Groups of emergency physicians and consumer advocates in multiple states are calling for stricter enforcement of decades-old laws banning the ownership of medical practices by companies not owned by licensed physicians.
33 states In addition, the District of Columbia has rules for so-called corporate medical practices. But critics say that over the years, companies have bought or set up local talent groups nominally owned by doctors, limiting their powers so they can’t control them directly. have successfully circumvented the ban on possession of medical practice.
Appearing nearly 100 years ago, these laws and regulations oppose the commercialization of pharmaceuticals, preserve the independence and authority of physicians, and place the physician-patient relationship above the interests of investors and shareholders. was intended.
Those campaigning for stricter enforcement of the law say physician staffing firms owned by private equity investors are among the most egregious offenders. A private equity-backed staffing firm manages a quarter of her emergency rooms across the country, according to one Raleigh, N.C.-based doctor who runs an ER doctor recruitment site.Two of the largest are based in Nashville imagine health careowned by investment giants KKR & Co.., and Knoxville-based team healthowned by black stone.
Court filings in multiple states, including California, Missouri, texasWhen Tennesseeaccused Envision and Team Health of using physician groups as strawmen to circumvent corporate practice laws. relating to the incident.
Now doctors and consumer advocates across the country are California lawsuit against Envision, is scheduled to begin in January 2024 in federal court.Plaintiff in the case, based in Milwaukee Physician Group of the American College of Emergency MedicineEnvision claims it uses a shell business structure to hold de facto ownership of ER staff groups and is asking the courts to declare them illegal.
“We are not asking them to pay any money, nor will we accept being paid to drop the case,” said David Milstein, the plaintiff’s lead attorney. , we are simply asking the courts to ban this model of practice.”
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“Possibility to spread nationwide”
A group of doctors believe the victory will lead to a California-wide ban on the practice. This is done not only for the ER, but also for other staff provided by Envision and Team Health, such as anesthesiology and hospital care.California Medical Association uphold the lawsuitsaid it would “form the boundaries of California’s ban on corporate medical practices.”
Plaintiffs, along with many doctors, nurses, consumer advocates, and some lawmakers, believe that the success of the lawsuit will encourage regulators and prosecutors in other states to take corporate drug bans more seriously. North Carolina Senator Julie Mayfield said, “A decision anywhere in the country that corporate ownership of medical practices is illegal could have national and I absolutely hope that is the case.
But many are skeptical of the move to reinvigorate laws restricting corporate practices in health care, believing it is ushering in a golden age of health care. The genie came out of the bottle, they say, noting that the profit motive permeates every corner of healthcare. About 70% of doctors Currently employed by companies and hospitals in the US.
Barack Richman, a law professor at Duke University, says the medical doctrine corporate practice “has a very interesting history and isn’t very flattering.” “Healthcare professionals were trying to assert their professional superiority in ways that were less beneficial to patients and the market, and which provided many benefits for themselves.”
The California lawsuit involves Placentia-Linda Hospital in northern Orange County, where the plaintiff’s physician group lost its ER management contract with Envision. The complaint alleges that Envision uses the same business model at numerous hospitals across the state.
“Envision exercises deep and pervasive direct and indirect control and/or influence over medical practice, makes decisions that directly and indirectly affect medical practice, and treats physicians as mere treating them as employees and diminishing their independence and freedom from commercial interests.” to complaints.
Envision said the company complies with state law and its operating structure is typical in the healthcare industry. “Legal challenges to the structure have proven futile,” Envision wrote in an email. “Care decisions have and will always be made between clinicians and patients,” he added.
TeamHealth, an indirect target of the incident, claims that its “world-class operational team” provides administrative services and that “clinicians are commonly used by hospitals, health care systems, and other health care providers. Through structure, we will be able to focus on the practice of medicine and patient care.” Country.
State rules vary widely
State laws and regulations governing corporate medical practice determine whether there are exceptions for nonprofit organizations, how much of a doctor’s earnings outside of the management company can be retained, who can own the equipment, and how violations are punished. It depends a lot on several factors, including whether the New York, Texas, and California are believed to have the most restrictive restrictions, while Florida and 16 other states have none.
Kirk Ogroski, a partner at law firm Goodwin Proctor, said this type of control structure predates the emergence of private equity in the industry. “I would be surprised if a company interested in investing in this space messed up its founding documents. It would shock me,” Ogroski said.
Private equity-backed companies have been drawn to emergency rooms in recent years because ERs are profitable and can charge large sums for out-of-network treatment. At least until federal law cracks down on sudden charges. Envision and TeamHealth are prioritizing profits by maximizing revenue, cutting costs and consolidating smaller clinics into larger groups, critics say.
Envision and TeamHealth are privately held companies, so it’s difficult to find reliable data on their financial health and market penetration.
Dr. Leon Adelman, Co-Founder and CEO ivy clinicianRaleigh-based startup recruiting site for emergency doctors spent 18 months piecing together data to find that private equity-backed staffing firms operate 25% of the nation’s emergency rooms. I discovered that there is TeamHealth and Envision have his two largest shares at 8.6% and 8.3% respectively, Adelman said.
Other estimates put the penetration of ER by private equity at nearly 40%.
Doctor presses investigation
Efforts by emergency doctors and others to challenge alleged violations of private equity and staffing firms have so far had frustrating results.
advocacy group called take back the medicinewas formed last year by a handful of ER doctors. sent a letter In July, it asked North Carolina Attorney General Josh Stein to investigate corporate violations of the ban on medical practice. National Association of Attorneys Generalthe letter also called on him to persuade his fellow AG to “launch multi-state investigations into widespread lack of enforcement” of corporate practices in health care laws.
The group’s leader, Dr. Mitchell Li, initially Disappointed with reaction He received it from Stein’s office, which promised to consider his request. But having secured a January appointment with officials at Stein’s office, Lee is now more hopeful.
Dr. Robert McNamara, co-founder of Lee’s group and director of emergency medicine at Temple University’s Louis Katz School of Medicine, along with Houston physician Dr. David Hoyer, submitted a draft complaint to the Texas Medical Commission. and asked the Commission to intervene in two cases. Physicians accused of predecessors to professional organizations controlled by Envision and TeamHealth. In both cases, the board has refused to intervene.
McNamara, chief medical officer for a group of doctors in the California Envision case, also said: filed a complaint Pennsylvania Attorney General Josh Shapiro said a group called Pennsylvania PC’s Emergency Medical Services, which was trying to contract ER doctors from the Closer Keystone Health System, is wholly owned by TeamHealth and is trying to avoid scrutiny. claimed to function as a shell for
A senior official in Shapiro’s office complained and answered Despite being referred to two state agencies, McNamara said he hadn’t heard from him in over three years.
Disagreements on the Role of Private Equity
Proponents of private equity ownership say it has brought many benefits to healthcare. Jamal Hagler, vice president of research at the American Investment Council, said private equity brings expertise to the hospital system, adding: or the development of new technologies.”
But many physicians who have worked for private equity firms say their mission is incompatible with medical best practices. They cite a preference for speed and high patient volumes over safety, a preference for untrained and cheap providers, and inappropriate treatment protocols for certain patients.
Dr. Sean Jones, an emergency physician in Asheville, North Carolina, said his first full-time job was at a Florida hospital where Emcare, a subsidiary of Envision, operated emergency rooms. According to Jones, EmCare worked with hospital owners to push physicians to meet performance goals related to wait times and treatments that aren’t always good for patients.
For example, if a patient showed up with an abnormally high heart and respiratory rate (a sign of sepsis), doctors would have expected to administer large amounts of fluids and antibiotics within an hour, Jones said. However, these symptoms can also be caused by panic attacks or heart failure.
“I don’t want to give a heart failure patient two or three liters of fluids. I get emails saying, ‘You’re not doing this,'” he said. “No, I didn’t. They couldn’t breathe because they had too much water in their lungs.”
Envision says its 25,000 clinicians “like all clinicians are high quality, compassionate and use independent judgment to deliver clinically appropriate care.”
Jones felt otherwise. “He doesn’t need an MBA to tell you what to do,” he said.
This story KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. KHN is one of his three major operational programs in the United States, along with policy analysis and polling KFFMore (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the public.
