Private equity is into Ortho now...

[rakotomazoto]

More orthopedic physicians sell out to private equity firms, raising alarms about costs and quality

While some doctors seem eager for the payout, others are warily watching what happens when private equity firms take charge of orthopedic practices.

www.cbsnews.com

History repeats itself. It's almost eerie...

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[sevoflurane]

Our big ortho group in town will never do this unless the buyout is absolutely gigantic. They do very well here and have the biggest footprint in town by a long shot.

Unfortunately, one other group and one very successful shoulder surgeon went down the golden parachute route. Definitely happening.

 

[aneftp]

The big orthopedic practice in Florida got paid over 250 million “joint venture” with a new hospital being built. An idiot can presume each managing orthopedic surgeon got in excess of 10 million each partner plus an equity stake in the new hospital. Basically a deal valued more than 20 plus million per partner.

 

[NICMAN]

I heard of that Orlando deal.

A little farther north where I practice the group was bought out and each partner received a nice 8 figure buyout--after which many of them took the first 2 week vacation any of them had ever taken their whole lives. Now they complain less when I cancelled their cases.

 

[Anestheezee]

More orthopedic physicians sell out to private equity firms, raising alarms about costs and quality

While some doctors seem eager for the payout, others are warily watching what happens when private equity firms take charge of orthopedic practices.

www.cbsnews.com

History repeats itself. It's almost eerie...

That PE firm mentioned in the article (WCAS) owns USAP

 

[dannyboy1]

I heard of that Orlando deal.

A little farther north where I practice the group was bought out and each partner received a nice 8 figure buyout--after which many of them took the first 2 week vacation any of them had ever taken their whole lives. Now they complain less when I cancelled their cases.

And the PE firms continue to scratch their heads as to why they are not making as much as projected. I don’t see their angle here. In dermatology they hire a bunch of PA/NP because they can get away with it. Not gonna be able to do that in ortho.

 

[nimbus]

And the PE firms continue to scratch their heads as to why they are not making as much as projected. I don’t see their angle here. In dermatology they hire a bunch of PA/NP because they can get away with it. Not gonna be able to do that in ortho.

Skimming professional fees?

Bigger ortho practices also have in-house ancillaries like imaging, ASCs, OT/PT, etc which are money makers for the owners.

I’m sure they run the past and current numbers before acquiring. What the future holds is unknown.

 

[Fpg1245]

It’s gonna be the same greedy cycle we saw with other specialties. The first movers get the real money. Everyone that comes after will be getting crumbs/forced to sell. Payers start looking at Ortho reimbursement and start cutting accordingly.

Of course orthopods welcome it! They’ve spent their entire lives getting jerked off by admin and device reps to send patients to their hospital or use their freaking 20K hip implant system that’s not different or ASC. So when a big PE firm comes to give them a giant payday, they aren’t gonna ask questions. Orthos in general aren’t a very introspective bunch either so expect all sorts of justifications for this type of behavior. I expect the AAOS to provide a neutered response in general meanwhile taking gobs of money from them when conferences come around.

I feel for those junior Ortho partners who will be getting precisely dick.

 

[kidthor]

In dermatology they hire a bunch of PA/NP because they can get away with it. Not gonna be able to do that in ortho.

I don’t see why not? They already have midlevels doing MOHS and colonoscopies (not to mention doing anesthesia, running icus, doing interventional pain, and so forth). I don’t see why ortho procedures aren’t next. Private equity has no limits.

 

[Vandalia]

And the PE firms continue to scratch their heads as to why they are not making as much as projected. I don’t see their angle here. In dermatology they hire a bunch of PA/NP because they can get away with it. Not gonna be able to do that in ortho.

Ortho hospitals.

If you control the surgeons, and you build/acquire the new trend of "ortho hospitals", then you have your revenue stream.

Cut nursing to the bone, CRNA staffing, CT/MRI/PET everyone at hospital rates, and there you have the income potential ...

 

[kidthor]

Ortho hospitals.

If you control the surgeons, and you build/acquire the new trend of "ortho hospitals", then you have your revenue stream.

Cut nursing to the bone, CRNA staffing, CT/MRI/PET everyone at hospital rates, and there you have the income potential ...

Yes plus the parent company will own a stake in the device companies and somehow have a suspicious yet quasi-legal stark law carve out. Because… “synergy” and “economies of scale”.

 

[nimbus]

I don’t see why not? They already have midlevels doing MOHS and colonoscopies (not to mention doing anesthesia, running icus, doing interventional pain, and so forth). I don’t see why ortho procedures aren’t next. Private equity has no limits.

I’ve seen the paper out of Hopkins but has anybody actually seen midlevels doing endoscopy?

 

[dantt]

Our big ortho group in town will never do this unless the buyout is absolutely gigantic. They do very well here and have the biggest footprint in town by a long shot.

Unfortunately, one other group and one very successful shoulder surgeon went down the golden parachute route. Definitely happening.

That's what gets you the biggest buyout.

 

[BLADEMDA]

What if the buyout was $8 million? or $10 million? That's what it would take for some groups and I suspect private equity will pay it. If you were an Ortho doctor 3 years into your career and were offered $10 million plus a $500K salary would you take it?

 

[GassYous]

What if the buyout was $8 million? or $10 million? That's what it would take for some groups and I suspect private equity will pay it. If you were an Ortho doctor 3 years into your career and were offered $10 million plus a $500K salary would you take it?

Easily especially with capital gains tax

 

[GravelRider]

What if the buyout was $8 million? or $10 million? That's what it would take for some groups and I suspect private equity will pay it. If you were an Ortho doctor 3 years into your career and were offered $10 million plus a $500K salary would you take it?

I was working with a hand surgeon who is maybe 5-7 years out recently and he said he wouldn’t even glance at a buyout offer under $10 million.

 

[nycitygas]

I’ve seen the paper out of Hopkins but has anybody actually seen midlevels doing endoscopy?

Yes. VA in MO

 

[narcotics999]

Ortho hospitals.

If you control the surgeons, and you build/acquire the new trend of "ortho hospitals", then you have your revenue stream.

Cut nursing to the bone, CRNA staffing, CT/MRI/PET everyone at hospital rates, and there you have the income potential ...

Every patient gets a central line and A-line for controlled hypotension to avoid bleeding.....

 

[Fpg1245]

Every patient gets a central line and A-line for controlled hypotension to avoid bleeding.....

Despite having a tourniquet on for bloodless surgical field

Plus cell saver

Plus everyone gets 3 bottles of Ofirmev

Plus an EMG immediately post op

Plus a genetic testing on pseudocholinesterase deficiency despite using suga for all cases

 

[abolt18]

Despite having a tourniquet on for bloodless surgical field

Plus cell saver

Plus everyone gets 3 bottles of Ofirmev

Plus an EMG immediately post op

Plus a genetic testing on pseudocholinesterase deficiency despite using suga for all cases

Plus the CSE for post-op pain control...

 

[nimbus]

Every patient gets a central line and A-line for controlled hypotension to avoid bleeding.....

Reminds me of HSS where they were doing high epidural anesthesia, Alines, CVP +- PA catheters and epi infusions for total hips.

#1 Ortho hospital in America 😂

Randomized Trial of Hypotensive Epidural Anesthesia in Older Adults

Background. Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients.Methods. This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective...

pubs.asahq.org

 

[GassYous]

Reminds me of HSS where they were doing high epidural anesthesia, Alines, CVP +- PA catheters and epi infusions for total hips.

#1 Ortho hospital in America 😂

https://watermark.silverchair.com/0000542-199910000-00011.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAwEwggL9BgkqhkiG9w0BBwagggLuMIIC6gIBADCCAuMGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQMzY8kLGawAvPXgQaeAgEQgIICtGL1H7aWR-BUN1pm0J0CGYNGSuY0gvatsZaWBAv3CD9Ib5EEVss8C5fssDaW4wMV-mgiewLQHv0lEoDVvdMD5oGXoFvX6uSFpUkZXhr8lZ3EccutAdA5smLxS_aAbHUoj5aW_WmLEFu0YwP03ma0oKi2vhrja3PpMDS3Lk-SKRPrg8MBb6N0BKF_7g6aHwZIq7sTPuAX1ca1TC10dGIig7k-5Lm8b2Q9DhI7EgdWUXdACrhZDTNZWvKtnIGwLIkXi-M6Mlcf1uDyBvQdQNtoUyueqbGB7VMsm_nzixm7YzVPxyAKu6KqIPjOznR5RrskavsB1mAO1wjew1bHsrVvO7I40Qqgze84huIiAmRT3qWainYnQCwVw861h0K-E5LWEuzDcE3LmlcaERl73sQTjhe4_wyZ6Ockc0bXaCO1WKpl9cg-3YTSNRw23mEqMpae1oRDCobPxoRGp0t89yX7KlnPFkxlxSnThOrH7lKP_doR2exh2IDMV1c9QPDtUGcuDc-KL7xEkHkGOZ2atrXb6Sp3kP_M1ZfCWEtPUtBxXjfvEl9GGswypDLQq_zOL2oEWVxjkV70Q2t0Mi74njo0CMrQXY4gBT21IP9VVa5Oe-t4dfA1MetEWS0bs5XJzSRuiULYvIpeFNcNQFGqeHsidh4ScWFwuned-iPyR5neIe2XnRnMGclwRCNBFd3F2cIhsRWw_5cFKtwALFfTwyiWYZMw9VpIhlNJC3Zl1OnKAuR2DugVvF64On8NMy-fFj0fV96o369rF_e5YVbOEZ075B9WJRMRdIyD-EkjL8-f16fmoHWZ50hRQC9F-Leb_XUKm3vHXYVDGOqXu7N99n-davE03jAssNgR7gcIeUkSzo0FDTFEVrT-qqee55eeaVmFWEdLrpqtkZBiODr4-mSH8EKxkphi

That is just insane. We probably complete our totals before they finish all the unnecessary procedures.

 

[dabears505]

I'm so sad anesthesia doesn't get buyout money anymore, just contact loss and replacement.

 

[stormn12]

Reminds me of HSS where they were doing high epidural anesthesia, Alines, CVP +- PA catheters and epi infusions for total hips.

#1 Ortho hospital in America 😂

Randomized Trial of Hypotensive Epidural Anesthesia in Older Adults

Background. Data are sparse on the incidence of postoperative cognitive, cardiac, and renal complications after deliberate hypotensive anesthesia in elderly patients.Methods. This randomized, controlled clinical trial included 235 older adults with comorbid medical illnesses undergoing elective...

pubs.asahq.org

This publication is 25 years old, definitely not doing central lines and PACs for hips.

 

[nimbus]

This publication is 25 years old, definitely not doing central lines and PACs for hips.

But they did it for quite a while. Got many publications and startup units out of it.

This was published in 2006. It was their routine practice then and they were trying to convince others to do it too. I read the papers as they were being published and thought they were crazy. AFAIK nobody else was doing what they were doing for total hips.


“However, patients with CRD could potentially benefit from HEA, which offers many advantages in total hip replacement (THR), such as reduced blood loss and blood transfusion, low rate of venous thromboembolism,19 improved cement fixation20 and a low postoperative mortality rate.21 For these reasons, we began utilising increasing degrees of HEA in patients with CRD so that by 1998–99, our routine practice was to utilise HEA in all patients with CRD. This study describes the experience of using HEA in 50 patients with preoperative CRD.

Methods. From a database of 1893 consecutive patients undergoing total hip replacement (THR) under hypotensive epidural anaesthesia (HEA) from 1999 to 2004, 54 patients were identified with CRD (preoperative serum creatinine ≥124 μmol litre−1). Fifty matched pairs were identified for patients with normal renal function who have hypertension (n=50) or no hypertension (n=50). Changes in serum creatinine and blood urea nitrogen (BUN) were recorded daily for 3 days. Acute renal failure was defined as an increase in serum creatinine of 44 μmol litre−1.”

Hypotensive epidural anaesthesia in patients with preoperative renal dysfunction undergoing total hip replacement

Abstract. Background. Hypotensive anaesthesia does not impair renal function after surgery in normal patients but there are no reports of hypotensive anaesthesi

academic.oup.com

Another paper measuring transcranial Doppler using same anesthetic technique from 2016. The target MAP was <50. I know one of the authors (Drummond) would not allow that in his own patients but he doesn’t practice at HSS.

Google Scholar

scholar.google.com

The papers span from 1990-2016. A long freakin time.

 

[nimbus]

Addiction treatment is yet another widget factory for private equity.

“They brought us doughnuts and said, ‘We have an exciting announcement,’” Dawn recalled. “’We’re selling it, but don’t freak out, because nothing is going to change. It’s just they have more money so you’re going to be able to be paid more.’”

Sound familiar?

For addiction recovery facilities, does private equity money help or hurt?

Addiction treatment has become a prime investment target because of the ongoing opioid overdose crisis and improved health insurance coverage.

www.marketplace.org

 

[ambiturner]

Addiction treatment is yet another widget factory for private equity.

“They brought us doughnuts and said, ‘We have an exciting announcement,’” Dawn recalled. “’We’re selling it, but don’t freak out, because nothing is going to change. It’s just they have more money so you’re going to be able to be paid more.’”

Sound familiar?

For addiction recovery facilities, does private equity money help or hurt?

Addiction treatment has become a prime investment target because of the ongoing opioid overdose crisis and improved health insurance coverage.

www.marketplace.org

Has there ever been anything more profitable than getting a country addicted to opioids? I mean this is a new low but so much money is in the production, distribution, prisons, treatment…

 

[nimbus]

Has there ever been anything more profitable than getting a country addicted to opioids? I mean this is a new low but so much money is in the production, distribution, prisons, treatment…

Also sad is that PE has zero interest in anesthesia or orthopedics or addiction treatment or fried chicken or whatever their next thing is.