Job Market - Envision Based group

[dp101]

Hello, I apologize if this topic has been discussed before. New grad coming out of fellowship, and looking for work. Ive found several hospitals which look appealing, however they are funded by Envision. Ive heard both good and bad things, and curious if any would would share their experience or what they've heard.

Thanks in advance.

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[GassYous]

Some reading for you

Sheridan anesthesia

Anybody know anything about them?

forums.studentdoctor.net

Envision (formerly Sheridan) acquired by KKR

https://www.bizjournals.com/nashville/news/2018/06/11/envision-healthcare-sold-for-9-9-billion.html

forums.studentdoctor.net

Envision evaluating option for bankruptcy filing

Envision Healthcare to Consider Bankruptcy Filing It seems the Pandemic is hitting hard financially for Envision, who was already in debt following a leveraged buy-out. They've already delayed new hire emergency medicine physicians' and anesthesiologists' start date bonuses until Q4. How...

forums.studentdoctor.net

After watching Somnia screw up Long Beach, Bakersfield, and Fresno, Envision says, "Hold my beer."

So, it goes without saying that all the good anesthesia practices (and I mean ALL the good ones) were bought out 5+ years ago, or are simply not for sale. But what to do if you are losing money with all your recent acquisitions, but your private equity backers want more growth at any cost? You...

forums.studentdoctor.net

Inland Empire, 2021 Update

The previous discussion about hospitals in the Inland Empire was locked to further contact, so I had to create a new thread: Spring, 2021 Update: Riverside: As predicted, Envision made an absolute disaster of Riverside Community Hospital, and is being kicked out June, 2021. Envision took...

forums.studentdoctor.net

Have we reached peak AMC (Anesthesia Management Company)?

New to the forum. Out of residency now 15 years, all that time in private practice in Connecticut and Colorado and--for the last two years--California. Moved west in search of physician-only anesthesia jobs. But enough about me. I realize this website is mostly for students (and residents)...

forums.studentdoctor.net

Here's an EM thread:

Envision screwing doctors again!!!!

Never a bad time to dump on the cmg a -holes https://www.bloomberg.com/news/articles/2020-04-03/kkr-backed-envision-withholds-doctor-pay-as-routine-care-slows

forums.studentdoctor.net

 

[Endee]

TL;DR is avoid if you can, but many times you can't, especially if you want to live in a certain area.

 

[fittipaldi1of1]

The hospital that just fired all the anesthesiologists and now ran by CRNAs is envision

 

[Blackmateria]

They are snakes. Recruiters will sweet talk you and then ghost you. "Assignment" and practice location will change without you knowing. Stay away.

 

[gasdoc77]

They are snakes. Recruiters will sweet talk you and then ghost you. "Assignment" and practice location will change without you knowing. Stay away.

Agreed. They desperately want your CV so they can present you around and try to pimp you out. NEVER give a recruiter your CV unless it is for a particular agreed upon (ahead of presentation) assignment and with strict instructions denying them permission to present you anywhere else. I would even alter the CV that you send to specify that hospital/assignment on the top heading.

 

[GravelRider]

What good things have you heard?

 

[deleted126335]

What good things have you heard?

Not as bad as Northstar?

 

[Blackmateria]

They will also quote you a good hourly rate, completely unsustainable by the payer mix, backed up by hospital support. When the contract is up they will beg for more hospital support and not get it, losing the contract and your job.

 

[Volatile]

As someone who locums for similar AMC’s, I’m happy to take their money when they are desperate, but I would never consider working for any of them in a permanent position. Just my two cents based on what I’ve seen go down at multiple hospitals.

 

[narcotics999]

They will also quote you a good hourly rate, completely unsustainable by the payer mix, backed up by hospital support. When the contract is up they will beg for more hospital support and not get it, losing the contract and your job.

Isn't perfect to do locums there? You get the $$$, move on. AMC loses the contract. Or better, the new group invites you to join.

 

[Blackmateria]

Isn't perfect to do locums there? You get the $$$, move on. AMC loses the contract. Or better, the new group invites you to join.

I guess if you can tolerate the instability for a few weeks, but OP is coming out of fellowship for his first job.

 

[Leinie]

Hello, I apologize if this topic has been discussed before. New grad coming out of fellowship, and looking for work. Ive found several hospitals which look appealing, however they are funded by Envision. Ive heard both good and bad things, and curious if any would would share their experience or what they've heard.

Thanks in advance.

Keep looking. There are no "good" things about working for Envision. You have a fellowship and can do better than an AMC, particularly this AMC.

 

[DolphinVA]

Keep looking. There are no "good" things about working for Envision. You have a fellowship and can do better than an AMC, particularly this AMC.

I'm also interested in people's personal opinions of Envision. In my particular region of the US in my particular subspecialty, there are really only two options: AMC managed "PP" or academic. Both have predatory features.

Envision owns a particularly attractive option I am considering. Their compensation model is fair, the group has been let to self manage (sans X% cut off the top to envision), the hospital relationships are strong, and the group is stable and thriving.

I understand the hate for Envision and other AMCs in general, but there are many many people working for these groups HAPPILY. The experience seems to vary greatly from group to group. Does anyone here have personal and specific negatives about Envision to add?

 

[dp101]

Thank you for all the responses. Has anyone heard good or bad things about Team Health?

Also, Im finishing up peds. Are there jobs out there where you can work in a physician only group, and do only pediatrics?

 

[GassYous]

Thank you for all the responses. Has anyone heard good or bad things about Team Health?

Also, Im finishing up peds. Are there jobs out there where you can work in a physician only group, and do only pediatrics?

No one likes team health.

Yes you can do only pediatrics in a physician only group.

 

[Beach bum]

I'm also interested in people's personal opinions of Envision. In my particular region of the US in my particular subspecialty, there are really only two options: AMC managed "PP" or academic. Both have predatory features.

Envision owns a particularly attractive option I am considering. Their compensation model is fair, the group has been let to self manage (sans X% cut off the top to envision), the hospital relationships are strong, and the group is stable and thriving.

I understand the hate for Envision and other AMCs in general, but there are many many people working for these groups HAPPILY. The experience seems to vary greatly from group to group. Does anyone here have personal and specific negatives about Envision to add?

Ignorance is bliss!!

 

[Morzh]

I'm also interested in people's personal opinions of Envision. In my particular region of the US in my particular subspecialty, there are really only two options: AMC managed "PP" or academic. Both have predatory features.

Envision owns a particularly attractive option I am considering. Their compensation model is fair, the group has been let to self manage (sans X% cut off the top to envision), the hospital relationships are strong, and the group is stable and thriving.

I understand the hate for Envision and other AMCs in general, but there are many many people working for these groups HAPPILY. The experience seems to vary greatly from group to group. Does anyone here have personal and specific negatives about Envision to add?

I am a recent fellowship graduate and joined an Envision group. The group was a very stable true pp group for over two decades but sold to Envision around 3-4 years ago. I was wary going in because of all the negative publicity I'd heard, but still ended up picking Envision because it was the best option for me in the area. I'm doing my sub-specialty 90% of the time, no supervision ever, high acuity cases, with many experienced "partners" who are good mentors. My overall compensation is fair (it's good - definitely not bad, but not stellar) and my call burden / working hours, while not cushy, are reasonable. I'm probably averaging 45-50 hours/week in the hospital, including call.

The other options in the area I wanted were either (A) another AMC that works a LOT more hours - albeit with a higher ceiling on compensation - but would only be doing 30-50% of my sub-specialty, or (B) academics but only doing my sub-specialty maybe 25% of the time and with worse compensation.

From my limited new-grad perspective, Envision hasn't screwed anything up yet. As you said, the group manages itself much the same way as it always had before the sale. Only difference so far is Envision takes their cut off the top and does all the HR / payroll / legal / billing stuff now. The old partners are still happy here for the most part. They were previously a profitable group, but when the other pp group in town sold to the other AMC, this group "felt like they had to sell to remain competitive" (at least that's what they say). It's been a bit over 3 years since they sold, so if everything turns to **** in the next few years I won't be terribly surprised. I'll just re-evaluate my options at that point. But for me it seemed like a good opportunity right out of fellowship to do all my own cases in my own sub-specialty, in the city we want to be in, making decent money. Not a bad way to start my career.

Also, Im finishing up peds. Are there jobs out there where you can work in a physician only group, and do only pediatrics?

This is what I am doing.

 

[IMGASMD]

I don’t have a “personal” experience. But I did interview with a group who sold out to envision a few years ago. When I was interviewing they were In the process of renegotiate local governance, since the “partners” were finally done with their obligations to envision.

For those who don’t know, a lot of times in order to “sell”, the Private Practice is obligated to man the practice for 3-5 years to sustain the practice. Sometimes a second exodus will happen when the obligation to AMC is done. There’s also divisions between the “old partners” and the “new hires”; since the new hires don’t really know what kind of deals the old partners have, the pay structure, the call burden, type of calls can all be different. Sometimes the AMC will also place a clause in their contract, unless they find a replacement for your spot, you can’t really leave.

Back to my experience. While I was interviewing, I felt the old partners are really on their way out, and just trying to sell me to join in order to take over a seat that will be emptied soon, so they can get out. There isn’t really the cohesiveness that I was hoping/looking for in a private practice. I know it’s “just” a job, but I am also looking for a brother/sisterhood together to slay the big bad hospital/insurance companies, in order to save the world. While you’re in an AMC, regardless how you slice it, you’re a cog to make money for AMC. Their “job” is to make money for their investors and nothing else.

 

[fittipaldi1of1]

I'm also interested in people's personal opinions of Envision. In my particular region of the US in my particular subspecialty, there are really only two options: AMC managed "PP" or academic. Both have predatory features.

Envision owns a particularly attractive option I am considering. Their compensation model is fair, the group has been let to self manage (sans X% cut off the top to envision), the hospital relationships are strong, and the group is stable and thriving.

I understand the hate for Envision and other AMCs in general, but there are many many people working for these groups HAPPILY. The experience seems to vary greatly from group to group. Does anyone here have personal and specific negatives about Envision to add?

There is no “group self management” that is a lie they will tell you. They are all just employees being told what to do, when to do it

 

[aneftp]

Not the biggest Sheridan Envison fan. But depending on region. The florida region they raised their pay in many parts.

Obviously it all depends if the “old” practice was brought out and the former partners have their own side deals (less calls/more money) than the new hires.

There is not one size fits all.

Envision took over a contract I knew of and increased paid vacation to 12 weeks (from 10 weeks) plus increase Pay 50k. And I’m talking Close to 600k. Obviously those guys work hard 60 hours but that’s decent money. So they had to do it to retain the docs after taking over from another amc. But the new docs being hired won’t get the same deal. More like 450k/8 weeks.

The competing usap “partners” in the same region make 550-600k after their 3 year buy in (400k-450k working 65 hours a week with 2 weeks paid vacation) plus buy in for 3 years.

There is no “group self management” that is a lie they will tell you. They are all just employees being told what to do, when to do it

incorrect. The practices that sell out do manage their own schedule. It all depends on the buyout and negotiations. One particular practice I know. The 7 partners get their own side deal. Less calls. Different bonus structure for partners than the new hires. The new hires last 1-3 years and many move on to different jobs. New hires more straight w2 with compensation for working extra.

In that sense. Envision has gotten better with w2 worker bees working more than usual. Like if someone works post call after in house. If they work to 11 they will get $1500 extra for those 3 hours. If they work entire 8 hours. It’s $3000 extra (on top of their w2 pay)

So every little amc practice is “managed” differently.

 

[UscGhost]

I imagine it's highly dependent on the area.

I have been with envision for over 7 years. They let us run things how we want at the local level. 1099 with a small management fee.

We hire and fire who we want. No predatory partner tracks. Equal pay and access to cases with a blended unit. Better pay than pretty much all the local groups.

Can't really say it's missing anything

 

[Beach bum]

I remember when I was a med student in south Florida (4 years ago). The new anesthesiologists we’re making 220 working for envision. I showed them the mgma data and they told me I was a dumb med student and didn’t know what I was talking about… lol, a sucker is born every day…

With comments like this it is easy to see how AMCs have taken over our practices!!

 

[fittipaldi1of1]

Not the biggest Sheridan Envison fan. But depending on region. The florida region they raised their pay in many parts.

Obviously it all depends if the “old” practice was brought out and the former partners have their own side deals (less calls/more money) than the new hires.

There is not one size fits all.

Envision took over a contract I knew of and increased paid vacation to 12 weeks (from 10 weeks) plus increase Pay 50k. And I’m talking Close to 600k. Obviously those guys work hard 60 hours but that’s decent money. So they had to do it to retain the docs after taking over from another amc. But the new docs being hired won’t get the same deal. More like 450k/8 weeks.

The competing usap “partners” in the same region make 550-600k after their 3 year buy in (400k-450k working 65 hours a week with 2 weeks paid vacation) plus buy in for 3 years.

incorrect. The practices that sell out do manage their own schedule. It all depends on the buyout and negotiations. One particular practice I know. The 7 partners get their own side deal. Less calls. Different bonus structure for partners than the new hires. The new hires last 1-3 years and many move on to different jobs. New hires more straight w2 with compensation for working extra.

In that sense. Envision has gotten better with w2 worker bees working more than usual. Like if someone works post call after in house. If they work to 11 they will get $1500 extra for those 3 hours. If they work entire 8 hours. It’s $3000 extra (on top of their w2 pay)

So every little amc practice is “managed” differently.

Not trying to start a fight.. but I truly don’t believe the local groups have much say in what they can do other than manage their own daily schedule.

During the covid shutdown, didn’t envision announce 30% pay cuts across the board? Did the local groups have any say in that?

 

[IMGASMD]

It’s all relative….. “control” is a funny word. If you’re making “enough” money for mother ship. Everyone is happy. Of course, money is money is money. But if you’re NOT making a profit, then whatever you want will be denied. Ultimately, any big or drastic decisions that is made, will most likely bypass any local level.
It’s also dependent on how the group is ran before the sell. If there were five levels od partnerships, you bet there will be some frictions within the old group and the new hires.

TL;DR: making money for AMC is good, not making money is bad.

 

[Cookie]

I don’t want to change the subject but how do you think the No Surprises Act that prevents out of network billing to patients is going to affect AMCs revenue?

 

[Volatile]

Thank you for all the responses. Has anyone heard good or bad things about Team Health?

Also, Im finishing up peds. Are there jobs out there where you can work in a physician only group, and do only pediatrics?

Team Health is not great. A few of the hospitals they have won contracts at I think mostly regret going with them, at least that’s what I’ve heard from the chief of surgery at one of these hospitals. In the Midwest they have had so much trouble hiring they are using CRNA’s to “staff” multiple SRNA rooms as a way to get cases done.

 

[<(^_^)>]

I don’t want to change the subject but how do you think the No Surprises Act that prevents out of network billing to patients is going to affect AMCs revenue?

Nothing is certain but if I had to guess not great across the board, but much worse for AMCs. The main reason AMCs can hire at all is that they get better reimbursement than mom and pop, so despite their cut it’s not THAT much lower in many cases. If they get the same reimbursement rates as mom and pop I don’t really know why anyone would work for one, and I think their business model is essentially dead.

 

[UscGhost]

Not trying to start a fight.. but I truly don’t believe the local groups have much say in what they can do other than manage their own daily schedule.

During the covid shutdown, didn’t envision announce 30% pay cuts across the board? Did the local groups have any say in that?

The pure private practice groups fared worse during the pandemic. No work at all means no revenue. Envision basically paid people to stay at home so I don't think any of the Envision physicians should be upset.

 

[UscGhost]

I don’t want to change the subject but how do you think the No Surprises Act that prevents out of network billing to patients is going to affect AMCs revenue?

The surprise billing acts basically destroyed any leverage that anesthesia groups had in negotiations with payors. So small groups will be at the mercy of the payors and the big AMCs can at least afford the legal bills necessary to negotiate

 

[payme2]

Private groups who paid themselves w2 and listed themselves as employees of the group qualified for PPP loan and made more money than previous years. Correct me if I'm wrong but I dont know of any AMCs that shared any covid relief funds.

 

[UscGhost]

Private groups who paid themselves w2 and listed themselves as employees of the group qualified for PPP loan and made more money than previous years. Correct me if I'm wrong but I dont know of any AMCs that shared any covid relief funds.

Envision pays us via 1099..so I got the ppp loan myself along with the HHS funds.

For the w2 Envision folks who were being paid a salary despite doing no cases..I think they ended up better off financially.

 

[BioChemDork]

Thank you for all the responses. Has anyone heard good or bad things about Team Health?

Also, Im finishing up peds. Are there jobs out there where you can work in a physician only group, and do only pediatrics?

Yes there are. I do 100% peds in private practice.

 

[fittipaldi1of1]

Private groups who paid themselves w2 and listed themselves as employees of the group qualified for PPP loan and made more money than previous years. Correct me if I'm wrong but I dont know of any AMCs that shared any covid relief funds.

Yah, private groups were eligible for PPP loans and did well. Envision was too large to get handouts so cut their employees pay and even withheld their “profit sharing bonus” from the previous year.

 

[Hoya11]

Private groups who paid themselves w2 and listed themselves as employees of the group qualified for PPP loan and made more money than previous years. Correct me if I'm wrong but I dont know of any AMCs that shared any covid relief funds.

Yah, private groups were eligible for PPP loans and did well. Envision was too large to get handouts so cut their employees pay and even withheld their “profit sharing bonus” from the previous year.

This was not my experience. I was in a hardly hit hospital near NYC.

My PP group was devastated financially and had no help from our hospital.

We got no stipend to begin with. We couldn't take PPP because the hospital was threatening to kick us out (during the pandemic while we have docs sleeping in house, intubating in the ICUs and staffing call teams for emergency cases). There was a new CEO who thought this was a good opportunity to "go with new model" for anesthesia services. Essentially just left us to fail... (and provide free services during this time, oh and sent the icu docs home at 3pm and we would cover major icu issues )

If you look at the details of the PPP loan - its not just free money. There is a 100k cap per employe, and lots of stipulations where you may have to repay the money if people leave the practice. Which was happening because healthcare was in chaos. I know lots of other PP groups that went through major stress during covid. If the AMC doesnt screw you the hospital will.

 

[kidthor]

This was not my experience. I was in a hardly hit hospital near NYC.

My PP group was devastated financially and had no help from our hospital.

We got no stipend to begin with. We couldn't take PPP because the hospital was threatening to kick us out (during the pandemic while we have docs sleeping in house, intubating in the ICUs and staffing call teams for emergency cases). There was a new CEO who thought this was a good opportunity to "go with new model" for anesthesia services. Essentially just left us to fail... (and provide free services during this time, oh and sent the icu docs home at 3pm and we would cover major icu issues )

If you look at the details of the PPP loan - its not just free money. There is a 100k cap per employe, and lots of stipulations where you may have to repay the money if people leave the practice. Which was happening because healthcare was in chaos. I know lots of other PP groups that went through major stress during covid. If the AMC doesnt screw you the hospital will.

Why did you do all that for free?

 

[sevoflurane]

This was not my experience. I was in a hardly hit hospital near NYC.

My PP group was devastated financially and had no help from our hospital.

We got no stipend to begin with. We couldn't take PPP because the hospital was threatening to kick us out (during the pandemic while we have docs sleeping in house, intubating in the ICUs and staffing call teams for emergency cases). There was a new CEO who thought this was a good opportunity to "go with new model" for anesthesia services. Essentially just left us to fail... (and provide free services during this time, oh and sent the icu docs home at 3pm and we would cover major icu issues )

If you look at the details of the PPP loan - its not just free money. There is a 100k cap per employe, and lots of stipulations where you may have to repay the money if people leave the practice. Which was happening because healthcare was in chaos. I know lots of other PP groups that went through major stress during covid. If the AMC doesnt screw you the hospital will.

Leave. Bad partner.
I would NEVER do a job for free, especially if it involves an infectious disease that could kill me.

Good Community partners are crucial to your practice and the hospital system itself.

 

[Hoya11]

Why did you do all that for free?

In our contractual agreement with the hospital, we had to give 6 months notice prior to leaving and "ensure an orderly transition"

they held us to this, and we were advised that we could be held financially liable for any incidents that occurred if we didnt staff the cases

ie if there is no one to do this emergency trauma case or no one to do this intubation, hospital is going to sue us for breach of contract...

we had to terminate all employees and do everything as partners just to make it through. i was sleeping on the floor in an office with an icu full of covid patients. after this 6 month period the department was taken over and we all made different decisions..

 

[abolt18]

In our contractual agreement with the hospital, we had to give 6 months notice prior to leaving and "ensure an orderly transition"

they held us to this, and we were advised that we could be held financially liable for any incidents that occurred if we didnt staff the cases

ie if there is no one to do this emergency trauma case or no one to do this intubation, hospital is going to sue us for breach of contract...

we had to terminate all employees and do everything as partners just to make it through. i was sleeping on the floor in an office with an icu full of covid patients. after this 6 month period the department was taken over and we all made different decisions..

I guess your contract somehow required you to manage ICU intubations and other random non-OR stuff free of charge? I don't understand how you were still getting roped into doing OTHER stuff and not getting paid.

 

[sevoflurane]

In our contractual agreement with the hospital, we had to give 6 months notice prior to leaving and "ensure an orderly transition"

they held us to this, and we were advised that we could be held financially liable for any incidents that occurred if we didnt staff the cases

ie if there is no one to do this emergency trauma case or no one to do this intubation, hospital is going to sue us for breach of contract...

we had to terminate all employees and do everything as partners just to make it through. i was sleeping on the floor in an office with an icu full of covid patients. after this 6 month period the department was taken over and we all made different decisions..

Damn.

 

[DolphinVA]

This is a great thread -- thanks to everyone who took time to post.

I think an important takeaway I'm seeing is that regardless of practice setup you are always beholden to the bottom line of revenue. Other factors help, especially a cozy relationship between your group and hospital leadership, but you're never totally safe. Best you can do as an individual is work with partners you can trust, understand the flow of money, and strive for the flattest leadership structure possible. But even then you may get screwed.

My past gig was a group that had been acquired by a hospital physician practice group (formerly private) at a tertiary academic center. Good group, seemingly stable arrangement, hospital liked our group and we were involved and friendly with them. Then the hospital decided to sell. New owners didn't like the subsidies. We realized our group was getting shopped around (AMCs, medical schools). Then they ghosted us for over a year after our individual contracts were up. Much like the other poster above, hospital responsibilities increased in the interim because we had 6 month clause and no leverage. It wasn't pleasant, but it's another example of how our specialty is viewed by admin.

 

[abolt18]

This is a great thread -- thanks to everyone who took time to post.

I think an important takeaway I'm seeing is that regardless of practice setup you are always beholden to the bottom line of revenue. Other factors help, especially a cozy relationship between your group and hospital leadership, but you're never totally safe. Best you can do as an individual is work with partners you can trust, understand the flow of money, and strive for the flattest leadership structure possible. But even then you may get screwed.

My past gig was a group that had been acquired by a hospital physician practice group (formerly private) at a tertiary academic center. Good group, seemingly stable arrangement, hospital liked our group and we were involved and friendly with them. Then the hospital decided to sell. New owners didn't like the subsidies. We realized our group was getting shopped around (AMCs, medical schools). Then they ghosted us for over a year after our individual contracts were up. Much like the other poster above, hospital responsibilities increased in the interim because we had 6 month clause and no leverage. It wasn't pleasant, but it's another example of how our specialty is viewed by admin.

How does responsibility GROW overtime if you're not signing a new contract saying you will take on those additional responsibilities? Shouldn't requests for "additional coverage" be answered with "sure, let's sit down and put it in the contract that we both agree to"

 

[DolphinVA]

How does responsibility GROW overtime if you're not signing a new contract saying you will take on those additional responsibilities? Shouldn't requests for "additional coverage" be answered with "sure, let's sit down and put it in the contract that we both agree to"

It's an easy trap to fall into. In our case I think the group thought new owners would appreciate us being "team players" by picking up some things here and there. Hospital admins further preyed on this knowing that, despite big talk of walking, most are unlikely to actually walk away from good salaries and uproot their families over a matter of principle.

 

[<(^_^)>]

The surprise billing acts basically destroyed any leverage that anesthesia groups had in negotiations with payors. So small groups will be at the mercy of the payors and the big AMCs can at least afford the legal bills necessary to negotiate

Am I missing something? Maybe I misread but my understanding is the law states out of network “providers” cannot bill patients for more than they would pay if they were in-network, and you have 30 days to settle the dispute with the insurance company in arbitration if you don’t like what they offer. Both sides submit “bids” and the arbitrator selects which is closer to the median in-network rate.

So USAP says “our offer is 100 a unit” and UHC says “good joke, our median in network rate is 50 a unit because we basically are (by choice) out of network with anyone but bargain basement groups, we will give you 45” then the arbitrator selects the closest bid to the median, and you get 45.

That is why the law is so controversial (to say the least). I expect the bargaining power USAP/envision etc had will basically go up in smoke. Compensation won’t radically fall, subsidies will be necessary for anesthesia to be provided in most of the country, except the “value add” for large groups negotiating power will be eliminated while I’m sure they will still attempt to take their cut.

If I’m wrong or missing something (I haven’t looked into it more than 20 min or so) I would love to know, but as it stands it doesn’t seem great for anyone (and even worse for AMCs).

 

[chessknt]

Am I missing something? Maybe I misread but my understanding is the law states out of network “providers” cannot bill patients for more than they would pay if they were in-network, and you have 30 days to settle the dispute with the insurance company in arbitration if you don’t like what they offer. Both sides submit “bids” and the arbitrator selects which is closer to the median in-network rate.

So USAP says “our offer is 100 a unit” and UHC says “good joke, our median in network rate is 50 a unit because we basically are (by choice) out of network with anyone but bargain basement groups, we will give you 45” then the arbitrator selects the closest bid to the median, and you get 45.

That is why the law is so controversial (to say the least). I expect the bargaining power USAP/envision etc had will basically go up in smoke. Compensation won’t radically fall, subsidies will be necessary for anesthesia to be provided in most of the country, except the “value add” for large groups negotiating power will be eliminated while I’m sure they will still attempt to take their cut.

If I’m wrong or missing something (I haven’t looked into it more than 20 min or so) I would love to know, but as it stands it doesn’t seem great for anyone (and even worse for AMCs).

The classic argument from the right will be just don't provide services for patients out of network because nobody is forcing you to work. The magical market will see its error and come to you begging to put you in their network.

 

[deleted126335]

In our contractual agreement with the hospital, we had to give 6 months notice prior to leaving and "ensure an orderly transition"

they held us to this, and we were advised that we could be held financially liable for any incidents that occurred if we didnt staff the cases

ie if there is no one to do this emergency trauma case or no one to do this intubation, hospital is going to sue us for breach of contract...

we had to terminate all employees and do everything as partners just to make it through. i was sleeping on the floor in an office with an icu full of covid patients. after this 6 month period the department was taken over and we all made different decisions..

Risk of ownership.

 

[kidthor]

... most are unlikely to actually walk away from good salaries and uproot their families over a matter of principle.

Being rooted in a community with a family and a house are indeed factors that make walking around a non-starter all too often.

 

[UscGhost]

Yah, private groups were eligible for PPP loans and did well. Envision was too large to get handouts so cut their employees pay and even withheld their “profit sharing bonus” from the previous year.

Envision was paying a salary to people that weren't working

Am I missing something? Maybe I misread but my understanding is the law states out of network “providers” cannot bill patients for more than they would pay if they were in-network, and you have 30 days to settle the dispute with the insurance company in arbitration if you don’t like what they offer. Both sides submit “bids” and the arbitrator selects which is closer to the median in-network rate.

So USAP says “our offer is 100 a unit” and UHC says “good joke, our median in network rate is 50 a unit because we basically are (by choice) out of network with anyone but bargain basement groups, we will give you 45” then the arbitrator selects the closest bid to the median, and you get 45.

That is why the law is so controversial (to say the least). I expect the bargaining power USAP/envision etc had will basically go up in smoke. Compensation won’t radically fall, subsidies will be necessary for anesthesia to be provided in most of the country, except the “value add” for large groups negotiating power will be eliminated while I’m sure they will still attempt to take their cut.

If I’m wrong or missing something (I haven’t looked into it more than 20 min or so) I would love to know, but as it stands it doesn’t seem great for anyone (and even worse for AMCs).

Problem is...that UHC will drop every group that makes a good contract rate..so that pushes everything down until the median rate is the the minimum 125% of Medicare. UHC will be very happy with that. If we refuse that rate then we still only get 125% of medicare

 

[zizzer]

I work for a PP group owned by Envision. Whichever way you cut it, being owned by Envision is a downside, but not enough to necessarily say you shouldn't consider the job. Just factor it in to the decision like every other pro and con.

I'm a relatively recent graduate doing physician only cases at a busy tertiary care academic center and love my job. Going to work and doing big cases is fun for me. Therefore, I like my job despite being owned by Envision, not because of it. The Envision part is a downside. The worst part about dealing with Envision has been their deficiencies in reimbursement for extra work done at times. I shouldn't have to pester people to get paid for after-hours cases in a timely manner.

 

[UscGhost]

I work for a PP group owned by Envision. Whichever way you cut it, being owned by Envision is a downside, but not enough to necessarily say you shouldn't consider the job. Just factor it in to the decision like every other pro and con.

I'm a relatively recent graduate doing physician only cases at a busy tertiary care academic center and love my job. Going to work and doing big cases is fun for me. Therefore, I like my job despite being owned by Envision, not because of it. The Envision part is a downside. The worst part about dealing with Envision has been their deficiencies in reimbursement for extra work done at times. I shouldn't have to pester people to get paid for after-hours cases in a timely manner.

While you definitely shouldn't have to pester anyone to get paid what you are owed..its no different in PP. In PP, you have to personally pester insurance companies to pay you or bug your billers about it. If you PP group bills for you, then it's likely they just accept a certain percentage of revenue being lost to poor billing and collections or you have to bug your group.

It's generally the same ice cream..just different flavors.

That being said...the best PP groups are probably better than the best AMCs..but the best AMCs are better than alot of PP groups. And the worst AMCs can be pretty bad along with the worst PP groups.

General assumptions about which is better won't really serve the needs of an individual in an individual situation and location l. I find it's more useful to discuss the pros and cons to look out for so that you can be aware of the right questions to ask