TeamHealth Needs You

[Alvarez13]

Dear new EM grad, please stop fighting and let Blackstone take their profits, at least until we replace you by human decision making pathways.
- Kevin Klauer DO, traitor to his specialty


It matters how you take care of people...or we can just sue the poor ones.

A Private Equity-Owned Doctors' Group Sued Poor Patients Until It Came Under Scrutiny

After the Blackstone Group acquired a large national physician staffing firm in 2017, low-income patients faced far more debt collection lawsuits. They stopped only after news media investigated.

www.npr.org

TeamHealth also had policies in place that made it difficult for patients to access charity care, a form of financial assistance for low-income patients.


It doesn't matter who's trying to legislate the practice of medicine...we're still going to practice illegally.

TeamHealth Hit with Class-Action Lawsuit Accusing it of Hospital and ER Billing Fraud | Hagens Berman

www.hbsslaw.com

The successful goal of this enterprise is to maximize corporate profits while avoiding state bans on the corporate practice of medicine.


Don't lose focus on who' the most important...our investors

How Rich Investors, Not Doctors, Profit From Marking Up ER Bills

TeamHealth, a medical staffing firm owned by private-equity giant Blackstone, charges multiples more than the cost of ER care. All the money left over after covering costs goes to the company, not the doctors who treated the patients.

www.propublica.org

TeamHealth, a medical staffing firm owned by private-equity giant Blackstone, charges multiples more than the cost of ER care. All the money left over after covering costs goes to the company, not the doctors who treated the patients.

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Members don't see this ad.

 

[RustedFox]

"When you're at the bedside... what matters is... that I'm not at the bedside, doing any real work. Move faster, so I can stack cash to the ceiling."

NVM that a third of graduating residents don't have jobs.

I'm seriously sickened by what EM has become.

 

[Siggy]

So... buy KKR shares?

 

[coachB]

So... buy KKR shares?

And how would you do that?

 

[Siggy]

And how would you do that?

Your local broker... they're a publicly traded company.

KKR & Co. Inc. – Investor Relations

ir.kkr.com

NYSE

www.nyse.com

 

[GeneralVeers]

I used to work with Kevin Klauer at EMP. He was our "Chief Quality Officer" at the time, making 400K doing very little. He subsequently moved to TeamHealth. Glad to see he's still got it.

 

[Janders]

“It doesn’t matter how hospital policies may govern how you delivery care...”

WTAF. Of course it does! Rule #1, the only rule that matters, is “Do what is right for the patient”. If hospital policy harms patient care, hospital policy must be actively and rapidly changed! It IS the bedside clinician’s job not just to be a bedside clinician, but an advocate for her/his patients on all fronts, especially within the hospital setting.

Don’t be troublemakers just to be loud, but... don’t be sheep.

 

[RustedFox]

I used to work with Kevin Klauer at EMP. He was our "Chief Quality Officer" at the time, making 400K doing very little. He subsequently moved to TeamHealth. Glad to see he's still got it.

I met him a few times. Total slimeball.
Perfect example of the bloat that needs to go.

 

[bravotwozero]

So... buy KKR shares?

I've always wondered about that. If EPs could buy up shares in HCA and KKR to the point where they become majority shareholders?

 

[Alvarez13]

So... buy KKR shares?

If you want to invest in Envision then yes. If you want to invest in Team Health then it's Blackstone? Both equally commit billing fraud and screw patients and physicians over.

 

[Backpack234]

Posting this here probably isn’t good for someones wellness ranch business

 

[coachB]

Your local broker... they're a publicly traded company.

KKR & Co. Inc. – Investor Relations

ir.kkr.com

NYSE

www.nyse.com

My bad. I thought they were exclusively private equity. Would have to dig in to see how much buying the publicly traded component gives you exposure to any specific areas of interest.

 

[MechEDoc]

Posting this here probably isn’t good for someones wellness ranch business

Can I still buy into the wellness ranch? Do I get voting or non-voting shares? Is this like one of those real estate syndications that doctors keep talking about..?

 

[RustedFox]

Forgive me: is this "wellness ranch" item that keeps getting mentioned a joke that I missed? I feel like it is. No shade to anyone posting it; I just can't make sense out of it or identify what it is referring to.

 

[MechEDoc]

Forgive me: is this "wellness ranch" item that keeps getting mentioned a joke that I missed? I feel like it is. No shade to anyone posting it; I just can't make sense out of it or identify what it is referring to.

KK Moody opened a "Wellness" ranch in Washington (Glacier Rock Wellness) and invited EM docs to crowdfund her place (no shares, just give me money). She's now opened another one in Tennessee (Boozy Creek Wellness).

Anyone want to go and feel well?

 

[emergentmd]

these VC/PE thought EM was money making machine but now is finding out the margins are not great esp when the insurance carriers are tightening the pocketbooks. For some reason, they didn't realize that Professional fees is a sliver of a pts bills and the hospitals are making the bulk of the money.

Thus Emcare/TH is teetering on bankruptcy and the PEs are trying anything to recoup their Billions in lost investments.

Good Luck docs, the belts will continue to be tightened until the VCs/PEs make their books look better so they can go public again to make their money back.

 

[MechEDoc]

Thus Emcare/TH is teetering on bankruptcy and the PEs are trying anything to recoup their Billions in lost investments.

Any data to support your views on their finances?

 

[emergentmd]

No Data, just alot of scuttlebut. A yr ago, we had a "mtg" with the regional VP and he reassured everyone that they were not going bankrupt. Those meeting tends to be the beginning of the end or some big issues.

These VCs tend to take public companies that they think have value private. Clean up the books, then reintroduce it to the public again to cash out. They haven't cashed out yet which tells me alot.

They surely are not spending billions to make millons in profits. They want their billions back quickly so they can go hunt for more deals.

 

[dchristismi]

BOOZY CREEK???
WTabsoluteF.

I mean, props for good marketing to a bunch of crispy EM docs, but sheesh.
I'll AirBNB my guest room if anyone wants to come over. I have a firepit, live on a chain of lakes and have some kayaks. Or actually, if you want to bring the booze, you can just crash here.

/derail

 

[GeneralVeers]

No Data, just alot of scuttlebut. A yr ago, we had a "mtg" with the regional VP and he reassured everyone that they were not going bankrupt. Those meeting tends to be the beginning of the end or some big issues.

These VCs tend to take public companies that they think have value private. Clean up the books, then reintroduce it to the public again to cash out. They haven't cashed out yet which tells me alot.

They surely are not spending billions to make millons in profits. They want their billions back quickly so they can go hunt for more deals.

Envision very nearly went bankrupt during COVID when volumes plummeted. They had to keep paying physicians contractually at a loss for 6-8 months and this made them hemorrhage cash. Their VC overlords are not happy with how the investment is going, so they are actively trying to slash pay at the highest cost sites, and fire as many physicians as they can. The goal is to get back to as much profit as possible, and increase valuation so that KKR can get their equity out of Envision.

 

[Backpack234]

I still don’t understand the EM billing thing.

Professional services are only billed on an RVU basis. So have one doc who never orders CTs bill only slighly less or maybe the same as someone who orders a thousand CTs.

Meanwhile the hospital makes tons of money on those CTs.

why the heck is this so disconnected from professional billing?

 

[Backpack234]

Also, is all of this doom and gloom for the CMGs real? It seems like the next 10-20 years are gonna have CMGs everywhere.

if they’re really under so much stress, shouldn’t that leave the door open for docs to start forming SDGs? Maybe a professional society could help make that happen

 

[docB]

I still don’t understand the EM billing thing

Professional services are only billed on an RVU basis. So have one doc who never orders CTs bill only slighly less or maybe the same as someone who orders a thousand CTs.

Meanwhile the hospital makes tons of money on those CTs.

why the heck is this so disconnected from professional billing?

Also, is all of this doom and gloom for the CMGs real? It seems like the next 10-20 years are gonna have CMGs everywhere.

if they’re really under so much stress, shouldn’t that leave the door open for docs to start forming SDGs? Maybe a professional society could help make that happen

There are a lot of things I don't understand either. Does the hospital make money on those CTs? They're always hounding us about "resource utilization," particularly cutting down on CTs. I've always wondered if they can collect for all of these things, or if they only collect on the "facility charge" or some other scheme. Or if it's different for each payer depending on what they've negotiated.

I don't think SDGs are coming back. Let's not forget that SDGs weren't perfect and there were a lot of predatory SDGs out there. Remember the "partnership track" bait and switch? But we definitely fell out of the frying pain and into the fire with CMGs. I suspect we're going to see a continuation of CMG proliferation and then more of what we have now with CMGs preying on each other and contracts swapping around. Everyone keeps talking about hospitals trying to run their own physician groups. I don't think that's become a significant move at this point it might in the future, particularly as some of the CMGs have cozy relationships with some of the big hospital chains at the national level.

 

[clibby]

I still don’t understand the EM billing thing.

Professional services are only billed on an RVU basis. So have one doc who never orders CTs bill only slighly less or maybe the same as someone who orders a thousand CTs.

Meanwhile the hospital makes tons of money on those CTs.

why the heck is this so disconnected from professional billing?

Well, if the patient has gastritis and you treat and d/c, that is a level 3 chart. If you are worried about AAA, bowel obstruction, pancreatitis, etc. and order a CT, but it turns out to be gastritis, then that is a level 5 chart depending on your biller.

 

[emergentmd]

Envision very nearly went bankrupt during COVID when volumes plummeted. They had to keep paying physicians contractually at a loss for 6-8 months and this made them hemorrhage cash. Their VC overlords are not happy with how the investment is going, so they are actively trying to slash pay at the highest cost sites, and fire as many physicians as they can. The goal is to get back to as much profit as possible, and increase valuation so that KKR can get their equity out of Envision.

Yea we may have been on some similar conference call with Emcare. When a mtgs is set up to say we are not going bankrupt, then something bad is going to happen.

Even if Envisions goes bankrupt, VCs will just restructure it/pay pennies on the debt dollar then reorganize it under some different Envision entity with a much cleaner balance sheet and less debt. Its a win win for them no matter what happens.

 

[emergentmd]

Hospitals may spout that they want to utilize less CTs as I believe this is tied into payment. They may say they want less work ups, but they make so much more having level 5's.

Envisions may bill an extra 2-300 per Level 5 professional but hospitals can bill 10K+ more for level 5s. I have seen facility CTs billed at 9+K per.

 

[bravotwozero]

$9,000 for a ct scan? Are you serious? was it performed using liquid 24k gold iv contrast?

 

[emergentmd]

I do billing review and this happens all the time. CT facility charges are all over the place. I have seen CTs as low as 2K and well over 9K which doesn't include the radiologist charges. For some reason a CT abd typically is less than a CT head.

There was a "trauma" activation for a low impact MVC that the APC ordered a CT head, Cspine, T spine, L spine and the CT facility charges were over 20K. The whole hospital charges were over 50K after throwing in some xrays/Trauma activation, etc.

The auto insurance coverage typically pays well too so I am sure the hospital made a good 15+K on this pt.

 

[namethatsmell]

There are a lot of things I don't understand either. Does the hospital make money on those CTs? They're always hounding us about "resource utilization," particularly cutting down on CTs. I've always wondered if they can collect for all of these things, or if they only collect on the "facility charge" or some other scheme. Or if it's different for each payer depending on what they've negotiated.

I’ve heard a few theories for this

1) In many parts of the country rad studies are
under increasing scrutiny by insurers who may very well decline to pay even though the study has already been done on an emergency patient. Hospital certainly doesn’t want to eat the cost.

2) The hospital wants to create the illusion that they’re trying to be good stewards of resources ... when of course they are often incentivized to do the opposite (capitated payments being a major exception). This allows hospitals to better compete for “quality” rankings for marketing purposes and more importantly which admin‘s can use to justify their inflated salaries/bonuses and the perpetual creation of more administrators to justify their collective existence.

3) Demonstrating “resource utilization” can help hospitals when negotiating rates with insurers.

Who knows how legit these are… if anything, my suspicion at most hospitals is that number 2 is almost always involved

 

[Alvarez13]

Also, is all of this doom and gloom for the CMGs real? It seems like the next 10-20 years are gonna have CMGs everywhere.

if they’re really under so much stress, shouldn’t that leave the door open for docs to start forming SDGs? Maybe a professional society could help make that happen

AAEM's physician group is trying to do just that: Home | AAEM Physician Group

The goal is you agree to some AAEM's stipulations like having an open books group and a defined partnership track. They in turn will provide resources in forming SDGs and even legal resources when you try to take a hospital contract from TeamHealth and others.

Still kind of taking off, but I like the idea and what AAEM stands for.

 

[Backpack234]

Still taking off seems like an understatement. Last group they announced looks like 8/16/19

 

[Alvarez13]

Still taking off seems like an understatement. Last group they announced looks like 8/16/19

We need your help.

 

[EctopicFetus]

these VC/PE thought EM was money making machine but now is finding out the margins are not great esp when the insurance carriers are tightening the pocketbooks. For some reason, they didn't realize that Professional fees is a sliver of a pts bills and the hospitals are making the bulk of the money.

Thus Emcare/TH is teetering on bankruptcy and the PEs are trying anything to recoup their Billions in lost investments.

Good Luck docs, the belts will continue to be tightened until the VCs/PEs make their books look better so they can go public again to make their money back.

I think you have it wrong. What they did is saddle the company with debt, take their cut, make their profit. Read the planet money post on J Crew. Look at toys r us. The private equity guys aren't dumb. they "restructured" debt. You know who didn't get screwed private equity. you know who did.. those who bought the debt handed out by PE.

 

[EctopicFetus]

Yea we may have been on some similar conference call with Emcare. When a mtgs is set up to say we are not going bankrupt, then something bad is going to happen.

Even if Envisions goes bankrupt, VCs will just restructure it/pay pennies on the debt dollar then reorganize it under some different Envision entity with a much cleaner balance sheet and less debt. Its a win win for them no matter what happens.

Envision did restructure their debt. These guys defaulted.

Private Equity-Owned Companies Fuel Surge in Defaults

Companies backed by Blackstone, Apollo, and KKR have defaulted in the second quarter, according to Moody’s.

www.institutionalinvestor.com

Then you have USACS who convinced their "owners" that paying 10.5% interest makes sense to buy out WCAS. Sweet deal for Apollo and WCAS. DBag is out there making money being a slave owner. Poor docs are the property.

 

[Old_Mil]

“It doesn’t matter how hospital policies may govern how you delivery care...”

Sounds like it fails the Borello test...

 

[thegenius]

I've always wondered about that. If EPs could buy up shares in HCA and KKR to the point where they become majority shareholders?

Technically yes. It's a lot of shares though

KKR has 576 M outstanding shares

 

[southerndoc]

Technically yes. It's a lot of shares though

KKR has 576 M outstanding shares

Keep pumping out residents and we would only need each ER doc to buy about 100 shares.

 

[thegenius]

I do billing review and this happens all the time. CT facility charges are all over the place. I have seen CTs as low as 2K and well over 9K which doesn't include the radiologist charges. For some reason a CT abd typically is less than a CT head.

There was a "trauma" activation for a low impact MVC that the APC ordered a CT head, Cspine, T spine, L spine and the CT facility charges were over 20K. The whole hospital charges were over 50K after throwing in some xrays/Trauma activation, etc.

The auto insurance coverage typically pays well too so I am sure the hospital made a good 15+K on this pt.

totally disgusting