Doctors are now disappearing from emergency rooms (ERs) as hospitals cut costs, thanks to private equity firms dipping their fingers into the healthcare industry.
Kaiser Health News (KHN) zoomed in on the case of a Tennova Healthcare facility in Clarksville, Tennessee. The hospital had outsourced its ERs to American Physician Partners (APP), a medical staffing company backed by private equity investors. A confidential company document obtained by KHN and National Public Radio revealed that APP employs fewer doctors in ERs as a cost-saving measure to increase earnings.
"APP has numerous cost-saving initiatives underway as part of the company's continual focus on cost optimization," said the document. Among these initiatives was a "shift of staffing" between doctors and mid-level practitioners, such as nurse practitioners (NPs) and physician assistants (PAs). Mid-level practitioners can perform many of the same duties as doctors and generate much of the same revenue, but for less than half of the pay.
APP defended the staffing shift in a statement, saying it serves to ensure all ERs remain fully staffed. It touted this "blended model" that allows doctors, NPs and PAs to "provide care to their fullest potential."
Dr. Robert McNamara, chief medical officer of the American Academy of Emergency Medicine, blasted APP and other medical staffing firms as the most aggressive entities in replacing physicians to cut costs.
"It's a relatively simple equation," he said. "Their No. 1 expense is the board-certified emergency physician, so they are going to want to keep that expense as low as possible."
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KHN elaborated that private equity companies "pool money from wealthy investors to buy their way into various industries, often slashing spending and seeking to flip businesses in three to seven 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." (Related: Nonprofit hospitals in New Jersey paying CEOs millions per year.)
Cost-cutting measures leave patients worse off than before
Critics say, however, that the cost-cutting measures leave patients vulnerable to misdiagnoses, higher medical bills and inadequate care – with various papers attesting.
One such paper by the National Bureau of Economic Research, which was published in October 2022, looked at roughly 1.1. million visits to 44 ERs throughout the Veterans Health Administration (VHA). NPs with the VHA can treat patients without physician oversight.
The study authors found that treatment by an NP resulted in a seven percent increase in the cost of care on average and an 11 percent increase in length of stay. Moreover, it found that ER patients treated by a nurse practitioner were 20 percent more likely to be readmitted to the hospital for a preventable reason within 30 days.
KHN also cited the most blatant reminder of the dangers of outsourcing care to less-trained practitioners in its piece. It shared the ordeal of Natasha Valle, who visited the same Tennoval Healthcare hospital for a miscarriage.
She first visited in January 2021 as she was bleeding, but was sent home after an examination. Valle returned when her cramping became very painful, only to be sent home once more. It ultimately took three ER trips, with three separate bills, before a doctor was finally able to look at her blood test results and confirm that she indeed miscarried.
"At the time I wasn't thinking, 'Oh, I need to see a doctor,'" Valle recalled. "But when you think about it, it's like, "Well, why didn't I see a doctor?'"
It remains unclear whether the repeat visits were due to delays in seeing a physician, but the experience worried her. KHN reported that Valle is still paying the bills for those ER visits as of writing. Meanwhile, Tennova Healthcare declined to discuss her case citing patient privacy.
Watch whistleblower AJ DePriest disclose how Tennessee hospitals are being paid whenever a patient is admitted for Wuhan coronavirus (COVID-19) infection on "The HighWire."
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