The Fallout of APP's Failure: providers pay the price
Also: FSEDs fitting in; the helpline sent me here; more on unions; and "best hospitals" list
Top of the week
Could this happen to you?
As a reminder of their footprint, APP had contracts in over 150 hospitals and health systems. They employed a combined over 2500 APCs and physicians. As recently as June they were giving assurances to providers that their financial structure was much different and better than Envision’s, and they were in no danger of succumbing to a similar fate. It turns out that less than 60 days later APP gave many (if not most/all) hospitals and health systems about 2 weeks to find new EM contract management groups because APP was going out of business. Should we really believe that APP leaders did not know the company’s fate in June, or even 6 months ago? Plenty of APP leaders had time to prepare for this; providers did not.
The effect on providers
Recall that these providers, like you all, were subjected to the chronic stressors associated with Covid and post- Covid employment. Now, they had been told with a few weeks’ notice that their employer would cease to exist. Job related problems (job loss, unexpected change) are frequently cited in the top 10 most impactful stressors in a person’s life. Providers had been told that their employer could not pay their last paycheck(s); that their employer would not pay their tail liability coverage. However, even if remedies for these two did materialize, who would be the next employer? Though there would be 2 weeks before the end of the current APP contract, providers would likely only have a few days to examine a contract from the new, incoming contract management group. How does such a life impacting decision be made in just 2-3 days?
What if the terms and conditions of the new employer’s contract are not satisfactory? One may feel as though there is no choice due to other immediate financial obligations that don’t allow for gap in paychecks. One may be geographically constrained due to family obligations, like kids’ schools, or a spouse’s job. One may find that other employer options offer contracts that are virtually equally dissatisfying or even worse. Lastly, one’s local ED provider leadership may not remain in place with the new CMG. Subsequently, one may wonder if one’s schedule will be satisfactory, or the new local leadership will sincerely listen to job-related concerns and advocate for the team.
Heading to a shift and wondering if the department will have adequate nursing staff and capability, e.g., timely CT interpretations, creates its own stress for providers. Being worried about how you will financially take of yourself, and family should not be something EM providers should have to worry about. Ask questions. Stay informed. Recognize your value and protect it.
Emergency Medicine
Are Freestanding EDs the answer for everyone?
Plenty of EM providers will tell you it makes them nervous to receive CVA patients, trauma patients, and other critically ill patients in FSEDs. There is an obvious limit to the management that can be provided before the patient needs advanced care by specialists in a hospital.
If a main campus ED’s capability gets severely degraded by boarding patients, then what happens to FSED’s who are also boarding patient’s requiring transfer/ admission? It’s back to seeing patients in the waiting room. Lots of patients are receiving quality care in FSEDs across the country. These outposts are making lots of money. However, is it the best solution for every community?
House of Medicine
24-hour helplines send more patients to hospital
So, you sign up for your next patient and greet them. You ask, “what brought you in today?” Patient says, “my doctor told me to come right to the ER.” We’ve all heard this before. Many times, I find no doctor or APC told them to come here, but rather somebody on a help line did. More of this is coming. It appears there is an increase of big insurance groups establishing helplines for patients to call for medical advice. Giving medical advice over the phone is challenging and does not come without risk. One way for these companies to mitigate the risk: ” you should go right to the ER.” It would seem this will contribute to increased ED visits. The good news is that there are well trained, qualified EM NPs & PAs out there to see patients.
PeaceHealth workers move to unionize
There continues to be increased discussion about healthcare workers, including providers, moving toward unionization. In Vancouver, Washington, a group of NPs and PAs are taking real steps to joining a union that already includes physicians. Nurses in the same state recently voted to unionize. It’s not a wonder why there is more consideration for unionizing. Collective bargaining consolidates the power of the healthcare worker and help level the playing field against employers. In Michigan a health care union of about 200 workers plans to strike on August 4th. Topping their list of reasons are: bad faith bargaining and low wages. With the threat of closing certain department operations, the hospital is incentivized to listen and attempt to bargain.
Hospitals, health systems, and more
How responsive is your hospital to staff?
Check out this list by Beckers that identifies the best hospitals in each state who are most responsive to staff. Will you find your hospital on this list?
Transparency in medical billing is needed
Some outpatient clinics seem to be gouging patient pocketbooks by charging fees for services as if those services were performed in a hospital. These newly increased clinic-based fees can be as high as 10 times more than previously charged.
The Good Stuff
A soldier - PA provides care in Kenya. Thank you for your service, MAJ Corporan-Reyes!
A victim advocate NP in New York receives an international award for her work with abused patients. It takes a special kind of person to do this kind of work; but to do it for such a long time makes her blessing to communities. Thank you, Nancy.
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