Founded in 2015, American Physician Partners (APP) is one of the newest Emergency Medicine management companies. Since its start, the company has grown to more than 150 hospital contracts in 18 states, solidly landing it in the number one spot on the Nashville Business Journal’s fastest-growing private companies list and Inc. 5000’s fastest-growing private companies list.
Here John Rutledge, Founder & CEO, and Dr. Tony Briningstool, Co-founder and Chief Medical Officer share what makes APP different from others in the market and the factors they attribute to the company’s phenomenal success.
Founder & Chief Executive Officer
Tony Briningstool, MD, FACEP
Co-founder & Chief Medical Officer
Why start a new EM company? There were already a large number of groups in this space when APP was founded.
John: Unlike others in our space, I’m a former hospital and system executive, so I had actual experience using these other companies. None of them ever stood out as anything more than a “staffing company,” filling slots but no more—and some couldn’t even do that well. I felt there was a definite need for a new model, so we brought together two patient-focused, physician-centric groups in 2015 and set out to be a true management partner, not a staffing company. Clearly other hospital executives felt there was a need as well, as we’ve enjoyed double-digit growth every year since then.
What does it mean to be a management company and not a staffing company?
John: We often hear from hospital leaders that their EM group was present in the beginning after winning the contract and was rarely seen after that. For APP, being a management company means taking full ownership of and accountability for the performance of the emergency departments we have the privilege to serve. That goes way beyond staffing. It’s forging a partnership with the nursing team and medical staff. It’s leading in quality, meeting monthly to review our KPI Scorecard and sharing plans for improvements. It’s becoming embedded in that hospital, in that community, and partnering with the hospital to build the “ED of choice” in their market to enhance market share and growth.
How is APP structured to ensure you fulfill your role as a management company?
John: While many groups talk about their “dyad” or “triad” teams, ours is a bit different in that we pair seasoned Regional Medical Directors who have experience leading physician teams and Regional Vice Presidents who are former hospital executives. This provides the ideal blend of clinical and business expertise to ensure success for the department. We’ve found our hospital clients appreciate working with someone who has been in their shoes, someone who understands how tough it is to run a hospital, and how to turn the emergency department from a headache into a center of excellence, as the “front door” of the hospital should be. This has led us to enjoy the highest client retention rate in the business.
How has APP been successful recruiting when others haven’t?
John: We hire seasoned recruiters, and we keep the span of hospitals they recruit for intentionally small, unlike others in our space that have recruiters working for 10, 15, even 20 hospitals at a time. We seek cultural fit beyond just meeting the clinical qualifications. We like to hire physicians and advance practice clinicians (APCs) who recognize and value our patient-centered, provider-centric culture. By all accounts, it’s working. Our metrics indicate that consistently we score a 9.8 out of 10.0 for likelihood to recommend APP to a colleague, and at less than 0.5%, we enjoy what we believe to be the lowest locum tenens usage rate in the industry. Building a core team of permanent and engaged providers is essential and worth the investment. If you don’t have that, you can’t even begin thinking about quality and patient care initiatives, yet so many hospitals are struggling with this basic issue.
Who leads the practice at the local level?
Tony: Every one of our practices has a Site Medical Director who serves as the leader of the provider team and is APP’s liaison to the hospital. Because of the critical nature of this role, we make a significant investment in hiring, onboarding, developing, and training these physician leaders. On a daily basis, they have real-time access to the metrics for their departments, enabling them to truly own the performance of their EDs. They receive extensive support and mentoring from their regional dyad leadership team and have access to the comprehensive resources provided by our Support Center, including recruiting, credentialing, scheduling, provider enrollment, human resources, IT, etc. The “business” side of the practice is taken care of for them so they can devote their time to developing strong working relationships with the medical staff, the ED Nurse Manager, and leading their teams.
What kind of quality initiatives can a hospital expect from APP?
Tony: We have a very robust IT platform that enables us to track multiple metrics across all of our practices. We develop a KPI Scorecard for each practice that incorporates all standard key ED metrics (door-to-MCE, LWBS %, etc.) as well as specific metrics that are important to that hospital. We conduct a Monthly Operational Review internally on every contract, with detailed action plans for metrics that fall short of goal. Our Site Medical Directors and regional leadership teams also meet monthly with the key leaders at each hospital to review performance on the KPI metrics, celebrate wins with the team, and proactively address areas that may need improvement.
We’re also on the leading edge of participating in a number of value-based care initiatives. Each year we identify the Merit-based Incentive Payment System metrics we will follow for that year and develop key educational materials on these initiatives to ensure evidence-based best practices are hardwired throughout all of our practices. We are a very metric-focused, outcomes-driven company, and it shows. On average, our metrics outperform national benchmarks in almost every key area. And every single hospital we’ve served has realized metric improvement under APP’s model.
How is APP a good financial partner to hospitals?
John: Unlike some others in this space, we don’t low-bid contracts then increase subsidies down the road. Our leaner model affords us the opportunity to be a lower-cost provider at the start of each new relationship, often reducing or even eliminating subsidies for our hospital partners. This can be achieved through right-sizing provider compensation for the market, optimizing staffing models, and eliminating the cost of locums. We also contribute to revenue growth by significantly reducing the patients who leave the ED without being seen and positively positioning your hospital with the local EMS service and community. This helps position our client hospitals as the “ED of choice” in the market to drive market share and growth.
As a former hospital executive, you understand how difficult and politically charged the decision can be to change ED partners. What do you have to say to other CEOs in this position?
John: I think it’s often made more complicated than it needs to be. If you’re not happy with your current group, if they’re not delivering the performance you and your patients deserve, then you owe it to all parties to make a change. APP has an excellent track record of retaining close to 100% of existing providers that our hospital partners desire to retain in a transition, and we’re typically fully staffed with a core team within 90 days. Our internal Transition Team meets weekly to discuss all new onboarding contracts, ensuring every last detail is handled, so the actual transition date is usually a non-event. Looking back on the experience, most of our clients tell us they wish they’d made the switch sooner. The ED is the front door to the hospital—why not make it one of the best-performing departments in your facility?
What do you see in the future for American Physician Partners?
John: I’m very optimistic about our future. As we all start to transition from the day-to-day management of the pandemic and look to the future, we’re seeing more hospitals who are no longer satisfied with the status quo for their EDs. Hospitals—and systems—are looking for a proactive partner to take the lead in managing their emergency departments. We’re proud to be that partner. Our front-line providers led with courage and passion throughout the pandemic, and we owe much of our past and future success to these stellar physicians and APCs who have committed to our mission to provide safe, compassionate, and efficient care to every patient, every time.
“As long as we continue to use our mission as our north star and foster our patient-centered, physician-centric culture, we will continue to exceed the expectations of our patients, our providers and employees, and our hospital partners well into the future.”