APP getting bought out by Schumacher

[Pudortu]

Supposedly scp is gonna take the christus contracts and banner. The Tennova contracts are getting pieced out.

Everything is tbd. More news and clarity tomorrow. A lot of chaos to ensue.

SCP already has the majority of the christus contracts. I feel like the real move is the Methodist contracts.

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[GassYous]

Didn't envision already declare bankruptcy

 

[bravotwozero]

Didn't envision already declare bankruptcy

Yes, chapter 11. Allows them to survive, but no way in any position to acquire new contracts.

 

[DocEspana]

I knew this had to be falling through when my regional director (at SCP) made a comment about envision and APP being failed groups collapsing after the no surprise (billing) act.

you don't call your new acquisition a failed group. He does have a way with words.

 

[bravotwozero]

Methodist main getting taken over by USUKS.

Ouch. Can’t believe Methodist got duped into taking usuks as their staffing company.

EDIT: it’s not just the mothership but all Methodist.

 

[nVictus]

Wonder if usuks will cut pay

 

[scummie]

Wonder if usuks will cut pay

Does a bear crap in the woods?

 

[alpinism]

Houston salaries will start plummeting over the next few years.

Wouldn't be surprised if they cut pay to 200 hr for the docs.

 

[bravotwozero]

There is a narrow window of opportunity for the Methodist docs to band together and push back. Could generate bad press.

 

[emergentmd]

Man, if Usacs is the best option, docs/hospitals/pts gonna be in for some pain. Time to hire a bunch of APCs and burn everyone out.

 

[nVictus]

Houston salaries will start plummeting over the next few years.

Wouldn't be surprised if they cut pay to 200 hr for the docs.

Ouch. 200/hr to work in that weather is rough. Going to be hard to recruit talent at those rates

 

[bravotwozero]

Ouch. 200/hr to work in that weather is rough. Going to be hard to recruit talent at those rates

It’s already hard enough right now. Every group here is short staffed and looking to hire.

 

[nVictus]

It’s already hard enough right now. Every group here is short staffed and looking to hire.

No system wants to but they probably need to permanently raise rates instead of hiring locums or doing temporary bonuses.

 

[KGflyboy]

I'm in a SDG that isn't predatory. We have the usual aches and pains, but a stellar unicorn job. I see over an over again a theme that "SDG's" can't take over CMG contracts, but see the other threads. It's just a matter of time before CMG's are on the chopping block, and it'll take a group of 10+ docs to band together and take the contract back. We all have seen/known the crappy groups (SDG, CMG and academic). Try to get to know as much as you can about the group before you sign, and realize that the only power they have over you is your own desire to stay in that region... otherwise you hold the power to walk... or stay.

Same here. Good SDGs exist.

This forum is full of people complaining that they simply don't have any viable SDG options, meanwhile they are only looking in large coastal cities or select competitive non coastal cities.

Some people are just set in only living in certain places, which is fine. Everybody has different priorities.

There are large Midwest cities with professional sports teams, decent social scene, and plenty of stuff to do. Many of these cities have SDG jobs. It's not like you have to live on a farm 100 miles from the nearest Walmart just to find SDG jobs.

I personally chose to live and work in the Midwest where cost of living is low and pay is relatively good.

You can buy a big house here, then buy a vacation home, and then take as many family vacations as you want to the best beaches around the world and still have more money left over than if you take a job working at a CMG in NY or Southern Florida.

Heck... We have several docs that choose to live hundreds of miles away and just fly here to work their shifts, stay in a rental, and then fly home to where they want to live on their weeks off. They still come out ahead financially and have better job satisfaction than working for Teamhealth or USACS.

 

[Boatswain2PA]

Wonder if usuks will cut pay

They will promise pay raises and bonuses, better benefits, and the bonus of their well-established risk management systems.

Then pay will be cut, nobody will qualify for the bonuses, coverage hours will be cut, metrics will be imposed, and nobody will care about their risk management schemes.

 

[alphaholic06]

APP to close shop on 7/31

 

[alpinism]

 

[scummie]

And conveniently sign a one page contract before pay day in less than 48 hours. SMDH

 

[DO3]

APP also had residencies as well...I wonder what will happen to those...

 

[alphaholic06]

And conveniently sign a one page contract before pay day in less than 48 hours. SMDH

That’s subject to change.

 

[TysonCook]

LOTS of leverage for those docs. I'd band together quickly and find out what you want that contract to say.

 

[ensuii]

What a cluster. Having a USACs position in Houston is bad enough. Knowing the culture of the Methodist system, I have a hard time seeing this last. It's like bringing in a McDonald's manager to run a Michelin star restaurant.

 

[alpinism]

The Houston Methodist docs need to meet and decide on a fair contract.

I'd ask for minimum 300/hr to continue to work the rest of their shifts.

Regardless it's only a matter of time before they start cutting their compensation package to pay off their debts in the next few years.
I'll add that while its not the most desirable city in the country its a huge city and there will be plenty of new grads with a family or spouse that want to stay in town after residency that will happily take 100/hr with RVUs if that's what's available in Houston.

 

[alphaholic06]

To our valued team,
We would like to provide an update on our current financial position and next steps as a company. As you know, we have been actively exploring strategic options to strengthen our financial footing to take APP into the next phase of our growth. Unfortunately, these efforts did not result in a solution which would enable us to continue operations, and therefore, we will begin transitioning our hospital contracts and winding down operations in the coming weeks.
As we shared two weeks ago, our strained financial position and goal of maintaining continuity led us to enter into a Letter of Intent with SCP Health. This transaction did not materialize, as we were unable to come to an agreement that would maximize value and provide the necessary continuity for our hospital and health system partners, clinicians, employees, and the patients we serve.
While our management team, board, and advisors have worked tirelessly to explore all possible pathways, unfortunately, we no longer have the liquidity to continue operations. Therefore, we are in the process of transitioning our clients to other strategic emergency medicine companies or an insourced model with the respective hospitals or systems by July 31, 2023. We will also be ceasing operations at our Support Center in the coming weeks.
Through this process, our priority is to minimize disruption for our hospital and health system clients, physicians, APCs, and Support Center employees, and to create as seamless a transition as possible for all stakeholders. This news comes with a heavy heart, as we understand the impact it has on each and every one of you and the communities we serve.
To learn more about what this means for APP and our team, you will receive an invitation shortly for one of the following two Town Halls this afternoon:
• 2:00pm CT – Support Center Employees
• 3:00pm CT – Clinicians
If you are unable to attend the Town Hall, please reach out to your supervisor, site medical director or regional medical director for an update.
In the coming weeks, we expect that you will have questions, and we are committed to doing our best to provide information and resources to support a smooth transition. Thank you for your understanding, professionalism, and the incredible mark you have left on APP and the communities we serve.
Sincerely,
Tony Briningstool, MD, Chief Medical Officer
Andy McQueen, Chief Development and Legal Officer
Matt Stapleton, Chief Operating Officer


What a crock of ****?

 

[PianoMedic]

It’s like no one remembers what USACS did to Summa in Akron, took them several years to get that mess fixed.

 

[GonnaBeADoc2222]

The Houston Methodist docs need to meet and decide on a fair contract.

I'd ask for minimum 300/hr to continue to work the rest of their shifts.

Regardless it's only a matter of time before they start cutting their compensation package to pay off their debts in the next few years.
I'll add that while its not the most desirable city in the country its a huge city and there will be plenty of new grads with a family or spouse that want to stay in town after residency that will happily take 100/hr with RVUs if that's what's available in Houston.

You don't think they planned for hold out docs?

That's the reason they have firefighters.

The scabs will be brought in to rescue any distressed contract or new takeover.

Emergency credentials can be granted by the hospital at a moments notice.

Speaking as a former scab.

 

[bravotwozero]

What a cluster. Having a USACs position in Houston is bad enough. Knowing the culture of the Methodist system, I have a hard time seeing this last. It's like bringing in a McDonald's manager to run a Michelin star restaurant.

Truth. Methodist is all about patient satisfaction and vip crap, with a good payout mix.

The usacs cut everything and burn it down to the ground approach is going to piss off a lot of patients and admin.

Attempts are being made by docs to approach admin privately. We’ll see what happens.

 

[Dr Mantis Toboggan]

You don't think they planned for hold out docs?

That's the reason they have firefighters.

The scabs will be brought in to rescue any distressed contract or new takeover.

Emergency credentials can be granted by the hospital at a moments notice.

Speaking as a former scab.

Is USACS good anywhere? Or just mostly terrible?

 

[ScepticSkeksis]

Is USACS good anywhere? Or just mostly terrible?

As a new-ish attending in TX, I won't even consider a hospital run by USACS. I'll even look at HCA/Envision before I'd consider working at their flaming piles of low pay.

 

[GonnaBeADoc2222]

As a new-ish attending in TX, I won't even consider a hospital run by USACS. I'll even look at HCA/Envision before I'd consider working at their flaming piles of low pay.

At least with other CMGs like Team, you know what youre getting into.

With USACS, they **** you while smiling at you.

 

[alphaholic06]

At least with other CMGs like Team, you know what youre getting into.

With USACS, they **** you while smiling at you.

The problem with the devil you know beats the devil you don’t argument is… You’re still dealing with the devil.

 

[Pudortu]

Don’t worry guys. Usacs has these awesome shares that will be worth millions any day now.

 

[Brigade4Radiant]

You are all just jealous you guys aren’t OWNERS!

Lol even on Facebook groups they are attempting to rebuttal crap USACs jobs on EM doc jobs group by saying “have you worked at all our sites?”

 

[alphaholic06]

Don’t worry guys. Usacs has these awesome shares that will be worth millions any day now.

Is this before or after they go belly up in 2026 when their loans are due?

 

[GonnaBeADoc2222]

The problem with the devil you know beats the devil you don’t argument is… You’re still dealing with the devil.

True.

I always got the sense that many people who work for Team/Envision are the more savvy 1099 types, while the USACS crew were the sheeple.

 

[FlaminHotER]

At least with other CMGs like Team, you know what youre getting into.

With USACS, they **** you while smiling at you.

usuks is the type of company that will F ** K an EM Doc and not even given them the G dam curtesy of a reach around

 

[alphaholic06]

usuks is the type of company that will F ** K an EM Doc and not even given them the G dam curtesy of a reach around

 

[CajunMedic]

APP also had residencies as well...I wonder what will happen to those...

I did my TY at one of them I had originally wanted to stay at. I hope to God it burns down. Malignant, can't keep a PD, 4 yr program. Didn't match a single spot this year and filled in the SOAP. Ran off one of the best attendings they had

 

[alphaholic06]

So any word on if the Methodist docs signed USUCKS contract?

 

[EMhawkeye]

Which residency programs does APP run? Im curious .

 

[CajunMedic]

The only one I knew was what is now “Health Education Services Emergency Medicine Residency” in Hattiesburg, MS

 

[ScepticSkeksis]

So any word on if the Methodist docs signed USUCKS contract?

Of course they will because doctors are bad at business, easily cowed, and are mostly spineless enough to not risk anything.

 

[bravotwozero]

There are being some attempts being made by docs approaching ceos and cmos about starting their own group. We’ll see how it goes.

 

[alphaholic06]

There are being some attempts being made by docs approaching ceos and cmos about starting their own group. We’ll see how it goes.

I hope they’re successful.

 

[emergentmd]

There are being some attempts being made by docs approaching ceos and cmos about starting their own group. We’ll see how it goes.

I hope they create a SDG and I hope they can negotiate a stipend. It all depends how strong the group or doctors are and their relationship with the CEO.

I am not convinced there are enough on the bones with just professional fees to make it worth it.

 

[EctopicFetus]

I hope they create a SDG and I hope they can negotiate a stipend. It all depends how strong the group or doctors are and their relationship with the CEO.

I am not convinced there are enough on the bones with just professional fees to make it worth it.

I dont know a lot about houston but apparently methodist is a pretty solid payer mix.

 

[emergentmd]

I dont know a lot about houston but apparently methodist is a pretty solid payer mix.

I hope SDGs take over of the CMGs but I am jaded by hospital CEOs who eventually see a functional group thus putting more shackles on them.

Even if a SDG can make $400/hr on professional fees, the future headwinds makes the risks very high IMO.
1. future insurance cuts
2. Hospital CEOS adding on more crappy contracts, metrics, committees, non EM work like running the money losing hospitalist group
3. increased overhead to meet CMS/government mandates

Even if SDGs flourish, the rich EM owners will look to expand then sell out to VC/CMGs.

My gut feeling is EM docs will eventually become hospital Employees which is already happening in Tx.

 

[Groove]

APP’s Cause of Death - The PE Business Model

Also: ACEP & AAEM hug it out re: CPOM, EMPATH for the win, half of US physicians don’t trust their leaders, & “nurses are screaming for help; lawmakers should listen.”

emworkforce.substack.com

 

[Groove]

A poignant reminder of the potential catastrophic loss one might incur if you are heavily buying into any of these CMG private equity shareholder programs to raise capital for the company and they end up going bankrupt.

Judging from the article, SCP was interested...but then backed out once they saw the books leading to the chapter 7.

In my region (SE), it's interesting that Apollo only seems to have taken one of those contracts. Most seem to have been snapped up by TH and/or SCP.

 

[EctopicFetus]

I hope SDGs take over of the CMGs but I am jaded by hospital CEOs who eventually see a functional group thus putting more shackles on them.

Even if a SDG can make $400/hr on professional fees, the future headwinds makes the risks very high IMO.
1. future insurance cuts
2. Hospital CEOS adding on more crappy contracts, metrics, committees, non EM work like running the money losing hospitalist group
3. increased overhead to meet CMS/government mandates

Even if SDGs flourish, the rich EM owners will look to expand then sell out to VC/CMGs.

My gut feeling is EM docs will eventually become hospital Employees which is already happening in Tx.

I don’t disagree. However it is important to note that APP and Envision were making money. They got killed by their debt service / PE squeeze. All the things you mention are real and worrisome. Re #1 will be interesting with the NSA. I think for better (though mostly for worse) we now have a set rate groups will get paid. Reality is the QPA is the same for CMGs and SDGs. It is unlikely a CMG will be able to negotiate much better than the QPA. This might change once they fix the IDR process and groups can win more than the QPA then they may have some leverage.

No disagreement at all on 2 and 3. I also think re the sale you are right but the returns will be worse if you try to sell. PE could borrow money cheaply those days are gone for now. I actually think there will be more opportunity coming up.

Lastly, as the workforce issues take hold it might be where an SDG is making 280/hr and the CMG job 180.

I see our pay going down in the next 5-7 years.

Keep in mind it is clear the feds are coming for all docs.