BA: It’s true that emergency medicine is not going to go away, and it’s critical and adds tons of value to the system, but if I can get 4 percent on a $730 million book of business, I’ll take the $29 million. I’m going to get the ED visits out that I can because not all of them do add value. I don’t think it’s a myth that the ED is a high-cost place. If it’s an ankle sprain, do you want to write a $1,200 check, or do you want to write a $200 check?

JK: Brent, as a hospital administrator, are you and the American Hospital Association willing to sit with me as President of the College and have a discussion about why hospitals are shifting huge overhead to the emergency departments? Since over 75 percent of emergency hospital bills are related to hospital charges, could we have a conversation about making the visit cheaper for the patient?

BA: It’s going to happen. It’s hospital-based pricing, and I say to my colleagues all of the time, it’s going to get cut. The hospital can’t escape it, so if they can’t reduce their costs, they’re not going to be successful. I wanted to throw that in there because it was feeling more like a waiting room bubbler tank than a shark tank.

RM: It is a shark tank, so shark away. Prices are dropping now that it’s becoming more visible to people. The average deductible is $1,500 for hospital admission. The average person has less than $1,000 in savings, so do the math. That’s called bad debt, and it’s a lot.

Audience: For a lot of us, getting merged or acquired is a contract of adhesion. We don’t have a lot to say about it. What are the warning signs? When do you stay, and when do you start pulling up stakes and looking for someplace else?

RI: Four years ago, Emergency Medical Associates (EMA) looked at, “Should we do something?” We decided, no, we shouldn’t. We ended up having these big meetings with 200 partners. This time when we did it, the board came to me and said, “We’re just going to do this as a board because it was very disruptive doing it the other way.” The board did a lot of deliberation, and the partners of EMA voted yes or no. Was it a secret that we were having these discussions? No. What were the warning signs? There were lots of meetings that don’t normally take place and parking lots filled with cars that you don’t recognize. If you’re an owner, hopefully you have a voice. If you’re in a group where you’re not an owner but they have a culture of including physicians and they invite your opinions, then you should give them and ask for information. The other thing you should do is check your employment agreement. There may be protections or considerations included.