- Joined
- Jul 26, 2010
- Messages
- 55
- Reaction score
- 38
300/hr is a yawn. You'd think they'd actually offer a carrot for last minute coverage.
Why are we not discussing this? CMGs gobbling up SDGs
- Thread starter EctopicFetus
- Start date
- Joined
- Oct 21, 2008
- Messages
- 6,281
- Reaction score
- 2,538
My read of that email is that they're going to pay $300/hr right now to get staffed up. Pay will drop after that. They're also unlikely to keep paying the PA-Cs $150/hr.
- Joined
- Jul 6, 2008
- Messages
- 3,489
- Reaction score
- 6,004
Anyone else get the email blast from USACS about Summa? If not, here it is:
Two short days ago, US Acute Care Solutions (USACS) was asked to staff Summa Health, Akron, OH area, effective midnight Jan 1, 2017. Unfortunately contract negotiations with the current group broke down leaving the care of 180,000 patients in limbo. As you may have heard, USACS is a national physician-owned group based in Canton, Ohio and when a major local hospital system asked for help, we accepted. To care for patients is our first and foremost value.
We need your help to cover Physician and APP shifts at any of following facilities.
Akron City Hospital- 100,000 visits - Trauma Center
- EM Residency Training program - Akron, OH
Barberton Hospital - 41,000 visits - Barberton, OH
Medina Medical Center - 9,000 visits - Medina, OH
Wadsworth-Rittman Hospital - 10,000 visits - Wadsworth,OH
Green Emergency Department - 21,000 visits - Uniontown, OH
10, 12 & 24 hour shifts are available.
During this critical staffing period, the premium rate for physicians is $300 per hour and for Advanced Practice Providers the rate is $150 per hour.
Interested and want to learn more?
Email Darrin Grella [email protected] or call 330.416.9460 (mobile)
What a JOKE. $300/hr until they get fully staffed which will be about 6 months or so. And for that you get to work in a Crap Hole for 6 months, poorly staffed, staff hates working there, Admin backstabbing everyone, Fellow Docs who have no clue how the ED works, All docs will be slow for 1 month figuring out charting, call system, ect..
The Crappy docs they get to staff that place will be suckers and half the docs there will SUCK. I have worked in Many EDS and there are always 1 out of 10 Boarded Docs that SUCK. The only ones working there will be the old group docs or Hired guns.
If someone from that place calls me, I would want atleast $800/hr with all travel paid for and then a guarantee of 1 year. And I would not budge. Seriously. in Freaking OHIO? I get $500/hr now in a stable ED.
And I am only making 2x an APP? Are You kidding me. I would be embarrassed to take a job where an APP makes 1/2 what I make for 1/10 the liability and responsibility.
My current full time job I make 4x the APP and my Locums, I make 5X the APP and I feel I am under paid.
This place needs to burn in hell and I am sure this place will never be staffed well.
The previous group either pissed someone off or did a HORRIBLE job to be canned with such short notice.
D
deleted109597
Or, you know, the CMO is married to someone high up in USACS, who exists to increase contracts.
- Joined
- Jul 6, 2008
- Messages
- 3,489
- Reaction score
- 6,004
I get the nepotism but there has to be more. No one is stupid enough to put their neck on the line and can a decent size group with such short notice.
Those poor docs. It takes atleast 90 dys to get credentialed somewhere else. Most takeovers gives atleast that much notice so docs can decide to stay or leave.
Another reason to have a locums gig. Can me tonight, and I can 15 locums shifts tomorrow
- Joined
- Jun 20, 2012
- Messages
- 475
- Reaction score
- 728
how does one vet the SDGs to exclude predatory groups? it seems any group has a risk of selling out on short notice,. no?
- Joined
- Jul 6, 2008
- Messages
- 3,489
- Reaction score
- 6,004
You can't. They may be solid today, and sold in a month. Watch your back. Watch out for yourself. EM is in short supply, so strike when the money is there.
Don't be fooled by owners who says their group has been a SDG for 20+ yrs and will not change. Once a CMG offers enought $$, it will be sold.
AAEM involved. Residents at entire hospital upset.
http://www.ohio.com/news/local/resi...2525252525252525252527%252525252525252525253d
Sorry for long URL. Again, trained there. Can't speak highly enough of the docs, really, what SDG has residents, speaks volumes of their passion. I am sure there is more to the story but definitely not an issue with care. Former EMP had a contract at one of the hospitals this SDG staffs now but lost it because they were terrible, but now going back to an off shoot of EMP. Very shady. Actually had contract renegotiations when I was a resident and was told no issues at all, but it was a different CMO and CEO at that time.
I disagree with emergentmd, if you are in a truly democratic group, hard to sell out, unless you have a majority of the group that votes on it. It would screw you if there was an extended partnership track and only a handful of partners, but that doesn't sound democratic at all anyway.
ps. flu season is going to be terrible
http://www.ohio.com/news/local/resi...2525252525252525252527%252525252525252525253d
Sorry for long URL. Again, trained there. Can't speak highly enough of the docs, really, what SDG has residents, speaks volumes of their passion. I am sure there is more to the story but definitely not an issue with care. Former EMP had a contract at one of the hospitals this SDG staffs now but lost it because they were terrible, but now going back to an off shoot of EMP. Very shady. Actually had contract renegotiations when I was a resident and was told no issues at all, but it was a different CMO and CEO at that time.
I disagree with emergentmd, if you are in a truly democratic group, hard to sell out, unless you have a majority of the group that votes on it. It would screw you if there was an extended partnership track and only a handful of partners, but that doesn't sound democratic at all anyway.
ps. flu season is going to be terrible
- Joined
- Nov 18, 2002
- Messages
- 5,220
- Reaction score
- 2,438
Is this where we start sending Darrin Grella hate mail and texting him at all hours of the night to just string him along?
Man I'd hate having my name on that notice.
Man I'd hate having my name on that notice.
- Joined
- Mar 19, 2005
- Messages
- 7,704
- Reaction score
- 7,467
Interesting you say this. One of my colleagues at work also mentioned the wife. It's just too bad that the patients, doctors, and staff have to suffer because of the greed and nepotism of the guys who run EMP (now USACS). Seriously the are the worst of the big CMGs, and their leadership runs it like a cult who prey upon those too stupid or gullible to think for themselves.
- Joined
- Nov 21, 2003
- Messages
- 3,363
- Reaction score
- 2,855
Any group can lose a contract at almost any time. A predatory SDG isn't necessarily one that's going to sell out on short notice. A predatory SDG is a group that sounds democratic but has a small number (or even 1) partner(s) that actually control the group and make a habit of cutting loose pre-partners just before they'd reach the carrot of partnership. Obtaining an accurate employment history of docs with the group is the quickest way to eyeball things, if they'll show you their books (uncommon but not unheard of) you can also track where the money flows.
Agree with the CMO-CEO marriage looking super shady. The fact that it made it this far before a new contract was signed makes me think that the hospital was asking for something that SEA couldn't or wouldn't give. Otherwise new contract would have been finalized long before expiration date. The fact that they were still negotiating day with USACS day before contract ran out either means USACS was trying to rake them over the coals (they're going to lose tons of money in short term paying way above market rate to staff) or whatever the hospital wanted was unreasonable enough that USACS was concerned they weren't going to have long term profitability under those terms.
For those of you that haven't had to deal with the C-suite, especially at a system level, it's important to realize how interconnected and complex the relationship between physician/MLP staffing, nurse/tech staffing, hospital policies on scope of practice, and the dynamics of in-patient care have on an ED being "successful" When a group loses a contract due to metrics, it's almost never simply the result of bad docs/inadequate coverage. Unfortunately the pressure to meet the metrics given inadequate nursing/hospital resources causes a lot of nursing directors blame the doc group. Everyone being tortured (nursing leadership typically will be both privately reprimanded and publicly shamed among their director peers for "inadequate performance) eventually 1) breaks or 2)quits and is replaced by someone that is willing to blame the doc group to save their own skin. It's sometimes easier from an organizational standpoint to fire a critical but ultimately replaceable doc group versus doing the sort of institution wide reorganization to address the root cause of the problem. As a bonus, turmoil from an entirely new group of doctors provides some cover for the management team. "Sure we're struggling with the metrics but once the new docs learn the system we'll be great again!"
- Joined
- Oct 21, 2008
- Messages
- 6,281
- Reaction score
- 2,538
Best you can do is ask around. Helpful if you know people in the group or residency faculty who know the group, have a feel for the local market (CMG presence).
- Joined
- Jul 6, 2006
- Messages
- 577
- Reaction score
- 445
I really hope that docs PAs and NPs do not enable this by taking that offer to work for USACS.
Likely they have their own firefighters who will also just staff the EDs.
It does seems USACS has multiple residencies so it seems they should be capable of taking care of this residency as well (groups love residencies, it's a recruitment pipeline for their company)
However I know how it feels, back when I was a resident my intern year, the ED transitioned from hospital employees and then to two different groups over the time before I graduated. When the residents raised similar concerns, one of the groups agreed; they cut the residency size in half, hired PAs and said "there we fixed it". This could backfire on the residents like it did to us.
- Joined
- Nov 21, 2003
- Messages
- 3,363
- Reaction score
- 2,855
$150 is significantly above market rate for them (although to be fair $300/hr is super high for Ohio on the doc side of things). Unless the hospital has super demeaning rules about scope of practice and supervision requirements, I'd be surprised if they don't fill up pretty quickly.
- Joined
- Jul 6, 2006
- Messages
- 577
- Reaction score
- 445
I do hope these "firefighters" realize how they contribute to the bastardization of our specialty. (maybe I am being too harsh, I think most individual docs are blinded to this, they just show up and work their shifts)
D
deleted109597
D
deleted77919
…
Last edited by a moderator:
- Joined
- Oct 31, 2008
- Messages
- 1,784
- Reaction score
- 3,655
Was this site the mothership or just a satellite community shop for the residents?
Core site. Level 1 Trauma. Stroke Center. About 250-300 ppd. The comments section on that gruntdoc website is entertaining.
- Joined
- Nov 21, 2003
- Messages
- 3,363
- Reaction score
- 2,855
It's always a mistake to assume that the person across the table from you is 1) competent and 2) accountable for their actions.
The portions I still don't understand are what happened that the hospital wanted them out exactly at midnight ?
Was the contract negotiation with SEA that bad that they couldnt pay them for 2 weeks of transition time?
Did the hospital kick the group out then ask USACS to provide the care, causing them to scramble to get coverage?
It seems something happened between SEA and Summa
Was the contract negotiation with SEA that bad that they couldnt pay them for 2 weeks of transition time?
Did the hospital kick the group out then ask USACS to provide the care, causing them to scramble to get coverage?
It seems something happened between SEA and Summa
I have no idea what happened at Summa but I have watched many friends lose contracts over the last 10-15 years or so. In almost every case it wasn't quality but other issues. I think in every case I know of the SDG had traditionally received some sort of financial support from the hospitals. It might have been directorship stipends, or EMS director stipends, or income guarantees. In the end the hospital asked them to give up that support and when they refused the hospitals turned to a CMG. The CMG's have enough scale to do without the hospital payments. My friends across the country all lost contracts that way and all of them were stunned that the hospitals refused to quit supplementing them in one way or another. I suspect from reading between the lines that SEA wanted something that the hospitals no longer wanted to give. The hospitals and the payers have all the power now. Certainly not an SDG.
My own group watched our hospitals cut everything they had every given us while asking us to do more and realized we would be working for Team or Emcare if we didn't do something. So we were one of the first to join USACS (which really isn't just a renamed EMP at this point). After joining it was even more clear how hard it is going to be in the future for SDGs to compete. Our malpractice rates went down 75% while we got a better policy with the same provider we always had! Our billing costs went down 50%. Our health insurance costs went down 30%. MSO costs went way down too. At the same time payers who had for years refused to renegotiate reimbursement rates because they knew the hospital would be pissed if we termed them suddenly agreed to increased rates. Pretty hard to compete when the playing field is that uneven. Much as we like the idea of SDG's I think they may eventually go the way of the town bookstore in the age of Amazon. Still around but pretty uncommon.
It looks to me like two different people registered on Gruntdoc to comment as Dr. Bagnoli. One is listed as Dominic Bagnoli and might be the actual CEO of USACS. The other is listed as Dr. Bagnoli and almost certainly isn't.
My own group watched our hospitals cut everything they had every given us while asking us to do more and realized we would be working for Team or Emcare if we didn't do something. So we were one of the first to join USACS (which really isn't just a renamed EMP at this point). After joining it was even more clear how hard it is going to be in the future for SDGs to compete. Our malpractice rates went down 75% while we got a better policy with the same provider we always had! Our billing costs went down 50%. Our health insurance costs went down 30%. MSO costs went way down too. At the same time payers who had for years refused to renegotiate reimbursement rates because they knew the hospital would be pissed if we termed them suddenly agreed to increased rates. Pretty hard to compete when the playing field is that uneven. Much as we like the idea of SDG's I think they may eventually go the way of the town bookstore in the age of Amazon. Still around but pretty uncommon.
It looks to me like two different people registered on Gruntdoc to comment as Dr. Bagnoli. One is listed as Dominic Bagnoli and might be the actual CEO of USACS. The other is listed as Dr. Bagnoli and almost certainly isn't.
- Joined
- Feb 27, 2007
- Messages
- 5,710
- Reaction score
- 5,461
You guys need a Mod to break the Summa story out in this thread. Every MS4/prospective ER resident who has already interviewed needs to find out because it sounds like it was a place they would have ranked highly before yesterday.
I cannot believe that the CEO is dumb enough to have responded on the internet in the comments section of a blog post. The board's response to the residents (you didn't sign your names so it carries no weight) is also dumb.
I cannot believe that the CEO is dumb enough to have responded on the internet in the comments section of a blog post. The board's response to the residents (you didn't sign your names so it carries no weight) is also dumb.
D
deleted109597
Disagree. The Summa story is literally what this thread is about amongst others.
We don't need more clutter.
We don't need more clutter.
- Joined
- Jun 6, 2002
- Messages
- 13,884
- Reaction score
- 4,441
There are several articles on the web from news sites stating that USACS is offering a $100,000 signing bonus and $1,000/hour for the first 3 weeks. Given that none of the SEA docs signed on, I'm assuming they will need to extend the 3 week period for several months in order to get coverage. I cannot see how they can make money doing this. I love how the email you posted made it seem like SEA just said "we're out" and USACS came to SummaHealth's rescue. Given that the CMO is USACS' CEO's wife, I think there are other issues possibly at play here.
For the record, USACS is owned by Welsh, Carson, Anderson & Stowe. It's an investment company. USACS does not appear to be "physician owned" as the email you posted seems to suggest.
- Joined
- Nov 21, 2003
- Messages
- 3,363
- Reaction score
- 2,855
EmCare took over a (sorta) SDG here and was losing a million a month on staffing for a while before they recruited their permanent staff.
My gut is that Summa wanted them to drop the subsidy for working at their FSED. Unlike physician owned FSEDs that make money for the docs because of the facility fee, hospitals soak up that part of profit. What is left is trying to pay market rate for 24 hr doc coverage when they're billing 7-14 level 3 charts a day. Given that staffing never drops below 1 doc you're looking at about 0.5 pph. That's not sustainable for any length of time if you're paying anything to the doc.
- Joined
- Sep 19, 2004
- Messages
- 2,950
- Reaction score
- 3,281
A colleague of mine from residency worked for an emcare site, and emcare lost that contract to a SDG. Looks like the reverse can also happen ...
Sent from my iPhone using Tapatalk
Sent from my iPhone using Tapatalk
- Joined
- Nov 24, 2002
- Messages
- 23,794
- Reaction score
- 12,309
An @ERMudPhud sighting!
I still remember about 14 years ago and PRES. I keep that one in my toolbox.
- Joined
- Jul 6, 2008
- Messages
- 3,489
- Reaction score
- 6,004
If you are still a resident, I can see why you have such a colored glasses view.
You can be the best performing democratic group that requires Zero subsidies, work well with the hospital O's, have completely equal partners and you are at Risk. We had a similar group and our contract buy out had NO issues with quality of care of subsidies. We were a fully profitable, stand alone group, that asked the hospital for nothing and met/exceeded all the metrics.
The problem arose when they got tired of subsidizing the hospitalists group and wanted us to take/subsidize the hospitals group over. Our choice was to take over the hospitalist group vs letting a CMG that would be glad to do that. ALL partners agreed to be bought out vs taking a huge pay cut.
Everyone needs to get this straight. CMG vs SDG has very little to do with quality. It has everything to do with $$$$.
If a CMG offered to pay the hospital $5 mil/yr for the SDG contract, you will be out in 3 months. Our group got a much bigger buy out but if the CMG could have paid 1/4 of the buyout to the hospital, they would have given our contract away. The hospital just didn't want the unrest when 150+ providers left.
D
deleted109597
Or 36 hours even, if the contract is coming up for renewal.
- Joined
- Sep 19, 2004
- Messages
- 2,950
- Reaction score
- 3,281
I just got off the phone with Paul Kivela from ACEP about this. He's spoken to about 12 people on this issue so far. Apparently someone told him off the record that the current group was threatening to go 'on strike' by January 1, if their terms were not met. He does not know if this is true, but I don't believe this for a second. The other issue he mentioned is that no one is willing to speak with him on the record, and he held accountable for their statements, making it difficult for ACEP to take a position. Also mentioned that if anyone is involved in this and actually has firsthand information, that he wants to hear their side. So far, no one has done this.
Sent from my iPhone using Tapatalk
Sent from my iPhone using Tapatalk
- Joined
- Mar 19, 2005
- Messages
- 7,704
- Reaction score
- 7,467
I also find this hard to believe. Typically the hospital would issue a 90 day notice of termination of contract, during which time the new group would transition. I doubt the old group would "go on strike" over contract negotiations. They may not agree to sign the new one, but they could operate under the old contract for the 90 day period.
Having been through a group termination before, as well as one site that has been sold to larger and larger groups 3X over the last 2 years, I can say that I doubt the doctors went on strike.
- Joined
- Jul 4, 2007
- Messages
- 304
- Reaction score
- 118
Out of curiosity, what do you guy think about Kaiser as a group to work for?
- Joined
- Mar 19, 2005
- Messages
- 7,704
- Reaction score
- 7,467
Low pay, good work environment, good benefits.
- Joined
- Jul 6, 2008
- Messages
- 3,489
- Reaction score
- 6,004
Someone from the old group needs to step up and talk. Otherwise, they have no footing and I will just assume they triggered this by threatening to strike.
There must have been a major catastrophe pending for them to give them a 36 hr termination. Even if the contract ends on Jan 1st, everyone's schedule is out 2-3 months ahead of time. That is why there is a 90 day outclause from both sides usually.
There is no benefit for the hospital to terminate in 36 hrs when they should have atleast 3 months. This is utter chaos and close to a poison pill.
There is no benefit for the CMG to push for a 36 hrs termination due to cost of staffing, Chaos when a 3 month termination would be smoother allowing for staffing to be in place and training to be in place.
I can envision that the SDG threatened something nuclear like striking and admin called their bluff. They were willing to swallow the poison pill b/c a strike would be worse.
I am sure the SDG has a noncompete and threatened to enforce this. Trying to convince 50+ docs with debt/a mortgage/family responsibilities to not cross the line would require something major like a non compete. Esp when they were given a 75/hr raise.
I know when we were in negotiations, if they did a takeover about 1/2 of our docs would have signed on to the CMG. Our SDG would never go to enforce the noncompete b/c its way too expensive with no income source to pay for it.
D
deleted109597
Depending on the state, it would probably be money down the drain anyway. No judge in their right mind would let you sue docs for staffing an understaffed emergency room, especially the trauma center.
I agree, something sounds bad, and the strike threat is probably right. But since noone is willing to go on record, I guess we will hear about it during the lawsuits.
- Joined
- Jun 14, 2004
- Messages
- 4,556
- Reaction score
- 461
I thought that non-compete clauses were unenforceable for emergency physicians. We hold no trade secrets and have no patients of our own. Does anyone know of a case where a group was able to enforce a non-compete clause?
- Joined
- Aug 2, 2002
- Messages
- 7,629
- Reaction score
- 381
I'm on a closed Facebook EM doc group and heard the same thing.
D
deleted109597
You and 9000 of your closest friends. And me.
- Joined
- Oct 21, 2008
- Messages
- 6,281
- Reaction score
- 2,538
Yes.
Lots of variability between regions and even individual sites. The structure makes it difficult to compare with more traditional settings. I think the pay ends up being better than a lot of people think, particularly if you are in it for the long haul and retire with a pension.
- Joined
- Nov 2, 2004
- Messages
- 4,461
- Reaction score
- 5,245
D
deleted109597
OMG! You too?!?
At this point its about 35% owned by Welsh I think. Rest is owned by the docs. Board after the ESP merger I think shows 2 members from the old EMP, 1 from MEP, 2 from Welsh, 1 from outside, and 1 was actually from our old group before taking another route to being on the USACS board. I heard somewhere that there would be 2 board members from ESP. Bottomline though is that private equity is not the majority owner or the majority on the board
I wandered back because I figured this would be a good source for what people in the field thought of what happened in Ohio. Didn't want to get all my info just from official USACS sources.
I know several SDG's that lost or gave up their contract over this exact issue. Team and Emcare both run hospitalist divisions specifically for this reason so they can dangle that carrot in front of the CEO's. Give us your contract and never worry again about having to pay for your hospitalists. Many hospitalist programs even at hospitals with good payer mixes seem to lose money.
- Joined
- May 3, 2004
- Messages
- 12,250
- Reaction score
- 2,868
All hospitalists require a subsidy. The Emcare/TeamHealth groups use the EDs to subsidize the hospitalists. This SEA thing is sad. I think USACS is a bottom feeder and Dom is not an honest business man. Thats my 2 cents.
