What Can We Learn from the Envision Bankruptcy?

This study ignited a firestorm of press criticism and was followed by an aggressive lobbying and PR campaign funded by United and other large commercial payers  aimed at restricting balance billing by firms like Envision.  This campaign culminated in the Dec 2020 Congressional passage of the No Surprises Act, which effectively ended balance billing and subjected thousands of Envision’s out-of-network bills to an arbitration process. NSA went into effect in January 2022.   Ironically, days prior to its Chapter 11 filing, Envision won a $91 million judgment from an arbitration panel against United for out-of-network billing disputes from 2017-2018.  If this judgment survives the inevitable challenges, the proceeds will end up repaying Envision’s creditors.   A significant longer term threat to Envision’s bargaining power was the proposed Federal Trade Commission prohibition on non-competes for its physicians. Non-compete clauses in employment contracts forbid employed physicians from working for others (e.g. local hospitals, in-market physician groups or competing multi-market staffing firms)  in the same community for a period of years.  Outlawing non-competes would remove a major leverage point for physician staffing companies- the threat of terminating an unfavorable hospital contract and forcing the hospital to cover its ERs and ORs from out-of-the market docs. If historical FTC precedents hold, non-profit hospitals and...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: The Business of Health Care Envision HCA Jeff Goldsmith Private equity Sound Physicians Tenet United HealthGroup Source Type: blogs