Becker's ASC Review

32 JOINT VENTURES 10 things to know about AmSurg By Angie Stewart A mSurg is among the largest surgery center management companies in the U.S., with more ASCs than both United Surgical Partners International and Surgical Care Affiliates. It is the ambulatory unit of Envision Healthcare. Here are 10 things to know. 1. Envision and AmSurg merged in De- cember 2016, creating a healthcare services company that was valued at $10 billion. As of Dec. 31, 2017, Envision owns and operates 264 surgery centers and one surgical hospital catering to a variety of specialties, includ- ing gastroenterology, ophthalmology and orthopedics. 2. Envision shares hit a 52-week low of $26.34 in November 2017 and missed Zacks Equity Research's quarterly estimates by 16.1 percent. Envision struggled aer the AmSurg merger, seeing its shares drop 60 percent in the time leading up to the 52-week low. 3. UnitedHealth, which acquired Surgical Care Affiliates in 2017, reportedly submitted a bid earlier this year to acquire AmSurg. UnitedHealth is said to have pulled out of talks aer Envision filed a lawsuit alleging the insurer decreased payments to Envision physicians and wouldn't add Envision physi- cians to its network post-merger. 4. A class action lawsuit filed against Envision in February alleges the company illegally billed and collected payments from patients who received emergency medical services from out-of-network providers at in-network facilities. Axios suggested the lawsuit against UnitedHealth is an attempt to frame its alleged balance-billing practices as a result of United's refusal to add Envision physicians to its network. 5. Envision reported $132.6 million in net income for the fourth quarter of 2017, and its ambulatory services segment generated $1.41 million in average revenue per con- solidated center. Net revenues for Envision's ambulatory services reached $333.1 million, a $6.4 million increase from the fourth quarter of 2016. Same-center revenue for ambulatory services is expected to grow 1 to 2 percent in 2018. 6. Chris Holden now serves as president and CEO of Envision aer leading AmSurg as president, CEO and director from 2007 to 2016. He was previously senior vice presi- dent and a division president of Plato, Texas- based Triad Hospitals, which he helped found. In 2016, he received $21.7 million in compensation, the New York Times reported. William Sanger is Envision's chairman. 7. AmSurg has undergone major acquisitions and mergers in the physician practice area to reduce its reliance on ASCs, but it remains a major surgery center operator. 8. Sheridan Healthcare is AmSurg's physi- cian services unit. It provides out-of-hospital physician services in areas including primary care, pediatrics, obstetrics, orthopedics and gynecologic oncology. 9. In response to national reports on patient tragedies that painted a negative picture of the ASC landscape, AmSurg issued a statement emphasizing its commitment to quality: "At AmSurg, we partner with our physicians and employees to deliver the highest stan- dards of care and quality. AmSurg centers are Medicare-approved and undergo voluntary accreditation by the Accreditation Associa- tion for Ambulatory Health Care or e Joint Commission. In addition, our centers voluntarily comply with the [Outpatient and Ambulatory Surgery Consumer Assessment of Healthcare Providers and Systems] survey process. Each center's governing board and medical staff review quality information every quarter to ensure a culture focused on safety, quality, and the patient experi- ence. We pride ourselves in providing every patient with personalized care." 10. AmSurg celebrated its 25th anniversary in April 2017. Its physicians have performed more than 12 million procedures over the past 10 years. n Health systems acquire 5k independent practices during 2015-16 By Eric Oliver H ealth systems are on an independent practice shopping spree. Between July 2015 and July 2016 the Physicians Advocacy Institute re- ports 5,000 independent practices were acquired by health systems. Here's what you should know. 1. Over the same time period, the number of hospital-employed physicians grew by 14,000, representing a nearly 11 percent growth in employed physicians. 2. In July 2012, only 25 percent of all physicians were employed by hospitals. In July 2016, that number rocketed to 42 percent. 3. Avalere Health conducted the analysis, finding physicians are leaving private practice behind to become employed by hospitals and health systems. 4. The spike in hospital-employed physicians caused Medicare costs for healthcare services to rise $3.1 billion between 2012 and 2015. 5. Insured patients are footing the cost, with beneficiaries paying $411 million more for services that are now being performed in a hospital setting. PAI President Robert Seligson said, "As payers and hospitals continue [to] drive consolidation across the healthcare system, it is becoming more and more difficult for a physician to maintain an independent practice. Payment policies mandated by insurers and [the] government heavily favor large health systems, creating a competitive advantage that stacks the deck against inde- pendent physicians, who are already struggling to survive under expensive, time-consuming administrative and regulatory burdens." n

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