[g.giancaspro_108]

 
RP is already laying off radiologists.
 
This pandemic is hurting all practices and private practices are no exception, but of course when there is a thick layer of investors to feed, it seems like the radiologists are hurt twice as badly.  

[Unknown Member]

Where did you hear RP laying off radiologists?  I heard they had $400M COH and said they could ride it out?  Very curious.

[g.giancaspro_108]

Quote from Chgdoc

Where did you hear RP laying off radiologists?  I heard they had $400M COH and said they could ride it out?  Very curious.

 
That information came direct from the horse’s mouth.  I do not know their COH status but don’t confuse their ability to ride it out as a company, which i do not doubt, with their radiologists staying employed or full compensated.  This isn’t a group of radiologists, it is a company that employs radiologists to generate money for their investors, is it not?

[raghunadharelli_57]

Everyone is cutting back and everyone will take a pay cut in one form or another. Can our private practice borrow to keep comp unchanged today, sure. Will we have to pay that piper later? Most likely. It is still a compensation cut b/c the volumes are gone. Just a matter of timing is all.

[ranweiss]

Lots of extremes in regards to predictions here.
 
Those saying that we will be back to business as usual in 3 months are likely too optimistic, those saying it will be years before radiology recovers are likely the usual doomsday crowd.
 
Spoke to a close friend who is an economist that follows healthcare trends this morning – he told me to expect a ‘relative’ return to normalcy by the spring of 2021 – if next winter proves to not be a disaster. If we have another ‘pandemic’ with everything being shutdown next winter, it could take a year or two more….but he deemed that unlikely given the fact that people are finally starting to take social distancing and hygiene seriously. 

[kathleen.hibler]

Thats insane.

There will be a relative return to normalcy in summer/early fall 2020.

Maybe a much smaller second step back next winter, and then will be back to complete normalcy.

This virus is Bad, no doubt, but far less terrifying than early implications. a large portion of the population is already immune (one benefit of leading the world in cases)

The drastic nature of this shutdown is looking like a one time deal

[afazio.uk_887]

^ Agree. Mitigation is working and death projections are dropping.  This will be under control by early summer and then the economy will start to slowly open up. 

[ranweiss]

Quote from AngryBirds

Thats insane.

There will be a relative return to normalcy in summer/early fall 2020.

Maybe a much smaller second step back next winter, and then will be back to complete normalcy.

This virus is Bad, no doubt, but far less terrifying than early implications. a large portion of the population is already immune (one benefit of leading the world in cases)

The drastic nature of this shutdown is looking like a one time deal

 
Hey, I hope so.
 
His point was simply that people are going to be very weary of spending money bc of the shock from this shutdown, and elective procedures etc ( which affect us and nearly every other non emergent based doc ) will likely take a backseat for a while, until people are ‘comfortable’ again, which he predicted would be next spring. If it normalizes way sooner, great. 

[Unknown Member]

Very interesting.  Will be curious how this all shakes out with RP groups across the nation.

[Unknown Member]

Quote from Chgdoc

Where did you hear RP laying off radiologists?  I heard they had $400M COH and said they could ride it out?  Very curious.

 
The cash on hand figure sounds large, but it doesn’t mean anything without an estimate of their monthly expenditures.
 
What follows is pure speculation based upon stuff one can google.  No inside information and could be completely wrong.  Take it all with a grain of salt and make no decisions on it.
 
For example, they have ~1500 rads.  Say that each rad costs $400,000 (low balling).  That’s $600 million in annual expenses right there.  Divide by 12 months, about $50 million in monthly expenses, just for a lowball estimate of radiologist salary commitments.
 
I have no idea what they pay their IT staff, administrative staff, rent, utilities, upkeep, etc.  But lumped together, that’s probably tens of millions of dollars too.  
 
They also have hundreds of millions of dollars in loans, probably north of a billion.  Moody’s put them at Caa2 in January, BEFORE all this started.  This is rated as “extremely speculative”, well into the junk bond category, and I think that RadPartners is paying somewhere around 7-9% interest rates on those VC investments.  Not sure when that starts, or if it will actually be paid.  But $1 billion x .07 divided by 12 months is around $6 million in interest payments a month, plus whatever prinicipal they have to pay.
 
Now, they are still having SOME revenue come in.  Probably around a 40-50% drop in volume if they’re like everywhere else, and their actual cash cycle is probably starting to show the dip by now.
 
Again, this is all speculation based upon stuff you can Google in 5 seconds.  Take it with a heaping grain of salt, and make no investment decisions off it.  This is merely to illustrate that knowing a figure like having $400 million cash on hand sounds good at first, but it really doesn’t mean anything until one knows what the monthly expenditures are.  If you have $400 million on hand and you spend $10,000 a month, you can survive essentially indefinitely.  If you have $400 million on hand and you spend $100 million+ a month and your incoming revenue just got severely crunched, well, that’s not an indefinite time frame.

[Unknown Member]

I think VC/PE is going to pull the plug here. They were close to recognizing this conclusion was necessary before this. The debt costs are the key here. VC/PE relies on low cost debt. Most will not be able to use the government loans. They will have to go to the credit markets that are drying up. It looks very bad for corporate radiology IMO.
 
This is the time to take radiology back into private practice. Hospital contracts will be up for grabs. Get out there and make yourselves known to administrators.

[Count Contrastula]

Imo this will be the final nail in the PE coffin. Even if imaging recovers in the next few months the damage done to them when they were dangling by a financial thread will be too great. Its like having bad copd and getting covid. How fitting

[Unknown Member]

Doubt it, theyll just pass down their losses to the rad and non rad employees. Question is: if and when volume goes back up, how many of those employees will stick around

[ruszja]

Moodys. That’s the company that labeled all those mortgage backed securities AAA. 
Their opinion on Envision is noted.

[katiemckee84_223]

This is a surprise win in an otherwise sea of bad news and central planning chaos.

[Unknown Member]

$400k annual salary for RP is not low balling; its probably average at best.

[Unknown Member]

I’m sure the Fed will buy junk bonds soon.  They are going to be buying everything eventually and prop up the bubble again.
 
[link=https://www.reuters.com/article/usa-bonds-credit/risky-u-s-debt-recovers-from-march-lows-on-stimulus-hopes-idUSL2N2BW1O8]https://www.reuters.com/article/usa-bonds-credit/risky-u-s-debt-recovers-from-march-lows-on-stimulus-hopes-idUSL2N2BW1O8[/link]

[Unknown Member]

[link=https://www.cnbc.com/2020/04/08/kkr-sets-up-50-million-international-coronavirus-relief-fund.html?&qsearchterm=kkr]https://www.cnbc.com/2020….html?&qsearchterm=kkr[/link]

Doesnt seem like the PE owners of Envision are hurting for cash. Theyre not going anywhere

[Unknown Member]

I’m sure the Fed will buy junk bonds soon.  They are going to be buying everything eventually and prop up the bubble again.
 
[link=https://www.reuters.com/article/usa-bonds-credit/risky-u-s-debt-recovers-from-march-lows-on-stimulus-hopes-idUSL2N2BW1O8]https://www.reuters.com/article/usa-bonds-credit/risky-u-s-debt-recovers-from-march-lows-on-stimulus-hopes-idUSL2N2BW1O8[/link]

[Unknown Member]

Quote from fw

Moodys. That’s the company that labeled all those mortgage backed securities AAA. 
Their opinion on Envision is noted.

 
That’s the real thing to notice. How could Moodys have these securities rated higher even before this crisis? It’s so obviously a shell game.
 
They are in the pockets of the PE/VC firms in the good times when money is easy to get because of an expanding economy. When the curtain is finally pulled back they have no choice but to downgrade and PE/VC is hosed.

[Unknown Member]

Just like Muni bonds, how all these states like IL and NJ aren’t junk outright is a real condemnation of their “ratings.”

[debra.paulk_16]

Quote from irfellowship2020

Doubt it, theyll just pass down their losses to the rad and non rad employees. Question is: if and when volume goes back up, how many of those employees will stick around

This is an interesting point. This event may kill morale/culture more than it hurts corporate finances, which is likely worse.

[Unknown Member]

Theyll be given large low interest government guaranteed loans and continue their leveraged BS to the detriment of docs and patients.

[kathleen.hibler]

Quote from ar123

Hey, I hope so.

His point was simply that people are going to be very weary of spending money bc of the shock from this shutdown, and elective procedures etc ( which affect us and nearly every other non emergent based doc ) will likely take a backseat for a while, until people are ‘comfortable’ again, which he predicted would be next spring. If it normalizes way sooner, great. 

 
 
More than half of imaging studies are covered by Medicare/Medicaid that don’t lapse with unemployment.  And despite the insane unemployment numbers, most people still have jobs and those that  are furloughed still have health benefits.  Even more will regain jobs when this ends..
 
Yea, maybe the 26 year old unemployed kid wont get their TMJ MRI.  But most people aren’t putting off their health concerns for 2 years.  I don’t think we’ll be back to the insane volumes we were dealing with two months ago, but we’ll be closer to that than what’s going on right now.

[Unknown Member]

Quote from irfellowship2020

[link=https://www.cnbc.com/2020/04/08/kkr-sets-up-50-million-international-coronavirus-relief-fund.html?&qsearchterm=kkr]https://www.cnbc.com/2020….html?&qsearchterm=kkr[/link]

Doesnt seem like the PE owners of Envision are hurting for cash. Theyre not going anywhere

 
They are not going anywhere but that doesn’t mean they won’t jettison their radiology business. There is a reason they are sitting on all of that cash. They may make bad decisions but they know when to cut their losses and bail.

[Unknown Member]

Quote from ADHD

Quote from irfellowship2020

[link=https://www.cnbc.com/2020/04/08/kkr-sets-up-50-million-international-coronavirus-relief-fund.html?&qsearchterm=kkr]https://www.cnbc.com/2020….html?&qsearchterm=kkr[/link]

Doesnt seem like the PE owners of Envision are hurting for cash. Theyre not going anywhere

They are not going anywhere but that doesn’t mean they won’t jettison their radiology business. There is a reason they are sitting on all of that cash. They may make bad decisions but they know when to cut their losses and bail.

 
Yes.  KKR, of which RP is but a mere portion, is a huge firm with a variety of investments.  Like a sports team, they know that not every prospect is a winner, but finding a star makes the ten other busts worthwhile.  If a prospect seems like it’s going to be a bust, well, with low, low interest rates, there are plenty of other investment opportunities out there at which to throw money.

[Unknown Member]

.

[Dr_Cocciolillo]

The local practice furloughs the people. Not RP

[Patrick]

KKR is Envision. KKR has deep pockets but their interest in pressing a bet will be interesting.

RP is not KKR owned. Big backers are NEA and Starr in last round.

The disaster I hope we avoid is one in which KKR buys RP or RP buys Envision or Mednaxs (publically traded) radiology assets. Deals are going to be made, and past deals are going to be broken. Something to watch.

[Patrick]

Wisdom, we will see… And, will all RP practices respond in the same way? I would imagine each will have its own P&L statement based on local market, conditions, and strategy. Maybe there will be a bold move to maintain the status quo for future advantage. Maybe. But somehow and someway someone is going to pay for that advantage.

I really dont think any type of practice is completely safe… Impact is only a question of time. Early retirement, furloughs, lay offs, pay cuts, hiring freezes. I dont think anyone is immune… Even government jobs. Good news is my obligations are only to my patients, my partners, and our employees.

[Unknown Member]

Mednax is the only window we have right now and we see how its stock price has performed. Radiology is just part of Mednax however. RP and Envision finances are opaque due to the private nature of private equity.
One thing we do know is Vrad is not using expensive locums and subsidizing IR like the others.
 
Mednax radiology division
 
[ul][*]Established in 2017[*]100+ Partner facilities[*]7 States[*]275+ Physicians [/ul]  
Vrad
 
[ul][*]Established in 2001[*]2,100 Partner facilities[*]50 States[*]500+ Physicians[*]6,000,000 Annual studies [/ul]  
per Mednax website
[ul] [/ul]  

[Unknown Member]

Pediatrix is much bigger
 
[ul][*]Established in 1979[*]950+ Partner facilities[*]41 States & Puerto Rico[*]1,975+ Physicians[*]1,050+ Advanced practice providers [/ul]  

[Unknown Member]

American Anesthesiology- Mednax
 
[ul][*]Established in 2007[*]450+ Partner facilities[*]15 States[*]1,400+ Physicians[*]2,025+ Anesthetists [/ul]  

[Unknown Member]

 Eighty percent of hospitals pay an anesthesia subsidy. i.e. doesn’t sound lucrative.

[msc5405]

Wisdom beat me to it. I think it’s the local practice environment that’s cutting rads, not necessarily RP. One I know in LA hasn’t seen a pay cut (although I did ask 2 weeks ago… it could have changed). He said they’re confident things will be okay because of the $700 MM they received last summer. I’m not sure if it’s because he drinks the company koolaid or if he actually believes it will be ok. 
 
Legit question. If one of those PE companies folds, what happens to the practices? Do they have to bid for the hospital contract again as a PP? 

[Unknown Member]

Quote from texas rads

Wisdom beat me to it. I think it’s the local practice environment that’s cutting rads, not necessarily RP. One I know in LA hasn’t seen a pay cut (although I did ask 2 weeks ago… it could have changed). He said they’re confident things will be okay because of the $700 MM they received last summer. I’m not sure if it’s because he drinks the company koolaid or if he actually believes it will be ok. 

Legit question. If one of those PE companies folds, what happens to the practices? Do they have to bid for the hospital contract again as a PP? 

 
That’s a great question.  I suppose the first question to ask is if any of the RP rads are still encumbered by a non-compete if RP folds or gives up the contract.
 
I think it depends on the mindset of the individual rads.  I wonder if, in that situation, the path of least resistance would be for some sort of three-way negotiation wherein the previously RP-employed rads became hospital-employed rads.
 
I don’t think this would be a particularly good situation for the rads.  The hospital will likely be displeased at the thought of hiring expensive new employees in a department experiencing a severe drop in revenue at a time when the hospital system is likely bleeding money.
 
The longterm smart play for potentially abandoned rads would be to muscle up, borrow money while there is a negligible interest rate, set up a PP and come to the hospital that way instead of hat in hand asking for a job during an economic and imaging downturn.

[debra.paulk_16]

Quote from radgrinder

That’s a great question.  I suppose the first question to ask is if any of the RP rads are still encumbered by a non-compete if RP folds or gives up the contract.

I think it depends on the mindset of the individual rads.  I wonder if, in that situation, the path of least resistance would be for some sort of three-way negotiation wherein the previously RP-employed rads became hospital-employed rads.

I don’t think this would be a particularly good situation for the rads.  The hospital will likely be displeased at the thought of hiring expensive new employees in a department experiencing a severe drop in revenue at a time when the hospital system is likely bleeding money.

The longterm smart play for potentially abandoned rads would be to muscle up, borrow money while there is a negligible interest rate, set up a PP and come to the hospital that way instead of hat in hand asking for a job during an economic and imaging downturn.

 
I assume that the non-competes are going to be enforced (with the goal of pressuring rads to buy out the non-compete at some absurd rate so they don’t have to move). This raises the question of where a group of available “abandoned rads” large enough would come from? This is specially true since they wouldn’t be able to enter negotiations until their contracts were nulled. 
 
Also, let say RP does okay during this financially, but various hospitals become dissatisfied. How do hospitals make it know that a new PP could compete for the contract? 

[g.giancaspro_108]

.

[Unknown Member]

Quote from sandeep panga

Quote from jopo

Also, let say RP does okay during this financially, but various hospitals become dissatisfied. How do hospitals make it know that a new PP could compete for the contract? 

The hospital would issue a Request for Proposals inviting other radiology groups to apply to provide services.

That being said, there is no reason a suitable group could not approach a hospital that has not issued a RFP and try to convince them how much better the hospital would be with their radiology group instead of the current group.

 
This

[Unknown Member]

Were I a rad in this type of situation interested in remaining onsite, Id be asking hospital admin to pressure the VC company into letting the rads out of their noncompetes.

Why would the VCs do that? Because the hospital could likely sue them for abandoning their contracts, particularly during a healthcare crisis. And if the existing onsite rads had been doing a halfway decent job, yeah, the hospital would likely weigh the available options and decide that protecting the imaging department income is important and since the VC would be intending to leave the hospital in the lurch anyway, no reason to be nice.

Hammer the VCs with threats of a lawsuit for abandoning a contract, creating at least a temporary solution for the staffing problem of the radiology department by using the existing onsite rads who are now out of their noncompete. Then issue an RFP and see if those existing rads can put together a group, and/or see if another group is interested, with the third option of the hospital hiring the rads individually as employees.

That would be how the hospital extracts themselves from a VC mess under favorable conditions. If the rads are strong enough, thats the start of a very favorable situation for them as well.

[Unknown Member]

So much depends on the particular hospital system There are some that value their staff and others that will chase the latest cheap deal placed in front them.

[ruszja]

Very few radiologists have the vision and enterpreneurial knack to set up a group on short notice. And if they do, they probably dont work for one of the corporate outfits at this time.
 
If one of the corporates goes under, most of their contracts are going to be snagged up by other corporates.

[Unknown Member]

Quote from fw

Very few radiologists have the vision and enterpreneurial knack to set up a group on short notice. And if they do, they probably dont work for one of the corporate outfits at this time.

If one of the corporates goes under, most of their contracts are going to be snagged up by other corporates.

This is what happened to the MDIG and Envision contracts in AZ and TX. They now have new corporate providers.

[Unknown Member]

Quote from drad123

Quote from fw

Very few radiologists have the vision and enterpreneurial knack to set up a group on short notice. And if they do, they probably dont work for one of the corporate outfits at this time.

If one of the corporates goes under, most of their contracts are going to be snagged up by other corporates.

This is what happened to the MDIG and Envision contracts in AZ and TX. They now have new corporate providers.

 
That was when the shell game was still in full force and these PE/VC backed groups could still make the case that they will be able to stay solvent and capture enough market share to become profitable. That has all been turned on its head with COVID-19..
 
It’s probably true that there are not enough savvy and well trained radiologists to figure out how to do it right now. It doesn’t mean there is not an opportunity right now for those willing to put some work in and ask for help from guys like Dan Corbett.

[Unknown Member]

I am just realizing part of the problem here. So many of you that have complained about how a senior partner is not pulling their weight on the RVU side and how you should be paid more for the work that you do.
 
Well guess what, now that you have the opportunity to make it better for yourselves you don’t know where to turn because you were not in the med exec meetings making connections. You were not working on committees where you could network with administration and develop the type of relationships you need right now.

[Patrick]

Another interesting read.  We have to look at things from the macro level as well:
[link=https://www.vanityfair.com/news/2020/04/how-private-equity-is-winning-the-coronavirus-crisis]https://www.vanityfair.com/news/2020/04/how-private-equity-is-winning-the-coronavirus-crisis[/link]
 
Enforce-ability or release from non-competes will be essential–there need to be state and federal reforms to this end.  

[Unknown Member]

Quote from ADHD

Quote from drad123

Quote from fw

Very few radiologists have the vision and enterpreneurial knack to set up a group on short notice. And if they do, they probably dont work for one of the corporate outfits at this time.

If one of the corporates goes under, most of their contracts are going to be snagged up by other corporates.

This is what happened to the MDIG and Envision contracts in AZ and TX. They now have new corporate providers.

That was when the shell game was still in full force and these PE/VC backed groups could still make the case that they will be able to stay solvent and capture enough market share to become profitable. That has all been turned on its head with COVID-19..

It’s probably true that there are not enough savvy and well trained radiologists to figure out how to do it right now. It doesn’t mean there is not an opportunity right now for those willing to put some work in and ask for help from guys like Dan Corbett.

Why do you say savvy and well trained? A radiology hospital based practice is not complicated. Contact a billing company. Hell use the same billing company that RP or Envision used.
 
Someone with a high school education could set up and run a hospital based rad practice.

[Unknown Member]

I guess just savvy then. I know its not that complicated. It does require feeling like you have a chance though. That comes from being interested and having some sense of familiarity with the administration environment. Most worker bee positions will not be conducive to that. 

[Unknown Member]

Look at the post from ts above. They would like to know how to do it. We can tell them they just have to give it the old college try but they just wont feel comfortable or believe its possible. They have been conditioned to think things like this must be handled by experts who have the proper credentials. 

[Unknown Member]

Quote from ADHD

Look at the post from ts above. They would like to know how to do it. We can tell them they just have to give it the old college try but they just wont feel comfortable or believe its possible. They have been conditioned to think things like this must be handled by experts who have the proper credentials. 

 
A reasonable time period to learn how to do it is about a year.  That’s if one were being a full-time radiologist as well, and you hired some help.  But give yourself a year to learn how to negotiate halfway decently, learn the basics of coding, billing, some insurance know-how, and how to run meetings, keep people in a productive state, and build a reputation.
 
Any radiologist has the mental faculties to do it.  After that it’s more about persistence and the willingness not to care about feeling embarrassed due to a lack of knowledge.  By the time many rads enter practice, they avoid situations where they feel uncomfortable or are not The Expert in the Room.  I think the trend towards subspecialization is indicative of that.  

[Unknown Member]

I guess that’s a knock on me, but you can take what I said at face value. I do think we should be a community and help each other and all of that mumbo jumbo, you know, perhaps a bit of “mentorship” or whatever they used to call it. You know, some of us are willing to tug on the bootstraps and give it a go. Obviously it’s not easy.
 
For those of us who came out in the last decade, we dealt with a crappy market, seeing our seniors freak about getting ANY job, seeing nothing but RP listings on the ACR site.  And in the NYC area, nothing that resembled a traditional PP.
 
So yes, we can see the problems, but it’s hard to know what to do when you’re a worm and can get squashed for suggesting something as revolutionary as comp days for weekend call days, much less try to move a system back in the favor of radiologists.
 
Constructive comments appreciated.

[Unknown Member]

Ts I hear you. I am definitely not trying to be critical. I would love to help if I could. I just dont know your situation well enough. I do think it comes down to feeling like you have some relationship with hospital admin.

[Unknown Member]

Appreciate that. But its worthwhile to keep in mind that many of us have no familiarity with physician-run practices. They just werent available to us. Its not a generational thing… were doing the work and grinding and building relationships where we can. But yeah, I would like to know that my career and future is in the hands of other radiologists, not the way it is now. And I speak for my cohort when I say we definitely would work towards making that happening.

[Unknown Member]

Quote from ts298

Appreciate that. But its worthwhile to keep in mind that many of us have no familiarity with physician-run practices. They just werent available to us. Its not a generational thing… were doing the work and grinding and building relationships where we can. But yeah, I would like to know that my career and future is in the hands of other radiologists, not the way it is now. And I speak for my cohort when I say we definitely would work towards making that happening.

A physician run practice is no panacea. Try one sometime.
 
The five regimes of radiology practice-
 
Aristocracy- The radiology contract is passed from father to son. No one else is a partner. Can be a nice place to work only if ruled by a “philosopher king”- a radiologist ruled by reason and wisdom.
Timocracy- A small group of shareholders owns the contact. No one else gets in. These yahoos often sell to VC.
Oligarchy- Rule by wealth. This means VC and private equity. The VC rulers become rich and the rads become poor. The distribution of power prevents the wise and virtuous radiologist from influencing the group but the incompetent MBA has full sway. The oligarchs are only interested in enriching themselves.
Democracy- Oligarchy degenerates into democracy. Everyone becomes a partner no matter how incompetent or dysfunctional. Anarchy ensues. Democracy proliferates in a tight job market. It is unstable because it is not ruled by reason and wisdom.
Tyranny- Democracy then degenerates into tyranny where no one has disciple and the group is in chaos. Power must be seized to maintain order. A tyrant rad will sneak behind the group and take power. The rest of the rads will hate him and try to remove him but will be unable to. The tyrant rad will commit all acts of injustice and destroy any rad who opposes him. Tyrants thrive in a soft radiology market when there are no other jobs.
 
I have seen all of these in 20 years of practice.
 
 

[Unknown Member]

Thats a great breakdown, drad. A lot of truth in it. A comment would be that everything degenerates eventually, but what happens in the interim counts too. People are happy for a short or long while depending on how much they are involved, families and economies grow and thrive, people have jobs, and so on.

The sun eventually swallows the Earth, but there are useful things to be done in the meantime :).

Hmm. On another note, the Fed seems to be bailing out Wall Street by backstopping high interest loans and junk bonds. RP may not be in trouble after all, and may end up being subsidized by taxpayer dollars.

[Unknown Member]

Quote from radgrinder

Thats a great breakdown, drad. A lot of truth in it. A comment would be that everything degenerates eventually, but what happens in the interim counts too. People are happy for a short or long while depending on how much they are involved, families and economies grow and thrive, people have jobs, and so on.

The sun eventually swallows the Earth, but there are useful things to be done in the meantime :).

Hmm. On another note, the Fed seems to be bailing out Wall Street by backstopping high interest loans and junk bonds. RP may not be in trouble after all, and may end up being subsidized by taxpayer dollars.

 
They are not currently buying CCC rated junk bonds in either primary or secondary facilities they are setting up (RP’s last bond sale was CCC).  BB- is the worst (for now).
 
Primary facility purchasing:  [link=https://www.federalreserve.gov/newsevents/pressreleases/files/monetary20200409a5.pdf]https://www.federalreserve.gov/newsevents/pressreleases/files/monetary20200409a5.pdf[/link]
 
secondary facility purchasing:  [link=https://www.federalreserve.gov/newsevents/pressreleases/files/monetary20200409a2.pdf]https://www.federalreserve.gov/newsevents/pressreleases/files/monetary20200409a2.pdf[/link]

[debra.paulk_16]

Quote from fw

Very few radiologists have the vision and enterpreneurial knack to set up a group on short notice. And if they do, they probably dont work for one of the corporate outfits at this time.

If one of the corporates goes under, most of their contracts are going to be snagged up by other corporates.

 
Assuming there are many radiologist around the country eager for the opportunity to start their own group, maybe even willing to move to do it. Is there or could there be an organization that organizes these radiologists to form new small groups for hospitals.
 
i.e. A group of radiologist form a non-profit quasi-recruitment / practice forming group. Hospital “X” is being hurt by their current radiology group (for whatever reason… not a corporate priority, can’t recruit new talent, older practice leaders don’t want to invest more, weight of maintaining the status-quo is causing too much drag, …). This organization could say: We have 500 members, 10 radiologist in town Y, 50 others are willing to move to town Y, and out of those these 30 radiologists and one administrator fit the needs of hospital X in town Y. Then the organization could send a proposal singed by those willing to take on the challenge and form their own practice. Maybe they also get a little help securing a loan to start, but then they would be an independent private practice. Since it’d be a relatively small group of motivated individuals there might be a lot of creativity and innovation along the way which could help the profession.
 
Could this be a way to balance consolidation?  (I don’t think consolidation is always bad, but there has to be a counteracting force)

[msc5405]

I don’t know how a non-compete would be enforceable if the employer (RP or other PE) goes under. I’d gather it’s a state by state problem.

[Unknown Member]

ADHD,

Pretty much. That only applies to a subset of younger rads who prefer to be worker bees. And there is absolutely nothing wrong with that.

But if you want to be something more? Well, first you have to want it. Not just the money. Youve got to have some fire in the belly.

Otherwise, youre just looking for someone else to endorse your check, whether that be RP, Envision, the hospital or whoever is next.

[Unknown Member]

Quote from radgrinder

Pretty much. That only applies to a subset of younger rads who prefer to be worker bees. And there is absolutely nothing wrong with that.

 
Exactly. But if that’s what you want this is a good time to see what you give up for it.

[Unknown Member]

RP has its own RFP website. How convenient.
 
I see many mega corp type groups do too.
 
[link=https://www.radpartners.com/request-for-proposal]https://www.radpartners.com/request-for-proposal[/link]
 
 

[Unknown Member]

Investment funds raise money to be used in a particular way. Cash raised for that purpose must be used that way. That money is supposed to be used to purchase practices. If that can’t be done at a good valuation then the whole thing falls apart.
 
Having a mountain of cash even if it could be used to weather the storm does nothing for the long tern health of PE/VC backed corporate radiology. They need an exit point and those are becoming like unicorns.

[Unknown Member]

ADHD,

Yes. Which is why theyd want multiple bids on their RFP. If they enable former VC rads to form a group, those former VC rads are likely to have a degree of gratitude or good feeling towards the hospital, and emotional investment in wanting the new group they just made to succeed.

So were I in the hospitals shoes, thats the kind of radiology group Id like to be negotiating with, because its highly likely to end with a positive/cheap outcome for the hospital.

So yeah, Id go about creating the circumstances and playing field that is going to predispose me, as the hospital, to ending up a winner.

[Unknown Member]

I am one of those who has chosen the “worker bee” life and love it, but when it comes to this stuff I fully support MDs taking back control and would go out of my way to support that. Just let me know how.
 
Today I got an email from an administrator with an MBA, telling me I may be redeployed to the ICU, with an attachment going over the clinical basics of COVID-19. This is not the way.

[Unknown Member]

Cool. Again, not criticizing the worker bee path. There are pluses and minuses to anything one does.

[Patrick]

Texas Rad…  It is state by state.  What we have seen with anesthesia with local contract beings lost is an unwillingness to release docs from their non-competes.  Sometimes they will offer assistance in relocation, sometimes they will require a financial buy out.  Look to prior threads and reports of Atrium Health and MedNax in North Carolina and United and MedNax in Minnesota.  If a corporation were to completely dissolve, ok, or to find themselves substantively in breech of contract, but often it will just shut down locally or get sold on to the next buyer, who might try to squeeze value out of anything.  There is precedent for vultures buying contracts with express purpose of extracting monetary payments in exchange for release from non-competes. It rare, but it happens.
 
ZDoggMD has had some interesting comments on the practice lately.

[Unknown Member]

Your system sounds too big to be able to work with in your position Im afraid. I hope the downside of your curve is steep so you can avoid ICU duty. What a ridiculous idea to tap the radiologists to help there. You are in a tough spot for sure. 

[DanielQuilli]

A hospital based radiology practice is probably one of the simplest businesses to create and operate. Does not take any special level of knowledge or intelligence. What most rads have lacked in the past is time. It does take a little free time which in the past has been the major impediment to rads and physicians in general getting involved in the business aspect of things. Sorry there is just nothing complicated or special about running a hospital based rad group.

[Unknown Member]

Quote from tigershark06

A hospital based radiology practice is probably one of the simplest businesses to create and operate. Does not take any special level of knowledge or intelligence. What most rads have lacked in the past is time. It does take a little free time which in the past has been the major impediment to rads and physicians in general getting involved in the business aspect of things. Sorry there is just nothing complicated or special about running a hospital based rad group.

 
The complicated part is the politics of running the group. Just think of grabbing 10 of the posters on AM, and trying to wrangle them into a coherent group based on the posts you read. 
The billing etc is fairly straight forward; there are companies that will do it all for you. 

[Unknown Member]

Quote from boomer

Quote from tigershark06

A hospital based radiology practice is probably one of the simplest businesses to create and operate. Does not take any special level of knowledge or intelligence. What most rads have lacked in the past is time. It does take a little free time which in the past has been the major impediment to rads and physicians in general getting involved in the business aspect of things. Sorry there is just nothing complicated or special about running a hospital based rad group.

The complicated part is the politics of running the group. Just think of grabbing 10 of the posters on AM, and trying to wrangle them into a coherent group based on the posts you read. 
The billing etc is fairly straight forward; there are companies that will do it all for you. 

Right. Then throw in specialization, particularly IR and mammo- gunpowder, treason, and plot- boom!

[ruszja]

Quote from boomer

Quote from tigershark06

A hospital based radiology practice is probably one of the simplest businesses to create and operate. Does not take any special level of knowledge or intelligence. What most rads have lacked in the past is time. It does take a little free time which in the past has been the major impediment to rads and physicians in general getting involved in the business aspect of things. Sorry there is just nothing complicated or special about running a hospital based rad group.

The complicated part is the politics of running the group. Just think of grabbing 10 of the posters on AM, and trying to wrangle them into a coherent group based on the posts you read. 
The billing etc is fairly straight forward; there are companies that will do it all for you. 

 
I dont see much of a politics issue at the start. The problem is you need to get just the right number of initial founding partners without having to resort to things like hiring locums to cover your initial contract. You also need the right mix of subspecialties to be able to offer the full package to a hospital. The biggest issue is finding ‘n’ others who have
– the same vision
– the willingness to invest time and treasure for a payback that is not certain.
 
The nuts & bolts of setting up a practice are not that difficult. Certainly gets easier the second time around.  A good billing/management company can be a great help (or great obstacle if they are dolts).
Oh, you do need some money. For a while it is ‘bring your money to work day’. Unless you have an unusual situation like a hospital writing a practice loan, you are unlikely to find a bank to advance you the money to get started.
The biggest obstacle is finding the right people. They have to have at least a basic concept of what it takes to run a group and the cash & flexibility to move for a hospital contract. You may be able to find some in the corporate workforce who ended up there after their group was sold out from under them, but your average ‘worker bee’ who wants to know about his 401k match is probably not it.

[debra.paulk_16]

Quote from fw

Quote from boomer

Quote from tigershark06

A hospital based radiology practice is probably one of the simplest businesses to create and operate. Does not take any special level of knowledge or intelligence. What most rads have lacked in the past is time. It does take a little free time which in the past has been the major impediment to rads and physicians in general getting involved in the business aspect of things. Sorry there is just nothing complicated or special about running a hospital based rad group.

The complicated part is the politics of running the group. Just think of grabbing 10 of the posters on AM, and trying to wrangle them into a coherent group based on the posts you read. 
The billing etc is fairly straight forward; there are companies that will do it all for you. 

I dont see much of a politics issue at the start. The problem is you need to get just the right number of initial founding partners without having to resort to things like hiring locums to cover your initial contract. You also need the right mix of subspecialties to be able to offer the full package to a hospital. The biggest issue is finding ‘n’ others who have
– the same vision
– the willingness to invest time and treasure for a payback that is not certain.

The nuts & bolts of setting up a practice are not that difficult. Certainly gets easier the second time around.  A good billing/management company can be a great help (or great obstacle if they are dolts).
Oh, you do need some money. For a while it is ‘bring your money to work day’. Unless you have an unusual situation like a hospital writing a practice loan, you are unlikely to find a bank to advance you the money to get started.
The biggest obstacle is finding the right people. They have to have at least a basic concept of what it takes to run a group and the cash & flexibility to move for a hospital contract. You may be able to find some in the corporate workforce who ended up there after their group was sold out from under them, but your average ‘worker bee’ who wants to know about his 401k match is probably not it.

Agreed.
 
Finding the right mix of people is the challenge and I’m not sure current professional networks would be able to address this challenge well. 

[Unknown Member]

I think there would be some pleasant surprises. Sometimes having a large pool of applicants is more a curse than a blessing. Recruiting for the true go-getters will yield a relatively small crop, but it can be amazing how much rocket fuel truly engaged, smart and motivated people bring to the table. You only need a couple of those.

[Unknown Member]

Quote from radgrinder

A reasonable time period to learn how to do it is about a year.  That’s if one were being a full-time radiologist as well, and you hired some help.  But give yourself a year to learn how to negotiate halfway decently, learn the basics of coding, billing, some insurance know-how, and how to run meetings, keep people in a productive state, and build a reputation.

Any radiologist has the mental faculties to do it.  After that it’s more about persistence and the willingness not to care about feeling embarrassed due to a lack of knowledge.  By the time many rads enter practice, they avoid situations where they feel uncomfortable or are not The Expert in the Room.  I think the trend towards subspecialization is indicative of that.  

 
You can hire a good billing company and they will give you a lot of useful info about coding, billing and etc. 

As you said, it is not rocket science. Just you have to grow a pair and be willing to accept some loss in the beginning.

Sub-specialization mentality is the opium of the independent radiology group. 

[msc5405]

[link=https://www.investopedia.com/federal-reserve-launches-an-additional-usd2-3-trillion-in-support-4802350?utm_source=personalized&utm_campaign=bouncex&utm_term=19996492&utm_medium=email]https://www.investopedia.com/federal-reserve-launches-an-additional-usd2-3-trillion-in-support-4802350?utm_source=personalized&utm_campaign=bouncex&utm_term=19996492&utm_medium=email[/link]
 
Methinks RP might qualify for some of this new Fed money. 
I still wonder how we can call this a free market economy. 
 

[katiemckee84_223]

We can’t. There will be unintended consequences, though.
It’s sad.
 
At least those that criticized capitalism have been finally proven totally wrong that this was anything but capitalism — crony capitalism, indeed. Far closer to socialism/communism, where Bernie is now getting his wish:
 
Massive unemployment and police state. No wonder he didn’t care to run anymore, mission accomplished.

[Unknown Member]

Quote from texas rads

[link=https://www.investopedia.com/federal-reserve-launches-an-additional-usd2-3-trillion-in-support-4802350?utm_source=personalized&utm_campaign=bouncex&utm_term=19996492&utm_medium=email]https://www.investopedia.com/federal-reserve-launches-an-additional-usd2-3-trillion-in-support-4802350?utm_source=personalized&utm_campaign=bouncex&utm_term=19996492&utm_medium=email[/link]

Methinks RP might qualify for some of this new Fed money. 
I still wonder how we can call this a free market economy. 

 
They won’t.  Moody’s has them rated at B3 (B-).  Fed (for now) is only backing bonds rated previously rated at least BBB- prior to March 22nd and subsequently downgraded no lower than BB-.
 
Also, the only ETFs the Fed will buy are those where the price does not exceed the NAV.  So for instance, right now HYG is trading at 82.36 but NAV is 78.75.  They won’t be buying.  Anyway the secondary facility that would buy from has a lot of limitations.  It’s all in the two Fed links I posted.
 
So far this is them doing a confidence boost to the markets rather than actually propping up the corporate bond markets.

[Unknown Member]

Any new predictions on how the RPs or other corporates in our realm will fare?

[Unknown Member]

Moody’s has a good review of RP they made back in Jan of this year.  Registration is free to view their stuff (to some extent):  [link=https://www.moodys.com/research/Moodys-assigns-Caa2-rating-to-Radiology-Partners-proposed-senior-unsecured–PR_417157]https://www.moodys.com/research/Moodys-assigns-Caa2-rating-to-Radiology-Partners-proposed-senior-unsecured–PR_417157[/link]
 
The were at 8x at the time of the posting.  So this portion is where they are now headed imo:
 
“Ratings could be downgraded if the company’s liquidity and/or operating performance deteriorates, it fails to effectively integrate acquired practices, or if its financial policies become more aggressive. Ratings could also be downgraded if Moody’s believes that the company will sustain adjusted debt/EBITDA above 7.5 times.”

[msc5405]

Thanks for that Moody’s report ztune. Do you know when it gets reassessed?

[Unknown Member]

The last periodic review was Feb of this year:  [link=https://www.moodys.com/research/Moodys-announces-completion-of-a-periodic-review-of-ratings-of–PR_415109]https://www.moodys.com/research/Moodys-announces-completion-of-a-periodic-review-of-ratings-of–PR_415109[/link]
 
Prior to that it was March 2019 and the rating was unchanged (B3).  Next one probably in a year if nothing changes (unlikely).
 
They will have a rating placed each time they issue debt.  If there is something substantial to the corporate rating they will issue an announcement whenever that happens.

[Unknown Member]

When we talk bonds can we please distinguish between corporate bonds and U.S. treasuries?

[Unknown Member]

How many RFPs have you seen lately?
Nowadays these things are sent privately to RP and Envision and maybe Mednax.

[Unknown Member]

here’s an old one from a rural hospital in Ohio.
 
[link=https://www.fcmh.org/documents/RFP-for-Radiology-Services-Jan-25-2018.pdf]https://www.fcmh.org/documents/RFP-for-Radiology-Services-Jan-25-2018.pdf[/link]
 
Town population 14k.
 
25k reads, all modalities.
 
Not enough to support a full-time rad.
 
40 miles from Columbus
 
 

[forgottenegao_866]

The idiot CEO of RP came out and said they have plenty of money (1B cash) and are in strong position to whether the storm probably better than no sell out practices. Wonder how much of that cash belongs to NEA.

[Unknown Member]

That cash was supposed to be for new purchases, not keeping the boat afloat. PE is not going to be happy to watch it all be pissed away. It’s not really cash also. It’s backed by expensive debt.

[Unknown Member]

Right. In an odd way, this is a scary thing to hear. In these days of cheap debt and minimal interest rates, corporations dont just sit on piles of cash like dragons. Its foolish to do so; one is better off spending it to acquire assets and then borrowing more cash and small interest rates if need be.

So if youre sitting on a massive pile of cash, then that means that you cant find anything good enough to spend it on, which is bad for radiology because that means that the analysis of the field as a whole sucks. Thats also bad for VC, since well, theyre in radiology.

Alternatively, sitting on a massive pile of cash like that could mean that while there might be things out there you want to buy, but no one is currently willing to lend you money, so youve got to keep your cash on hand to pay your bills until things improve and you can borrow again or, well, things dont improve fast enough. Given the bond quality, I lean towards this interpretation.

Again, this is all pure speculation, complete and total BS from an Internet forum, and should not be listened to seriously.

[forgottenegao_866]

My guess is the cash is really money that belongs to the investment firm (NEA and Starr) and they really dont have much of anything. A friend on mine who works for them said that many of the groups either cut salaries or furloughed (like many none PEs) but when the groups ask for help to back peoples salaries especially associates who have contracted rates RP told them they didnt have the cash for that

[afazio.uk_887]

Meh…. dept of HHS is directly depositing money into practices at the tune of $30B…. RP, envision, mednax will get that money into their accounts also keep in mind.  I don’t see covid taking out any of the corporate interests in radiology.  It may delay their ascendancy to complete domination of the field some but that’s about it.

[Robbro524_990]

I disagree. Right now, everyone has liquidity problems.

And, if you are highly leveraged (ie. you have a lot of high interest debt), then you are disproportionally screwed.

These firms’ accounting departments will smooth this over as much as they can for a while (while ultimately trying to sell these crappy leveraged practice buyouts and/or debt to the ‘greater fool), but ultimately, this PE medicine game is likely over (for several years, at least). Just my opinion.

[debra.paulk_16]

Quote from Waduh Dong

Meh…. dept of HHS is directly depositing money into practices at the tune of $30B…. RP, envision, mednax will get that money into their accounts also keep in mind.  I don’t see covid taking out any of the corporate interests in radiology.  It may delay their ascendancy to complete domination of the field some but that’s about it.

 

[link]https://youtu.be/w-eX4sZi-Zs?t=2278[/link]

[nasosmunfc_332]

Good to hear about rfp ending up with original group in many instances. Hopefully, the capital intensive nature of bidding and starting a group will prevent corporate raiders from taking established contracts or at least delay it.

[msc5405]

I think some underestimate the ability for the business people in the hospital c-suite to think more like the business people at VC, rather than think about it from a physician perspective. We are not experts, we are a number on an expense sheet. 
 
 

[Unknown Member]

No doubt. Especially before COVID. I your hospital thinks that way you were screwed. 

[Unknown Member]

State pension funds are not opposed to taking to court to try and recoup losses if PE is reckless with their money. Continuing to fund a sinking ship like RP could easily be construed that way. 

[g.giancaspro_108]

.

[Patrick]

I’ve seen 1 locally, also went to incumbent group.   

[Patrick]

Also, as relates to corporates and PE, anyone else notice that Lucid Health (Riverside and gang) have teamed up with AIDoc and are co-marketing services?

[Unknown Member]

Quote from sandeep panga

Quote from drad123

How many RFPs have you seen lately?
Nowadays these things are sent privately to RP and Envision and maybe Mednax.

This past year, just one.  I think the hospital that posted it thought one of the big corporate groups would come in and sweep them off their feet.  The contract was ‘awarded’ to the original private group so I guess the hospital couldn’t get what they wanted from the corporates.

How big was the contract radiologist wise?
 
What do you think the hospital wanted and didn’t get from the corporates?

[ruszja]

Quote from drad123

here’s an old one from a rural hospital in Ohio.

[link=https://www.fcmh.org/documents/RFP-for-Radiology-Services-Jan-25-2018.pdf]https://www.fcmh.org/documents/RFP-for-Radiology-Services-Jan-25-2018.pdf[/link]

Town population 14k.

25k reads, all modalities.

Not enough to support a full-time rad.

40 miles from Columbus

The folks who mentioned how ‘simple’ it is to run a radiology practice should read that. That’s a little 25 bed CAH, not a 300 bed hospital with IR, mammo and nucs.

[Unknown Member]

Back of the envelope…about 12-14000 RVUs.

Hire VRad for the overnights and subspecialty reads you dont feel comfortable with. Find a locums company beforehand to spec out some weeks of vacation.

A solo rad could carve out a comfortable niche in that job.

[ruszja]

Quote from radgrinder

Back of the envelope…about 12-14000 RVUs.

Hire VRad for the overnights and subspecialty reads you dont feel comfortable with. Find a locums company beforehand to spec out some weeks of vacation.

A solo rad could carve out a comfortable niche in that job.

 
Sure. And you are competing against corporates and larger groups who can guarantee ‘subspecialty reads’ for MSK, Neuro, Mammo and a warm body on site 2 days/wk. Unless you have an ‘in’ on the hospitals board or you know the CEO from a prior gig, your solo-rad + locums submittal will go far down in the pile (unless there is no pile and you are the last radiologist on earth).

[debra.paulk_16]

Quote from fw

Sure. And you are competing against corporates and larger groups who can guarantee ‘subspecialty reads’ for MSK, Neuro, Mammo and a warm body on site 2 days/wk. Unless you have an ‘in’ on the hospitals board or you know the CEO from a prior gig, your solo-rad + locums submittal will go far down in the pile (unless there is no pile and you are the last radiologist on earth).

Agreed, the latter part of this thread is getting to the current problem – finding and competing for contracts. Corporations shouldn’t have to go Chapter 7 or 11 for others to compete and innovate. I’m hopeful the evolving pressures allow for the formation of agile groups willing to challenge current practices.  
 
 

[Unknown Member]

Quote from fw

Quote from radgrinder

Back of the envelope…about 12-14000 RVUs.

Hire VRad for the overnights and subspecialty reads you dont feel comfortable with. Find a locums company beforehand to spec out some weeks of vacation.

A solo rad could carve out a comfortable niche in that job.

Sure. And you are competing against corporates and larger groups who can guarantee ‘subspecialty reads’ for MSK, Neuro, Mammo and a warm body on site 2 days/wk. Unless you have an ‘in’ on the hospitals board or you know the CEO from a prior gig, your solo-rad + locums submittal will go far down in the pile (unless there is no pile and you are the last radiologist on earth).

Fayette County Memorial Hospital (FCMH) has partnered with Riverside Radiology and lnterventional Associates….. private equity backed- Excellere Partners. LOL

[Unknown Member]

I was unable to find any RFPs for even small group size contracts.
 
Radiology contracts are hard to come by.
 

[benoit.elens]

The few times I have been involved with RFPs, the hospital was just using our group for negotiating power/leverage with its existing group.  Insincere process but you don’t get it unless you try.

[Robbro524_990]

That happens a lot, for sure.

Gotta love administration. 😉

[nasosmunfc_332]

In my experience, it has been the opposite. Admin already has a verbal deal with another group (tele possibly from solicitation) and then does an rfp, removes the pre existing group, and puts in the chosen group. They do this with the intention of breaking up the previous group and picking off some of the more productive people.
 
I’ve never seen an rfp end up with the initial group but sure it happens.

[Unknown Member]

Quote from lk

In my experience, it has been the opposite. Admin already has a verbal deal with another group (tele possibly from solicitation) and then does an rfp, removes the pre existing group, and puts in the chosen group. They do this with the intention of breaking up the previous group and picking off some of the more productive people.

I’ve never seen an rfp end up with the initial group but sure it happens.

 
This was the status quo before COVID. It’s going to be interesting if the PE/VC money will be allowed to go looking for contracts anymore. Not pulling back some of those dollars is going to look like throwing good money after bad to a lot of investors now. Companies that are successful don’t make that mistake very often.

[Unknown Member]

Quote from lk

In my experience, it has been the opposite. Admin already has a verbal deal with another group (tele possibly from solicitation) and then does an rfp, removes the pre existing group, and puts in the chosen group. They do this with the intention of breaking up the previous group and picking off some of the more productive people.

I’ve never seen an rfp end up with the initial group but sure it happens.

 
Was part of a group where a main hospital put out a surprise RFP.  Thought they had Envision ready to come in, but they bailed and the group kept the contract.  Weren’t particularly happy with the hospital.  The hospital admin ended up changing over this and other misadventures.

[Unknown Member]

Quote from ADHD

State pension funds are not opposed to taking to court to try and recoup losses if PE is reckless with their money. Continuing to fund a sinking ship like RP could easily be construed that way. 

Why is RP a sinking ship? They seem to be growing. We can’t see their balance sheet but Rich Whitney has declared they have half a  a billion in cash. Sounds more like they are in a position of power the likes of which radiologists have never seen.

[ranweiss]

Whitney recently bought a nearly 7 million dollar house in so cal….The MD on staff, browner or whatever, has a 5 million dollar house..Even the young guys in their 30’s have 2 million + homes…I think they are doing just fine….Even if RP tanks, they made their money.

[afazio.uk_887]

How do you know this?  Is this public information?

[ranweiss]

Quote from Waduh Dong

How do you know this?  Is this public information?

 
Yeah, public information. Google-able. 

[debra.paulk_16]

Quote from ar123

Whitney recently bought a nearly 7 million dollar house in so cal….The MD on staff, browner or whatever, has a 5 million dollar house..Even the young guys in their 30’s have 2 million + homes…I think they are doing just fine….Even if RP tanks, they made their money.

 
I think Whitney got most of his money from DiVita. Anyways, I don’t think any of this matters. They are smart people and are therefore likely protecting their personal and family interest well. I’d rather focused on understanding the current state of radiology practices and the profession. 

[Unknown Member]

Quote from jopo

I think Whitney got most of his money from DiVita. Anyways, I don’t think any of this matters. They are smart people and are therefore likely protecting their personal and family interest well. I’d rather focused on understanding the current state of radiology practices and the profession. 

 
What exactly do you mean by this?
Whitney and his 7 million dollar house are not relevant to the current state of radiology? -or the current state of America? -or the current state of most of the world?

[ranweiss]

Quote from jopo

Quote from ar123

Whitney recently bought a nearly 7 million dollar house in so cal….The MD on staff, browner or whatever, has a 5 million dollar house..Even the young guys in their 30’s have 2 million + homes…I think they are doing just fine….Even if RP tanks, they made their money.

I think Whitney got most of his money from DiVita. Anyways, I don’t think any of this matters. They are smart people and are therefore likely protecting their personal and family interest well. I’d rather focused on understanding the current state of radiology practices and the profession. 

 
This doesn’t sounds sketchy at all…

[Unknown Member]

Quote from ar123

Whitney recently bought a nearly 7 million dollar house in so cal….The MD on staff, browner or whatever, has a 5 million dollar house..Even the young guys in their 30’s have 2 million + homes…I think they are doing just fine….Even if RP tanks, they made their money.

Bronner has a 4 million dollar brownstone mansion in Old town between Lincoln Park and Gold Coast. Not bad for a “radiologist.”

[Unknown Member]

By my google Rich’s Manhattan Beach mansion is worth 23 million.
A few blocks from the beach. Impressive.

[Dr_Cocciolillo]

Im surprised no one has had a knee taken out

[debra.paulk_16]

Quote from wisdom

Im surprised no one has had a knee taken out

 
That would be quite the story! I’m not sure which investigative journalist is going to retire off of their book on the story of PE in medicine; but if the economy doesn’t recovery, and PE firms continue their ways… there is going to be a Tanya Harding-esque chapter which is really going to add to the sales. Probably even going to be a Netflix mini-series. 

[ranweiss]

Quote from jopo

Quote from wisdom

Im surprised no one has had a knee taken out

That would be quite the story! I’m not sure which investigative journalist is going to retire off of their book on the story of PE in medicine; but if the economy doesn’t recovery, and PE firms continue their ways… there is going to be a Tanya Harding-esque chapter which is really going to add to the sales. Probably even going to be a Netflix mini-series. 

 
Honestly, if someone exposed how private equity has profited off the backs of doctors , patients, insurance companies, and how they *truly* offer 0 value to the system, there would be widespread outrage. 
 
They are way too smart to let that happen though. 

[debra.paulk_16]

Quote from ar123

Quote from jopo

Quote from wisdom

Im surprised no one has had a knee taken out

That would be quite the story! I’m not sure which investigative journalist is going to retire off of their book on the story of PE in medicine; but if the economy doesn’t recovery, and PE firms continue their ways… there is going to be a Tanya Harding-esque chapter which is really going to add to the sales. Probably even going to be a Netflix mini-series. 

Honestly, if someone exposed how private equity has profited off the backs of doctors , patients, insurance companies, and how they *truly* offer 0 value to the system, there would be widespread outrage. 

They are way too smart to let that happen though. 

 
Real journalist are smart enough to make it happen. Currently a few of them are putting out nice 2000 word articles on the topic. One of these articles might go viral and motivated the real muck-raking required for a nice 70,000 word book exposing the tragedy of it all currently. 

[mariana.gonzalez_122]

Link?

[ranweiss]

Quote from drad123

By my google Rich’s Manhattan Beach mansion is worth 23 million.
A few blocks from the beach. Impressive.

 
You’re right. He made a serious upgraded in 2017 to the 20 million dollar place. Can’t imagine how much money these guys are making if they’re buying 20 million dollar homes. He still owns the 7 million dollar one though. 
 
At the end of the day, this is a capitalist country and I can’t knock the guy for being so successful. Good for him. Should just be eye opening to the people working for RP where the capital is headed, that’s all. 
 
If he’s got this kind of dough, I’m guessing new enterprise capital has more money than god, lol. 

[Unknown Member]

Quote from ar123

At the end of the day, this is a capitalist country and I can’t knock the guy for being so successful. Good for him. Should just be eye opening to the people working for RP where the capital is headed, that’s all. 

Question your first assumptions. Capitalism is a tool, not an end.

My point is it is not right for a generation of radiologists to have their labor stolen from them because it is a capitalist country and private equity bought the hospital contracts. 
 
Radiologists futures shouldn’t be for sale. I think we have a right to our reading fees even if they are done in a hospital that owns the imaging equipment.
 
So many Americans accept being cheated because they are told it is a capitalist country. Are radiologists going to accept this too?
 
Private equity buys up all the hospital radiology contracts in the USA. All rads now now get paid 20 dollars per wRVU. 
-just capitalism at its best. Nothing to see here.
 

[Unknown Member]

^ Yes.

[Robbro524_990]

All good points, no doubt

[leboyd1]

For what it’s worth, I laugh reading through this and wondering why the ARIS thing was taken down so rapidly while threads like this go on and on about other corporate rad groups which are similarly speculative about their business prospects, salary cuts and possible bankruptcy. Doesn’t matter to me either way, just an observation about the ARIS mystery versus why these posts are OK.
 
But my devil’s advocate side to much of this discussion is that US radiologists have generally benefited from the capitalist system, and continue to do so. We have always had by the far the highest average salaries and while they are coming down in many cases, they are still much higher than comparable countries. And the I think the salary complaining just smacks of wanting your cake and eating it too. We want to rake it in during the good times and have it protected in the bad times because we are special and did so much training (or could have gone into finance instead), etc. 
 
I’m not saying that PE is a good thing – they consistently come into industries and appear to totally demolish anything that might have been good in the name of profit. But as long as medicine is run as a business, we will endure the encroachment of corporate America and the ups and down of the business cycle.

[Unknown Member]

Quote from NewEngRad

But my devil’s advocate side to much of this discussion is that US radiologists have generally benefited from the capitalist system, and continue to do so. We have always had by the far the highest average salaries and while they are coming down in many cases, they are still much higher than comparable countries. And the I think the salary complaining just smacks of wanting your cake and eating it too. We want to rake it in during the good times and have it protected in the bad times because we are special and did so much training (or could have gone into finance instead), etc. 

I’m not saying that PE is a good thing – they consistently come into industries and appear to totally demolish anything that might have been good in the name of profit. But as long as medicine is run as a business, we will endure the encroachment of corporate America and the ups and down of the business cycle.

Yes, US radiologists have benefited from a fragmented system. Commercial and self pay rates have historically been high- 300% or more of medicare. Big players benefit much more than we do. I wouldn’t go so far as to call it a capitalistic system. Far from it.
 
Many rad practices would be happy to get Medicare rates from everyone.
120% of medicare for commercial doesn’t cover the holes in self pay and medicaid.
 
“But as long as medicine is run as a business, we will endure the encroachment of corporate America and the ups and down of the business cycle.”  -so true
 
PE is not good for radiology or probably anything it touches. Almost everyone seems to agree with this.
 

[debra.paulk_16]

Quote from drad123

Quote from ADHD

State pension funds are not opposed to taking to court to try and recoup losses if PE is reckless with their money. Continuing to fund a sinking ship like RP could easily be construed that way. 

Why is RP a sinking ship? They seem to be growing. We can’t see their balance sheet but Rich Whitney has declared they have half a  a billion in cash. Sounds more like they are in a position of power the likes of which radiologists have never seen.

 
RP’s adjusted debt/EBITDA was approximately 8.0 on September 30, 2019 according to Moody’s. Since then they have taken out more debt at a high interest rate (over 9%). Plus their earnings just got cut in half. Even if the government makes up for some of this loss revenue they will still be going deeper in the hole. Also, the cash on hand is probably ear-marked for something else and their PE backers might not be happy having to use it to keep the ship afloat before they get even a portion of their capital back. 
 
There are reasons for their recent downgrade (see my next post). 
 
It’s a bad situation for RP and the employed radiologist to be in. I hope RP finds a way through without hurting too many of their employees and patients. 
 
 

[debra.paulk_16]

It happened:
 
Issuer: Radiology Partners, Inc.
 
Downgraded:
Corporate Family Rating to Caa1 from B3
Probability of Default Rating Caa1-PD from B3-PD
Senior secured 1st lien revolving credit facility expiring in 2024 to B3 (LGD3) from B2 (LGD3)
Senior secured 1st lien term loan due 2025 to B3 (LGD3) from B2 (LGD3)
Global unsecured notes due 2028 to Caa3 (LGD5) from Caa2 (LGD5).
 
[link=https://www.moodys.com/research/Moodys-announces-rating-actions-on-9-healthcare-staffing-radiology-and–PR_422294]https://www.moodys.com/research/Moodys-announces-rating-actions-on-9-healthcare-staffing-radiology-and–PR_422294[/link]

[ranweiss]

Good. Just life catching up to reality. 
 
Won’t matter for the RP or VC backing staff – they will continue to relax in their mansions while the rest of the current RP herd takes paycuts, furlough time, etc, etc. 
 
Should be a wake up call. 

[Unknown Member]

That’s funny about the ratings downgrade. Only 3 days after I posted Moody’s does the announcement prn and not on a scheduled basis. Honestly they did it sooner than I expected. I figured they would be busy reevaluating actual corporations that don’t consolidate to sell off to another investor given how many downgrades will be coming out soon.

[debra.paulk_16]

Agreed. Definitely didn’t expect them to act so soon when I started this thread a week ago. 
 
[u][b]Current overview of Corporate/PE radiology. [/b][/u]
Incase you are not familiar with these ratings:  [link=https://en.wikipedia.org/wiki/Moody%27s_Investors_Service]https://en.wikipedia.org/wiki/Moody%27s_Investors_Service[/link]  For transparency: These ratings are not perfect but most experts agree they have significantly improved in quality/reliability over the past decade. 
 
[u][b]Radiology Partners: just downgraded. [/b][/u]
Corporate Family Rating: Caa1
Probability of Default Rating: Caa1-PD
H[i]ighlights: company’s debt/EBITDA was “approximately 8.0 times at September 30, 2019”; not the “company will likely need to increase debt through revolver borrowings that will permanently increase its financial leverage”. “The company will have limited ability to repay debt unless it significantly changes its financial policies, including refraining from acquisitions.”[/i]
 
[u][b]MEDNAX[/b][/u]
Corporate Family Rating: B1
Probability of Default Rating: B1-PD
 
[i]Highlights: The “company’s leverage will remain well above its historical range of 2.5x — 3.5x for the foreseeable future.” “The company has announced compensation cuts for its management, which could extend to its professional physicians too. Nevertheless, Moody’s believes that the company is limited in its ability to significantly reduce physician compensation as it could result in workforce attrition and risk the company’s ability to benefit from the ramp-up of demand for elective procedures when the crisis wanes.” [/i]So Moody’s doesn’t think they are currently cutting physician’s compensation…I find that hard to believe, maybe they should be rated one lower?
 
[u][b]RadNet: (Ratings currently placed under review for downgrade)[/b][/u]
Corporate Family Rating: B2
Probability of Default Rating: B2-PD
[i]Highlights: pending review, probably going to get a negative outlook rating despite “adequate liquidity”. Also, “If debt/EBITDA is expected to remain above 6.0 times, there could be a downgrade.”[/i]
 
[u][b]Envision Healthcare:[/b][/u]
Corporate Family Rating: Caa2
Probability of Default Rating: Caa2-PD
[i]Highlight: Outlook was changed to negative on Apr. 6th. Situation continues to get worse. [/i]
 
[u][b]Aris Radiology:[/b][/u]
[i]Bankrupt right before pandemic.[/i]
 
[u][b]LucidHealth:[/b][/u]
No Moody’s analysis currently.
[i]Currently a little below the internet information radar. Just acquired some practices in Wisconsin, acquiring and integrating practices is expensive so not great timing.[/i]
 
 
[link=https://www.moodys.com/research/Moodys-downgrades-Envision-Healthcares-CFR-to-Caa2-outlook-changed-to–PR_422234]https://www.moodys.com/research/Moodys-downgrades-Envision-Healthcares-CFR-to-Caa2-outlook-changed-to–PR_422234[/link]
[link=https://www.moodys.com/research/Moodys-announces-rating-actions-on-9-healthcare-staffing-radiology-and–PR_422294]https://www.moodys.com/research/Moodys-announces-rating-actions-on-9-healthcare-staffing-radiology-and–PR_422294[/link]
 
Am I forgetting any groups?
 
Also for reference most university medical centers, Mayo, Partners, … have ratings around Aa2.  If you are going to be a new grad with student debt (i.e. personal financial risk) I would recommend taking a job at a stable organization before speculating with a corporation that might fail before you get yourself out of debt/trouble.  

[katiemckee84_223]

Great summary, jopo
 
Thanks.
 
What’s your prediction on what happens? Do some go under entirely?

[Robbro524_990]

Excellent post / recap Jopo. Thank you.

[afazio.uk_887]

I hear from a friend RP cutting rad salaries across the board, 25% or more, temporary partial furlough type situation.  Volumes in general down 50-60% across the board.  A big part of their business is in outpatient centers and those are all closed which means they are getting killed on that side.  If they get through this they may find themselves on the other side in a good recruiting situation for them in terms of a poor job market for rads.  Pretty big “if” tho considering the situation right now.
 
 
 

[Unknown Member]

Excellent post and summary jopo.

[Robbro524_990]

WD,

If you had been furloughed or ‘cut’ during this time (or your salary had been slashed 50%), would you want to work for RP after this deal? Plus, ‘radiologists talk,’ so even the new grads will be wary of joining them. Hopefully, it’ll create more opportunities for the existing (independent) groups, though. We will see.

[Unknown Member]

Talked to a friend this AM who is a managing partner in one of the world’s largest PE firms. They have no radiology business in the U.S. They do have a big stake in Australia. He said they briefly looked at the market in the U.S. to see if there was a chance to get in at lower valuations and they wouldn’t touch it with a ten foot poll. He said they are all going to be owned by the bond holders.

[Unknown Member]

Great post.
 
They may have overpaid for contracts. Any price paid for a contract has to be extracted from future radiologists or passed on to another buyer.
The corps cannot avoid subsidizing IR radiologists.
The corps have never been able to pay boots on the ground rads 20 per wRVU. Staffing some radiologists onsite is a provision in most contracts I have seen. Evening and potentially some day work can be transformed into more profitable tele but this is limited.
RP and Envision cannot use out of network billing anymore due to political backlash. Envision had to sign a compliance agreement with the OIG.
Corps may not have the power to extract any more money from the few remaining health insurance oligopolies.
Hospital employed and remaining private practice groups are able to absorb corp radiology defectors. These setups are more efficient and can pay radiologists more.
We have had a long bull market and imaging volumes have grown so that there a no surplus radiologists to monetize.
Corporate overhead is too high for rads to make a decent income. Radiologist morale is low and service declines as a result.

[debra.paulk_16]

Quote from drad123

Quote from jopo

I think Whitney got most of his money from DiVita. Anyways, I don’t think any of this matters. They are smart people and are therefore likely protecting their personal and family interest well. I’d rather focused on understanding the current state of radiology practices and the profession. 

What exactly do you mean by this?
Whitney and his 7 million dollar house are not relevant to the current state of radiology? -or the current state of America? -or the current state of most of the world?

 
Sorry I wasn’t clear. It is relevant, but not directly. Maybe a better way to say it :Whitney’s personal and RP financials are likely not directly related. He could be doing great and RP could also be doing great or failing. So, I’d rather focus on what we can know about RP rather than Whitney personally. Now, if you have information that Whitney hurt RP for personal gain… I’d be really interesting in that.

[debra.paulk_16]

Quote from DOCDAWG

WD,

If you had been furloughed or ‘cut’ during this time (or your salary had been slashed 50%), would you want to work for RP after this deal? Plus, ‘radiologists talk,’ so even the new grads will be wary of joining them. Hopefully, it’ll create more opportunities for the existing (independent) groups, though. We will see.

 
Your point is a good one! I’ll just add that although some practices are not going to have to cut base salary, everyone is going to go without a portion or all of the usual bonuses/incentive pay. The problem for these corporation is that pay was below market to begin with (per time unit and work units; this is essential to their business model), so them cutting pay even more is likely going to grind axes and salt wounds. 

Quote from Waduh Dong

I hear from a friend RP cutting rad salaries across the board, 25% or more, temporary partial furlough type situation.  Volumes in general down 50-60% across the board.  A big part of their business is in outpatient centers and those are all closed which means they are getting killed on that side.  If they get through this they may find themselves on the other side in a good recruiting situation for them in terms of a poor job market for rads.  Pretty big “if” tho considering the situation right now.

 
Heard Lucid is cutting salaries a lot deeper than that, but I also know many radiologist that are not taking a cut to base salary at all (academic / hospital employees). All things relative I guess. 
 
I think they may get through this, but doing so is going to cause many (specially the original partners of acquired groups) to bail ASAP. Recruiting is going to be tough (specially if some hypothetical awesome lady tries to unionize radiologists working for corporations) and the money to pay PE/Bonds is going to be like getting blood from a stone.  
 
 

[Patrick]

JOPO and DRRAD, recent posts very informative.  Thanks.
 
ADHD, I’d hate to be owned by bond owning hold outs… When the vultures get involved, it is ugly.  Just ask Argentina.  

[Unknown Member]

Quote from NYC

JOPO and DRRAD, recent posts very informative.  Thanks.

ADHD, I’d hate to be owned by bond owning hold outs… When the vultures get involved, it is ugly.  Just ask Argentina.  

I don’t know what bondholders would get in a default situation. Unprofitable hospital contracts could not be sold at a reduced rate.
Maybe this has something to do with the low rating.

[Unknown Member]

Envision and RP will push for perm rads in this downturn. Locums will eat up their capital.

[Unknown Member]

Quote from NYC

ADHD, I’d hate to be owned by bond owning hold outs… When the vultures get involved, it is ugly.  Just ask Argentina.  

 
There will be nothing to own. That’s the point. Everyone will just walk away at a loss. The loss will only get bigger if they try to spend the “cash” on hand.

[Patrick]

Fair point.  The more relevant fear is that someone steps in with new capital and buys the “assets” cheap.  The value of a hospital or OP contract is debatable, but I suspect based on the mountains of cash (real liquid assets, not mere commitments) sitting in some PE firms coffers, someone will step in for the right price…
 
Bond holders may be left nothing, sure, but there are vultures that may seize the opportunity to buy up assests and use the presence of non-competes as leverage in negotiations with healthsystems or even groups of physicians that may choose to buy back their independence…  
 

[Unknown Member]

Quote from NYC

Fair point.  The more relevant fear is that someone steps in with new capital and buys the “assets” cheap.  The value of a hospital or OP contract is debatable, but I suspect based on the mountains of cash (real liquid assets, not mere commitments) sitting in some PE firms coffers, someone will step in for the right price…

 
Sure this is possible. The only reason I posted was because I ran it by one of the potential buyers and they said GTFO. Sure there is cash in the coffers but most know enough to recognize when something is worth nothing at any price.

[Unknown Member]

Suits and docs square off… what happens to the patients caught in the middle?
 
Business people have no fiduciary duty, docs do- this will be exploited.

[Unknown Member]

[link=https://www.reuters.com/article/us-envisionhealthcare-debtrestructuring/exclusive-kkrs-envision-healthcare-hires-bank-to-explore-debt-restructuring-sources-idUSKCN21S114]https://www.reuters.com/a…-sources-idUSKCN21S114[/link]

So far, sounds like no luck for Envision.

[Patrick]

ADHD, your friend is smarter than average bear…
 
DRAD, is that the always the case?  

[msc5405]

@ADHD— excuse me for being dense. Just clarifying. If RP goes bankrupt, then the bond issuers essentially have nothing? 

[Unknown Member]

The latest bonds are unsecured so yes they get nothing. Prior ones probably are as well.

[link=https://markets.businessinsider.com/news/bonds/radiology-partners-inc-moody-s-assigns-caa2-rating-to-radiology-partner-s-proposed-senior-unsecured-notes-1028827182]https://markets.businessi…cured-notes-1028827182[/link]

[Unknown Member]

Quote from texas rads

@ADHD— excuse me for being dense. Just clarifying. If RP goes bankrupt, then the bond issuers essentially have nothing? 

 
If the “cash” on hand is spent then yes. They could try and continue to run the practices somehow but they are money losing right now. There are minimal to no hard assets in these groups. It’s all in the hospital contracts which require expensive labor to fulfill.

[Unknown Member]

I think Envision has a decent amount of cash on hand from the 2019 bonuses they are refusing to pay their physicians. I guess that will all go to the bond holders.

[katiemckee84_223]

ADHD, what’s your prediction on how this shakes out over the next year?

[debra.paulk_16]

Quote from ADHD

Quote from texas rads

@ADHD— excuse me for being dense. Just clarifying. If RP goes bankrupt, then the bond issuers essentially have nothing? 

If the “cash” on hand is spent then yes. They could try and continue to run the practices somehow but they are money losing right now. There are minimal to no hard assets in these groups. It’s all in the hospital contracts which require expensive labor to fulfill.

 
That is the definition of an unsecured bond, a bond that has no assets to back it up. The bond holders just have to trust RP is going to pay them back in good faith. That is why the Moody’s ratings are important to investors, and Moody’s thinks RP is about as risky as you can get (i.e. don’t expect any money back and definitely don’t expect a return on your money). 
 
Anyone know or want to guess where the “physician-owners” would be in line for a payout? Typically bonds, even unsecured bonds, have a higher priority than shares. I doubt any of the physicians that “invested” or received shares as part of their buyout will see any money going forward. 
 

Quote from [link=https://www.radpartners.com/faq

https://www.radpartners.com/faq%5B/link%5D%5D [size=”3″][b]Is there equity opportunity for partners?[/b][/size]  
Yes. In fact, not only are most RP radiologists shareholders, but physicians own a large share of the practice. We feel its critically important that our physician partners have a voice in who we are and who we will become. And if the practice does well, they should share in that success through equity ownership.
 

 

[jtpollock]

With the Fed backstopping junk bonds, the money will continue to flow to these guys, they know how to get the big money, not the bullsh*t 10G’s that doesn’t float a week in the real world. They will use this crisis as an opportunity to drive down cost (rad salaries) and expand into new markets (small firms that go under). 

[debra.paulk_16]

Quote from docholliday126

With the Fed backstopping junk bonds, the money will continue to flow to these guys, they know how to get the big money, not the bullsh*t 10G’s that doesn’t float a week in the real world. They will use this crisis as an opportunity to drive down cost (rad salaries) and expand into new markets (small firms that go under). 

 
I was not aware they are buying junk bonds. 
 
This is the last I heard: [link=https://www.federalreserve.gov/newsevents/pressreleases/files/monetary20200409a5.pdf]https://www.federalreserve.gov/newsevents/pressreleases/files/monetary20200409a5.pdf[/link] 

[Unknown Member]

Yes they haven’t bought any yet and will not buy any rated like Envision or RP. Also no need for them to even get into the HYG type ETFs as prices aren’t below NAV which is when they would buy after exhausting funds in investment grade first.

[jtpollock]

Not sure how it works, and I am assuming the Rad corps are eligible via the program or their proxy PE backers….

[link=https://www.barrons.com/articles/the-fed-for-the-first-time-can-buy-junk-bonds-that-should-help-fallen-angels-51586449148]https://www.barrons.com/a…len-angels-51586449148[/link]

[Dr_Cocciolillo]

One of the main issues Rad practices consider selling out is the scumbag CEOs that now run major hospital chains.  To a lesser extent, it’s because “the deals” are too good to be had — but that also has a “in this environment” component.  This environment basically means Hospitals holding all the keys to the contract and giving away RFPs not because of issues with service, but because of various kickbacks. 
 
In other words, if you feel that your contract is insecure and there is nothing you can do about it because your C suite is a revolving door of crooks and liars, with connections to PE backed groups, why not consider selling if the break even is 7 years or 9 years?   

That to me is a big issue. It used to be that contracts were lost because of poor service.  No longer the case in some places.  The C Suite is made up of pathological liars and profiteering crooks.   
 
 

[debra.paulk_16]

Quote from docholliday126

Not sure how it works, and I am assuming the Rad corps are eligible via the program or their proxy PE backers….

[link=https://www.barrons.com/articles/the-fed-for-the-first-time-can-buy-junk-bonds-that-should-help-fallen-angels-51586449148]https://www.barrons.com/a…len-angels-51586449148[/link]

The article seems to indicated that they could buy junk bonds only if they were recently downgraded from investment grade to junk. The problem for these corporations is that they were not investment grade prior to this. There were junk bonds that got downgraded to a lower form of junk. 
 
I’m not saying they won’t get any money; but they are not going to be a priority and competitors are in a better position to qualify for cash currently. 

[Unknown Member]

Quote from NYC

ADHD, your friend is smarter than average bear…

and fabulously successful as a result. The next question is how much?
 
Will the others continue to throw good money after bad or will they cut their losses. I asked if he knew who the other groups were and he said he had no idea. Lost interest when they decided it was a bad business. 
 
I did find it a bit surprising that the business is successful in Australia. He said the radiologists make less money and like to surf… 

[Unknown Member]

Quote from ADHD

Quote from NYC

ADHD, your friend is smarter than average bear…

and fabulously successful as a result. The next question is how much?

Will the others continue to throw good money after bad or will they cut their losses. I asked if he knew who the other groups were and he said he had no idea. Lost interest when they decided it was a bad business. 

I did find it a bit surprising that the business is successful in Australia. He said the radiologists make less money and like to surf… 

 Radiology Partners, (RP), the largest physician-led and physician-owned radiology practice in the U.S., today (3-2018) announced it has closed a $234 million growth equity funding round. Radiology Partners plans to use the funds to support continued growth by scaling operations, investing in its evidence-based clinical programs and expanding in both existing and new markets.
 
The Future Fund is Australias sovereign wealth fund and invests for the benefit of future generations of Australians. The Future Fund was established in 2006 to strengthen the Australian Governments long-term financial position and currently manages approximately A$140 billion. The organization also manages four additional public asset funds, including the Disability Care Australia Fund, the Medical Research Future Fund and two Nation-building Funds.  The Fund operates independently from Government and tailors the management of each fund to its unique investment mandate.
 
So radiologist hunting is better in Australia- why is Australia investing in RP then?

[Unknown Member]

Not enough opportunity in my friend’s fund I guess. Remember when something like this starts and it shows some early good returns it triggers more people wanting to get in. All of a sudden there is a lot of money that needs to be put to work.
 
I reported here a year or so ago that a friend who is in the venture debt business mentioned to me  that the pressure to put money to work in investment funds is so strong people make bad choices all of the time.

[Unknown Member]

Are you a radiologist and available to locum in 2020? Prescript now has dates available in various Queensland locations for up to $4000 per day.
 
[link=https://jobs.ranzcr.com/jobs/view/new-locum-radiologist-dates-across-qld-august-december-2020/53774462/]https://jobs.ranzcr.com/jobs/view/new-locum-radiologist-dates-across-qld-august-december-2020/53774462/[/link]
 
I think Australian rads are much more like US rads than you think.

[Unknown Member]

Its not what I think. I have no idea. Just reporting what a friend said that has invested PE money in Australian radiology practices and says it has been successful for them.