Ascension, the current owner of Evanston’s Saint Francis Hospital, will outsource more than 110 employees at all of its Illinois hospitals, a change effective June 1.
Crain’s Chicago Business broke the news, reporting that staffing changes will affect the health system’s “hospitalist” employees – medical directors, doctors, physician assistants, nurse practitioners and other employees who care for patients during a hospital stay. These employees are essentially being fired and asked to re-apply for the same jobs at Atlanta-based SCP Health staffing firm. Crain’s reported that hospitalists were concerned that SCP Health’s practices, such as requiring doctors to see more patients per day, would hurt the quality of care.
In a statement to the RoundTable, Ascension spokesperson Tim Nelson confirmed that employees would be outsourced but didn’t directly address reported concerns about the impact of the decision.
“We spent many months evaluating potential organizations and feel that our culture and goals are well aligned with SCP Health,” he said. “The goal of this agreement is to continue to deliver safe, high-quality care and an exceptional patient experience with no gaps in service. We continue to work with our hospitalists to make this a smooth transition.”
Nelson didn’t respond to questions about how the change is expected to affect Saint Francis specifically.
Ascension has been struggling financially, ending its last 2022-2023 fiscal year with a $2.7 billion net loss. The system did make a profit during the most recent quarter by cutting expenses, and it benefited from increased admissions.
Hospital staffing agencies have long been used to help staff hospitals during emergencies, but since the late 2010s, hospitals have been increasingly using them for day-to-day staffing. The trend increased during the COVID pandemic. According to its 2022 annual review, Atlanta-based SCP Health provides staffing in more than 400 hospitals and health systems across more than 30 states, employing more than 7,500 clinicians to treat more than 8 million patients.
Warning of risk
The November 2021 High Stakes of Outsourcing in Healthcare study, published by the Mayo Clinic, found that outsourcing staff such as hospitalists can save health systems money and make operations more efficient, but it also warned of significant risks. Those include losing control of quality of care, which would hurt patient satisfaction, hurting employee confidence and losing some flexibility, since the health system has to take staffing contracts into account. Patient records may become more vulnerable to leaks, since they would need to be sent to staffing firms.
The study also warned that savings may not end up as significant as the hospitals initially believe, pointing to “hidden, sometimes ballooning costs” such as the costs of ensuring the staffing firm follows the agreement and even the cost of writing a contract.
“Although a primary goal of outsourcing is cost efficiency, the resulting financials often do not meet expectations, especially if the indirect costs of lower quality are accurately calculated as contributing to poor outcomes such as medical errors, loss of employees’ trust, and increased hospital readmissions,” the study states.
Generally, the study found that outsourcing works best for functions that don’t involve direct interactions with patients.
Since 2015, Toronto-based Onex Corporation investment firm had an undisclosed majority stake in SCP Health. Crain’s reported that the involvement of a private equity firm, which focuses on getting a return on investment, is a major concern. According to Crain’s, SCP Health is reportedly looking to increase hospitalists’ case load from around 18 patients a day to around 30 a day, while asking them to take a pay cut of “anywhere from $15,000 to $25,000.”
Saint Francis Hospital, 355 Ridge Ave., was founded in 1900. It has gone through several owners over the last few decades. Most recently, it was owned by Presence Health, which Ascension acquired in 2018. At the time, Ascension operated its Chicago-area hospitals as a joint venture with AdventHealth under the AMITA Health brand, so Saint Francis was rebranded to “Amita Health Saint Francis Hospital.” When the joint venture was dissolved effective April 1, 2022, it was rebranded again, this time with the Ascension name.
Equity firms and medicine don’t seem to match in terms of treating patients. Their goals are quite different.
Our healthcare system is obviously eroding right in front of our eyes. I hope you will also examine all the cuts that Endeavor is doing. They are in the process of dismantling the Kellog Center and the clinic that Northshore controls at ETHS.
Delivering “safe, high-quality care and an exceptional patient experience with no gaps in service” is a woeful oxymoron, inconsistent with seeing 30 patients a day. Even the private equity “suits” who come up with this disingenuous, unachievable goal don’t believe it. It’s a testament to their cold blooded profit motive that they can even make such an assertion with a straight face.
Think about it. Even in a 10-hour workday (which is probably a contract no-no to begin with), a clinician would have only 20 minutes per patient, and that would include writing prescriptions, ordering lab tests, and documenting the encounter. Moreover, where would the lunch break fit in? The bathroom breaks? The communications with staff? The collegial interactions? Allowing a 30 minute lunch would mean cutting the caseload by 1-1/2 patients, or put another way, leave only 19 minutes per patient for the complete 30-patient caseload. How does that allow for safety, quality, patient satisfaction, and seamless service? Hint: it doesn’t.
ERs have long since become part emergency care, part primary care, and the fallout from private equity takeovers will only add fuel to that fire. Moving right along, I realize that most people yawn when they hear about pay cuts for doctors (and that may be justified for some of the specialties, like neurosurgery, orthopedic surgery, interventional cardiology, ENT, radiology, and the like), but pediatricians, psychiatrists, family medicine doctors, and other, non surgery primary care doctors, who are the majority in the profession, are hardly the super high earners that the public imagines.
Since when, especially in the current economy and despite the hard work and long hours that doctors put in during the CoVid pandemic, risking their own health— since when are pay cuts for doctors a thing? Okay, so it’s not only doctors, but also other health care professionals who will suffer pay cuts, but they deserve better too. It’s astounding that professionals are being fired and simultaneously given the opportunity to be rehired for less pay. And guess what?— some doctors will be grateful for this opportunity because it’s “take it or leave it.” Others, in their sixties or seventies will simply retire now, and more power to them, but unfortunate for patients.
Corporate bottom liners are able to take advantage of health care professionals, especially doctors, because they know that doctors put patients first and are good at complaining about the broken health care system, but not at organizing to do anything about it. In addition, more and more the new generation of doctors is choosing employed shift work instead of private single or group practice, what with all the insurance hassles of prior authorizations, mounting computer work, etc., etc., So if Ascension/St. Francis fires them, they either accept the conditions of being recycled or they move to a different corporate employer.
Disclaimer: I am one of these MD complainers, but thankfully, now retired.
Several months ago I left my last 2 doctors at St. Francis due to abysmal experiences. My cardiologist changed my appointment from October 2023 to April 2024. Not kidding. In late December I saw my PCP. She had a nurse in training, not her former nurse who I knew for years, but someone new who was in training. The last time I went there one of the elevators broke down. When someone came to fix it a woman in a wheelchair came out screaming. There is no security. I’ve seen people sleeping in chairs near the 800 Austin ground floor. Two of my doctors there, Orthopedics and Dermatology, retired. They had been through enough! All of my doctors are now at Endeavor at 9650 Gross Point Road. It’s a fabulous new building with free valet parking. And, most importantly, the best health care I’ve had in many years.
Wow. *I* want to choose a hospital that makes all its highest-responsibility workers into temps, cuts their pay, and doubles their workload. This fills me with confidence in the quality of care I’m going to get.
The reporter cites a study led by several business professors on behalf of the (hardly disinterested) Mayo Clinic published in 2021. It’s a long report but this passage captures what makes this type of “evidence” so frustrating:
“For instance, one for-profit radiology practice serving more than 15 US hospitals signed off on 71,512 radiology reports during an 8-month period, with radiologists viewing only 5840 of those images. Most of the images were reviewed by radiology practitioner assistants, who were inexpensive to hire but not fully qualified to review images or provide accurate diagnoses, putting at risk thousands of patients as well as the reputations of clinicians and the hospital that approved these services. Writing about outsourced radiology examinations, Robert Wachter has noted that outsourcing may have virtue but that the practice can be harmful if it sacrifices quality.”
Yes, it certainly can be. Absent any solid data about harms — deaths, lawsuits, X-ray mixups — we can only conclude that the transition from in-house to outsourced radiology was worth it for these 15 hospital chains.
Then ask yourself, if outsourcing radiology is such a risk, why would risk-averse hospital chains chance it? Not being a medical malpractice lawyer, I would say because they could significatnly cut costs while keeping care above the legal standard for medical malpractice. More broadly, because a combination of market forces and ACA reforms (and coming soon, AI) make outsourcing inevitable. It’s like the old diagram your car mechanic hung on his wall: “Price – Quality – Time: You Pick Two.”
It’s not like St. Francis is throwing off piles of cash and is gouging customers because everyone wants that top-tier Amita/Ascension/Presence service. Sister Mary Alfreda left the building a long time ago.
I say all this as a satisfied St. Francis patient who wants to keep going to my neighborhood hospital. Recently I visited the newly-outsourced St. Francis lab on the first floor of the 800 Austin building. It appeared to be a one-person shop. The person who checked me in also took my draw. I had my results on the app within hours. Overall, it was a better experience than my in-house lab experience two years ago.
“The goal of this agreement is to continue to deliver safe, high-quality care and an exceptional patient experience with no gaps in service.”
How exactly is any of this purporting to benefit patients? The only people making out well here are the vulture capitalists at the private equity firm, and presumably the Ascension execs who get bonuses tied to cost savings. Medical care is in such a horrible state right now and things like this, which will make the situation significantly worse for patients and medical providers, should be criminalized. We need to get money OUT of healthcare or end up with no care at all for the non-wealthy.
No way can a medical professional see 30 patients a day and continue with his/her quality care. I can see some older persons retiring rather than cut back on their care of their patients. Patients will leave their medical professionals at St. Francis reluctantly because they will not feel that they are being taken care of as they have been. There might be more readmissions and Medicare, at least, does not like that at all. I’m not sure if other professionals will be able to see an influx of new patients in a timely manner. It might be several months. That might mean that the ER will see more patients. What a mess!
The only motive for this outsourcing is to spend less money on needed personnel. Increases in efficiency that may be needed can be achieved by “insourcing” it from discussions with employees and patients.
Nothing gets better when private equity gets involved.
Counterproductive. Ensures that our family will Endeavor to look elsewhere for our medical needs.