon to be able to compare death rates of Sweden with neighboring countries to see real life impact of restrictions on flattening the curve.

There is already good evidence that flattening the curve is working. In the Bay Area, Seattle, etc, cases are no longer rising exponentially and more importantly icu admissions are relatively flat despite the fact that those areas got hit earlier then most.

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[RadOncDoc21]

There is already good evidence that flattening the curve is working. In the Bay Area, Seattle, etc, cases are no longer rising exponentially and more importantly icu admissions are relatively flat despite the fact that those areas got hit earlier then most.

Too bad certain states are going to keep the curve steeper than it has to be.

 

[medgator]

Too bad certain states are going to keep the curve steeper than it has to be.

Some states are still in the denial stage....

 

[RickyScott]

Too bad certain states are going to keep the curve steeper than it has to be.

Exactly, the virus doesn’t care about state borders. Really limits impact of restrictions in those places that have them.

 

[RickyScott]

Great news

Fauci: It’s mind-boggling that China’s wet markets are still operating during coronavirus pandemic

The country’s top infectious disease expert said China’s wet markets should be closed as so many diseases, like COVID-19 caused by coronavirus, have emanated from such operations.

www.google.com

 

[thecarbonionangle]

EM seeing it too, there was a thread about the mega hospital chains trying to expand em residency spots in their own self interest

I remember when i looked into ER a few years ago, many of the “top” programs were random no name private hospitals.

 

[thecarbonionangle]

“I will toil endlessly, and accept that which my paymaster deems appropriate.”

Hippocratic Oath, 2020

this has been the case in medicine for a while. Many are just seeing it

Some states are still in the denial stage....

Mississippi has the confederate flag as their flag. They are worried about the civil war not corona.

 

[PhotonBomb]

The Alabama, Georgia, and Louisiana expected trends are scary.

 

[medgator]

Will soon to be able to compare death rates of Sweden with neighboring countries to see real life impact of restrictions on flattening the curve.

Sweden’s liberal pandemic strategy questioned as Stockholm death toll mounts

Sweden's liberal pandemic strategy questioned as Stockholm death toll mounts

A spike in novel coronavirus infections and deaths in Stockholm has raised questions about Sweden's decision to fight the outbreak without resorting to the lockdowns that have left much of Europe at a standstill.

www.reuters.com

 

[RickyScott]

Sweden’s liberal pandemic strategy questioned as Stockholm death toll mounts

Sweden's liberal pandemic strategy questioned as Stockholm death toll mounts

A spike in novel coronavirus infections and deaths in Stockholm has raised questions about Sweden's decision to fight the outbreak without resorting to the lockdowns that have left much of Europe at a standstill.

www.reuters.com

Takes a lot of balls on part of leaders. Will have an answer soon if they suffer more for it. Follow deaths on Hopkins map. Sweden has more than double the population of neighboring Scandinavian countries so can get a rough idea of how this is working out for them.

 

[RickyScott]

Good read by a cancer doc

How Does the Coronavirus Behave Inside a Patient?

We’ve counted the viral spread across peoples; now we need to count it within people.

www.google.com

 

[Gfunk6]

KKR-Backed Envision Withholds Doctor Pay as Routine Care Slows

Virtually every physician nationwide will feel the financial hurt. Things may be ok now but in 2-6 weeks it will become painful for those who don’t belt tighten and/or have an emergency fund.

You can vilify VC all you want but less money in = less money out. Only the feds can print money.

 

[RickyScott]

Breach of Contract: Protecting Doctors During COVID-19 (w/Kyle Claussen)

Contract negotiation isn't something they teach in med school.

zdoggmd.com

 

[PhotonBomb]

Yes in fact I WILL vilify private equity and VC. Thanks for permission, GFunk. They are pure trash.

Long thread warning:

 

[theradiator]

Yes in fact I WILL vilify private equity and VC. Thanks for permission, GFunk. They are pure trash.

Long thread warning:

Yes, we lived through this nightmare with 21C, Oncure and Vantage and now the vultures have since moved on to other areas in medicine.

 

[Gfunk6]

Yes in fact I WILL vilify private equity and VC. Thanks for permission, GFunk. They are pure trash.

Long thread warning:

I listened carefully to the audioblog that Ricky Scott posted above. Clearly, it VCs/hospitals are unilaterally changing contracts in violation of agreements, that is a huge problem. One of the most trenchant insights (love that Simpsons episode) from the blog was the statement along the lines of: "Our entire medical establishment in the US is predicated on the profitability of elective procedures. Once those stop happening, it caused a cascade of events that caused the whole system to tumble like a house of cards."

It is true that a crisis tends to bring out the worst (or best) in people and will let you see their true colors. However, unlike grocery stores who are at least seeing more business, medicine is heading the opposite way. I think it's safe to say that most of us are earning > $200,000 per year at our jobs. We will not be eligible for stimulus checks nor will we be eligible for having our salaries propped up the small business forgivable loan program from Congress as it explicitly disallows doing so if you earn > $100,000.

I hope that all of you didn't put your entire life savings in the stock market and have a robust rainy day fund.

 

[DebtRising]

I listened carefully to the audioblog that Ricky Scott posted above. Clearly, it VCs/hospitals are unilaterally changing contracts in violation of agreements, that is a huge problem. One of the most trenchant insights (love that Simpsons episode) from the blog was the statement along the lines of: "Our entire medical establishment in the US is predicated on the profitability of elective procedures. Once those stop happening, it caused a cascade of events that caused the whole system to tumble like a house of cards."

It is true that a crisis tends to bring out the worst (or best) in people and will let you see their true colors. However, unlike grocery stores who are at least seeing more business, medicine is heading the opposite way. I think it's safe to say that most of us are earning > $200,000 per year at our jobs. We will not be eligible for stimulus checks nor will we be eligible for having our salaries propped up the small business forgivable loan program from Congress as it explicitly disallows doing so if you earn > $100,000.

I hope that all of you didn't put your entire life savings in the stock market and have a robust rainy day fund.

I agree that if all revenue goes down, then we will not be spared. But all have to share in this for it to be fair. If the CEO of the group, whether its a hospital based, VC backed, or private practice, cuts their salary but keeps their deferred comp - they shift the burden to the physicians. If the head of the gift shop, which has been closed for 3 weeks and is bigger than a department store, keeps their salary and while yours get cut, despite any clinical volume you have, that's again abusing the physicians.

If it is equitable, all in. The issue with the VC funds is that they have massive losses on their other investments, so they are squeezing docs in the middle of a pandemic to cover their losses because staffing costs are one of their recurring high costs they can turn off with a button without harm to them. Shame on us as physicians in general for ever being in this situation, our fault, but that arrangement is quite honestly bullsh*t. We get farmed into 'compassion, compassion, compassion' and hundreds of thousands of loans and lost years and end up in this submissive position when we are the ones delivering care, and this crisis will be a golden opportunity for anyone in the C-suite to take advantage of that further and deferentially cut us more.

My advice to everyone is to make sure you know what revenue you are bringing into your practice right now, whatever setup it is. Document your numbers on treatment, your billing codes, whatever you are comfortable with. Evaluate what you bring to the group that is indispensable. If that is nothing, then you may have no leverage except to start looking. I was contacted for 2 emergent jobs in the last week, no joke. If it is something that even the 40 year vet telemeding his OTVs can't do, then you make sure you bring that up when they tell you to take less, unless those people are also taking less. If all are taking less, and you can verify this, then that's what is needed to survive and that is a mark of a worthwhile organization to be with. If not, then you realize you will just be squeezed and discarded anytime something comes up again.

And put all your money in bitcoin...that is the only safe haven

 

[Gfunk6]

I agree that if all revenue goes down, then we will not be spared. But all have to share in this for it to be fair. If the CEO of the group, whether its a hospital based, VC backed, or private practice, cuts their salary but keeps their deferred comp - they shift the burden to the physicians. If the head of the gift shop, which has been closed for 3 weeks and is bigger than a department store, keeps their salary and while yours get cut, despite any clinical volume you have, that's again abusing the physicians.

I agree with this 100%. The pain has to be felt uniformly and distributed evenly.

 

[RadOncDoc21]

Hahaha, when has anything ever been fair in life?

 

[medgator]

. We will not be eligible for stimulus checks nor will we be eligible for having our salaries propped up the small business forgivable loan program from Congress as it explicitly disallows doing so if you earn > $100,000.

Pretty sure there is no income test on the payroll protection program, only that the maximum benefit is at $100k salary/year per employee and the business has to have less than 500 employees. Plenty of medical groups are applying, including ours, as we speak. Essentially, these are cancellable loans through the SBA program at various banks that you don't have to pay back as long as the money is used to keep the business/practice running without layoffs or significant paycuts

For once, this isn't looking like another corporate bailout/handout. The f500 companies are only getting loans with strict terms.

Congress finally learned something from the financial crisis. Most of the coronavirus aid is going to average Americans, not giant corporations.

Big businesses have to pay back the loans they get from the government, while small businesses and families get direct relief through grants.

www.businessinsider.com

 

[OTN]

KKR-Backed Envision Withholds Doctor Pay as Routine Care Slows

Virtually every physician nationwide will feel the financial hurt. Things may be ok now but in 2-6 weeks it will become painful for those who don’t belt tighten and/or have an emergency fund.

You can vilify VC all you want but less money in = less money out. Only the feds can print money.

This is true. Those of us in private practices without VC funding are going through the same. I'm anticipating a significant drop in income for several months. It's worse in other subspecialties, though. My hand surgeon and GI friends are down 90% of their business. The hand surgeon fired 75% of his staff and is only going to take trauma call until this all blows over.

If you have a truly diverse private practice, there's going to be SOME business out there. Can't wait too long on a head and neck, lung, pelvic, and intracranial malignancies. Breast, prostate, skin can be deferred, of course. The stem cell transplant program is an interesting question. For many of those patients those transplants can be a last hope, with TBI included. They cleared it out for now, so none on the horizon, thank goodness.

 

[evilbooyaa]

People who are salary and RVU based will make less money based on RVU, but should be able to be guaranteed their salary.... at some point. Furlough for 2-4 weeks is not unreasonable in the same way that paying rent has been pushed back by say a month.

The concept of unilaterally denying people their contractually obligated compensation (without a plan for future 'makegood' of that compensation) is hypocritical, IMO. If physicians are just employees, then we deserve the same rights as all other employees. If that means some have to be laid off, that means physicians are available for unemployment benefits. If you don't want to be laid off, then unfortunately you have to accept their offer.

 

[Gfunk6]

Pretty sure there is no income test on the payroll protection program, only that the maximum benefit is at $100k salary/year per employee and the business has to have less than 500 employees.

I researched this again and I believe you are right, I stand corrected. However, that amount will only supplement a fraction of RO MD compensation not to mention our expensive, professionally-licensed support staff (RTT, Dosi, Physics).

 

[medgator]

I researched this again and I believe you are right, I stand corrected. However, that amount will only supplement a fraction of RO MD compensation not to mention our expensive, professionally-licensed support staff (RTT, Dosi, Physics).

Agree, but as they say, something is better than nothing, and if the Fed printing presses are getting fired up, you should try to get your share of the $$$

 

[RickyScott]

Takes a lot of balls on part of leaders. Will have an answer soon if they suffer more for it. Follow deaths on Hopkins map. Sweden has more than double the population of neighboring Scandinavian countries so can get a rough idea of how this is working out for them.

Good control group

https://www.google.com/amp/s/www.washingtonpost.com/world/europe/coronavirus-pandemic-for-many-in-sweden-life-goes-on-as-usual/2020/04/06/7402f68e-75bb-11ea-ad9b-254ec99993bc_story.html%3foutputType=amp

 

[medgator]

Good control group

https://www.google.com/amp/s/www.washingtonpost.com/world/europe/coronavirus-pandemic-for-many-in-sweden-life-goes-on-as-usual/2020/04/06/7402f68e-75bb-11ea-ad9b-254ec99993bc_story.html%3foutputType=amp

Sweden's Relaxed Approach to the Coronavirus Could Be Backfiring

The Nordic country has a much higher fatality rate than its neighbors

time.com

Not looking good over there

 

[medgator]

I researched this again and I believe you are right, I stand corrected. However, that amount will only supplement a fraction of RO MD compensation not to mention our expensive, professionally-licensed support staff (RTT, Dosi, Physics).

$30 billion coming from CMS to all Medicare providers based on revenue, will be released in "tranches", nothing needs to be done apparently to get them

HHS Begins Funding $30 Billion to Medicare Providers – Attestations to Be Required | McGuireWoods

First 30 Billion Tranche Public Health Social Services Emergency Fund

www.mcguirewoods.com

‘No Strings Attached’: CMS Sending $30 Billion to Home Health Agencies, Other Medicare Providers

If home health and hospice providers discover an unexpected Medicare payment from the Centers for Medicare & Medicaid Services (CMS) later this week,

homehealthcarenews.com

 

[Gfunk6]

$30 billion coming from CMS to all Medicare providers based on revenue, will be released in "tranches", nothing needs to be done apparently to get them

HHS Begins Funding $30 Billion to Medicare Providers – Attestations to Be Required | McGuireWoods

First 30 Billion Tranche Public Health Social Services Emergency Fund

www.mcguirewoods.com

‘No Strings Attached’: CMS Sending $30 Billion to Home Health Agencies, Other Medicare Providers

If home health and hospice providers discover an unexpected Medicare payment from the Centers for Medicare & Medicaid Services (CMS) later this week,

homehealthcarenews.com

This is simply "pre-payment." You still have to pay it back when this is over. Assuming there is an RO clinical volume surge on the back end of COVID pandemic, you may find yourself working hard but still not rising about base compensation as the "extra" money will be going back to CMS.

 

[medgator]

This is simply "pre-payment." You still have to pay it back when this is over. Assuming there is an RO clinical volume surge on the back end of COVID pandemic, you may find yourself working hard but still not rising about base compensation as the "extra" money will be going back to CMS.

That's a different program gfunk, these are grants from what I've been reading and my sources are saying.

Per the above link:

The fund will be released in tranches in order to disburse dollars as quickly as possible, with the first $30 billion of the fund released to Medicare providers in the form of “no strings attached” grants.

Below are the details Administrator Verma announced regarding distribution of the first $30 billion of the fund:

1. The funding will be in the form of grants based on Medicare revenue. There are no strings attached to the grants, which will allow healthcare providers receiving these funds to “spend that in any way that they see fit.”
   
   
2. For healthcare providers with direct deposit accounts set up with CMS, the funds will be automatically deposited into the provider’s bank accounts. For providers without direct deposit, CMS will require the providers to complete a “very simple” registration in order to receive the funds. CMS has not yet released further details regarding the registration process.
   
   
3. The first round of funding is expected to happen this week.
   
   
4. Funding is not available on a first-come, first-serve basis; the program is based on providers’ Medicare revenue.
   
   
5. The second tranche of funding will address organizations and healthcare providers that receive significant revenue from sources other than Medicare, including pediatricians, children’s hospitals, OB-GYNs, nursing homes and other providers receiving funds primarily from Medicaid or other payer sources.

The program you are thinking of is this one which was previously announced as "advanced/accelerated" payments:

CMS has doled out nearly $34B in advance, accelerated payments to providers to combat COVID-19

The Trump administration delivered nearly $34 billion in advance and accelerated payments to providers over the past week to help facilities combat COVID-19.

www.fiercehealthcare.com

 

[Burt Radnolds]

That's a different program gfunk, these are grants from what I've been reading and my sources are saying.

Per the above link:



The program you are thinking of is this one which was previously announced as "advanced/accelerated" payments:

CMS has doled out nearly $34B in advance, accelerated payments to providers to combat COVID-19

The Trump administration delivered nearly $34 billion in advance and accelerated payments to providers over the past week to help facilities combat COVID-19.

www.fiercehealthcare.com

Agree with medgator. Have been hashing this out in our group and unbelievably, it seems these payments are just free money, separate from the other programs that have been mentioned, although there are certain rules that apparently need followed that I have not read yet.

 

[medgator]

Agree with medgator. Have been hashing this out in our group and unbelievably, it seems these payments are just free money, separate from the other programs that have been mentioned, although there are certain rules that apparently need followed that I have not read yet.

Breakdown of both programs from CMS

 

[medgator]

A Major Medical Staffing Company Just Slashed Benefits for Doctors and Nurses Fighting Coronavirus

Alteon Health, backed by private-equity firms Frazier Healthcare Partners and New Mountain Capital, will cut salaries, time off and retirement benefits for providers, citing lost revenue. Several hospital operators announced similar cuts.

www.propublica.org

Now they want bailout money too

Medical Staffing Companies Owned by Rich Investors Cut Doctor Pay and Now Want Bailout Money

Companies that employ emergency room medical personnel, many owned by private equity firms, say they are reeling from vanishing demand for non-coronavirus care. But critics worry that bailout money would be a windfall for rich investors.

www.propublica.org

 

[Irradi8or]

This is a joke right? 21C, US Oncology, Vantage, ION, Eplus (now ION)....

Sorry I’m super late to this discussion, but need to bring up OneOncology.It’s backed by a $200M PE General Atlantic and is very predatorial. Scooping up mostly Med Onc but also rad Onc practices.

 

[Reaganite]

Woke up to a chunk of change from hhs that I definitely did not apply for this morning...

 

[Gfunk6]

Agree with medgator. Have been hashing this out in our group and unbelievably, it seems these payments are just free money, separate from the other programs that have been mentioned, although there are certain rules that apparently need followed that I have not read yet.

Wow. Feds are sure printing a lot of money for these programs.

 

[Chartreuse Wombat]

Wow. Feds are sure printing a lot of money for these programs.

Our children and grandchildren will be paying this bill for their entire lives.

 

[medgator]

Wow. Feds are sure printing a lot of money for these programs.

It's nice being the world's reserve currency (for now)

 

[w00tz]

Yeah, MAGA!!! Free money. TRUMP TRUMP TRUMP, USA USA USA.

Real talk - all this money coming out of thin air can't be good long-term for the US, right?

 

[thecarbonionangle]

Yeah, MAGA!!! Free money. TRUMP TRUMP TRUMP, USA USA USA.

Real talk - all this money coming out of thin air can't be good long-term for the US, right?

we will all pay. You just wait

 

[medgator]

Yeah, MAGA!!! Free money. TRUMP TRUMP TRUMP, USA USA USA.

Real talk - all this money coming out of thin air can't be good long-term for the US, right?

Depends on which party is in power....

 

[RickyScott]

Sweden's Relaxed Approach to the Coronavirus Could Be Backfiring

The Nordic country has a much higher fatality rate than its neighbors

time.com

Not looking good over there

Still making it interesting ...

Sweden sees just 77 new deaths from coronavirus

The 77 new deaths - down from 106 yesterday - bring the total from 793 to 870, according to figures from Sweden's public health agency.

www.dailymail.co.uk

 

[DoctwoB]

Yeah, MAGA!!! Free money. TRUMP TRUMP TRUMP, USA USA USA.

Real talk - all this money coming out of thin air can't be good long-term for the US, right?

Like most things in macroeconomics, the answer is “it depends.” The fed is buying bonds and injecting money into the economy (printing money is an obvious misnomer), but not entirely inaccurate in principle. This would typically be pro Inflationary as more money supply chasing the same quantity of goods drives up prices. However, The monetary supply isn’t a fixed thing, it is dynamic based on the rate at which currency is moving through the economy, which is currently slowing, which would typically be deflationary. So the fed may be able to “print” money with little to no consequence.

On the other hand, the federal government (different from the fed) is using debt to fund stimulus and bailout programs. This will drive up the deficit which will mean higher debt service payments in the future. Fortunately this debt is cheap as hell as real interest rates for the government are negative, meaning people are paying the government to take their money. However if they were to do nothing, the deficit would skyrocket anyways due to reduced tax receipts. So this way you may (key word) blunt that effect, keep the economy moving, and limit the effect on the deficit. Basically the deficit was going to be screwed either way, this way we might get something for it.

 

[w00tz]

Like most things in macroeconomics, the answer is “it depends.” The fed is buying bonds and injecting money into the economy (printing money is an obvious misnomer), but not entirely inaccurate in principle. This would typically be pro Inflationary as more money supply chasing the same quantity of goods drives up prices. However, The monetary supply isn’t a fixed thing, it is dynamic based on the rate at which currency is moving through the economy, which is currently slowing, which would typically be deflationary. So the fed may be able to “print” money with little to no consequence.

On the other hand, the federal government (different from the fed) is using debt to fund stimulus and bailout programs. This will drive up the deficit which will mean higher debt service payments in the future. Fortunately this debt is cheap as hell as real interest rates for the government are negative, meaning people are paying the government to take their money. However if they were to do nothing, the deficit would skyrocket anyways due to reduced tax receipts. So this way you may (key word) blunt that effect, keep the economy moving, and limit the effect on the deficit. Basically the deficit was going to be screwed either way, this way we might get something for it.

Thanks for this really thoughtful response.

 

[maruchan]

 

[RickyScott]

View attachment 301839

Obviously they will have an initial spike as that is the intention here. Waiting to see if the health system is overwhelmed and final death totals.

 

[medgator]

Obviously they will have an initial spike as that is the intention here. Waiting to see if the health system is overwhelmed and final death totals.

Looks like the highest risk group is taking the brunt of it. Seems stupid to not even require a mask among healthcare workers in a high risk setting like a nursing home....

Anger in Sweden as elderly pay price for coronavirus strategy

Staff with no masks or sanitiser fear for residents as hundreds die in care homes

www.theguardian.com

 

[Lamount]

With the lurking risk of deflation (oil at lows and everyone out of work so no one is buying anything so companies lose profits and lay off more... and the cycle continues), I am not so sure “printing money” and borrowing with no interest is a bad idea. Falling revenue feels like a greater threat than spending. in actuality, this is one of those things where no one is smart enough to know all of the factors involved.

 

[medgator]

With the lurking risk of deflation (oil at lows and everyone out of work so no one is buying anything so companies lose profits and lay off more... and the cycle continues), I am not so sure “printing money” and borrowing with no interest is a bad idea. Falling revenue feels like a greater threat than spending. in actuality, this is one of those things where no one is smart enough to know all of the factors involved.

Yup, didn't help walking into this with a supposedly "strong" economy running trillion dollar annual deficits though.... generally the idea has been to save for "rainy day" events like this rather than run roaring deficits. I think the risk is we may end up like Japan with perpetual "stagflation", but part of their problem may be demographics....

 

[RickyScott]

Looks like the highest risk group is taking the brunt of it. Seems stupid to not even require a mask among healthcare workers in a high risk setting like a nursing home....

Anger in Sweden as elderly pay price for coronavirus strategy

Staff with no masks or sanitiser fear for residents as hundreds die in care homes

www.theguardian.com

Tough decisions. Pain now or later? Sweden has a population about half that of nyc. Come May 1st they are still on tract to have less than .5 nyc deaths and they will be relatively home free, having achieved herd immunity and minimizing the economic effects.
When 2nd wave of corona virus comes around in 6 months, guess who is not going to be affected much ? Corona virus apparently has low mutation rate relative to flu.

 

[xrthopeful]

Tough decisions. Pain now or later? Sweden has a population about half that of nyc. Come May 1st they are still on tract to have less than .5 nyc deaths and they will be relatively home free, having achieved herd immunity and minimizing the economic effects.
When 2nd wave of corona virus comes around in 6 months, guess who is not going to be affected much ? Corona virus apparently has low mutation rate relative to flu.

What percent of their population got it? Not exactly herd immunity when such a small proportion of the Swedish population was affected.