Grassley To Ascension - Illinois Hospital SCP Staffing

May 31, 2024
VIA ELECTRONIC TRANSMISSION
Polly Davenport, D.Sc., RN, FACHE

SVP Ministry Market Executive Ascension Illinois
200 South Wacker Drive, 12th Floor
Chicago, IL 60606
Dear Ms. Davenport:
I am concerned about private equity’s impact on patient care and outcomes at your
hospital.1 It is my understanding that beginning on June 1, 2024, Ascension, a not-for profit
hospital group, will outsource the hospitalist function staffing of its Illinois hospitals to SCP
Health, a Canadian private-equity-backed staffing firm.2 My office has received allegations that
the staff outsourcing includes: medical directors, doctors, nurse practitioners, and physicians’
assistants.3 Currently, these hospitalists are directly employed by Ascension.4
Ascension’s website states that,
At Ascension, our commitment to patients and families begins with

the doctors, nurses and care teams serving in our hospitals and care
sites across the country. Our Catholic identity and healing Mission
call us to care for everyone with dignity and respect, valuing those
we serve and those we serve alongside.5
Ascension states that it has a “[m]ission of delivering compassionate, personalized care to

all with special attention to persons living in poverty and those most vulnerable.”6 Its website
further reports that, “[i]n FY2023, Ascension provided $2.2 billion in care of persons living in
poverty and other community benefit programs.”7 Due to Ascension’s work with vulnerable
1
On December 6, 2023 the Senate Budget Committee launched a bipartisan investigation into the impacts of private
equity on our nation’s hospitals. See: https://www.grassley.senate.gov/news/news-releases/senate-budget-
committee-digs-into-impact-of-private-equity-ownership-in-americas-hospitals.
2
Healthcare Dive. Ascension will outsource Illinois hospitalist functions to PE-backed staffing firm. (March 26,
2024). https://www.healthcaredive.com/news/ascension-outsource-private-equity-chicago/711372/.; ONEX. Our
Portfolio: SCP Health. https://www.onex.com/portfolio/OP-OpCo-SCPHealth. (last accessed: 5/9/24); Forbes
Profile: ONEX. Forbes. https://www.forbes.com/companies/onex/?sh=cd923bc6a09e. (last accessed: 5/9/24).
3
See Exhibit A, attached.
4
Healthcare Dive. Ascension will outsource Illinois hospitalist functions to PE-backed staffing firm. (March 26,
2024). https://www.healthcaredive.com/news/ascension-outsource-private-equity-chicago/711372/. ONEX. Our
Portfolio: SCP Health. https://www.onex.com/portfolio/OP-OpCo-SCPHealth. (last accessed: 4/18/24).
5
Ascension, About Ascension, https://about.ascension.org/about-us. (last accessed: 5/30/24).
6
Id.
7
Id.
Ascension Illinois Hospitals
May 31, 2024
Page 2 of 3
patients, Ascension Illinois hospitals receive federal support through Medicaid Disproportionate
Share Hospital (DSH) payments as well as the 340B Drug Pricing Program.8
In contrast with Ascension Illinois not-for-profit hospitals, SCP Health is backed by

Toronto-based Onex Corporation’s private equity platform, Onex Partners.9 Onex states that it is
“growing great businesses and building strong relationships to the long-term benefit of our
investors and partners.”10 Onex also states that “[w]e have returned in excess of $3 billion to
shareholders since inception in the form of share buybacks and dividends”11 These objectives
are competing and stand in stark contrast in principle and spirit with Ascension’s stated mission
and services.
Whistleblowers have provided disclosures to my office with respect to proposed changes

to staffing and procedures if SCP Health assumes control and the hospitalist function is
outsourced.12 If executed, these models could affect the patients’ quality of care, increase health
care workers’ loads to unsustainable levels, and could raise questions on whether proper internal
controls are in place with regards to protecting patient information and ensuring billing
accuracy.13
I am concerned that if the staffing plans are executed as stated to my office, hospitalists
would carry very high patient loads. For example, based on records provided to my office, SCP
models would change the average number of patients that hospitalists see per day from between
16 and 19 to between 22 and 30.14 The national average patient load for hospitalists is between
14 and 15.15 These patient loads would be carried between physicians and nurse practitioners
and physician assistants (NPPAs). If hospitalists are to carry such high patient loads, it raises
legitimate questions about how medical care can be efficiently approved and performed in a
manner adequate for each patient’s specific requirements. Whistleblowers disclosed to my office
that some of the plans propose that in some cases physicians would oversee the care of advance
practice clinician (APC) patients utilizing a “roundtable” instead of directly examining the
patient.
According to allegations, even under this circumstance, physicians would still be required
to approve the care provided by mid-level providers without physically seeing and examining
patients. This seems incredibly unsafe and could place a liability on physicians’ medical
licenses. Further, a sample contract provided by whistleblowers shows that physicians are
expected to provide a special power of attorney allowing SCP to bill and collect for all services
8
Ascension. Illinois Covered Entities. https://about.ascension.org/en/about-us/community-impact/340b-drug-
pricing-program/illinois. (last accessed: 3/18/24).
9
Onex. Our Portfolio: SCP Health. https://www.onex.com/portfolio/OP-OpCo-SCPHealth. (last accessed: 5/16/24).
10
Onex. Private Equity. https://www.onex.com/private-equity. (last accessed: 4/18/24).
11
Onex. Accelerating Shareholder Value. https://www.onex.com/shareholders. (last accessed: 4/18/24).
12
See Exhibits A and B, attached.
13
See Exhibits A and B, attached.
14
Based on whistleblower disclosures. Also see Exhibit A.
15
Society of Hospital Medicine, 2023 State of Hospital Medicine Report.
https://www.hospitalmedicine.org/practice-management/shms-state-of-hospital-medicine2/.
Ascension Illinois Hospitals
May 31, 2024
Page 3 of 3
on their behalf.16 This would be done even if physicians have minimal contact with a patient and
play little to no role in the level of care the patient required and received.
In light of Ascension’s non-profit tax status, I pose the following questions with respect
to the aforementioned allegations to gain clarity about Ascension’s perspective on this matter.
Please provide responses to the following questions and produce documents that support your
responses by June 14, 2024.
1. Do the staffing models (Exhibit A) developed by SCP health provide complete patient
care? Have the staffing models in Exhibit A been updated? If so, explain how they
provide complete patient care and all updated records.
2. What steps is Ascension taking to ensure that all its staff are fully informed of the
hospitalist staffing transition and have the ability to raise and address concerns without
fear of retaliation?
3. Ascension Illinois is a non-profit hospital that provides care for underserved communities
and receives federal subsidies as a result. How will billing for uninsured and underserved
patients be affected once the services are performed by hospitalists employed by SCP, a
for-profit firm? Please explain.
4. I am aware of a recent cyberattack that targeted Ascension hospitals, including Illinois

hospitals.17 It is my understanding that SCP is in the process of building an interface
with Ascension in order to access the electronic medical records of Ascension patients for
billing purposes. What level of security and guardrails will SCP utilize to protect patient
information? For SCP’s personnel who will access the information of patients at
Ascension Illinois, where will they be located?
If you have any questions regarding this request, please contact my Senate Budget
Committee staff at (202) 224-0642.
Sincerely,
Charles E. Grassley
Ranking Member
Senate Budget Committee
16
See Exhibit B. Page 5. #6 BILLING AND COLLECTION.
17
Ascension. Illinois Cybersecurity Event Update. May 13, 2024. https://about.ascension.org/cybersecurity-
event/regional-pages/illinois. (last accessed: 5/16/24).

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May 31, 2024

VIA ELECTRONIC TRANSMISSION

Polly Davenport, D.Sc., RN, FACHE

Dear Ms. Davenport:

Ascension’s website states that,

At Ascension, our commitment to patients and families begins with

Ascension states that it has a “[m]ission of delivering compassionate, personalized care to

In contrast with Ascension Illinois not-for-profit hospitals, SCP Health is backed by

Whistleblowers have provided disclosures to my office with respect to proposed changes

4. I am aware of a recent cyberattack that targeted Ascension hospitals, including Illinois

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