A dozen local doctors at The Queen’s Medical Center are out of jobs today after the hospital hired a mainland firm that has come under fire for its controversial billing practices.

The physicians are hospitalists — doctors who take care of patients only while in the hospital. They belong to Medical Specialists of Hawaii, which has held the contract to care for Queen’s surgical patients for the past decade. In a departure, Queen’s hired Envision Healthcare Corp., one of the nation’s largest physician-staffing companies owned by private equity firm KKR, to provide surgical hospitalists as of today.

Envision, based in Nashville, Tenn., has faced scrutiny nationally for allegedly charging insurers and patients higher rates than warranted and for not participating with certain health insurance which the patients did not know until they received huge bills from the contracted doctors.

Hospital employees say they were blindsided by the move and have concerns about the company’s reputation of surprising patients with high medical bills. A 2017 Yale University study concluded that emergency departments run by Envision’s emergency staffing division, EmCare Inc., had substantially higher charges after the company took over, as well as increased hospital admissions and imaging tests.

In 2017 EmCare agreed to a $29.8 million settlement to resolve claims that it was paid by hospital chain Health Management Associates to increase Medicare admissions from 2008 to 2012, according to the U.S. Department of Justice. The same year, the New York Times reported that EmCare charged the “highest -level billing code” at Newport Hospital and Health Services, a small hospital in Washington state, for nearly 28% of patient visits, up from about 6% by the previous contractor, leaving patients on the hook for “surprisingly large bills.”

Envision has also faced a class-action lawsuit claiming it “habitually charged exorbitant fees,” according to Forbes. The company subsequently became participating providers with more health insurers.

Dr. Russell Wong, owner of Medical Specialists of Hawaii, said his group staffed Queen’s hospital 24-hours a day with eight physicians who took care of roughly 80 patients. The local doctors helped treat and admit surgical patients with other medical conditions.

Envision is planning to have a daily staff of four doctors and a nurse practitioner for the same workload, he said.

“The workload is going to be significantly higher than what we’re presently staffed for. Over time, patient safety can be compromised from the excessive workload,” Wong said.

Rick Bruno, Queen’s vice president for patient care, insists “patient care and physician coverage are not impacted by this change.”

He added, “Queen’s is committed to providing the highest quality patient care. While we do not comment on the terms of our physician agreements, we can confirm that The Queen’s Medical Center has entered into a contract with Envision, which already has been providing hospitalist services for The Queen’s Medical Center-West Oahu campus for the past five years. All of the affected physicians working under MSH were offered employment through Envision or the Queen’s Medical Group. All of them remain active members of our medical staff, which allows them to continue to see patients at Queen’s.”

While the 12 independent physicians still have privileges at Queen’s, they are no longer paid or contracted to take care of patients there.

Bruno did not respond to questions about how Envision got the contract, how many doctors it is bringing in or how it plans to staff the hospital. He also did not address concerns over the company’s billing practices. Representatives of Envision didn’t respond to requests for comment.

An email from an Envision Physician Services recruiter obtained by the Honolulu Star-Advertiser said the company is seeking 36 hours of coverage during the day, which equates to three doctors on 12-hour shifts, as well as an advanced practice nurse for a 10-hour shift and a 12-hour night shift physician.

The Star-Advertiser interviewed half a dozen people involved with Queen’s, most of whom asked not to be identified due to the sensitivity of the issue and fear of retribution.

In an Aug. 30 letter to the medical staff, Queen’s chief medical officer Leslie Chun said Envision hospitalists will be available 24 hours a day and that “referring physicians may continue to ask for the admitting service or physician with active privileges of their choice.”

Meanwhile, Envision has been staffing Queen’s-West Oahu for the past five years, but doctors say the facility has been chronically short of hospitalists.

“Envision has never been fully staffed at West in five years. MSH has been helping them fill the gaps when they can’t get people,” Wong said. “Historically we know that doctors from the mainland don’t stay.”

All 12 Queen’s doctors were offered positions with Envision, but none took jobs.

“What Queen’s is doing, Envision has done nationwide. My old group, they’re all panicking,” Wong said. “The problem is, if we don’t have a job, there are no jobs in Hawaii. Everybody’s scrambling. It’s unfortunate that physicians dedicated to practice in Hawaii will potentially have to move to the mainland to acquire jobs. That will be a loss for the state of Hawaii.”