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                    Our 7 Favorite Field Jackets for Tackling Fall Weather

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                    The Best Leather Jackets for Guys – No Matter Your Budget

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                      Energizing Foods and Drinks To Consume Before a Workout

                      Energizing Foods and Drinks To Consume Before a Workout

                      Classic Beer Styles You Should Know How to Brew

                      Classic Beer Styles You Should Know How to Brew

                      The Best Flour Alternatives That Work in Any Recipe

                      The Best Flour Alternatives That Work in Any Recipe

                      Cheese Tortellini in Creamy Marinara

                      Cheese Tortellini in Creamy Marinara

                      Unusual Products That Come From Animals and Their Uses

                      Unusual Products That Come From Animals and Their Uses

                      Tips for Creating a Homemade Wine Cellar

                      Tips for Creating a Homemade Wine Cellar

                      How the wine you choose can help you have an eco-friendly home

                      How the Wine You Choose Can Help You have an Eco-Friendly Home

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                        Another GOP Primary Debate … Another Night of Verbal Clashes

                        Another GOP Primary Debate … Another Night of Verbal Clashes

                        Science Says Teens Need More Sleep. So Why Is It So Hard to Start School Later?

                        Science Says Teens Need More Sleep. So Why Is It So Hard to Start School Later?

                        Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans

                        Start Shopping: Enrollment Begins Nov. 1 for Most Obamacare Insurance Plans

                        Why Is Finding Covid Shots for Young Children Still So Hard?

                        Why Is Finding Covid Shots for Young Children Still So Hard?

                        For People With Sickle Cell Disease, ERs Can Mean Life-Threatening Waits

                        For People With Sickle Cell Disease, ERs Can Mean Life-Threatening Waits

                        Mothers of Color Can’t See if Providers Have a History of Mistreatment. Why Not?

                        Mothers of Color Can’t See if Providers Have a History of Mistreatment. Why Not?

                        Social Security Overpayments Draw Scrutiny and Outrage From Members of Congress

                        Social Security Overpayments Draw Scrutiny and Outrage From Members of Congress

                        As Younger Children Increasingly Die by Suicide, Better Tracking and Prevention Is Sought

                        Florida Gov. Ron DeSantis Injects Presidential Politics Into the Covid Vaccine Debate

                        Florida Gov. Ron DeSantis Injects Presidential Politics Into the Covid Vaccine Debate

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                          What To Know Before Popping the Big Question

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                          The Benefits of Visiting a Multicultural City

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                          Common Dog Owner Mistakes and How To Avoid Them

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                          3 Reasons To Give an Antique or Vintage Engagement Ring

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                          Outdoor Luxuries To Add to Your Backyard

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                            Defense contractors spent $70 million lobbying ahead of annual defense budget bill

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                            ByteDance sets new lobbying record amid scrutiny of TikTok’s China ties

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                            Virginia campaigns set fundraising records

                            Campaign Legal Center and OpenSecrets sue the FEC for delayed response to transparency rulemaking petition

                            Campaign Legal Center and OpenSecrets sue the FEC for delayed response to transparency rulemaking petition

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                            Incumbent politicians enjoy record reelection in an aging Congress

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                            Kentucky governor’s race on track for new fundraising record

                            Ante up: $8 million casino referendum in Virginia breaks state record

                            Ante up: $8 million casino referendum in Virginia breaks state record

                            OpenSecrets Partners with Browser Extension Consciously to bring Political Giving Alerts to Online Shopping Experience

                            OpenSecrets Partners with Browser Extension Consciously to bring Political Giving Alerts to Online Shopping Experience

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                            Primaries underway for America’s third-largest party with grassroots and self-funded candidates

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                              ER Doctors Vow to Pursue Case Against Envision Despite Bankruptcy

                              by Staff Writer
                              May 16, 2023
                              in Health
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                              [Editor’s note: This article was updated at 12:30 p.m. PT on May 15, 2023, to reflect the news that Envision filed for bankruptcy protection and to add comments from the company’s spokesperson.]

                              Envision Healthcare announced Monday it has filed for bankruptcy protection, but a group of emergency physicians vows to continue a federal lawsuit that claims the private equity-backed company is violating California’s ban on corporate control of medical practices.

                              “I anticipate that we will ask the bankruptcy judge to let our case proceed,” said David Millstein, an attorney representing the Milwaukee-based American Academy of Emergency Medicine Physician Group. “Among other things, Envision’s practices violate the law, are continuing, and need to be addressed.”

                              Envision said it filed under Chapter 11 in bankruptcy court in Houston hoping to liquidate most of its $7.7 billion in debt and restructure the business. So far, the company said, its plan has the support of creditors holding about 60% of its debt, and it expects support “to grow in coming days.” The Wall Street Journal first reported on May 9 that Envision was preparing to reorganize its business, having missed an interest payment in April and failing to report quarterly financial results by a March 31 deadline.

                              Envision spokesperson Aliese Polk declined to comment on the emergency physicians’ lawsuit but said the company is compliant with state laws. Polk said that other legal challenges to its business model “have proved meritless.”

                              The lawsuit does not ask for monetary damages, so the physician group would presumably not have a financial claim against Envision. Instead, the doctors seek a legal finding that the company’s alleged use of shell business structures to retain de facto ownership of ER staffing groups is illegal. A trial in San Francisco had been scheduled to start next January, but the date has been pushed back.

                              The doctors believe that a victory in their case would lead to a ban on that business strategy across California — not just in ERs run by Envision but also by TeamHealth, another private equity-owned medical staffing firm, and in other medical services the two companies provide, including anesthesiology, hospital-based medicine, and gynecology.


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                              Many doctors, nurses, consumer advocates, and even some lawmakers, hope a legal victory would spur prosecutors and regulators in other states to take the issue of medical practices controlled by corporations more seriously.

                              Envision runs 467 emergency departments across the country and TeamHealth operates 511, according to Ivy Clinicians, a startup job search website for emergency physicians. Together, the two companies control more than 17% of emergency departments, the data shows.

                              Envision was acquired by the investment firm KKR in 2018 for $9.9 billion, making it the largest private equity deal in health care during that decade. The deal saddled Envision with about $7 billion in debt. Last September, analysts at S&P Global Ratings estimated that the company’s debt was 29 times its earnings in 2022, a staggeringly high figure that raised alarms about its ability to pay its obligations.

                              At the same time, Envision’s revenue picture has deteriorated. The federal No Surprises Act, which protects patients from unexpected bills sent by out-of-network providers, sapped a key source of revenue. The pandemic shrank patient volumes, and burnout among health care workers fueled staffing shortages that have jacked up labor costs. A fierce battle with insurance giant UnitedHealthcare over payments for patient care also hit Envision.

                              Envision said the bankruptcy process would allow it to shed about $5.6 billion in debt, which will either be canceled or exchanged for equity in the restructured company. Its ambulatory surgery affiliate, AMSURG, will become a separately owned firm.

                              Envision said it has “more than ample cash” to continue operating without interruption.

                              “The financial profile of the company is just not strong enough to manage the debt they have on the balance sheet, and I think that’s really what the bottom line is,” said David Peknay, a director at S&P Global Ratings.

                              [Editor’s note: This article was updated at 12:30 p.m. PT on May 15, 2023, to reflect the news that Envision filed for bankruptcy protection and to add comments from the company’s spokesperson.]

                              Bernard J. Wolfson:
                              bwolfson@kff.org,
                              @bjwolfson

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