"Everyone at ACEP is a CMG shill." Proof?

[CoolDoc1729]

Cool. You say have no idea how reimbursement works but you have no concept of what running a business looks like. Let me help you with some basic economics. Lets say you "sum dude" is gifted an In N out burger franchise. Its already operational and oddly all the employees come trained to you. There are lemmings who are trained to work in your burger joint as a burger flipper and oddly this is their only option. A few will go off and open up a food truck serving burgers (DPC) or move elsewhere along the burger supply chain some may only serve premium beef (ICU) but for the most part you know there is no shortage of labor and in case of emergency you can hire some burger flippers who couldnt cut it at In N out U and went to krystal U (MLPs) and are inferior but most of your customers wont notice.

Now your business is fine you make a profit of $1M a year on this franchise. You have no rent costs cause the strip mall is so excited to have you there they cover all your NNN costs. Your labor costs $20/hr per burger flipper. Your customers pay you on average of $15 per order. Things are humming along but you gather that all of a sudden In N out U and Krystal U is pumping out fresh lemmings at 2x the needed rate (I took some liberty here). Then you hear that the customers (insurance companies) might be willing to only pay $14/order. You are nervous cause with the 100k orders a year this will hurt your profits by 100k. On the other hand you studied Adam Smith and The Theory of Moral sentiments. Suddenly you realize your labor has no choice so you lower wages and make up that 100k with a cut where you end up net positive.

Simply put CMGs and hospitals pay not based on collections but rather supply and demand of 'providers". Why is it that people make $500-1k picking up last minute shifts? Did those patients suddenly promise to pay more or have better insurance?

FWIW I have intimately known 2 SDGs and have done consulting for 15-20 groups and seen their books and helped with insurance negotiating and hospital negotiating but yeah dude Im the one who has no idea.

A simpler example. If I ran a business and my revenue and profit went up 25% do you think suddenly I would pay my people more if the market said I was paying at market or slightly above market rates? Perhaps your logic needs to be applied to USACS in colorado? Why do they pay $140/hr? Is something broken in colorado or is it the obvious supply and demand curves of that (and other markets). You dont have to agree with me by 2030 this reality will smack you in the face if you arent in an SDG.

While you are right that commercial contracts are tied to medicare only an idiot would negotiate it without tying it to a specific year of medicare. I have done this with each contract I negotiated. As I said above ACEP did a tiny bit to help SDGs, it helped the CMGs way more. The NSA is gonna hurt us all no doubt about that. Why was the NSA necessary cause ACEP stood by as the CMGs screwed people and ACEP was on its knees doing what ACEP shills do best for their PE masters.

Appreciate the choice of lemminghere, mindlessly jumping off the cliff together

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[Birdstrike]

I hate to be the one to say it, but if you’re a healthcare provider in 2022, you serve someone. You may serve a CMG, a hospital system, private group, academic department or insurance companies. But you serve someone.

Even if you totally opt out of the “system” in hopes to “stick it to the man” and do concierge, cash-only medicine, you’re a servant to the patients. You think patient satisfaction is bad in the ED? It takes over 100% in direct care.

 

[RustedFox]

I hate to be the one to say it, but if you’re a healthcare provider in 2022, you serve someone. You may serve a CMG, a hospital system, private group, academic department or insurance companies. But you serve someone.

Even if you totally opt out of the “system” in hopes to “stick it to the man” and do concierge, cash-only medicine, you’re a servant to the patients. You think patient satisfaction is bad in the ED? It takes over 100% in direct care.

"Gotta serve Somebody" - Bob Dylan.
San Francisco 1980 (Album).

 

[Birdstrike]

"Gotta serve Somebody" - Bob Dylan.
San Francisco 1980 (Album).

Aha!

Remember how I used to put song quotes on my absurdly long tome-like posts?

While writing the above post, I was thinking, “Didn’t Dylan have a lyric like this?” I was about to Google it post it and then someone rang my door bell, so I just said f it.

And then you read my mind!

That’s a Dylan deep cut, too. Most people don’t know that one. Love Dylan, nasally gravel and all.

 

[RustedFox]

Aha!

Remember how I used to put song quotes on my absurdly long tome-like posts?

While writing the above post, I was thinking, “Didn’t Dylan have a lyric like this?” I was about to Google it post it and then someone rang my door bell, so I just said f it.

And then you read my mind!

That’s a Dylan deep cut, too. Most people don’t know that one. Love Dylan, nasally gravel and all.

1. I do remember that writing mechanic of yours.

2. Yeah; that's deep Dylan. It was in that super-weird era of music where we had all this new technology (readily available synths, playback loops, etc) and I kinda feel like the artists of the day let their enthusiasm run away with their better judgement; resulting in this chaotic, washed-out, "synthy" sound.

 

[Birdstrike]

2. Yeah; that's deep Dylan. It was in that super-weird era of music where we had all this new technology (readily available synths, playback loops, etc) and I kinda feel like the artists of the day let their enthusiasm run away with their better judgement; resulting in this chaotic, washed-out, "synthy" sound.

Agree 100%. Some of that stuff is cool. But I've always liked music with a more authentic vibe, myself.

 

[GonnaBeADoc2222]

I hate to be the one to say it, but if you’re a healthcare provider in 2022, you serve someone. You may serve a CMG, a hospital system, private group, academic department or insurance companies. But you serve someone.

Even if you totally opt out of the “system” in hopes to “stick it to the man” and do concierge, cash-only medicine, you’re a servant to the patients. You think patient satisfaction is bad in the ED? It takes over 100% in direct care.

At least with direct care, being a "servant to the patient" and beholden to patient sat ia a choice (strengthens your business and makes you a lot more money).

Also, at risk of sounding liberal crunchy, service to the patient is what we signed up for way back when when we took the oath.

 

[BoardingDoc]

Also, at risk of sounding liberal crunchy, service to the patient is what we signed up for way back when when we took the oath.

Idk if you're just being pedantic, but birdstrike was clearly pointing out that this job requires you to be "customer service" oriented whether you want to or not. As far as I'm aware, the Hippocratic oath talks about taking care of patients. It has nothing to do with providing a "good customer experience."

I don't think that the providing of actual medical care is what drives most of us insane. It's being forced (via one mechanism or another) to cater to their wants and whims in addition to their actual medical needs.

 

[sum dude]

Cool. You say have no idea how reimbursement works but you have no concept of what running a business looks like. Let me help you with some basic economics. Lets say you "sum dude" is gifted an In N out burger franchise. Its already operational and oddly all the employees come trained to you. There are lemmings who are trained to work in your burger joint as a burger flipper and oddly this is their only option. A few will go off and open up a food truck serving burgers (DPC) or move elsewhere along the burger supply chain some may only serve premium beef (ICU) but for the most part you know there is no shortage of labor and in case of emergency you can hire some burger flippers who couldnt cut it at In N out U and went to krystal U (MLPs) and are inferior but most of your customers wont notice.

Now your business is fine you make a profit of $1M a year on this franchise. You have no rent costs cause the strip mall is so excited to have you there they cover all your NNN costs. Your labor costs $20/hr per burger flipper. Your customers pay you on average of $15 per order. Things are humming along but you gather that all of a sudden In N out U and Krystal U is pumping out fresh lemmings at 2x the needed rate (I took some liberty here). Then you hear that the customers (insurance companies) might be willing to only pay $14/order. You are nervous cause with the 100k orders a year this will hurt your profits by 100k. On the other hand you studied Adam Smith and The Theory of Moral sentiments. Suddenly you realize your labor has no choice so you lower wages and make up that 100k with a cut where you end up net positive.

Simply put CMGs and hospitals pay not based on collections but rather supply and demand of 'providers". Why is it that people make $500-1k picking up last minute shifts? Did those patients suddenly promise to pay more or have better insurance?

FWIW I have intimately known 2 SDGs and have done consulting for 15-20 groups and seen their books and helped with insurance negotiating and hospital negotiating but yeah dude Im the one who has no idea.

A simpler example. If I ran a business and my revenue and profit went up 25% do you think suddenly I would pay my people more if the market said I was paying at market or slightly above market rates? Perhaps your logic needs to be applied to USACS in colorado? Why do they pay $140/hr? Is something broken in colorado or is it the obvious supply and demand curves of that (and other markets). You dont have to agree with me by 2030 this reality will smack you in the face if you arent in an SDG.

While you are right that commercial contracts are tied to medicare only an idiot would negotiate it without tying it to a specific year of medicare. I have done this with each contract I negotiated. As I said above ACEP did a tiny bit to help SDGs, it helped the CMGs way more. The NSA is gonna hurt us all no doubt about that. Why was the NSA necessary cause ACEP stood by as the CMGs screwed people and ACEP was on its knees doing what ACEP shills do best for their PE maste

1) USACS uses suckers who want to live in Denver to supplement people forced to live in Ohio. They use APP staffing to supplement whatever PE firm they owe money too. Hospitals/CMG's can afford to pay a few shifts over market in short term...but as hospitals have shown us, what works short term won't work long term.

2) "Tie an insurance contract to a specific year of Medicare" lol...you've definitely never negotiated an insurance contract in past 15 years. I'm going to tell United Health, which makes more money than every ED in the country, what they're going to do, let alone a hypothetical Medicare rate, "as you've done." Ok dude. Again, you can posture on made up message boards, but this has zero chance of happening in real life for an EM group. You obviously haven't managed a group in years (or work consulting, which would explain the terrible, non applicable advice)

3) Are we supposed to root for cutting Medicare rates 20% b/c it will hurt CMG's more...sounds like the cult of McNamara, where we cut off our noses to spite the face. We can't all make $850k/yr working at an Ivory tower.

4) I really hope people on this forum are smart enough to learn how to we get reimbursed, and how much of that is based on government. EMTALA, Medicare, insurer reimbursement...EM is not run by free-market forces, but rather inefficient, government-incentivized oligolopolies who are too big to fail and pull all the levers on healthcare.

 

[EctopicFetus]

1) USACS uses suckers who want to live in Denver to supplement people forced to live in Ohio. They use APP staffing to supplement whatever PE firm they owe money too. Hospitals/CMG's can afford to pay a few shifts over market in short term...but as hospitals have shown us, what works short term won't work long term.

2) "Tie an insurance contract to a specific year of Medicare" lol...you've definitely never negotiated an insurance contract in past 15 years. I'm going to tell United Health, which makes more money than every ED in the country, what they're going to do, let alone a hypothetical Medicare rate, "as you've done." Ok dude. Again, you can posture on made up message boards, but this has zero chance of happening in real life for an EM group. You obviously haven't managed a group in years (or work consulting, which would explain the terrible, non applicable advice)

3) Are we supposed to root for cutting Medicare rates 20% b/c it will hurt CMG's more...sounds like the cult of McNamara, where we cut off our noses to spite the face. We can't all make $850k/yr working at an Ivory tower.

4) I really hope people on this forum are smart enough to learn how to we get reimbursed, and how much of that is based on government. EMTALA, Medicare, insurer reimbursement...EM is not run by free-market forces, but rather inefficient, government-incentivized oligolopolies who are too big to fail and pull all the levers on healthcare.

Re #1. thats not true. If I owned 10 burger joints. 9 of them made me 100K and 1 lost 100k. I wouldnt supplement the one losing money with the 9 making money. I would drop the 1 money loser. That is how it works. USACS and Envision and TH have to make profit on each contract (note not every hospital). If I have a contract with ABC hospital the overall profit for that contract and the 4 hospitals has to make sense even if I lose money at one (or more of those 4 hospitals). If I am losing money on that contract my solution is dumping that contract. So point 1 is incorrect. The Denver low pay goes to corporate profits. That is where it goes.

Re #2 weird I just negotiated with Centene, Cigna, United, BCBS, BrightHealth, Humana (for Oscar) and a few smaller local payers in the past few years and every insurer was fine with this. Tying this to whatever medicare wants might mean you or whoever is negotiating on your behalf is the sucker. On top of that I also have raises built into every contract we have signed. But yep dude.. you got it. Maybe you have attended a few too many ACEP meetings instead of learning how to run a business. I just met this week with another group and luckily they seem to be in my school. Worried about the future but well positioned. They havent gotten taken over the barrel like it sounds your group does.

#3 Im not rooting for medicare cuts. It will suck. Does McNamara make that much? I would be shocked given temple sits in a horrid part of Philly. If he does good on him but I dont see that being the truth. He at least stands for docs. ACEP has knee bursitits. Will have to see where this reference of yours comes from. I will respond. below.

#4 Agreed. However when you work for a CMG those factors matter minimally in how much you get paid. Same for hospital employees.

 

[EctopicFetus]

Is the medicare thing you think I'm rooting for the medicare cuts? I'm not but rather pointing out it won't directly impact the pay for CMG docs. Instead what will happen is they may use it as an excuse to cut pay. On top of that, they will use the NSA to cut pay. That being said that is because they have to put profit first. That being said if they got $500/pt and they could fully staff their EDs @ 200/hr they would and there would be no pay raise. Similarly, if we didn't have 10k too many residents in the pipeline by 2030 and there was a legit shortage regardless of the issues we would see pay raised however pay cuts ARE coming but they are coming regardless of medicare reimbursement.

If this gets passed ACEP will go around and tell everyone how they were responsible for this. They will ignore the reality that they played a role (assuming this gets fixed) but they will pretend they did all the work. It's standard stupid ACEP stuff. Take full credit for all the good but pretend that you are helpless in anything that is bad.

Quite the playbook. Not surprising for a failed and irreversibly flawed organization.

 

[southerndoc]

I've been hearing forever that all of the leadership at ACEP is just a shill for CMG's, etc. Logically, they'd also be staffed at CMG sites (versus SDG/hospital employment, etc). Since they're public figures driving our future this information shouldn't be anonymous at all. However it's impossible for me to tell which sites are CMG sites. The purpose of this isn't to "shame" or "out," it's for us to know who is holding the keys.

So my question is, how many of these are really "CMG shills?" Which ones are primarily working at, for example, TeamHealth sites?

Mark Rosenberg - President
St. Joseph's Health. Patterson, NJ

Gillian Schmitz - President-Elect
Brooke Army Medical Center/Uniformed Services University of Health Sciences/University of Texas Health.
Most of those seem legit

Christopher Kang - Chair of the board
Madigan Army Medical Center. Tacoma, WA/Olympia Emergency Physicians, LLC/Providence St. Peter Hospital, Olympia WA.
Seems like army/SDG?

Alison Haddock - vice president
Baylor college of medicine, houston.
Seems like academics. One step below CMG but not as good as having SDG peeps imo

Aisha Terry - Secretary treasurer
george washington university
more academics

William Jaquis - immediate past president
Senior vice president, Envision health/Aventura medical center, FL
SHILL! At least one so far.

Board members

Anthony Cirillo
US acute care solutions
Another shill

John Finnell
Indiana university

Jeffrey Goodloe
Hillcrest medical center

Gabor Kelen
Johns Hopkins Emergency Medicine Services, LLC
SDG?

James Shoemaker
Elite Emergency Physicians, Inc

Ryan Stanton
Central Emergency Physicians

Arvind Venkat -- only board member not riding the old white man train, btw
Allegheny Health Network-- USACS


Off the bat, I only see two people that absolutely shouldn't be there. I can't comment on most of the rest. Anyone know?

EDIT: Now 3

Dr. Aisha Terry Chosen 2022 ACEP President-Elect - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

Goodloe is academics.

Looks like more academic people on the board now.

 

[EctopicFetus]

Dr. Aisha Terry Chosen 2022 ACEP President-Elect - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.

www.acepnow.com

Goodloe is academics.

Looks like more academic people on the board now.

People who don’t know or understand the cpom / cmg issue. Seems about right. Their membership is shrinking so that’s a positive.

 

[sylvanthus]

People who don’t know or understand the cpom / cmg issue. Seems about right. Their membership is shrinking so that’s a positive.

Completely removed from press ganey and bs metrics. They need some community docs on the board.

 

[CliveStaples]

Completely removed from press ganey and bs metrics. They need some community docs on the board.

As one of these academic types, I just wanted to say that my department's compensation has metrics tied to patient satisfaction, productivity metrics like LWBS, etc. So I wouldn't say that all academic centers are totally removed from what it's like to be a community ER doctor, though I am sure my department is an exception, not the rule for academics.

Really the biggest plight that I think academic physicians don't understand is what it's like to have a patient who needs transfer to a tertiary care center but you're left holding the grenade due to how dysfunctional our hospital systems and referral centers are.

 

[WilcoWorld]

As one of these academic types, I just wanted to say that my department's compensation has metrics tied to patient satisfaction, productivity metrics like LWBS, etc. So I wouldn't say that all academic centers are totally removed from what it's like to be a community ER doctor, though I am sure my department is an exception, not the rule for academics.

Really the biggest plight that I think academic physicians don't understand is what it's like to have a patient who needs transfer to a tertiary care center but you're left holding the grenade due to how dysfunctional our hospital systems and referral centers are.

Yep, academic hospitals have C-suites as well.