EmCare

EmCare was a United States healthcare-services brand and physician-practice-management company founded in 1972. It supplied and managed physician services for hospitals rather than operating primarily as a consumer-facing medical brand. Its service portfolio included emergency-department staffing and management, inpatient physician services, acute-care surgery, trauma and general surgery, women's and children's services, radiology and teleradiology, and anesthesiology. The company expanded through contracts with hospitals and health systems. By the period described in reference material, EmCare had more than 1,000 hospital contracts across 42 U.S. states. Its business model involved arranging physician coverage, administrative support, billing, and related operational services for hospital-based specialties. This model placed EmCare between hospitals, physicians, insurers, and patients, particularly in emergency medicine, where patients often have little practical ability to select an individual clinician before treatment. EmCare's corporate history was closely tied to changes in ownership of the broader emergency-medical-services and physician-services sector. Laidlaw acquired EmCare in 1997. In 2004, Laidlaw sold EmCare and American Medical Response to Onex. Onex placed the acquisitions under Emergency Medical Services Corporation, which became a public company in December 2004. Clayton, Dubilier & Rice acquired EMSC in 2011. In 2013, EMSC changed its name to Envision Healthcare and began trading publicly under the ticker EVHC. EmCare subsequently operated within the Envision physician-services structure, alongside other healthcare-service businesses. The brand attracted substantial criticism over out-of-network billing. Investigations and academic research cited in the reference material found that out-of-network billing increased sharply at some hospitals after EmCare began providing services, while other hospitals already had very high out-of-network rates. In a larger sample of hospitals where EmCare handled billing, the reported average out-of-network billing rate was 62 percent, above the national average. The controversy reflected a broader dispute over surprise medical bills, hospital staffing companies, insurer negotiations, and the financial incentives attached to emergency-department physician contracting. EmCare is no longer in business as an independent operating brand. The reference material states that EmCare Holdings Inc. was purchased by Envision Physician Services. Because the available material does not identify a separate continuing EmCare website, current headquarters, founder, or a distinct post-acquisition operating structure, those fields remain unspecified.

EmCare began in 1972 as a U.S. provider of physician-practice-management services. Its role was to help hospitals organize and administer physician coverage in emergency departments and other hospital-based specialties. Rather than functioning as a conventional retail healthcare brand, it operated through contracts with hospitals and health systems. Its areas of activity included emergency medicine, inpatient physician services, acute-care surgery, trauma and general surgery, women's and children's services, radiology and teleradiology, and anesthesiology. The company's growth reflected the increasing use of external physician-management organizations by hospitals. Under this model, a hospital could contract with a specialized provider to recruit or schedule physicians, manage clinical operations, administer billing, and support coverage across demanding services. Emergency departments were particularly important because they require continuous staffing and must treat patients regardless of their ability to select a doctor in advance. Ownership of EmCare changed several times. Laidlaw acquired the company in 1997. In 2004, Laidlaw sold EmCare together with American Medical Response to Onex. Onex established Emergency Medical Services Corporation as the parent organization for the two businesses, and EMSC became publicly traded in December of that year. Clayton, Dubilier & Rice acquired EMSC in 2011. On June 11, 2013, EMSC adopted the name Envision Healthcare and became publicly traded under the symbol EVHC. EmCare became part of the resulting Envision physician-services organization; the wider group also included American Medical Response and Evolution Health at the time described by the reference material. EmCare's business practices became controversial because of out-of-network billing. Critics argued that hospital patients could receive care from EmCare-affiliated physicians without knowing that the physicians were outside their insurance network. Such bills could expose patients to much higher charges, and emergency patients usually could not make an informed provider choice before treatment. Research cited in the reference material examined hospitals using EmCare and found that out-of-network billing rose rapidly at some facilities. At other facilities, the rate was already close to 100 percent and did not fall. A broader sample of 194 hospitals in which EmCare handled billing reportedly showed an average out-of-network billing rate of 62 percent, substantially above the national average. Comparisons with hospitals where competitor TeamHealth took over billing showed a smaller increase in out-of-network billing in that comparison group. These disputes placed EmCare within the wider national debate over surprise medical bills, insurer-provider negotiations, hospital contracting, and the financial structure of outsourced emergency-medicine services. The available reference material does not establish a separate current corporate operation for EmCare. It states that EmCare Holdings Inc. was purchased by Envision Physician Services and that EmCare is no longer in business, so the brand is classified as defunct rather than active.

1. 2013Reorganization under Envision Healthcare

   Emergency Medical Services Corporation changes its name to Envision Healthcare and lists publicly under EVHC, with EmCare operating within the physician-services group.

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2. 2011Clayton, Dubilier & Rice acquisition

   Clayton, Dubilier & Rice acquires Emergency Medical Services Corporation.

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3. 2004Onex acquisition and EMSC formation

   Onex buys EmCare and American Medical Response from Laidlaw and forms Emergency Medical Services Corporation as their parent.

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4. 2004Parent company goes public

   Emergency Medical Services Corporation becomes publicly traded in December.

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5. 1997Laidlaw acquisition

   Laidlaw acquires EmCare.

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6. 1972EmCare is founded

   EmCare begins operations as a U.S. provider of physician-practice-management services for hospitals and acute-care specialties.

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A hospital-facing physician-practice-management provider focused on staffing, operating, and administratively supporting emergency and other hospital-based clinical services.

• Emergency-department physician servicesEmergency medicine

  EmCare's core offering was the provision and management of physician coverage for hospital emergency departments. The service included the operational organization of emergency-medicine practices and related administrative and billing functions under contracts with client hospitals.

• Inpatient physician servicesHospital medicine

  The company supplied physician-practice-management services for inpatient hospital care. The available reference material identifies this as a major service area but does not provide a separate product name or detailed clinical scope.

• Acute-care, trauma and general surgerySurgery

  EmCare supported hospital-based acute-care surgery, trauma services, and general surgery through physician staffing and practice-management arrangements.

• Radiology and teleradiology programsDiagnostic services

  Radiology and teleradiology were among EmCare's hospital-service lines. These programs used physician practice management and remote-reading capabilities to support diagnostic imaging services, although the available source does not specify technology platforms or program names.

• Anesthesiology servicesPerioperative services

  EmCare also managed anesthesiology services for hospitals. The source identifies the specialty as part of the portfolio but does not provide further details about its staffing model or geographic organization.

• Women's and children's servicesSpecialty physician services

  Women's and children's healthcare services formed another part of EmCare's physician-services portfolio. The available material does not identify individual programs, facilities, or branded offerings within this category.

• 2013Parent renamed Envision HealthcareStrategy

  Following the 2011 acquisition of Emergency Medical Services Corporation by Clayton, Dubilier & Rice, the parent organization reorganized its corporate identity.

  What changed. Emergency Medical Services Corporation changed its name to Envision Healthcare and listed under EVHC.

  Aftermath. EmCare continued within the Envision physician-services structure rather than as a separately listed company.

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• 2004Onex places EmCare under Emergency Medical Services CorporationM&A

  Onex acquired EmCare and American Medical Response from Laidlaw and needed a parent structure for the combined healthcare-services holdings.

  What changed. Onex formed Emergency Medical Services Corporation as the parent company for the acquisitions.

  Aftermath. EMSC became publicly traded in December 2004 and later changed its name to Envision Healthcare.

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• EmCare Holdings is purchased by Envision Physician ServicesM&A

  EmCare's operations were incorporated into the Envision physician-services organization.

  What changed. Envision Physician Services purchased EmCare Holdings Inc.

  Aftermath. The reference material states that EmCare ceased operating as an independent business.

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• Out-of-network and surprise-billing controversyControversy

  EmCare was criticized over the use of out-of-network billing in hospital emergency departments and other settings. Research cited in the reference material reported rapid increases at some hospitals and an average out-of-network billing rate of 62 percent across a larger sample of hospitals where EmCare handled billing. The controversy centered on patients' limited ability to choose emergency physicians and the resulting risk of unexpectedly high bills.

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• 2011Clayton, Dubilier & Rice acquires Emergency Medical Services Corporation

  Clayton, Dubilier & Rice acquired the parent company that included EmCare.

  M&A
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• 2004Onex acquires EmCare and American Medical Response from Laidlaw

  Onex purchased EmCare and American Medical Response from Laidlaw and organized them under Emergency Medical Services Corporation.

  M&A
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• 2004Emergency Medical Services Corporation becomes a public company

  Emergency Medical Services Corporation, the parent formed for Onex's healthcare acquisitions, went public in December.

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• 1997Laidlaw acquires EmCare

  Laidlaw acquired EmCare as part of the consolidation of emergency-medical and physician-practice-management services.

  M&A
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• Envision Physician Services purchases EmCare Holdings

  EmCare Holdings Inc. was purchased by Envision Physician Services and ceased operating as an independent business.

  M&AOther
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1. EmCare