Physicians would rather leave than work for Envision, doctor says

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Physicians at Corona Regional Medical Center and Temecula Valley Hospital in California have threatened to leave the hospitals if for-profit owner Universal Health Services changes the staffing management firm to Envision Healthcare, according to an emergency room doctor who heads the hospitals' current staffing firm.

Emergent Medical Associates (EMA) – founded by ER physician Dr. Irv Edwards, who is its president – competes with Envision Physician Services as a management company for staffing anesthesiologists, hospitalists and ER doctors.

Edwards said Universal Health Services (UHS) has yet to give official notice of the change in staffing management, but in talks with the administration, he expects this to happen by the end of June. No one at UHS returned a request for comment.

"We haven't been officially terminated," Edwards said. "It's a plan under consideration." 

The UHS administration has confirmed to him that there is such a proposal, he said.

"We expect to be notified by the end of June unless pressure is brought," Edwards said. "My hope is to reverse this and to stay."

WHY THIS MATTERS

Physicians object to Envision over concerns of lower pay and staffing levels leading to lower quality of care, according to Edwards.

Envision declined immediate comment.

An Envision Impact Report released last year shows quality clinical stats in the treatment of pain without opioids, sepsis and the use of antibiotics.

Edwards said the switch is appealing to UHS because the Southern California group of five hospitals, which includes the Corona and Temecula facilities, has allegedly been losing money due to COVID-19 and higher pay for travel nurses.

Universal Health Services pays EMA physicians a subsidy. UHS believes it could save money by switching to Envision, Edwards said.

"They hope to eliminate $9 million of subsidies through all five hospitals," Edwards said.

The other three hospitals in the Southern California system are already using Envision.

Pressure to keep EMA at the two facilities has been brought in the form of an online petition to "Save Corona and Temecula Medical Centers." Edwards said the petition is a grassroots effort that he did not post. 

Pressure has also come from physicians of both hospitals who said they would rather leave than work for Envision, according to Edwards. Of the 110 doctors and allied healthcare professionals surveyed at the two campuses, 85 said they would leave to work for another facility managed by Emergent Medical Associates, he said. EMA runs 25 ERs. This information was shared in a letter to Universal Health Services.

The letter reads in part: "Should UHS terminate the contracts with the CHP/TVEP/TVHMG and award them to any other group, we would be likely to explore other professional opportunities which would allow us to practice with quality in mind while preserving our current income levels." 

THE LARGER TREND

Edwards believes there is a problem with Envision running the staffing due to a prohibition in California on the corporate practice of medicine. Corporate groups must be owned by a physician, Edwards said. 

Envision was sued over this issue in December 2021, by the American Academy of Emergency Medicine Physician Group (AAEM-PG). The group filed the lawsuit against Envision Healthcare in responding to the takeover of an emergency department contract at California's Placentia Linda Hospital, which is part of the Tenet system, according to the American Academy of Emergency Medicine.

AAEM-PG alleged that Envision, as a lay entity owned by the private equity firm Kravis, Kohlberg and Roberts, was in violation of the California prohibitions on lay ownership of medical practices, AAEM said. That lawsuit is ongoing.

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org

Twitter: @SusanJMorse
Email the writer: SMorse@himss.org