Envision screwing doctors again!!!!

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Yes. Same. We have been formally told not to go to the OR for PPE. So I bought my own and shaved my head. Typical.

For real, B.

If you're going to stop me from heading to the OR once a shift and saying "Hey, homeys.... toss me a tie-back-bonnet."

No.

No.

Eff you.

HELLO ADMINS:

ONE BONNET A DAY.
MAYBE FIVE, IF OTHER LONGHAIRED FOLKS LIKE ME WANNA SAVE THEIR HEADS.
THAT'S LIKE, WHAT, FIVE CENTS A BONNET?

WAY TO BE POUND-WISE/PENNY-FOOLISH.
YOU FAIL BUSINESS-SKULE.

ATTENTION, ALL ADMINISTRATORS:
IT'S TIME TO GET REAL.
GET LEAN, OR GET DED (SIC).

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I managed to get a back-alley grey market haircut. Came to my house and cleaned it up for $25. Everyone was jealous.

Who would think that that's what the future would look like - black market haircuts?
 
I managed to get a back-alley grey market haircut. Came to my house and cleaned it up for $25. Everyone was jealous.

Who would think that that's what the future would look like - black market haircuts?

Just wait until a future President declares a "Climate Emergency". We will likely have drastic impositions or our daily activities in the name of saving the planet.

I'm all for resisting these government diktats. Go out, have a picnic, and get back-alley hair-cuts. It's gotten to the point of ridiculousness.

We paid our girl $200 to come over for hair cuts. She's got 3 kids, and was very appreciative since she has zero income now, and doesn't qualify for UI as an independent contractor.
 
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I managed to get a back-alley grey market haircut. Came to my house and cleaned it up for $25. Everyone was jealous.

Who would think that that's what the future would look like - black market haircuts?
Impossible! You need the govt to approve a 2000hr doctor of barbering curriculum and exact licensing fees to keep a log of authorized clipper practitioners....you know, for your protection
 
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Impossible! You need the govt to approve a 2000hr doctor of barbering curriculum and exact licensing fees to keep a log of authorized clipper practitioners....you know, for your protection
I mean, Barbers do require more hours than NPs.
 
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I mean, Barbers do require more hours than NPs.

So do Petsmart groomers...
 
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And the other foot drops.
 
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And the other foot drops.

Dammit.
Paywall'ed.
 
Dammit.
Paywall'ed.
Here you go:



Envision Healthcare to Consider Bankruptcy Filing
By Katherine Doherty
April 20, 2020, 4:45 PM EDT Updated on April 20, 2020, 7:16 PM EDT
  • Medical staffing firm hires restructuring lawyers, bankers
  • Company squeezed after pandemic halts elective procedures

Envision Healthcare Corp. has hired restructuring advisers and is contemplating a bankruptcy filing after the Covid-19 pandemic halted elective surgeries and left the company struggling to manage the $7 billion of debt from its 2018 leveraged buyout, according to people with knowledge of the matter.


The KKR & Co.-backed company, one of the largest physician staffing firms in the U.S., has already been holding back pay for doctors, and it has struggled to convince its bondholders to take a haircut in exchange for a new loan that would pare its debt load.




The company recently hired law firm Kirkland & Ellis LLP, and KKR is working with lawyers at Paul Weiss Rifkind Wharton & Garrison LLP to advise on Envision’s restructuring options, including a potential Chapter 11 filing, said the people, who asked not to be identified because the discussions are private. Investment bank Houlihan Lokey Inc. was also tapped for advice, the people said.


The situation remains fluid and plans could change, depending on market conditions and the length of the shutdown of the company’s businesses, the people said.



Representatives for Nashville, Tennessee-based Envision, KKR and Houlihan declined to comment, while spokespeople for Kirkland and Paul Weiss didn’t immediately comment.
Lenders Organize
Envision’s debt has been trading at deeply distressed levels. Its $1.23 billion of unsecured bonds due 2026 traded last week for less than 30 cents on the dollar, according to the Trace bond-price reporting system.


The company’s lenders have also engaged advisers of their own to begin talks with the company, the people said. Certain holders of its term loans are working with lawyers at Akin Gump Strauss Hauer & Feld LLP and investment bank Guggenheim Securities, they said.
A representative for Guggenheim declined to comment while Akin Gump didn’t immediately respond to requests for comment.
The pandemic has forced patients to avoid hospitals and forgo elective surgeries, which are more lucrative for health-care providers than emergency services typically related to treatment for Covid-19. In just two weeks, Envision’s business shrank by 65% to 75% at its 168 open ambulatory surgical centers, compared with the same period last year, Bloomberg reported last month.
Envision said at the time that it may need additional financing if conditions worsen. It reported $650 million in cash on its balance sheet at the end of March, $175 million of which is restricted from corporate use.
Debt Proposal
The company sought to ease its debt load with a proposal for bondholders to swap $1.2 billion of unsecured notes at a discount for a new term loan with higher priority and an earlier due date. But just $198 million of those holders have agreed to the swap. Creditors have until April 30 to decide whether to participate in the deal.
Hospitals and doctors groups have been pushing to get emergency government funds from the CARES Act while also trying to persuade lawmakers to approve more aid. But it remains unclear whether private equity-backed companies like Envision will receive any of those funds to offset losses.
KKR agreed to buy Envision in June 2018 in a deal that valued the company at $9.9 billion including debt. The firm planned to invest as much as $3.5 billion of equity in the transaction, a regulatory filing shows.
The health-care sector, long seen as a haven during economic downturns, has attracted billions of dollars of private equity investment in recent years. Envision was built through a series of acquisitions, culminating in a tie-up with AmSurg, a large surgery center and physician staffing group, in 2016.
(Updates with bond price in sixth paragraph)
 
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Here you go:



Envision Healthcare to Consider Bankruptcy Filing
By Katherine Doherty
April 20, 2020, 4:45 PM EDT Updated on April 20, 2020, 7:16 PM EDT
  • Medical staffing firm hires restructuring lawyers, bankers
  • Company squeezed after pandemic halts elective procedures

Envision Healthcare Corp. has hired restructuring advisers and is contemplating a bankruptcy filing after the Covid-19 pandemic halted elective surgeries and left the company struggling to manage the $7 billion of debt from its 2018 leveraged buyout, according to people with knowledge of the matter.


The KKR & Co.-backed company, one of the largest physician staffing firms in the U.S., has already been holding back pay for doctors, and it has struggled to convince its bondholders to take a haircut in exchange for a new loan that would pare its debt load.




The company recently hired law firm Kirkland & Ellis LLP, and KKR is working with lawyers at Paul Weiss Rifkind Wharton & Garrison LLP to advise on Envision’s restructuring options, including a potential Chapter 11 filing, said the people, who asked not to be identified because the discussions are private. Investment bank Houlihan Lokey Inc. was also tapped for advice, the people said.


The situation remains fluid and plans could change, depending on market conditions and the length of the shutdown of the company’s businesses, the people said.



Representatives for Nashville, Tennessee-based Envision, KKR and Houlihan declined to comment, while spokespeople for Kirkland and Paul Weiss didn’t immediately comment.
Lenders Organize
Envision’s debt has been trading at deeply distressed levels. Its $1.23 billion of unsecured bonds due 2026 traded last week for less than 30 cents on the dollar, according to the Trace bond-price reporting system.


The company’s lenders have also engaged advisers of their own to begin talks with the company, the people said. Certain holders of its term loans are working with lawyers at Akin Gump Strauss Hauer & Feld LLP and investment bank Guggenheim Securities, they said.
A representative for Guggenheim declined to comment while Akin Gump didn’t immediately respond to requests for comment.
The pandemic has forced patients to avoid hospitals and forgo elective surgeries, which are more lucrative for health-care providers than emergency services typically related to treatment for Covid-19. In just two weeks, Envision’s business shrank by 65% to 75% at its 168 open ambulatory surgical centers, compared with the same period last year, Bloomberg reported last month.
Envision said at the time that it may need additional financing if conditions worsen. It reported $650 million in cash on its balance sheet at the end of March, $175 million of which is restricted from corporate use.
Debt Proposal
The company sought to ease its debt load with a proposal for bondholders to swap $1.2 billion of unsecured notes at a discount for a new term loan with higher priority and an earlier due date. But just $198 million of those holders have agreed to the swap. Creditors have until April 30 to decide whether to participate in the deal.
Hospitals and doctors groups have been pushing to get emergency government funds from the CARES Act while also trying to persuade lawmakers to approve more aid. But it remains unclear whether private equity-backed companies like Envision will receive any of those funds to offset losses.
KKR agreed to buy Envision in June 2018 in a deal that valued the company at $9.9 billion including debt. The firm planned to invest as much as $3.5 billion of equity in the transaction, a regulatory filing shows.
The health-care sector, long seen as a haven during economic downturns, has attracted billions of dollars of private equity investment in recent years. Envision was built through a series of acquisitions, culminating in a tie-up with AmSurg, a large surgery center and physician staffing group, in 2016.
(Updates with bond price in sixth paragraph)

Sheridan to Amsurg rolled into envision then KKR. Just daisy chaining along until the music stops. Well...the music stopped.
 
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It's going to be a great time for doctor's groups to negotiate with hospitals to form their own SDGs. If Envision unilaterally breaches their contract with doctors, it would be grounds to petition the hospital to cancel the overall contract in order to maintain services without interruption.
 
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It's going to be a great time for doctor's groups to negotiate with hospitals to form their own SDGs. If Envision unilaterally breaches their contract with doctors, it would be grounds to petition the hospital to cancel the overall contract in order to maintain services without interruption.

Makes me wonder if there are groups out there that will shepherd SDGs through the process of managing their billing, etc. in order to stand up these new organizations. R1 maybe? This would be a great thing for AAEM (or less likely ACEP) to resource - teaching EPs to help themselves...
 
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Makes me wonder if there are groups out there that will shepherd SDGs through the process of managing their billing, etc. in order to stand up these new organizations. R1 maybe? This would be a great thing for AAEM (or less likely ACEP) to resource - teaching EPs to help themselves...

Yeah, call AAEM. Someone WILL get back to you, and give you some guidance on the issue. I had contacted them about this in the past, and i think it was robert mcnamara? who responded and said he'd be happy to speak with me anytime I wanted. I didn't go through with it any further, but I'm sure they can help you.
 
Guess envision now can cancel most of their debts, cancel their ER doc contracts, and rebrand themselves Envision Prime then lower doc contracts by 30%.
 
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As usual, A CMG siphons off 80% of each patient encounter. Pays us a small fraction and then claims "We are losing money" and cuts all the physicians salaries, cuts our hours, expects us to see more patients with less physicians, etc..

But what happened to that 80% they siphoned!!

One day hopefully CMGS will all fail and collapse and life, healthcare, and quality of care can all go back to standard...
 
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Guess envision now can cancel most of their debts, cancel their ER doc contracts, and rebrand themselves Envision Prime then lower doc contracts by 30%.
Like USACS err.. EMP
 
If Envision goes under, all that medical malpractice tail coverage is gone? Dang...
 
As usual, A CMG siphons off 80% of each patient encounter. Pays us a small fraction and then claims "We are losing money" and cuts all the physicians salaries, cuts our hours, expects us to see more patients with less physicians, etc..

But what happened to that 80% they siphoned!!

One day hopefully CMGS will all fail and collapse and life, healthcare, and quality of care can all go back to standard...

Is it really as high as 80%; the amount stole- er, siphoned, that is?
 
Is it really as high as 80%; the amount stole- er, siphoned, that is?

Depends on the group, your mode of employment, and how many PPH you see.

If your group has lower hourly pay, you are a 1099-so you are only receiving $/hour plus malpractice coverage, and you see 2+ PPH; Then Yes its likely they are keeping about 80%.
They are billing about $1000 per patient, some more, some less, depending on insurance status (and yes there are variations on the actual amounts collected from the different payers),
But lets say they get just $700/patient, and you saw 2 patients so they made $1400 that hour. They paid you about $250 (pay and malpractice) for that hour, they keep $1150 or 82% of your hourly profit...
 
I think the only reason ACEP is so much bigger than AAEM is because residencies provide memberships for free to their residents and faculty. Residents who want to continue involvement in a national organization after graduating will naturally buy memberships with ACEP as opposed to branching out and trying something new like AAEM. I can't figure out why, but residencies love ACEP.

If residencies started providing memberships to AAEM instead of ACEP, I think very few people would take it upon themselves to join ACEP.

It would take many years to really make a difference, but over time residencies could shift the membership numbers away from ACEP and toward AAEM.

I know many people on this forum think ACEP has failed to adequately represent physician and EM interests, but ACEP continues to be the largest EM organization simply because they hook so many people as residents, and a small percentage of those people go on to become long term members.
 
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I think the only reason ACEP is so much bigger than AAEM is because residencies provide memberships for free to their residents and faculty. Residents who want to continue involvement in a national organization after graduating will naturally buy memberships with ACEP as opposed to branching out and trying something new like AAEM. I can't figure out why, but residencies love ACEP.

If residencies started providing memberships to AAEM instead of ACEP, I think very few people would take it upon themselves to join ACEP.

It would take many years to really make a difference, but over time residencies could shift the membership numbers away from ACEP and toward AAEM.

I know many people on this forum think ACEP has failed to adequately represent physician and EM interests, but ACEP continues to be the largest EM organization simply because they hook so many people as residents, and a small percentage of those people go on to become long term members.


ACEP has a draw because of their big conferences. People enjoy going and catching up and hanging out with old residency friends. Even better if your residency encourages you to go as a resident and it sort of becomes a norm.

As far as being represented for the money AAEM is much better about actually defending EM Physicians, not CMGs.

AAEM has drawbacks as it is much smaller, and has smaller conferences, It also therefore does not bring in as much money to spend on representation. As always Money talks, organizations with more money have more influence. CMGs pay off ACEP, ACEP has money, they do what the CMGs want
 
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Any advice for a PGY-3 that signed a contract with envision pre-corona...start date isn’t until late July. Not sure if I should be looking for a backup plan at this point or not
 
Any advice for a PGY-3 that signed a contract with envision pre-corona...start date isn’t until late July. Not sure if I should be looking for a backup plan at this point or not


Always have a backup plan for any job you hold (many docs work per diem at another spot just to be credentialed somewhere else)

I would wait and see what the terms of the new contract will be, If they cut too much, find other job.
 
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ACEP has a draw because of their big conferences. People enjoy going and catching up and hanging out with old residency friends. Even better if your residency encourages you to go as a resident and it sort of becomes a norm.
Chicken or egg?

Does ACEP have huge well attended conferences because of their large membership numbers? Nearly all residents and faculty are ACEP members after all. Or does ACEP have more members than AAEM because they have such awesome and huge conferences everybody wants to join? I think it's the former. Without large membership numbers funded by residencies, ACEP's conferences wouldn't be as large.

Many ACEP members are sheep who only remain members because they weren't exposed to other organizations as much in training. If they started off with AAEM memberships in training, more would remain AAEM members as attendings. Over time, ACEP would have fewer members with smaller conferences, and AAEM would have more members and bigger conferences.

What percentage of ACEP attendees are residents or faculty? I'm not sure, but my impression last year was that it is a very high percentage.

Residencies have the power to change this dynamic.

Residencies can't control all the sponsorship money from CMGs that goes to ACEP, but that's fine. EM physicians would still be better off in a world with a moderately funded AAEM representing their interests than they are currently with a well funded ACEP representing the interests of private equity.
 
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As a resident you get free ACEP > free EMRA, EMRAP and Annals which likely contributes to inertia
 
Any advice for a PGY-3 that signed a contract with envision pre-corona...start date isn’t until late July. Not sure if I should be looking for a backup plan at this point or not

I'd highly recommend that you find another job or at least have a backup job available.

There's a real chance that if they go bankrupt they may stop paying you like what happened with legacy physician partners.
 
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It’s probably hard to find a job that pays less than USACS... they are one of the lowest paying companies
To their credit, USACS has protected directors and providers with no cuts beyond decreasing coverage. Benefits and hourly not changed.
 
It’s probably hard to find a job that pays less than USACS... they are one of the lowest paying companies
Envision Is gonna say “”hold my beer”. Look at how successful USACS has been in Texas driving rates down. ESP joined and they bought some contracts and then driving rates down.
 
To their credit, USACS has protected directors and providers with no cuts beyond decreasing coverage. Benefits and hourly not changed.
when you make so far below market what’s there to cut.
 
Any advice for a PGY-3 that signed a contract with envision pre-corona...start date isn’t until late July. Not sure if I should be looking for a backup plan at this point or not
EmCare has stopped payMent on signing bonuses, delayed starting dates and switched new grads from ft to pt with a later start date. So yeah. U need to get credentialed elsewhere with someone not from the same CMG if possible. Smart to have your foot in the door at another place or 2. If they go bankrupt expect major seismic shifts. I think it’s 50/50 if they do.
 
I think the only reason ACEP is so much bigger than AAEM is because residencies provide memberships for free to their residents and faculty. Residents who want to continue involvement in a national organization after graduating will naturally buy memberships with ACEP as opposed to branching out and trying something new like AAEM. I can't figure out why, but residencies love ACEP.

If residencies started providing memberships to AAEM instead of ACEP, I think very few people would take it upon themselves to join ACEP.

It would take many years to really make a difference, but over time residencies could shift the membership numbers away from ACEP and toward AAEM.

I know many people on this forum think ACEP has failed to adequately represent physician and EM interests, but ACEP continues to be the largest EM organization simply because they hook so many people as residents, and a small percentage of those people go on to become long term members.

You also overlook that AMA (which love them or not, are the only ones even close to having sway in washington. the rest just get pit against each other by legislative aids who dont want to have to keep track of any more smaller special interest groups). The AMA only recognizes ACEP. So ACEP both gets legitimacy from that and gets votes directly for their group in the AMA house of delegates. AAEM had been offered formal representation and, iirc, there was some hesitancy to take the AMA up on it. Because they hesitated to take votes, they have been relegated to observer status. They send people sometimes but they dont vote and dont have any real standing beyond getting to have 1 or 2 people sit in the back and eat continental breakfast at the Hyatt Regency on Wacker Drive in Chicago.

Choosing to spurn the AMA a few years back when they got big enough to qualify for representation was a mistake because AAEM has only gotten bigger and are still regulated to the children's seat in the only organizaton the government cares about - and an organization who can and does choose sides in these sort of inter-specialty rivalries.
 
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Depends on the group, your mode of employment, and how many PPH you see.

If your group has lower hourly pay, you are a 1099-so you are only receiving $/hour plus malpractice coverage, and you see 2+ PPH; Then Yes its likely they are keeping about 80%.
They are billing about $1000 per patient, some more, some less, depending on insurance status (and yes there are variations on the actual amounts collected from the different payers),
But lets say they get just $700/patient, and you saw 2 patients so they made $1400 that hour. They paid you about $250 (pay and malpractice) for that hour, they keep $1150 or 82% of your hourly profit...

Your head’s in the right place but your numbers are way off. As you mentioned, what you bill is meaningless, it’s only what you collect. No CMG is collecting $700/pt off your professional charges. $100-$200/pt is more realistic depending on payor mix. The real math is more that you saw 2.5 pph and generated $250-$500 for them. They paid you $250 for that hour and then had $0-250 to cover all other expenses (billing, malpractice, Heath insurance, scribes, scheduling, and other operational expenses). Whatever’s left after that is their profit. They are still skimming off of you, but there is nowhere that is keeping 80% of your revenue.
 
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The AMA only recognizes ACEP. So ACEP both gets legitimacy from that and gets votes directly for their group in the AMA house of delegates. AAEM had been offered formal representation and, iirc, there was some hesitancy to take the AMA up on it
Interesting. I was not aware of that.
 
For real, B.

If you're going to stop me from heading to the OR once a shift and saying "Hey, homeys.... toss me a tie-back-bonnet."

No.

No.

Eff you.

HELLO ADMINS:

ONE BONNET A DAY.
MAYBE FIVE, IF OTHER LONGHAIRED FOLKS LIKE ME WANNA SAVE THEIR HEADS.
THAT'S LIKE, WHAT, FIVE CENTS A BONNET?

WAY TO BE POUND-WISE/PENNY-FOOLISH.
YOU FAIL BUSINESS-SKULE.

ATTENTION, ALL ADMINISTRATORS:
IT'S TIME TO GET REAL.
GET LEAN, OR GET DED (SIC).

I bought like 5 of these. They are dew rags but work freaking great.
 
EmCare has stopped payMent on signing bonuses, delayed starting dates and switched new grads from ft to pt with a later start date. So yeah. U need to get credentialed elsewhere with someone not from the same CMG if possible. Smart to have your foot in the door at another place or 2. If they go bankrupt expect major seismic shifts. I think it’s 50/50 if they do.

Is there any point to "hoping" that they go bankrupt, such that all HCA hospitals terminate their contracts?
 
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I bought like 5 of these. They are dew rags but work freaking great.

That's awesome. I bought almost the exact same thing except the ones I got don't have the tie in the back.

Amazon product

I love these because they give me some padding under my respirator straps.
 
Right, wouldn't HCA just go with another CMG like Teamhealth to get their 15% kickback and keep all their ED contracts under one umbrella?
Is there any point to "hoping" that they go bankrupt, such that all HCA hospitals terminate their contracts?

"Adversity introduces a man to himself."
 
I think they would be far more likely to go the way of the hospital employee model.
 
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