Envision screwing doctors again!!!!

[EctopicFetus]

Never a bad time to dump on the cmg a -holes

KKR-Backed Envision Withholds Doctor Pay as Routine Care Slows

Envision Healthcare Corp., one of the biggest medical providers backed by private equity, is withholding some pay for doctors and contemplating salary cuts amid the coronavirus pandemic.

www.bloomberg.com

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[sylvanthus]

Looks like 1/3 pay cut? Ouch. Im wondering when the cuts are gonna start happening here. Volumes are so low in the ED. ( which just goes to show how much BS comes into the ED), I wouldnt be surprised to see most docs getting pay cuts coming up. What I am more worried about, are the damn customer satisfaction scores. That nonsense is prob gonna be even more important to admin because they want their ERs full. Since volumes are down, I can see them using pt satisfaction metrics more than ever. God help us.

 

[RustedFox]

No surprise here.

 

[GeneralVeers]

> 50% pay cut here if they don't pay out the bonus like planned.

On the plus side, they might go bankrupt and then we can bid for the contract ourselves.

 

[Brigade4Radiant]

Well let’s see these companies can’t maintain hold on the money losing hospitals and when this picks up docs need to renegotiate. Private backed equity of medical care needs to end

 

[deleted941485]

My friend works at an envision site in a local leadership role. Basically told them no bonuses this year at all. Effectively cutting pay by 40%.

 

[Groove]

We just had our hours slashed and went from 9h shifts to 8h shifts. The MLP shifts were cut from 10h to 8h. Super low volumes. I saw like 10 patients yesterday during my entire shift. I'm sure this next paycheck is going to be painful.

 

[RustedFox]

Said it before, but it bears repeating:

"What good is a contract if one party can change it anytime they want to?"

 

[Birdstrike]

Said it before, but it bears repeating:

"What good is a contract if one party can change it anytime they want to?"

Emergency Physician contracts are structured to make it look like the physician is protected by contract, while functioning in the real world as if one is a highly paid hourly worker that can be terminated at any time.

 

[RustedFox]

Emergency Physician contracts are structured to make it look like the physician is protected by contract, while operating as a highly paid hourly worker that can be terminated at any time.

I fully agree.

So, as a part of my #physicianrevolution - I say that AAEM retain legal services like the ones that this guy provides:




... and take the CMGs and the admins to the mat over it.

 

[Birdstrike]

I fully agree.

So, as a part of my #physicianrevolution - I say that AAEM retain legal services like the ones that this guy provides:




... and take the CMGs and the admins to the mat over it.

Employed physicians need to unionize. It is 100% legal for employee physicians to do so. The power of the group negotiating en bloc is infinitely greater than each negotiating on their own. CMGs could give a flying --- if a doc here or a doc there, refused to sign their rigged contracts. But if 10,000 of them refuse all at once, now you've got some leverage. The businessmen count on using our ethical passivity to bully us and they know our training has ingrained in us that we deserve it. It's about time it stops. But won't without a significant change in attitude by physicians. Complaining isn't enough, docs need to get angry enough to take bold action.

 

[RustedFox]

Employed physicians need to unionize. It is 100% legal for employee physicians to do so. The power of the group negotiating en bloc is infinitely greater than each negotiating on their own. CMGs could give a flying --- if a doc here or a doc there, refused to sign their rigged contracts. But if 10,000 of them refuse all at once, not you've got some leverage. The businessmen count on using our ethical passivity to bully us. It's about time it stops. But won't without a significant change in attitude by physicians. Complaining isn't enough, docs need to get angry, really angry.

I'm on board, amigo.
I refused to sign the non-compete when APP bought our small pseudoSDG and took it all over.
I think the only one who did sign it was our site director.

 

[ShockIndex]

Employed physicians need to unionize. It is 100% legal for employee physicians to do so. The power of the group negotiating en bloc is infinitely greater than each negotiating on their own. CMGs could give a flying --- if a doc here or a doc there, refused to sign their rigged contracts. But if 10,000 of them refuse all at once, not you've got some leverage. The businessmen count on using our ethical passivity to bully us. It's about time it stops. But won't without a significant change in attitude by physicians. Complaining isn't enough, docs need to get angry, really angry.

I’m actually in a union - house staff at my hospital are unionized. I jokingly tell my Dad that I’m now economically aligned with Bernie Sanders for the next couple of years despite having political beliefs that are slightly to the right of Atilla the Hun’s. 😉

I suppose that going back to fellowship makes for some interesting bedfellows, eh? To all my critics who told me that I’d sacrifice 2 years of attending salary in fellowship - ha ha. Just kidding...really. All those years in Catholic high school really paid off as my timing is impeccable.

That video from ZDog is great. However, I’m wondering how many contracts are being violated. I looked over some of my old employment agreements and my employers had broad ability to adjust my hours and bonuses were not guaranteed income. We need to be very careful with what we sign.

 

[Birdstrike]

I’m actually in a union - house staff at my hospital are unionized. I jokingly tell my Dad that I’m now economically aligned with Bernie Sanders for the next couple of years despite having political beliefs that are slightly to the right of Atilla the Hun’s. 😉

I suppose that going back to fellowship makes for some interesting bedfellows, eh? To all my critics who told me that I’d sacrifice 2 years of attending salary in fellowship - ha ha. Just kidding...really. All those years in Catholic high school really paid off as my timing is impeccable.

That video from ZDog is great. However, I’m wondering how many contracts are being violated. I looked over some of my old employment agreements and my employers had broad ability to adjust my hours and bonuses were not guaranteed income. We need to be very careful with what we sign.

Good post.

I'm sure many contracts are being violated. And I'm sure just as many are structured so heavily in favor of the employer they don't even have to violate them to hose the doc.

 

[GeneralVeers]

Contractually they are only obligated to pay the base hourly, around $140/hour. The "Bonus" is typically what's left over after subtracting the base hourly from the total amount collected.

The situation would be just as bad if we were a small SDG. We'd still have volume down 30% and have to cut heavily to avoid a loss.

I feel bad for all those Level 5 Vituity partners who won't be getting their sweet 20% bonus this year.......unless they are dicks and pile that debt on to all their local contracts.

 

[Birdstrike]

Contractually they are only obligated to pay the base hourly, around $140/hour. The "Bonus" is typically what's left over after subtracting the base hourly from the total amount collected.

The situation would be just as bad if we were a small SDG. We'd still have volume down 30% and have to cut heavily to avoid a loss.

I feel bad for all those Level 5 Vituity partners who won't be getting their sweet 20% bonus this year.......unless they are dicks and pile that debt on to all their local contracts.

I take a pay cut every time my volume's down. Every time. It sucks but it's life under a productivity based system. It felt much worse when it happened during my ED years, though. Probably because I had much less control over my volume.

 

[Dr Mantis Toboggan]

yeah what’s bull**** is when the CMG makes $500 an hour off of you they pay you $225. when they make $100 off of you they cut your pay.

 

[GeneralVeers]

yeah what’s bull**** is when the CMG makes $500 an hour off of you they pay you $225. when they make $100 off of you they cut your pay.

Let's hope they all go out of business and we can start to run our own show for short period of time.

 

[Brigade4Radiant]

Typically an ER physician will make 1.2-1.4 million for a CMG and you get 300k-400k

 

[ShockIndex]

Contractually they are only obligated to pay the base hourly, around $140/hour. The "Bonus" is typically what's left over after subtracting the base hourly from the total amount collected.

The situation would be just as bad if we were a small SDG. We'd still have volume down 30% and have to cut heavily to avoid a loss.

I feel bad for all those Level 5 Vituity partners who won't be getting their sweet 20% bonus this year.......unless they are dicks and pile that debt on to all their local contracts.

Do you have a minimum monthly hour threshold that your employer must provide? I seem to recall that EMP had to give me at least 95 hrs/month to be full-time. They could go up to 180 hrs or so per month and then there was a clause about emergency staffing and 1.5X the hourly rate for hours over 180.

I’d imagine that independent contractors are very vulnerable at the moment.

 

[e30ftw]

I'm 100% RVU IC and expect to see about a 30% reduction on next month's check.

I wouldn't change anything and it still seems fair to me.

That said, I went through a contract change from Envision to another CMG and immediately had a 25% increase in compensation for exactly the same work.

 

[GeneralVeers]

Do you have a minimum monthly hour threshold that your employer must provide? I seem to recall that EMP had to give me at least 95 hrs/month to be full-time. They could go up to 180 hrs or so per month and then there was a clause about emergency staffing and 1.5X the hourly rate for hours over 180.

I’d imagine that independent contractors are very vulnerable at the moment.

I'm W2 now so they have to guarantee 120 hrs/month. People are going to be pissed if they cut off benefits because Envision forces them below 120

 

[thegenius]

Said it before, but it bears repeating:

"What good is a contract if one party can change it anytime they want to?"

I agree...but many of the contracts don't stipulate specific physician scheduling parameters right? They can mess with those and reduce your pay. Maybe they can't say "we are going to reduce your RVU multiplier from 30 to 20" without having you re-sign a contract, but they can effective reduce your hours to accomplish the same thing.

I'm waiting for an ER group to stand up to this stuff, hire some lawyers, and fight this.

 

[thegenius]

Talk about low volumes.....

My shift in the ER yesterday (Sunday). I usually see about 20-25 on this shift. Yesterday I saw

1. 27 yo G7P4 19 wks pregnant with nausea and stomach pain, is out of her methadone, wanted Zofran and some methadone
2. 28 yo guy tweaking on methamphetamine, this is his 24th visit in the past 2 weeks (I kid you not)
3. 30 yo F homeless with psych problems, came in with knee pain. Walking basically normally. Her 16th visit in the past 2 weeks (I swear...)
4. some middle aged dude with chronic b/l knee pain
5. PD clearance on a pt with BP 190/120
6. young guy with b/l adenopathy and tonsillar exudate for 2 wks, + monospot test
7. 30 yo woman with a painful 5x3 cm abscess in her R armpit.
8. old due to ripped out his trach and G-tube, we replaced it, and now the facility won't take him back.

and I had a signout on a psych patient whose meth wore off...but was now just being a jerk and requiring more olanzapine, Haldol, and Ativan to keep him calm.


Not a single emergency, and the only legitimate use IMO was #7

 

[thegenius]

Typically an ER physician will make 1.2-1.4 million for a CMG and you get 300k-400k

that doesn't seem right...
ER docs might make 60-70% of billing, above you put 25%.
Good places might be 80% or higher.

 

[Brigade4Radiant]

that doesn't seem right...
ER docs might make 60-70% of billing, above you put 25%.
Good places might be 80% or higher.

Most physicians bill about 1.4-1.6 billion and this is using midlevel charts that bill under your name

 

[e30ftw]

Most physicians bill about 1.4-1.6 billion...

Apparently I’m doing it wrong.

 

[DrDrummer]

Apparently I’m doing it wrong.

Obviously under billing Level 11 charts. You need to include peer-reviewed citations in your MDM and throw in some illustrations to upgrade your medical complexity.

 

[BoardingDoc]

Talk about low volumes.....

My shift in the ER yesterday (Sunday). I usually see about 20-25 on this shift. Yesterday I saw

1. 27 yo G7P4 19 wks pregnant with nausea and stomach pain, is out of her methadone, wanted Zofran and some methadone
2. 28 yo guy tweaking on methamphetamine, this is his 24th visit in the past 2 weeks (I kid you not)
3. 30 yo F homeless with psych problems, came in with knee pain. Walking basically normally. Her 16th visit in the past 2 weeks (I swear...)
4. some middle aged due with chronic b/l knee pain
5. PD clearance on a pt with BP 190/120
6. young guy with b/l adenopathy and tonsillar exudate for 2 wks, + monospot test
7. 30 yo woman with a painful 5x3 cm abscess in her R armpit.
8. old due to ripped out his trach and G-tube, we replaced it, and now the facility won't take him back.

and I had a signout on a psych patient whose meth wore off...but was now just being a jerk and requiring more olanzapine, Haldol, and Ativan to keep him calm.


Not a single emergency, and the only legitimate use IMO was #7

Damn. I suspect that will change. My volume is also way down, as in 60% of normal volume. That said, I now see 1 bs vag bleed or wants STD testing patient, the rest are either dying from something routine (e.g. stemi, urosepsis, whatever), have covid and can go home, or have covid and are satting 60% on RA.

 

[TooMuchResearch]

Our SDG is slashing hours as much as possible. Since we all take a hit if the company goes bankrupt, it's easier to leave early.

Contractually they are only obligated to pay the base hourly, around $140/hour. The "Bonus" is typically what's left over after subtracting the base hourly from the total amount collected.

The situation would be just as bad if we were a small SDG. We'd still have volume down 30% and have to cut heavily to avoid a loss.

I feel bad for all those Level 5 Vituity partners who won't be getting their sweet 20% bonus this year.......unless they are dicks and pile that debt on to all their local contracts.

 

[TooMuchResearch]

What?

How many pph are they making you see?

No effing way.

Typically an ER physician will make 1.2-1.4 million for a CMG and you get 300k-400k

 

[Brigade4Radiant]

What?

How many pph are they making you see?

No effing way.

counting the mid level one sees like 4 pph

 

[TooMuchResearch]

That's nuts.

Still shouldn't get to $1.2 mil in collections though.

counting the mid level one sees like 4 pph

 

[deleted547339]

What?

How many pph are they making you see?

No effing way.

That sounds right for total billing, but not collections. My annual billing is about 400-600/y and I’m half time.

 

[turkeyjerky]

Our SDG is slashing hours as much as possible. Since we all take a hit if the company goes bankrupt, it's easier to leave early.

This seems infinitely preferable to the sneaking suspicion that your corprate overlords are using this as an excuse to cut reimbursement permanently

 

[EctopicFetus]

Keep in mind CMG level 5s are often right at 2k billed charges. $1500 for level 4. Rough estimates from fairhealth.

Listen F the CMGs. there is a 0% chance you are getting 80% of your collections unless the hospital is also getting a fat ass subsidy. THE CMGS can all eat a big fat D.

 

[ShockIndex]

Talk about low volumes.....

My shift in the ER yesterday (Sunday). I usually see about 20-25 on this shift. Yesterday I saw

1. 27 yo G7P4 19 wks pregnant with nausea and stomach pain, is out of her methadone, wanted Zofran and some methadone
2. 28 yo guy tweaking on methamphetamine, this is his 24th visit in the past 2 weeks (I kid you not)
3. 30 yo F homeless with psych problems, came in with knee pain. Walking basically normally. Her 16th visit in the past 2 weeks (I swear...)
4. some middle aged due with chronic b/l knee pain
5. PD clearance on a pt with BP 190/120
6. young guy with b/l adenopathy and tonsillar exudate for 2 wks, + monospot test
7. 30 yo woman with a painful 5x3 cm abscess in her R armpit.
8. old due to ripped out his trach and G-tube, we replaced it, and now the facility won't take him back.

and I had a signout on a psych patient whose meth wore off...but was now just being a jerk and requiring more olanzapine, Haldol, and Ativan to keep him calm.


Not a single emergency, and the only legitimate use IMO was #7

Damn. I suspect that will change. My volume is also way down, as in 60% of normal volume. That said, I now see 1 bs vag bleed or wants STD testing patient, the rest are either dying from something routine (e.g. stemi, urosepsis, whatever), have covid and can go home, or have covid and are satting 60% on RA.

I’m going to preface this by saying I don’t want to see hard working EPs hurt or go jobless. However, this “crisis” should be teaching all EPs 2 important lessons if they were not already obvious:

1) The healthcare system is a false economy built on elaborate price controls for select patients and rent controls for the providers. Like most other false economies, it didn’t take a lot of huffing a puffing to bring this deck of cards down. We are just 3 weeks into this and it’s being called “unprecedented.” I have some sad news - this is far from unprecedented. It has happened before in living memory and will not come close to being the greatest calamity of our lifetime.

2) Contrary to what we were told by ACEP and the academics in ivory towers, both of which were incentivized to justify a massive EM industry, 98% of what came into the ED up until last month was not unavoidable. If it was, we wouldn’t be seeing 30-40% of that now. It was a false economy built around the system and most of what we did in our daily work routine was not essential. If it was, there would be a bunch of corpses rotting at home due to lack of emergency care.

Thus, we have been over-staffing the EDs to handle the actual number of emergencies. We did this because it was convenient to the system, but we now know what will happen when the system is stressed by the slightest perturbance. Some systems may not survive this and those that do will be strapped for cash and looking to save a buck. They now have a very clear roadmap on how to navigate through low overhead ED care should the need arise. Prepare accordingly...

 

[TooMuchResearch]

Our volume of strokes, STEMIs, sepsis, pretty much all emergencies have dropped dramatically. I don't understand it.

I’m going to preface this by saying I don’t want to see hard working EPs hurt or go jobless. However, this “crisis” should be teaching all EPs 2 important lessons if they were not already obvious:

1) The healthcare system is a false economy build on elaborate price controls for select patients and rent controls for the providers. Like most other false economies, it didn’t take a lot of huffing a puffing to bring this deck of cards down. We are just 3 weeks into this and it’s being called “unprecedented.” I have some sad news - this is far from unprecedented. It has happened before in living memory and will not come close to being the greatest calamity of our lifetime.

2) Contrary to what we were told by ACEP and the academics in ivory towers, both of which were incentivized to justify a massive EM industry, 98% of what came into the ED up until last month was not unavoidable. If it was, we wouldn’t be seeing 30-40% of that now. It was a false economy built around the system and most of what we did in our daily work routine was not essential. If it was, there would be a bunch of corpses rotting at home due to lack of emergency care.

Thus, we have been over-staffing the EDs to handle the actual number of emergencies. We did this because it was convenient to the system, but we now know what will happen when the system is stressed by the slightest perturbance. Some systems may not survive this and those that do will be strapped for cash and looking to save a buck. They now have a very clear roadmap on how to navigate through low overhead ED care should the need arise. Prepare accordingly...

 

[southerndoc]

Our volume of strokes, STEMIs, sepsis, pretty much all emergencies have dropped dramatically. I don't understand it.

Less stress from work. Seriously, there is research that more STEMI's happen on Mondays than any other day of the week and least happen on Fridays. Work stresses people out.

 

[Torsion]

How long do you suspect it will take for volumes to return? It will be tough training residents if every hospital is seeing half the volume. Wouldn't bode well for employment prospects after finishing residency either. It's a morally weird situation to be in wishing that more people would show up to the emergency department.

 

[ShockIndex]

Our volume of strokes, STEMIs, sepsis, pretty much all emergencies have dropped dramatically. I don't understand it.

Makes for an interesting retrospective study.

 

[ShockIndex]

How long do you suspect it will take for volumes to return? It will be tough training residents if every hospital is seeing half the volume. Wouldn't bode well for employment prospects after finishing residency either. It's a morally weird situation to be in wishing that more people would show up to the emergency department.

Assuming there is some seasonal component, I’m hopeful that we will start to reopen parts of the country in mid-May. Things will quickly ramp up within a month. My fear is that it could return in the Winter, and that uncertainty may keep things from returning to full volumes for a year of more.

 

[bravotwozero]

I am doubtful there will be a seasonal component, there are countries with quite warm weather that have covid cases that aren't slowing down. Subsequent waves of infection are inevitable, unless we want to be on lockdown indefinitely, we'll see what that does to volumes.

 

[thegenius]

Keep in mind CMG level 5s are often right at 2k billed charges. $1500 for level 4. Rough estimates from fairhealth.

Listen F the CMGs. there is a 0% chance you are getting 80% of your collections unless the hospital is also getting a fat ass subsidy. THE CMGS can all eat a big fat D.

That was our last contract prior to dissolving our relationship with our CMG.

No ER doctor collects 1.2 - 1.4 m / year
We can bill whatever we want. We can bill $50K / chart. The average chart pays about $150.

 

[thegenius]

I’m going to preface this by saying I don’t want to see hard working EPs hurt or go jobless. However, this “crisis” should be teaching all EPs 2 important lessons if they were not already obvious:

1) The healthcare system is a false economy built on elaborate price controls for select patients and rent controls for the providers. Like most other false economies, it didn’t take a lot of huffing a puffing to bring this deck of cards down. We are just 3 weeks into this and it’s being called “unprecedented.” I have some sad news - this is far from unprecedented. It has happened before in living memory and will not come close to being the greatest calamity of our lifetime.

2) Contrary to what we were told by ACEP and the academics in ivory towers, both of which were incentivized to justify a massive EM industry, 98% of what came into the ED up until last month was not unavoidable. If it was, we wouldn’t be seeing 30-40% of that now. It was a false economy built around the system and most of what we did in our daily work routine was not essential. If it was, there would be a bunch of corpses rotting at home due to lack of emergency care.

Thus, we have been over-staffing the EDs to handle the actual number of emergencies. We did this because it was convenient to the system, but we now know what will happen when the system is stressed by the slightest perturbance. Some systems may not survive this and those that do will be strapped for cash and looking to save a buck. They now have a very clear roadmap on how to navigate through low overhead ED care should the need arise. Prepare accordingly...

This is like saying 1 + 1 = 2

(duh....)

I have not see one child in the ED in the past 3 weeks. And it's the latter half of the flu / cold season.

This is also the reason why I think the whole concept of urgent care is silly. 90% of what UC offers doesn't need to happen because the medical complaint will just go away.


Anyone else notice that consult services are more likely to come into the ED now?

 

[deleted836128]

Envision sucks. Worst company I have ever worked for. Of course I went through almost ten contract changes; they change the contract whenever they see fit. I make about 40 to 50 percent more now than I did with that God forsaken nightmare of a group.

 

[deleted836128]

This is like saying 1 + 1 = 2

(duh....)

I have not see one child in the ED in the past 3 weeks. And it's the latter half of the flu / cold season.

This is also the reason why I think the whole concept of urgent care is silly. 90% of what UC offers doesn't need to happen because the medical complaint will just go away.


Anyone else notice that consult services are more likely to come into the ED now?

OMG. I just realized - I haven’t seen a child in the ER in at least three weeks either. How bizarre.

And yes about the specialists. And they’re NICE. I had one of the usually harsh orthopedists today literally apologize to ME (the lowly PA) for the fact that his patient came to the ER for some postoperative bleeding. “So sorry... you shouldn’t have to deal with that... thanks so much for taking care of him... have a great day... stay well... mmm hmm, you have a really great day... thank you so much, bye.” It is unreal.

 

[thegenius]

Our volume of strokes, STEMIs, sepsis, pretty much all emergencies have dropped dramatically. I don't understand it.

That's a good point.
the real medical emergencies should be about the same.
Except for trauma - although a few days ago we have 4 GSWs in about 2 hours.

We have markedly reduced volumes but proportionally it's still mostly nonsense stuff for the most part.

 

[Cinclus]

I am seeing an unprecedented number of OHV accidents. Multiple every shift. I think that's all people have to do now that everything else is closed. Doing lots and lots and lots of ortho stuff.

 

[TooMuchResearch]

Right, and that $150 is before you/the company pays overhead: office staff, coding/billing company, office rent, IT, legal counsel, etc.

That was our last contract prior to dissolving our relationship with our CMG.

No ER doctor collects 1.2 - 1.4 m / year
We can bill whatever we want. We can bill $50K / chart. The average chart pays about $150.