FTC sues private-equity backed anesthesia staffing firm, saying it tried to corner the market and drive up prices

[dmk5n]

FTC sues private-equity backed anesthesia staffing firm, saying it tried to monopolize the market

The suit against U.S. Anesthesia Partners follows comments by the FTC chair that the agency would probe anticompetitive practices at companies acquired by private-equity firms.

www.nbcnews.com

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[dmk5n]

NVM

 

[Airway]

Great.

 

[sevoflurane]

👍🏽

 

[Arantius]

Hearing chatter that USAP is about to lose a bunch of contracts in Dallas. Maybe there’s hope for the smaller groups to break up their dominance. Would be nice since their non compete is so draconian

 

[nimbus]

How far do you all think the Amazon lawsuit will go?

 

[amyl]

Hearing chatter that USAP is about to lose a bunch of contracts in Dallas. Maybe there’s hope for the smaller groups to break up their dominance. Would be nice since their non compete is so draconian

Lol… is that the “chatter?” There are a number of contracts that we are considering walking away from if we don’t get what we want. USAP doesn’t at all dominate dallas… metro, utsw, valiant, champion, sound, nph emergenc health… just to name a few.

Our non compete is to protect the partnership as a whole. We see the benefit of having relationships with admin… the non compete exists so that no one dr can use that relation they’ve developed to undermine the best interests of the group…. For example say my chief, who spends their time with admin decides s/he can run it themselves…. It exists to protect the interests of the whole group from an individual undermining all the drs best interest. It’s happened… not in my division but in another division- it was chaos

It’s never been to punish an individual leaving the group to go down the road… if so they would’ve come after me lol as I did it.

 

[kidthor]

Our non compete is to protect the partnership as a whole.

Out of curiosity how is it written and what does it restrict / for how long?

 

[crash2500]

Out of curiosity how is it written and what does it restrict / for how long?

It says you can't practice within a 5 mile radius of a usap facility for 2 years without a agreed upon buyout.

 

[Arantius]

It says you can't practice within a 5 mile radius of a usap facility for 2 years without an agreed upon buyout.

Yup

 

[Howard888]

And this is just another reason why I am good for USAP to fail. The explanation behind that type of non compete is a joke.

Our private groups non compete is only facility specific. You can’t work at the facility we staff -basically if we lost contract you couldn’t work there. Hospital/ASC down the road with another group or hospital employee or whatever-and we have never staffed the facility-by all means, leave and we wish you well.

We are anesthesia. No surgeon is moving their cases for an individual anesthesiologist (unless some illegal kickback going on). One could argue having a non compete at all, even a lax one like our groups, isn’t justified and I’d agree with them

 

[Arantius]

And this is just another reason why I am good for USAP to fail. The explanation behind that type of non compete is a joke.

Our private groups non compete is only facility specific. You can’t work at the facility we staff -basically if we lost contract you couldn’t work there. Hospital/ASC down the road with another group or hospital employee or whatever-and we have never staffed the facility-by all means, leave and we wish you well.

We are anesthesia. No surgeon is moving their cases for an individual anesthesiologist (unless some illegal kickback going on). One could argue having a non compete at all, even a lax one like our groups, isn’t justified and I’d agree with them

Exactly, if they really just wanted to protect contracts it would be the single site, not force people to move out of entire metroplexes to work.

 

[amyl]

lol no one is forced to move out of the metroplex to work. one person left my group to go to utsw this year, zero people brought it up.
if the way you are interpreting the legal language is true then I violated the non compete... was never mentioned. i have never heard of a usap non compete being enforced in Dallas or the surrounding areas. never. if anyone has a specific example where someone had to move to find work I would love to hear it.

 

[nycitygas]

It says you can't practice within a 5 mile radius of a usap facility for 2 years without a agreed upon buyout.

I don’t think this is accurate anymore. The GHA (MD owned group prior to USAP) employed physician contract was 5 miles from any of their sites for two years. A friends employment lawyer marked it out for him on a map and it was the entire city.

This is was completely unenforceable and stupid as it turned away many qualified applicants.

A graduating resident had me review his USAP contract and it was very reasonable. I believe it only covered their current sites.

Back in the GHA days, the job market was abysmal and groups could get away with terrible contacts. Now, anyone would run for the hills.

 

[abolt18]

lol no one is forced to move out of the metroplex to work. one person left my group to go to utsw this year, zero people brought it up.
if the way you are interpreting the legal language is true then I violated the non compete... was never mentioned. i have never heard of a usap non compete being enforced in Dallas or the surrounding areas. never. if anyone has a specific example where someone had to move to find work I would love to hear it.

USAP took over a site in Indiana. One partner retired shortly after (reportedly never signed the contract with them) and went to a competing hospital 16 miles away. Worked for a bit, before the hospital lawyers got a letter in the mail for USAP HQ indicating they'd be pursuing legal action if they continued to let this anesthesiologist continue to work. Sooooo.....

 

[Howard888]

I’ve heard this exact scenario happened quite a bit in Colorado

 

[crash2500]

I don’t think this is accurate anymore. The GHA (MD owned group prior to USAP) employed physician contract was 5 miles from any of their sites for two years. A friends employment lawyer marked it out for him on a map and it was the entire city.

This is was completely unenforceable and stupid as it turned away many qualified applicants.

A graduating resident had me review his USAP contract and it was very reasonable. I believe it only covered their current sites.

Back in the GHA days, the job market was abysmal and groups could get away with terrible contacts. Now, anyone would run for the hills.

This was the clause as of September 2022.

 

[FiO2@21]

This must be city-specific for USAP. I know of at least one site that has a very standard facility specific non-compete as of this past year.

 

[ucladoc2b]

The perk of California: non-competes are essentially illegal (ironically, this has been argued as one of the reasons the tech second has been very successful here).

 

[OTCAwesome]

USAP took over a site in Indiana. One partner retired shortly after (reportedly never signed the contract with them) and went to a competing hospital 16 miles away. Worked for a bit, before the hospital lawyers got a letter in the mail for USAP HQ indicating they'd be pursuing legal action if they continued to let this anesthesiologist continue to work. Sooooo.....

Can confirm, this is my father. @abolt18 is one of my new partners who is an absolute rockstar.

If this were in the private forum I would disclose more details.

but TLDR: Group had no choice but to be bought out my phymed, phymed went bankrupt, sold to USAP. USAP being jerks because paying under market rates at this location and know they're going to have a mass exodus after buyout service obligation is done. Father completed service obligation, told them a year in advance he was going to retire. Worked for a year without any official contract, retired. Joined my group 4 months later, worked for a couple months until USAP lawyer said he couldn't because non-existant non-compete. Now awaiting declaratory judgment from judge saying that there is no reason why this physician who has served his community for 42 year cannot continue to do so. USAP being jerks filed for 2nd 30 day extension. Hope to be back to having our morning coffee together in a couple months.

Bottom line, In our regional market, USAP not only enforces their non-competes, but will go out of their way to be asshats for anyone who leaves and wants to practice in the same city even if the non-compete is no longer effective

 

[Arantius]

Can confirm, this is my father. @abolt18 is one of my new partners who is an absolute rockstar.

If this were in the private forum I would disclose more details.

but TLDR: Group had no choice but to be bought out my phymed, phymed went bankrupt, sold to USAP. USAP being jerks because paying under market rates at this location and know they're going to have a mass exodus after buyout service obligation is done. Father completed service obligation, told them a year in advance he was going to retire. Worked for a year without any official contract, retired. Joined my group 4 months later, worked for a couple months until USAP lawyer said he couldn't because non-existant non-compete. Now awaiting declaratory judgment from judge saying that there is no reason why this physician who has served his community for 42 year cannot continue to do so. USAP being jerks filed for 2nd 30 day extension. Hope to be back to having our morning coffee together in a couple months.

Bottom line, In our regional market, USAP not only enforces their non-competes, but will go out of their way to be asshats for anyone who leaves and wants to practice in the same city even if the non-compete is no longer effective

Yeah, that non compete is not to “protect a partnership” is to protect their margin

 

[nimbus]

Yeah, that non compete is not to “protect a partnership” is to protect their margin

“No margin, no mission”. Even god needs a margin

 

[D P356]

Can confirm, this is my father. @abolt18 is one of my new partners who is an absolute rockstar.

If this were in the private forum I would disclose more details.

but TLDR: Group had no choice but to be bought out my phymed, phymed went bankrupt, sold to USAP. USAP being jerks because paying under market rates at this location and know they're going to have a mass exodus after buyout service obligation is done. Father completed service obligation, told them a year in advance he was going to retire. Worked for a year without any official contract, retired. Joined my group 4 months later, worked for a couple months until USAP lawyer said he couldn't because non-existant non-compete. Now awaiting declaratory judgment from judge saying that there is no reason why this physician who has served his community for 42 year cannot continue to do so. USAP being jerks filed for 2nd 30 day extension. Hope to be back to having our morning coffee together in a couple months.

Bottom line, In our regional market, USAP not only enforces their non-competes, but will go out of their way to be asshats for anyone who leaves and wants to practice in the same city even if the non-compete is no longer effective

It’s not that a non-compete is not enforceable. If you have to fight it to prove you’re correct, it will cost time and money.

That’s pretty terrible they’re going after him with no non-compete at all.

However, that must be pretty cool working with your old man.

 

[D P356]

Yeah, that non compete is not to “protect a partnership” is to protect their margin

Also to control the availability of labor within a region.

 

[amyl]

USAP took over a site in Indiana. One partner retired shortly after (reportedly never signed the contract with them) and went to a competing hospital 16 miles away. Worked for a bit, before the hospital lawyers got a letter in the mail for USAP HQ indicating they'd be pursuing legal action if they continued to let this anesthesiologist continue to work. Sooooo.....

That makes no sense…. If he never signed a contract with USAP then there would be no non compete…. And 16 miles is definitely outside the contract IF there was one signed - which it sounds like there wasn’t - I don’t understand this anecdote

 

[kidthor]

That makes no sense…. If he never signed a contract with USAP then there would be no non compete…. And 16 miles is definitely outside the contract IF there was one signed - which it sounds like there wasn’t - I don’t understand this anecdote

I could definitely see USAP (and others like them) saying they’ll sue someone and saying there was a noncompete, even if one wasn’t actually signed. Just threatening someone with a lawsuit is probably deterrent enough to drive them out of town, even if it’s ultimately technically not legal.

 

[aneftp]

That makes no sense…. If he never signed a contract with USAP then there would be no non compete…. And 16 miles is definitely outside the contract IF there was one signed - which it sounds like there wasn’t - I don’t understand this anecdote

There has to be more to the story. Even in “forced buyouts”. AMC give token 300-500k money to partners to stay 1-2 years. To stabilized things.

 

[abolt18]

That makes no sense…. If he never signed a contract with USAP then there would be no non compete…. And 16 miles is definitely outside the contract IF there was one signed - which it sounds like there wasn’t - I don’t understand this anecdote

Sense or not, 'tis true. See above from @OTCAwesome as it's his dad this happened to.

 

[amyl]

Well I will say that USAP does have regional differences so I’m not sure about the situation in indiana.
As for Colorado there haven’t been any enforced non competes. A good friend works for USAP in the Denver market and her former partners that have walked work in the OR right next door - formed their own group and still work in the same hospital that they worked for USAP….

 

[aneftp]

Well I will say that USAP does have regional differences so I’m not sure about the situation in indiana.
As for Colorado there haven’t been any enforced non competes. A good friend works for USAP in the Denver market and her former partners that have walked work in the OR right next door - formed their own group and still work in the same hospital that they worked for USAP….

Too many factors. Like I questioned before. Was this an original buyout ?

Original buyouts require 1-5 years (whatever the terms are) to stay on board ….

 

[GassYous]

Well I will say that USAP does have regional differences so I’m not sure about the situation in indiana.
As for Colorado there haven’t been any enforced non competes. A good friend works for USAP in the Denver market and her former partners that have walked work in the OR right next door - formed their own group and still work in the same hospital that they worked for USAP….

There are lawsuits

 

[thinkorswim]

Well I will say that USAP does have regional differences so I’m not sure about the situation in indiana.
As for Colorado there haven’t been any enforced non competes.

It seems your friend may have been a lucky one.

“Harkness sued USAP with four colleagues in 2020 to extract themselves from their employment contracts, arguing that they contained an unreasonably restrictive noncompete clause that required them to pay damages to USAP to practice elsewhere in Denver. The heart of the case was settled with the doctors paying undisclosed amounts to USAP and the company terminating restrictions on where they could work in Denver.”

https://www.washingtonpost.com/business/2023/06/29/private-equity-medical-practices-raise-prices/

 

[aneftp]

It seems your friend may have been a lucky one.

https://www.washingtonpost.com/business/2023/06/29/private-equity-medical-practices-raise-prices/

Those docs sold out. Obviously they didn’t get as good as a deal as they thought they would.

Usap really should be sued not on their no compete by these original partners (well the original were the big 3 Houston Dallas Orlando)

But the supposedly failed ipo in early 2018 was the real killer for many of these buyiut. No ipo. Very bad deal.

That’s how the real money was to be made. And it never happened.

 

[Howard888]

Yes lawsuits in Colorado. Yes regional differences. I know folks at other groups in Nevada and Texas as well. They are actively looking for other jobs but tough to move with families.

Pretty sure amyl has the best USAP situation out of all-and that’s great but for many others it’s not great or they’ve just accepted it

 

[midazzoler]

So on pg 59 of the FTC complaint they describe USAP’s agreement for market allocation with a “at the time…..was a subsidiary of.….a publicly traded nationwide healthcare company”. The name of the company was redacted. Any ideas on which company?

 

[Arantius]

So on pg 59 of the FTC complaint they describe USAP’s agreement for market allocation with a “at the time…..was a subsidiary of.….a publicly traded nationwide healthcare company”. The name of the company was redacted. Any ideas on which company?

I suspect it’s Napa but have no info. I think they colluded about USAP dominating dallas and Napa dominating Austin

 

[Howard888]

That’s an interesting idea. When Capitol in Austin sold to USAP, Napa (Mednax at that time) in Austin was really struggling. Many thought Capitol was going to start taking their HCA sites even, and that was part of the USAP deal.

If your theory is true that makes sense why Capitol/USAP never picked up any of Napa/Mednaxs St David’s institutions

Dirty dirty if so

 

[GravelRider]

That makes no sense…. If he never signed a contract with USAP then there would be no non compete…. And 16 miles is definitely outside the contract IF there was one signed - which it sounds like there wasn’t - I don’t understand this anecdote

Sure it does. Those non-competes are transferable. When USAP bought or acquired whatever remained of the previous group or company, they also acquired those non-competes even if the employee never technically signed a new contract with the new owner/employer. We are transferable commodities to these PE groups. You are too.

 

[Arantius]

That’s an interesting idea. When Capitol in Austin sold to USAP, Napa (Mednax at that time) in Austin was really struggling. Many thought Capitol was going to start taking their HCA sites even, and that was part of the USAP deal.

If your theory is true that makes sense why Capitol/USAP never picked up any of Napa/Mednaxs St David’s institutions

Dirty dirty if so

Exactly my thought. For those of us around TX the fact USAP didn’t take those HCA contracts was really strange. Furthermore the fact NAPA never made it into the DFW market also strange

 

[triggermaster]

Exactly my thought. For those of us around TX the fact USAP didn’t take those HCA contracts was really strange. Furthermore the fact NAPA never made it into the DFW market also strange

Well Mednax/American Anesthesiology/NAPA was in Austin (AAG) before GHA/USAP, but USAP went into Austin (Capitol Anesthesia) anyway.

 

[Ashers]

Sure it does. Those non-competes are transferable. When USAP bought or acquired whatever remained of the previous group or company, they also acquired those non-competes even if the employee never technically signed a new contract with the new owner/employer. We are transferable commodities to these PE groups. You are too.

This is so depressing. I hate it, so I will continue to do locums.

 

[Howard888]

Well Mednax/American Anesthesiology/NAPA was in Austin (AAG) before GHA/USAP, but USAP went into Austin (Capitol Anesthesia) anyway.

Correct…but AAG (Mednax) was known to be struggling and reputation was bad. Had lost some surgery centers to Capitol.

USAP had relationships with HCA in other markets. HCA was getting more commercial patients in north Austin. We all thought the reason Capitol was selling was to USAP was plans to take the HCA contracts from AAG given USAPs relationship with HCA and AAGs struggles.

That never happened. This theory would explain why.

 

[Howard888]

Well Mednax/American Anesthesiology/NAPA was in Austin (AAG) before GHA/USAP, but USAP went into Austin (Capitol Anesthesia) anyway.

Correct…but AAG (Mednax) was known to be struggling and reputation was bad. Had lost some surgery centers to Capitol.

USAP had relationships with HCA in other markets. HCA was getting more commercial patients in north Austin. We all thought the reason Capitol was selling was to USAP was plans to take the HCA contracts from AAG given USAPs relationship with HCA and AAGs struggles.

That never happened. This theory would explain why.

 

[amyl]

HCA is a difficult operation to deal with - they always want everything for nothing. They always think they know better… case in point with how they’re trying to take everything in house

 

[aneftp]

HCA is a difficult operation to deal with - they always want everything for nothing. They always think they know better… case in point with how they’re trying to take everything in house

Depends on level of desperation HCA is in.

My friends practice just raped hca over big time in the eastern seaboard. I mean absolutely destroyed them during negotiations. They had nothing. As all 14 of them were in unison.

The 2 week by 2 week contract. Just stringing hca along the last 3 months. They played the admin the right way.

Got themselves 150k more than what another amc is paying them for the same 45
Hr workweeks. 13 weeks off. Not bad making low 700s/high 600s. And no. They aren’t looking

Those dudes also got a double buyout. It’s kinda of funny. And the amc who brought them out was trying to sue hca to reclaim their buyout.

 

[Howard888]

HCA is a difficult operation to deal with - they always want everything for nothing. They always think they know better… case in point with how they’re trying to take everything in house

Last I have heard, they haven’t brought HCA Austin in house. Napa is still there.

How much is USAP paying you to come on here? No, I don’t really think that…and I don’t know if this theory (or FTC claim so more than a theory) about Austin is true, but it really does meet the description of the FTC lawsuit and history backs it up.

Mednax/Napa never moved into Dallas despite being in Texas and USAP never took over an HCA facility in Austin other than a surgery center that had surgeon owners and wasn’t under Napa to start. That’s facts, history backs it up.

Just be careful what you cheerlead unless you can back up.

 

[amyl]

I was speaking of my direct experience with individual hca hospitals I’ve worked at. They’ve been unrealistic.

Personally I hate meditech with a passion and love epic so maybe I’m biased.

Usap isn’t perfect…. But mine is the best gig out there - in my opinion - and that’s why I champion usap
If anyone has a better one hiring I’m all ears.

 

[PeterGriffin]

Last I have heard, they haven’t brought HCA Austin in house. Napa is still there.

How much is USAP paying you to come on here? No, I don’t really think that…and I don’t know if this theory (or FTC claim so more than a theory) about Austin is true, but it really does meet the description of the FTC lawsuit and history backs it up.

Mednax/Napa never moved into Dallas despite being in Texas and USAP never took over an HCA facility in Austin other than a surgery center that had surgeon owners and wasn’t under Napa to start. That’s facts, history backs it up.

Just be careful what you cheerlead unless you can back up.

Interesting theory, but untrue.