NAPA?

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amyl

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I heard a rumor Napa just fired a bunch of admins and practice mangers - whispers this is the beginning of the end for them… anyone know? Private forum?
I agree w the basic sentiment that most AMCs are done…. Wondering the order in which they’ll fall…
 
amyl said:
I heard a rumor Napa just fired a bunch of admins and practice mangers - whispers this is the beginning of the end for them… anyone know? Private forum?
I agree w the basic sentiment that most AMCs are done…. Wondering the order in which they’ll fall…
Click to expand...
Some will go out of business. Some will downsize or be acquired by others. This is a tough bug to kill. If/When we get an excess of anesthesia personnel again, it will provide fertile ground for their reemergence.
 
amyl said:
I heard a rumor Napa just fired a bunch of admins and practice mangers - whispers this is the beginning of the end for them… anyone know? Private forum?
I agree w the basic sentiment that most AMCs are done…. Wondering the order in which they’ll fall…
Click to expand...

I don't work for an AMC and interactions with their higher ups in prior interviews, I couldn't shake that I was talking to someone akin to a used car salesman.

Could I ask, why do you believe AMCs are in trouble? Where I am, AMCs have actually expanded in our city in the last year.
 
Dr. Rude said:
Some will go out of business. Some will downsize or be acquired by others. This is a tough bug to kill. If/When we get an excess of anesthesia personnel again, it will provide fertile ground for their reemergence.
Click to expand...


It’s the corporate American way. Profit off the labor of others. Doctors were largely shielded from this until the 1990s but the horse has left the barn.
 
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TheLoneWolf said:
I don't work for an AMC and interactions with their higher ups in prior interviews, I couldn't shake that I was talking to someone akin to a used car salesman.

Could I ask, why do you believe AMCs are in trouble? Where I am, AMCs have actually expanded in our city in the last year.
Click to expand...


No surprises act took away the ability to bill outrageous out of network rates as a negotiating tactic to get higher in network rates. That was a major part of most AMC business models.
 
amyl said:
I heard a rumor Napa just fired a bunch of admins and practice mangers - whispers this is the beginning of the end for them… anyone know? Private forum?
I agree w the basic sentiment that most AMCs are done…. Wondering the order in which they’ll fall…
Click to expand...
It just comes down to payor mix.

AMC tried to gain market share by gobbling up even bad contracts hoping to strong arm the remaining private insurance payors to pony up more money.

Now AMCs will just walk away from bad contracts

That’s what I see Napa doing. Keep the good. Toss the bad.

They will downsize
 
aneftp said:
It just comes down to payor mix.

AMC tried to gain market share by gobbling up even bad contracts hoping to strong arm the remaining private insurance payors to pony up more money.

Now AMCs will just walk away from bad contracts

That’s what I see Napa doing. Keep the good. Toss the bad.

They will downsize
Click to expand...

Also clinician payroll costs are killing them. On top of that in a good market best people leave, good people who are geographically limited quiet quit.
Leads to hospital and surgeon unhappiness.
 
amyl said:
I heard a rumor Napa just fired a bunch of admins and practice mangers - whispers this is the beginning of the end for them… anyone know? Private forum?
I agree w the basic sentiment that most AMCs are done…. Wondering the order in which they’ll fall…
Click to expand...

This is a new tune from a chronic supporter of USAP!
What has changed?
 
aneftp said:
It just comes down to payor mix.

AMC tried to gain market share by gobbling up even bad contracts hoping to strong arm the remaining private insurance payors to pony up more money.

Now AMCs will just walk away from bad contracts

That’s what I see Napa doing. Keep the good. Toss the bad.

They will downsize
Click to expand...


Napa took over a county hospital nearby and are paying median mgma for q3 call. Previous PP group left on short notice, mostly medicare/medicaid; tough inner city neighborhood so I can't imagine an AMC can turn a profit there.
 
Dr. Rude said:
Also clinician payroll costs are killing them. On top of that in a good market best people leave, good people who are geographically limited quiet quit.
Leads to hospital and surgeon unhappiness.
Click to expand...
Yeah. They thought they could just bribe the partners and underpay everyone else indefinitely, but the strong job market has made it hard for them to take money off our backs.
 
AMCs have pivoted. You don't see them buying practices anymore, most of their new business is hospitals asking for their services and paying the AMC a % fee on top. So the downside risk has shifted to being minimal for the AMC in bad markets. This type of gossip, while entertaining is not productive. Likely back office "streamlining" to cut non clinical costs -ie why do you need local HR when centralized can do it faster and better.
 
sbmed100 said:
AMCs have pivoted. You don't see them buying practices anymore, most of their new business is hospitals asking for their services and paying the AMC a % fee on top. So the downside risk has shifted to being minimal for the AMC in bad markets. This type of gossip, while entertaining is not productive. Likely back office "streamlining" to cut non clinical costs -ie why do you need local HR when centralized can do it faster and better.
Click to expand...

It’s productive if you’d like to see AMCs fail. If the gossip makes it hard for them to recruit then keep it up as far as I’m concerned.
 
sbmed100 said:
AMCs have pivoted. You don't see them buying practices anymore, most of their new business is hospitals asking for their services and paying the AMC a % fee on top. So the downside risk has shifted to being minimal for the AMC in bad markets. This type of gossip, while entertaining is not productive. Likely back office "streamlining" to cut non clinical costs -ie why do you need local HR when centralized can do it faster and better.
Click to expand...


Yes streamlining is what PE does, both clinical and non-clinical.
 
triggermaster said:
It’s productive if you’d like to see AMCs fail. If the gossip makes it hard for them to recruit then keep it up as far as I’m concerned.
Click to expand...
True private groups are disbanding also. Two of my friends have disbanded their once profitable practices. Labor costs too high even for to pay employee MD and employee crnas. Everyone is going per diem or pure 1099. Why? Because they can pick the days they want to work.

That leaves the group partners screwed now. Sure they can make extra but only so much to work once can do. And it’s still better to have employee work and partners take a percentage of the employee pay.
 
Dr. Rude said:
I thought it meant doing just enough to get by.
Click to expand...

You are correct that it means doing the bare minimum to keep your job. No more going above and beyond.

But it’s more of a corporate term. What would quiet quitting even look like in anesthesia? Canceling just the right amount of cases for borderline reasons?
 
thinkorswim said:
You are correct. It means just doing the bare minimum to keep your job, with no more going above and beyond.

But what does quiet quitting even look like in anesthesia? Canceling just the right amount of cases for borderline reasons?
Click to expand...

Not taking any extra risk, pt shows up…you are on the fence about cancelling…it’s gone…especially if it is afternoon and you get an early out. Not taking any extra effort. Dragging your feet to OB when called for an epidural late in labor so mom will be pushing by the time you get there…Surgeon asks for a central line for post op use…nah consult Crit care…diagnostic LP help requested by the ER.. consult IR…etc, etc.
 
Dr. Rude said:
Not taking any extra risk, pt shows up…you are on the fence about cancelling…it’s gone…especially if it is afternoon and you get an early out. Not taking any extra effort. Dragging your feet to OB when called for an epidural late in labor so mom will be pushing by the time you get there…Surgeon asks for a central line for post op use…nah consult Crit care…diagnostic LP help requested by the ER.. consult IR…etc, etc.
Click to expand...


Works if you’re salaried or paid by shift. Does not work if your income depends on unit production.
 
Dr. Rude said:
Not taking any extra risk, pt shows up…you are on the fence about cancelling…it’s gone…especially if it is afternoon and you get an early out. Not taking any extra effort. Dragging your feet to OB when called for an epidural late in labor so mom will be pushing by the time you get there…Surgeon asks for a central line for post op use…nah consult Crit care…diagnostic LP help requested by the ER.. consult IR…etc, etc.
Click to expand...

I know some attendings from my academic place that do this every day for the past 10 years.
 
Dr. Rude said:
Not taking any extra risk, pt shows up…you are on the fence about cancelling…it’s gone…especially if it is afternoon and you get an early out. Not taking any extra effort. Dragging your feet to OB when called for an epidural late in labor so mom will be pushing by the time you get there…Surgeon asks for a central line for post op use…nah consult Crit care…diagnostic LP help requested by the ER.. consult IR…etc, etc.
Click to expand...

That stuff existed WAY before the term “quiet quitting” was coined. When I came out of residency there were some old timers who had perfected laziness to be an art form. The problem in anesthesia has always been the laziest anesthesiologists are often the happiest, especially in an employed model. Mediocrity is the way to go. The hardest workers do more work and get the crappiest cases and get nothing extra for their effort. Why go above and beyond? Pride doesn’t pay the bills.
 
aneftp said:
True private groups are disbanding also. Two of my friends have disbanded their once profitable practices. Labor costs too high even for to pay employee MD and employee crnas. Everyone is going per diem or pure 1099. Why? Because they can pick the days they want to work.

That leaves the group partners screwed now. Sure they can make extra but only so much to work once can do. And it’s still better to have employee work and partners take a percentage of the employee pay.
Click to expand...
Better for the partners 👎
 
amyl said:
I always a supporter of USAP… we are different. I believe that. We are physician run…. For better or worse.
Click to expand...
Some of us will never see eye to eye on this sentiment. You may be physician run but you are corporate owned.
 
triggermaster said:
It’s productive if you’d like to see AMCs fail. If the gossip makes it hard for them to recruit then keep it up as far as I’m concerned.
Click to expand...
In many markets, without the AMCs you will have no other option than hospital employment. Is that really what you are asking for? In other markets, without competition from the AMCs the private practice groups (less than 50) would have less incentive to offer maternity (at all), paid paternity, CME, and such things that are all so important to new hires.
 
amyl said:
Yup. Be careful what you wish for.
My group had zero maternity leave until they became USAP.
Click to expand...


We’re still private and have always had unpaid maternity and paternity leave. (We’re 100% production based). We even had a guy who took off for 2months every winter to do research on diving penguins in Antarctica. The thing is that all this can be voted on in a private practice. The whole point is autonomy. In a private practice, the only people you need to convince are your partners….talk to them, then vote on it. Maybe this is true for your division of USAP too.
 
Rumors are everywhere. Word is USAP in very bad shape at several sites. Trimming facilities all over the place and still can’t keep staff-causing high hours and further staff loss

Napa rumors too. They’ve lost places

It was already said. It’s a struggle now to profit off anesthesia. Supply/demand rules. Easy for CRNAs to find 300k salaries right now. As an MD you really shouldn’t be accepting less than $275/hr W2 and $325 1099. That’s lowest to work.

Doesn’t matter if AMC or Hospital or whoever-loyalty is gone, pay, hours, workload all that matters. With the shortages that exist and no surprises act it’s time for straight contract pay. CRNAs just figure it out faster than MDs. It’s actually a good time to be in anesthesia…if you don’t settle for anything less than you’re worth
 
nimbus said:
We’re still private and have always had unpaid maternity and paternity leave. (We’re 100% production based). We even had a guy who took off for 2months every winter to do research on diving penguins in Antarctica. The thing is that all this can be voted on in a private practice. The whole point is autonomy. In a private practice, the only people you need to convince are your partners….talk to them, then vote on it. Maybe this is true for your division of USAP too.
Click to expand...
Your payor mix has probably stayed stable as well as workload

Hospitals in big cities keep demanding and demanding. What was once ep coverage 2x a week is now 5x a week.

What was once elective gi 2x a week now involves bs elective Gi (on patients they won’t do at their profitable asc plus inpatients 5 days a week around gi docs office and asc hours (after 5pm and before 9am). These are very unprofitable cases (the Gi inpatient cases)
 
aneftp said:
Your payor mix has probably stayed stable as well as workload

Hospitals in big cities keep demanding and demanding. What was once ep coverage 2x a week is now 5x a week.

What was once elective gi 2x a week now involves bs elective Gi (on patients they won’t do at their profitable asc plus inpatients 5 days a week around gi docs office and asc hours (after 5pm and before 9am). These are very unprofitable cases (the Gi inpatient cases)
Click to expand...


We’re in a top 10 metro.

Edit: apparently we’ve been surpassed by a lot of other areas. But still in the top 20, 3mil+ population.
 
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Howard888 said:
Rumors are everywhere. Word is USAP in very bad shape at several sites. Trimming facilities all over the place and still can’t keep staff-causing high hours and further staff loss

Napa rumors too. They’ve lost places

It was already said. It’s a struggle now to profit off anesthesia. Supply/demand rules. Easy for CRNAs to find 300k salaries right now. As an MD you really shouldn’t be accepting less than $275/hr W2 and $325 1099. That’s lowest to work.

Doesn’t matter if AMC or Hospital or whoever-loyalty is gone, pay, hours, workload all that matters. With the shortages that exist and no surprises act it’s time for straight contract pay. CRNAs just figure it out faster than MDs. It’s actually a good time to be in anesthesia…if you don’t settle for anything less than you’re worth
Click to expand...
Bottom line is as long as the check clears do you really care who writes it? W-2 or 1099 as long as you are being paid fairly for the work then it doesn't matter who writes the check. I agree about $250-$275 with full benefits for W-2 (per hour) and $300-$325 for 1099 without benefits. The range is based on workload and type of job (1:4 vs 1:2 for example) as well as location. I am perfectly happy collecting $300 1099 covering 1-2 rooms or doing my own room.
I am not happy at $300 1099 at 1:4 as that should be closer to $375 per hour. Again, the reasons you all aren't earning that pay are market forces and location. There are too many with the old mind set to accept whatever the AMC or hospital doles out. If everyone demanded fair pay and fair working conditions the entire specialty would be better off. The CRNAs are simply better at this than most Anesthesiologists. That said, I know a few who are making a fortune in this market (over $800,000 plus) by being paid "fair market value" for day time and call shifts.
 
nimbus said:
We’re still private and have always had unpaid maternity and paternity leave. (We’re 100% production based). We even had a guy who took off for 2months every winter to do research on diving penguins in Antarctica. The thing is that all this can be voted on in a private practice. The whole point is autonomy. In a private practice, the only people you need to convince are your partners….talk to them, then vote on it. Maybe this is true for your division of USAP too.
Click to expand...

You know that the state provides paid parental lead for 8 weeks

Also these threads really make me feel like a chump
 
GassYous said:
You know that the state provides paid parental lead for 8 weeks
Click to expand...




When I got sick, I was able to collect state disability while I was out but it was a paltry amount. Is parental leave from the state disability fund?

I also collected accounts receivables from the work I did during the preceding months but my partners didn’t pay me to stay home.
 
GassYous said:
You know that the state provides paid parental lead for 8 weeks

Also these threads really make me feel like a chump
Click to expand...


Found it. It is from the same or similar fund.


I got around $1500/week while I was out sick. Not good but better than $0. I hadn’t even considered it but one of our practice managers told me I am eligible. EDD was the agency that administered my disability payments.


Paid Family Leave

Paid Family Leave (PFL) provides benefit payments to people who need to take time off work to care for a seriously ill family member, bond with a new child, or participate in a qualifying event because of a family member’s military deployment.
edd.ca.gov edd.ca.gov

State Disability Insurance

Apply for Disability Insurance or Paid Family Leave benefits through myEDD. Enjoy higher benefit payments starting in 2025, direct deposit, and easy access to claim updates.
edd.ca.gov edd.ca.gov
 
Last edited by a moderator:
BLADEMDA said:
Bottom line is as long as the check clears do you really care who writes it? W-2 or 1099 as long as you are being paid fairly for the work then it doesn't matter who writes the check. I agree about $250-$275 with full benefits for W-2 (per hour) and $300-$325 for 1099 without benefits. The range is based on workload and type of job (1:4 vs 1:2 for example) as well as location. I am perfectly happy collecting $300 1099 covering 1-2 rooms or doing my own room.
I am not happy at $300 1099 at 1:4 as that should be closer to $375 per hour. Again, the reasons you all aren't earning that pay are market forces and location. There are too many with the old mind set to accept whatever the AMC or hospital doles out. If everyone demanded fair pay and fair working conditions the entire specialty would be better off. The CRNAs are simply better at this than most Anesthesiologists. That said, I know a few who are making a fortune in this market (over $800,000 plus) by being paid "fair market value" for day time and call shifts.
Click to expand...
Most people want to work in an environment where they appreciate and like their colleagues…ie not in a constant dumpster fire. That in itself is still worth something.
 
BLADEMDA said:
Bottom line is as long as the check clears do you really care who writes it? W-2 or 1099 as long as you are being paid fairly for the work then it doesn't matter who writes the check. I agree about $250-$275 with full benefits for W-2 (per hour) and $300-$325 for 1099 without benefits. The range is based on workload and type of job (1:4 vs 1:2 for example) as well as location. I am perfectly happy collecting $300 1099 covering 1-2 rooms or doing my own room.
I am not happy at $300 1099 at 1:4 as that should be closer to $375 per hour. Again, the reasons you all aren't earning that pay are market forces and location. There are too many with the old mind set to accept whatever the AMC or hospital doles out. If everyone demanded fair pay and fair working conditions the entire specialty would be better off. The CRNAs are simply better at this than most Anesthesiologists. That said, I know a few who are making a fortune in this market (over $800,000 plus) by being paid "fair market value" for day time and call shifts.
Click to expand...
Crnas playing 4D chess with the hourly model especially those working 6/7 days a month 24 hours and freeing up their entire schedule to do whatever they want.

Docs stupid taking backup beeper etc and working the next day as “early out” or day off potentially. That backup beeper is valuable time. I’d rather just work 24 hours and that’s 60% of my work week. Come back and work 16 hours and be done with the week.

Rather than work 10-11 hours as backup call doc. Be on beeper and come back and work 2-3 hours and leave at 9/10 am. The full day off is more important to me. Showing up is 80% of the effort.
 
sbmed100 said:
Most people want to work in an environment where they appreciate and like their colleagues…ie not in a constant dumpster fire. That in itself is still worth something.
Click to expand...
Every place I’ve been at. Big or small. Always some type of work conflict personalities

Maybe one place I was at true private before we lost contract to amc. I got along super well with more than half the group. Maybe that’s because we were all within 2-3 years of each other including 4 of us born the same year. So it’s fun when you work with cohorts your same age with similar ages. That was a great group I worked with. Really enjoyed it. Covered for each other. Went out with each others families.

Have stayed together but payor mix got bad and subsidies needed. And was a battle with admin to get more.
 
nimbus said:
Found it. It is from the same or similar fund.


I got around $1500/week while I was out sick. Not good but better than $0. I hadn’t even considered it but one of our practice managers told me I am eligible. EDD was the agency that administered my disability payments.


Paid Family Leave

Paid Family Leave (PFL) provides benefit payments to people who need to take time off work to care for a seriously ill family member, bond with a new child, or participate in a qualifying event because of a family member’s military deployment.
edd.ca.gov edd.ca.gov

State Disability Insurance

Apply for Disability Insurance or Paid Family Leave benefits through myEDD. Enjoy higher benefit payments starting in 2025, direct deposit, and easy access to claim updates.
edd.ca.gov edd.ca.gov
Click to expand...

Not good? That's 12k of your own money back that you paid into the system.
 
I can tell people Napa (in general). Obviously not all Napa places. But in general Napa like many big amc gets complacent. Aka lazy. That’s on administration. Local hospitals demand big administration to be on site or their representatives from corporate. And Napa many times fails to come in to talk to hospital admin

That’s on senior leadership. Unless administrators evolve and delegate responsibilities appropriately as they expanded. They will continue to have problems.
 
aneftp said:
I can tell people Napa (in general). Obviously not all Napa places. But in general Napa like many big amc gets complacent. Aka lazy. That’s on administration. Local hospitals demand big administration to be on site or their representatives from corporate. And Napa many times fails to come in to talk to hospital admin

That’s on senior leadership. Unless administrators evolve and delegate responsibilities appropriately as they expanded. They will continue to have problems.
Click to expand...
Funny enough, I've seen certain locums agencies doing more. Going out to dinner with the hospital leadership, regular meetings to discuss needs and staffing, etc.
 
aneftp said:
Your payor mix has probably stayed stable as well as workload

Hospitals in big cities keep demanding and demanding. What was once ep coverage 2x a week is now 5x a week.

What was once elective gi 2x a week now involves bs elective Gi (on patients they won’t do at their profitable asc plus inpatients 5 days a week around gi docs office and asc hours (after 5pm and before 9am). These are very unprofitable cases (the Gi inpatient cases)
Click to expand...
Sounds like my place. Admin always thinking that just because volume is good for THEM, it must be good for Anesthesia. These admins have NO clue how Anesthesia billing works. I even asked the head honcho of the “clinically integrated network” that we’re affiliated with (a good guy who has helped improve our billing greatly, while we continue to enjoy our “independence”), who WAS a hospital CEO for years—-“Did you ever know how anesthesia billing worked, when you were a Hospital CEO??”- His response—-“Nope!”.

We don’t even clear $200 on our average GI. By the time you figure in the downtime, and the fact that the greedy/disrespectful GI’s wanna do it from 2-6pm (off peak hours), we LOSE money (no to mention, morale). Think about it—-we’d have to do 1500 of the damned things to even pay ONE CRNA (salary plus bennies) (1500 x $200= $300k). A complete joke.

“Hey!! Let’s recruit some Vascular Surgeons!!!” Again—-a bunch of long, complicated, poor paying (Medicare and unfunded) cases. Sure, the HOSPITAL makes money. Anesthesia?? Nope.

Then they have the GALL to ask us why we can’t reduce the stipend. These cases make YOU money (hospital), but we LOSE money on nearly every one….
 
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DirtDocMD said:
Sounds like my place. Admin always thinking that just because volume is good for THEM, it must be good for Anesthesia. These admins have NO clue how Anesthesia billing works. I even asked the head honcho of the “clinically integrated network” that we’re affiliated with (a good guy who has helped improve our billing greatly, while we continue to enjoy our “independence”), who WAS a hospital CEO for years—-“Did you ever know how anesthesia billing worked, when you were a Hospital CEO??”- His response—-“Nope!”.

We don’t even clear $200 on our average GI. By the time you figure in the downtime, and the fact that the greedy/disrespectful GI’s wanna do it from 2-6pm (off peak hours), we LOSE money (no to mention, morale). Think about it—-we’d have to do 1500 of the damned things to even pay ONE CRNA (salary plus bennies) (1500 x $200= $300k). A complete joke.

“Hey!! Let’s recruit some Vascular Surgeons!!!” Again—-a bunch of long, complicated, poor paying (Medicare and unfunded) cases. Sure, the HOSPITAL makes money. Anesthesia?? Nope.

Then they have the GALL to ask us why we can’t reduce the stipend. These cases make YOU money (hospital), but we LOSE money on nearly every one….
Click to expand...
Seems like a large hassle. Not sure why anyone bothers with PP these days. Let the hospital pay for anesthesia coverage per hour if it’s so important to do these cases.
 
DirtDocMD said:
Sounds like my place. Admin always thinking that just because volume is good for THEM, it must be good for Anesthesia. These admins have NO clue how Anesthesia billing works. I even asked the head honcho of the “clinically integrated network” that we’re affiliated with (a good guy who has helped improve our billing greatly, while we continue to enjoy our “independence”), who WAS a hospital CEO for years—-“Did you ever know how anesthesia billing worked, when you were a Hospital CEO??”- His response—-“Nope!”.

We don’t even clear $200 on our average GI. By the time you figure in the downtime, and the fact that the greedy/disrespectful GI’s wanna do it from 2-6pm (off peak hours), we LOSE money (no to mention, morale). Think about it—-we’d have to do 1500 of the damned things to even pay ONE CRNA (salary plus bennies) (1500 x $200= $300k). A complete joke.

“Hey!! Let’s recruit some Vascular Surgeons!!!” Again—-a bunch of long, complicated, poor paying (Medicare and unfunded) cases. Sure, the HOSPITAL makes money. Anesthesia?? Nope.

Then they have the GALL to ask us why we can’t reduce the stipend. These cases make YOU money (hospital), but we LOSE money on nearly every one….
Click to expand...

Facility fees go up.

vs. Anesthesia (and physician) billing that is always on the chopping block.

This is the AHA long game.
 
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