JK: You should look around and start seeing if there is an option for you that will allow you to get something from your years of service. There are some groups where they will give you a certain amount of partnership for years that you’ve been practicing with them. There are some options where you may be able to retain local control and still be part of a larger group.

If you’ve got a lot of partners that are toward the end of their career and they have an idea that their lifelong investment now needs to be monetized, I think that’s a very clear warning sign. —Savoy Brummer, MD, FACEP

SB: I think one problem with many groups is that they originated and began without the end in sight. Many times, independent practices will see there’s an issue but will be too paralyzed because of their structure to actually do something about it. If you’ve got a lot of partners that are toward the end of their career and they have an idea that their lifelong investment now needs to be monetized, I think that’s a very clear warning sign. When groups are using creative financing to deal with some of their financial obligations, clearly that’s a problem. If there are any preferred partner arrangements or joint-venture agreements, I would immediately consider that a threat as well.

Audience: When does an acquisition become predatory? I have a very close friend. His CEO tapped him on the shoulder and said, “You know, we want you to joint venture with this particular organization. It’s going to be such a great deal for you. You’re going to give them all your revenue; they’re going to split the profit with us, the hospital, and we’re going to pay you less because you’re paid too much. We want to keep you because we love you, but you know that Tesla that’s in the parking lot is too much.”

BA: You just answered your own question. I think that’s a description of when it’s predatory, and ACEP should take a stand on that. I don’t know whether or not you’ll be able to stop it, but I think that’s a pretty clear example of when it gets predatory.

JK: If hospitals are coming and saying to physician groups, “You have to joint venture with us, and in return, we’re going to take some of your professional fee and feed it back to the hospital,” then that’s fraud, and ACEP should take a strong stance with regard to that.