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

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