NAPA pulls out of WB and Scranton hospitals.

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m.citizensvoice.com

Anesthesia teams quitting at W-B General amid dispute

Anesthesia teams at several area hospitals are quitting June 30 amid a dispute over reconciliation payments to the company that employs them. North American Partners in Anesthesiology, or NAPA, accuses Commonwealth Health of reneging on its promise to pay
m.citizensvoice.com m.citizensvoice.com

Does anyone know what’s going on here? I assume NAPA has played hardball like this at many other hospitals, all at the cost of the anesthesia providers, who are forced to move due to noncompetes. The other big losers are the hospital, the community and the surgeons. How long will the government allow the corporate practice of medicine to disrupt healthcare?


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Non compete enforceability will matter a lot. Hard area to recruit for.
 
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Wasn’t something that happened overnight. Among Corporate practices NAPA is in a league of its own in terms of ruthlessness. Hospitals were enticed by the efficiency and the low subsidies and in the end they got burned.

Although NAPA was the first to walk, but something tells me they’ve probably threatened it before if a system didn’t pay up.
 
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RadsWFA1900 said:
Wasn’t something that happened overnight. Among Corporate practices NAPA is in a league of its own in terms of ruthlessness. Hospitals were enticed by the efficiency and the low subsidies and in the end they got burned.

Although NAPA was the first to walk, but something tells me they’ve probably threatened it before if a system didn’t pay up.
Click to expand...

Now with Mednax’s territory. Would it get better or worse for physicians? My vote, worse......
 
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Lol. Napa is nasty. But community health is even nastier. They are much worst than hca.

I’m actually siding with Napa in this case. Knowing the way CHS is run.

it’s just not a profitable anesthesia place to work at. The hospital has to pony up the money if they want 24/7 coverage especially OB services.

let this be a lesson to young docs who “want to take over a contract”. My friend did fee for service at community health system hospital in mid Atlantic as well. He made only 300-400k. No one taking money off the top. But covering 60 hours a week cause of mandatory in house ob coverage. On a 24 hour Saturday call. One Medicaid ob epidural. No or case. So $72 for 24 hour coverage. That’s less than minimum wage sitting around.

he kept arguing with hospital admin about the agog 30 min “decision to incision” guideline. But admin wanted anesthesia in house with running epidural even though he was 22 min door to door. They claimed he would need 15 min to setup for stat c/s. So only would need to live within 15 min of hospital according to hospital admin.
 
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IMGASMD said:
Now with Mednax’s territory. Would it get better or worse for physicians? My vote, worse......
Click to expand...

Worse

Also probably plenty of fault on both sides likely. One over promising and the other overly demanding. I definitely have a bias against NAPA.

AMCs are probably just running into the same issues PP did. Hospital wants coverage and doesn’t want to hear about paying for it.

Maybe they’ll just employ them outright. But this story plays out again and again.
 
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aneftp said:
Lol. Napa is nasty. But community health is even nastier. They are much worst than hca.

I’m actually siding with Napa in this case. Knowing the way CHS is run.

it’s just not a profitable anesthesia place to work at. The hospital has to pony up the money if they want 24/7 coverage especially OB services.

let this be a lesson to young docs who “want to take over a contract”. My friend did fee for service at community health system hospital in mid Atlantic as well. He made only 300-400k. No one taking money off the top. But covering 60 hours a week cause of mandatory in house ob coverage. On a 24 hour Saturday call. One Medicaid ob epidural. No or case. So $72 for 24 hour coverage. That’s less than minimum wage sitting around.

he kept arguing with hospital admin about the agog 30 min “decision to incision” guideline. But admin wanted anesthesia in house with running epidural even though he was 22 min door to door. They claimed he would need 15 min to setup for stat c/s. So only would need to live within 15 min of hospital according to hospital admin.
Click to expand...

Completely agree with your comment about community health.


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So they are quitting June 30 and the hospital finds out on June 20 with a huge surgical backlog. Anyone who is available for locums can write his own check....
 
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These disputes often reveal proprietary numbers. Looks like one of the sites was getting $6.9mil for 4MD’s and 17CRNA’s. If the cost to employ the CRNA’s is $250k each, that leaves $2.65mil for the 4MD’s and the NAPA overlords. Hopefully the MD’s were getting paid well to supervise at a fairly high ratio.
 
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nimbus said:
These disputes often reveal proprietary numbers. Looks like one of the sites was getting $6.9mil for 4MD’s and 17CRNA’s. If the cost to employ the CRNA’s is $250k each, that leaves $2.65mil for the 4MD’s and the NAPA overlords. Hopefully the MD’s were getting paid well to supervise at a fairly high ratio.
Click to expand...

That doesn’t even include their billing! I’ll bet they cleaned up. And why the hospital was pushing for a major change.
 
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AdmiralChz said:
That doesn’t even include their billing! I’ll bet they cleaned up. And why the hospital was pushing for a major change.
Click to expand...

I did some locums in the area about 15 years ago. Salaries were below average for docs and CRNAs then (at least at one hospital in the region). It is a depressed low income area. Poor insurance mix very heavy Medicare Medicaid.


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dannyboy1 said:
So they are quitting June 30 and the hospital finds out on June 20 with a huge surgical backlog. Anyone who is available for locums can write his own check....
Click to expand...

Remindme of a locums assignment I did years back. All of us locums were pulling 60-70k a month easy. One dude was pulling in 80k a month. $250/hr regular rate. $300/hr overtime. We worked hard. The hours were long. Hospital busy. Tons of overtime which was key.

They even pay us $2000 post call day and not require us to work.

All this was because private practice group walked out Friday on zero notice. On Monday. They could only run 3 operating rooms out of their normal 12 (All MD practice)

Very similar situation. The group had negotiated in good faith. They gave their 90 day notice to terminate contract months prior Bad payor mix. Than it became “ok” we will extend it for 30 days etc. finally deadline came. No give by hospital. Group walked. 4 original docs stayed on by that monday.

Every day a hospital cannot run an operating room costs them a minimum of 50k per room easy.

Although this was a “non profit” hospital locums assignment. Hospital ceo lost his job because of this.

CHS is very stingy. Will see what happens.
 
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nimbus said:
These disputes often reveal proprietary numbers. Looks like one of the sites was getting $6.9mil for 4MD’s and 17CRNA’s. If the cost to employ the CRNA’s is $250k each, that leaves $2.65mil for the 4MD’s and the NAPA overlords. Hopefully the MD’s were getting paid well to supervise at a fairly high ratio.
Click to expand...
Worked in that area right out of residency. No way CRNAs are making that much. More like 150.
Edit. After looking at gasworks, looks like you may be right.
I was totally underpaid at my first job, but it was easy.
 
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aneftp said:
Remindme of a locums assignment I did years back. All of us locums were pulling 60-70k a month easy. One dude was pulling in 80k a month. $250/hr regular rate. $300/hr overtime. We worked hard. The hours were long. Hospital busy. Tons of overtime which was key.

They even pay us $2000 post call day and not require us to work.

All this was because private practice group walked out Friday on zero notice. On Monday. They could only run 3 operating rooms out of their normal 12 (All MD practice)

Very similar situation. The group had negotiated in good faith. They gave their 90 day notice to terminate contract months prior Bad payor mix. Than it became “ok” we will extend it for 30 days etc. finally deadline came. No give by hospital. Group walked. 4 original docs stayed on by that monday.

Every day a hospital cannot run an operating room costs them a minimum of 50k per room easy.

Although this was a “non profit” hospital locums assignment. Hospital ceo lost his job because of this.

CHS is very stingy. Will see what happens.
Click to expand...

What happened afterwards? CEO fired and then pp group got a new contract?


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narcotics999 said:
What happened afterwards? CEO fired and then pp group got a new contract?


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Click to expand...
CEO got fired. Guess what ceo did afterwards? They get rehired at another hospital. It’s a scam these hospital executives jobs. They just recycle because they have experience. Same with anesthesia chiefs. They just recycle. So don’t go blaming hospitals executives.

most of memebers of old group came back in a year as “new private group”. Much higher guaranteed 1099 income (mid 500s) plus 8 weeks guarantee vacation pay. Almost illegal 1099 deal but the hospital Did the deal.
 
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aneftp said:
CEO got fired. Guess what ceo did afterwards? They get rehired at another hospital. It’s a scam these hospital executives jobs. They just recycle because they have experience. Same with anesthesia chiefs. They just recycle. So don’t go blaming hospitals executives.

most of memebers of old group came back in a year as “new private group”. Much higher guaranteed 1099 income (mid 500s) plus 8 weeks guarantee vacation pay. Almost illegal 1099 deal but the hospital Did the deal.
Click to expand...


Usually CEO’s have a 6-7 figure severance so they can’t lose.
 
so it sounds like the ORs wont be running much in july over there....

sucks for the anesthesiologists who lost their jobs.... i wonder if their non competes cover the entire area and now they are forced to choose between joblessness and moving
 
anbuitachi said:
so it sounds like the ORs wont be running much in july over there....

sucks for the anesthesiologists who lost their jobs.... i wonder if their non competes cover the entire area and now they are forced to choose between joblessness and moving
Click to expand...

Isn’t NAPA notorious for enforcing their non-compete?
 
The Locum Recruitment has begun. Got this email 2 days ago.
-------------------------------------------------------------------------------------------
VeloSource currently has a client needing 16 Locum Anesthesiologist to work at one of their four locations in Northeastern Pennsylvania. For quick details on the sites, please see below:
- 2 sites require cardiac capable
- 1 site is general cases only
- 1 site is general cases w/ OB
- 24 hrs to get Pennsylvania License
o Facilitated /covered by VeloSource
- Quick credentialing
- Flexible scheduling
- Travel & Lodging provided
If you have any interest or availability, please let me know. I would love to set up a time to discuss!
 
Zekchar said:
The Locum Recruitment has begun. Got this email 2 days ago.
-------------------------------------------------------------------------------------------
VeloSource currently has a client needing 16 Locum Anesthesiologist to work at one of their four locations in Northeastern Pennsylvania. For quick details on the sites, please see below:
- 2 sites require cardiac capable
- 1 site is general cases only
- 1 site is general cases w/ OB
- 24 hrs to get Pennsylvania License
o Facilitated /covered by VeloSource
- Quick credentialing
- Flexible scheduling
- Travel & Lodging provided
If you have any interest or availability, please let me know. I would love to set up a time to discuss!
Click to expand...
Wow that's a quick licensure!?
Any idea money?
 
Zekchar said:
The Locum Recruitment has begun. Got this email 2 days ago.
-------------------------------------------------------------------------------------------
VeloSource currently has a client needing 16 Locum Anesthesiologist to work at one of their four locations in Northeastern Pennsylvania. For quick details on the sites, please see below:
- 2 sites require cardiac capable
- 1 site is general cases only
- 1 site is general cases w/ OB
- 24 hrs to get Pennsylvania License
o Facilitated /covered by VeloSource
- Quick credentialing
- Flexible scheduling
- Travel & Lodging provided
If you have any interest or availability, please let me know. I would love to set up a time to discuss!
Click to expand...
Send me the details. 24 hours to get a PA license? I will do it.
 
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I always find it funny (shameful?) that "regular" licensing and credentialing takes several months dealing back and forth with idiots, yet when the rubber hits the road they can do it in 24 hrs.
 
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kidthor said:
I always find it funny (shameful?) that "regular" licensing and credentialing takes several months dealing back and forth with idiots, yet when the rubber hits the road they can do it in 24 hrs.
Click to expand...
Because it's total BS. Just another way for some high-school dropout to sit, barely do any work and get paid.
 
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Likely the next move will be by the health care system to file an emergency injunction seeking to void the noncompete. (Best interest of the community).
 
dr doze said:
Likely the next move will be by the health care system to file an emergency injunction seeking to void the noncompete. (Best interest of the community).
Click to expand...

Or some other group comes in, claims they can do it cheaper and better than NAPA did, get the contract and screw the hospital and community again.
 
"There's an old saying in Tennessee—I know it's in Texas, probably in Tennessee—that says, 'Fool me once, shame on...shame on you. Fool me—you can't get fooled again."

That the one you looking for?
 
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IMGASMD said:
"There's an old saying in Tennessee—I know it's in Texas, probably in Tennessee—that says, 'Fool me once, shame on...shame on you. Fool me—you can't get fooled again."

That the one you looking for?
Click to expand...

Applies equally well to admin. They’ll likely make this mistake again or maybe just Employ them
Outright
 
IMGASMD said:
"There's an old saying in Tennessee—I know it's in Texas, probably in Tennessee—that says, 'Fool me once, shame on...shame on you. Fool me—you can't get fooled again."

That the one you looking for?
Click to expand...

Bet you never thought you'd miss him, huh?
 
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RadsWFA1900 said:
Applies equally well to admin. They’ll likely make this mistake again or maybe just Employ them
Outright
Click to expand...

When you’re desperate you do stupid things.

It’s the same play book by NAPA/Mednax/Envision/Premier/USAP/AMC, don’t think they really have any other tricks, but why are they still expanding?

SaltyDog said:
Bet you never thought you'd miss him, huh?
Click to expand...

Sigh.
 
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Emergency hospital privileges can can take as little as 24 hours.

emergency state license can take as little as 7-14 days.
 
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All this hospital system needs to do is go to ACGME and start an anesthesia residency program...screw it start an SRNA program two let the two fight it out for cases. Labor problem solved! Literally zero quality control at this point...probably could pull this off.
 
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After reading the article. As much as a despise NAPA. I’m on their side on this matter. You can’t have 24/7 anesthesia coverage without paying up.

This is one of the main reasons hospitals do not want to employ anesthesia as hospital w2. They know if they employe anesthesia they can’t demand more services cause it would cost the hospital more money. Anesthesia is expensive. But if u want services. U gotta pay for them

Just like any business.
 
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chocomorsel said:
Send me the details. 24 hours to get a PA license? I will do it.
Click to expand...
We have 4 hospitals – 2 of them are requiring cardiac capable and all general cases beyond that. With the cardiac piece providers are not doing their own cases so they will just be supervising those procedures. These sties will compensate $220/hr.

The other 2 sites are all general cases one of which will have a decent amount of OB (working on finding out if they will need locum to handle those cases). The other is a small location with only general cases. These sites will compensate $195/hr.

Scheduling is flexible so we will check to see what the client thinks!
 
kmurp said:
How does one run a practice with 4 docs/ 17 crnas?
Click to expand...

Docs: 1 on call, 1 backup call, 1 pre-call, 1 on vacay.

3 docs supervising 10-12 starts each day. With CRNAs taking call as well, 5-7 on day off, vacay, a couple post call...it's about right.
 
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Zekchar said:
We have 4 hospitals – 2 of them are requiring cardiac capable and all general cases beyond that. With the cardiac piece providers are not doing their own cases so they will just be supervising those procedures. These sties will compensate $220/hr.

The other 2 sites are all general cases one of which will have a decent amount of OB (working on finding out if they will need locum to handle those cases). The other is a small location with only general cases. These sites will compensate $195/hr.

Scheduling is flexible so we will check to see what the client thinks!
Click to expand...

For a second i thought you are there right now.
 
kmurp said:
How does one run a practice with 4 docs/ 17 crnas?
Click to expand...
Easy. One doc on vacation. One doc works post call (peels out early). Doc probably beeper call from home light call back. Two docs there all day.

17 Crnas usually means only 11-12 working daily. Post call OB crna. 3 crnas on vacation.
So 3 docs covering 10-12 locations routinely. OB crna essentially independent except c/s.
 
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