Have we reached peak AMC (Anesthesia Management Company)?

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Ezekiel2517 said:
There used to be a thread on here about the takeover of groups in San Jose,CA by cep. For those who may not know, MAC/Envision recently acquired the contracts for their 2 biggest sites - Good Sam hospital and Regional Med Center
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I am little dense when it comes to these things. Are you trying to say AMC is still going?
 
Direct Laryngoscopy said:
Yes. Would rather be an AMC employee or a hospital one is the question one has to ask themself.
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Hospitals tend to have longer time horizons than the typical 5 year PE/AMC flip cycle (acquire at a discount, buff the numbers, sell for fun and profit.). You are literally a widget to a PE owned AMC.
 
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GravelRider said:
Does it matter?
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In theory, you’d rather your fate be tied to folks interested in the place you work rather than some suit in NYC. Note this doesn’t apply as much for large, multi state corporations as much like HCA or CHI.

Plus you might be able to climb the physician leadership ladder if you’re nimble enough...
 
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AdmiralChz said:
In theory, you’d rather your fate be tied to folks interested in the place you work rather than some suit in NYC. Note this doesn’t apply as much for large, multi state corporations as much like HCA or CHI.

Plus you might be able to climb the physician leadership ladder if you’re nimble enough...
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Good points. However, I’ve see some hospital employee non-compete clauses that put AMCs to shame in their restrictiveness. If you plan on being in a place for a while then hospital employee might be the better option. However, the hospital suits have wizened up and know that your negotiating power comes from your ability to walk, so they’ll do what they can to take that power away. The hospital suits are not much different than the AMC suits sitting in an office in NYC. In the end you are an expense in their eyes.
 
narcotics999 said:
As long as you are not forced to do unsafe cases and get paid handsomely, why do you care who the boss is?
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Said like someone who has always had a boss. You might think they are paying you handsomely, but how does your boss get paid? Their salary comes from the collective efforts of their employees, which is you. If you have a boss, can you really guarantee that you will not be pressured to do things that you would not do if you were your own boss?
 
rakotomazoto said:
Said like someone who has always had a boss. You might think they are paying you handsomely, but how does your boss get paid? Their salary comes from the collective efforts of their employees, which is you. If you have a boss, can you really guarantee that you will not be pressured to do things that you would not do if you were your own boss?
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nobody should ever go into anesthesia if they want to be "their own boss". Even in private practice that sort of thing doesn't really exist.
 
rakotomazoto said:
If you have a boss, can you really guarantee that you will not be pressured to do things that you would not do if you were your own boss?
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Exactamundo. This is why it is a slippery slope employing physicians
 
narcotics999 said:
As long as you are not forced to do unsafe cases and get paid handsomely, why do you care who the boss is?
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I guess I have a different mentality. If my group was to lose our contract or get bought out I probably would do the locums route. Time is the most precious commodity, and I would want some say in it. Plus I'm a "boss" in my other ventures outside of medicine.
 
GravelRider said:
Good points. However, I’ve see some hospital employee non-compete clauses that put AMCs to shame in their restrictiveness. If you plan on being in a place for a while then hospital employee might be the better option. However, the hospital suits have wizened up and know that your negotiating power comes from your ability to walk, so they’ll do what they can to take that power away.
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At my last practice (hospital-employed), my non-compete included all of the sounding counties. Even after the practice imploded, the admin threatened everyone with enforcement of the non-compete, and some of the other groups in the area said they weren't interested in dealing with bringing in someone with a potential legal battle. That meant that when I left, I would have needed to drive an hour in any direction to exceed the restrictive covenant and find a new job. Instead, I sold the house I had purchased less than a year before, and moved states.
 
I don't think non competes are always bad, just depends on who you're signing it with, and why.

If your group is doing it to make you their slave, then run away. If your group is doing it to make it more difficult for your group to lose a contract, then it's not necessarily bad, and I would evaluate it in the context of other aspects of the job (pay, call, etc). If you think that group is worth it and want to see that group continuing to have their contract, then go and sign it, it's job security.

Never, ever sign a non compete as a direct employee of a hospital, it is always nefarious.
 
rakotomazoto said:
Said like someone who has always had a boss. You might think they are paying you handsomely, but how does your boss get paid? Their salary comes from the collective efforts of their employees, which is you. If you have a boss, can you really guarantee that you will not be pressured to do things that you would not do if you were your own boss?
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You will be an employee. You know what you can do about it? Act like an employee. Do the minimum possible. Volunteer for a committee. Nope. Practice has a hole in the schedule that they can’t fill? Not my problem, I’m scheduled to be off. Use it or lose it sick days? Use em all. Ect. Let them get what they pay for.
 
AMCs are on the way out because they don't offer any benefits to hospitals, physicians, or patients.

They love going out of network, saddling patients with non covered services. Do physicians see that money? Nope, goes straight to the shareholders/private owners.

Hire more docs to improve scheduling? Nope, how about forced attrition and overburdening remaining staff. Are physicians paid more to compensate them for increased workload? Nope, they take away benefits.

Hospitals don't see the savings, they see a disgruntled workforce.

The pyramid scheme is imploding.
 
Mikkel said:
If your group is doing it to make it more difficult for your group to lose a contract, then it's not necessarily bad
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Why would this be the case? A PP, by saying that they have a noncompete for all the doctors, make the hospital less likely to get rid of them?

Aren’t there better ways to tie an associate to the group? Shorter partnership track, better benefit, competitive compensation?

Unless I am missing the point, I don’t think noncompete should be used to restrict where people can/should work, especially in our line of work. As an anesthesiologist, I am not competing for anyone’s business since I don’t bring any patients to the hospital. We are certainly not “stealing” any proprietary secrets either. So why would noncompete be part of the discussion? :?
 
Mikkel said:
AMCs are on the way out because they don't offer any benefits to hospitals, physicians, or patients.

They love going out of network, saddling patients with non covered services. Do physicians see that money? Nope, goes straight to the shareholders/private owners.

Hire more docs to improve scheduling? Nope, how about forced attrition and overburdening remaining staff. Are physicians paid more to compensate them for increased workload? Nope, they take away benefits.

Hospitals don't see the savings, they see a disgruntled workforce.

The pyramid scheme is imploding.
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A disgruntled workforce of dumb slaves who just keeps on coming to work every day. 😉

Nothing is imploding, except for free market healthcare.
 
IMGASMD said:
Why would this be the case? A PP, by saying that they have a noncompete for all the doctors, make the hospital less likely to get rid of them?

Aren’t there better ways to tie an associate to the group? Shorter partnership track, better benefit, competitive compensation?

Unless I am missing the point, I don’t think noncompete should be used to restrict where people can/should work, especially in our line of work. As an anesthesiologist, I am not competing for anyone’s business since I don’t bring any patients to the hospital. We are certainly not “stealing” any proprietary secrets either. So why would noncompete be part of the discussion? :?
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A restrictive covenant for a small, democratic private practice that is site specific only may make sense. It may ward off a hospital replacing the practice with an AMC. However, the non-competes that restrict you from working within the county, the state, or for anyone they deem to be a competitor should be outlawed (and I would never sign a contract with language like that). Even the arbitrary mileage radius limits are a no-go for me. Pushing through legislation that outlaws these overly inclusive non-competes should be at the top of every state’s medical society legislation to-do list.
 
FFP said:
A disgruntled workforce of dumb slaves who just keeps on coming to work every day. 😉

Nothing is imploding, except for free market healthcare.
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The partners got their payday so they don't really care that much. The juniors without payday, if they stick around, they're the real dummies.

I don't know what you're talking about with free market healthcare though. With all the regulation, government mandated pay rates for entitlement payors, restricted workforce via Medicare limits on residency slot funding, third party insurance companies negotiating with hospitals and docs, employer subsidized healthcare plans, etc. Definitely not free market.


What will fix EVERYTHING is Trump's executive order forcing hospitals and insurers to reveal their actual payment rates.

When they start doing that, I'm dumping my current insurance for catastrophic coverage and self insuring the rest of it. I'll be able to use published payment rates as a start for negotiating the cost of treatments.
 
IMGASMD said:
Why would this be the case? A PP, by saying that they have a noncompete for all the doctors, make the hospital less likely to get rid of them?

Aren’t there better ways to tie an associate to the group? Shorter partnership track, better benefit, competitive compensation?

Unless I am missing the point, I don’t think noncompete should be used to restrict where people can/should work, especially in our line of work. As an anesthesiologist, I am not competing for anyone’s business since I don’t bring any patients to the hospital. We are certainly not “stealing” any proprietary secrets either. So why would noncompete be part of the discussion? :?
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Gravelrider said it very well. Facility based non competes are all you need. It prevents the hospital from dumping the group contract and expecting to have all the docs already there to work under a new contract.

It's also great because if the hospitals are stupid enough to proceed anyway, the lack of geographic restriction allows the docs to fill in at others area hospitals while the previous hospital is trying to figure out why they're not able to staff their ORs anymore.


Geographic non competes, especially for anesthesiologists, are unethical, unfair, and legally difficult to defend (depending on the state).
 
GravelRider said:
A restrictive covenant for a small, democratic private practice that is site specific only may make sense. It may ward off a hospital replacing the practice with an AMC. However, the non-competes that restrict you from working within the county, the state, or for anyone they deem to be a competitor should be outlawed (and I would never sign a contract with language like that). Even the arbitrary mileage radius limits are a no-go for me. Pushing through legislation that outlaws these overly inclusive non-competes should be at the top of every state’s medical society legislation to-do list.
Click to expand...



Mikkel said:
Gravelrider said it very well. Facility based non competes are all you need. It prevents the hospital from dumping the group contract and expecting to have all the docs already there to work under a new contract.

It's also great because if the hospitals are stupid enough to proceed anyway, the lack of geographic restriction allows the docs to fill in at others area hospitals while the previous hospital is trying to figure out why they're not able to staff their ORs anymore.


Geographic non competes, especially for anesthesiologists, are unethical, unfair, and legally difficult to defend (depending on the state).
Click to expand...

I am still have a difficult time understanding this. Are you speaking from the point of view of the hospital or the PP?

So you want the hospital to sign a noncompete? How’s that different than a exclusive contract? Or you want the individual doctors sign a noncompete with the PP? If that’s the case, wouldn’t a stronger contract amongst the physicians solve the problem?

Edit: never mind. I just re-read it again. So it’s a little more clear now. Thanks.
 
Mikkel said:
The partners got their payday so they don't really care that much. The juniors without payday, if they stick around, they're the real dummies.

I don't know what you're talking about with free market healthcare though. With all the regulation, government mandated pay rates for entitlement payors, restricted workforce via Medicare limits on residency slot funding, third party insurance companies negotiating with hospitals and docs, employer subsidized healthcare plans, etc. Definitely not free market.


What will fix EVERYTHING is Trump's executive order forcing hospitals and insurers to reveal their actual payment rates.

When they start doing that, I'm dumping my current insurance for catastrophic coverage and self insuring the rest of it. I'll be able to use published payment rates as a start for negotiating the cost of treatments.
Click to expand...


You’ll be able to negotiate about as well as you can with your plumber when your sewer backs up.
 
nimbus said:
You’ll be able to negotiate about as well as you can with your plumber when your sewer backs up.
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You can call around and get the best price. It's harder in emergencies, but you should do your research and find the more cost effective hospitals beforehand so you know which hospital you should go for emergencies.

It's like auto repair shops. NEVER let the tow truck take your car to their shop of choice, because they get kickbacks and also the shop can charge whatever you want, and you'll be unlikely to ask for a tow from that shop to a cheaper one. That's why you would know which mechanic to use before you even have your car break down.
 
AdmiralChz said:
In theory, you’d rather your fate be tied to folks interested in the place you work rather than some suit in NYC. Note this doesn’t apply as much for large, multi state corporations as much like HCA or CHI.

Plus you might be able to climb the physician leadership ladder if you’re nimble enough...
Click to expand...
Unfortunately, my experience with those nimble physicians are the ones who don't really want to be up at 2 AM and are willing to kiss A** and throw their cohorts more call while the bus is driving over them....( the vast majority.... I know their are good souls who still do the grunt work and administrative work but they are few and far between)
 
dannyboy1 said:
You will be an employee. You know what you can do about it? Act like an employee. Do the minimum possible. Volunteer for a committee. Nope. Practice has a hole in the schedule that they can’t fill? Not my problem, I’m scheduled to be off. Use it or lose it sick days? Use em all. Ect. Let them get what they pay for.
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This is a recipe for being replaced by a nurse doctor anesthesiologist
 
ryanjmy said:
This is a recipe for being replaced by a nurse doctor anesthesiologist
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Only thing that stops them now are state/hospital requirements. That wouldn’t change. Don’t put in a drop of extra effort for these a$$holes. Act like the cog in the wheel that they pay for ....
 
Ezekiel2517 said:
There used to be a thread on here about the takeover of groups in San Jose,CA by cep. For those who may not know, MAC/Envision recently acquired the contracts for their 2 biggest sites - Good Sam hospital and Regional Med Center
Click to expand...

It is, unfortunately, only trading one AMC for another, but the latest chapter that Ezekiel is alluding to is being discussed on this thread:

San Jose Anesthesiology Upheaval (CEP takeover). Who has the real scoop?

Gaswork presently has four separate ads for anesthesiologists in San Jose, all through CEP. I agreed to work some locum shifts for them. It has sucked so far, but maybe that's not all CEP's fault. Word is that CEP just won the bid for three hospitals in San Jose. Where I am (Regional), not...
forums.studentdoctor.net
CEP/Vituity (a multi-specialty group which "manages" ER physicians, hospitalists, and anesthesiologists) was fired and replaced with a different multispecialty group that operates under at least he following names: Sheridan, MAC, Envision, and Emcare (...and that leaves out their locum subsidiary, TIVA). It's part of their strategy to make it so difficult that nobody can keep it all straight.

And here are the links to the CSAHQ letters in question:

 
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GravelRider said:
I don't work for an AMC, but in the Northeast there are several AMCs that have lost contracts (EmCare, TeamHealth, and NAPA off the top of my head). The new enemies are these mega- hospital systems looking to employ all docs. From what I've seen, these can be worse than AMC jobs.
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Where did teamhealth lose the contract?
 
So I was pondering this the other day, and feel like this thread is as good a place as any to pose the question:

Given the political climate with OON legislation in the works and M4A out on the horizon, does having all this wall street/private equity money (and its associated connections to people in high places) benefit the specialty in a roundabout way? Is it a silver lining to have that lobby power/influence on our side?? Maybe just more wishful thinking on my part?
 
SaltyDog said:
So I was pondering this the other day, and feel like this thread is as good a place as any to pose the question:

Given the political climate with OON legislation in the works and M4A out on the horizon, does having all this wall street/private equity money (and its associated connections to people in high places) benefit the specialty in a roundabout way? Is it a silver lining to have that lobby power/influence on our side?? Maybe just more wishful thinking on my part?
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Double edged sword...
www.modernhealthcare.com

House leaders investigate private equity firms over surprise medical bills

Lawmakers are investigating private equity-backed physician-staffing companies to determine whether they use out-of-network billing as a strategy to drive up their pay rates, the latest missive in the surprise medical bill fight.
www.modernhealthcare.com www.modernhealthcare.com
 
C4C said:
I was with a group that got purchased by USAP in Denver. After USAP bought us, they bought the other group in town, and then used their monopolistic power to raise rates on the insurance companies.

That sounds anti-competitive to me, and only a matter of time until the insurance companies file suit. Even if somehow you convince me it is legal (or just winkingly ignored by the insurance cos), it is unsustainable from an economic point of view. Walmart didn't run corner grocers out of business by raising the price on their customer...but AMCs are touting consolidation strictly for their power to raise prices.
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And you all thought the FTC was a bunch of worthless bureaucrats. Would a worthless bunch of bureaucrats five years to figure out what a simple clinician found absolutely obvious 5+ years ago?

Get ready for a strongly-worded rebuke. Or the tiniest slap on the wrist. Or, more likely, nothing at all:

www.wsj.com

FTC Probes Market Power of One of Country’s Biggest Anesthesia Providers

The federal antitrust enforcer is investigating U.S. Anesthesia Partners, a private-equity-owned company that has built a large presence in Texas, Colorado and Florida.
www.wsj.com www.wsj.com

The investigation, which began more than a year ago, according to people familiar with the matter, is an example of stricter government scrutiny of private equity’s involvement in the healthcare industry under FTC Chairwoman Lina Khan. Ms. Khan has criticized what she calls private equity’s focus on short-term profits, which she said “can incentivize practices that may reduce quality of care, increase costs for patients and payers, and generate appalling patient outcomes.”

...

Prices paid for anesthesiology increased by 26% after outpatient healthcare facilities, including hospitals, switched to practices owned by private-equity firms, according to a paper published in February by researchers from Columbia University and Weill Cornell Medical College in the Journal of the American Medical Association.

As large, private-equity-backed anesthesia groups gain more market share in a region, they tend to have success negotiating higher prices, according to Ambar La Forgia, a professor at Columbia and one of the paper’s authors.

“USAP has a very strong presence in Texas,” Dr. La Forgia said. “So the more facilities they have in Texas...the more leverage they gain because now they can really dominate the network.”
 
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