Envision Healthcare teeters on the brink of bankruptcy

[OptionOffense]

seems like only insurance companies are allowed to have monopolies? 1 out of 3 people are insured by blue cross in certain markets but thats ok. This is more government targeting likely lead by insurance companies lobbyists

Exactamundo. They are picking winners and losers. #1 problem in this entire economy and giving capitalism a bad name.

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[nimbus]

Exactamundo. They are picking winners and losers. #1 problem in this entire economy and giving capitalism a bad name.

Hasn’t capitalism always been this way? Best lobbyists, bribes, and payoffs win.

 

[amyl]

Crony capitalism.

 

[jwk]

($5000 for an epidural is insane and I had a friends insurance pay USAP that-it’s a 5 minute procedure-makes Anesthesia look terrible)

.

It’s not difficult if you have friends in Texas or some other amc dominated state. Look at their EOB/statements. They get paid crazy high amounts-which only fuels CRNAs arguments about them being cheaper

Not sure where you live -plenty of practices where only CRNAs staff OB

CRNAs would bill for the exact same amount. They're not cheaper to the patient. Never have been.

If CRNAs have taken over the OB part of any group or hospital with anesthesiologists, then those anesthesiologists are part of the problem. I get that people some people don't like it. I don't enjoy it - but I can ooh and ahh with the best of them during C-sections. It's part of my job, and in my particular case, it's a very significant part of our business. Anesthesiologists do every single epidural and spinal in our practice with 25,000+ deliveries per year.

 

[Status Sciaticus]

Ha metro a week argument. USAP still
has likely more than 50% market share in Dallas and Houston. 50% in Austin. Denver maybe more than 60%

Articles have come out showing the increased costs with PE running these practices.

Is that enough to break up these groups? Prob not, but glad they are investigating, either way no surprises act has capped these groups crazy rates ($5000 for an epidural is insane and I had a friends insurance pay USAP that-it’s a 5 minute procedure-makes Anesthesia look terrible)

If you think $5000 for an epidural is appropriate then that is exactly why CRNAs will win the scope of practice argument.

You can also argue that having two players in a city can lead to price fixing just as easily as you can argue that having one large player can lead to a monopoly. I dont think it matters because FTC is looking at pre and post acquisition reimbursements and billing practices, but they dont really have any teeth to render an effective judgement.

It doesnt matter if the procedure is 5 minutes, 2 minutes, or 2 hours. What you are paying for is the skill of the proceduralist which involves the time it took to train that person and the risk involved with the procedure that the physician bears in terms of liability. Hence why doing a robotic laparoscopic procedure pays more than doing an open one, because of the increased training involved.

 

[peltier]

I have the solution!

Fire all the administrators.

Most hospital systems are going to vastly reduce the number of middle managers and Chiefs of Fluff, Chiefs of Experience, Chiefs of Roses and Lollipops, etc. Additionally, the systems are going to demand some performance and accountability. As docs and nurses become more frustrated, systems will be forced to negotiate and importantly, listen, to those providing bedside care. Anyone at the bedside is safe for now, but there is so much bloat in our system with administrative pigs at the trough sucking billions out of the system with no value add. Can ANY non-profit hospital CEO justify a multiple 7 figure salary? I don't think so. CEO pay is tied to volume of patient services and revenue...not quality outcomes, physician and nurse retention, etc. The chickens are coming home to roost.

 

[peltier]

If you're in a small boutique private practice, the practice ie company, is the asset. The potential future is either the profit sharing of the company or the share of any buyout. That's the risk and potential reward.

Other than that, yes I tend to agree with you, "buying in" to a company that doesn't give you future profit sharing or splitting of a company sale would be a red-flag.

Now I do think the whole "selling out" is a bit of a thing of the past because now, well at least the past decade, the AMC just comes in and overpromises and underdelivers and takes the contract due to a hospital CFO trying to save a buck. Maybe these issues with the likes of Envision and NAPA slows that down but I see the end result, as others have said, just being hospital employment.

And some hospital systems do a terrible job as employers of physicians. For example, my boss was a pediatrician who was VPMA. She knew essentially nothing about the OR, anesthesia, surgeons, etc. She was professional, courteous, and approachable but ignorant about how surgeons and anesthesiologists work in the OR. BIG RED FLAG! Needless to say, I left the system after 6 months of complete BS.

 

[OptionOffense]

Most hospital systems are going to vastly reduce the number of middle managers and Chiefs of Fluff, Chiefs of Experience, Chiefs of Roses and Lollipops, etc. Additionally, the systems are going to demand some performance and accountability. As docs and nurses become more frustrated, systems will be forced to negotiate and importantly, listen, to those providing bedside care. Anyone at the bedside is safe for now, but there is so much bloat in our system with administrative pigs at the trough sucking billions out of the system with no value add. Can ANY non-profit hospital CEO justify a multiple 7 figure salary? I don't think so. CEO pay is tied to volume of patient services and revenue...not quality outcomes, physician and nurse retention, etc. The chickens are coming home to roost.

And you know this how?

 

[OptionOffense]

, I left the system after 6 months of complete BS.

What kind of BS?

 

[peltier]

And you know this how?

If you read Becker's, there are several systems laying off middle managers. Additionally, I was in leadership for 12 years and have contacts all over the US from a variety of groups and systems. For a system to survive, they will have to figure out how to reduce the number of administrators. Administrators are the true cost center for an organization because their activities do not generate revenue.

 

[peltier]

What kind of BS?

The Department of Anesthesia was under the governance of the Department of Surgery (1950's style). As Chair, I was not on the Medical Executive Committee. As Chair, I worked 1 FTE in the OR with no administrative days. We lacked basic resources, anesthesia techs, etc. It was a nightmare without end.

 

[OptionOffense]

Administrators are the true cost center for an organization because their activities do not generate revenue.

Im not sure they want physicians to be managers. Im not sure physicians want to be managers. The only physicians who want to be managers are ones that are not very talented. WHy would a talented Oncologist, surgeon, etc want to give up their practice to be in meetings with a bunch of complete zeros? Anybody who wants that job should not have it.

 

[OptionOffense]

The Department of Anesthesia was under the governance of the Department of Surgery (1950's style). As Chair, I was not on the Medical Executive Committee. As Chair, I worked 1 FTE in the OR with no administrative days. We lacked basic resources, anesthesia techs, etc. It was a nightmare without end.

That IS B.S.

 

[ambiturner]

If you read Becker's, there are several systems laying off middle managers. Additionally, I was in leadership for 12 years and have contacts all over the US from a variety of groups and systems. For a system to survive, they will have to figure out how to reduce the number of administrators. Administrators are the true cost center for an organization because their activities do not generate revenue.

My hospital has increased administrators substantially since 2020. They also are losing more money than they ever have. Nonetheless, there has as of yet been no attempts to decrease administrators other than dragging their feet on replacing them if they leave.

To your other point about clinicians being the true revenue generators, to my administrators’ credit they are making more efforts to recruit specialists. With traveling nurses now getting paid close to what physicians get, why not? We’ll even pick up the slack for nursing shortages.

 

[kidthor]

Administrators are the true cost center for an organization because their activities do not generate revenue.

I’ve met many administrators that think they’re the true income generators because they’re such great managers and optimizers, and blame the physicians for not working hard enough. The admins are the ones doing all the party planning, going to all the parties, and taking photos with the celebrity donors after all (while we’re in the OR on Saturday night of course).

Plenty administrators blame the physicians and nurses for wanting more money, with endless guilt trips poured in. I think it’s just not flying any more now that the markets are opened up. But the admins, as far as I’ve seen, aren’t being fired. Rather they’re still being retained as the solution. I’ve seen systems hire outside consultants for even more money, and the consultants tell the hospitals what they want to hear (doctors and nurses are demanding too much, don’t cave in!) rather than a real solution.

Case in point my hospital just reduced physician pay after also not giving retirement matching during COVID while blaming the physicians for wanting too much money that the hospital “doesn’t have”…. At the same time they’re throwing cash at traveling nurses and they just hired outside consultants (again) who apparently told them to squeeze the docs by paying “only for what they actually do” (aka cut subsidies).

 

[Twiggidy]

Im not sure they want physicians to be managers. Im not sure physicians want to be managers. The only physicians who want to be managers are ones that are not very talented. WHy would a talented Oncologist, surgeon, etc want to give up their practice to be in meetings with a bunch of complete zeros? Anybody who wants that job should not have it.

there's some truth here

 

[GravelRider]

Most hospital systems are going to vastly reduce the number of middle managers and Chiefs of Fluff, Chiefs of Experience, Chiefs of Roses and Lollipops, etc. Additionally, the systems are going to demand some performance and accountability. As docs and nurses become more frustrated, systems will be forced to negotiate and importantly, listen, to those providing bedside care. Anyone at the bedside is safe for now, but there is so much bloat in our system with administrative pigs at the trough sucking billions out of the system with no value add. Can ANY non-profit hospital CEO justify a multiple 7 figure salary? I don't think so. CEO pay is tied to volume of patient services and revenue...not quality outcomes, physician and nurse retention, etc. The chickens are coming home to roost.

But then who will make the “Heroes Work Here” posters and change the number on the “XX days without a fall” posters?

 

[IMGASMD]

But then who will make the “Heroes Work Here” posters and change the number on the “XX days without a fall” posters?

Or hand out “thank you” breakfast, and “serving” you all heroes at thanksgiving?!

As a poor resident I loved free food. As a attending, I always decline…. Something just doesn’t feel right.

 

[OptionOffense]

The hospital systems dont care about good care. They only care if it looks like good care. So the more billboards and radio spots the better. What happened to building a reputation through word of mouth? DOes that still exist?

Worlds greatest ER,,,, This exit -------->>>>>> 2 min wait times
Are you Depressed? Call our hotline
Avg Weight Loss 190lbs call our Bariatric surgeon.
CMON

 

[gasdoc77]

The hospital systems dont care about good care. They only care if it looks like good care. So the more billboards and radio spots the better. What happened to building a reputation through word of mouth? DOes that still exist?

Worlds greatest ER,,,, This exit -------->>>>>> 2 min wait times
Are you Depressed? Call our hotline
Avg Weight Loss 190lbs call our Bariatric surgeon.
CMON

Hospital systems have replaced factories as the employers of middle class USA. They use the Henry Ford assembly line models and care only about throughput. They are run by C student MBA's using six sigma strategies. Quantity is all that matters and quality ONLY to the extent that it affects the prior.

 

[nimbus]

Hospital systems have replaced factories as the employers of middle class USA. They use the Henry Ford assembly line models and care only about throughput. They are run by C student MBA's using six sigma strategies. Quantity is all that matters and quality ONLY to the extent that it affects the prior.

That makes us the assembly line factory workers.

 

[peltier]

Im not sure they want physicians to be managers. Im not sure physicians want to be managers. The only physicians who want to be managers are ones that are not very talented. WHy would a talented Oncologist, surgeon, etc want to give up their practice to be in meetings with a bunch of complete zeros? Anybody who wants that job should not have it.

That is not entirely true. Some physicians who are excellent clinically and have earned trust with partners throughout the years want to walk away into the sunset in a non-clinical role but remain in the healthcare space either as a CMO, COO, or CEO. Most of the physicians I know who have done this, and a few are good friends, have a lot to offer hospital administrators in this arena IF they listen to the physicians. A lot of HCOs do not listen to the physicians, and that is the problem.

 

[peltier]

Or hand out “thank you” breakfast, and “serving” you all heroes at thanksgiving?!

As a poor resident I loved free food. As a attending, I always decline…. Something just doesn’t feel right.

The Pizza Parties, balloons, cakes, and so-called appreciation lunches, etc. have become patronizing efforts to put on the veneer of caring while reducing salary, increasing RVU expectations, or cutting benefits.

 

[IMGASMD]

The Pizza Parties, balloons, cakes, and so-called appreciation lunches, etc. have become patronizing efforts to put on the veneer of caring while reducing salary, increasing RVU expectations, or cutting benefits.

I think you hit the nail on the head. Thats exactly it!
Thanks.

 

[GravelRider]

That makes us the assembly line factory workers.

Sounds pretty accurate to me.