Ascension Wisconsin’s ICU Doctor Outsourcing Plan Concerns Nurses

Ascension Columbia St. Mary’s Hospital in Milwaukee. Coburn Dukehart/Wisconsin Watch

A nonprofit chain of Wisconsin hospitals will replace some of its doctors with services from a national physician staffing agency, WPR has confirmed.

As first reported by the Milwaukee Journal Sentinel, Ascension Wisconsin is developing plans to staff some of its intensive care units with doctors from TeamHealth, a private equity-backed company based in Knoxville, Tennessee.

Those doctors will provide care both in person and via telehealth, and the full coverage plan is still being developed, a spokesperson for Ascension Wisconsin told WPR.

“Ascension Wisconsin is adapting critical care services across our health system to better align staffing and resources to match the acuity level of the patients our hospitals treat,” said the spokesperson in a written statement. “This includes transitioning from multiple critical care contractors and models to a single physician group of intensivists employed by TeamHealth.”

But nurses at one Ascension hospital expressed concerns about how the changes will affect the care that they can provide.

“At what cost are we continuing to put our patients — my mom, your mom, anybody’s mom or dad, brother, sister, family member — at risk?” said Connie Smith, president of the Wisconsin Federation of Nurses and Health Care Professionals, a union that represents much of the health care staff at Ascension St. Francis Hospital, on the south side of Milwaukee.

And a St. Francis nurse, April Menke, said she worried that incorporating more telehealth would slow down response times.

“Time is muscle. Time is your brain,” she said. “The faster you can get a patient to the services that they need, the faster you are able to restore the blood flow to that area, the better outcomes you would have.”

According to the Ascension spokesperson, the hospital network is changing its staffing model to “enhance care coordination.”

The move is part of an increasing trend of outsourcing clinical staff to private equity-backed firms.

While that model has been common for other health care staff for years, the turn to alternate models for staffing doctors reflects a post-pandemic crisis in health care, said Zoey Kernodle, who directs the Center for the Business of Health at the University of North Carolina-Chapel Hill.

There’s been a falloff in health care providers, she said, who became burnt out during the COVID-19 emergency, coupled with hospitals searching for ways to cut costs.

“The trend is certainly moving in a direction where hospitals are looking for cost savings and outsourcing clinical staff is certainly the easiest way to lighten expenses,” Kernodle said.

Those costs can accrue elsewhere when private equity is involved, she added, including higher costs billed to patients or insurers, and mixed health care results.

And with recent cuts to Medicaid — a program many hospitals that serve low-income patients rely on — “this reliance on private equity and outsourcing is only going to increase,” she said.

“It’s neither all bad, (and) it’s certainly not all good,” she said. “It’s always more complex than it seems in health care because there are usually not great other options in these circumstances.”

Nurses alarmed about downstream effects of physician changes

Smith, a medical technician who has worked at St. Francis for 24 years, said she has open questions about how changes to physician staffing will affect her own ability to provide care.

That includes how many patients nurses will be responsible for, or how to transfer complex cases out of the ICU or refer patients for surgery or other procedures if doctor levels have lessened. She said that could increase wait times for patients.

And Smith said she’s worried that the use of remote doctors will set nurses up to take the fall if something goes wrong within an intensive care setting.

“Our nurses are licensed professionals, but yet they’re not licensed to be scapegoats for a cheaper version of physician care,” she said.

“By no means am I saying that these physicians are not professionals or that their care is not good,” she added. “But … they should be at the bedside just as much as a nurse should be at the bedside.”

According to the Ascension spokesperson, all acute care hospitals will “have providers on site 24/7 and 24/7 access to intensivists,” also known as critical care doctors.

That spokesperson did not respond to follow-up questions about how many doctors will be physically present in its ICUs and whether there will be time periods when critical care doctors are not available on-site.

Menke, who works in the emergency room and is also a union official, said that her team is in constant communication with intensivists to determine how to transfer emergency patients. She said replacing those doctors with remote physicians, who might come from different departments or specialties, could also result in long delays.

“If we don’t have an intensivist who’s here giving orders, running different scenarios that could possibly be happening … it just blows my mind,” she said. “I see on different areas of telehealth where the delays are, I don’t have faith that the delays are not going to be here, as well.”

Private equity tied to increased patient costs, ‘mixed’ health results

TeamHealth, the staffing agency that Ascension Wisconsin will be partnering with, did not respond to WPR’s request for comment. In a 2017 press release, that company heralded its acquisition by funds tied to Blackstone, an asset management and private equity firm.

In that release, the company said its goal is to empower clinicians and that it provides staff and support to thousands of health care facilities.

Health care research shows that incorporating private equity into health care might save costs for the overall system, but passes those costs to patients or insurers, Kernodle said.

“From a quality perspective, there’s mixed outcomes, or some of the research would skew toward worsening outcomes. But I would say, on average, the outcomes are mixed,” she said. “From a quality perspective, they’re certainly not better.”

At the same time, she said, hospitals are attempting to solve a very real problem of staffing shortages, which can be compounded in rural or otherwise underserved areas. Those challenges might be particularly present in acute care settings, where patient populations ebb and flow and can be more unpredictable.

“And so having sort of a sustaining staff model aligned to that is a challenge, especially when the pandemic really threw a wrench in staffing challenges that were already heading in a direction that were challenging, where we have an aging population and not enough people to care for them,” she said.

Those outcomes and shifted costs have gotten the attention of Democratic and Republican lawmakers in other states.

In 2024, Sen. Chuck Grassley, R-Iowa, in his capacity on the Senate Budget Committee, wrote a letter to Ascension’s Illinois leadership about outsourcing care in that state to a different private equity-backed staffing agency.

In his letter, Grassley wrote that implementing staffing models designed by a for-profit company “could affect the patients’ quality of care” and “increase health care workers’ loads to unsustainable levels.”

That same year, Sen. Gary Peters, D-Mich., in his capacity on the Senate Committee on Homeland Security and Governmental Affairs, wrote a letter to Blackstone and TeamHealth leadership about the staffing of an emergency department at one Ascension hospital in Detroit where doctors eventually went on strike to protest changes under TeamHealth.

“I am concerned by the risks these physicians have raised and their potential impact on patients and families as well as the homeland security implications, such as the ability of emergency departments to respond to a mass casualty event, terrorist attack, pandemic, or other emergency that would require treating high volumes of patients,” Peters wrote.

Peters argued that concerns over matters like patient safety, staff levels and physician independence are not unique to private equity-backed medical practices. But he said those concerns could be exacerbated when private and profit-driven entities are involved.

Kernodle, the business of health care expert, said hospital reliance on for-profit funding could increase following federal cuts to Medicaid.

“Health care does have a cash flow problem that there’s only so many places that can infuse cash,” she said.

And that can create what she describes as “a perpetual negative feedback loop” — where increasing costs and decreasing staff drive more hospitals to turn to what can be a less-than-perfect private solution.

Listen to the WPR report

Ascension Wisconsin plans to outsource ICU doctors, a move that concerns nurses was originally published by Wisconsin Public Radio.