Sheridan anesthesia

[amyl]

Anybody know anything about them?

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[Arch Guillotti]

Reported to be the devil.

 

[aneftp]

Sheridan is (Was) a very large Anesthesia management company that was recently sold to Amsurg for 2.35 billion. Amsurg is the largest single speciality owner of surgery centers, mainly GI centers and a few multi specialty centers.

Of note most of corporate directors are all cronies from Rick Scott's (governor of Florida) days as CEO of Columbia HCA. When Columbia HCA imploded because of fraud in the mid 90s. Many of them went to work for Amsurg.

Amsurg is currently involved in shady anesthesia "company model" google OIG opinion 12-06 anesthesia kickbacks in many of their facility. If you look at Amsurg profit report recently. They have recently expanded their anesthesia services mainly because of this kickback model. This has contributed to their huge profit margin.

So if Sheridan is the devil. Sheridan just got brought by someone worst than the devil.

 

[Planktonmd]

Unfortunately these "devils" are the future of anesthesia...
These mega companies with huge capitals are taking over anesthesia practices all over the country and they are all the same.

 

[aneftp]

Unfortunately these "devils" are the future of anesthesia...
These mega companies with huge capitals are taking over anesthesia practices all over the country and they are all the same.

The issues isn't take over.

It's the illegal stuff these companies have done on their way up.

U gotta understand Amsurg practice model. They buy a "51-% stake in GI center". So 51/49 facility joint venture with GI docs or other general surgeons.

They normally split just the facility fees.

However in the past 2 years Amsurg has accelerated their anesthesia take over by offering physician co owners of the facility someone regular anesthesia companies or groups cannot.

It's the fee splitting of anesthesia revenue. It's is highly illegal and Amsurg has gotten so big they done care. It's ok for Amsurg to collect 100% of anesthesia profits. But when they kickback 40-49% of anesthesia profits back to Gi docs or other surgeons than that violates stark anti kick back laws.

 

[amyl]

Hmmm. Think this is sustainable or will they get caught? What happens if they do? They own south Florida it seems so if you wanna work there you literally have to make a deal with the devil?

 

[aneftp]

Hmmm. Think this is sustainable or will they get caught? What happens if they do? They own south Florida it seems so if you wanna work there you literally have to make a deal with the devil?

These management companies (when they get as large as some do), don't really care if they get "caught". They have already started their "legal defense" in case the government slowly enforces this.

This is their thinking (legal defense strategy) (one of many)
1. The OIG opinion 12-06 only applied to "one situation". It's a "we didn't now it applied in our case defense strategy".
2. Amsurg will try to defend itself by saying their anesthesia contract company model protects the company because they will invoke the "safe harbor" clause even though many of ways they pay their anesthesia providers is through 1099 independent contracts (which completely invalidates any safe harbor clause they may try to invoke)
3. They are also counting on every single State in the USA having it's own separate OIG opinions
4. last and the biggest fall back they have is is the thought they will get a slap on the wrist. Stop what they are doing. At that point, they own so many anesthesia contracts, the physician co owner conspirators (GI docs and surgeons) are forced to just give up their 49% of the anesthesia profits and let amsurg run the anesthesia show altogether with no profit sharing of anesthesia.

And if they do get civil or criminal fine, that's where their political ties will come into place. They will just buy themselves out of the mess. Small anesthesia management companies abandoned the "company" model back in 2012. That's where Amsurg started their aggressive take over of anesthesia practice.

https://www.asahq.org/For-Members/A...Federal-Fraud-Alert-on-the-Company-Model.aspx

This is a more recent article about a psychiatry group trying to push for anesthesia kickback in an related OIG opinion as well in clear violation of the original OIG violation 12-06.

http://www.healthlaw-blog.com/category/anesthesia-issues/

But you see, the enforcement takes so long. Amsurg will be (or already way too big). And that's why they won't care what happens if they get caught.

 

[Planktonmd]

The mode of operation these companies employ is very sophisticated and they have experienced legal teams formulating their contracts.
They basically form a new company in each location and the name of the main mega corporation is no where on the contract.
Basically the anesthesia providers are employed by individuals who have formed a new corporation with a new name ( X county anesthesia group) and the main corporation is only the entity that handles the billing for that corporation.
The main mega corporation will not be liable for the behavior of these small corporations since it's only a billing agent.

 

[aneftp]

The mode of operation these companies employ is very sophisticated and they have experienced legal teams formulating their contracts.
They basically form a new company in each location and the name of the main mega corporation is no where on the contract.
Basically the anesthesia providers are employed by individuals who have formed a new corporation with a new name ( X county anesthesia group) and the main corporation is only the entity that handles the billing for that corporation.
The main mega corporation will not be liable for the behavior of these small corporations since it's only a billing agent.

Everyone knows that.

All you have to do is go to Sunbiz.org and type in Amsurg in your search and see how many "Amsurg anesthesia LLC" practices are. They are all separate.

But the facts are that the GI docs and other surgeons who participate in these individual practices are liable. All it takes is one group of individual doctors to get nailed by the OIG for the entire Amsurg anesthesia practice to fall. Because other docs who do joint venture in anesthesia fee splitting will be scared as heck to continue doing business with Amsurg anesthesia model.

They make enough with their own speciality (Gi, general surgeon, urology etc). Once those dominos fall, they will learn it's simply not worth it to try to collect another $100k per partner for extra anesthesia cut of the profits.

 

[deleted171991]

Greedy surgeons and AMC executives won't learn their lesson until some of them go to federal prison.

 

[Euripides]

An alternative explanation is that the acquisition of Sheridan is how Amsurg transitions from their current potentially problematic anesthesia relationships into a more conventional anesthesia management company model. Amsurg is traded on the public market and ownership by surgeons/proceduralists at that level takes all of the "company model" fretting off of the table. In addition, there are other ways to structure the relationships to take the company model off of the table. If not, then no multispecialty or academic medical center practice would be immune. Money is redistributed within those arrangements as a matter of course and are time tested. The "company model" hue and cry is generated by ASA and consultants who see their business models going by the way side.

 

[nimbus]

An alternative explanation is that the acquisition of Sheridan is how Amsurg transitions from their current potentially problematic anesthesia relationships into a more conventional anesthesia management company model. Amsurg is traded on the public market and ownership by surgeons/proceduralists at that level takes all of the "company model" fretting off of the table. In addition, there are other ways to structure the relationships to take the company model off of the table. If not, then no multispecialty or academic medical center practice would be immune. Money is redistributed within those arrangements as a matter of course and are time tested. The "company model" hue and cry is generated by ASA and consultants who see their business models going by the way side.

Exactly this.

The ONLY leverage anesthesiologists and CRNAs have to prevent this is to restrict the supply of new graduates. And nobody has the will to do this. Indeed, I wouldn't be surprised if Sheridan/Amsurg doesn't start it's own anesthesia residency program, just like NAPA. The future is bleak. Market forces are creating a situation where professionalism and pride in ones' work is not incentivized. Instead the corporations will create a class of clock-punching employees. We will all be working for da' man.

 

[BLADEMDA]

What are the retirements plans like for these AMCs? Does Sheridan offer a good 401K? American Anesthesiology any better in terms of a good plan?

 

[BuzzPhreed]

It's not sustainable.

Sooner or later this model is going to implode. It will start by people refusing to work in such arrangements. They will prove to be a revolving door. There will be no firm and lasting relationships formed between the surgeons, hospital administration, and the anesthesia team on management committees or otherwise. Surgeons hate seeing a new unknown face every few months. Then these big groups once they get entrenched will start to nickel-and-dime administration for everything. Administrators will start to see these groups like a glioblastoma growing into their organization taking more and more brain away from them and getting more and more powerful with each service they start to control (radiology, emergency department, anesthesiology, and soon surgical services). Pretty soon the hospital will just become a shell of a building that these fatcat administrators are no longer administering anything else except for tangible assets (computer systems, lab, equipment, space, etc.) and then the real fight for the $$$ is going to begin. When this happens, these groups will be shoved out and then the big lawsuits will start. The hospitals are the only ones with the deep pockets to take this on. It will be things like hiring people in spite of their restrictive covenants.

The hospitals are battling for control of these groups too. When they employ the physicians directly, then they have control. They can collect what's billed, pool it, and pay a salary to the physician just the same as an AMC can. My hospital has done this and their profits have grown by double digits over the past few years. Follow the $$$. Why would they give up a service that is bringing cash in the door instead of going to an outside group? Also they can equally and powerfully negotiate directly with the payers for group services. The only thing that I see is true is that the private practice model for ancillary service doctors is dead. They just won't be able to compete. So, these private practice anesthesia groups that are still out there submitting RFPs and trying to keep their contracts are going to lose if they don't sell their practice to an AMC or the hospital itself and become employees somehow. And I think eventually the hospitals are going to win because they hold all the cards.

Timeframe: 5-7 years.

 

[aneftp]

What are the retirements plans like for these AMCs? Does Sheridan offer a good 401K? American Anesthesiology any better in terms of a good plan?

It's been years since I looked at a Sheridan contract and their "benefits".

I think the last contract i saw essentially had no matching 401k. Health care benefits was I want to say 70% subsidized for employee. But zero or close to zero subsidy for employee family. Which means you end up paying $1000 plus a month in health premiums plus the $6000 deductible.

Hospitals W2 generally have much better "benefits" than AMCs.

 

[BLADEMDA]

Mednax has a high physician retention rate. Yet, American Anesthesiology offers salaries in the low 300-350 range. Is the job market that bad out there where Anesthesiologists can't do better than Mednax? Is the job so easy that Mednax can keep a 90 percent plus retention rate?

 

[Ipassgas]

Mednax has a high physician retention rate. Yet, American Anesthesiology offers salaries in the low 300-350 range. Is the job market that bad out there where Anesthesiologists can't do better than Mednax? Is the job so easy that Mednax can keep a 90 percent plus retention rate?

Yes, I think it is. I haven't seriously looked for a job in 2 years, though. I had 5 offers. Every type - academic, big AMC, small AMC, private partnership track, private employee. The private partnership track may just have been the one Buzz Phreed worked in. It was sketchy from the word go. The "partnership" was some sort of vague junior clinical partner that wasn't guaranteed after 3 years of 70 seventy percent market wages - as a 1099. Then, partnership, if granted, doesn't allow access to the books or revenue. The income is whatever the voting partners decide to grant (and you'll never be a voting partner). The small AMC was even more sketchy. The others were pretty comperable. 300-380 in total compensation - max.
I was reading Blades what's your number thread with a sigh. Some of you guys save nearly my entire pre-tax income. There isn't anything better out there anymore. Nearly every group behaves as an AMC. Only difference is if wall street or older docs skim the profits.

 

[IanMcGalt]

Mednax has a high physician retention rate. Yet, American Anesthesiology offers salaries in the low 300-350 range. Is the job market that bad out there where Anesthesiologists can't do better than Mednax? Is the job so easy that Mednax can keep a 90 percent plus retention rate?

Where else is there to go? Private practices are no better than Mednax these days. I took a job with a private practice that is really just an AMC. I have an academic job offer, but it pays about the same as an AMC. I'm unaware of any actual private practices where it isn't just 'partners' looking to take your earnings.

 

[BuzzPhreed]

Yes, I think it is. I looked for a job in 2 years, though. I had 5 offers. Every type - academic, big AMC, small AMC, private partnership track, private employee. The private partnership track may just have been the one buzz phreed worked in. It was sketchy from the word go. The small AMC was even more sketchy. The others were pretty comperable. 300-380 in total compensation - max.

Maybe. There are a lot of these "deals" (ahem) in the southeast. They are all bullsh*t. Don't believe a word they tell you.

Live small for a few years out of residency. My wife and I are doing that now trying to sell our house. Fortunately we don't have kids yet. But this still put a big strain on our marriage.

 

[BuzzPhreed]

Where else is there to go? Private practices are no better than Mednax these days. I took a job with a private practice that is really just an AMC. I have an academic job offer, but it pays about the same as an AMC. I'm unaware of any actual private practices where it isn't just 'partners' looking to take your earnings.

This is exactly what happened to me.

 

[aneftp]

Mednax has a high physician retention rate. Yet, American Anesthesiology offers salaries in the low 300-350 range. Is the job market that bad out there where Anesthesiologists can't do better than Mednax? Is the job so easy that Mednax can keep a 90 percent plus retention rate?

Not exactly a high retention rate.

How can you say mednax has a high retention rate when the waiting period for the sell out docs are obligated to be with mednax usually for at least a five year period.

And look at the places where mednax recently takes over. You immediately see job openings (probably from W2 employee docs leaving).

Let's re examine their retention rates in 2017-19.

My friends place sold out to mednax almost 7 years ago and they already had 5 partners leave within the past 2 years once they fulfilled their obligations.

But the others are planning to leave or retire when their guaranteed salary time period is over (hint...they were one of the first groups to sell out to mednax) and they got a super sweetheart deal for X years guaranteed salary. Much longer than what mednax offers even for the best groups these days.

 

[BLADEMDA]

When the selling doctors get millions each upfront then work for another 5 years saving more money it is expected many will leave the practice for retirement or greener pastures (e.g., ASC work) once their obligation is up.

Mednax has a high retention rate in terms of new physician retention and hospital contracts.

 

[BLADEMDA]

Practice Leadership

Steven Edbril, M.D.
Medical Director, American Anesthesiology of Florida in Delray, Florida

Alan Cordover, M.D.
Medical Director, American Anesthesiology of Florida in Fort Lauderdale, Florida

Jeffrey D. Shapiro, M.D.
Medical Director, American Anesthesiology of Georgia in Atlanta, Georgia

Charles Clifton, M.D.
Medical Director, American Anesthesiology of Georgia in Decatur, Georgia

Larry Goldstein, M.D.
Medical Director, American Anesthesiology of Georgia, Lawrenceville, Georgia

Lewis Hogge, M.D.
American Anesthesiology of Maryland in Baltimore, Maryland

Gregg Brent, M.D.
Medical Director, Great Lakes Anesthesia Associates in Grand Blanc, Michigan

Rhonda Marvar, M.D.
Medical Director, American Anesthesiology of Michigan in Royal Oak, Michigan

Idrees Ahmad, M.D.
Medical Director, Anesthesia and Pain Management Group in Millburn, New Jersey

Richard Gargiulo, M.D.
Medical Director, Burlington Anesthesia Associates in Mount Holly, New Jersey

Glen Paris, M.D.
Medical Director, Summit Anesthesia Associates in Summit, New Jersey

Michael Moses, M.D.
Medical Director, American Anesthesiology of New York in Kingston, New York

David Miller, M.D.
Medical Director, American Anesthesiology of New York in Mount Kisco, New York

Kenny Santos, M.D.
Medical Director, American Anesthesiology of Syracuse in Syracuse, New York

James Adams, M.D.
Medical Director, Burlington Anesthesia, Inc. in Burlington, North Carolina

Joshua Miller, M.D.
Medical Director, Southeast Anesthesiology Consultants, an affiliate of American Anesthesiology of the Southeast in Charlotte, North Carolina

Daniel Singer, M.D.
Medical Director, American Anesthesiology of the Southeast in Greensboro, North Carolina

Francis J. Abdou, M.D.
Medical Director, American Anesthesiology of North Carolina in Raleigh, North Carolina

Robert M. Shakar, Jr., M.D.
Medical Director, American Anesthesiology of the Carolinas in Wilmington, North Carolina

Chris Yetter, M.D.
Medical Director, American Anesthesiology of Tennessee in Chattanooga, Tennessee

Mark Carver, M.D.
Medical Director, American Anesthesiology of Tennessee in Kingsport, Tennessee

Tucker Gentry, M.D.
Medical Director, American Anesthesiology of Tennessee in Knoxville, Tennessee

Noah Bunker, M.D.
Medical Director, Austin Anesthesia Group in Austin, Texas

Mark Brauer, M.D.
Medical Director, Brazos Anesthesiology Associates in Bryan, Texas

Hector Santiago, M.D.
Medical Director, American Anesthesiology of Texas in Houston, Texas

Jeffrey A. Scheidlinger, M.D.
Medical Director, Fairfax Anesthesiology Associates, an affiliate of American Anesthesiology of Virginia in Fairfax, Virginia

W. Scott Brosche, M.D.
Medical Director, American Anesthesiology Associates of Virginia, an affiliate of American Anesthesiology of Virginia in Fredericksburg, Virginia

Lorna Miller, M.D.
Medical Director, American Anesthesiology of Virginia in Leesburg, Virginia

 

[BLADEMDA]

http://forums.studentdoctor.net/threads/mednax.924597/

Mednax keeps getting bigger because groups keep selling their practices.

 

[aneftp]

When the selling doctors get millions each upfront then work for another 5 years saving more money it is expected many will leave the practice for retirement or greener pastures (e.g., ASC work) once their obligation is up.

Mednax has a high retention rate in terms of new physician retention and hospital contracts.

You cannot make a blanket statement about new physician retention rates because well we are talking about new hires.

It will be another 3-4 years before this plays out with mednax. We know Sheridan has a relatively high turnover rate although much lower than in past years because of market saturation in some areas.

And I am watching very closely one of mednax big hospital contracts up north. Because a friend of mind is one of the administrators in the hospital system. Another Goliath AMC has made a bid for one of mednax contracts.

 

[BuzzPhreed]

Another Goliath AMC has made a bid for one of mednax contracts.

And the WalMarting of our specialty continues...

 

[BLADEMDA]

Just bumping this excellent thread.

Antone know about the 401K MATCH at Mednax/American Anesthesiology or Sheridan? Any CME money by the company?

 

[PracManCA]

Just bumping this excellent thread.

Antone know about the 401K MATCH at Mednax/American Anesthesiology or Sheridan? Any CME money by the company?

Depends practice to practice. CME yes in almost all cases. 6-10k from what I've heard.

 

[bonesmd]

Just bumping this excellent thread.

Antone know about the 401K MATCH at Mednax/American Anesthesiology or Sheridan? Any CME money by the company?

Sheridan does not match 401k

 

[BuzzPhreed]

Someone I know just took a job with Sheridan/AmSurg. Took a huge pay cut to be in a location he wanted to be. It is a far crappier job all the way around. I hope he has a happier life outside the hospital than he did before, because that's all he got.

In my book, it's like being a pro ball player and asking to be traded down to the Houston Astros farm team just so you can live in Fresno. There's no upside.

 

[jwk]

Just bumping this excellent thread.

Antone know about the 401K MATCH at Mednax/American Anesthesiology or Sheridan? Any CME money by the company?

Y'all getting courted?

 

[IkeBoy18]

Since AMCs dominate FL, is FL off limits for new grads? If you want a fair deal that is..

 

[BLADEMDA]

Since AMCs dominate FL, is FL off limits for new grads? If you want a fair deal that is..

No. An AMC job can be a "fair deal" provided the work is reasonable and the pay is decent. AMCs in Florida can pay as much as $350 for a new graduate up to $400K for those with experience. So, If you like the area (beach, boating, warm weather) look for the right fit.

If you want to maximize income the Midwest is your best option.

 

[jthedestroyr]

Someone I know just took a job with Sheridan/AmSurg. Took a huge pay cut to be in a location he wanted to be. It is a far crappier job all the way around. I hope he has a happier life outside the hospital than he did before, because that's all he got.

In my book, it's like being a pro ball player and asking to be traded down to the Seattle Mariners farm team just so you can live in Bakersfield. There's no upside.

There I fixed it for you. Don't knock Fresno, it's not as bad as Bakersfield. 😉 They actually have a pretty good Ped's hospital with an awesome private peds anesthesia group.

 

[nimbus]

There I fixed it for you. Don't knock Fresno, it's not as bad as Bakersfield. 😉 They actually have a pretty good Ped's hospital with an awesome private peds anesthesia group.

But everybody needs to breathe....and it's not so fun breathing in Bakersfield or Fresno.

 

[aneftp]

Sheridan and mednax are both self insured for malpractice.

What this means is there is "no tail" coverage needed if you were to leave them. Which is a good thing.

The no tail portion is usually worth $10-15k after one year and upwards to 35-40k in 5 years.

Most private practice groups won't offer tail coverage should they decide to ax you or you leave on your own terms.

 

[westerngas]

I worked for Sheridan / Amsurg now called Envision Healthcare. They are true corporate monsters. The corporate management doctors up top don't care of your working hours, don't care if you work a 32 hour shift including eight hours post call as nurse anesthetists are allowed to call out sick. Doctors can be fired without any due process at Envision / Sheridan. No notice - out the door. Keep looking for a better job with private practice, university or perhaps Northstar or Napa but whatever you do avoid Sheridan / Envision Healthcare.

 

[DeadSpace]

I worked for Sheridan / Amsurg now called Envision Healthcare. They are true corporate monsters. The corporate management doctors up top don't care of your working hours, don't care if you work a 32 hour shift including eight hours post call as nurse anesthetists are allowed to call out sick. Doctors can be fired without any due process at Envision / Sheridan. No notice - out the door. Keep looking for a better job with private practice, university or perhaps Northstar or Napa but whatever you do avoid Sheridan / Envision Healthcare.

Is Mednax any better than Sheridan/Envision? I feel like I hear the same negative things about them. The rate at which these AMCs are taking over is scary. I want to avoid them like the plague.

I've heard some positive things about Northstar, is it the lesser of evils?

 

[deleted171991]

Northstar has been called Deathstar on this forum, AFAIK.

I would be VERY careful before signing with any AMC. Work as a locum for them, first.

 

[AdmiralChz]

Northstar has been called Deathstar on this forum, AFAIK.

I would be VERY careful before signing with any AMC. Work as a locum for them, first.

I strongly agree with this approach, if they allow it. Ruling out ALL AMC jobs is probably a little aggressive, there are certainly some out there that are far better than others. If you can “trial” it out as a temporary locums to see if you like the work flow and set up, that could be optimal.

 

[norwood]

I'd say any place that asks you to cover 4:1 or worse is looking out for themselves, not for you or your patients.

There are certainly non-AMC groups that ask for that but I am not aware of AMCs that don't.

 

[Scotty_G]

I like the no AMC policy it suits me well :0 (unless doing prn/locums) :0

 

[facted]

I'd say any place that asks you to cover 4:1 or worse is looking out for themselves, not for you or your patients.

There are certainly non-AMC groups that ask for that but I am not aware of AMCs that don't.

NAPA doesn't at least at their main sites (lij, north shore). Mostly 2:1 with some 3:1. Might be different at some of their less established sites.

 

[norwood]

NAPA doesn't at least at their main sites (lij, north shore). Mostly 2:1 with some 3:1. Might be different at some of their less established sites.

I'm glad to hear it, that's cool. Was it always that way? Or did they back off from extreme ratios?

 

[racerx]

Where else is there to go? Private practices are no better than Mednax these days. I took a job with a private practice that is really just an AMC. I have an academic job offer, but it pays about the same as an AMC. I'm unaware of any actual private practices where it isn't just 'partners' looking to take your earnings.

I can't speak for the other private practice groups out there, but our small group is pretty damn equal. If we operated like an AMC, I couldn't look at myself in the mirror.

I must say, I am experiencing the schadenfreude of MEDNAX (American) and Sheridan doing battle in NC. First off, it is not boding well for either AMC, one is losing contracts all over the state, and the other has only been able to land one of MEDNAX's former sites. Not to mention, our group, which is recruiting, has experienced a big influx of quality candidates in the past 1-1/2 weeks as a result.

 

[racerx]

Maybe. There are a lot of these "deals" (ahem) in the southeast. They are all bullsh*t. Don't believe a word they tell you.

.

Sorry you got screwed over. Saying ALL are bull**** is a bit, ahem, strong. Comes across as bitter, and rightfully so. However, not everyone is out to screw you.

 

[racerx]

I'd say any place that asks you to cover 4:1 or worse is looking out for themselves, not for you or your patients.

There are certainly non-AMC groups that ask for that but I am not aware of AMCs that don't.

Any place having you cover worse than 4:1 is either breaking the law with billing, or screwing themselves. If you are >4:1, by law you are only allowed to bill 3 RVUs for each and every case running while >4:1. That's a lot of money flying out the window if one of the cases is a spine case, or other higher RVU case. Hell, in my group we can't even be supervising 4:1 and place a preop block for the next case without our billing company calling it a concurrency violation and dropping to med supervision.

 

[FollowTheMoney]

Any place having you cover worse than 4:1 is either breaking the law with billing, or screwing themselves. If you are >4:1, by law you are only allowed to bill 3 RVUs for each and every case running while >4:1. That's a lot of money flying out the window if one of the cases is a spine case, or other higher RVU case. Hell, in my group we can't even be supervising 4:1 and place a preop block for the next case without our billing company calling it a concurrency violation and dropping to med supervision.

Not sure why anyone would NOT demand a portion of the revenue generated for supervising more rooms. You are the one putting your license on the line taking on all the risk and the AMC is reaping all the reward, so the anesthesiologists are the suckers here. It wasn’t so bad 10-15 years ago when there were actual private practices in major metro areas and anesthesiologists were the ones billing and receiving the income, but now anesthesiologists are just the hunchmen carrying out the unethical dirty work for the mob boss for pennies on the dollar. I love how everyone pretends that this is not a dead field walking.

 

[somedumbDO]

Any place having you cover worse than 4:1 is either breaking the law with billing, or screwing themselves. If you are >4:1, by law you are only allowed to bill 3 RVUs for each and every case running while >4:1. That's a lot of money flying out the window if one of the cases is a spine case, or other higher RVU case. Hell, in my group we can't even be supervising 4:1 and place a preop block for the next case without our billing company calling it a concurrency violation and dropping to med supervision.

You need a new billing company

 

[racerx]

You need a new billing company

Why? So the new company can allow us to bill in violation of CMS rules? That is a set up for an audit and subsequent fines.

Granted, we DO need a new billing company, but that is another story altogether.