practice takeover by AMC

[Jeff05]

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so if a practice is taken over by an AMC and physicians stay on and work for the AMC - what does this mean for their job security?

 

[joepinkslip]

so if a practice is taken over by an AMC and physicians stay on and work for the AMC - what does this mean for their job security?

The AMC will say anything to try to keep current anesthesiologists from attempting to fight their hostile take over of your anesthesia department. Little of what the AMC says will turn out to be true, but carefully sculpted from many previous hostile anesthesia group takeovers to trick current anesthesiologists into thinking they are your friends and working only for your benefit.


As soon at the AMC gets a strangle hold on the hospital, the promised increase in pay will never appear but the current anesthesiologists will see a drastic cut pay and if they dare to complain, they will quickly get fired. In a year the group will be composed of mostly of cheaper anesthesiologists that AMC's prefer to employ, i.e Visa workers, new graduates, and workers with license and / or competency issues.

 

[militarymd]

so if a practice is taken over by an AMC and physicians stay on and work for the AMC - what does this mean for their job security?

Usually pretty good. The hospital still needs bodies. They just want new management.

However, a couple of the "troublemakers" in the old group will usually be asked to leave.

 

[deleted126335]

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[urge]

The AMC will say anything to try to keep current anesthesiologists from attempting to fight their hostile take over of your anesthesia department. Little of what the AMC says will turn out to be true, but carefully sculpted from many previous hostile anesthesia group takeovers to trick current anesthesiologists into thinking they are your friends and working only for your benefit.


As soon at the AMC gets a strangle hold on the hospital, the promised increase in pay will never appear but the current anesthesiologists will see a drastic cut pay and if they dare to complain, they will quickly get fired. In a year the group will be composed of mostly of cheaper anesthesiologists that AMC’s prefer to employ, i.e Visa workers, new graduates, and workers with license and / or competency issues.

Didn't your group get taken over by an AMC? How did it go. Are you working for the AMC now? Did your salary drop? Did your hours go up?

 

[joepinkslip]

Didn't your group get taken over by an AMC? How did it go. Are you working for the AMC now? Did your salary drop? Did your hours go up?

With a little time and some explaining the majority of the Anesthesiologists saw that working for the AMC is not a desirable change in the practice environment. They saw that working for the AMC was going to mean a big cut in pay, along many more hours, more call and less autonomy. We got the surgeons on board and the administrators who were pushing for the AMC finally backed off.

The trouble makers that Mil talks about, is anyone who has the strength to stand up to the AMC, question their lies, and worse of all to talk their fellow anesthesiologists about the how the AMC plans to destroy the anesthesia practice environment.

The basic economic reality is that there is only so much money that an anesthesia practices can generate. The AMC owner will lie all day long about how they will improve efficiency, how they are how the will reorganize the schedule, how they will improve billing and collections, thus making the practice so much more successful. The truth is while the AMC may be able to make small changes to improve efficiency and collections, their need to take a 25% to 50% management fee will guarantee that working for the AMC is going to mean a big cut in pay, along more hours, and more call.

 

[g3pro]

What is "AMC"?

 

[huron]

What is "AMC"?

Anesthesia management company [AMC] is a for profit entity that will con the hospital administrators into getting the exclusive anesthesia contract and then do everything in their power to make as much money as possible. Despite a constant stream of lies to the contrary, treating employees fairly and honestly or providing quality anesthesia services are not important goals of the AMC. The one and only goal of the AMC is to make as much money as possible for its, out of town absentee, owner.



Press release by an AMC proposing to train clueless hospital adminstrators into choising the best AMC;

The five rules for choosing the right anesthesia management company
The decision to use an anesthesia management company [AMC] is not an easy one. It often comes at a time when other options have been explored and proven to be incomplete, untimely or both. Using an AMC is not a magic elixir and, depending upon the issues the facility is facing and its expectations, desired outcomes may or may not be fully achievable. An AMC can very often improve situations but how much and at what operational and financial costs may be uncertain. The anesthesia predicaments faced by most institutions generally center on staffing, department development, contracting, revenue management and quality improvement. The overarching quandary, however, is how to solve these problems in the most efficient and effective ways given the fiscal constraints faced by nearly all facilities and the relative scarcity of anesthesia providers.


Rule 1: Identify the most appropriate type of AMC for your facility

Some AMC’s focus on providing term-limited consultative services, others concentrate on implementation and several offer both. When it comes to choosing your AMC, the latter company usually offers more deployable resources to assess and solve problems. In any case, however, the AMC should have a core focus on anesthesia and the infrastructure to support it.

It has become fashionable for many physician practice management companies [PPM] to enter new specialty lines. Pediatric, neonatology or infertility PPM’s, ASC’s and hospital management companies have, or may enter the anesthesia space. Be very cautious however, anesthesia is fairly unique and the operational, financial and administrative issues have little to no transference to other specialties. Moreover, if an AMC has entered, or is entering a new specialty or service line, this may cause resource diversion and take corporate focus off of anesthesia. Finally, anesthesia is now delivered in three venues—hospitals, surgery centers and office-based surgical facilities. Even if a facility limits its scope to one venue, engaging an AMC that understands the interplay between the three environments may have strategic utility.

Rule 2: A needs analysis and assessment [NAP] should prelude engaging an AMC

A consultative experience is instrumental to specifically define the breadth and depth of pre-existing problems and provide some guidance on corrective measures and their associated cost. Generally speaking, the on-site component should take 3 to 7 days and involve meetings with multiple levels of the administrative and clinical hierarchy.

The consultative experience and resulting NAP should be performed by professionals that have experience and expertise in both the clinical and operational aspects of administering an anesthesia department, as well as first-tier business acumen and an appreciation for local, regional and national anesthesia marketplace issues. One mistake commonly made by facilities is to retain consultants who have little or no anesthesia-specific clinical experience. An OR administrator, nurse technician or seasoned consultant is not an anesthesiologist and their expertise, although useful in some aspects, will cause anesthesia service issues to be viewed through a colored prism.

One critical part of a NAP is an inventory of operating room staffing needs, from the perspective of all relevant stakeholders. There is usually some misalignment from a needs assessment perspective, which the NAP should reconcile. For instance, administration may want to improve efficiency by shifting more volume towards regular weekday hours, but surgeons may be accustomed to scheduling “elective” procedures after hours, thus causing accommodation difficulties. If the anesthesia department goals articulated by senior administration are discordant with operational demands, unhappy surgeons, anesthesia providers and operating room staff is the likely outcome.

Obtaining buy-in from the existing anesthesia team is critical since it will lead to a more productive and collaborative experience for everyone. The problem is, however, that many anesthesia clinicians will be skeptical of the facilities intentions and fear job elimination thus leading to a guarded demeanor. If the consultative experience is performed by a non-clinician then the “us verses them” mindset may be more likely to prevail than if an anesthesiologist, CRNA or someone with a similar background is involved. Some facilities choose to have the consultative experience performed as part of a hospital-centric goal of enhancing operating room efficiency or effectiveness. In communicating to clinicians, candor and clarity serve as valuable adjuncts to garner support.

Rule 3: The most common anesthesia service issue centers on staffing

Anesthesia staffing and anesthesia department development is as profoundly important as it is challenging given the current anesthesia marketplace. The demand for anesthesiologists has outstripped supply since the mid 1990s and depending on the number of new residency graduates and the overall growth in the number of surgical procedures requiring anesthesia, this deficit may persist for some time. Although some studies have suggested that deficits may start to level off in the early part of the next decade, the number of facilities requiring anesthesia coverage, combined with the aging baby boomers, may result in continued deficits. An AMC should be able to provide facilities guidance on the limitations and encumbrances that will be faced if staff augmentation or replacement is a goal.

Anesthesia staff shortages have impacted hospitals more than ambulatory anesthesia venues. After all, ambulatory anesthesia positions generally offer less stressful cases and better hours with no call or weekend work. Moreover, given the demographics of the typical ambulatory surgery patient, insurance demographics tend to favor higher unit rates, higher case rates and, in the final analysis, sometimes better take home pay. In short, fewer hours spent working and taking call, with greater pay has served as a magnet for many anesthesiologists—good news for ambulatory surgical facilities and not so good news for hospitals. An AMC should be able to assemble a strategic plan whenever possible and leverage this knowledge to effectuate an acceptable outcome.

With that being said, the sobering reality is that recruitment is very difficult and very expensive. AMC’s are not magicians and can not change the various market forces that establish the “provider market” nor the provider costs. It is common for there to be some disconnect between hospital expectations of provider costs and work schedules, and what the market commands. Naturally, there are outliers, but the rule that you pay for what you get holds very much true. As the diagram illustrates, providers that come in at lower than market costs do so for a reason—generally clinical or experience shortcomings, interpersonal issues or both.



A management company should be able to give you guidance on the various ways to achieve your staffing objectives, and the range of costs that should be expected. They should also be able to provide you an analysis of the rationale for the FTE count and the most cost efficient staffing model given the acceptance of CRNAs or, when applicable, Anesthesia Assistants. Naturally, in-depth discussions about the pre-existing and planned service lines are critical in determining the head count and skill set of the team. Administrative needs are also important to bear in mind since not all anesthesiologists desire to sit on hospital committees or have the zeal to troubleshoot administrative problems. Finally, the use of locums or other “bridge solutions” should be addressed.

Beyond the anesthesia staffing census assessment, is the task of filling positions with the right anesthesiologists at the right cost. Some AMCs have internal recruiting departments; others use external recruiters and many a blend of the two. Generally speaking, AMCs that use more external recruiters have an overall higher expense burden for recruiting and this may result in higher AMC fees. For AMCs that have remarkable internal recruiting functionality, it is important to define the number and type of people involved with internal recruiting, the technologies deployed and to learn about how they manage the recruitment cycle from beginning to end. Positive metrics usually translate into competency with recruitment and retention and, compared to external recruiters, at a lesser expense. That having been said, external recruiters often have access to many fine candidates and their use may be obligatory with larger staffing projects or in geographic areas where recruitment is predicted to be difficult.

AMCs should also have an expertise in making provisions for vacation coverage and experience addressing unexpected shortages. Knowledge concerning basic human resource tasks such as anesthesia compensation, incentive plans, benefits coordination, training, education and conflict resolution should be a core skill of most AMCs. Poor human resource support can rapidly lead to anesthesia provider dissatisfaction and encumber staff retention.

Rule 4: AMC competency with anesthesia revenue management is an important metric.

An AMC should have comfort discussing and presenting the three components that contribute to the overall financial resources of the department—anesthesia collections resulting from the rendering of services, facility-based subsidies and the input of any patient-borne revenue.

Depending on the type of engagement model, the ability for the AMC to effectively manage the anesthesia billing and collections process may be very important. For instance, in the case of a “revenue guarantee” model, the facility may have to fund the anesthesia department whenever the monthly collections fall short of projections. Even in the case of a straight forward fee-for-service model, if the AMC is unable to bill and collect for anesthesia services provided by the department, the facility may be summoned to help provide a safety line.

To these points, it is critical that the facility closely examine all aspects of the anesthesia revenue management process to be deployed by the AMC. Some AMCs simply outsource the entire function to local, regional or national anesthesia billing companies. Similar to recruiting, internalization of the anesthesia billing process can result in significant operational cost-savings that often translate into lower AMC fees. In addition, an AMC that has an in-house billing department allows for more discretion than might be possible with an outsource model which can be effective in troubleshooting issues before they come to the attention of surgeons. Regardless of the billing and collection methodology, human and technological resources should be completely evaluated and their competency assessed through comparison to relevant industry benchmarks. For instance, a smaller system may be apropos for a one room facility while a large system, such as IDX, may be indicated for large, multi-facility anesthesia practices. Similarly, an accounts receivable profile and payer-specific reports must be correctly benchmarked by the AMC to ensure ongoing quality control.

An AMC is seldom magical, given a fixed or insufficient subsidy and high staffing costs, accepting market rates with payor contracts may not be feasible. What an AMC can offer, however, through their own or proprietary data is a sense for market rates. In addition, to the extent that an AMC has a payor contracting department, they should have experience and expertise in negotiating astute contracts that address anesthesia–specific issues.

Rule 5: Anesthesia engagement models should not be a one size fits all.

An AMCs ability to discuss and implement sophisticated engagement models should be carefully assessed. In broad terms, models fall into several categories and within each category a multitude of permutations are possible.

AMC comfort with developing fair and reasonable subsidy arrangements should be carefully reviewed since many hospital and ASC anesthesia departments require some financial support. This often takes the form of revenue guarantees, case guarantees, or a flat subsidy. For facilities that have a fiscally healthy anesthesia department, an AMC might be asked to help formulate an engagement model whereby the assumption of some financial risk by the facility permits the recognition of reward. In this case, the facility should gauge the AMCs’ comfort with compliance implications as well as applicable state and federal prohibitions. Most AMCs that are physician owned and operated should also be able to articulate the potentially greater financial gains possible if the anesthesia department assists with other revenue generating activities.

Conclusion.

Working with the incumbent group should always be the first priority, as an AMC is seldom a panacea for anesthesia issues. If an AMC is retained, a needs analysis plan is imperative for implementation, along with subsequent interval corrective actions plans developed to keep projects on target. Additionally, an AMC should be able to manage the key elements of a successful anesthesia department. These include staffing, human resource administration, payor contracting, revenue management and legal services