Anesthesia Private Equity News Article

[aneftp]

Lol…. Can I borrrow your Amex black card for my portion. The docs don’t have that kind of money… and I don’t think that we have the political capital that PE firms do. I hate to always blame Washington but..::

I do think saying physician owned is very misleading. I don’t know what percentage the physicians own. All I know is that private equity has the controlling shareholder voting rights.

Welsh Carson isn’t in the business to keep collecting 20% margins. They are in the business of pump and dump. If you look at their healthcare companies.

US Anesthesia Partners (USAP) | Investment Profile - WCAS

U.S. Anesthesia Partners Care Delivery | Healthcare Website Initial Press Release See How US Anesthesia Partners Is Investing in Better Healthcare US Anesthesia Partners (USAP) is the nation’s leading provider of anesthesia services, with over 4,500 clinicians providing expert patient care in...

www.wcas.com

Look closely when you click on each company they invest in “status”. They buy and sell companies. Some companies sold. Some not. It’s not a matter of if Usap gets sold. It’s a matter of when it gets sold. Only problem for them is no buyers out there despite how profitable they are.

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[amyl]

You’ve made some great points.

I’m curious though - why are you defending this private equity group who are overlords of your anesthesia practice?

I mean I love my job but will gladly throw my overlords shade when appropriate.

Because they really aren’t overlords… some of the USAP markets that have had some trouble in the past few years have had trouble because the doctors had too much autonomy - the business guys gave advice and the docs ran amok and crashed the ship.
Physican owned. Physician run. For better or worse.
Why do I defend usap?! Because I’ve lived with the alternative- I’ve been in a true pp group, hospital employee and now w usap. My only regret was I didn’t make it here sooner.
Ok - y’all have ripped us a new one… I’m tired of the defense. Good night all… busy OR day tomorrow

 

[amyl]

I do think saying physician owned is very misleading. I don’t know what percentage the physicians own. All I know is that private equity has the controlling shareholder voting rights.

Welsh Carson isn’t in the business to keep collecting 20% margins. They are in the business of pump and dump. If you look at their healthcare companies.

US Anesthesia Partners (USAP) | Investment Profile - WCAS

U.S. Anesthesia Partners Care Delivery | Healthcare Website Initial Press Release See How US Anesthesia Partners Is Investing in Better Healthcare US Anesthesia Partners (USAP) is the nation’s leading provider of anesthesia services, with over 4,500 clinicians providing expert patient care in...

www.wcas.com

Look closely when you click on each company they invest in “status”. They buy and sell companies. Some companies sold. Some not. It’s not a matter of if Usap gets sold. It’s a matter of when it gets sold. Only problem for them is no buyers out there despite how profitable they are.

Doctors are the largest group of shareholders.
no other amc even allows any ownership- we are different — “partners” with PE not owned by.

 

[lane]

You’ve made some great points.

I’m curious though - why are you defending this private equity group who are overlords of your anesthesia practice?

I mean I love my job but will gladly throw my overlords shade when appropriate.

I work closely with them and have a collaborative working relationship with the local, regional, and national business leadership. Believe me when I tell you I don’t always agree with everything and have those conversations with them personally. I’m not going to throw shade unnecessarily at them on a public forum when I largely agree with the organization’s goals and plans. There are many good, intelligent, motivated people working hard to run a complex business in a difficult environment. As I’ve said before, USAP is certainly not perfect but we are the only entity with the scale and resources to fight the insurance carriers and their shenanigans that affect the entire practice of anesthesiology.

 

[Southpaw]

I work closely with them and have a collaborative working relationship with the local, regional, and national business leadership. Believe me when I tell you I don’t always agree with everything and have those conversations with them personally. I’m not going to throw shade unnecessarily at them on a public forum when I largely agree with the organization’s goals and plans. There are many good, intelligent, motivated people working hard to run a complex business in a difficult environment. As I’ve said before, USAP is certainly not perfect but we are the only entity with the scale and resources to fight the insurance carriers and their shenanigans that affect the entire practice of anesthesiology.

I would agree that USAP has done a much better job than the majority (maybe all?) of private practices in negotiating with insurance companies. Don’t hate the playa, hate the game. Right? If one accepts the place and power that insurance companies hold, and that we should all extract as much as one humanly can from them to increase your companies bottom line, then the business guys at USAP have done a good job. Seriously, how did anyone get > $120/unit out of UH?!?! UH pushed a lot of private practices out of network simply as a power move.

I think their stock is a pyramid scheme/scam.

 

[Howard888]

It’s not they did a better job it’s that they bought the majority of practices so they had more negotiating power then abused that power to get rates sometimes double someone who was providing an identical service -monopoly.

They won’t lose to ftc because there are other small groups around in all of these states but when you look at the Texas or Co they own enough that it’s clear to everyone is a monopoly.

I’ve heard of USAP collections for $10k a labor epidural.

Makes whole specialty look bad

 

[sloh]

It’s not they did a better job it’s that they bought the majority of practices so they had more negotiating power then abused that power to get rates sometimes double someone who was providing an identical service -monopoly.

They won’t lose to ftc because there are other small groups around in all of these states but when you look at the Texas or Co they own enough that it’s clear to everyone is a monopoly.

I’ve heard of USAP collections for $10k a labor epidural.

Makes whole specialty look bad

Where do you draw the line that it’s abuse and not a reasonable increase in rates?

 

[lane]

It’s not they did a better job it’s that they bought the majority of practices so they had more negotiating power then abused that power to get rates sometimes double someone who was providing an identical service -monopoly.

They won’t lose to ftc because there are other small groups around in all of these states but when you look at the Texas or Co they own enough that it’s clear to everyone is a monopoly.

I’ve heard of USAP collections for $10k a labor epidural.

Makes whole specialty look bad

That’s… quite the collection of takes

 

[nimbus]

Well I should have read the OP’s link more carefully.

“USAP officials often tout that the company is “physician-owned,” with doctors owning about 45 percent of company stock. Many physicians own USAP stock because when USAP bought doctor practices, it often paid the doctors partly in stock.
Several physicians said that they have been unable to redeem their shares, which they valued at hundreds of thousands of dollars. They asked that their names not be used because they are still seeking to sell their shares back and fear retaliation.
In a statement, USAP acknowledged that some share redemptions “did not occur.” The statement attributed this to the pandemic, saying “we were cautious about how we deployed our capital and used our cash.”
Five years after USAP began its foray into Colorado, physicians began to leave in larger numbers than before. Many had signed employment agreements when USAP acquired the medical groups, and those were expiring. The pandemic had begun.
Turnover at USAP climbed to 8 percent in 2020, 17 percent in 2021 and 11 percent in 2022, according to company figures. By comparison, the median rate of physician turnover nationally was 7 percent annually in 2020 and 2021, according to a survey by the Association for Advancing Physician and Provider Recruitment. A national figure for 2022 is not yet available. While the company had once employed 330 anesthesiologists in the state, according to its website, the figure has dropped to 275, the company said.



“Like many organizations, including other physician practices across the country, USAP-Colorado’s turnover increased during the pandemic,” Coward said. The company attributed part of its turnover to the contract dispute with United Health. It said the 2022 figures show that turnover has begun to decline.
In interviews, 12 former USAP anesthesiologists cited an array of reasons for leaving.
For starters, their pay declined more than they expected, they said. The company more often required them to work shifts of more than 24 hours, physicians said. Some said they were asked to take on more than 80 hours in a week. Several said that under USAP management, they felt like interchangeable “widgets” with less control over the practice than they previously had.”

 

[nimbus]

On another note, why aren’t the insurance giants (UHC, Cigna, etc) being investigated by the FTC for antitrust violations? Seems like selective enforcement.

 

[sevoflurane]

Just been silent in the background here during this discussion. Don’t have much to say that has not already been brought up.
Appreciate @amyl and @lane for speaking up.

 

[epidural man]

I work closely with them and have a collaborative working relationship with the local, regional, and national business leadership. Believe me when I tell you I don’t always agree with everything and have those conversations with them personally. I’m not going to throw shade unnecessarily at them on a public forum when I largely agree with the organization’s goals and plans. There are many good, intelligent, motivated people working hard to run a complex business in a difficult environment. As I’ve said before, USAP is certainly not perfect but we are the only entity with the scale and resources to fight the insurance carriers and their shenanigans that affect the entire practice of anesthesiology.

Well it seems to me, the things people are complaining about are the things you physicians have the power to change.

Quit the stock options - seems like a scam.

Make the parnership track 3 months. You can tell in 2 weeks if they are a good fit. Give it an extra 2.5 months just to be safe.

Fix that, and you have the best group on the planet it sounds like.

 

[epidural man]

Well I should have read the OP’s link more carefully.

“USAP officials often tout that the company is “physician-owned,” with doctors owning about 45 percent of company stock. Many physicians own USAP stock because when USAP bought doctor practices, it often paid the doctors partly in stock.
Several physicians said that they have been unable to redeem their shares, which they valued at hundreds of thousands of dollars. They asked that their names not be used because they are still seeking to sell their shares back and fear retaliation.
In a statement, USAP acknowledged that some share redemptions “did not occur.” The statement attributed this to the pandemic, saying “we were cautious about how we deployed our capital and used our cash.”
Five years after USAP began its foray into Colorado, physicians began to leave in larger numbers than before. Many had signed employment agreements when USAP acquired the medical groups, and those were expiring. The pandemic had begun.
Turnover at USAP climbed to 8 percent in 2020, 17 percent in 2021 and 11 percent in 2022, according to company figures. By comparison, the median rate of physician turnover nationally was 7 percent annually in 2020 and 2021, according to a survey by the Association for Advancing Physician and Provider Recruitment. A national figure for 2022 is not yet available. While the company had once employed 330 anesthesiologists in the state, according to its website, the figure has dropped to 275, the company said.



“Like many organizations, including other physician practices across the country, USAP-Colorado’s turnover increased during the pandemic,” Coward said. The company attributed part of its turnover to the contract dispute with United Health. It said the 2022 figures show that turnover has begun to decline.
In interviews, 12 former USAP anesthesiologists cited an array of reasons for leaving.
For starters, their pay declined more than they expected, they said. The company more often required them to work shifts of more than 24 hours, physicians said. Some said they were asked to take on more than 80 hours in a week. Several said that under USAP management, they felt like interchangeable “widgets” with less control over the practice than they previously had.”

My group (just counting the civilians of course) has had 0% turnover since I started as a civilian (2016).

Actually, not true - one person quit to move to Hawaii.

 

[aneftp]

I would agree that USAP has done a much better job than the majority (maybe all?) of private practices in negotiating with insurance companies. Don’t hate the playa, hate the game. Right? If one accepts the place and power that insurance companies hold, and that we should all extract as much as one humanly can from them to increase your companies bottom line, then the business guys at USAP have done a good job. Seriously, how did anyone get > $120/unit out of UH?!?! UH pushed a lot of private practices out of network simply as a power move.

I think their stock is a pyramid scheme/scam.

Usap has market share in Houston Dallas Orlando and most parts of Denver thus have more leverage.

It’s all local negotiationing power. Remember Usap has United health care issues in Texas and Colorado due to their monopoly power.

Usap doesn’t have that same leverage say in Maryland with United healthcare there so takes lessen rate with less market share.

 

[nimbus]

Nope. Youre referring benefits of 'partnership' in USAP. Several MD groups that pay people the same rate day 1. I was in a group that paid the same call pay to me as a partner that was there for 10 years because they don't believe in leeching off their associates/future partners.

I assume that youre in Houston. I was pointing out the fact that the starting pay and the sign-on bonus has increased quite a bit in response to market forces, which is a totally different tune than what the recruiters/interviewers were playing just a year ago.

What, then, would be the benefit of pursuing partnership in such a group?

This reply is all that most people need to see. If “partners” need to eat their young in order to get adequate compensation, then it’s not a good practice. Especially with the current labor shortage, nobody should be paying homage to old farts like me.

 

[aneftp]

This reply is all that most people need to see. If “partners” need to eat your young in order to get adequate compensation, then it’s not a good practice. Especially with the current labor shortage, nobody should be paying homage to old farts like me.

The traditional “buy in” in most 3-5 year partnership tracks used to involve a $200-300k a year reduction in pay for partnership track people.

Think of a 3 year partnership track as a 750k-1 mil buyin. A 5 year partnership as a 1.3-1.5 mil buy in.

Considering Usap partners make around 700-800k (the money will vary). I’m just giving a quick estimate. It falls in line with a traditional partnership track buy in. So it’s fair.

The only issue is the market is changing so quickly where 600k (high 400s before incentive calls/weekends) is what is being offered already at many places right off the bat. (Assuming same weeks off roughly 10 weeks off)

So the break even point about pursing a Usap partnership and it’s higher income vs 600k right off the bat. The break even point may be 10 years.

600k x 10 years equals 6 million at amc/hospital employee

450k x 3 years equal 1.35k
750k Usap partners income equals 6.2 years to make up the difference (plus the original 3 years partnership track). Equals 9.2 years just to break even.

The math is simple here.

 

[Dr. Rude]

The traditional “buy in” in most 3-5 year partnership tracks used to involve a $200-300k a year reduction in pay for partnership track people.

Think of a 3 year partnership track as a 750k-1 mil buyin. A 5 year partnership as a 1.3-1.5 mil buy in.

Considering Usap partners make around 700-800k (the money will vary). I’m just giving a quick estimate. It falls in line with a traditional partnership track buy in. So it’s fair.

The only issue is the market is changing so quickly where 600k (high 400s before incentive calls/weekends) is what is being offered already at many places right off the bat. (Assuming same weeks off roughly 10 weeks off)

So the break even point about pursing a Usap partnership and it’s higher income vs 600k right off the bat. The break even point may be 10 years.

600k x 10 years equals 6 million at amc/hospital employee

450k x 3 years equal 1.35k
750k Usap partners income equals 6.2 years to make up the difference (plus the original 3 years partnership track). Equals 9.2 years just to break even.

The math is simple here.

The math is simple. The "X" Factors are perception of cost and perception of risk and work intensity and emotional satisfaction and fit, etc., etc.,

 

[pgg]

Yeah, no, a

3 year partnership track as a 750k-1 mil buyin

absolutely isn't fair or appropriate in the world we live in today. Any applicant who is offered such a thing should turn around and walk out immediately.

I'm plus or minus on whether the applicant should pee on the rug before walking out.

Multi year six figure buy-in? GTFO.

 

[aneftp]

Yeah, no, a



absolutely isn't fair or appropriate in the world we live in today. Any applicant who is offered such a thing should turn around and walk out immediately.

I'm plus or minus on whether the applicant should pee on the rug before walking out.

Multi year six figure buy-in? GTFO.

That’s what a Usap partnership essentially entails.

It was even worse 3 -4 years ago where they were making in the 300s and low 400s to mid 400 (working 60 hours) with equivalent of 4 weeks paid off Really doing 800-900k of labor

That’s what we older folks know how the game is played you want the new grads to put in the extra work. Extra work means more income for the partners to stay at home plus still collect from the pot the new grads is putting into it doing extra work.

It’s like telling a resident in the my old days they can work like an attending for an extra $50/hr which sounds good when I was getting paid 38k-39k (it was low) as a ca-3/pgy4 in super expensive east coast city. And that was in early 2000s. Sounded good to me to moonlight

So a new grad getting paid an extra $1500 post call equivalent to do an extra shift the same partner gets $3000 sounds good to the new grad

The extra $1500 goes into the partners pot to split up.

 

[pgg]

That’s what a Usap partnership essentially entails.

It was even worse 3 -4 years ago where they were making in the 300s and low 400s to mid 400 (working 60 hours) with equivalent of 4 weeks paid off Really doing 800-900k of labor

That’s what we older folks know how the game is played you want the new grads to put in the extra work. Extra work means more income for the partners to stay at home plus still collect from the pot the new grads is putting into it doing extra work.

It’s like telling a resident in the my old days they can work like an attending for an extra $50/hr which sounds good when I was getting paid 38k-39k (it was low) as a ca-3/pgy4 in super expensive east coast city. And that was in early 2000s. Sounded good to me to moonlight

So a new grad getting paid an extra $1500 post call equivalent to do an extra shift the same partner gets $3000 sounds good to the new grad

The extra $1500 goes into the partners pot to split up.

Yeah I hear what you're saying, I understand how the exploitation has worked in the past.

There was a time when I was a new grad, on active duty in the Navy, looking for extra shifts to moonlight. I knew very well that for the $170/hr (in 2010) they paid me, that the group was making a lot of money off my back, but at the time and under the circumstances it was an acceptable deal to me.

I'm just saying, today, anyone who tolerates a partner track longer than a year, or 6-figure+ buy-in / pay disparity, is being foolish. And that if offered such a deal, they should reject it with righteous indignation and disgust that leaves the recruiting partner no illusions.

 

[Anesthesia_Guy]

I'm plus or minus on whether the applicant should pee on the rug before walking out.

Definitely in the plus camp. Micturating on the carpet shows them who's boss.

 

[Howard888]

That rug really tied the room together

 

[DirtDocMD]

80’s/90’s/00’s—there was a lot of “relationship cultivating” going on between groups and admin, and while there was certainly some greed involved, “buying in” to a partnership certainly had its place and the long-term benefits (10-20 years at a facility and a stable job) were certainly tangible.

These days, most/many of the hospitals are “for profit”, with the “churn” (short duration) of administration that comes with that (3-5 year “life expectancy” for CEO/COO/CFO at the same facility). Groups are on a 2-3 year contract, at best. Groups are subject to the “whims” of admin’s ambitious plans/quick cost-cutting strategies (handing over the contract to whatever ACM made the slickest/cheapest pitch at their RFP). The “long-term stability”, is no longer there.

You’re not buying into a 10-20 year or longer stable situation, you’re buying into a 2-3 year contract/“hope and a dream”/possible small scale pyramid scheme.

A small “sacrifice” (say, $50-$100k) to acknowledge that a new grad is inexperienced or may be less-productive in certain ways, for a short time, may be legit, but groups that are still expecting $250k/$500k (or more) buy-ins, THESE DAYS, are jerking folks around.

 

[lane]

This reply is all that most people need to see. If “partners” need to eat their young in order to get adequate compensation, then it’s not a good practice. Especially with the current labor shortage, nobody should be paying homage to old farts like me.

Earning partnership and the economic benefits (and risks) that come along with it is not “eating our young”
Offering employment contracts with defined call burden, full benefits package, 401k, risk management, malpractice and legal coverage, paid vacation, RCM, and stability for fair market value as assessed by objective third parties is not taking advantage of anyone. People have plenty of choices in where, how, and when they want to work. You can make what partners make easily by sacrificing any number of the benefits above. Partners are expected to take an active role in the management of the practice, which you simply cannot expect of someone who just walks in the door.

 

[linkin06]

i can say my personal experiences w USAP were that the old guys ran 3-4 rooms “supervising”, just signing charts, and letting the nurses induce and extubate alone. They were there because required time after buyout. I imagine many left or retired now..

 

[aneftp]

Earning partnership and the economic benefits (and risks) that come along with it is not “eating our young”
Offering employment contracts with defined call burden, full benefits package, 401k, risk management, malpractice and legal coverage, paid vacation, RCM, and stability for fair market value as assessed by objective third parties is not taking advantage of anyone. People have plenty of choices in where, how, and when they want to work. You can make what partners make easily by sacrificing any number of the benefits above. Partners are expected to take an active role in the management of the practice, which you simply cannot expect of someone who just walks in the door.

Yes and no

Most successful practices like Orlando Houston Dallas aren’t really successful due to anything you said. It really isn’t. It’s nothing special. The highest grossing practices in a mid Atlantic area I know have ridiculously great commercial insurance. Close to 80% commercial and Medicare advantage. One sold for multi-millions per partner. 3x what Usap gave the original three. The other two have remained private simply because they wanted the the 10 figure buyout as well. But they continue to be super successful as private.

Just gonna to cut to the chase.

Just successful due to Payor mix. That’s the easiest way to explain to people. Payor mix

Let’s see how Usap operates as commercial Payor mix goes down to the mid 30% level. It just can’t. It’s just the simple truth.

I’m not trying to argue with you. It all has to due with payor mix. Not how efficient you are. None of the bs quality metrics matter.

As demographics changes or climate changes. It can and will structurally change how a medical model can survive. And I’m not talking about anesthesia. I have good friends who own orthopedics , general surgery , medical oncology. They are less prone to effects of commercial insurance as anesthesia though.

 

[nimbus]

i can say my personal experiences w USAP were that the old guys ran 3-4 rooms “supervising”, just signing charts, and letting the nurses induce and extubate alone. They were there because required time after buyout. I imagine many left or retired now..

The WaPo article states that USAP Colorado has contracted from 330 to 275 doctors. It’s likely that many who left were part of the original buyout who were partially paid in stock. At least some of theses doctors are still trying to sell their USAP stock after they have left because USAP is trying to preserve capital. That is what the great business minds on the USAP board have decreed. Makes sense because 50+ redemptions would weaken the balance sheet. Like a ponzi, the model works if business is growing. If business contracts, the stock will lose value. Maybe Welsh Carson will flip USAP for a large profit one day. If that occurs, the stock will be more valuable. But that seems unlikely now.

 

[Arch Guillotti]

Earning partnership and the economic benefits (and risks) that come along with it is not “eating our young”
Offering employment contracts with defined call burden, full benefits package, 401k, risk management, malpractice and legal coverage, paid vacation, RCM, and stability for fair market value as assessed by objective third parties is not taking advantage of anyone. People have plenty of choices in where, how, and when they want to work. You can make what partners make easily by sacrificing any number of the benefits above. Partners are expected to take an active role in the management of the practice, which you simply cannot expect of someone who just walks in the door.

Yeah everybody wants to have their cake and eat it too these days.

 

[aneftp]

The Usap Colorado deal was a horrible deal probably for the partners. Only 626k cash and 225k in fake Usap stock with a 5 year vesting. For a 21% reduction in salary.

Horrendous deal unless the Colorado partners could get more blood in the partnership track to recoup that annual 21% reduction in pay.

That’s why the Colorado anesthesiologists wanted out. They were sold on the Usap stock being worth 5-6x its initial 225k Usap stock awarded to them.

https://www.courts.state.co.us/Courts/Court_of_Appeals/Opinion/2018/17CA0099-PD.pdf

All these things are in open records

The original 3 was a better deal with 3x more stock awarded. And 3x more cash involved.

 

[Arch Guillotti]

Can’t imagine how it’s preferable to sell your private practice and continue the grind of that versus selling your practice to the hospital or just letting it collapse. When you sell to the hospital, at least then they can't work you more arbitrarily because "the payor mix guys, the payor mix!" or try to force you into more "efficiency" by increasing ratios. If you can't run the sites, it's on the hospital to hire more people if they own the practice. That's a much preferable situation to working for a PE company that controls you.

626k? Like how bad does your job have to be to run for the hills for essentially a years salary? Might as well work in an academic center rather than selling given the horrendous usap workloads as partners

I would like to know what you are selling to the hospital? I think you just collect your outstanding A/R and become an employee. Would like anyone to chime in who has “sold” to a hospital.

 

[aneftp]

Can’t imagine how it’s preferable to sell your private practice and continue the grind of that versus selling your practice to the hospital or just letting it collapse. When you sell to the hospital, at least then they can't work you more arbitrarily because "the payor mix guys, the payor mix!" or try to force you into more "efficiency" by increasing ratios. If you can't run the sites, it's on the hospital to hire more people if they own the practice. That's a much preferable situation to working for a PE company that controls you.

626k? Like how bad does your job have to be to run for the hills for essentially a years salary? Might as well work in an academic center rather than selling given the horrendous usap workloads as partners

It’s the Usap stock offering that was the key to the deal. When Usap formed. They had every single intention of going ipo by end of 2017/early 2018.

That 225k Usap stock was in theory worth another 1 million dollars

No ipo. No real public value.

It’s internally valued at whatever usap wants to value it. It’s been a while since I talked to someone. It was like between $2-2.50 a share internally. I may be wrong. But it’s somewhere in that number in theory.

Since the stock was difficult to unload. And former partners giving 20% of their income forever. With no way to make up the difference luring new blood in.

So the irony is the Colorado “partner” docs didn’t want to work extra only to keep giving more of their extra work to welsh Carson. So they made say 600k as a partner back in 2014 which was good money. New income 420k cause 20% went to welsh Carson. Now if they wanted to work extra say another 10 hours a week which significantl. They could maybe get their income to 500k (20k or that 100k extra income goes to Usap for their extra work). Psychologically and physically the partners knew that didn’t look good either. Cause Usap parent company sleeps at night while they are working an extra night of call and Usap parent company gets to take another 20% of that extra work.

Sound familiar? Why would partnership employees want to work extra only to give to the partners and parent company as well.

 

[Arch Guillotti]

That’s what I mean. Offload all the pain of billing and collections to the hospital. They’ll pay a little below what you once made but it also caps the workload in most cases. Then the hospital can’t blame anyone but themselves for staffing problems

Private groups either handle billing in-house or sub it out. Yes it is a pain and we are all getting slaughtered these days. If you “sell” to a hospital, you are getting jack. Take them for a ride if you can!

 

[Shimmy8]

It’s never as simple as “let the group collapse”and “let the hospital take over.” Some states don’t even legally allow hospital employment.

If you’ve never been inside a failing or struggling group, then you don’t know what you don’t know.

 

[Fpg1245]

It’s never as simple as “let the group collapse”and “let the hospital take over.” Some states don’t even legally allow hospital employment.

If you’ve never been inside a failing or struggling group, then you don’t know what you don’t know.

My philosophy is why struggle. Dump and run. Let the hospital figure it out.

 

[circleK]

We “sold” to the hospital for a very small payout about 6months after our independent hospital became associated with a larger healthcare entity. However we were in a progressively worsening payor mix area. Salary actually went up, but that is more due to timing and the market in order to be able to recruit and retain anesthesia staff.

 

[JOHNBROCHILL]

We “sold” to the hospital for a very small payout about 6months after our independent hospital became associated with a larger healthcare entity. However we were in a progressively worsening payor mix area. Salary actually went up, but that is more due to timing and the market in order to be able to recruit and retain anesthesia staff.

Have working conditions changed since you became hospital employed? I'm assuming with buyouts you owe them X number of years to receive full payout. Is there any language in a buyout contract that limits how they can abuse you in the coming years?

 

[circleK]

I would say my hours are actually much better than when we were private now that we are appropriately staffed; that took about 12 months bc they were shockingly bad at physician recruitment at first.

3 years

No specific language in the contract but so far no abuse and I do feel admin listens, maybe moreso than our old admin. It’s all about staffing levels and right now all is good on that front.

 

[aneftp]

We “sold” to the hospital for a very small payout about 6months after our independent hospital became associated with a larger healthcare entity. However we were in a progressively worsening payor mix area. Salary actually went up, but that is more due to timing and the market in order to be able to recruit and retain anesthesia staff.

It’s all about Payor mix. Hospitals can absorb the poorer payor mix (Medicare ), hospitals can’t absorb worsening Medicaid payor mix

Private anesthesia groups cannot absorb increasing Medicare payor mix ratios. And especially not increasing Medicaid payor mix.

 

[ucladoc2b]

It’s all about Payor mix. Hospitals can absorb the poorer payor mix (Medicare ), hospitals can’t absorb worsening Medicaid payor mix

Private anesthesia groups cannot absorb increasing Medicare payor mix ratios. And especially not increasing Medicaid payor mix.

In some states (CA) MediCal payments significantly favor hospitals over physicians.

 

[nimbus]

Profits, Providers, and Private Companies: What Happens When Wall Street Owns Your Neonatal Care or Anesthesia Practice? Part one

Myron Yaster MD and William Greeley MD, MBA

ronlitman.substack.com

“When I first started attending annual meetings of the ASA, IARS, SCCM, and SPA, the exhibitor halls were jammed packed with what was new and where the profession practice was heading. There were booths for drugs, equipment, books and journals. And yet, over the past couple of years this has changed rather dramatically, and the exhibitor booths are increasingly being dominated by physician management companies and individual hospitals and locum practices looking to recruit faculty.”

“ I must admit that while I was researching articles for today’s PAAD, I was astonished at how little literature exists in the anesthesia literature on this topic which was “hiding in plain sight”. Indeed, today’s featured articles come from JAMA Internal Medicine1, 2and not from our professional journals Anesthesiology or Anesthesia and Analgesia. Indeed, I discovered these articles after reading about the effects of PMCs and PE in NICUs in this month’s issue of Pediatrics.3, 4 How could something that affects so many of us be so under the radar in our professional publications?”

 

[nimbus]

In some states (CA) MediCal payments significantly favor hospitals over physicians.

Medi-Cal provider rates to increase under Governor’s budget

In a win for physicians and patients, the budget proposal released today includes an increase to some Medi-Cal provider rates for the first time in more than two decades.

www.cmadocs.org

“In a win for physicians and patients, the budget proposal includes an increase to some Medi-Cal provider rates for the first time in more than two decades. Effective January 1, 2024, the budget proposal would increase provider rates to at least 87.5% of Medicare for primary care, maternity care and non-specialty mental health services. Starting in the 2024-25 budget year, the provider rate increases would be expanded to some additional health care services and specialists.”

 

[ambiturner]

Medi-Cal provider rates to increase under Governor’s budget

In a win for physicians and patients, the budget proposal released today includes an increase to some Medi-Cal provider rates for the first time in more than two decades.

www.cmadocs.org

“In a win for physicians and patients, the budget proposal includes an increase to some Medi-Cal provider rates for the first time in more than two decades. Effective January 1, 2024, the budget proposal would increase provider rates to at least 87.5% of Medicare for primary care, maternity care and non-specialty mental health services. Starting in the 2024-25 budget year, the provider rate increases would be expanded to some additional health care services and specialists.”

I guess anesthesia care didn’t make the cut huh

 

[nimbus]

I guess anesthesia care didn’t make the cut huh

There’s hope that we will in 2025. Right now straight Medi-Cal is about 60% of Medicare although some Medi-Cal HMOs pay around 150% of Medicare.

 

[coffeebythelake]

There’s hope that we will in 2025. Right now straight Medi-Cal is about 60% of Medicare although some Medi-Cal HMOs pay around 150% of Medicare.

seems like a ****ing race to the bottom. wondering when a major hospital will just say NO to this type of charity care

 

[narcotics999]

There’s hope that we will in 2025. Right now straight Medi-Cal is about 60% of Medicare although some Medi-Cal HMOs pay around 150% of Medicare.

The problem is medicare pays us little. Only if medicare pays 60% of commercial....

 

[aneftp]

The problem is medicare pays us little. Only if medicare pays 60% of commercial....

But commercial overpays anesthesia. That is the 800 pound gorilla in the room when we complain about Medicare payments 15-20 cents on the dollar compare to commercial billing.
Medicare is 17-20 dollars a unit? Commercial insurance varies so much from $60 a unit in some places in California to as much as $150/unit in other parts of the country.

Can you seriously tell me why a gi doc gets $400-600 for a gi scope for commercial and anesthesia gets $800 for a 10-12 min csse? (Commercial insurance)

Now for Medicare the gi doc gets like $250-300 for the scope and anesthesia gets $100-125 for the case.

So anesthesia gets overpaid for most commercial insurance and under paid for Medicare compared to other specialities.

 

[kidthor]

Can you seriously tell me why a gi doc gets $400-600 for a gi scope for commercial and anesthesia gets $800 for a 10-12 min csse? (Commercial insurance)

Sure - because it’s a bigger miracle to render someone into general anesthesia and not kill them versus just sticking a camera into a bunghole.

In all seriousness I think it’d be reasonable for anesthesiologists to be reimbursed more than proceduralists.

 

[narcotics999]

Sure - because it’s a bigger miracle to render someone into general anesthesia and not kill them versus just sticking a camera into a bunghole.

In all seriousness I think it’d be reasonable for anesthesiologists to be reimbursed more than proceduralists.

Especially think of these bariatric EGD.

 

[Status Sciaticus]

But commercial overpays anesthesia. That is the 800 pound gorilla in the room when we complain about Medicare payments 15-20 cents on the dollar compare to commercial billing.
Medicare is 17-20 dollars a unit? Commercial insurance varies so much from $60 a unit in some places in California to as much as $150/unit in other parts of the country.

Can you seriously tell me why a gi doc gets $400-600 for a gi scope for commercial and anesthesia gets $800 for a 10-12 min csse? (Commercial insurance)

Now for Medicare the gi doc gets like $250-300 for the scope and anesthesia gets $100-125 for the case.

So anesthesia gets overpaid for most commercial insurance and under paid for Medicare compared to other specialities.

assuming a colonoscopy takes 30 minutes to perform, thats 2 units plus the 3 for the startup. Even at $100/unit, thats $500, not $800. and that $100/unit is already being optimistic. Assuming your 10-12 minute number, realistic reimbursement should be about $300-$400.

 

[aneftp]

assuming a colonoscopy takes 30 minutes to perform, thats 2 units plus the 3 for the startup. Even at $100/unit, thats $500, not $800. and that $100/unit is already being optimistic. Assuming your 10-12 minute number, realistic reimbursement should be about $300-$400.

I’ve seen colonoscopy payments well over $1000. That’s anesthesia payments. The super bill is even higher. I used to cover a surgery center for an amc as independent 1099 contractor and got the payments accidentally for IN NETWORK Cigna. Cigna was paying that much on the physical check. That’s why I said commercial billing rates varies from $60 unit to $150/unit in network 6 units x $150 equals $900