Opportunities in Colorado?

[Euripides]

FYI. Heard yesterday that USAP is exiting a number of Centura Health and HCA hospital contracts in Denver pending a USAP Colorado partner vote. Can’t recruit enough to cover the losses of those leaving USAP and the finances are upside down. Those of you wiling to relocate have a chance to set up your own practices or in partnership with others. Something frequently discussed in this forum.

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[ryanjmy]

Those of you wiling to relocate have a chance to set up your own practices or in partnership with others. Something frequently discussed in this forum.

That's not how this works. The hospital will put out a request for proposal and the usual ****ty employers will surface and get the contract. Local guys might have a shot but an unknown anesthesiologist or group of MDs doesn't.

 

[Euripides]

That's not how this works. The hospital will put out a request for proposal and the usual ****ty employers will surface and get the contract. Local guys might have a shot but an unknown anesthesiologist or group of MDs doesn't.

Typically yes but there is an opportunity. Ever see multiple hospitals in one area all lose coverage at once? Shut down all their procedural areas that require anesthesia? Chaos creates opportunity but I understand it‘s too bold for many.

 

[GassYous]

I don't think that they would drop their better reimbursing spots first so...

 

[amyl]

With rising labor prices USAP is triaging business. We have done so in Texas - although I don’t know directly about Colorado I would I imagine it’s the same. Some places/contracts aren’t as lucrative anymore.

 

[BLADEMDA]

With rising labor prices USAP is triaging business. We have done so in Texas - although I don’t know directly about Colorado I would I imagine it’s the same. Some places/contracts aren’t as lucrative anymore.

Hospitals need to pony up larger and larger subsidies in order to maintain group profitability. USAP, Envision, NAPA, Northstar, Team health, Sound, etc all want to make money. The CEOs/CFOs are stuck in the mindset that some other group will take less than the current one needs/wants to maintain the contract. Typically, these CEOs/CFOs are wrong and are on the hook for more stipend money than they bargained for. Regardless of whether the hospital goes in house or hires another AMC the stiped is going up.

Market forces dictate wages not AMCs or CEOs any longer. This is a change in the paradigm and USAP knows it. The new mantra in the AMC business is profitability not size so everyone is willing to give up on the losers.

 

[BLADEMDA]

This entire specialty needs to catch up to the CRNAs in terms of salary increases over the past 2 years. CRNAs have no problem getting wage increases above COLA these past 2 years. Anesthesiologists now want the same treatment and are getting it as well. This puts pressure on hospitals to pony up a larger stipend. In the end, they will have no choice but to do so.

The days of paying an Anesthesiologist $400K for a 50 hour per week job are pretty much over because a large enough % of the labor pool are saying "no mas". "Show me the money" means either pay me fair market wages or I am going elsewhere.

 

[ERRES2288]

This entire specialty needs to catch up to the CRNAs in terms of salary increases over the past 2 years. CRNAs have no problem getting wage increases above COLA these past 2 years. Anesthesiologists now want the same treatment and are getting it as well. This puts pressure on hospitals to pony up a larger stipend. In the end, they will have no choice but to do so.

The days of paying an Anesthesiologist $400K for a 50 hour per week job are pretty much over because a large enough % of the labor pool are saying "no mas". "Show me the money" means either pay me fair market wages or I am going elsewhere.

That’s what’s so tough to figure out and really depends on location.

 

[BLADEMDA]

That’s what’s so tough to figure out and really depends on location.

There is one HUGE market for anesthesia services in the USA. There are pockets of certain areas where the hospitals can exploit the labor pool of providers because "everyone" wants to live there. This was working well for the CEOs up until the pandemic. Now, post pandemic, all providers want to get paid fairly based on the national demand for services. Hence, I expect over time a gradual narrowing of these huge salary discrepancies we see in regions. They will still exist because in some areas the pay is for solo practice vs ACT vs collaborative practices/models. However, as CRNA pay approaches $250K the financial incentive for the ACT model diminishes if the CEO/CFO can hire you for $450K-$475K. The CEO/CFO can get more hours out of you for that pay, 45 hours vs 40 hours for the CRNA, plus a lot of "non paid" call shifts.

 

[<(^_^)>]

There is one HUGE market for anesthesia services in the USA. There are pockets of certain areas where the hospitals can exploit the labor pool of providers because "everyone" wants to live there. This was working well for the CEOs up until the pandemic. Now, post pandemic, all providers want to get paid fairly based on the national demand for services. Hence, I expect over time a gradual narrowing of these huge salary discrepancies we see in regions. They will still exist because in some areas the pay is for solo practice vs ACT vs collaborative practices/models. However, as CRNA pay approaches $250K the financial incentive for the ACT model diminishes if the CEO/CFO can hire you for $450K-$475K. The CEO/CFO can get more hours out of you for that pay, 45 hours vs 40 hours for the CRNA, plus a lot of "non paid" call shifts.

Exactly. I also imagine mortgage rates + housing prices going up means that formerly “desirable” areas aren’t nearly as desirable. Cost of housing has literally doubled over last 2 years (factoring in interest rates + higher property taxes) in many desirable areas now. Makes it more tempting for people there to leave, and less tempting for new people to move there.

 

[Shimmy8]

CEOs are also getting tired of footing the bill via subsidy for AMCs to make major profits.

 

[Howard888]

Opportunities in Colorado?

FYI. Heard yesterday that USAP is exiting a number of Centura Health and HCA hospital contracts in Denver pending a USAP Colorado partner vote. Can’t recruit enough to cover the losses of those leaving USAP and the finances are upside down. Those of you wiling to relocate have a chance to set up...

forums.studentdoctor.net

Rumors from Colorado true. All you folks on here thinking USAP should think twice….again not all the same, Dallas ok per folks, Austin the worst per folks.

First Mednax, then Napa, now USAP.. if you can get a could deal -take it, just make sure you’re flexible on leaving when the crash comes

 

[Ashers]

I also heard that they pulled out of places in San Antonio. I heard that EmergencHealth took over for USAP in at least one of the health systems.

 

[chocomorsel]

I also heard that they pulled out of places in San Antonio. I heard that EmergencHealth took over for USAP in at least one of the health systems.

Damn. San Antonio used to be so good.

 

[Ashers]

Damn. San Antonio used to be so good.

Lots of locums jobs being advertised there now. More than before with USAP.

 

[Status Sciaticus]

I also heard that they pulled out of places in San Antonio. I heard that EmergencHealth took over for USAP in at least one of the health systems.

I very nearly took that job too, but got that sense that they were in a downward spiral. Hope they dont lose the city though, because Envision is absolutely garbage in SA

 

[epcotdoc]

When I interviewed with SA they told me they were giving up some of their lower paying (actually said some of the places cost them money to continue to staff) contracts to prioritize staffing their better paying places. Can’t say I blame them in this environment.
Looks like according to gaswork emergence will be adding CRNAs “working at the top of their license”

 

[sevoflurane]

Tejas and Star were ok back in the day. Those days are LONG gone.

Surprised to see USAP failing in CO. They had something like 17 centura hospitals.

A lot of cracks in AMCs lately.

 

[sevoflurane]

FYI. Heard yesterday that USAP is exiting a number of Centura Health and HCA hospital contracts in Denver pending a USAP Colorado partner vote. Can’t recruit enough to cover the losses of those leaving USAP and the finances are upside down. Those of you wiling to relocate have a chance to set up your own practices or in partnership with others. Something frequently discussed in this forum.

Possible. Local docs w no non-competes have the highest chance of picking up a contract- especially at surgery centers which typically have a descent payor mix.

 

[Shimmy8]

I wouldn’t be surprised if a lot of these hospitals they’re backing out of simply aren’t profitable.

Paying locums/OT rates just to break even doesn’t cut it long term for a smart group. Better to contract, fortify the profit centers and staff them appropriately and keep those places happy than slog your way through pissing everyone off (own employees and hospitals) by being short.

I commend those groups that are willing to cut shops where hospitals won’t play ball with fair subsidies.

 

[nycitygas]

I'm sure these hospitals have terrible payor mixes and were basically being subsidized by the larger practice. The hospitals in the end will end up paying more in subsidy to the new groups.

 

[amyl]

USAP is definitely triaging business and quitting the contracts that don’t make sense financially. Kind of have to these days… with rising labor costs.
Lots of people, especially hospital admins (and some doctors) think these labor cost surges are temporary.
It will be interesting to see how this all plays out over the next few years

 

[dannyboy1]

The endgame is definitely here for PE/AMC’s. They simply can’t find enough suckers to work for their terrible contracts. They can’t offer better contracts because that is their profit margin. For some reason they have no problem giving top $$ to locums to serve as band aids. Maybe it looks good on their books through some accounting magic but eventually it will catch up…

 

[undalay]

Colorado is one of the worst places to work. Lots of anesthesiologists have tried it and moved on.

 

[Blockit]

Colorado is one of the worst places to work. Lots of anesthesiologists have tried it and moved on.

Why is that, out of curiosity?

 

[chocomorsel]

Why is that, out of curiosity?

When I interviewed there, the pay was low. I guess that’s the price to pay for the beauty of Colorado.

 

[ASA6]

Possible. Local docs w no non-competes have the highest chance of picking up a contract- especially at surgery centers which typically have a descent payor mix.

This basically already happened and is why they are so unprofitable. After the 5 year handcuffs ended a lot of senior anesthesiologists broke off and took lucrative surgery center contracts (heavy ortho ones). I believe there were a few lawsuits over it that ended up settling in favor of the new groups. Now they are left mostly just staffing the hospitals.

 

[aneftp]

Maybe Colorado (and Texas and even more areas haven’t caught up with the rest of the country. Even in high amc areas. The going rate is mid 450s BEFORE WEEKEND call incentives. That’s with 9-10 weeks paid off as well. So that’s 40 hours a week on average for 450K which isn’t bad.

So weekend calls incentive pushes pay into the low to mid 500s. At least those are contracts I have seen (and friends who actually work there) from florida all the way up the mid Atlantic up to up state New York.

Now you are running around covering 3 and sometimes 4 rooms or doing solo cases. It’s not easy at some of these places. But the physical hours working are averaging 40 hours a week excluding weekends calls. The week day calls are never 24 hours.

This is just my experience and me talking to my big network of friends or acquaintances I text.

 

[ERRES2288]

Maybe Colorado (and Texas and even more areas haven’t caught up with the rest of the country. Even in high amc areas. The going rate is mid 450s BEFORE WEEKEND call incentives. That’s with 9-10 weeks paid off as well. So that’s 40 hours a week on average for 450K which isn’t bad.

So weekend calls incentive pushes pay into the low to mid 500s. At least those are contracts I have seen (and friends who actually work there) from florida all the way up the mid Atlantic up to up state New York.

Now you are running around covering 3 and sometimes 4 rooms or doing solo cases. It’s not easy at some of these places. But the physical hours working are averaging 40 hours a week excluding weekends calls. The week day calls are never 24 hours.

This is just my experience and me talking to my big network of friends or acquaintances I text.

450k straight salary for 40 hrs? I mean that’s 7-3 everyday. And for no nights, weekends, and 9 weeks off? Market is good yes and everywhere is hiring but I haven’t seen that where I’m at in Midwest

 

[aneftp]

450k straight salary for 40 hrs? I mean that’s 7-3 everyday. And for no nights, weekends, and 9 weeks off? Market is good yes and everywhere is hiring but I haven’t seen that where I’m at in Midwest

Yup. It averages to 40 hours a week. Before weekend call incentives.

Work one day 11 hours. Monday (No call)
Next day off Tuesday off
Work the next day work 8 hours. Wednesday
Next day work 5 hours (early out) Thursday
The next day 8 hours. Friday

Just do the math. That’s 32 hours for the week.
Than add in $5000-6000 per 24 hour weekend. Call. Or $1000 backup

These things add up.

There are quite a few of these jobs up and down the east coast.

Or if u are an 8 hour person that day. U get $300/hr extra to stay past 3 as w2.

We are just in a weird market these days.

 

[Status Sciaticus]

Yup. It averages to 40 hours a week. Before weekend call incentives.

Work one day 11 hours. Monday (No call)
Next day off Tuesday off
Work the next day work 8 hours. Wednesday
Next day work 5 hours (early out) Thursday
The next day 8 hours. Friday

Just do the math. That’s 32 hours for the week.
Than add in $5000-6000 per 24 hour weekend. Call. Or $1000 backup

These things add up.

There are quite a few of these jobs up and down the east coast.

Or if u are an 8 hour person that day. U get $300/hr extra to stay past 3 as w2.

We are just in a weird market these days.

where exactly are you seeing this setup?

 

[aneftp]

where exactly are you seeing this setup?

Florida Virginia New York just to name a few. These are not “easy” places to work but the hours are reasonable. Mainly 1:4. Some solo cases.

Envison napa hca etc. many are adjusting to market conditions. The craizer the shortage. The better for full time docs work hours. I know it sounds strange but that’s why the full time docs stay. Symbiotic relationships with locums etc.

I suspect these working conditions will last for the next 2-3 years.

Only good thing is the crnas locums are asking for $225/250 an hour as well. So some of us may bugged by crna’s but they actually are causing MD income to raise by virtue of their own salary demands.

 

[sevo00]

Florida Virginia New York just to name a few. These are not “easy” places to work but the hours are reasonable. Mainly 1:4. Some solo cases.

Envison napa hca etc. many are adjusting to market conditions. The craizer the shortage. The better for full time docs work hours. I know it sounds strange but that’s why the full time docs stay. Symbiotic relationships with locums etc.

I suspect these working conditions will last for the next 2-3 years.

Only good thing is the crnas locums are asking for $225/250 an hour as well. So some of us may bugged by crna’s but they actually are causing MD income to raise by virtue of their own salary demands.

My crna friend gets 307 a hr for overtime doing locums In Virginia

 

[anbuitachi]

thats good to know docs are walking

 

[aneftp]

My crna friend gets 307 a hr for overtime doing locums In Virginia

Yup. The more crnas demand. The higher the rate the docs get

Notice the aana no longer markets crna’s are “cheaper” to employ. Aana just markets crna’s are cheaper to train these days.

Administrators know this.

 

[gasguy]

Seems like a good time for the ASA to partner up with the AHA to pressure Congress to increase Medicare payment for anesthesia services. The reason hospitals need to provide subsidies is often directly due to “poor payor mix” (read high Medicare / Medicaid). Why should the hospitals have to pony up subsidies for anesthesia groups when the main issue is that payment is too low?

 

[aneftp]

Seems like a good time for the ASA to partner up with the AHA to pressure Congress to increase Medicare payment for anesthesia services. The reason hospitals need to provide subsidies is often directly due to “poor payor mix” (read high Medicare / Medicaid). Why should the hospitals have to pony up subsidies for anesthesia groups when the main issue is that payment is too low?

On the flip side. Usap only exist due to the good payor mix hospitals. There is no profit in poor payor mix hospitals for usap even with subsidies.

Do you think it’s fair for anesthesia to get paid the equivalent of $500-700 for a 5 min egd with commercial insurance?

That’s the real issue with anesthesia

My ortho friends get paid around 70% up to 80% for Medicare Vs commercial insurance.

Obviously anesthesia Medicare reimbursements are so low as a percentage of commercial. But commercial insurance is overly inflated.

So we are stuck.

 

[gasguy]

Well, you’re correct in that the USAPs and PE-run practices only exist because of good payor mix hospitals. Their goals are to make as much profit as possible - that’s capitalism.

My main point however, was just to say that I think hospitals would have a vested interest in lobbying Congress to provide fair Medicare payments for anesthesia services. The AHA is a powerful lobby and when combined with efforts from the ASA maybe we could finally make some progress on the despicably low Medicare payments.

And, to answer your question I 1000% believe that $500 as payment for anesthesia for an EGD is perfectly reasonable ($700 may be a tad much). I don’t think that is overly inflated at all. I value my time, my expertise, the years of hard work, training, suffering, and dedication that it took to get to where I am. I think a huge problem is that our society and government don’t value it enough, and sadly it seems that some of my colleagues don’t either.

 

[aneftp]

Well, you’re correct in that the USAPs and PE-run practices only exist because of good payor mix hospitals. Their goals are to make as much profit as possible - that’s capitalism.

My main point however, was just to say that I think hospitals would have a vested interest in lobbying Congress to provide fair Medicare payments for anesthesia services. The AHA is a powerful lobby and when combined with efforts from the ASA maybe we could finally make some progress on the despicably low Medicare payments.

And, to answer your question I 1000% believe that $500 as payment for anesthesia for an EGD is perfectly reasonable ($700 may be a tad much). I don’t think that is overly inflated at all. I value my time, my expertise, the years of hard work, training, suffering, and dedication that it took to get to where I am. I think a huge problem is that our society and government don’t value it enough, and sadly it seems that some of my colleagues don’t either.

Agree. There has to be some middle ground. But govt and insurance wouid rather pay anesthesia on the low end close to Medicare rates which are extremely artificially low as a percentage commercial rates.

I mean. Commercial ob rates pay something like $4000-5000 per epidural plus 10 hours running time easy these days. And Medicare is 1/8 of that.

So where is the middle ground?

Off anesthesia topic I don’t think spine docs should get paid as much as they do. But that’s off topic

 

[UscGhost]

On the flip side. Usap only exist due to the good payor mix hospitals. There is no profit in poor payor mix hospitals for usap even with subsidies.

Do you think it’s fair for anesthesia to get paid the equivalent of $500-700 for a 5 min egd with commercial insurance?

That’s the real issue with anesthesia

My ortho friends get paid around 70% up to 80% for Medicare Vs commercial insurance.

Obviously anesthesia Medicare reimbursements are so low as a percentage of commercial. But commercial insurance is overly inflated.

So we are stuck.

Yea $500 for an EGD is reasonable.

A plumber or HVAC will charge you $75 just to come out and tell you how much more he will charge you. A basic repair can easily cost 2-300 for an hr of time

Just because it's easy for us to do because of our extensive training doesn't mean our service should be undervalued

 

[GravelRider]

Yea $500 for an EGD is reasonable.

A plumber or HVAC will charge you $75 just to come out and tell you how much more he will charge you. A basic repair can easily cost 2-300 for an hr of time

Just because it's easy for us to do because of our extensive training doesn't mean our service should be undervalued

Yup. I recently had an HVAC guy come to my house and it was $125 just for him to show up then another $200 for work that took an hour. So, $325 for the guy to be at my house for an hour (it would have been more if I didn’t get the cash “discount”).

 

[Pappy Van Propofol]

Agree. There has to be some middle ground. But govt and insurance wouid rather pay anesthesia on the low end close to Medicare rates which are extremely artificially low as a percentage commercial rates.

I mean. Commercial ob rates pay something like $4000-5000 per epidural plus 10 hours running time easy these days. And Medicare is 1/8 of that.

So where is the middle ground?

Off anesthesia topic I don’t think spine docs should get paid as much as they do. But that’s off topic

Where is an epidural $4-5k? I want to move there and do OB only. Holla at me.

 

[IMGASMD]

Where is an epidural $4-5k? I want to move there and do OB only. Holla at me.

It may be senior partner only job. Not only 4K PLUS 10 hr time units!!!!!

For that kind of money I am moving…. And sign me up for OB all day everyday

 

[Southpaw]

I mean. Commercial ob rates pay something like $4000-5000 per epidural plus 10 hours running time easy these days. And Medicare is 1/8 of that.

Never heard of this. My guess is if it’s happening it’s extremely rare. I don’t want anyone reading to get misinformation here. And there are few to no medicare labor epidurals, but a lot of Medicaid epidurals. Medicaid pays worse than Medicare.

 

[aneftp]

Where is an epidural $4-5k? I want to move there and do OB only. Holla at me.

Those are routine anesthesia payments down in the south. Trust me. I’ve been responsible for paying such a bill from an anesthesia company for my child ($6000 high deductible family plan).

$2500 for anesthesia for 30 min c/s.

This is not a joke. It’s routine responsibly from the insured to the anesthesia company.

The ridiculous nature of this is the global Ob provider fee is $4500 for all those visits plus $500 for the c/s.

 

[Southpaw]

Those are routine anesthesia payments down in the south. Trust me. I’ve been responsible for paying such a bill from an anesthesia company for my child ($6000 high deductible family plan).

$2500 for anesthesia for 30 min c/s.

This is not a joke. It’s routine responsibly from the insured to the anesthesia company.

The ridiculous nature of this is the global Ob provider fee is $4500 for all those visits plus $500 for the c/s.

For this to be true we'd need two variables to be accurate:

X - contract rate of $200/unit or more
Y - billing 20-25 units, on average, for a labor epidural

Since the extreme large majority of practices in the South do not get $200/unit (my guess is out of all of them, and out of all of their contracts, there may be 1 or 2 contracts that give this rate, and they're AMCs) and most labor epidurals do not bill for 20-25 units, then your statement is not true for the extreme large majority of practices.

If X were $100/unit then it gets even more absurd. Y would necessitate 40-50 units, on average. It's not happening.

Also, most insurers these days, to my knowledge, are reimbursing labor epidurals at a flat rate.

Your reimbursement for a CS is wrong for the same reasons.

Don't get me wrong. I wish it were true! But it's not happening. I'm sorry you're wife was cared for by the 0.1% AMC with the best contract out there, and that she was in labor forever. Hope all ended well!

 

[aneftp]

For this to be true we'd need two variables to be accurate:

X - contract rate of $200/unit or more
Y - billing 20-25 units, on average, for a labor epidural

Since the extreme large majority of practices in the South do not get $200/unit (my guess is out of all of them, and out of all of their contracts, there may be 1 or 2 contracts that give this rate, and they're AMCs) and most labor epidurals do not bill for 20-25 units, then your statement is not true for the extreme large majority of practices.

If X were $100/unit then it gets even more absurd. Y would necessitate 40-50 units, on average. It's not happening.

Also, most insurers these days, to my knowledge, are reimbursing labor epidurals at a flat rate.

Your reimbursement for a CS is wrong for the same reasons.

Don't get me wrong. I wish it were true! But it's not happening. I'm sorry you're wife was cared for by the 0.1% AMC with the best contract out there, and that she was in labor forever. Hope all ended well!

I have the anesthesia bill. I wish I were lying but I’m not. And it wasn’t an amc at the time. It was a private practice. They actually sold out years ago and the ob anesthesia bill is even higher in 2022

 

[DirtDocMD]

Yea $500 for an EGD is reasonable.

A plumber or HVAC will charge you $75 just to come out and tell you how much more he will charge you. A basic repair can easily cost 2-300 for an hr of time

Just because it's easy for us to do because of our extensive training doesn't mean our service should be undervalued

Yep. We ought to at least be making slightly more than an auto mechanic or plumber, for “government time” (Medicare/Medicaid).

Look at a medicaid 1-hour pedi dental rehab case. A 5 unit start and 4 time units. (9 x $18 to $20). That’ll get you just $150 to $175.

Do you like making $150 to $175, with a HIGH liability potential case, at HALF the rate a locums company would pay you for an hour of work?? Bad enough the pay is low, and you’re doing the work at cut-rate so some dentist can make bank yanking/capping baby teeth. THEN add the potential for a multi-million dollar lawsuit (because—-kiddo). It’s absolutely ridiculous. A similar case could be made for Medicare pts with laundry lists of problems (Hey, it happens when you hit 75-80...). HIGH difficulty management for LOW pay..

 

[midazzoler]

$125 initial fee and $175/hr for a plumber must be commercial rates.

What does Medicare reimburse? Can the plumber bill for the balance? Does the plumber get dinged if there isn’t an EMR? If the plumber could charge a facility fee would you have to bring in your clogged toilet? Did the plumber have to get prior authorization?

Like with medical errors there are many factors that contribute to a poor outcome.

 

[IMGASMD]

$125 initial fee and $175/hr for a plumber must be commercial rates.

What does Medicare reimburse? Can the plumber bill for the balance? Does the plumber get dinged if there isn’t an EMR? If the plumber could charge a facility fee would you have to bring in your clogged toilet? Did the plumber have to get prior authorization?

Like with medical errors there are many factors that contribute to a poor outcome.

21.56 per unit. Colonoscopy, therefore, 3 (base) + 1 (time) = 4 ~$87.

No. But I hope the price is agreed upon before they start. Unlike surgery/anesthesia they can walk away in the middle of the job.

I’d like to see them spend as much time documenting and not getting paid for their time.

I suppose if I can transport my toilet, so they charge less, I’d do it.

No but like I said before, I hope the price is agreed upon before they get started. Also maybe, if it was a claim against home insurance.

My partner likes to say, Medicaid epidurals pay about the same amount as one of our epidural kit costs us. So we are taking on liability for 18+ years, for nothing.

Edit: clarification.