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appalachiablue

(42,906 posts)
Sun Feb 12, 2023, 07:05 PM Feb 2023

Emergency Rms Staffed by Private Equity Firms Aim to Cut Costs, Make More Money, Hire Fewer Drs: NPR

Last edited Tue Feb 14, 2023, 01:06 PM - Edit history (1)

-'ER's Staffed by Private Equity Firms Aim to Cut Costs by Hiring Fewer Doctors,' NPR, Feb. 11, 2023. Ed. - Diagnosing and treating patients was once an ER doctor's domain, but they are increasingly being replaced by health practitioners who can perform many of the same duties & generate much the same revenue for less than half the pay.

Pregnant & scared, Natasha Valle went to a Tennova Healthcare hospital in Clarksville, TN, in Jan. 2021 because she was bleeding. She didn't know much about miscarriage, but this seemed like one. In the emergency room, she was examined then sent home. She went back when her cramping became excruciating. Then home again. Valle said it ultimately took 3 trips to the ER on 3 consecutive days, generating 3 separate bills, before she saw a doctor who looked at her bloodwork & confirmed her fears. "At the time I wasn't thinking, 'Oh, I need to see a doctor.' "But when you think about it, it's like, 'Well- dang - why didn't I see a doctor?' "It's unclear if the repeat ER visits were due to delays in seeing a physician, or if that affected her care, but the experience worried her. And she's still paying the bills.

The hospital declined to discuss Valle's care, citing patient privacy. But 17 months before her 3 -day ordeal, Tennova had outsourced its emergency rooms to American Physician Partners, a medical staffing company owned by private equity investors. APP employs fewer doctors in its ERs as one of its cost-saving initiatives to increase earnings, according to a confidential company document obtained by KHN & NPR. - This staffing strategy has permeated hospitals, & particularly emergency rooms, that seek to reduce their top expense: physician labor. While diagnosing & treating patients was once doctors' domain, they are increasingly being replaced by nurse practitioners & physician assistants, collectively known as "midlevel practitioners," who can perform many of the same duties & generate much of the same revenue for less than half the pay.

"APP has numerous cost saving initiatives underway as part of the Company's continual focus on cost optimization," the document says, including a "shift of staffing" between M.D.s and mid-level practitioners.

APP said this strategy is a way to ensure all ERs remain fully staffed, calling it a "blended model" that allows doctors, nurse practitioners & physician assistants "to provide care to their fullest potential." - Midlevel Providers Fill Primary Care Doctors' Shoes. Critics of this strategy say the quest to save money results in treatment meted out by someone with far less training than a physician, leaving patients vulnerable to misdiagnoses, higher medical bills, & inadequate care. These fears are bolstered by evidence that suggests dropping doctors from ERs may not be good for patients. Research published in Oct. by the Natl. Bureau of Economic Research, analyzed roughly 1.1M visits to 44 ERs throughout the Veterans Health Admin., where nurse practitioners can treat patients without oversight from doctors. Researchers found that treatment by a nurse practitioner resulted on average in a 7% increase in cost of care & an 11% increase in length of stay, extending patients' time in the ER by minutes for minor visits & hours for longer ones..

For private equity firms, dropping ER docs is a 'simple equation.' PE companies pool money from wealthy investors to buy their way into various industries, often slashing spending & seeking to flip businesses in 3 -7 years. While this business model is a proven moneymaker on Wall Street, it raises concerns in health care, where critics worry the pressure to turn big profits will influence life-or-death decisions that were once left solely to medical professionals.. "It's a relatively simple equation," "Their No. 1 expense is the board-certified emergency physician. So they are going to want to keep that expense as low as possible." ..The "shift" is nearly invisible to patients because hospitals rarely promote branding from their ER staffing firms & there is little public documentation of private equity investments...

- More, https://www.npr.org/sections/health-shots/2023/02/11/1154962356/ers-hiring-fewer-doctors

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Response to appalachiablue (Original post)

Freethinker65

(11,136 posts)
3. Going to a mid level care giver for continuing treatment is much different than for a diagnosis
Sun Feb 12, 2023, 07:53 PM
Feb 2023

I recently returned from a "dermatologist" appointment to continue treatment for a chronic condition I have had for over 40 years. Instead of a doctor, I saw an FNP-C. I had no idea I would not be seeing a board certified dermatologist until I googled the name of who I would be seeing.
The Family Nurse Practitioner was up to date on treatments available and her prescriptions and course of action were nearly identical to those, often heads of their department, dermatologists I have seen throughout the years. I am now curious how much my insurance will be billed for not seeing a doctor.
The FNP explained that extra years of study and "internships" (forgot the exact wording) were done to specialize in derm. I feel ok about the results of the appointment as I was already very knowledgeable on my options. I don't think I would feel as confident had I come in for a diagnosis, however my last "real" dermatologist was the worst I have ever had (prescribing novel medication combination delivery systems that were both costly and specifically advised against for the target area).
They need ER doctors in the ER.

mitch96

(14,653 posts)
7. I have been out of hospital work for almost 10 years and that's the way it was going back then
Sun Feb 12, 2023, 10:03 PM
Feb 2023

We had a huge ER and two or three ER docs and a boat load of ARNP (Nurse Practitioners) and PA's (Physician Assistant) doing most of the heavy lifting along with the Nurses and aids... It was obvious where things were going but we did not have a management company messing with things.
The Admins in the hospital did a good job of messing with things..
I miss the patients and some of the people I worked with but on the most part I'm glad I'm out... The politics will kill you... or the patient... Follow the money...
m

markodochartaigh

(2,058 posts)
9. I worked as an RN for three decades
Sun Feb 12, 2023, 11:53 PM
Feb 2023

in one of the largest public hospitals in the US. In the mid 80's the idea that if an administrator could manage a McDonald's they could manage a hospital began to take hold. I guess to administrators whose only real loyalty was to their own pocketbook it made sense.

https://www.mit.edu/people/dmredish/wwwMLRF/links/Humor/Administratium.html

mitch96

(14,653 posts)
10. My manager made all decisions via her spread sheet. If the numbers were not there it did not go.
Mon Feb 13, 2023, 10:58 AM
Feb 2023

To sometimes disastrous results.. But she looked good to her bosses.. She could document her decisions with the spread sheets. She dealt with numbers not people...
and kept getting promoted...
m

appalachiablue

(42,906 posts)
11. I believe it. These toxic practices in the name of higher profits that overburden
Mon Feb 13, 2023, 01:23 PM
Feb 2023

staff and too often result in delays and problems have been around for years. Working in this atmosphere must have been rough, thanks for your endurance. Around 10-15 years ago we knew two people, both insured who had critical problems yet their practitioners dismissed their concerns. A friend of one in distress had to fight to get her admitted to the ER. The system is a mess.

mitch96

(14,653 posts)
14. "toxic practices in the name of higher profits" I understand that a hospital is a business
Mon Feb 13, 2023, 04:37 PM
Feb 2023

with a lot of dead weight. In Radiology we made a bucket load of profit for the hospital..
Housekeeping....not so much but they have to be paid.
People get outraged about the $2 aspirin. Yes you can buy it cheaper in the drug store but think about it.
The doctor orders you aspirin. Who pulls the order off the chart? The ward clerck.
Who pays her? The pharmacy gets the order and fills it.
Who filled the order in the pharmacy?
How did did it get to the floor?
who administered it. All those people don't work for free.
ergo, the $2 aspirin.
Big diagnostic toys are expensive and if you want to be competitive in the market place you need the toys. Doc's who bring $$$ into the hospital go where there are the best toys..
Look at little rural hospitals closing b/c they don't have the equipment that doctors want and need to do their job... No revenue b/c of poor management?
A fine line between profit, break even and loss... A quandary for sure...
m

slightlv

(4,325 posts)
4. This is when healthcare goes to hell in a handbasket.
Sun Feb 12, 2023, 08:21 PM
Feb 2023

Private equity firms are only brought out for one reason... to rape as much as they can for their shareholders and kill the entity. Unfortunately, those within that entity will be us.

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