Dr. Dominic Bagnoli has sometimes been dubbed a visionary for growing a three-physician emergency medical practice into a Canton-area powerhouse that now manages ERs at 170 sites across the country.
Yet when Bagnoli’s company went to work in his own backyard Jan. 1 — abruptly taking over Summa Health System ERs after last-minute contract negotiations fell through with Summa’s longtime provider — Bagnoli said he was unfairly depicted as a villain.
“We stepped up to see patients at financial risk and we’re the bad guys?” Bagnoli asked during an interview last week. “We’re the good guys.”
Bagnoli and his company, US Acute Care Solutions (USACS), have been at the center of a firestorm that started about eight weeks ago when Summa administrators reached out to them and two similar companies seeking replacement physicians for its five ERs.
Yet the story of Bagnoli and USACS has largely been overshadowed by an ugly back-and-forth between Summa and Summa Emergency Associates (SEA), the physician-owned group that couldn’t come to terms on a contract after staffing the emergency department at Summa’s Akron City Hospital for more than 30 years.
Among other things, SEA physicians suggested negotiations failed because Summa administrators intended to steer the ER contract to Bagnoli and USACS because Bagnoli is married to Dr. Vivian von Gruenigen, Summa’s chief medical officer who was involved early on in contract negotiations with SEA.
Bagnoli last week said the claim is ridiculous. USACS, now the fourth-largest emergency medicine staffing company in the U.S., neither sought nor needed the business, he said.
SEA only lost the contract because of its own poor negotiation skills, Bagnoli said. And USACS only ended up with it, he said, because both the other companies Summa contacted conceded they were unable to pull off such an extraordinary staffing transition, happening over hours instead of a more customary 30 to 90 days.
How successfully USACS has been managing Summa’s ERs is debatable.
Summa’s President and CEO Dr. Tom Malone last month submitted his resignation after more than 250 physicians — including those who lost the Summa ER contract to USACS — voted no confidence in his leadership over his handling of the ER contract.
An accreditation board this month stripped Summa of its ability to train up-and-coming emergency medicine physicians, in part because it determined USACS hadn’t provided proper faculty to run the program three weeks after taking it over.
The national accrediting group also found that some patients at Summa’s emergency room were seen and sent home by medical residents without the supervision of a physician. Summa is challenging the findings, and USACS disputes much of what is in the report.
Whatever difficulties USACS had during the first few days of staffing Summa’s five ERs have been worked out, Bagnoli said.
Bagnoli said he wants to push forward, but it’s difficult because a false David vs. Goliath health care narrative has developed, pitting supporters of SEA, which has about 60 local physicians, against USACS, which has more than 1,000 physicians nationwide.
“We’ve been painted as we’re bad, just because we’re big,” Bagnoli said.
But size and scale in modern health care can often yield better care, Bagnoli said, because physicians with subspecialties can develop protocol for all physicians involved in a group like USACS to use, yielding better patient care.
Growing ER giant
Bagnoli’s physician staffing business wasn’t always giant.
It started in the early 1990s just a few years after SEA launched at Akron City Hospital.
Bagnoli was looking for a local job as he was wrapping up his third year of training in emergency medicine at Akron General Medical Center.
He grew up Hartville and wanted to remain in the area, especially since his wife, von Gruenigen, was still two years away from completing her OB-GYN residency at Summa, he said.
Neither Akron General nor Summa were hiring.
But Bagnoli, a fellow resident and an ER physician they knew heard that Massillon Community Hospital (now Affinity Medical Center) was having a hard time recruiting ER doctors, Bagnoli said.
“There are never enough residency-trained, board-certified, high-quality emergency physicians to go around,” Bagnoli said. “The farther you move from larger metro areas, the harder it is to find high-quality docs.”
In 1992, Bagnoli, the resident and a physician formed Emergency Medical Physicians (EMP), a physician-owned group, and took over Massillon’s emergency department. In 1995, EMP expanded and began staffing ERs in Cambridge and Parkersburg, W.Va. A few years later, EMP picked up a Columbus hospital and Barberton.
“Marcus Welby, the one doctor responsible for everything, was the unicorn that doesn’t exist,” Bagnoli said.
Joining forces
Government regulation, complicated billing, evolving technology and other office needs were expensive, forcing physicians to form groups like EMP.
“We recruited a lot from Akron General and Akron City, chief residents, the best and brightest, some of whom are still with us,” Bagnoli said.
The key was having physician ownership and providing quality care, he said.
“Have you ever washed a rental car? No,” Bagnoli said, because you have no investment.
But when you own a business, you care. And when physicians have a stake in a partnership, Bagnoli said, it changes how they do business.
By 2015, EMP had grown to staff 90 ER sites across the U.S., employing about 400 people in its Canton-area headquarters to back up the ERs with human resources, patient billing, IT and other office functions.
Business was good, and Bagnoli said he hadn’t planned to change until he saw similar-sized businesses being gobbled up by larger companies in 2015, and realized EMP had to grow to survive.
After weighing options, EMP in 2015 made a deal with New York investment firm Welsh, Carson, Anderson & Stowe to create a new company called US Acute Care Solutions. Bagnoli serves as CEO.
It’s unclear how much private equity the New York group put into the deal.
But with an the influx of cash, USACS began wooing smaller emergency medicine providers — including SEA, which declined several invitations in 2016 — to join them.
USACS also hired about 100 more people at the former EMP offices in Canton, bringing employment there to about 500.
The New York investment group now owns about 30 percent of USACS, Bagnoli said. But USACS insists the group has zero influence over physicians providing medical care.
Physicians still own about 65 percent of the company, Bagnoli said.
In the 20 months since USACS was formed, it’s doubled the size of EMP. The company now sees 5.8 million patients annually, managing 170 emergency medicine sites, including Summa’s at Akron City, Green, Wadsworth, Medina and Barberton.
Amanda Garrett can be reached at 330-996-3725 or agarrett@thebeaconjournal.com.