Another good SDG bites the dust

Started by ERMudPhud
Apply Smarter with MyERAS
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Get help with your application

Use all the free resources available to you from SDN: articles, guides, expert advising, forums discussions, and school research.

Browse articles Compare schools My application plan Read Interview Feedback
Practice for interviews Ask an Advisor
Advertisement - Members don't see this ad
Emapp20177 said:
Not a knock on the Eugene group at all, as I have no info, but in regards to the title, how do we know that the group was "good?"
Click to expand...
I sent several residents that way over the years. They reported open books, equitable scheduling, and everyone getting to vote on how compensation worked. The foundations of an SDG.

If the leaders of your "SDG" have secret bonuses that don't require your approval its not an SDG. When I was with an SDG if I wanted an extra $1000/month as COO every partner had to vote on it.
 
alpinism said:
I hate to do this but those above statements are not accurate based on their current business model.



"In the capital structure we’re above the ceo and the founders who own common equity."
Click to expand...
That particular quote is perhaps the most damning. In any sort of exit they get paid back/profit before anyone else. Also another quote from the same newsletter. " The operating companies generate excess cash that we use to make either investments in private healthcare companies where we feel we have some competitive advantage..." My old SDG never had excess cash. It just went back to the docs.

Based on their web sites seems like Valor Bridge has exited ApolloMD. Not sure where the cash came from to pay for that exit or at what price. No idea if they took on other loans to fund it or if they had enough money somehow to just buy out Valor Bridge. Seems unlikely they were just sitting on a giant pile of cash to buy out Valor Bridge. if so, then all the physician owners should be congratulated on successfully exiting the relationship. My only questions for SouthernDoc

1. Do your shares come with any votes on how the company is run? Do you get to vote on board members? Do you get to vote on anything beyond local operations?

2. What happens to your shares when you leave?
 
ERMudPhud said:
1. Do your shares come with any votes on how the company is run? Do you get to vote on board members? Do you get to vote on anything beyond local operations?

2. What happens to your shares when you leave?
Click to expand...
It depends what type of shares you own for voting rights (similar to Berkshire Hathaway class A vs class B shares).

Shares are either bought back by the company or if you choose to keep them, then you'll receive dividends and have the chance to sell them later. Keep in mind that since it's not a publicly-traded company, you have to either sell back to the company or find a buyer (another physician).
 
Advertisement - Members don't see this ad
In our SDG, there were different level's of ownership but difference was small. But no matter what level of ownership you had, everything was equal including schedule/time off.

Also, everyone had access to the numbers, including income/expenses/overhead. Everyone had similar votes on if we wanted to add APCs including many big/small changes.

If Apollo MD allows all owners "access" to the books then I can get on board that they are physician driven. If they do not allow owners open books, then they are in line with USCACS.

Also, when you buy/sell shares to another physician, is the price what is agreed by the docs OR is it some magical number set by the "company". My point being, if I had 1 share of Apollo MD and found a doc that was willing to pay $500K for it; would this get a rubber stamp or does someone above put restrictions on the sale?

Do APCs also able to buy into the group? Are the docs the only owners or are there non physician owners?
 
southerndoc said:
It depends what type of shares you own for voting rights (similar to Berkshire Hathaway class A vs class B shares).

Shares are either bought back by the company or if you choose to keep them, then you'll receive dividends and have the chance to sell them later. Keep in mind that since it's not a publicly-traded company, you have to either sell back to the company or find a buyer (another physician).
Click to expand...
What about the other questions? Do you have local control (i.e. the local owners, midlevels included, I guess, vote on staffing, distribution of profits, set compensation, adjust benefits, etc.) or no?
 
I appreciate the discussion and DMs, but unfortunately, I'm going to withdraw participation in this thread.

It seems every time I post something positive about ApolloMD, I'm either told I'm a bootlicker or that I'm blind-sided by my own group.

As I alluded to earlier, there is a reason the health system wasn't happy with the SDG. If the health system isn't happy with ApolloMD in a few years, then ApolloMD may be in the same situation. I encourage you to do as much research into the SDG as you have done with ApolloMD and you might be surprised at what you find.

Stay safe out there.
 
southerndoc said:
I appreciate the discussion and DMs, but unfortunately, I'm going to withdraw participation in this thread.

It seems every time I post something positive about ApolloMD, I'm either told I'm a bootlicker or that I'm blind-sided by my own group.

As I alluded to earlier, there is a reason the health system wasn't happy with the SDG. If the health system isn't happy with ApolloMD in a few years, then ApolloMD may be in the same situation. I encourage you to do as much research into the SDG as you have done with ApolloMD and you might be surprised at what you find.

Stay safe out there.
Click to expand...
I think most people have asked honest questions and haven’t resorted to names. I think withdrawing from the thread without answering the questions (à la that new program director from Florida or wherever) pretty much confirms the answers you haven’t been willing to give.

My final thoughts are that several things can be true. You can be happy in your job. ApolloMD can also be bad for EM. You can say that ApolloMD isn’t as bad as USACS, TeamHealth, etc., and while that may be true, it certainly doesn’t make them a good guy in the game. You can say the previous SDG was predatory and much worse, which may very well be true, but still doesn’t make ApolloMD the best solution.

This was your chance to answer honest questions and shed light on a group that you’re fond of. It’s a chance to correct preconceived notions on the “ownership” from those who you say are misinformed. Your silence tells me they’re not as misinformed as you make them out to be.
 
I want to know what occurred that made the hospital look for another option. If all was peachy, they would not look to replace a long standing group.

Was it money/subsidy, poor metrics, lack of cooperation? Etc
 
NYEMMED said:
I want to know what occurred that made the hospital look for another option. If all was peachy, they would not look to replace a long standing group.

Was it money/subsidy, poor metrics, lack of cooperation? Etc
Click to expand...

Hospital system was 3 hospitals. C suite needs more profit so decides to close one of them without an infrastructure plan to support the other two. ER volumes inevitable rise along with wait times. CEO now big mad at the consequences of her decisions so blames ER doctors.
 
I was gonna do a dive into what happened but that video probably summed it up well


Medicine is going to get an in interesting inflection point over the next few years. I maintain my prediction the pendulum swings hard in corporate favor then violently the other way. CMG bans/single payor is only a few riots/dead children of senators away
 
AlmostAnMD said:
I was gonna do a dive into what happened but that video probably summed it up well


Medicine is going to get an in interesting inflection point over the next few years. I maintain my prediction the pendulum swings hard in corporate favor then violently the other way. CMG bans/single payor is only a few riots/dead children of senators away
Click to expand...

Agree. But it's not going to produce the outcome you want. CMS as the single payor will be far worse than any CMG / private insurer.
 
WhatJobDoIPick said:
Agree. But it's not going to produce the outcome you want. CMS as the single payor will be far worse than any CMG / private insurer.
Click to expand...

I'm not sure this is correct. You actually don't hear very much from patients complaining about their traditional medicare, at least nearly as much as medicare advantage. It's more costly but you get much less red tape than you do from a managed plan.

Also the denials workflow is insanely less complex, which is my area. They actually don't even have a denials program...hospitals just get a QIO audit occasionally, they pull some medicare inpatient visits and see which are statused as IP and see what % should be obs instead of IP. If you're under 20% error rate, you're golden. If you're over you get audited more frequently until you're in compliance. We are <10%, the cases that are found to be obs are usually just getting healthier much faster than expected when initially statused (DC <2 MN)

Literally couldn't be more simple.

From an outpatient standpoint, trad medicare patients have pretty much unlimited freedom to see the doctor of their choosing. Any specialty, any primary care. There is essentially zero "network" issue. Managed care plans obfuscate this so, so badly and limit patient choice severely. Very bad for patients.

Curious why you think it wouldn't work, though. I can tell you traditional medicare patients are the least bureaucratically complex admin patients any system can have. I highly doubt anyone would dispute this but welcome the viewpoint!
 
AlmostAnMD said:
I'm not sure this is correct. You actually don't hear very much from patients complaining about their traditional medicare, at least nearly as much as medicare advantage. It's more costly but you get much less red tape than you do from a managed plan.

Also the denials workflow is insanely less complex, which is my area. They actually don't even have a denials program...hospitals just get a QIO audit occasionally, they pull some medicare inpatient visits and see which are statused as IP and see what % should be obs instead of IP. If you're under 20% error rate, you're golden. If you're over you get audited more frequently until you're in compliance. We are <10%, the cases that are found to be obs are usually just getting healthier much faster than expected when initially statused (DC <2 MN)

Literally couldn't be more simple.

From an outpatient standpoint, trad medicare patients have pretty much unlimited freedom to see the doctor of their choosing. Any specialty, any primary care. There is essentially zero "network" issue. Managed care plans obfuscate this so, so badly and limit patient choice severely. Very bad for patients.

Curious why you think it wouldn't work, though. I can tell you traditional medicare patients are the least bureaucratically complex admin patients any system can have. I highly doubt anyone would dispute this but welcome the viewpoint!
Click to expand...
I guess I'm approaching it from a purely compensation perspective. Medicare pays far less than private and rates for physicians have not been meaningfully increased in years. Medicaid is one step up from not being paid at all. If there's one payor, where's the market forces to prevent them from paying next to nothing.

The government absolutely hates private physician groups so I'm sure they'd love to do this. Would be the end of nearly every private group or there. Hospital employment for all. You think the abuse is bad now just wait.
 
WhatJobDoIPick said:
I guess I'm approaching it from a purely compensation perspective. Medicare pays far less than private and rates for physicians have not been meaningfully increased in years. Medicaid is one step up from not being paid at all. If there's one payor, where's the market forces to prevent them from paying next to nothing.

The government absolutely hates private physician groups so I'm sure they'd love to do this. Would be the end of nearly every private group or there. Hospital employment for all. You think the abuse is bad now just wait.
Click to expand...

Disagree with the viewpoint, especially since the carrot being dangled here is payment, which private insurers routinely hold from us. Hell, Humana took a star rating hit and did nothing about it other than appeal. The amount of fraud these people do just to AVOID payment is pretty intense and getting litigated everywhere all the time. So what your statement is missing is private insurance can pay more.....IF THEY PAY. Keep in mind I'm talking about healthcare in general, not just ED. ED $'s are a fraction of overall hospital care, which is why no one cares about it. I don't think I've ever even heard ED dollars come up in a single financial meeting, although the 2k ED bill vs the 100k IP bill can explain why quickly.

Medicaid is the worst of all of them, and I say that as a medicaid appeals specialist. You get the combo of ****ty reimbursement with the conman behavior of private insurance. It's no wonder docs don't want to take this. It took me a year in my state to FORCE a medicaid payor to prior auth certain obvious IP-only procedures as IP and even then I had to take them to an admin court to do it.

Value-based care was a good "idea" but it came with consequence--payors are incentivized to increase patient "value" (UHC notorious for this, sending midlevels to homes to "add" diagnoses" to patients to increase their complexity) whilst at the same time encouraged to not pay for anything so they can keep the balance of the value of the patient.

Horrible, horrible model. I know FFS doesn't encourage cost saving but what it also doesn't encourage is withholding care/denying care.

My ideal setup

FFS medicare for all

some + version for people with jobs

ban all CMGs or restrict them to regional powers to prevent them from accumulating too much power in volume

I can't imagine this making things worse
 
Advertisement - Members don't see this ad
NYEMMED said:
I want to know what occurred that made the hospital look for another option. If all was peachy, they would not look to replace a long standing group.

Was it money/subsidy, poor metrics, lack of cooperation? Etc
Click to expand...
Sometimes it's as simple as somebody in the c-suite is new and has a relationship from a previous facility or is golf buddies with somebody high up in one of the CMGs. They tell them of course they can save the hospital money and then overly congratulate the c-suiter on such a great hole as they tap in for triple bogey.
 
emergentmd said:
In our SDG, there were different level's of ownership but difference was small. But no matter what level of ownership you had, everything was equal including schedule/time off.

Also, everyone had access to the numbers, including income/expenses/overhead. Everyone had similar votes on if we wanted to add APCs including many big/small changes.

If Apollo MD allows all owners "access" to the books then I can get on board that they are physician driven. If they do not allow owners open books, then they are in line with USCACS.

Also, when you buy/sell shares to another physician, is the price what is agreed by the docs OR is it some magical number set by the "company". My point being, if I had 1 share of Apollo MD and found a doc that was willing to pay $500K for it; would this get a rubber stamp or does someone above put restrictions on the sale?

Do APCs also able to buy into the group? Are the docs the only owners or are there non physician owners?
Click to expand...
Multiple levels of partnership? Lol.
Share price is an arbitrary token amount set by the company and then new partners are written into the legal entity in an addendum. Nobody can buy or sell shares from anyone else.
 
About 75% of physician staff across all specialities at Peacehealth participated in a vote regarding this change by leadership to bring in Apollo MD.

Of those who participated, 93% supported a vote of no confidence in hospital administration.

99% supported reversing the decision to replace Eugene Emergency physicians with the Apollo MD staffing company.
 
Last edited:
Cauchy said:
About 75% of physician staff at Peacehealth participated in a vote regarding this change by leadership to bring in Apollo MD.

Of those who participated, 93% supported a vote of no confidence in hospital administration.

99% supported reversing the decision to replace Eugene Emergency physicians with the Apollo MD staffing company.
Click to expand...
I know the math is not meant to be taken this literally... but unless they have >100 doctors, I'm curious about that one guy who decided to vote 2/3 for not being replaced but 1/3 for "ehhh lets just do it."
 
Sorry, my message could have been a bit more clear.

That vote is not from the local ER group, which has about 40 ER docs. The votes of no confidence and to reverse the decision are from the physicians of all other specialities at the hospital. Across all specialities, there are almost 500 providers, and of those about 75% participated in the votes.
 
What’s the latest? I think AAEM (not crappy ACEP) is helping these docs. Maybe Oregon ACEP helped but USACS controlled ACEP wants nothing to do with helping you know.. actual ACEP (probably and unfortunately) members.
 
EctopicFetus said:
Any update?
Click to expand...
The nurses association voted no confidence in the PeaceHealth leadership as well.

The EEP physicians have asked the Oregon Health Authority to look into the legality of a corporate staffing agency like Apollo to operate in Oregon under the recent senate bill 951, which limits the ability of corporate medicine to operate in Oregon. So far leadership has provided no information on why this choice was made.

On an encouraging note, it seems like there is a healthy appetite to fight this corporate takeover, both among the EEP group and the staff physicians at PeaceHealth.
 
Cauchy said:
The nurses association voted no confidence in the PeaceHealth leadership as well.

The EEP physicians have asked the Oregon Health Authority to look into the legality of a corporate staffing agency like Apollo to operate in Oregon under the recent senate bill 951, which limits the ability of corporate medicine to operate in Oregon. So far leadership has provided no information on why this choice was made.

On an encouraging note, it seems like there is a healthy appetite to fight this corporate takeover, both among the EEP group and the staff physicians at PeaceHealth.
Click to expand...
Glad to hear it.. I hope the hospital bleeds, I hope Apollo bails. Apollo is not going to do these docs any favors.
 
Advertisement - Members don't see this ad
There was a time some of us believed physicians might actually take medicine back, that the profession still had enough fight left to matter. It seems that window has closed.

Are we fighting for autonomy anymore or just managing our defeat?
 
Birdstrike said:
There was a time some of us believed physicians might actually take medicine back, that the profession still had enough fight left to matter. It seems that window has closed.

Are we fighting for autonomy anymore or just managing our defeat?
Click to expand...
Definitely managing defeat. The young crowd has too few willing to fight and frankly they have been conditioned by the HCAs and academics of the world to be employees and servants of large health care orgs.
 
EctopicFetus said:
Definitely managing defeat. The young crowd has too few willing to fight and frankly they have been conditioned by the HCAs and academics of the world to be employees and servants of large health care orgs.
Click to expand...

Speak for others but not me! I left EM to wage war on insurance companies full-time.

Sdg vs cmg is a microcosm of the bigger fight, which is insurance. I've made significant, long term inroads in our system with many more goals left to accomplish.

I've defeated 5 of the 6 medicaid payors in our main state, taking the last one to court. We also have other states our system operates in and I've defeated (ie, made them come to understand our definition of inpatient and not jerk us around on downgrades).

Allied with our state department of insurance to combat commercial fraud. Built a contact in the US dept of labor for ERISA commercial.

4208-F resuscitated our MA hopes with 2026 looking to be the year we turn the corner there

I'm actually impressed with myself with how much I've been able to change from a system level.

The war is far from finished.

I was originally more interested in just EM issues but the more I learned the more I saw EM is such a tiny fraction of the disputed money that hardly anyone pays attention to it....which in turn makes it ripe for rape via CMG.

In the meanwhile I tell everyone that will listen to abandon acep and gravitate towards AAEM. This is a problem that truly requires a community commitment to trash cmgs our of existence.

But first I'll take down the insurance overlords propping them up.

1773671103006.jpeg


Join the fight! Taking back what is yours starts with yourself
 
Pudortu said:
I saw a post on emdocs where the governor of Oregon is requesting the hospital system hold off for 6 months at least. Maybe they will actually win?
Click to expand...
I don’t know anything about that hospital system but I would assume things won’t go back to the way they were. That entire c-suite will be turned over before all this is done.
 
JacobMcCandles said:
I don’t know anything about that hospital system but I would assume things won’t go back to the way they were. That entire c-suite will be turned over before all this is done.
Click to expand...
That hospital system management has f'd things up in that area, and across the region so badly that it can only be hoped that is true.
 
Birdstrike said:
There was a time some of us believed physicians might actually take medicine back, that the profession still had enough fight left to matter. It seems that window has closed.

Are we fighting for autonomy anymore or just managing our defeat?
Click to expand...
Rearranging deck chairs on the titanic
 
Advertisement - Members don't see this ad
southerndoc said:
As I alluded to earlier, there is a reason the health system wasn't happy with the SDG. If the health system isn't happy with ApolloMD in a few years, then ApolloMD may be in the same situation. I encourage you to do as much research into the SDG as you have done with ApolloMD and you might be surprised at what you find.
Click to expand...

Well I guess I know why the SDG was disliked now?

Unless there is another plot twist
 
You must log in or register to reply here.

Similar threads

E
Another One Bites the Dust: My Emergency Medicine Eulogy
Replies
36
Views
12K
Entadus
Entadus
scummie
SDG Groups
Replies
30
Views
5K
emergentmd
E
T
Another Article
Replies
0
Views
1K
trackrunner321
T
G
Another "which job" thread
Replies
15
Views
3K
emergentmd
E
alpinism
Yet another reason to avoid private equity run emergency departments.
Replies
43
Views
7K
EctopicFetus
EctopicFetus