American Physician Partners bankrupt!
Also: EP's pushing against private equity; simplifying healthcare; and where are the prices for EM?
Top of the week
Another big company that staffs EDs, hospital medicine, and ICUs has fallen. American Physician Partners is a Tennessee based staffing company that has been in operation since 2015 with over 150 contracts in 18 states. It will be out of business by July 31st. In full disclosure, I am employed by American Physician Partners - at least until July 31st. At one point APP was ranked first on the Nashville Business Journal’s fastest-growing private companies list.
It has been well known that the company has struggled with debt since at least 2021. In December of that year, the company owed over $470 million in debt, and it was having trouble repaying overdue loans. It should be noted, though, that from 2018-2021 the company reported an over 154 % raise in annual revenues totaling $633 million. So why the financial collapse?
Multiple contributing factors for the financial hardships have been cited; among them was the end of surprise billing. Multiple practice groups were adversely affected by the end of surprise billing, but to what extent should the solvency of a company rely on billing patients’ exorbitant amounts?
Labor costs also strained EM staffing companies’ finances. It is well known that when staffing companies cannot fill permanent employment positions, it must use temporary staffing that can easily cost over double of the cost for permanent staff providers. But why is there a labor problem to begin with? Providers are leaving emergency medicine, and resident physicians are hesitant to select EM. You can imagine the high anxiety that EM, HM and ICU providers experienced when APP gave them a few weeks’ notice that their employment was ending, and thousands of providers did not have clear answers to many questions regarding payroll, benefits, tail coverage, and employee stock value. These experiences will not improve provider confidence in working in emergency medicine. So how does a company staff an ED and manage EM providers.
We are witnessing a major paradigm shift in how to staff EDs and manage providers. It is likely that a number of staffing models will emerge to address the modern challenges of delivering emergency medicine. However, to successfully survive for the next 10 years or more, staffing companies will have to re-focus their attention on the provider.
Providers’ voices will have to be heard more frequently. Providers’ concerns will have to be identified and validated. Hospitals and EM employers will have to take real measurable actions to address those concerns. Truly competitive merit-based compensation will have to be a part of the solution to stabilize the work force. Also, providers will have to be offered a portion of the staffing company’s profits in the form of matching 401k or profit sharing. These are just some features that make providers truly feel as if they are part of a “team” as opposed to just hearing that word thrown around like an empty slogan.
Emergency Medicine
EPs trying to take back control from private equity
In a July 14 statement, ACEP reasserted its opposition to the corporate practice of medicine. EPs have a number of concerns when private equity-controlled staffing companies exert influence on clinical decisions, like order entry decision. Also, EPs wish to reserve the right to determine the right number of patients to be seen. It is not yet clear how to operationalize ACEPs position.
California’s ED problem getting worse
Over the past 10 years, the number of EDs in California decreased as the state’s population increased, as has the ED wait times. To make matters worse, the number high acuity visits increased by 68% while the low acuity visits decreased by 63%.
Preparing for another possible tripledemic
We all remember last year’s challenge of RSV, Covid, and flu surge in EDs across the country. To prepare for another similar threat this year, 3 physician leaders have identified interventions they believe are successful to mitigating the negative effects of such surges. Some of the interventions include discharge lounges, pediatric direct admit processes, and outpatient urgent pediatric appointments.
House of Medicine
“The administrative burden of health care”
There is an increasing number of obstacles between providers and patients. Many of these are administrative tasks for which there is no provider reimbursement. Patients are also forced to spending more time in planning care, receiving care and making sure that insurance companies have paid their fair share for services. How can we capture all the time spent by providers and patients during the care delivery cycle?
Hospitals, health systems, and more
Hospitals hiding prices
Passed over 2 years ago, the Inpatient Prospective Payment law, also known as the Hospital Price Transparency law, requires hospitals to publish prices on-line. A recent report found that only 36% of hospitals studied were found to be fully compliant with the new mandate. The report found that not a single HCA facility was found to be in complete compliance.
The Good Stuff
Arkansas showing progress!
The state has passed legislation that allows PAs to be enrolled as providers in the Medicaid program. The states’ rural area residents had insufficient access to healthcare providers. It is felt that this issue was one of the contributing factors for the bill’s success.
There simply are not enough physicians to meet the increasing health care needs of this country; Arkansas is not alone. When we examine states that have considerable rural residents, we usually see an insufficient number of medical providers. Qualified NPs & PAs are great solutions to increasing access to quality care.
An NP’s writes to the Chicago Sun Times Editor
An NP makes the case for her profession. There is no question that there is no shortage of colorful anecdotes about bad NP/ PA practice. I feel certain that negative anecdotes are not limited to NPs & PAs. I’m sure there is room for improvement among all clinical professions. Communities in need can benefit from well trained and qualified NPs & PAs. The good news is that there are plenty of them.
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