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EctopicFetus

EctopicFetus

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Mostly or all in California, but apparently sent an email to their doctors that they are not going to make payroll for them this month and they will catch up in the next few months. Worth the discussion and light of what happened to a PP, envision bankruptcy, etc. Can’t imagine how bad your finances have to be that you miss payroll makes you wonder if you missed or stop paying your rent or other mandatory expenses as I would imagine missing payroll will be the last thing you wanna do because if I was a physician there, I certainly would not show up to work another shift and expose myself to liability with the concern that they’re not covering my medical malpractice like a PP.
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Businesses that miss payroll one month typically don’t make it up the next month (or any month after for that matter). I don’t know anything about NES but if I worked for them I wouldn’t expect any further paychecks and I’d have found a different job by the end of the day.
 
I would just go to Admin of the hospital and tell them the situation and that you will not be working the upcoming shifts. I would also be looking for a new job right now.
 
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JacobMcCandles said:
Businesses that miss payroll one month typically don’t make it up the next month (or any month after for that matter). I don’t know anything about NES but if I worked for them I wouldn’t expect any further paychecks and I’d have found a different job by the end of the day.
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Doesn’t seem you can recover from missing payroll.. where is the magical money coming from? Death spiral is about to ensue.
 
EctopicFetus said:
Doesn’t seem you can recover from missing payroll.. where is the magical money coming from? Death spiral is about to ensue.
Click to expand...
I read they requested a bridge loan.
 
xaelia said:
Don't work for free.

You don't owe them any loyalty; that's a trick corporations play to exploit workers.
Click to expand...
Except NES is telling their employees this is a temp situation. So likely, the docs will keep working in hopes that the payroll troubles get resolved (doubtful though)..
 
Ceez said:
Except NES is telling their employees this is a temp situation. So likely, the docs will keep working in hopes that the payroll troubles get resolved (doubtful though)..
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I’m honestly not sure what people expect them to say. Has a business in this situation come out and said “I don’t think we’re going to make it.”? If they do, they 100% won’t make it. If they pretend like everything is ok then the chance is only 99.99% that they won’t make it. Unless there are some kind of weird extenuating circumstances, these businesses are already cooked by the time it gets to missing payroll. There’s a good chance they knew this was going to happen and they already tried to get loans but were turned down for obvious reasons. If they didn’t see this coming then that tells you all you need to know about their leadership.
 
Ceez said:
Except NES is telling their employees this is a temp situation. So likely, the docs will keep working in hopes that the payroll troubles get resolved (doubtful though)..
Click to expand...
It's reasonable to suggest there's a continuum of trustworthiness you can afford to your employed based on their transparency and prior actions.

If there's a minimum of communication surrounding the financial circumstances leading to this crisis, then docs have every right to be skeptical. Failing to have sufficient cash on hand is not a "surprise!", it's the foreseeable conclusion to a sequence of poor outcomes – and absent an accounting of the current situation and the plan for resolution, anyone who keeps coming to work is gambling they might be doing it for free.
 
Just a reminder of biz speak.
About five months later, they were completely out of business. Docs did not get their tail, covered, and paychecks were missed.

Discerning Fact from Fiction​

Tony Briningstool, MD, FACEP, Chief Medical Officer
Some of you may remember the old “telephone game” we used to play as children, where you whisper a phrase in the first person’s ear, and they keep whispering it on down the line through multiple people. By the time you reach the last person in line, what that person heard was often vastly different than the original message. This reminds me of how stories can be taken out of context when they pass through the media or are posted on social media sites with comments. In light of the recent attention we have received in the media, I thought this would be a good opportunity to share an update with all of our physicians and advanced practice clinicians of what makes APP special, what we stand for, and provide reassurance to our team amidst these misrepresentations so you are able to discern fact from fiction should you read or hear about APP in the media, social media, or even discussions with colleagues. Our goal is that you are well informed so you can feel proud to work with APP and and also correct misinformation as you come across it.

We built APP to be a specialized management company, intentionally designed to deliver a level of engagement, expertise, and partnership that allows us to differentiate ourselves as an industry leader in quality in the patient care experience and provide an environment that allows our providers to practice at a high level within a winning team environment enhancing their professional satisfaction. Our focus is simply on exceeding the expectations for all those we serve.

As I have shared in other recent articles, the field of Emergency Medicine—and all practice types within the specialty—are facing several headwinds right now which must be navigated well:
  • Medicare reimbursement declines from sequestration and COVID relief starting in Q2 2023
  • Volatile patient volumes, with an overall net loss of more than 800,000 ED visits across our company from our pre-COVID volumes
  • Rising labor costs as physicians, APCs, and nurses leave the job market and companies must rely on more temporary staffing resources
  • Reimbursement volatility secondary to disruption from No Surprise Billing legislation
  • Our hospitals expecting their outsourced partners to share in the financial challenges they are experiencing from reimbursement declines
Despite these headwinds, we are confident we will successfully navigate these situational challenges together. With the strong support from each of our financial partners who are committed to facilitating our success, we will continue to be recognized as an industry leader and to serve in new markets as we grow. It is our collective responsibility as good stewards of our resources to manage our practices thoughtfully and adjust accordingly to any volume and reimbursement changes we experience. Know that we stand steadfast together on our commitment to exceed expectations for our patients, providers, and hospital partners, and to fulfil our mission to deliver safe, compassionate, and efficient care to every patient, every time.

While all of us in healthcare right now are working hard to provide exceptional patient care in a challenging environment, I truly believe that APP is well-positioned for a strong future, and the foundation we are laying today leads to enhanced operational security, access to more best practice resources, and ongoing educational deliverables to further support our clinical care teams. I want to take an opportunity to again “Thank You” for being a part of our journey to excellence.

As always, should you have any questions regarding anything I shared here or other questions about APP’s future, please EMAIL ME, call me at xxx-xxx-xxxx or click the “Ask Tony” button below that appears on every Clinical Update issue
 
EctopicFetus said:
Mostly or all in California, but apparently sent an email to their doctors that they are not going to make payroll for them this month and they will catch up in the next few months. Worth the discussion and light of what happened to a PP, envision bankruptcy, etc. Can’t imagine how bad your finances have to be that you miss payroll makes you wonder if you missed or stop paying your rent or other mandatory expenses as I would imagine missing payroll will be the last thing you wanna do because if I was a physician there, I certainly would not show up to work another shift and expose myself to liability with the concern that they’re not covering my medical malpractice like a PP.
Click to expand...

I was part of a PP previously that imploded like this (thankfully I left and made them cut a check for my tail coverage before they started skipping paychecks for doctors).

Once they started missing payroll, it was a downward spiral. Per the docs I knew who stayed longer than I did, they started “rotating payroll”, ie paying 1/3 of the docs one month, then 1/3 the next month, etc etc. They never made up what they owed to everyone. When they finally imploded, they owed some docs 3-4 months of pay (not sure why those docs kept working when they weren’t getting paid, but some did).

Bottom line: if stuff like this starts happening, run…
 
This is a hail mary to maybe get some bridge loan, some VC money infusion, some buyout, or giving the higher ups time to get some type of golden parachute.

The line docs pawns to allow for the hail mary to work which rarely does. Even if the hail mary works, you are working for a company that is teetering on bankruptcy.

Tough call for line docs to show up to work or not. I may cover for whatever days I am scheduled for a week just to give the pts a safety net. If the hospital doesn't intervene or if there are a shortage of providers, I am out.

As an aside, EM providers are being pressured from all sides and the margins are getting slimmer. Poorer payer mix, more high deductible plans, more uninsured, slower payment, higher cost to collect, higher provider costs, high benefit, higher health insurance, higher med mal.

We are going towards hospitals owning everything.
 
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EctopicFetus said:
Just a reminder of biz speak.
About five months later, they were completely out of business. Docs did not get their tail, covered, and paychecks were missed.

Discerning Fact from Fiction​

Tony Briningstool, MD, FACEP, Chief Medical Officer
Some of you may remember the old “telephone game” we used to play as children, where you whisper a phrase in the first person’s ear, and they keep whispering it on down the line through multiple people. By the time you reach the last person in line, what that person heard was often vastly different than the original message. This reminds me of how stories can be taken out of context when they pass through the media or are posted on social media sites with comments. In light of the recent attention we have received in the media, I thought this would be a good opportunity to share an update with all of our physicians and advanced practice clinicians of what makes APP special, what we stand for, and provide reassurance to our team amidst these misrepresentations so you are able to discern fact from fiction should you read or hear about APP in the media, social media, or even discussions with colleagues. Our goal is that you are well informed so you can feel proud to work with APP and and also correct misinformation as you come across it.

We built APP to be a specialized management company, intentionally designed to deliver a level of engagement, expertise, and partnership that allows us to differentiate ourselves as an industry leader in quality in the patient care experience and provide an environment that allows our providers to practice at a high level within a winning team environment enhancing their professional satisfaction. Our focus is simply on exceeding the expectations for all those we serve.

As I have shared in other recent articles, the field of Emergency Medicine—and all practice types within the specialty—are facing several headwinds right now which must be navigated well:
  • Medicare reimbursement declines from sequestration and COVID relief starting in Q2 2023
  • Volatile patient volumes, with an overall net loss of more than 800,000 ED visits across our company from our pre-COVID volumes
  • Rising labor costs as physicians, APCs, and nurses leave the job market and companies must rely on more temporary staffing resources
  • Reimbursement volatility secondary to disruption from No Surprise Billing legislation
  • Our hospitals expecting their outsourced partners to share in the financial challenges they are experiencing from reimbursement declines
Despite these headwinds, we are confident we will successfully navigate these situational challenges together. With the strong support from each of our financial partners who are committed to facilitating our success, we will continue to be recognized as an industry leader and to serve in new markets as we grow. It is our collective responsibility as good stewards of our resources to manage our practices thoughtfully and adjust accordingly to any volume and reimbursement changes we experience. Know that we stand steadfast together on our commitment to exceed expectations for our patients, providers, and hospital partners, and to fulfil our mission to deliver safe, compassionate, and efficient care to every patient, every time.

While all of us in healthcare right now are working hard to provide exceptional patient care in a challenging environment, I truly believe that APP is well-positioned for a strong future, and the foundation we are laying today leads to enhanced operational security, access to more best practice resources, and ongoing educational deliverables to further support our clinical care teams. I want to take an opportunity to again “Thank You” for being a part of our journey to excellence.

As always, should you have any questions regarding anything I shared here or other questions about APP’s future, please EMAIL ME, call me at xxx-xxx-xxxx or click the “Ask Tony” button below that appears on every Clinical Update issue
Click to expand...
This dude is now the CEO of Emergency Medicine for Sound Physician group. Beware!!
 
JacobMcCandles said:
Briningstool is such an apt name for someone in that position.
Click to expand...
He was quite the used car salesman in real life. So greasy. Touchy feely kind of guy that gave many women the creeps. Rumor is he spent vast sums of money using the APP corporate jet to fly to see his son play football every weekend for Clemson (tight end).

Lots of parallels between APP and Sound:

1) Same CEO
2) Lots of debt
3) Paying large sums of money to fill shifts because working conditions/staffing levels/expertise of staff are bad
4) Bad hospital Admin

If I worked for Sound, I would definitely be saving an emergency fund for Medical Malpractice Tail coverage. Sound is likely to go the way of APP.
 
Porfirio said:
He was quite the used car salesman in real life. So greasy. Touchy feely kind of guy that gave many women the creeps. Rumor is he spent vast sums of money using the APP corporate jet to fly to see his son play football every weekend for Clemson (tight end).

Lots of parallels between APP and Sound:

1) Same CEO
2) Lots of debt
3) Paying large sums of money to fill shifts because working conditions/staffing levels/expertise of staff are bad
4) Bad hospital Admin

If I worked for Sound, I would definitely be saving an emergency fund for Medical Malpractice Tail coverage. Sound is likely to go the way of APP.
Click to expand...
I was wondering if he was related to the tight end based on last name. Glad I didn't have to wait long to find out.

One of the crucial issues with APP was that most of their contract acquisitions (except Houston Methodist) were terrible. They were coming in after Team and Envision had gobbled up many of the available contracts and had already started to shed contracts that were money losers. APP started the game when the meta still allowed for the idea that the only number that mattered was how many contracts you had and how fast that number was going up. Even without 2020, I don't think APP survives because that business model isn't sustainable. I think Sound was starting on firmer footing but maybe we're entering the era of CMGs as vehicles expressly for artificially inflating value then selling out before it collapses. Which is wild considering the stability of the underlying business of providing emergency care.
 
Arcan57 said:
I was wondering if he was related to the tight end based on last name. Glad I didn't have to wait long to find out.

One of the crucial issues with APP was that most of their contract acquisitions (except Houston Methodist) were terrible. They were coming in after Team and Envision had gobbled up many of the available contracts and had already started to shed contracts that were money losers. APP started the game when the meta still allowed for the idea that the only number that mattered was how many contracts you had and how fast that number was going up. Even without 2020, I don't think APP survives because that business model isn't sustainable. I think Sound was starting on firmer footing but maybe we're entering the era of CMGs as vehicles expressly for artificially inflating value then selling out before it collapses. Which is wild considering the stability of the underlying business of providing emergency care.
Click to expand...

The story of APP:

Expanded by borrowing money, bought up contracts, gave prior dudes who owned contracts “equity” in APP, borrowed more money to fund “expansion,” brought in dudes who had equity to be “management” level regional directors and became very top heavy, debt load becomes unsustainable because of no more balance billing and COVID 2020, proceed to cut coverage throughout the organization, over pay for staffing because they burn bridges with docs everywhere, borrow more money to cover being horrible CMG to work for, Goldman Sachs (bank) comes to them and says “your company sucks and we are taking over because you owe us so much debt,” Goldman starts axing dudes left and right, CEO John Rutledge gets guillotined, Tony becomes full fledged CEO (he was the acting CEO during all this because John was a demented old man), the company continues to spiral down while putting on the face that everything is ok, Tony looks for a way out while he knows the ship is sinking, Goldman brings in tons of expensive “consultants” who charge out the arse for hourly fees, Goldman pillages the coffers while getting as much of their owed debt as possible, Goldman finally pulls all the money out of APP accounts, Goldman books an artificial loss and walks away, APP goes belly up, Tony heads to Sound to be CEO of Emergency Medicine, APP keeps billing for months while delaying bankruptcy, Tony gets paid on his way out the door, dudes with “equity” get shafted, docs get double fisted (no pay and no medical malpractice tail), Tony starts day one at Sound as if nothing happened.

Now keep in mind multiple dudes with “equity” lose their shirts. Most notably Congressman Mark Green who was rumored to own $20-25 million in APP equity.

This is the business of Emergency Medicine.
 
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Porfirio said:
The story of APP:

Expanded by borrowing money, bought up contracts, gave prior dudes who owned contracts “equity” in APP, borrowed more money to fund “expansion,” brought in dudes who had equity to be “management” level regional directors and became very top heavy, debt load becomes unsustainable because of no more balance billing and COVID 2020, proceed to cut coverage throughout the organization, over pay for staffing because they burn bridges with docs everywhere, borrow more money to cover being horrible CMG to work for, Goldman Sachs (bank) comes to them and says “your company sucks and we are taking over because you owe use so much debt,” Goldman starts axing dudes left and right, CEO John Rutledge gets guillotined, Tony becomes full fledged CEO (he was the acting CEO during all this because John was a demented old man), the company continues to spiral down while putting on the face that everything is ok, Tony looks for a way out while he knows the ship is sinking, Goldman brings in tons of expensive “consultants” who charge out the arse for hourly fees, Goldman pillages the coffers while getting as much of their owed debt as possible, Goldman finally pulls all the money out of APP accounts, Goldman books an artificial loss and walks away, APP goes belly up, Tony heads to Sound to be CEO of Emergency Medicine, APP keeps billing for months while delaying bankruptcy, Tony gets paid on his way out the door, dudes with “equity” get shafted, docs get double fisted (no pay and no medical malpractice tail), Tony starts day one at Sound as if nothing happened.

Now keep in mind multiple dudes with “equity” lose their shirts. Most notably Congressman Mark Green who was rumored to own $20-25 million in APP equity.

This is the business of Emergency Medicine.
Click to expand...
And now Green is going through a messy and ugly divorce. If you havent read the book plunder about PE it is worth a read and you will quickly learn how these PE dudes win…. Always.. APP took on very bad contracts to show growth. Totally stupid.. even more amazing is Sound hiring him.

I do wonder if sound will survive a little longer much of their biz is hospitalist medicine.. thats a very subsidy heavy business. Nonetheless its buyer beware..

TH refinanced their debt recently and so did USACS.. rates are insane.. USACS at 9 3/4 TH at 13/14%.. not a typo.. the amount of debt is stupid.

APP had 450m in debt for their 150 EDs.. do the math.. its insane..
 
emergentmd said:
Tough call for line docs to show up to work or not.
Click to expand...

Not really. If payroll gets missed, I am not coming to work. It’s just that simple and nothing bad is going to happen to you for doing so. Even if somehow they made the next payroll, I would still be out and in a different job.

I would probably give the CMG/hospital admin 48 - 72 hours to fix the issue (paycheck deposited in my account), and if they don’t, lol.
 
Porfirio said:
The story of APP:

Expanded by borrowing money, bought up contracts, gave prior dudes who owned contracts “equity” in APP, borrowed more money to fund “expansion,” brought in dudes who had equity to be “management” level regional directors and became very top heavy, debt load becomes unsustainable because of no more balance billing and COVID 2020, proceed to cut coverage throughout the organization, over pay for staffing because they burn bridges with docs everywhere, borrow more money to cover being horrible CMG to work for, Goldman Sachs (bank) comes to them and says “your company sucks and we are taking over because you owe us so much debt,” Goldman starts axing dudes left and right, CEO John Rutledge gets guillotined, Tony becomes full fledged CEO (he was the acting CEO during all this because John was a demented old man), the company continues to spiral down while putting on the face that everything is ok, Tony looks for a way out while he knows the ship is sinking, Goldman brings in tons of expensive “consultants” who charge out the arse for hourly fees, Goldman pillages the coffers while getting as much of their owed debt as possible, Goldman finally pulls all the money out of APP accounts, Goldman books an artificial loss and walks away, APP goes belly up, Tony heads to Sound to be CEO of Emergency Medicine, APP keeps billing for months while delaying bankruptcy, Tony gets paid on his way out the door, dudes with “equity” get shafted, docs get double fisted (no pay and no medical malpractice tail), Tony starts day one at Sound as if nothing happened.

Now keep in mind multiple dudes with “equity” lose their shirts. Most notably Congressman Mark Green who was rumored to own $20-25 million in APP equity.

This is the business of Emergency Medicine.
Click to expand...
I have a friend in the FSER world. Pre covid, had 2 successful sites, made good profit, was essentially set for life just running the 2 sites.

They thought it was a great idea getting VC money to expand because it was easy money. You know the story. Got VC money, lost control, FSER was not printing money anymore, VC wanted their money, could not service debt, eventually closed down, and Now back working in the hospital doing LOCUMS.

Greed and debt is never good.
 
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hoot504 said:
Not really. If payroll gets missed, I am not coming to work. It’s just that simple and nothing bad is going to happen to you for doing so. Even if somehow they made the next payroll, I would still be out and in a different job.

I would probably give the CMG/hospital admin 48 - 72 hours to fix the issue (paycheck deposited in my account), and if they don’t, lol.
Click to expand...
I am talking about doing the right thing for the patients. If all ER docs leave, the place shuts down or becomes a shell of an ER. Either way kills pt access to care which I still care about.
 
emergentmd said:
I have a friend in the FSER world. Pre covid, had 2 successful sites, made good profit, was essentially set for life just running the 2 sites.

They thought it was a great idea getting VC money to expand because it was easy money. You know the story. Got VC money, lost control, FSER was not printing money anymore, VC wanted their money, could not service debt, eventually closed down, and Now back working in the hospital doing LOCUMS.

Greed and debt is never good.
Click to expand...

Should have FIRE’d when he had the chance haha
 
Yeah he was one of the early adopters and he said they were printing money. From his volume and what I know, I am sure each site had about a 5+M/yr profit. Greed blinds you. He thought lets take on VC money, open up 3 more and turn that into 25M/yr.

When you are beholden to the lender, you do dumb things.
 
emergentmd said:
I am talking about doing the right thing for the patients. If all ER docs leave, the place shuts down or becomes a shell of an ER. Either way kills pt access to care which I still care about.
Click to expand...
Yep.. sure.. hospital can step up and pay me. If not too bad. I cant care more about patient access than the hospital since you know the federal government says as a doc i cant own my own hospital anymore. I’m not gonna be someone’s B. They want to be the kings of the castle then they have to do king stuff.
 
It sounds like **** keeps getting worse for their docs. Not only do they not get paid, they completely lose any tail coverage on their malpractice insurance and have to pay $$$ out of pocket to cover malpractice tail for any of the patients they saw for NES.
 
That stinks. I would not show up if they can't prove tail coverage.
 
I received corespondce this morning from NES's prior insurance carrier stating all tail coverage was being canceled for NES. I spoke with Michael Richards, insurance agent who previously covered their insurance. He states NES never had tail coverage but as they have now cancelled their coverage. He recommended I call Dr. Allan Rappaport (# 415.990.7979) who I have not received a callback from. Does anyone have information related to this? I've included the passage from my prior NES contract below which seemingly implies they will cover all incidents (tail?) at $1/$3million. Please let me know your thoughts
1732567016450.png
 
W22.0 said:
I received corespondce this morning from NES's prior insurance carrier stating all tail coverage was being canceled for NES. I spoke with Michael Richards, insurance agent who previously covered their insurance. He states NES never had tail coverage but as they have now cancelled their coverage. He recommended I call Dr. Allan Rappaport (# 415.990.7979) who I have not received a callback from. Does anyone have information related to this? I've included the passage from my prior NES contract below which seemingly implies they will cover all incidents (tail?) at $1/$3million. Please let me know your thoughts
View attachment 395649
Click to expand...
The patient will sue you and you won’t have malpractice coverage unless you pay for it. You could always try to sue NES but you can’t get blood from a turnip. Your contract is basically worthless now.

If it were me, I’d make sure I had malpractice coverage even if that meant I had to pay for it. This should go without saying but I wouldn’t continue working for them (which I hope you’re not).
 
Dam..... If I worked and did not have tail coverage, I would be pissed. I don't get pissed often, but this is leaving docs out to dry. Have a bad case, don't have insurance, then they will go after your personal assets.

The cost of tail is expensive too. geez..
 
Docs should consult a lawyer and ask the hospital to cover their tail. It would actually benefit the hospital. If a doc is bare, who do you think has the deepest pockets in the case of a suit? It ain't the doc. The juice is usually not worth the squeeze to go after their assets. The plaintiff lawyers want big money quick. It will be small money, slow. The hospital is now more exposed.
 
Docs need to come together and tell the hospital to pay for the tail or en masse they wont show tomorrow. Period.. full stop.. flex your muscle ASAP.. time is not on your side.
 
RustedFox said:
This is the kind of corporate nonsense that needs to be prosecuted.
Click to expand...


Unfortunately, this is the kind of thing that has been set up to happen and is supported.

Congress, CMS and every lawyer on the street knows the system is set up to let the cogs of the machine hang out to dry to protect the cash cows (hospital). This isn't a bug, it's a feature.

To whomever said docs won't get sued but hospitals will, probably also not true. Hosptials have actual coverage! And paid attorneys! The doc isn't worth much but it's the low hanging fruit to grab easily in this case--blindside the docs, smash and grab what you can get.

I do wish we could make CMGs go away. Id prefer a system that enforces sdgs that by law can't be larger than regional systems but can collectively bill as a large entity across the nation for better insurance negotiations.

Unfortunately congress writes the laws and they are owned by insurance companies so this is how this happens.
 
RustedFox said:
This is the kind of corporate nonsense that needs to be prosecuted.
Click to expand...
LOL. In America?

A land where you can commit brazen Medicare fraud, walk away with a $400m payout, be under FBI investigation, run for Senate in Florida and still win?

Don't hold your breath.
 
Last edited:
Never mind. Looks like they went completely bust

www.medpagetoday.com

Another Emergency Medicine Staffing Firm Goes Under

Doctors still not paid, now on the hook for malpractice tail coverage
www.medpagetoday.com www.medpagetoday.com

www.masslive.com

Holyoke Medical Center ER docs, hospital scramble as staffing company closes suddenly

Patients at the Holyoke emergency room – which sees 40,000 visits a year – shouldn’t notice a change, the hospital said.
www.masslive.com www.masslive.com

Getting to the point where you need to demand cash up front before working a shift for some of these CMGs
 
ERMudPhud said:
Never mind. Looks like they went completely bust

www.medpagetoday.com

Another Emergency Medicine Staffing Firm Goes Under

Doctors still not paid, now on the hook for malpractice tail coverage
www.medpagetoday.com www.medpagetoday.com

www.masslive.com

Holyoke Medical Center ER docs, hospital scramble as staffing company closes suddenly

Patients at the Holyoke emergency room – which sees 40,000 visits a year – shouldn’t notice a change, the hospital said.
www.masslive.com www.masslive.com

Getting to the point where you need to demand cash up front before working a shift for some of these CMGs
Click to expand...
Wait til USACS implodes.. 2026 is around the corner..
 
EctopicFetus said:
Wait til USACS implodes.. 2026 is around the corner..
Click to expand...
I'm fuzzy on the details and thankfully don't work for them. I know USACS is saddled with a ton of debt, do they have some balloon payment in 2026?
 
EctopicFetus said:
Wait til USACS implodes.. 2026 is around the corner..
Click to expand...
I'm not sure but I think they managed to refinance their debt and cut their interest rate to just under 10% so that may have kicked the can down the road to 2028 or so.
 
ERMudPhud said:
I'm not sure but I think they managed to refinance their debt and cut their interest rate to just under 10% so that may have kicked the can down the road to 2028 or so.
Click to expand...
The did refi.. but not that amount thats due in 2026.. thats still coming.. they will refi.. the new loan is at 9.75% from what i read. I think was $800m.. paying for locums coverage is gonna wreck them.. they are pushing hard to get that fixed so i hear. 2026 i hear from insiders is a critical year for them.. that initial Apollo loan is due.. my math says its about 75m in interest they are paying.. 10m visits.. about 170/visit.. $7.5 from each visit is gone.. about $10 per visit for medical director billing and coding and med mal (would be on the low end). Suddenly its $152.50 per patient before the scheduler, the docs and mlps and all the mid level managers.. its not pretty..
 
emergentmd said:
9.75% interest on 800M? They going down
Click to expand...

But not before golden parachutes are handed out, I'm sure.

Makes me sick. Hell, ought to be prosecuted.

I sponsor a man who did hard time. If he doesn't pay his probation costs, he goes back to jail. Monthly struggle for him when he's really getting his life back on track.

Send corporate people to prison.

EDIT: Iceland sent their bankers to prison after the 2009 financial meltdown. For as often as these Scandinavian nations are praised for their (whatever policy is praised), we need to do THIS, too.
 
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