Q&A With Dominic Bagnoli, MD: CEO of USACS


Dominic J. Bagnoli, Jr., MD, FACEP, FAAEM, serves as chief executive officer of US Acute Care Solutions (USACS), overseeing the strategic direction the company.

EPM: A common thread from SEA executives is a mistrust of Summa leadership, specifically the problem of conflicts of interest, since Summa’s Chief Medical Officer, Dr. Vivian von Gruenigen, is your wife. How do you respond to those suggestions?  


Bagnoli: “I am married to the CMO, who trained there, who worked there, who was the Chair of Women’s Health for eight years; who had the highest quality metrics in the State and was on the Board of Directors and then applied for the CMO job and started it six months ago. That’s fact. We never talked about business. She was not involved in any of the [USACS] negotiations. The only interaction I had with her around this contract was on the 24th, where she said: Tom’s going to call you. I hung up that phone call and started to say, “can you believe…” and then she goes, “I’m not talking to you about it.” And that’s the way our discussions went because she is the most principled, ethical person. I mean, she’s way better than anyone I know. And she’s getting dragged through the mud because why? Because she’s a female and she has a job and she happens to be married to a guy who runs a big business. Okay, but that’s all she’s done wrong. And it’s unfair to her. And these people, there’s been an outside counsel investigation of conflict of interest, that has been completely shown: no conflict, no impropriety. The Board is doing a second one. I mean, they are looking at all of this. There is nothing there. They’ve looked at all the emails. There’s nothing. There’s nothing to show that and there was nothing.”

EPM: Should you have done more to defend SEA as an independent group, perhaps turning down the contract in order to send a message to Summa leadership?  

Bagnoli: Our mission is to care for patients. And if a health system tells us that the docs are going to walk out on patients, we’re not going to standby and allow that to happen – if we could help. This happened to be in our own backyard and locations where our employees seek care; where many of our employees have friends and families that work in the system and have patients that go to those facilities. And three of the facilities, Medina, Barberton and Wadsworth, we had docs who had worked there for five, ten years. So from our perspective, if they couldn’t work it out, we had to step up and help. I got the [final]call at 5:00pm on December 31st. Tom Malone said: Well, I need you. And I said: What happened? He said: We offered them a deal. They refused it. And we offered an extension and they also said no. And so they’ll be leaving. And we said: Okay. And we showed up.


EPM: As EMP you were a “big small group” and as USACS you’ve become “a small big group”. In the narrative of this story, you’ve been painted as the large corporation fighting against the local, independent group. How does that strike you, given your background at EMP? 

Bagnoli: The groups that have joined us from around the country still have physician ownership. Because before we formed USACS, you had two choices: stay the course and take whatever risk comes your way – the SEA story is a good story about that; or sell to TeamHealth or EmCare and become an employee. That’s really what your choices were. USACS is a third alternative: Join us, become owners of USACS with other physicians across the country and continue to drive quality and physician ownership and create an environment where that can sustain itself long term in the market. That’s our entire strategy: finding the best physician-owned groups and saying, Join us and together we’ll own the company.

EPM: What have you done to insure that the residency program is taken care of, and that there’s a smooth transition for the residents? 

Bagnoli: When we showed up on January 1, the only surprise we got was all the residents were gone. The previous group instructed the residents to go home for a month of home study . . . We met with the residents two days later, and on January 3rd, they started to cover their shifts as they normally would. And we started to work with them. We appointed a program director, who was approved by their appropriate committee on January 5th. He started on the 8th and spent his first week meeting with every resident, making sure everyone’s on board and doing all their work. So in a week the residency was back, alive and working. We’ve identified ten core faculty. We’ve offered jobs to every core faculty in SEA. But none of them have chosen to come back.


Click here to read more from the Deal Breakers: The Summa Story series.



  1. Dr Ethan Wagner on

    This is perhaps the biggest pile of malarkey I have heard…yeah pal, hiring your husband for a multi million dollar contract couldn’t possibly be thought of as a conflict of interest. Its gotta be sexism…keep telling yourself that.

    Shame on you.
    You are no better than the drug seeker faking back pain, except your ethical trade off is for money. American Greed.

  2. Dr. John Smith on

    Well, someone has to say it, and it is not without risk for those who do…

    USACS is just another Team Health, or EmCare maybe worse. They pay low wages for cheap ED physician labor. They take the profits for themselves. The CEO and upper level few make millions along with their hedge fund partners. Millions driving away in high end sports cars. You take the risks.

    Slick and expensive marketing, expensive flashy parties, high-end consultants for the logo, websites, social media, and the presentations to the hospitals. Reminds me of a Ponzi scheme. Image is everything. Just don’t look too deep. A lot of new graduates who don’t know any better, fall for it.

    You are an owner as much as I am the owner of TESLA, with my 100 shares. TESLA has open books as a publicly traded company at least. These EM Physicians are reduced to assembly line workers. Cheap labor, that is easily replaced when something cheaper comes along. (cheap residents/graduates that flood the market as new training programs open up)

    I admire Dominic Bagnoli as a superior salesmen and showmen. He is brilliant. But to say this wasn’t a pre- planned takeover is just silly. It was intelligent business. And he was smart enough not to leave an email trail anywhere along the way. Phone or face to face only with him, or his wife. The Summa EP guys messed up their side of things and allowed him a clear path of entry, so they are not blameless either. They were out maneuvered. Badly.

    The “independent” law firm, Porter Wright Morris and Arthur, investigating the impropriety of the situation, clearing USACS of wrongdoing has directly represented USACS in the past, so perhaps they aren’t so independent after all, but who knows.

    And now the EM residency program at Summa Health has lost it’s accreditation with the ACGME. It’s over. Gone. With the residents in training as unfortunate casualties.

    Every contract that falls to USACS, or Team Health, or whatever other CMG is a loss for the ED Physician. You are becoming an expendable hourly employee, and with that you lose control, respect, and in the end, power. Not the power that these CMGs seek to possess over others, but the power to steer healthcare for the benefit of society, the community, and your patients, and not strictly for profits to a select few, at the expense of most working physicians.

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