Is Bigger Always Better?
Also: feel the burn; the danger within; the lonely provider; connecting with patients; and money is still tight.
Imagine buying one or two rental homes and enjoying the modest passive income they generate. This is fairly common these days. Now imagine going to the bank and borrowing as much as they can possibly loan you so you can buy as many rental units as possible in order to create even more passive income. Sound tempting? It can certainly pay off, and I’m sure it has for some. Now imagine that the economy drives rental prices down; and costs to maintain the properties go up. When you’re holding a large amount of debt and you are at the mercy of market forces that you can’t control, it doesn’t take much to threaten financial failure. This narrative is familiar to private-equity-backed contact medical groups, like American Physician Partners.
When the No Suprises Act arrived and prohibited out-of-network balance billing, the attractive profit margins shrank nearly instantly. The house of cards that some PE-backed CMGs, like APP, had built could no longer stand. Since large CMGS have a wide footprint, when they fail, a large number of NPs, PAs, and physicians are adversely affected. In turn this causes an impactful disruption to a hospital’s operations.
In the case of APP’s failure, host facilities paid final paychecks to providers because APP would not. Host facilities paid malpractice tail coverage because APP would not. That’s a lot of money for hospitals to pay out because of APPs poor financial decisions. Even in cases when the host facility takes such actions to make providers whole, this entire experience erodes trust by providers and can easily make providers flea the facility for fear that the hospital brings another incompetent CMG in to manage the ED,
Hospitals should take note. Simply being a “big” CMG that has consolidated contract market share does not necessarily translate to contract stability, nor quality. Hospital decision makers need to look no further than the provider labor force to get valuable information when selecting a CMG. How many physician shifts and NP/PA shifts per day are scheduled? Do the providers feel they are the right number and the right mix? How many of those shifts are actually assigned to a provider 3 months in advance? A contract that has consistent Locums contributions can signal that the CMG cannot provide a comprehensive experience (this includes pay) satisfactory enough that attracts and retains talent. When a “staffing company” can’t consistently “staff” the department adequately, how stable is the contract? Inadequate ED provider staffing burns out existing staff, and risks driving providers away.
When hospital leaders shop for CMGs, they should bear in mind that “bigger” is not necessarily “better.” When overly leveraged CMGs fail financially, they fail the providers who produced profits for them. They fail the hospitals they service. They fail the community who depends on a stable workforce of sufficient providers.
Emergency Medicine
Burn Out Continues
The AMA found the emergency physicians rank first as the most burned out of all specialists. With a current and projected shortage of physicians, efforts are needed to preserve the workforce. Employers have a big role in shaping the experience of an EM provider. Hospitals also have a responsibility to resource (people, equipment, capability) departments appropriately.
Danger in the ED
I feel certain that a large number of you have either experienced a violent event by a psychiatric patient or at least witnessed one in person in very close proximity. Check this EP’s thoughts regarding the risk posed by psychiatric patients.
House of Medicine
Loneliness
Many American hospitals seem to resemble a busy train station frequented by many providers who are there today and gone tomorrow. This author discusses loneliness experienced by hospital-based physicians.
Return of the House Call
More and more has been written about bringing health care to the patient versus waiting for all the patients to come to clinic. Using technology, this is another step in that effort.
Telehealth
Read how the AMA is prioritizing extending reach to underserved patients in remote areas. This is a noble effort. It should be noted, however, that qualified NPs & PAs are also a great resource to reach the same patients. I say we use all the resources available!
Hospitals, Health Systems, and More
Tough Times Continue
Hospitals and health systems are struggling with their balance sheets and struggling to keep services running. An Illinois health system finds itself drowning in debt. A Missouri health system has about a month’s worth of cash left. In an effort to survive, Mississippi hospitals trade inpatient services for Rural Emergency Status. Yet a Nebraska system looks to charge patients for returning messages. With all these financial challenges, how will your pay be affected?
The Need for Speed
Stealing an ambulance. Yes, that happened in my Tennessee community. Apparently, a Florida woman also went for own joy ride herself yesterday. A couple of weeks ago, a Northern Virginia ambulance responding to a call was stolen and used in a police chase to Washington D.C.
The Good Stuff
MD students and PA students share momentous occasions on the same day at the same institution. Different roles - same team.
From Massachusetts to Mongolia, this NP is serving her country proudly! Thank you for your service.
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