USAP Texas Suit still on

[Howard888]

US appeals court won't block FTC's case against Texas anesthesia group

"US Appeals Court denies appeal by US Anesthesia Partners to block FTC's antitrust lawsuit against them, alleging anticompetitive practices in Texas."

www.beckersasc.com

I’m no
Lawyer maybe there’s another appeal they can try but suit still on for now

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[aneftp]

I don’t think the ftc has authority either to be honest.

How will the ftc handle hospitals that have more than 50% share in a certain area? Hospitals collude on price fixing as well. Like in Florida we have Baptist advent Orlando Health etc.

It’s all collusion

I don’t think usap even has 50% of Dallas metro area. Or Houston.

 

[amyl]

Most hospital systems and most AMCs are probably guilty. Envision sure seems guilty in S Florida

 

[aneftp]

Most hospital systems and most AMCs are probably guilty. Envision sure seems guilty in S Florida

Sheridan (Envison) pretty much has at least 40% market share of south Florida for the last 10 years or more.

They are still keeping compensation lower in south Florida. It’s the only way to survive these days. Compensation (w2) is slowly coming up. But so far they have been able to hold off collapse and even able to keep locums rates to $250-275/hr. At most places. $300-hr is consider good rate down there.

Crna locums rates are around $175-185/hr down there.

Just supply and demand working

There is a place 65 miles north of downtown Miami I managed to get up to $400-hr but I really want $500/hr cause it’s high risk stuff they do.

 

[amyl]

I friend of mine (cards) gets 500$ an hour from envision in south Florida

 

[aneftp]

I don’t think usap even matters any more.

The price collusion of usap Envison Napa cannot keep up with the captial free markets in 80% of the USA anesthesia locations.

The leaks in these heavily fortified anesthesia areas are showing.

This is actually the time to support our fellow crnas. The more crnas demand. The more things get destabilized. Crnas are getting rolling 50k a year sign on bonus in addition to 10 weeks off paid in addition to base 220k pay plus 25k retirement match. To work 3 days a week. With no nights and weekends. So it’s lot like the crna is cheap. And places still have a hard time recruiting with this package.

It is absolutely nuts when things get destabilized. I thought I was making cash in my locums weeks. But this guy just upped me by 15-20k for the entire week to the tune of almost 70k for the week. It is insane times we live in.

Make these places pay for their 10-13 years of artificially depressed compensation. And I support the crnas demanding $250/hr. It just means more money for us.

 

[centdoc]

I don’t think the ftc has authority either to be honest.

How will the ftc handle hospitals that have more than 50% share in a certain area? Hospitals collude on price fixing as well. Like in Florida we have Baptist advent Orlando Health etc.

It’s all collusion

I don’t think usap even has 50% of Dallas metro area. Or Houston.

It’s been “known” anecdotally that USAP has about 60% of the Dallas market. That’s why they haven’t taken over any new hospitals in recent years, to avoid this exact scenario. They were walking on a thin line to avoid a monopoly lawsuit. There’s a reason why the Feds have setup regional offices right smack in the middle of Dallas to investigate medical fraud.

 

[aneftp]

It’s been “known” anecdotally that USAP has about 60% of the Dallas market. That’s why they haven’t taken over any new hospitals in recent years, to avoid this exact scenario. They were walking on a thin line to avoid a monopoly lawsuit. There’s a reason why the Feds have setup regional offices right smack in the middle of Dallas to investigate medical fraud.

Dallas is a big area. But this isn’t about usap monopoly.

This is likely United healthcare in the ears of the ftc feeling salty getting price gouge by usap

United would rather fight usap than the AHA MONOPOLY.

 

[Status Sciaticus]

It’s been “known” anecdotally that USAP has about 60% of the Dallas market. That’s why they haven’t taken over any new hospitals in recent years, to avoid this exact scenario. They were walking on a thin line to avoid a monopoly lawsuit. There’s a reason why the Feds have setup regional offices right smack in the middle of Dallas to investigate medical fraud.

probably because Dallas is the New York of the South.... Its a massive hub for all things.

 

[deleted1183938]

I don’t think usap even matters any more.

The price collusion of usap Envison Napa cannot keep up with the captial free markets in 80% of the USA anesthesia locations.

The leaks in these heavily fortified anesthesia areas are showing.

This is actually the time to support our fellow crnas. The more crnas demand. The more things get destabilized. Crnas are getting rolling 50k a year sign on bonus in addition to 10 weeks off paid in addition to base 220k pay plus 25k retirement match. To work 3 days a week. With no nights and weekends. So it’s lot like the crna is cheap. And places still have a hard time recruiting with this package.

It is absolutely nuts when things get destabilized. I thought I was making cash in my locums weeks. But this guy just upped me by 15-20k for the entire week to the tune of almost 70k for the week. It is insane times we live in.

Make these places pay for their 10-13 years of artificially depressed compensation. And I support the crnas demanding $250/hr. It just means more money for us.

I was with you until you said it’s time to support our fellow CRNAs. Nope nope nope. I can pretty much guarantee you there isn’t a CRNA saying this same thing about us. They are fighting to get paid the same as us. And if CRNAs are demanding and getting $250 an hour and MD/DOs in S Fl are being offered and accepting $275 an hour how is this math mathing?
Nope. Their crazy rates don’t necessarily increase ours. It just makes the gap closer.

 

[aneftp]

I was with you until you said it’s time to support our fellow CRNAs. Nope nope nope. I can pretty much guarantee you there isn’t a CRNA saying this same thing about us. They are fighting to get paid the same as us. And if CRNAs are demanding and getting $250 an hour and MD/DOs in S Fl are being offered and accepting $275 an hour how is this math mathing?
Nope. Their crazy rates don’t necessarily increase ours. It just makes the gap closer.

I agree. I can be a little sarcastic at times.

But the gap is closing in many locations where it’s just less of a headache and just use MD only.

Some crnas (not many) do realize this. And that they could price themselves out.

 

[Howard888]

I agree. I can be a little sarcastic at times.

But the gap is closing in many locations where it’s just less of a headache and just use MD only.

Some crnas (not many) do realize this. And that they could price themselves out.

They won’t price themselves out at all. There are not even close to enough MDs to cover all the locations currently covered with CRNAs in direction or supervision models.

The key is to focus on call and getting paid more for after 3pm hours or call. Many CRNAs don’t want call so more room to negotiate higher pay here.

Again The whole md only argument has zero chance as there aren’t even close to enough MDs and many MDs coming out now want basically part time work only compounding the problem

 

[amyl]

Agree. Not enough MDs. Higher than ever desire for surgery. I’ve been practicing for 12 years now and the CRNAs have changed dramatically in that time. They’ve become much more militant and independent-minded. I don’t think lots of them view it as “team” anymore…. We are just there because the state or hospital “makes” them have supervision.
The answer is obviously to train as many good AAs as possible as quickly as possible… but lots of anesthesiologists don’t support AAs enough… they are purists that think it should be md only… without realizing there just isn’t enough of us. people in America won’t wait 3 months for surgery like they will in other parts of the world. Unfortunately there just aren’t enough AA schools. And lots of very greedy doctors have preferred crnas so they can go over 4/1 ratios and leave the crna alone for the epidurals. We are our own worst enemies with the laziness and greed.

 

[deleted1183938]

I agree. I can be a little sarcastic at times.

But the gap is closing in many locations where it’s just less of a headache and just use MD only.

Some crnas (not many) do realize this. And that they could price themselves out.

Totally agree!!! Let them price themselves out!!!

 

[Ravenclaw90]

Here they are offering $220/hr to prn docs and $240/hr to prn crnas. It is messed up.

 

[PeterGriffin]

Here they are offering $220/hr to prn docs and $240/hr to prn crnas. It is messed up.

Oh come on

 

[aneftp]

Oh come on

It’s true. My old place pays docs $250/hr w2 prn. They may have raised it recently. But not by much.

W2 crnas on overtime get $260/hr.
This world makes no sense. Lol

I’d rather go next door at surgery center and make 1099 for $350/hr on my day off than volunteer to work extra for $250-hr.

Actually I can’t stand the private surgery center next door. They offered me $500/hr/$5000 guaranteed last minute and I just sat at home on my day off. I’m just fickle these days what I like to do.

 

[amyl]

Here they are offering $220/hr to prn docs and $240/hr to prn crnas. It is messed up.

Where? This makes absolutely no sense… unless it’s an opt out state and a crna owns the group or its north star or sound

 

[GassYous]

Here they are offering $220/hr to prn docs and $240/hr to prn crnas. It is messed up.

Then why wouldn't you just hire md only?
And who is signing up for this?

 

[narcusprince]

Here they are offering $220/hr to prn docs and $240/hr to prn crnas. It is messed up.

Cap….

 

[Maverikk]

Here they are offering $220/hr to prn docs and $240/hr to prn crnas. It is messed up.

Where? Is it an amc, hospital, PP? Is the place a desirable metro getting retired locals

 

[Ravenclaw90]

It’s an amc, fairly desirable metro and the people taking it want to live in these suburbs for the schools. I don’t understand the greed. They say 1:4 md to crnas brings in more money than solo md and are willing to pay crnas more.

 

[nimbus]

Here they are offering $220/hr to prn docs and $240/hr to prn crnas. It is messed up.

Are the anesthesiologists just kicking back, eating snacks, and online shopping in the “office” while CRNAs are doing all the work?

 

[nimbus]

They say 1:4 md to crnas brings in more money than solo md

I don’t understand how that is possible.

 

[nimbus]

Then why wouldn't you just hire md only?
And who is signing up for this?

Yeah.

4 rooms MD only would cost $880/hr

4 rooms 1:4 MD:CRNA would cost $1180/hr

 

[nimbus]

Actually I can’t stand the private surgery center next door. They offered me $500/hr/$5000 guaranteed last minute and I just sat at home on my day off. I’m just fickle these days what I like to do.

What’s wrong with that ASC?

 

[CopaceticOne]

Yeah.

4 rooms MD only would cost $880/hr

4 rooms 1:4 MD:CRNA would cost $1180/hr

Got to have someone to soak up all the liability?

 

[nimbus]

Got to have someone to soak up all the liability?

4 MDs can soak up their own liability at a lower cost. But maybe they can only find 1 MD.

 

[amyl]

Yeah.

4 rooms MD only would cost $880/hr

4 rooms 1:4 MD:CRNA would cost $1180/hr

But do the numbers again at 6 to 1 (or more) because that’s what we are really talking about. Also cannot find enough MDs to do 6 rooms. 6 to 1 or more is everyone’s answer. Hospital happy, crnas happy, keeps $ stable in the face of reduced reimbursements.
It’s good business if ethics don’t bother you.
This particular example is another example of a groups local monopoly and salary fixing - these doctors have to be in the area…. So there’s nowhere else to work- so the group gets to set income artificially low.

 

[aneftp]

What’s wrong with that ASC?

demanding surgeons want to cut at 6am. Plus demands flip room.

Labor is expensive these days.

You are using 4 crnas for a min of 10 hrs up to 14 hr at the surgery center and one doc.

Those crnas labor cost at at least $8k for 4. Up to 10k. That’s with no locums fees. Anesthesiologist fee is 4k.

So right off the bat you at down the hole for 14k. Usap takes a 20% cut of the billing on top of that.

What’s wrong with that ASC?

They really need 3 crnas but use 2 crnas and run it like 3 rooms. It’s a lot of stress to block patients
Flipping rooms. Starting rooms while crna is waking uo the patient in one room.

Crnas are worked to death there also but like the 1099 money. Some people get addicted to the 1099 tax deduction when a w2 job (married) for crna and compressed schedule and retirement matching and pretax employee gets them to the same point as 1099

But crnas are a different beast these days. Even if the w2 job is comparable to 1099. They still want 1099 to dictate their own schedule.

 

[aneftp]

Yeah.

4 rooms MD only would cost $880/hr

4 rooms 1:4 MD:CRNA would cost $1180/hr

You are wrong. That’s 2018 compensation.

4 rooms md only cost you at bare min $1200 an hour (4 x $300) with no locums markups

4 crnas x $200/hr equals $800 plus the MD $300/hr brings you to the same $1100 price point an hour.

Even my w2 MD Job. Back filling in benefits retirement matching and paid time off. I’m getting $300-320/hr for the work I do.

 

[centdoc]

But do the numbers again at 6 to 1 (or more) because that’s what we are really talking about. Also cannot find enough MDs to do 6 rooms. 6 to 1 or more is everyone’s answer. Hospital happy, crnas happy, keeps $ stable in the face of reduced reimbursements.
It’s good business if ethics don’t bother you.
This particular example is another example of a groups local monopoly and salary fixing - these doctors have to be in the area…. So there’s nowhere else to work- so the group gets to set income artificially low.

Hospitals happy, crNas happy… what about the anesthesiologists?

 

[NicholasPavona]

Hospitals happy, crNas happy… what about the anesthesiologists?

Irrelevant.

 

[psychbender]

You are wrong. That’s 2018 compensation.

4 rooms md only cost you at bare min $1200 an hour (4 x $300) with no locums markups

4 crnas x $200/hr equals $800 plus the MD $300/hr brings you to the same $1100 price point an hour.

Even my w2 MD Job. Back filling in benefits retirement matching and paid time off. I’m getting $300-320/hr for the work I do.

That's assuming you pay the anesthesiologist the same hourly rate to direct vs be solo. Pay those solo anesthesiologists $275/hr, and you're equal. Technically, you're slightly ahead, as that's only 4 benefits packages, as opposed to 5, if everyone is W2. Of course, the age-old counter argument is "we can't find four anesthesiologists. "

 

[deleted1183938]

You are wrong. That’s 2018 compensation.

4 rooms md only cost you at bare min $1200 an hour (4 x $300) with no locums markups

4 crnas x $200/hr equals $800 plus the MD $300/hr brings you to the same $1100 price point an hour.

Even my w2 MD Job. Back filling in benefits retirement matching and paid time off. I’m getting $300-320/hr for the work I do.

He was using the numbers I think you or someone else gave him to do the math from what I recall.

 

[amyl]

He was using the numbers I think you or someone else gave him to do the math from what I recall.

This - yes

 

[nimbus]

You are wrong. That’s 2018 compensation.

4 rooms md only cost you at bare min $1200 an hour (4 x $300) with no locums markups

4 crnas x $200/hr equals $800 plus the MD $300/hr brings you to the same $1100 price point an hour.

Even my w2 MD Job. Back filling in benefits retirement matching and paid time off. I’m getting $300-320/hr for the work I do.

I was referring to this post:

Here they are offering $220/hr to prn docs and $240/hr to prn crnas. It is messed up.

 

[nimbus]

Also cannot find enough MDs

That would be the only reason to do medical direction or supervision if CRNAs get paid more than MDs.

 

[aneftp]

I was referring to this post:

Oh ok. Got it.

Just that lower pay doesn’t work at surgery centers these days unless you are willing to live with a bunch of rotating older docs or mommy track docs. Surgery centers like their usual crews of staff.

I know a place with 16 locums docs on their calendar. For 2 doc position! They keep rotating them in and out Those locums docs back fill at the last minute when they form have anything else planned. But the surgery center had to recently increase their rates from $300 to $350 an hour as well.

 

[Gern Blansten]

Oh come on