USAP next to fall?

[Howard888]

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Law suit against United. Colorado short staffed with physicians leaving...no public offering of stock..rumors in Austin of med school taking over employment of Anesthesia...Maryland struggling.....are they the next mednax?

guess we will find out

 

[Hoya11]

Law suit against United. Colorado short staffed with physicians leaving...no public offering of stock..rumors in Austin of med school taking over employment of Anesthesia...Maryland struggling.....are they the next mednax?

guess we will find out

I hear a lot about USAP on here but never in the real world where I am, what areas of the country is USAP mostly found ?

 

[amyl]

Denver Dallas Houston Florida.

 

[amyl]

I’m not sure that there is interest within the ranks of USAP to go public.... I have not heard that Colorado has staffing problems. Which market are you specifically referring to? Denver or ???

 

[deleted126335]

Law suit against United. Colorado short staffed with physicians leaving...no public offering of stock..rumors in Austin of med school taking over employment of Anesthesia...Maryland struggling.....are they the next mednax?

guess we will find out

Got a link?

 

[lane]

That’s an awfully big jump to suggest a lawsuit against United (which, by the way, will affect everyone if United is able to drive median network rates down by booting large practices and facilities as they vertically integrate) and lack of public offering will be the downfall of the entire organization.

Pay attention to the United issue. It’s easy to blow off because AMC bad, but in this case you should be glad a practice has the scale and resources to fight back against the insurance industry.

 

[Howard888]

Hospitals are bringing in Anesthesia left and right or kicking out these AMCs for being out of network. . Look at HCA in FL. Atrium in CLT. Minneapolis. They will only tolerate a group being out of network for so long before giving that group the option of becoming hospital employed or going with a different group. The lawsuit, while could be a success, also only drives public attention to the fact they are out of network. Most of these lawsuits take years to resolve. Hospitals won’t wait years.

The majority of USAP groups were in network prior to selling to USAP. Doesn’t look good and adds fuel to the fire because it’s obvious the reason their rates are so high and United cancelled the contract is all the money is going to private equity.

with regard to Colorado their are posts on multiple threads how the USAP situation has gotten bad there. Same for Maryland.

the med school thing has been rumor since the group sold to USAP, with USAP OON, a led school likely won’t accept that.

 

[amyl]

Ultimately if USAP can hang in, I think United will loose this fight... but they are certainly working the system. And it’s just a matter of time - if they can delay and string things out for long enough they may end up winning because USAP looses business (as stated above). I wasn’t aware USAP CO was in trouble - will search for those threads - thanks

 

[aneftp]

I’m not sure that there is interest within the ranks of USAP to go public.... I have not heard that Colorado has staffing problems. Which market are you specifically referring to? Denver or ???

Usap has been trying to go ipo since end of 2017 that was the original 3 year maturation of the original big 3 (pinnacle Dallas, gha Houston, and jlr orlando). Those big 3 got the biggest stock deals since they were the original.

the groups give up 20% forever to welsh Carson Anderson private equity. But many of the “partners” can reclaim some of the 20% by suckering in new hires on “partnership” track. Essentially the partnership track employees give up 40% of their earnings (20% to Usap and 20% to the “partner) plus require to buy in Usap fake stock at arbitrary set price by Usap.

United healthcare is cheap. They are evil. So I’m actually siding with Usap on this one. And I hate Usap. Just sayin. So Usap and the large amc do serve a purpose in negotiating power.

 

[dchz]

Everyone should look at each situation objectively. But when I was looking USAP is the best option. It still is in the DFW and most major cities in Texas because I keep my pulse on the different offers.

In regards to market direction, I'm no better at timing the anes market than I am at timing the stock market.

 

[Euripides]

Hospitals are bringing in Anesthesia left and right or kicking out these AMCs for being out of network. . Look at HCA in FL. Atrium in CLT. Minneapolis. They will only tolerate a group being out of network for so long before giving that group the option of becoming hospital employed or going with a different group. The lawsuit, while could be a success, also only drives public attention to the fact they are out of network. Most of these lawsuits take years to resolve. Hospitals won’t wait years.

The majority of USAP groups were in network prior to selling to USAP. Doesn’t look good and adds fuel to the fire because it’s obvious the reason their rates are so high and United cancelled the contract is all the money is going to private equity.

with regard to Colorado their are posts on multiple threads how the USAP situation has gotten bad there. Same for Maryland.

the med school thing has been rumor since the group sold to USAP, with USAP OON, a led school likely won’t accept that.

How much leeway (months, years?) do hospitals give USAP for being OON?

The answer depends on how much volume they start to lose as surgeons ramp up moving cases to facilities to get access to in-network anesthesia services. If you are in an in-network practice (UH being the poster child) then it is not a bad time to strike up conversations with hospitals and surgery centers about those cases. Facilities might modify exclusive agreements if they get a sense that volume losses are going to be significant in terms of volume and time.

Some of the younger folks on here wonder how they can break into a facility or market- well, this is a way.

 

[Howard888]

How much leeway (months, years?) do hospitals give USAP for being OON?

The answer depends on how much volume they start to lose as surgeons ramp up moving cases to facilities to get access to in-network anesthesia services. If you are in an in-network practice (UH being the poster child) then it is not a bad time to strike up conversations with hospitals and surgery centers about those cases. Facilities might modify exclusive agreements if they get a sense that volume losses are going to be significant in terms of volume and time.

Some of the younger folks on here wonder how they can break into a facility or market- well, this is a way.

Absolutely!!! Texas is an no CON state with tons of good payer mix surgery centers. Usually very loose contracts too. Surgeons are investors so they care if the anesthesia is OON.

if I lived in Texas I would form an ambulatory group and go after these centers hard. United has a big presence in Texas. Easy sell to the owners of these surgery centers to kick out USAP if you can provide the same or better service

 

[BLADEMDA]

Remember, in 2022 all providers can NOT balance bill the patient. OON means you must spend time and money fighting the insurance company for a fair rate. I suspect many groups will just "cave in" and take $85-$90 per unit rather than try to win $120 per unit from an arbitration panel. My hunch is UHC will pay OON $60 per unit and make the provider/AMC/group fight it out later when the "panel" decides what is a fair rate.

So, for those using the in-network strategy to get contracts you have 8 months before this strategy becomes meaningless.

 

[BLADEMDA]

FLORIDA BECOMES THE LATEST STATE TO ENACT LAWS SHIELDING PATIENTS FROM OUT OF NETWORK MEDICAL BILLS​

Florida joins a host of states including New York and Texas that have enacted legislation shielding patients against the high cost of out-of-network claims. Prior to this legislation, only HMO subscribers were protected from out-of-network (OON) balance billing. The new legislation (HB 221) broadens these protections to both emergency and non-emergent hospital services. These protections include advance notice, greater transparency, and an independent process to resolve disputes between payors and providers.
The new law prohibits OON billing in emergency situations for all types of insurance products, including preferred provider organizations (PPOs). The new law also protects consumers when they are at in-network hospitals for non-emergency services, but are unknowingly treated by out-of-network physicians for covered services. The law requires that insurers “are solely liable for the payment of fees” minus any applicable cost-sharing amounts and prohibits out-of-network providers from balance billing patients. It also requires increased transparency and notice to consumers about the possibility of being treated by an out-of-network practitioner. Hospitals must post on their websites their in-network health plans and put consumers on notice that they may be seen by out-of-network practitioners.
Florida’s new law further strengthens the dispute resolution process for health plans and medical providers to resolve payment issues. It encourages non-participating providers to charge, and health plans to offer, reasonable amounts prior to beginning the dispute resolution process. If the dispute resolution process is initiated, the law requires the dispute resolution organization to be transparent and publish the evidence or data the organization used to make its findings.

 

[BLADEMDA]

When President Donald Trump signed into law the Continuing Appropriations Act, 2021, shortly before the end of 2020, it included a revised version of the bipartisan No Surprises Act, with long-sought curbs on unscheduled "surprise" out-of-network health care charges. These expenses often result when care is received at an out-of-network emergency room, or for ancillary services, such as when, without the patient's knowledge, an out-of-network anesthesiologist assists in a surgery performed by an in-network surgeon at an in-network hospital.


The limits on surprise billing by doctors and hospitals, and so-called balance billing in which health care providers charge plan enrollees for the balance of an out-of-network bill when an insurance company won't pay the full amount, should reduce unplanned costs for plan enrollees and help self-insured employers, especially, to manage their health care spending. Fully insured employees could see some moderation in premium increases. A study published last September in the American Journal of Managed Care found that a comprehensive federal law to rein in surprise medical billing could reduce overall health insurance premiums by 1 percent to 5 percent.

The new law "holds patients harmless from surprise bills, including from air ambulance providers, and prohibits out-of-network providers from balance billing unless they give patients 72-hour notice of their network status and an estimate of the charges," said Chatrane Birbal, vice president for public policy at the Society for Human Resource Management.

Consumers and employers, however, did not get everything they had sought in the final legislation, which could lessen the expected cost savings they had hoped to see.

What the Law Changes

Most of the new requirements take effect with plan years beginning Jan. 1, 2022. Among the provisions affecting employer-sponsored group plans, including self-insured plans, are the following:

 

[lane]

Remember, in 2022 all providers can NOT balance bill the patient. OON means you must spend time and money fighting the insurance company for a fair rate. I suspect many groups will just "cave in" and take $85-$90 per unit rather than try to win $120 per unit from an arbitration panel. My hunch is UHC will pay OON $60 per unit and make the provider/AMC/group fight it out later when the "panel" decides what is a fair rate.

So, for those using the in-network strategy to get contracts you have 8 months before this strategy becomes meaningless.

The rule writing is taking place now, but there is precedent for prior contracted rates being considered in the arbitration process.

 

[Howard888]

All true and known. Still doesn’t change the fact a surgery center and surgeons would rather have an anesthesia group that is in network with all major payers than not-yes arbitration will start and surprise billing will end, but you will still be out of network. If a patient calls United they will still say that provider is out of network. Takes a long time to educate the masses. Huge stigma with being out of network

Now is the time to move on these centers if you are in Texas. If I wasn’t tied down and gave a great job where I am I’d consider it

 

[deleted87051]

For all the vilification, AMCs did serve the specialty by driving average rates higher for everyone. And we all benefited from that whether we were part of an AMC or not.

 

[lane]

All true and known. Still doesn’t change the fact a surgery center and surgeons would rather have an anesthesia group that is in network with all major payers than not-yes arbitration will start and surprise billing will end, but you will still be out of network. If a patient calls United they will still say that provider is out of network. Takes a long time to educate the masses. Huge stigma with being out of network

Now is the time to move on these centers if you are in Texas. If I wasn’t tied down and gave a great job where I am I’d consider it

And you will bill patients to their EOB, and go the arbitration for the rest. Patients and surgeons won’t care because it won’t hit their pocketbooks to the extent that you believe you can just show up and take a contract.

 

[dchz]

And you will bill patients to their EOB, and go the arbitration for the rest. Patients and surgeons won’t care because it won’t hit their pocketbooks to the extent that you believe you can just show up and take a contract.

So you're telling me there is NOT a group forming in Houston with ex USAP physicians because of how unhappy they are with how their division is runned?

 

[Howard888]

So you're telling me there is NOT a group forming in Houston with ex USAP physicians because of how unhappy they are with how their division is runned?

Hope so on the Houston deal.

oh surgeons WILL care. United will just stop contracting with the ambulatory facilities because of the cost of having to go to arbitration every time. They’ve done it before: it’s Texas. They know there are plenty of other facilities for their patients to have ELECTIVE surgery.

soon as that happens both the surgeon investors and center management companies will jump at another anesthesia group.

time is now in Texas. Easy sell to the centers to throw out USAP

 

[lane]

So you're telling me there is NOT a group forming in Houston with ex USAP physicians because of how unhappy they are with how their division is runned?

Haven’t heard about it. Will be interesting to see how it plays out.

 

[lane]

Hope so on the Houston deal.

oh surgeons WILL care. United will just stop contracting with the ambulatory facilities because of the cost of having to go to arbitration every time. They’ve done it before: it’s Texas. They know there are plenty of other facilities for their patients to have ELECTIVE surgery.

soon as that happens both the surgeon investors and center management companies will jump at another anesthesia group.

time is now in Texas. Easy sell to the centers to throw out USAP

Again, that’s quite the leap. And United has been throwing facilities out of network for the past year anyway. That’s old news and has nothing to do with the anesthesia group at the facility.

 

[Howard888]

Again, that’s quite the leap. And United has been throwing facilities out of network for the past year anyway. That’s old news and has nothing to do with the anesthesia group at the facility.

Not all facilities but some definitely because of anesthesia. Happening to Napa on east coast

 

[Endee]

Hope so on the Houston deal.

oh surgeons WILL care. United will just stop contracting with the ambulatory facilities because of the cost of having to go to arbitration every time. They’ve done it before: it’s Texas. They know there are plenty of other facilities for their patients to have ELECTIVE surgery.

soon as that happens both the surgeon investors and center management companies will jump at another anesthesia group.

time is now in Texas. Easy sell to the centers to throw out USAP

Are you saying throw out USAP for a new group that takes the contract and that new group is expecting to be in-network with United, etc? If United kicks out USAP, why wouldn't they keep out anyone else? I'm missing something in the thought process here by which a new group is any more attractive to the ASC than the old group.

 

[deleted87051]

Are you saying throw out USAP for a new group that takes the contract and that new group is expecting to be in-network with United, etc? If United kicks out USAP, why wouldn't they keep out anyone else? I'm missing something in the thought process here by which a new group is any more attractive to the ASC than the old group.

USAP (and other AMCs) have to charge higher rates than independent private groups in order to send money to capitalist PE overlords and still have enough left over to pay the worker bees.

 

[gtb]

I hear a lot about USAP on here but never in the real world where I am, what areas of the country is USAP mostly found ?

I hear a lot about USAP on here but never in the real world where I am, what areas of the country is USAP mostly found ?

Seattle. USAP owns Physicians Anesthesia Services, and they cover all sites owned by Swedish which is owned by Providence.

 

[deleted87051]

I hear a lot about USAP on here but never in the real world where I am, what areas of the country is USAP mostly found ?

Scroll to bottom on link.

U.S. Anesthesia Partners |

www.usap.com