I witnessed first hand the closing of two company’s. Both suffered from large debt and too little revenue. The similarities are eerily familiar. Business defaults and bankruptcies are on the rise.
Yves here. We’ve written regularly on Eileen Appelbaum and Rosemary Batt’s important investigations into how private equity has taken over more and more of hospital staffing, including of emergency rooms. This in turn has allowed them to override patient efforts to have only in-network doctors assigned to their case, as well as to engage in other practices that greatly inflate patient charges (so-called surprise billing).
The legal fig leaf that allows private equity firms like Blackstone and KKR to play doctor is that their deals are structured so that MD or group of MDs is the nominal owner of the specialty practice, even though the business is stripped of its assets and the operating contracts are widely believed to strip them of any say. The now-notorious incident of Blackstone’s TeamHealth firing whistleblower Dr. Ming Lin confirms who is really in charge.
By Eileen Appelbaum, the Co-Director of the Center for Economic and Policy Research and visiting professor, School of Management, University of Leicester, UK and Rosemary Batt, the Alice Hanson Cook Professor of Women and Work, Cornell University ILR School. Produced by Economy for All, a project of the Independent Media Institute
Doctor Ming Lin is the first emergency room doctor to be fired for going public with his concerns about poor hospital emergency room safety practices and shortages of medical supplies and protective gear for health workers. He won’t be the last.
Like many hospitals in the US, PeaceHealth St. Joseph Medical Center in Bellingham Washington, where Ming Lin worked for the past 17 years as an emergency room doctor, has outsourced the management and staffing of its emergency rooms. So, Lin works on-site at the hospital’s emergency room, but he is employed by a physician staffing firm that runs the emergency room. These staffing firms are often behind the surprise medical bills for emergency room services that patients receive after their insurance company has paid the hospital and doctors, but not the excessive out-of-network charges billed by these outside staffing firms.
About a third of hospital emergency rooms are staffed by doctors on the payrolls of two physician staffing companies—TeamHealth and Envision Health—owned by Wall Street investment firms. Envision Healthcare employs 69,000 healthcare workers nationwide while TeamHealth employs 20,000. Private equity firm Blackstone Group owns TeamHealth, Kravis Kohlberg Roberts (KKR) owns Envision.
Care of the sick is not the mission of these companies; their mission is to make outsized profits for the private equity firms and its investors. Overcharging patients and insurance companies for providing urgent and desperately needed emergency medical care is bad enough. But it is unconscionable to muzzle doctors who speak out to advocate for the health of their patients and co-workers during the global pandemic that is rapidly spreading across the US.
Yet, that is what Blackstone-owned TeamHealth just did. Why would an experienced emergency room doctor be fired in the middle of a pandemic? One clue may be that Blackstone’s CEO, Stephen A. Schwarzman, is part of President Trump’s inner circle. He may not want to risk that relationship by allowing TeamHealth’s doctors to inform the public about Washington’s mishandling of the allocation of supplies and protective gear. The President might conclude that TeamHealth doctors didn’t appreciate him enough, and where would that leave Schwartzman?
PeaceHealth St. Joseph Medical Center may have the distinction of being the first hospital to have a doctor outsourced from a physician staffing firm unceremoniously fired for telling the public the truth. But it won’t be the last. Hospitals are now telling doctors treating coronavirus patients they will be fired if they speak to the press.
The American Academy of Emergency Medicine protested Dr. Lin’s ouster and questioned how TeamHealth is allowed to provide hospital services when the law requires that physician practices must be owned by a licensed medical practitioner. TeamHealth skirts the law by owning all the assets of the physician practices it acquires—the real estate, offices, equipment, supplies, inventory, and even accounts receivable.
On paper, the physician practices are owned by a doctor-led organization that TeamHealth has set up to comply with the law. But what does it mean to own a physician practice if the practice has no assets and no possibility to exist on its own?
The furor over patients hit by surprise medical bills revealed that TeamHealth controls the billing for the doctors it supplies to hospital emergency rooms. The firing of Doctor Ming Lin pulls back the curtain and reveals that TeamHealth controls the doctors as well.
The billionaire Tom Golisano was smoking a Padron cigar on his patio in Florida on Tuesday afternoon. He was worried.
“The damages of keeping the economy closed as it is could be worse than losing a few more people,” said Golisano, founder and chairman of the payroll processor Paychex Inc. “I have a very large concern that if businesses keep going along the way they’re going then so many of them will have to fold.”
President Donald Trump says he doesn’t want the cure for the Covid-19 pandemic “to be worse than the problem,” and some of America’s wealthiest people and executives are echoing his rallying cry. They want to revive an economy that could face its worst quarterly drop ever — even if it means pulling back on social distancing measures that public health officials say can help stop coronavirus. These investors aren’t prizing profits over lives, they say, they’re just willing to risk some horrors to avoid others.
“You’re picking the better of two evils,” said Golisano, who wants people to go back to their offices in states that have been relatively spared by the coronavirus, but remain at home in hot spots. “You have to weigh the pros and cons.”
In New York, where hospitals are at a tipping point and getting pummeled by patients, Governor Andrew Cuomo says the economy shouldn’t be restarted “at the cost of human life” and that he’s developing a plan that “lets younger people get back to work.”
The question is when they should do it.
Trump, guided by a group of hedge fund and private equity titans, wants the country up and running again by Easter, though public health officials warn that’s too soon for a virus that’s killed more than 18,400 and infected at least 400,000 worldwide. Only companies with less than 500 employees are required to provide paid sick leave for workers out with Covid-19. Economists from Northwestern University calculated that keeping social distancing practices in place until cases decline could save 600,000 lives nationwide.
Lloyd Blankfein, who ran Goldman Sachs Group Inc. until 2018, helped kickstart the calls to get back to work on Sunday when he tweeted that “extreme measures to flatten the virus ‘curve’” were sensible “for a time” but could crush the economy: “Within a very few weeks let those with a lower risk to the disease return to work.”
His longtime deputy, Gary Cohn, who left the bank to become Trump’s top economic adviser, asked if it was time “to start discussing the need for a date when the economy can turn back on.” Without clarity, businesses “will assume the worst,” he said.
Tilman Fertitta, owner of Golden Nugget casinos and Bubba Gump Shrimp, is calling on authorities to let businesses reopen at limited capacity in a couple of weeks to avoid a long economic disaster. Fertitta, who also owns the Houston Rockets and is worth $3.2 billion, said his company is “doing basically no business.” His demand goes against a school of thought that says prematurely reopening the economy could kill more people and eventually cause more economic harm.
Billionaires and other members of the elite have the luxury of social distancing while making money. The ones who want workers back in their jobs say they’re aiming to stop millions from suffering for years and falling further into debt. Officials are trying to accomplish that by restricting foreclosures and allowing Americans to defer mortgage payments.
“It’s outrageous,” said Robert Reich, who was labor secretary for President Bill Clinton and now studies public policy at the University of California, Berkeley. “It is absolutely necessary to shut down the economy so that millions of people don’t die. For the privileged among us to fail to see that and to give the economy precedence over this public health emergency is morally reprehensible.”
The push to restart the economy makes a certain amount of sense to rich people, according to Reich, because they have come to expect disproportionate gains as the system’s top winners. “The one flaw in their logic this time is that the coronavirus doesn’t understand class,” he added. “The more people are infected, the more likely it is that Blankfein and other billionaires will become infected as well.”
Jim Conway was a server in an Olive Garden in Pennsylvania until it closed about two weeks ago. He’s been out of work and isn’t getting paid while his application for unemployment benefits gets processed.
“Being an older worker, I’m in no hurry to go back in the middle of an epidemic,” Conway, 63, said. “Being a server means you’re in contact with lots of different people, and puts you at bigger risk of getting infected. I’m kind of glad they closed when they did.” He wants the outbreak under control before the restaurant reopens, but worries that politicians and businesses tend to focus on their bottom line before people like him.
“They’ve never really had our interests at heart,” he said. “And now would be a weird time to start.”
One of those government officials, Texas Lieutenant Governor Dan Patrick, said on Fox News that Americans should get back to work and let “grandparents” take care of themselves.
Dick Kovacevich, who ran Wells Fargo & Co. until 2007, wants to see healthy workers below about 55 or so to return to work late next month if the outbreak is under control. “We’ll gradually bring those people back and see what happens. Some of them will get sick, some may even die, I don’t know,” said Kovacevich, who was also the bank’s chairman until 2009. “Do you want to suffer more economically or take some risk that you’ll get flu-like symptoms and a flu-like experience? Do you want to take an economic risk or a health risk? You get to choose.”
Mark Cuban, who owns the Dallas Mavericks, wants Americans to listen to epidemiologists instead. “Ignore anything someone like me might say,” Cuban wrote in an email. “Lives are at stake.”
A private equity firm wants to buy the internet domain used by nonprofits. A group of online pioneers says it is not the place to maximize profits.
Two months ago, Ethos Capital, a private equity firm, announced that it planned to buy the rights to a tract of internet real estate for more than $1 billion.
But it wasn’t just any piece of digital property. It was dot-org, the cyber neighborhood that is home to big nonprofits and nongovernmental organizations like the United Nations (un.org) and NPR (npr.org), and to little ones like neighborhood clubs.
The deal was met with a fierce backlash. Critics argued that a less commercial corner of the internet should not be controlled by a profit-driven private equity firm, as a matter of both principle and practice. Online petitions and letters of concern came from hundreds of organizations, thousands of individuals and four Democrats in Congress, including Senator Elizabeth Warren of Massachusetts.
Rarely has the acronym-strewn realm of internet addresses — so-called domain names — stirred such passion.
Now, a group of respected internet pioneers and nonprofit leaders is offering an alternative to Ethos Capital’s bid: a nonprofit cooperative corporation. The incorporation papers for the new entity, the Cooperative Corporation of .ORG Registrants, were filed this week in California.
The goal of the group is not only to persuade the Internet Corporation for Assigned Names and Numbers, which oversees internet domain names, to stop the sale. It is also to persuade ICANN to hand it the management of dot-org instead.
“This is a better alternative,” said Esther Dyson, who served as the first chair of ICANN, from 1998 to 2000, and is one of seven directors of the new cooperative. “If you’re owned by private equity, your incentive is to make a profit. Our incentive is to serve and protect nonprofits and the public.”
Since 2003, dot-org has been run by the Public Interest Registry, which is controlled by the Internet Society, a nonprofit that helps develop internet standards, education programs and policy. The registry holds a contract to manage dot-org, which was renewed last year for 10 more years. With a sale to Ethos Capital, the Internet Society would gain an endowment to fund its operations and get out of the business of operating dot-org.
In buying the Public Interest Registry, Ethos Capital would acquire the rights to run dot-org and collect annual fees from the nearly 10.5 million registered dot-org names, held by both nonprofits and domain-name speculators. Those yearly fees are $10 to $20 on average, but can be far higher for big sites that buy several names to protect their brand and get added services like security against online attacks.
Opponents of the private-equity sale said they feared that to make an attractive profit on its pricey deal, Ethos Capital would have to raise prices, cut expenses, skimp on service — and most likely sell users’ data.
Ethos Capital said those concerns were unfounded.
In a blog post in December, Erik Brooks, the firm’s founder, said that “we understand that change brings uncertainty and concern,” which was reflected in “alarmist statements.”
Ethos Capital, Mr. Brooks said, wants to invest in dot-org “for the reputation of the platform and the values it represents in the marketplace.” He said his firm planned to build on that asset.
Big price increases have been a major concern for critics of the deal. When ICANN renewed the 10-year contract with the Public Interest Registry last year, it removed a price cap that limited price increases to 10 percent a year at most. That move was part of a broader ICANN policy to ease price controls across all internet domains.
Ethos Capital has pledged to adhere to the 10 percent cap, though it would have no contractual obligation to do so. In blog posts, the private equity firm said it planned to invest in new services and clamp down on spam, security attacks and other abuse launched from some illicit dot-org domains.
Some nonprofits worry that any cleanup effort could result in censorship, even if inadvertently. As the owner of the registry for dot-org, Ethos Capital would manage the acceptable business practices and conduct for dot-org domains. The same freedoms that open the door to extremist groups on some dot-org sites, nonprofit leaders say, also help protect free speech on public-interest dot-org sites in developing countries with authoritarian governments.Ethos Capital said it would never facilitate censorship. It has also vowed to set up an independent “stewardship council” to monitor its management of the dot-org network.
Since the deal was announced, Mr. Brooks and top executives of the Internet Society and the Public Interest Registry have spoken with skeptics in person, in web sessions and on conference calls, seeking to reassure them that dot-org would be in safe hands. And on Tuesday, they submitted a detailed response to the questions raised by the four members of Congress.
But whether the trust-building campaign has made progress is uncertain. Amy Sample Ward, the chief executive of NTEN, a nonprofit that assists other nonprofits with technology, is unconvinced.
“The internet was meant to be this democratizing force around the world, and nonprofits do that,” Ms. Sample Ward said. By contrast, she said, Ethos Capital is a creature of the “capitalist-based internet industrial complex.”
For the Ethos Capital deal to succeed, ICANN must give its approval. In December, it sent out a request for more information about the proposed transaction. ICANN has not indicated the timing of a decision, but one is expected early this year.
The newly formed cooperative group is hoping it can keep dot-org out of the for-profit economy. “There is a common good here that is at risk of being undermined,” said William Woodcock, a director of the cooperative, who is the executive director of the Packet Clearing House, a nonprofit that provides internet operational support for domains.
The cooperative corporation, which would run dot-org, collect fees and distribute savings back to the nonprofit users, is an “alternative model with a long-term commitment to the open and noncommercial internet,” said Katherine Maher, a director who is the chief executive of the Wikimedia Foundation, the nonprofit parent of Wikipedia.
“There are some things that operate better noncommercially, and that’s O.K.,” she said.