USAP TEXAS RECKONING?

[Howard888]

So...between another shutdown to elective cases and now university of Texas requiring budget cuts...how will USAP Texas deal with this?

I know Austin and Houston get significant stipends at academic trauma hospitals. How do you say to university officials well..we got 7 figure checks to sell our company and still make more than the academic anesthesiologist... but yeah we need a huge stipend?????

Good luck

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[2010houston]

1- if you read the governor’s exec order, there’s LOTS of leeway for electives. Most major hospital systems are not stopping them at this point. Even in Houston. All outpatient surgeries are ok (if hospital has enough PPE), and if they have bedspace available then inpatient ok too.

2- Houston academic trauma hospitals are not staffed by USAP. IDK about Austin.

 

[Howard888]

Ok..so what % of volume do you think these USAP practices are at after his announcement? I’d be shocked if over 70% as already down with people being fearful of hospitals right now.

Fair point on Houston, I thought USAP staffed Methodist. I do know that USAP staffs Dell Medical School in Austin though.

Just getting at any of these practices who sold to private equity, still make average or above average salaries, and request a stipend when the University /hospital system Is struggling are up against a tough wall/sell.

Then add massive decrease in revenues. I’m sure all the new USAP “partners” who paid six figures in stock right now with no money from buy out are feeling real good.

 

[aneftp]

Elective cases are not stopping. The state and federal govt will not shut down major industries. And elective hospitals surgery is major industry. Hospital beds are not full. There is plenty of PPE.

we are less than 5 months away from election. Unless more free money is coming. I cannot see another shutdown. There are more cases of Covid. But younger population.

 

[deleted126335]

Elective cases are not stopping. The state and federal govt will not shut down major industries. And elective hospitals surgery is major industry. Hospital beds are not full. There is plenty of PPE.

we are less than 5 months away from election. Unless more free money is coming. I cannot see another shutdown. There are more cases of Covid. But younger population.

Why do you think that there would not be another shutdown in the face of overflowing ICUs and people dying for lack of ICU bed space? This is a distinct possibility if not probability based on media reports.

 

[Arch Guillotti]

Why do you think that there would not be another shutdown in the face of overflowing ICUs and people dying for lack of ICU bed space? This is a distinct possibility if not probability based on media reports.

I think it is more likely to see surgeries that require overnight admission shut down.

 

[lane]

Ok..so what % of volume do you think these USAP practices are at after his announcement? I’d be shocked if over 70% as already down with people being fearful of hospitals right now.

Fair point on Houston, I thought USAP staffed Methodist. I do know that USAP staffs Dell Medical School in Austin though.

Just getting at any of these practices who sold to private equity, still make average or above average salaries, and request a stipend when the University /hospital system Is struggling are up against a tough wall/sell.

Then add massive decrease in revenues. I’m sure all the new USAP “partners” who paid six figures in stock right now with no money from buy out are feeling real good.

... Methodist isn’t a trauma hospital

This whole thread is dumb.

 

[anbuitachi]

Why do you think that there would not be another shutdown in the face of overflowing ICUs and people dying for lack of ICU bed space? This is a distinct possibility if not probability based on media reports.

need to see what happens. we have 40k+ new cases per day but only 600 or so deaths. previously we were having 20k cases but 2000 deaths per day. perhaps its because care improved a bit, and also the people catching it are younger. more tests so also catching milder cases. it's possible Texas wont be slammed like nyc was

 

[narcotics999]

need to see what happens. we have 40k+ new cases per day but only 600 or so deaths. previously we were having 20k cases but 2000 deaths per day. perhaps its because care improved a bit, and also the people catching it are younger. more tests so also catching milder cases. it's possible Texas wont be slammed like nyc was

It does not matter that the majority of infected are young and the mortality is low. If you were going to have a total knee, would you want to get it done now in Houston?

Hospital may not want to shut down the elective surgery; it does not mean patients are willing to come now.

 

[nimbus]

It will certainly affect procedures requiring postop ICU care.

 

[narcotics999]

Just read this, I guess USAP has no problem to cut physicians' salary if needed:

5 health systems cutting physician salaries
Alia Paavola - Monday, June 22nd, 2020 Print | Email

To help offset revenue losses attributed to the COVID-19 pandemic, many hospitals have implemented pay cuts for staff, including physicians.

Below are five hospitals or health systems that have announced pay cuts for clinicians, reported by Becker's Hospital Review in the last month.

1. ThedaCare physicians, advanced practice clinicians take pay cuts
ThedaCare physicians and advanced practice clinicians will take a 10 percent pay cut to help reduce the Appleton, Wis.-based health system's financial hit due to the COVID-19 pandemic.

2. Providence to cut salaries of 1,200 providers
Renton, Wash.-based Providence plans to reduce the salaries of 1,200 high-paid medical providers in its Oregon division to help offset losses from the COVID-19 pandemic. Providence told Becker's Hospital Review that the decision to cut salaries was made by local leadership and is limited to Oregon-based providers.

3. Cleveland's University Hospitals to cut all physician, clinical leader pay
University Hospitals, based in Cleveland, said it will temporarily cut pay for all physicians and clinical leaders in the organization to help offset losses driven by the pandemic.

4. Sentara executives, physicians take pay cuts
Senior leaders, executives and physicians at Norfolk, Va.-based Sentara Healthcare are taking pay cuts to help address an anticipated $778 million shortfall against projected revenue due to COVID-19, the organization confirmed to Becker's Hospital Review.

5. Loyola Medicine CEO, physicians take pay cuts amid pandemic
Leadership and faculty physicians at Maywood, Ill.-based Loyola Medicine will take three-month pay cuts in response to the COVID-19 pandemic, CEO Shawn Vincent said in an interview with Becker's Hospital Review.

 

[nycitygas]

Ok..so what % of volume do you think these USAP practices are at after his announcement? I’d be shocked if over 70% as already down with people being fearful of hospitals right now.

Fair point on Houston, I thought USAP staffed Methodist. I do know that USAP staffs Dell Medical School in Austin though.

Just getting at any of these practices who sold to private equity, still make average or above average salaries, and request a stipend when the University /hospital system Is struggling are up against a tough wall/sell.

Then add massive decrease in revenues. I’m sure all the new USAP “partners” who paid six figures in stock right now with no money from buy out are feeling real good.

Elective cases aren’t shut down in Houston and the operative volume is close to 100% of normal.

 

[Justice4all]

Will be naive thinking cases won't be discontinued at this pace. If the hospital is not going to cancel the cases, the patients will cancel it for them.

 

[dchz]

Ok..so what % of volume do you think these USAP practices are at after his announcement? I’d be shocked if over 70% as already down with people being fearful of hospitals right now.

Fair point on Houston, I thought USAP staffed Methodist. I do know that USAP staffs Dell Medical School in Austin though.

Just getting at any of these practices who sold to private equity, still make average or above average salaries, and request a stipend when the University /hospital system Is struggling are up against a tough wall/sell.

Then add massive decrease in revenues. I’m sure all the new USAP “partners” who paid six figures in stock right now with no money from buy out are feeling real good.

Are you on the inside at the leadership level? or are you getting all your sources from 2 states away? this sounds like youre speculating without any information on the actual stuff happening in Texas.

 

[deleted941485]

I guess the degree to which your AMC is hurting depends on where you hold most of your contracts. If your mostly coastal, then you’re screwed. South and Midwest probably less so.

 

[lane]

Just read this, I guess USAP has no problem to cut physicians' salary if needed:

5 health systems cutting physician salaries
Alia Paavola - Monday, June 22nd, 2020 Print | Email

To help offset revenue losses attributed to the COVID-19 pandemic, many hospitals have implemented pay cuts for staff, including physicians.

Below are five hospitals or health systems that have announced pay cuts for clinicians, reported by Becker's Hospital Review in the last month.

1. ThedaCare physicians, advanced practice clinicians take pay cuts
ThedaCare physicians and advanced practice clinicians will take a 10 percent pay cut to help reduce the Appleton, Wis.-based health system's financial hit due to the COVID-19 pandemic.

2. Providence to cut salaries of 1,200 providers
Renton, Wash.-based Providence plans to reduce the salaries of 1,200 high-paid medical providers in its Oregon division to help offset losses from the COVID-19 pandemic. Providence told Becker's Hospital Review that the decision to cut salaries was made by local leadership and is limited to Oregon-based providers.

3. Cleveland's University Hospitals to cut all physician, clinical leader pay
University Hospitals, based in Cleveland, said it will temporarily cut pay for all physicians and clinical leaders in the organization to help offset losses driven by the pandemic.

4. Sentara executives, physicians take pay cuts
Senior leaders, executives and physicians at Norfolk, Va.-based Sentara Healthcare are taking pay cuts to help address an anticipated $778 million shortfall against projected revenue due to COVID-19, the organization confirmed to Becker's Hospital Review.

5. Loyola Medicine CEO, physicians take pay cuts amid pandemic
Leadership and faculty physicians at Maywood, Ill.-based Loyola Medicine will take three-month pay cuts in response to the COVID-19 pandemic, CEO Shawn Vincent said in an interview with Becker's Hospital Review.

... but USAP didn’t cut anyone’s salary.

More dumb conjecture

 

[aneftp]

Listen folks. USAP IS NOT A PARTNERSHIP not matter what the “partners” tell you. It’s a Ponzi scheme. I guess the lesser of two evils between AMC like Sheridan/envision/napa/team health and usap. If given that Choice. I would take usap only if it were a one year buy in.

I’ve known people who left in the middle of a usap partnership track once they realize how much money they were giving up to actually work for an AMC that was paying 500k/11 weeks off. Sure they work like dogs at the amc. But he/she was working like a dog at usap for what amounted to 450k pre partnership with 3 weeks off. They (the partners want u to work like a dog. The more money u generate. The more money that goes into their pockets during those 3 plus years).

The partners made between 550-600k working less than the partnership track people most taking 8-9 weeks off and less weekend calls.

How many usap “partners” got their PPP/HHS Covid funding allocation last month. Zero. As in 0. My true partner friends all got between $30-50k money each directly to their Accounts. All that money went somewhere. And it’s not to the “partners”.

 

[aneftp]

... but USAP didn’t cut anyone’s salary.

More dumb conjecture

Everyone income got cut. The hourly docs were taken off the salary equals salary cut

the partnership track people off the schedules equals salary cut

less revenue coming in for everyone.

 

[aneftp]

Why do you think that there would not be another shutdown in the face of overflowing ICUs and people dying for lack of ICU bed space? This is a distinct possibility if not probability based on media reports.

Cases are on the rise For sure. Will not deny that . We all know that. I’m down in the southeast. If you believed the media. You think the sky is falling with hospital being overloaded. But icu COVID-19 related admission are around 60% of what is was like end of March/April. So even with triple the cases. We have less icu related admissions. So while we have more cases. The hospitals are no where need capacity. So there is no need to shut down elective cases.

testing is up big time. And if you examine the data super closely Look at New York State data. Compared to Texas florida etc. New York State testing has GONE DOWN to around 5000 a day. Down from a peak testing for 30000 a day. It doesn’t take a rocket scientist to figure out. New York has less testing and by conclusion. Less positives since lots of younger people walking around with no symptoms who likely have the virus.

COVID-19: Latest Data - NYC Health

 

[dchz]

Everyone income got cut. The hourly docs were taken off the salary equals salary cut

the partnership track people off the schedules equals salary cut

less revenue coming in for everyone.

Which USAP division was this?

 

[lane]

Which USAP division was this?

Not Houston

 

[dchz]

Not Houston

Are there not a lot of different divisions in Houston?

A group in Houston had almost half of their associates leave recently. They didn't cut pay technically, because they just made everyone work more hours for free.

Note: facts of this statement confirmed.

 

[aneftp]

Not Houston

Houston usap partners didn’t receive direct? Did they?

Covid money into the pot to distribute.

Where did the money go?

That’s what I’m stating when it’s not a true partnership. Don’t call it a partnership when it’s not. It masquerades as a partnership to make it sound like you have have something at stake in the company. You don’t.

 

[lane]

Are there not a lot of different divisions in Houston?

A group in Houston had almost half of their associates leave recently. They didn't cut pay technically, because they just made everyone work more hours for free.

Uh, no. I can straight up tell you that’s completely false.

edit:
at one smaller site in Houston, 2 associates recently resigned

 

[anbuitachi]

Cases are on the rise For sure. Will not deny that . We all know that. I’m down in the southeast. If you believed the media. You think the sky is falling with hospital being overloaded. But icu COVID-19 related admission are around 60% of what is was like end of March/April. So even with triple the cases. We have less icu related admissions. So while we have more cases. The hospitals are no where need capacity. So there is no need to shut down elective cases.

testing is up big time. And if you examine the data super closely Look at New York State data. Compared to Texas florida etc. New York State testing has GONE DOWN to around 5000 a day. Down from a peak testing for 30000 a day. It doesn’t take a rocket scientist to figure out. New York has less testing and by conclusion. Less positives since lots of younger people walking around with no symptoms who likely have the virus.

COVID-19: Latest Data - NYC Health

way too early for teh sky to be falling. 60% is nothing yet. the keyis to keep the sky from falling. NYC at peak is probably 300%+ icu capacity. all the floors turned to 'ICUs'

 

[deleted697127]

Cases are on the rise For sure. Will not deny that . We all know that. I’m down in the southeast. If you believed the media. You think the sky is falling with hospital being overloaded. But icu COVID-19 related admission are around 60% of what is was like end of March/April. So even with triple the cases. We have less icu related admissions. So while we have more cases. The hospitals are no where need capacity. So there is no need to shut down elective cases.

testing is up big time. And if you examine the data super closely Look at New York State data. Compared to Texas florida etc. New York State testing has GONE DOWN to around 5000 a day. Down from a peak testing for 30000 a day. It doesn’t take a rocket scientist to figure out. New York has less testing and by conclusion. Less positives since lots of younger people walking around with no symptoms who likely have the virus.

COVID-19: Latest Data - NYC Health

So you’re telling me if you don’t test, you won’t have cases? Where have i heard that before.

 

[nimbus]

Cases are on the rise For sure. Will not deny that . We all know that. I’m down in the southeast. If you believed the media. You think the sky is falling with hospital being overloaded. But icu COVID-19 related admission are around 60% of what is was like end of March/April. So even with triple the cases. We have less icu related admissions. So while we have more cases. The hospitals are no where need capacity. So there is no need to shut down elective cases.

testing is up big time. And if you examine the data super closely Look at New York State data. Compared to Texas florida etc. New York State testing has GONE DOWN to around 5000 a day. Down from a peak testing for 30000 a day. It doesn’t take a rocket scientist to figure out. New York has less testing and by conclusion. Less positives since lots of younger people walking around with no symptoms who likely have the virus.

COVID-19: Latest Data - NYC Health

5k tests is for NYC. NY State is still doing 50-80k tests/day. Look at the percent positive of the tests given. Florida and Texas are between 15-20% and rising. New York is about 2% and tapering off.

 

[nimbus]

In southeast Texas, COVID inpatients and COVID ICU census have doubled in 2 weeks. Hopefully it will slow down.

Microsoft Power BI

app.powerbi.com

 

[Status Sciaticus]

Listen folks. USAP IS NOT A PARTNERSHIP not matter what the “partners” tell you. It’s a Ponzi scheme. I guess the lesser of two evils between AMC like Sheridan/envision/napa/team health and usap. If given that Choice. I would take usap only if it were a one year buy in.

I’ve known people who left in the middle of a usap partnership track once they realize how much money they were giving up to actually work for an AMC that was paying 500k/11 weeks off. Sure they work like dogs at the amc. But he/she was working like a dog at usap for what amounted to 450k pre partnership with 3 weeks off. They (the partners want u to work like a dog. The more money u generate. The more money that goes into their pockets during those 3 plus years).

The partners made between 550-600k working less than the partnership track people most taking 8-9 weeks off and less weekend calls.

How many usap “partners” got their PPP/HHS Covid funding allocation last month. Zero. As in 0. My true partner friends all got between $30-50k money each directly to their Accounts. All that money went somewhere. And it’s not to the “partners”.

Isnt this just how it is? You make less than the partners do during your track years and then make more during your "partner years". This is the same thing as working at a PP with a partnership track. Maybe less weeks off, but essentially the same.

 

[nimbus]

Isnt this just how it is? You make less than the partners do during your track years and then make more during your "partner years". This is the same thing as working at a PP with a partnership track. Maybe less weeks off, but essentially the same.

The difference is that, at USAP, you don’t get to keep all the money you collect even after you’re a partner.

 

[kidthor]

Isnt this just how it is? You make less than the partners do during your track years and then make more during your "partner years". This is the same thing as working at a PP with a partnership track. Maybe less weeks off, but essentially the same.

??

In an actual partnership you and your partners own and fully control the company.

In an AMC "partnership" you are basically a senior employee that still has a corporate entity skimming off the top and telling you what to do.

Look at the USAP Leadership page: Leadership | U.S. Anesthesia Partners There are a handful of doctors and a small army of random finance and corporate owners installed by the financiers. The "partners" own and control nothing (save for perhaps some forced buy-in stock options, again to be a part of an entity they don't at all control).

With the current market forces I'd be wary of joining any partnership tracked job where you're paid less as part of your buy in. The odds are many AMCs and true PPs will go away in the coming years (via bankruptcy, dissolution, M&A, transition to hospital employees, and so on). Better now to be paid your full worth to endure the recession.

 

[dchz]

The difference is that, at USAP, you don’t get to keep all the money you collect even after you’re a partner.

The idea is that the amount net to "partners" post USAP is still more than the amount collected before USAP.

Theoretically, 100% of $100 is less than 80% of $150. Note: i have no clue whether this actually occurs in real life or the math for the groups is also favorable.

The problem for new grads in Texas: the "true" private practice groups in major cities are predatory AF.

 

[IMGASMD]

The idea is that the amount net to "partners" post USAP is still more than the amount collected before USAP.

Theoretically, 100% of $100 is less than 80% of $150. Note: i have no clue whether this actually occurs in real life or the math for the groups is also favorable.

The problem for new grads in Texas: the "true" private practice groups in major cities are predatory AF.

You also then assume that USAP has better rate than private groups. That may or may not always be the case.

 

[lane]

Uh, no. I can straight up tell you that’s completely false.

2 physicians at one site is not an exodus

 

[Status Sciaticus]

The difference is that, at USAP, you don’t get to keep all the money you collect even after you’re a partner.

But then you pay for the overhead, billing company, employees, etc... which you dont as a "partner"/senior employee at USAP.

You also then assume that USAP has better rate than private groups. That may or may not always be the case.

Well if you simply look at the postings for PP jobs (lets look at TX) - metro in dallas posted 240k start rate, no malpractice or benefits provided since theyre contracting as a 1099. USAP job 385k, 10 weeks off.

??

In an actual partnership you and your partners own and fully control the company.

In an AMC "partnership" you are basically a senior employee that still has a corporate entity skimming off the top and telling you what to do.

Look at the USAP Leadership page: Leadership | U.S. Anesthesia Partners There are a handful of doctors and a small army of random finance and corporate owners installed by the financiers. The "partners" own and control nothing (save for perhaps some forced buy-in stock options, again to be a part of an entity they don't at all control).

With the current market forces I'd be wary of joining any partnership tracked job where you're paid less as part of your buy in. The odds are many AMCs and true PPs will go away in the coming years (via bankruptcy, dissolution, M&A, transition to hospital employees, and so on). Better now to be paid your full worth to endure the recession.

So then wouldnt it be better just to contract with the hospital as an employee rather than deal with AMCs and PP since youre taking a larger risk with impeding insolvency? Even as an employee, the hospital is skimming off the top.

 

[deleted162650]

But then you pay for the overhead, billing company, employees, etc... which you dont as a "partner"/senior employee at USAP.

LOL. How’s that coolaid taste. Overhead for those things in my practice is right around 7%.

 

[dchz]

LOL. How’s that coolaid taste. Overhead for those things in my practice is right around 7%.

You don't have to drink the coolaid to work for USAP. The package they offer you just has to be better than the next best option, all things considered.

 

[amyl]

usap has a better reimbursment rate than other groups in dallas.... if others make more they are doing shady out of network stuff

 

[deleted162650]

You don't have to drink the coolaid to work for USAP. The package they offer you just has to be better than the next best option, all things considered.

Agree. The Dallas USAP package sounds reasonable.

For me the biggest issue with AMC v PP is control. You give up a lot when you’re not the boss anymore. That can have a much greater impact on job/life satisfaction than just the $$ (but everyone seems to focus on the $$ ).

 

[IMGASMD]

Well if you simply look at the postings for PP jobs (lets look at TX) - metro in dallas posted 240k start rate, no malpractice or benefits provided since theyre contracting as a 1099. USAP job 385k, 10 weeks off.

If that’s the case, I agree.
Just for my own information, how do these 250k PP expect to recruit? Do they say partner salary is? How long the track is?

 

[Arch Guillotti]

LOL. How’s that coolaid taste. Overhead for those things in my practice is right around 7%.

Do you employ the anesthetists or are you MD only?

 

[deleted162650]

Do you employ the anesthetists or are you MD only?

MD only.

 

[anbuitachi]

wow 380k and 10 weeks off? thats insane. do they work a lot with a lot of CRNA coverage?

 

[dchz]

Agree. The Dallas USAP package sounds reasonable.

For me the biggest issue with AMC v PP is control. You give up a lot when you’re not the boss anymore. That can have a much greater impact on job/life satisfaction than just the $$ (but everyone seems to focus on the $$ ).

I get your point.

But consider my counterpoint: You're 3-5 years out from being a "owner" anyways, and once you're the owner, you're essentially seen as a "junior" partner for a while. The lost impact is something to consider 6 years out, but it's difficult to take that seriously when you're offered more $ now.

 

[dchz]

wow 380k and 10 weeks off? thats insane. do they work a lot with a lot of CRNA coverage?

you know what they say about too good to be true.

 

[deleted162650]

I get your point.

But consider my counterpoint: You're 3-5 years out from being a "owner" anyways, and once you're the owner, you're essentially seen as a "junior" partner for a while. The lost impact is something to consider 6 years out, but it's difficult to take that seriously when you're offered more $ now.

I get where you’re coming from. Any track over 3 years is excessive and shady. Even 3 years I consider too long unless the pay increases each year. Any practice that has tiered partnerships is also shady and should avoided. I understand the allure of USAP if those are your options. This is why geographic flexibility is key.

 

[aneftp]

Traditional fee for service in Dallas is around 800k. Circa 2003-2015. No one skimming off the top. 55 hours of work. Q5/6 calls. Roughly taking 8-9 weeks off. All MD practices

how much is usap paying even its partners? If usap is still paying the “partners” 800k? Or are the “partners” making 600k?

My good buddy still pulls over 1 million the past 3 years (obviously this year is gonna to take a hit with pandemic).

but that the type of money a pure partner should be making in Dallas in all MD practice.

the previous pinnacle practice was notorious with how they low ball docs.

 

[Arch Guillotti]

So then wouldnt it be better just to contract with the hospital as an employee rather than deal with AMCs and PP since youre taking a larger risk with impeding insolvency? Even as an employee, the hospital is skimming off the top.

Though they are derided around here at times, groups that have exclusive contracts with a hospital will prevent you from dealing directly with the hospital.

 

[dchz]

Traditional fee for service in Dallas is around 800k. Circa 2003-2015. No one skimming off the top. 55 hours of work. Q5/6 calls. Roughly taking 8-9 weeks off. All MD practices

how much is usap paying even its partners? If usap is still paying the “partners” 800k? Or are the “partners” making 600k?

My good buddy still pulls over 1 million the past 3 years (obviously this year is gonna to take a hit with pandemic).

but that the type of money a pure partner should be making in Dallas in all MD practice.

the previous pinnacle practice was notorious with how they low ball docs.

Funny you say that, pinnacle merged with GHA to form USAP.

You still don't see the problem or you're ignoring it just to flex. No grad out of residency is being offered near that. So the best package available is still USAP. Metro, the "true private practice" in Dallas, is offering something closer to indentured servitude.

It's not just DFW, is anyone offering that anywhere in the country without a partnership track?

 

[dchz]

I get where you’re coming from. Any track over 3 years is excessive and shady. Even 3 years I consider too long unless the pay increases each year. Any practice that has tiered partnerships is also shady and should avoided. I understand the allure of USAP if those are your options. This is why geographic flexibility is key.

For the sake of argument, let's say I'm flexible, where would I go to get the top deal??