What's the inside word these days at USACS, Envision, and other PE-owned goliaths?

[namethatsmell]

News about the bullies this month doesn't appear favorable....

USACS is now looking for significantly more PE money (story is firewalled, if anybody happens to have access please post it):

US Acute Care Solutions, backed by WCAS, seeks $1bn-plus recap | PE Hub

Physician staffing businesses like USACS face less regulatory overhang after lawmakers reached a compromise to ban surprise medical billing in December.

www.pehub.com

I used to work at one of their shops after they took over a site I was at. I'm hearing they're continuing to slash coverage and cut pay. How will all the grunt docs "physician owners" be "rewarded" for having to swallow a (likely dilutional) influx of >$1 billion? I know this is newly announced, but does anybody know specifics of why they're looking to recap?


Envision is now completely out of network with UnitedHealth:

UnitedHealthcare cuts Envision from its provider network

UnitedHealthcare is continuing a trend of pressuring physician staffing firms by cutting Envision Healthcare from its network. | UnitedHealthcare is continuing a trend of pressuring physician staffing firms by cutting Envision Healthcare from its network.

www.fiercehealthcare.com

I briefly worked at an EmCare site several years ago and it was completely awful. I just looked and they somehow still have the contract -- I can't fathom how bad it must be now. I've also worked at a former Envision site where the hospital was so unhappy they canned them, refused to listen to a glossy pitch from any other large staffing company, and helped create an sdg out of the ashes. Do folks think that Envision, now being fully out of network with the country's largest insurance company, makes them less appealing/competitive to C-suite when they bid to keep their contracts or acquire new ones?

Any other whispers out there about these jokers (or their APP, Team, etc buddies) and guesses on what the short-term and long-term outlook is for them?

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[RustedFox]

Following this thread and holding my breath.

 

[southerndoc]

If you're charging 2-3 times what other players are charging, then it's bound to happen since the balance billing legislation became law.

There was a previous article where United cut Envision's radiology contracts. I can't gather from the article quoted whether this is for all services or just specific services (i.e., radiology, emergency medicine, hospitalist, anesthesia).

 

[namethatsmell]

If you're charging 2-3 times what other players are charging, then it's bound to happen since the balance billing legislation became law.

There was a previous article where United cut Envision's radiology contracts. I can't gather from the article quoted whether this is for all services or just specific services (i.e., radiology, emergency medicine, hospitalist, anesthesia).

From the horse's mouth, it appears that all of Envision services are now out of network w/United:

Insurer Refuses to Keep Envision Clinicians in Their Network

UnitedHealthcare has decided not to renew its longstanding partnership with Envision Healthcare in the midst of a national health crisis. This means Envision’s clinicians will not be part of United’s insurance plans starting January 1, 2021.

www.evhc.net

 

[bravotwozero]

I will say this about APP - they restored our base pay to pre-covid rates, and are now paying us back the money they cut in installments. Was $17k for me, so decent chunk of money. Still have to continue paying for scribes though.

 

[RustedFox]

I will say this about APP - they restored our base pay to pre-covid rates, and are now paying us back the money they cut in installments. Was $17k for me, so decent chunk of money. Still have to continue paying for scribes though.

How much did your "shares" get you?

 

[southerndoc]

I will say this about APP - they restored our base pay to pre-covid rates, and are now paying us back the money they cut in installments. Was $17k for me, so decent chunk of money. Still have to continue paying for scribes though.

Who is APP?

 

[Apollyon]

Who is APP?

American Physician Partners, I think.

 

[namethatsmell]

I will say this about APP - they restored our base pay to pre-covid rates, and are now paying us back the money they cut in installments. Was $17k for me, so decent chunk of money. Still have to continue paying for scribes though.

Glad to hear they're starting to make you guys whole and put your base back to its pre-covid level. Out of curiosity, are they giving you guys any interest on the $ they've delayed paying you or a one-time bonus?

 

[bravotwozero]

How much did your "shares" get you?

Umm, shares? APP doesn't offer shares as far as I know. At least, I don't own any.

Glad to hear they're starting to make you guys whole and put your base back to its pre-covid level. Out of curiosity, are they giving you guys any interest on the $ they've delayed paying you or a one-time bonus?

No, no interest. When our pay was cut, they told the cuts were going to be in the form of a 'repayable loan' to APP that will be paid back when possible, which is what they are doing now.

American Physician Partners, I think.

correct.

 

[BoardingDoc]

How much did your "shares" get you?

That's USACS, not APP

 

[RustedFox]

Umm, shares? APP doesn't offer shares as far as I know. At least, I don't own any.

Yep. I confused APP with USACS.
I'm sorry; this was an especially dumb mistake on my part, as APP ruined one of my job sites recently.

The hate must have been flowing thru me.

 

[Arcan57]

How much did your "shares" get you?

While they don't offer shares, they did set up a merch store that they pushed rather aggressively right around the time they started cutting pay/coverage/etc for COVID. That being said they're actually paying back some of the pay cuts, which essentially was an interest free loan we gave them because they were over-extended and wouldn't have made payroll in the fall. So yeah, pretty much all positive...

 

[Arcan57]

yeah whoever approved that merch shop was especially tone-deaf. “Why yes, I would like an APP-emblazoned fleece for $89.99 right after you cut my pay, my hours, and my scribes......”

Although even in fair times, calculating that a lot of docs would want to wear gear emblazoned with some random collection of letters that makes you thinks of NPs seems off. Especially considering most of APPs employ.... er independent contractors just had their group bought out in the last couple of years and still feel the sting of that.

 

[turkeyjerky]

Although even in fair times, calculating that a lot of docs would want to wear gear emblazoned with some random collection of letters that makes you thinks of NPs seems off. Especially considering most of APPs employ.... er independent contractors just had their group bought out in the last couple of years and still feel the sting of that.

I really thought you were joking about the merch store in your first post. WTF?

 

[bravotwozero]

He's not. We'd get emails about it all the time.

 

[GeneralVeers]

yeah whoever approved that merch shop was especially tone-deaf. “Why yes, I would like an APP-emblazoned fleece for $89.99 right after you cut my pay, my hours, and my scribes......”

Tone deaf describes most of the management and decisions, especially at USACS.

 

[RustedFox]

Tone deaf describes most of the management and decisions, especially at USACS.

What's the EM equivalent of us "GameStopping" the CMGs?
Someone work on this who is smarterer than me.

 

[Dr Mantis Toboggan]

What's the EM equivalent of us "GameStopping" the CMGs?
Someone work on this who is smarterer than me.

💎 🙌
🚀 🚀 🚀

 

[GeneralVeers]

What's the EM equivalent of us "GameStopping" the CMGs?
Someone work on this who is smarterer than me.

Well they are shorting our integrity, self-interest, and patient care. Let's stand up for ourselves.

 

[bravotwozero]

What's the EM equivalent of us "GameStopping" the CMGs?
Someone work on this who is smarterer than me.

I've thought about that so many times, the closest I could come up with was we band together to buy stock in envision and blackstone and become majority shareholders in the CMGs or their corporate backers via a hostile takeover...

 

[sum dude]

How much did your "shares" get you?

1.75 x vested shares. Which I'll give them credit--thought that $ was gone for sure. That's actually a weak gain for Welsh-Carson, who made 4x on spinning off US Anesthesia

 

[sum dude]

I've thought about that so many times, the closest I could come up with was we band together to buy stock in envision and blackstone and become majority shareholders in the CMGs or their corporate backers via a hostile takeover...

You'd be better off buying off the debt, which is ironically how KKR (Envision owner) became the giant PE firm it is...corporate raid the corporate raiders.

 

[sum dude]

American Physician Partners, I think.

It's ironic they're name is "APP"..don't even hide what they're planning ; p

 

[namethatsmell]

So a surprising update re: USACS. It seems that their call for new funding is to buy out their current PE owners and that this new funding will function as a loan. The supplier(s) of this new capital won't have any ability to exert control of the company. If this goes through USACS will apparently be ~80% physician owned.

I gotta say, I'm a bit shocked.

Of course, what this means for the grunt docs remains unknown. Unless they do things like raise pay for front-line docs, give local docs the opportunity to determine staffing levels at their own shops, and give every FT doc a chance to obtain meaningful ownership of the company (via sweat equity or a buy-in)...this move will basically be a farce.

Will be interesting to see how things play out for them.

 

[bravotwozero]

it will 100% be a farce, and is likely a move to lower tax burden, i suspect.

 

[JacobMcCandles]

So a surprising update re: USACS. It seems that their call for new funding is to buy out their current PE owners and that this new funding will function as a loan. The supplier(s) of this new capital won't have any ability to exert control of the company. If this goes through USACS will apparently be ~80% physician owned.

I gotta say, I'm a bit shocked.

Of course, what this means for the grunt docs remains unknown. Unless they do things like raise pay for front-line docs, give local docs the opportunity to determine staffing levels at their own shops, and give every FT doc a chance to obtain meaningful ownership of the company (via sweat equity or a buy-in)...this move will basically be a farce.

Will be interesting to see how things play out for them.

I would fully expect it to be a farce. 'Physician owned' doesn't mean anything. I doubt much will change for the pit docs.

 

[turkeyjerky]

I would fully expect it to be a farce. 'Physician owned' doesn't mean anything. I doubt much will change for the pit docs.

Seriously. Vituity is legitimately owned by the docs and credentials their NP/PAs for CVCs, LPs, etc

 

[GeneralVeers]

Seriously. Vituity is legitimately owned by the docs and credentials their NP/PAs for CVCs, LPs, etc

Yes it is, but it still has a pyramid structure. There are a level 5 physician partners who can't even handle 1 patient/hour, and still get the $80K annual bonus. I've worked with some of these geriatric gems, and it's painful to watch them.

 

[deleted547339]

Yes it is, but it still has a pyramid structure. There are a level 5 physician partners who can't even handle 1 patient/hour, and still get the $80K annual bonus. I've worked with some of these geriatric gems, and it's painful to watch them.

Ummmm....1 patient per hour is beyond a joke, even if they are all critical. My interns can do that. Please tell me your exaggerating.

 

[RustedFox]

Ummmm....1 patient per hour is beyond a joke, even if they are all critical. My interns can do that. Please tell me your exaggerating.

At my one former job site, the old crones ONLY worked the 6am-2pm shift, saw 1.3 patients (estimated, given volume) per hour, and tried to leave early all the time.

 

[Mr Bitterness]

1.75 x vested shares. Which I'll give them credit--thought that $ was gone for sure. That's actually a weak gain for Welsh-Carson, who made 4x on spinning off US Anesthesia

Except Dominic told all docs that 3.5x was their goal in 5 years. (I agree though, I assumed it would be gone.)

USACS borrowing money at 10.5% from Apollo seems a little junk bond-ish rate, esp in this environment.

Also- all docs only allowed to sell 20% of their shares, while Welsh Carson are cashing out completely. USACS also pushing for docs to buy more ”shares” to help out.

 

[alpinism]

What's the EM equivalent of us "GameStopping" the CMGs?
Someone work on this who is smarterer than me.

Funny enough was just discussing this with a few classmates from residency.

So it might actually be possible to "GameStop" the CMGs but on the retail market.

Essentially if enough emergency docs banded together it would be possible to secure enough capitol to start a massive marketing campaign focused on CMGs owned by billionaire wall street private equity firms. The primary reason this hasn't happened yet is the fact that most people are scared of speaking out publicly for fear of losing their jobs. The beautiful thing about reddit and all of the other online forums is that it allows people like ourselves to post anonymously without fear of being terminated by our employers. This changes the rules of the game because now
everyone including those working for CMGs can participate. Considering the amount of people who've been screwed over by them in the past there shouldn't really be very much difficulty in recruiting emergency docs to join a reddit group dedicated to fighting CMGs in the retail market. Even if you could get a fraction of the people in the Facebook group you could easily generate millions worth of investments. The trick at that point would be to locate and target vunerable contracts in competitive retail markets. Considering the intense public hatred for wall street and their history of screwing over the working class it shouldn't be too hard to design an effective marketing campaign.

 

[GeneralVeers]

Ummmm....1 patient per hour is beyond a joke, even if they are all critical. My interns can do that. Please tell me your exaggerating.

I wish it was a joke. It's part of the problem when you have a non-RVU socialist approach to medicine. These guys were still getting paid the full hourly, and getting the yearly bonus despite being drains on the system. Meanwhile I was seeing 2-3 pts per hour just to pick up the slack so the place didn't completely fall apart. People need to work at the VA if they have this poor work ethic.

 

[BoardingDoc]

I wish it was a joke. It's part of the problem when you have a non-RVU socialist approach to medicine. These guys were still getting paid the full hourly, and getting the yearly bonus despite being drains on the system. Meanwhile I was seeing 2-3 pts per hour just to pick up the slack so the place didn't completely fall apart. People need to work at the VA if they have this poor work ethic.

This is exactly why I can't imagine working at a place that isn't a keep what you kill model. Right now, I can hustle, and I get paid very well for it. If my colleagues are feeling lazy and slow down, that's fine. I make a bunch more money. I can't imagine working somewhere where patients just sit in the rack and there is literally no incentive for anyone to work harder and see them except to avoid being yelled at by the C-suite or some nursing supervisor.

The carrot works a lot better than the stick.

 

[Brigade4Radiant]

This is exactly why I can't imagine working at a place that isn't a keep what you kill model. Right now, I can hustle, and I get paid very well for it. If my colleagues are feeling lazy and slow down, that's fine. I make a bunch more money. I can't imagine working somewhere where patients just sit in the rack and there is literally no incentive for anyone to work harder and see them except to avoid being yelled at by the C-suite or some nursing supervisor.

The carrot works a lot better than the stick.

Yes I prefer fair RVU places because you’ll get killed as the night doc in some places

 

[Arcan57]

So a surprising update re: USACS. It seems that their call for new funding is to buy out their current PE owners and that this new funding will function as a loan. The supplier(s) of this new capital won't have any ability to exert control of the company. If this goes through USACS will apparently be ~80% physician owned.

I gotta say, I'm a bit shocked.

Of course, what this means for the grunt docs remains unknown. Unless they do things like raise pay for front-line docs, give local docs the opportunity to determine staffing levels at their own shops, and give every FT doc a chance to obtain meaningful ownership of the company (via sweat equity or a buy-in)...this move will basically be a farce.

Will be interesting to see how things play out for them.

The kind of capital that a growing CMG needs usually only comes from 3 places

PE: upsides- DEEP pockets, downsides- stack your boards with their pawns and try to extract more short term value than would naturally be present

IPO: upsides - can raise a lot of money, especially if you time it right, downsides - you're now a publicly traded company with all that means

Banks: upsides - keep control of the decision making, downsides - significant difficulties both in obtaining loan (no physical assets means collateral is harder to prove) as well as getting interest rates that don't act as an anchor slowing you down enough to get eaten by the CMGs doing PE or IPO.

Team and Envision cycle between PE and IPO based on where they are on the expansion/consolidation continuum. A lot of FSEDs were financed with the bank model (usually doc(s)' homes as collateral). Maybe USACS is trying for a fourth way.

I guess if you convinced enough docs to loan back to the CMG a significant percentage of their earnings that also would raise significant capital but you'd have to rely on most of your docs not having access to jobs that pay market rate. It also relies on the docs having no clue how disconnected and unconcerned MD/DOs working 0-4 shifts per month are about the conditions of the pit docs. Almost everything above the FMD level, by necessity, views pit docs as widgets. What separates the "good" RMD/VPs from the bad is that you don't automatically smell the age of the BS when a "good" VP is whipping you up with stories about kicking butt and taking names from when they were in the pits (as part of an SDG , 15 years ago). Make no mistake, if you're working 12+ shifts a month in an ED you don't own, you're always going to be labor. And we know what happens in this country when the interests of capital and the interest of labor conflict.

 

[Arantius]

From the horse's mouth, it appears that all of Envision services are now out of network w/United:

Insurer Refuses to Keep Envision Clinicians in Their Network

UnitedHealthcare has decided not to renew its longstanding partnership with Envision Healthcare in the midst of a national health crisis. This means Envision’s clinicians will not be part of United’s insurance plans starting January 1, 2021.

www.evhc.net

ok. I just posted this in another thread but there's a new anesthesia group in my neck of the woods- sound anesthesia? Apparently owned by UHC... Is that their end game? Just open their own group?

 

[turkeyjerky]

ok. I just posted this in another thread but there's a new anesthesia group in my neck of the woods- sound anesthesia? Apparently owned by UHC... Is that their end game? Just open their own group?

Yup. And they are awful

 

[coachB]

ok. I just posted this in another thread but there's a new anesthesia group in my neck of the woods- sound anesthesia? Apparently owned by UHC... Is that their end game? Just open their own group?

No, bought their own group.

 

[Airborne Flt Doc]

The ED docs will take a pay cuts in Ocala AdventHealth as well as take on big liability with the loss of experienced nurses who have gone to other hospitals with better pay and that hospital CMO/administration picks who stays for this nice pay cut with the new CMG. This shop was one of the last wonderful SDGs who lost a lot money during the pandemic & the hospital wouldn’t negotiate with them because they use “USACS contracts as the standard for West FL “ ....here is the letter from the USACS to the firefighters ....

 

[skougess]

That letter actually approaches corporate satire.

 

[GeneralVeers]

Why anyone is interested in "helping" their corporate overlords is beyond me.

 

[kumatie]

My contract just got taken over by usacs. We just received a similar letter and informed that if you ever had any malpractice claims made against you, regardless of outcome, that you would “not be retained because of liability concerns”. Guess what, half the docs are now gone and now replaced with midlevels.

 

[Fox800]

My contract just got taken over by usacs. We just received a similar letter and informed that if you ever had any malpractice claims made against you, regardless of outcome, that you would “not be retained because of liability concerns”. Guess what, half the docs are now gone and now replaced with midlevels.

Brilliant

 

[RustedFox]

ACEP needs to be held accountable.

 

[Birdstrike]

My contract just got taken over by usacs. We just received a similar letter and informed that if you ever had any malpractice claims made against you, regardless of outcome, that you would “not be retained because of liability concerns”. Guess what, half the docs are now gone and now replaced with midlevels.

None of those mid-levels ever had or will have claims filed against them? Sure they have, and will.

They have data showing PA’s generate less
liability than physicians?

Highly unlikely.

But they sure know they can pay them less!

This sounds like a business decision, not a “patient safety” decision springing from liability or quality improvement.

I’m tired of doctors getting lied to.

 

[robellis]

My contract just got taken over by usacs. We just received a similar letter and informed that if you ever had any malpractice claims made against you, regardless of outcome, that you would “not be retained because of liability concerns”. Guess what, half the docs are now gone and now replaced with midlevels.

Wtf...

 

[RustedFox]

ACEP needs to be held accountable.

Seriously, the more I think about it; the angrier I get.

What has ACEP done right in the past (x) years for our specialty?

 

[southerndoc]

My contract just got taken over by usacs. We just received a similar letter and informed that if you ever had any malpractice claims made against you, regardless of outcome, that you would “not be retained because of liability concerns”. Guess what, half the docs are now gone and now replaced with midlevels.

That should be illegal.