USAP Austin and Colorado-USAP decline begins?

[amyl]

Just curious what you think will happen in Colorado? Think USAP will have to pull up roots and walk like in reno? And it’ll go back to pp or hospital employed? Think another amc will try their hand? What about Colorado Springs? It’s split between USAP and another group. Durango?
I heard that there was a lawsuit involving those partners that left and took business with them…

---

Members don't see this ad.

 

[sevoflurane]

Just curious what you think will happen in Colorado? Think USAP will have to pull up roots and walk like in reno? And it’ll go back to pp or hospital employed? Think another amc will try their hand? What about Colorado Springs? It’s split between USAP and another group. Durango?
I heard that there was a lawsuit involving those partners that left and took business with them…

USAP presence in Denver and in other places in Colorado is quite massive. Don’t see them loosing big market share so quikcly. I think Centura alone is like 12 hospitals (not 100% sure but close).
The recent federal trade commission statement is quite interesting and undoubtedly steering the dialogue in the right direction.
AMCs have the potential to loose a ton of enforceability if this goes through. Loosing that leverage is bad for them and good for any individual anesthesiologist who wishes to practice in another hospital/group. This allows the anesthesiologist to not have to uproot their families while simultaneously keep taking care of the same community they have been taking care of for 5,10,15, 20+ years.

Big Business’ Plan to Block Biden’s Ban on Noncompete Agreements

Federal Trade Commission Chair Lina Khan’s rule faces a gauntlet of lobbyists led by the Chamber of Commerce.

theintercept.com

 

[nimbus]

USAP presence in Denver and in other places in Colorado is quite massive. Don’t see them loosing big market share so quikcly. I think Centura alone is like 12 hospitals (not 100% sure but close).
The recent federal trade commission statement is quite interesting and undoubtedly steering the dialogue in the right direction.
AMCs have the potential to loose a ton of enforceability if this goes through. Loosing that leverage is bad for them and good for any individual anesthesiologist who wishes to practice in another hospital/group. This allows the anesthesiologist to not have to uproot their families while simultaneously keep taking care of the same community they have been taking care of for 5,10,15, 20+ years.

Big Business’ Plan to Block Biden’s Ban on Noncompete Agreements

Federal Trade Commission Chair Lina Khan’s rule faces a gauntlet of lobbyists led by the Chamber of Commerce.

theintercept.com

And unlike tech, there are no trade secrets in the clinical practice of anesthesia. It is all open source. There is no anesthetic technique that is proprietary to any anesthesia group, academic department, or AMC.

There is financial information that can be damaging if disclosed publicly or to a competitor. But that can be addressed with a non disclosure agreement instead of a noncompete agreement.

 

[aneftp]

No I do not. You are right… my division is very stable - was here before USAP and will be here. I have friends elsewhere in USAP that a worry about and I do own stock.
I just truly believe that USAP is better - the lesser of all evils if you will. Envision Napa etc all take way bigger cuts and were pretty terrible to some employees during covid.
Hospital ceos and admin are sure to promote crna only or high ratio supervision type practices… they are business guys only and see that you can bill the same for both… as long as it doesn’t cost them surgeons they can’t easily replace they don’t care if it’s an md or crna or care team…
Case in point - my old hospital in indiana that was md only has gone to a crazy mishmash if providers. One crna practicing independently, a couple drs and an AA… AA was hired because she’s some surgeons wife. It’s a mess - they don’t care. They’ll get rid of all the drs the second they think they can get away with it

Yeah. I agree. There are so many separate entities of usap. We can’t group all of the practices together. Some usap entities are better performing than others. That’s why I’m sure your division is safe in Texas. It all boils down to payor mix at the end of the day.

I know the Orlando usap. The advent hospital system has more than 50% commercial insurance. Add in Medicare advantage which pays more than regular Medicare. It is hard to mess up that type of practice. Add in the surgery center contracts which is even more commercial percentage. One surgery center I covered in the area (not a usap facility, an amsurg/envision facility) as a 1099 in the area had a ridiculous 60% commercial and another 20% Medicare advantage. That was just 1:2 coverage. 3.5 million in anesthesia collections (the actual revenue).

Another has 1:4. 6 million in anesthesia revenue.

Each “provider” generating over 1 million in anesthesia revenue over 6-8 hours a day. Done by 2-3 pm each day. No call. No weekends. Considering the crnas making 200k. Employee w2 docs making 450k. Tons of money being kicked back to partners and Welsh Carson Anderson firm.

That’s why the original big 3 practices are fine as long as payor mix stays the same.

Now say a lucrative practice that was once Fairfax Virginia in wealthy suburbs of northern Virginia mednax had. Even though lots of good commercial contracts (tons of IT and obviously government workers and health care employees). More immigrant population has moved into the area over the last 30 years. It’s still a well oil machine up there. But the best of the best payor mix moved to smaller community hospitals like Reston Virginia (one of the lone remaining independent practices…cause they make so much money) and fair oaks 20 min west of Fairfax (they sold to napa for $$$$ and a ton of $$$$).

 

[Southpaw]

Hospital ceos and admin are sure to promote crna only or high ratio supervision type practices… they are business guys only and see that you can bill the same for both… as long as it doesn’t cost them surgeons they can’t easily replace they don’t care if it’s an md or crna or care team…
Case in point - my old hospital in indiana that was md only has gone to a crazy mishmash if providers. One crna practicing independently, a couple drs and an AA… AA was hired because she’s some surgeons wife. It’s a mess - they don’t care. They’ll get rid of all the drs the second they think they can get away with it

This hasn't been what I've seen. I can't speak to all practices of course, but the few I'm aware of the hospital has been much more fair to the anesthesia group for the sake of stability and recruitment. AMCs in my opinion are far more likely to cut corners because they have to profit off the practice. Hospitals don't have to profit off of anesthesia. They often have no clue about anesthesia. The hospital understands where their profit is made - keeping ORs running and facility fees. They generally want stability from anesthesia and people showing up for work to run the ORs. And as little drama as possible.

FYI I'm private practice

 

[circleK]

I am hospital employed for a year and a half now and would agree with Southpaw’s statement.

 

[amyl]

Just curious where your practices are that have fair administrations? Care team or md only practice?
Local politics and culture may prevent them from empowering mid levels.
Pick up one of the hospital admin magazines and journals and you will find lots of advice to undermine doctors of all specialities.
iF they don’t gut you for the bottom line it’s because they can’t in your locale… now.
They see that every other dr brings in business and revenue…. We dont. If surgeons are happy w crnas they will go that way… eventually

 

[sevoflurane]

One thing I would like to mention about USAP departure in my part of the state is that they did not hold the anesthesiologists to their non competes- not even in the same hospital system. In my mind, that move alone puts them above most if not all PE AMCs.

 

[GravelRider]

One thing I would like to mention about USAP departure in my part of the state is that they did not hold the anesthesiologists to their non competes- not even in the same hospital system. In my mind, that move alone puts them above most if not all PE AMCs.

What was the scenario behind those departures? Did the hospital system buy out the restrictive covenant from USAP in some way?

 

[sevoflurane]

What was the scenario behind those departures? Did the hospital system buy out the restrictive covenant from USAP in some way?

Hospital was not happy w usap model.

 

[gtb]

Colorado-word is USAP has lost multiple contracts not just St Joes

It is rumored that USAP declined to renew its contract at St. Joseph Hospital, which makes sense from a business strategy. However, I do not know what the real story is. St. Joes' is a semi-Kaiser hospital because Colorado Permanente does most (or all) inpatient cases for the metro area at that facility. The hospital is located in downtown Denver, a city that, like every other democrat-controlled bigger city, is enduring the outcome of social policies allowing unabated drug use, unlimited urban camping (large homeless encampments), and a substantial migrant influx secondary to their sanctuary city status. An EM friend in that facility's ED commented on the dramatic increase in non-English speaking, uninsured patients presenting for emergent cases and a wave of drug injectors with abscesses that will require surgical debridement. Additionally, their inpatient census includes many long-term, uninsured patients they cannot discharge because no respite beds are available in Denver. As everyone knows, elective-insured cases get canceled without a guaranteed postop inpatient bed. Consequently, and this is only reasoned speculation, it seems likely that many of nonKaiser OR cases have shifted to either Medicaid or charity care. USAP would have covered the majority of those cases, and that is not a sustainable business.

 

[Howard888]

My contact there said another few hospitals in addition to St Joe also gone and that will happen over spring/summer.

They’ve also lost several surgery centers.

To be fair to USAP-as amyl said each group different. As Denver was mostly MD only, this greatly reduces any benefit USAP brings. So all these increased expenses are felt more. Apparently “partners” at USAP Denver are some of the lowest earners in USAP system. Salaries only near 400k

Given how easy it is to find a job at 500k or higher right now (hospital employed, academic, or PO), they can’t keep anyone either.

They’ll still have some other hospitals…but long term looks very bleak

Same with Austin -they can’t get CRNAs or new MDs and they are working much much more to bring home similar or less income due to the higher expenses (although it’s because they won’t pay enough-which is on them, they are choosing this path)

 

[pro-propofol]

What’s up with USAP Swedish in Seattle?

 

[aneftp]

My contact there said another few hospitals in addition to St Joe also gone and that will happen over spring/summer.

They’ve also lost several surgery centers.

To be fair to USAP-as amyl said each group different. As Denver was mostly MD only, this greatly reduces any benefit USAP brings. So all these increased expenses are felt more. Apparently “partners” at USAP Denver are some of the lowest earners in USAP system. Salaries only near 400k

Given how easy it is to find a job at 500k or higher right now (hospital employed, academic, or PO), they can’t keep anyone either.

They’ll still have some other hospitals…but long term looks very bleak

Same with Austin -they can’t get CRNAs or new MDs and they are working much much more to bring home similar or less income due to the higher expenses (although it’s because they won’t pay enough-which is on them, they are choosing this path)

Anyone can Google the one of the Usap Colorado buyout details ($624k plus $225k fake Usap stock). That’s not a lot of money for 5 year buyout commitment with 20% reduction in salary. Just read it. Most likely an MD only model (similar to an east coast Usap buyout I know of MD model as well)

https://www.courts.state.co.us/Courts/Court_of_Appeals/Opinion/2018/17CA0099-PD.pdf

 

[GassYous]

Anyone can Google the one of the Usap Colorado buyout details ($624k plus $225k fake Usap stock). That’s not a lot of money for 5 year buyout commitment with 20% reduction in salary. Just read it. Most likely an MD only model (similar to an east coast Usap buyout I know of MD model as well)

https://www.courts.state.co.us/Courts/Court_of_Appeals/Opinion/2018/17CA0099-PD.pdf

That is horrible, what's the point of buying out? Over the five years you would have ended up making the same and now lock in the 20% reduction forever

 

[aneftp]

That is horrible, what's the point of buying out? Over the five years you would have ended up making the same and now lock in the 20% reduction forever

Because they were advised the Usap ipo (which should have happen end of 2017/beginning of 2018) could potentially be worth 3-5x the current internal Usap $1/share price they were being gifted as part of the buyout. The new hires I believe had to buy Usap stock at around $2.5/share (my rough estimate) between 2015-2017. So the fake paper money would have their private internal stock price at least double in net value.

But also remember the new partnership track people would be hired at the local company discretion at whatever salary the current local partners wanted. So they could make up that 20% reduction in salary by siphoning off hard work of new hires. The typical ponzi buy in scheme. To make themselves whole again.

 

[Dr. Rude]

That is horrible, what's the point of buying out? Over the five years you would have ended up making the same and now lock in the 20% reduction forever

It is a guarantee in an insecure world. Money up front.
Five years of security can sound appealing-even if not at the end of a career.
Capital gains treatment as opposed to ordinary income.

 

[NumTacos]

Anyone can Google the one of the Usap Colorado buyout details ($624k plus $225k fake Usap stock). That’s not a lot of money for 5 year buyout commitment with 20% reduction in salary. Just read it. Most likely an MD only model (similar to an east coast Usap buyout I know of MD model as well)

https://www.courts.state.co.us/Courts/Court_of_Appeals/Opinion/2018/17CA0099-PD.pdf

I’d love to meet this Dr Crocker guy, sounds like a mad lad!
“Old GCA sent Crocker $100 for his share, an amount that he refused. He later demanded payment in the amount of $1,030,996.”

 

[anesthesiologyattending40]

Austin working pre call, post call, can’t get CRNAs or new MDs as horrible job. Cost of living California level not helping

Colorado-word is USAP has lost multiple contracts not just St Joes

Pipeline for USAP has dried up…no new groups joining. Restrictions now on internal stock sales.

I thought USAP would be last amc standing, and I realize every usap location different-but if you don’t or can’t pay your mds and CRNAs and put returns to private equity first…….

USAP Colorado is horrendous and financially sinking fast. USAP Colorado got rid of St. Joe's because it's a terrible place to work and wasn't making the practice any money.

USAP treats their physicians like trash and lie about compensation on gasworks. The attrition continues to get worse toward the end of 2023. You get the privilege of providing relief to AAs and CRNAs at 3pm or 5pm every day. You get to stay late until 6pm or later most days and get just 2 sick days a year. Good luck if you have health issues or a family. The compensation is way below national average. They force you to become partner after 2 years with a $50k buy in for worthless shares. They continue to make policies that make life worse for physicians. Surgeons are pissed constantly with USAP's level of coverage. WCAS (private equity firm that owns USAP) pulls the strings even though it's "physician owned."

The clinical governance board is completely out of touch with the needs of physicians or considerations for lifestyle. You'll make less per hour than locums CRNAs once your calculate what you're making per hour. It's insulting. You'll get to supervise anesthesia assistants (27 months of training!) taking all the risk on your license while the higher ups profit off you running around the operating rooms and shuttling between hospitals all over the Denver metro area.

 

[triggermaster]

I hope that people who took a significant proportion of their “buy out” as stock or those who actually bought up more stock are not left in the dust. USAP lost a contract n my neck of the woods. Now back into PP hands.

Ummm… I hope they ARE left in the dust. Selling groups is largely selling a claim on the next generation’s income. F those guys.

 

[sevo00]

USAP Colorado is horrendous and financially sinking fast. USAP Colorado got rid of St. Joe's because it's a terrible place to work and wasn't making the practice any money.

USAP treats their physicians like trash and lie about compensation on gasworks. The attrition continues to get worse toward the end of 2023. You get the privilege of providing relief to AAs and CRNAs at 3pm or 5pm every day. You get to stay late until 6pm or later most days and get just 2 sick days a year. Good luck if you have health issues or a family. The compensation is way below national average. They force you to become partner after 2 years with a $50k buy in for worthless shares. They continue to make policies that make life worse for physicians. Surgeons are pissed constantly with USAP's level of coverage. WCAS (private equity firm that owns USAP) pulls the strings even though it's "physician owned."

The clinical governance board is completely out of touch with the needs of physicians or considerations for lifestyle. You'll make less per hour than locums CRNAs once your calculate what you're making per hour. It's insulting. You'll get to supervise anesthesia assistants (27 months of training!) taking all the risk on your license while the higher ups profit off you running around the operating rooms and shuttling between hospitals all over the Denver metro area.

I interviewed with USAP back in 2020. Got this same sense after my interview. Glad I didn’t take that job

 

[Arantius]

Just curious who the “big 3” are that you keep referring to?

Idk, the other pp group in my town is shady af. Super partners… playing games with credentialing…. Not a fair group for newcomers. USAP is much more transparent and fair.

I know a little gossip about Reno- USAP and admin didn’t see eye to eye on stipend… but that’s gossip and not an authorized source.

I know everyone likes to demonize usap… but it’s definitely the lesser of all evils. Napa and envision take much bigger $ cuts… team health etc. and if you think you’re better off working for a hospital admin - well good f—-ing luck.
Hospital admin are number one to support crna solo or high “supervision” malpractice sponge ratios…. Whatever is cheapest

Those people aren’t your friends.

At least other companies don’t have the USAP non-competes

 

[Arantius]

USAP Colorado is horrendous and financially sinking fast. USAP Colorado got rid of St. Joe's because it's a terrible place to work and wasn't making the practice any money.

USAP treats their physicians like trash and lie about compensation on gasworks. The attrition continues to get worse toward the end of 2023. You get the privilege of providing relief to AAs and CRNAs at 3pm or 5pm every day. You get to stay late until 6pm or later most days and get just 2 sick days a year. Good luck if you have health issues or a family. The compensation is way below national average. They force you to become partner after 2 years with a $50k buy in for worthless shares. They continue to make policies that make life worse for physicians. Surgeons are pissed constantly with USAP's level of coverage. WCAS (private equity firm that owns USAP) pulls the strings even though it's "physician owned."

The clinical governance board is completely out of touch with the needs of physicians or considerations for lifestyle. You'll make less per hour than locums CRNAs once your calculate what you're making per hour. It's insulting. You'll get to supervise anesthesia assistants (27 months of training!) taking all the risk on your license while the higher ups profit off you running around the operating rooms and shuttling between hospitals all over the Denver metro area.

Maybe we move this to the private board but can you say where in CO? I have a CO license and hoping to help locums. There’s some nice work up there during ski season

 

[MirrorTodd]

Maybe we move this to the private board but can you say where in CO? I have a CO license and hoping to help locums. There’s some nice work up there during ski season

Coincidentally, my wife and I are very interested in Colorado as a future place to live after the Army.

 

[Arch Guillotti]

Maybe we move this to the private board but can you say where in CO? I have a CO license and hoping to help locums. There’s some nice work up there during ski season

Normally threads are moved to the private forum at the OP request although sometimes exceptions are made. In this case the user in question does not have access so it is sort of a moot point.

 

[Arantius]

Normally threads are moved to the private forum at the OP request although sometimes exceptions are made. In this case the user in question does not have access so it is sort of a moot point.

Got it thanks.