Current case volume affect on AMCs

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spike7585

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Just wondering if anyone thinks that if this situation of "non-elective surgeries only" continues for a few months, what financial repercussions it may have on AMCs. I would imagine their overhead is more substantial than most smaller private practice groups, and how long are they willing to wait seeing no revenue (or a fraction of) before contemplating getting out? I am sure they'd ride it out if it was a matter of a few weeks/months, but what if this continues for 4/5/6+ months?
 
spike7585 said:
Just wondering if anyone thinks that if this situation of "non-elective surgeries only" continues for a few months, what financial repercussions it may have on AMCs. I would imagine their overhead is more substantial than most smaller private practice groups, and how long are they willing to wait seeing no revenue (or a fraction of) before contemplating getting out? I am sure they'd ride it out if it was a matter of a few weeks/months, but what if this continues for 4/5/6+ months?
Click to expand...
Massive firings.
 
Wonder if groups that are cutting salary will make the lower salary the new baseline going forward. Could this be the death of our current pay level?
 
2Fast2Des said:
Wonder if groups that are cutting salary will make the lower salary the new baseline going forward. Could this be the death of our current pay level?
Click to expand...


They certainly will try. Depends if the volume comes back and what the alternatives are in the job market. AMCs took in the teeth for awhile from about 2002-2008 when good paying jobs were plentiful.
 
Crnas always having hours cut. I guess if hospital cannot find enough coverage for icu. AMC May ask for volunteers to cover covid-19 positives patients with no hazard pay.
 
spike7585 said:
They're not gonna have an easy time recruiting at that point for the same crappy salary offer
Click to expand...
Sure they will. Hell, the AMCs might even be able to offer less.

The people who work for AMCs now aren't doing it because they have better options, given their life constraints (spouse's job, family location, absolute need to live within four minutes of a particular beach, etc). They'll have been out of work for a while, or doing locums work in hotspots, and their house, boat, and alimony payments will still be due.
 
Meh. They’ll have plenty of folks hire back on, at whatever they offer. You got CRNA’s trying to live like Anesthesiologists, and Anesthesiologists trying to live like Orthopedic Surgeons.

Three weeks into this, and you’ve already got some of these folks acting like they’re gonna starve to death. People never learn. “Emergency fund”?? “Living within your means”??? What’s that???
 
spike7585 said:
Just wondering if anyone thinks that if this situation of "non-elective surgeries only" continues for a few months, what financial repercussions it may have on AMCs. I would imagine their overhead is more substantial than most smaller private practice groups, and how long are they willing to wait seeing no revenue (or a fraction of) before contemplating getting out? I am sure they'd ride it out if it was a matter of a few weeks/months, but what if this continues for 4/5/6+ months?
Click to expand...
They have no plan on riding it out for a few months. Salary reductions and layoffs are happening NOW.
 
anbuitachi said:
teamhealth still going strong i believe. problem is even if they go under, once it all recovers, another one will just take its place
Click to expand...

Yup. Even worse, their noncompete clauses with individual docs may be considered corporate assets that can be transferred.


Sent from my iPhone using SDN mobile
 
anbuitachi said:
teamhealth still going strong i believe. problem is even if they go under, once it all recovers, another one will just take its place
Click to expand...
I don’t think they will go under. The biggest expense by far is salaries and benefits. That has an easy solution. They can just keep a bare bones staff. They may have some problems when things start up again but that’s a problem for another day.
 
dannyboy1 said:
I don’t think they will go under. The biggest expense by far is salaries and benefits. That has an easy solution. They can just keep a bare bones staff. They may have some problems when things start up again but that’s a problem for another day.
Click to expand...

i havent heard of teamhealth firing anesthesiologists yet. i believe they also announced they are not planning on firing staff...
 
Does anyone know if envision is cutting crna’s or anesthesiologists?
 
Mikkel said:
What's in the AMC employment contract that allows paycuts outside of contract agreements?
Click to expand...

They "ask" you to take unpaid leave or use up all your existing vacation time. Then, if desperate enough due to loss of case volume they give you the choice of voluntary unpaid leave or termination notice.
 
fittipaldi1of1 said:
Does anyone know if envision is cutting crna’s or anesthesiologists?
Click to expand...
Each group controls it's own situation to a certain extent. We haven't laid off any clinical people involuntarily, and hope not to, because we will need everyone back for the onslaught of backed up cases in just a few weeks. We're using a combination of using vacation time now instead of later, voluntary days off without pay or LOA with benefits costs paid by the company, etc. For those of us at higher risk (older, health issues, immunocompromised or SO that is) the voluntary unpaid leave with benefits is a welcome option. We've restructured our entire MD and anesthetist schedules to eliminate any premium time or OT. Everyone is sharing the pain of rotating shifts since we have temporarily ditched our premium shifts that covered late cases. We have created intubation teams 24/7 that uses a lot of otherwise idle staff. It's all worked well so far.

The company is shifting clinicians around where possible. A large number from areas that are not hit so hard with the virus, or whose caseload has tanked (like the outpatient centers) are volunteering to help those areas hit the hardest, including NYC. States that have relaxed their licensing requirements for this crisis make the shifting of staff relatively easy.
 
jwk said:
Each group controls it's own situation to a certain extent. We haven't laid off any clinical people involuntarily, and hope not to, because we will need everyone back for the onslaught of backed up cases in just a few weeks. We're using a combination of using vacation time now instead of later, voluntary days off without pay or LOA with benefits costs paid by the company, etc. For those of us at higher risk (older, health issues, immunocompromised or SO that is) the voluntary unpaid leave with benefits is a welcome option. We've restructured our entire MD and anesthetist schedules to eliminate any premium time or OT. Everyone is sharing the pain of rotating shifts since we have temporarily ditched our premium shifts that covered late cases. We have created intubation teams 24/7 that uses a lot of otherwise idle staff. It's all worked well so far.

The company is shifting clinicians around where possible. A large number from areas that are not hit so hard with the virus, or whose caseload has tanked (like the outpatient centers) are volunteering to help those areas hit the hardest, including NYC. States that have relaxed their licensing requirements for this crisis make the shifting of staff relatively easy.
Click to expand...
Imagine the range on your non compete now if you shift all over the country.
 
Ronin1 said:
Today Envision announced 30% reduction in base compensation for south east region. For indefinite length of time......
Click to expand...

Meanwhile KKR, the private equity firm that ows Envision, announced a 50 million dollar aid package. I assume KKR is doing this to "look good" when they apply for Billions of Dollars from the Cares Act this week. I guess the actual EMPLOYEES don't need the money.

www.nytimes.com

KKR Sets Up $50 Million International Coronavirus Relief Fund

KKR & Co Inc has established a $50 million global relief fund to help people affected by the new coronavirus, according to a letter the U.S. private equity firm sent to its investors on Tuesday.
www.nytimes.com www.nytimes.com
 
ENVISION/KKR


"The company’s contracts with physicians stipulate both a base salary and performance-related payment for services provided in hospitals and other facilities. The performance-related pay will be withheld indefinitely as Envision grapples with losses stemming from the coronavirus pandemic, management said on the call.

Envision said it intends to pay the amounts owed at a later date, when there is more certainty on the future health of the company, the people said. The company is also contemplating making additional 20% cuts to doctors’ base salaries if conditions worsen, they said. Envision’s senior leadership team has already reduced its salary by 50%, one person said.

Some of the physician-staffing groups are prepared to litigate the matter, and plan to contact lawyers, the people with knowledge of the plans said. The potential legal battle could be costly for Envision."
 
Ronin1 said:
Today Envision announced 30% reduction in base compensation for south east region. For indefinite length of time......
Click to expand...

Envision also didn't pay the "annual metric bonus" this year as posted above. The Physicians who work for Envision count on that bonus as part of their pay since Envision pays below fair market value. Typically, Envision pays 90-100% of that "bonus" each year in late March. This year the "workers" aren't getting a dime.

Envision is also trying to make existing employees work harder for less pay as they do not replace departing staff members. Welcome to the world of KKR.
 
Envision said today they have had a 40% reduction in income and will be reducing pay and furloughing physicians. They offered their employees the option of going to one of their NYC hospitals in the meantime
 
www.nytimes.com

KKR Sets Up $50 Million International Coronavirus Relief Fund

KKR & Co Inc has established a $50 million global relief fund to help people affected by the new coronavirus, according to a letter the U.S. private equity firm sent to its investors on Tuesday.
www.nytimes.com www.nytimes.com
[/QUOTE]
BLADEMDA said:
Envision also didn't pay the "annual metric bonus" this year as posted above. The Physicians who work for Envision count on that bonus as part of their pay since Envision pays below fair market value. Typically, Envision pays 90-100% of that "bonus" each year in late March. This year the "workers" aren't getting a dime.

Envision is also trying to make existing employees work harder for less pay as they do not replace departing staff members. Welcome to the world of KKR.
Click to expand...

How nice of them to pick the pockets of their employees, and not their investors, to make that big charitable contribution.
 
This will be just another path to consolidation into mega hospital systems. I think we will see more small PPs being employed by the hospital after this. I think AMCs will continue to lose market share to hospital-based anesthesia employment. We’re going to see more Northwells and less Envisions.
 
skypilot said:
www.nytimes.com

KKR Sets Up $50 Million International Coronavirus Relief Fund

KKR & Co Inc has established a $50 million global relief fund to help people affected by the new coronavirus, according to a letter the U.S. private equity firm sent to its investors on Tuesday.
www.nytimes.com www.nytimes.com
Click to expand...

How nice of them to pick the pockets of their employees, and not their investors, to make that big charitable contribution.
Click to expand...


tenor.gif
 
GravelRider said:
This will be just another path to consolidation into mega hospital systems. I think we will see more small PPs being employed by the hospital after this. I think AMCs will continue to lose market share to hospital-based anesthesia employment. We’re going to see more Northwells and less Envisions.
Click to expand...
This pandemic reveals the full purpose of these AMCs, which is making a profit. The thing they sell is protected income and this pandemic reveals that the income is anything but protected. Switching to hospital employment would only shift the risk over to the hospitals which I'm pretty certain they don't want either. Perhaps, switching to a private practice model would work but the reimbursements have gone down so much that nobody would do it?

Maybe someone who has seen the billings for the diff types of cases we do can weigh in, I haven't looked at that stuff in years.
 
46Long said:
This pandemic reveals the full purpose of these AMCs, which is making a profit. The thing they sell is protected income and this pandemic reveals that the income is anything but protected. Switching to hospital employment would only shift the risk over to the hospitals which I'm pretty certain they don't want either. Perhaps, switching to a private practice model would work but the reimbursements have gone down so much that nobody would do it?

Maybe someone who has seen the billings for the diff types of cases we do can weigh in, I haven't looked at that stuff in years.
Click to expand...

There are several challenges namely

1. Your forced to take crappy rates because the hospital will terminate your contract

2. If you take a subsidy expect to hear about it nonstop fromadmin who think They or mega AMC can do better

3. Payor mix is extremely important. CMS rates were poor 10 years ago and they are even lower now. See govt patients especially for anesthesia is an increasingly losing proposition.

4. Hospitals want anesthesia coverage For even the most god forsaken areas of the hospital and groups get strong armed into paying people to essentially sit around and do low value work or none at all

5. New govt legislation

6. Too many grads - every new grad MD or mid level that is pumped out reduces your leverage with these organizations.

The bottom line is it is becoming extremely difficult to run a good private practice - there are too many demands and too little money to go around. Hence why bigger organizations are being used to staff because the small groups can’t Absorb the financial blows anymore
 
RadsWFA1900 said:
There are several challenges namely

1. Your forced to take crappy rates because the hospital will terminate your contract

2. If you take a subsidy expect to hear about it nonstop fromadmin who think They or mega AMC can do better

3. Payor mix is extremely important. CMS rates were poor 10 years ago and they are even lower now. See govt patients especially for anesthesia is an increasingly losing proposition.

4. Hospitals want anesthesia coverage For even the most god forsaken areas of the hospital and groups get strong armed into paying people to essentially sit around and do low value work or none at all

5. New govt legislation

6. Too many grads - every new grad MD or mid level that is pumped out reduces your leverage with these organizations.

The bottom line is it is becoming extremely difficult to run a good private practice - there are too many demands and too little money to go around. Hence why bigger organizations are being used to staff because the small groups can’t Absorb the financial blows anymore
Click to expand...
I was under the impression that there was a deficit of anesthesiologists???
 
MirrorTodd said:
I was under the impression that there was a deficit of anesthesiologists???
Click to expand...
There is no true deficit of anybody who cannot write their own checks (i.e. "eat what they kill" plus incentives). 😉

Ergo there is only a "deficit" of anesthesiologists willing to work for peanuts (compared to what they bill), or willing to do jobs that other anesthesia "providers" wouldn't, or work in BFE etc.

Like we have a "deficit" of truck drivers, crop harvesters etc.
 
Last edited by a moderator:
46Long said:
This pandemic reveals the full purpose of these AMCs, which is making a profit. The thing they sell is protected income and this pandemic reveals that the income is anything but protected. Switching to hospital employment would only shift the risk over to the hospitals which I'm pretty certain they don't want either. Perhaps, switching to a private practice model would work but the reimbursements have gone down so much that nobody would do it?

Maybe someone who has seen the billings for the diff types of cases we do can weigh in, I haven't looked at that stuff in years.
Click to expand...

Oh I’m not saying anything about hospitals guaranteeing salaries. However they can “redeploy” their employees into other tasks without having to strike some kind of deal with AMCs or PPs. These mega hospital systems are more likely to remain solvent compared to an AMC, though. When all is said and done, I think smaller, independent hospitals will be a thing of the past too.
 
MirrorTodd said:
I was under the impression that there was a deficit of anesthesiologists???
Click to expand...
I can’t believe envision/Sheridan /amsurg/rick Scott/hca cronies did a 30% across the board paycut. Even for those hospitals still requiring almost the same hours work.
It’s one thing to not be working and not getting paid.

But many places are still 90-100% of same hours even with Reduce case loads. The mandatory hours in house is still the same
 
painstop said:
www.propublica.org

Medical Staffing Companies Owned by Rich Investors Cut Doctor Pay and Now Want Bailout Money

Companies that employ emergency room medical personnel, many owned by private equity firms, say they are reeling from vanishing demand for non-coronavirus care. But critics worry that bailout money would be a windfall for rich investors.
www.propublica.org www.propublica.org
Click to expand...

This coronavirus event was/is a great opportunity to starve these parasites of their lifeblood. Every physician who was furloughed or had salaries cut should have resigned on the spot and then went right back to the hospital to offer emergency care services for the covid crisis. I would have dared the companies to enforce their restrictive covenants in a national crisis where some hospitals are begging for healthcare workers. In a real capitalist system, cataclysms are opportunity.
 
GravelRider said:
This coronavirus event was/is a great opportunity to starve these parasites of their lifeblood. Every physician who was furloughed or had salaries cut should have resigned on the spot and then went right back to the hospital to offer emergency care services for the covid crisis. I would have dared the companies to enforce their restrictive covenants in a national crisis where some hospitals are begging for healthcare workers. In a real capitalist system, cataclysms are opportunity.
Click to expand...
Problem has been a lot of places don't really have a demand for non icu docs to help with covid. My place dmfor example was thinking of letting us work in icu, but there just hasn't been a need.
 
painstop said:
www.propublica.org

Medical Staffing Companies Owned by Rich Investors Cut Doctor Pay and Now Want Bailout Money

Companies that employ emergency room medical personnel, many owned by private equity firms, say they are reeling from vanishing demand for non-coronavirus care. But critics worry that bailout money would be a windfall for rich investors.
www.propublica.org www.propublica.org
Click to expand...
aneftp said:
I can’t believe envision/Sheridan /amsurg/rick Scott/hca cronies did a 30% across the board paycut. Even for those hospitals still requiring almost the same hours work.
It’s one thing to not be working and not getting paid.

But many places are still 90-100% of same hours even with Reduce case loads. The mandatory hours in house is still the same
Click to expand...

How is any of this surprising? People sold out to corporate overlords whose only motive is profit and then act surprised when the reimbursement policy is dictated by corporate overlords whose only motive is profit? Cmon....
 
Last edited:
aneftp said:
I can’t believe envision/Sheridan /amsurg/rick Scott/hca cronies did a 30% across the board paycut. Even for those hospitals still requiring almost the same hours work.
It’s one thing to not be working and not getting paid.

But many places are still 90-100% of same hours even with Reduce case loads. The mandatory hours in house is still the same
Click to expand...

My question is are people being forced to just sit in the hospital even with nothing to do? I mean cases are down substantially everywhere. Call requirements don't change because there are still emergencies. Are you saying people not on call are still being forced to be present even with nothing to do?

I just can't imagine a scenario where people are having to work as much as usual except with nothing to do. Paycuts I understand. That is happening everywhere because there is no more money coming in (or at least way less than normal). But we should all be working a bit less because there is less demand for our services.
 
Mman said:
My question is are people being forced to just sit in the hospital even with nothing to do? I mean cases are down substantially everywhere. Call requirements don't change because there are still emergencies. Are you saying people not on call are still being forced to be present even with nothing to do?

I just can't imagine a scenario where people are having to work as much as usual except with nothing to do. Paycuts I understand. That is happening everywhere because there is no more money coming in (or at least way less than normal). But we should all be working a bit less because there is less demand for our services.
Click to expand...

Man. Lots of hospitals especially those who employed anesthesiologists and crna are demanding 24/7 airway coverage even in community hospitals.

Saying “well case load is down”. You guys cover the covid airways. A dump off. If icu/er Docs are independent contractors who usually intubate or work for third party companies themselves. They don’t want to intubate either.

So yes. You sit on your ass waiting for airway to be called even if only 1-2 covid patients in house.
 
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