1 00:00:00,280 --> 00:00:00,940 Hi everyone, 2 00:00:00,940 --> 00:00:03,900 and thank you for tuning in to the Becker's Healthcare podcast series. 3 00:00:04,140 --> 00:00:08,340 I am Mariah Moham, writer for events and custom content for Becker's Healthcare, 4 00:00:08,680 --> 00:00:11,500 and I'm absolutely pleased to be joined by Andrew Ur, 5 00:00:11,640 --> 00:00:13,820 senior managing director at Zigler, 6 00:00:13,880 --> 00:00:17,780 and a founding member of Ziglar's corporate Finance healthcare Practice. Andrew, 7 00:00:17,780 --> 00:00:19,820 thank you so much for being here today. How are you? 8 00:00:20,640 --> 00:00:23,180 I'm doing great. Really appreciate you having me on the show. 9 00:00:24,140 --> 00:00:26,030 Yeah, of course. So glad to have you today, 10 00:00:26,030 --> 00:00:28,590 and I know we're gonna have an excellent discussion. So with that, 11 00:00:28,590 --> 00:00:31,310 we could jump right into the first topic of our conversation today. 12 00:00:31,730 --> 00:00:32,470 To get us started, 13 00:00:32,470 --> 00:00:35,670 would you mind introducing yourself and sharing a bit about your role and 14 00:00:35,670 --> 00:00:36,503 organization? 15 00:00:37,590 --> 00:00:40,670 Absolutely. So I'm one of the partners here at zeer, 16 00:00:40,670 --> 00:00:44,350 one of the owners of the firm. Been with the firm going on 17 years. 17 00:00:45,030 --> 00:00:47,830 I have a 20 year career in healthcare investment banking. 18 00:00:48,670 --> 00:00:52,270 I actually grew up in a family of physicians, my dad and brother, both doctors, 19 00:00:52,450 --> 00:00:57,270 and really soft firsthand the challenges with physicians on growing the 20 00:00:57,550 --> 00:01:01,590 business side of their practice. And it drove me to want to get into healthcare, 21 00:01:01,670 --> 00:01:03,750 particularly on the business side, 22 00:01:03,750 --> 00:01:08,030 really helping physicians grow and build their practices and, and, 23 00:01:08,030 --> 00:01:09,230 and build equity value. 24 00:01:09,330 --> 00:01:12,950 And so I had a chance to cut my teeth across a number of larger 25 00:01:14,230 --> 00:01:15,870 advisory firms on Wall Street, 26 00:01:15,890 --> 00:01:20,750 and then had an opportunity in 2006 to come over to Ziegler and help build the 27 00:01:21,150 --> 00:01:25,550 advisory practice here and have now built the team from just two of us at, 28 00:01:25,570 --> 00:01:30,190 at the onset to now about 50 m and a professionals and, uh, 29 00:01:30,190 --> 00:01:32,750 servicing really all across the us. 30 00:01:32,850 --> 00:01:36,310 And I lead our efforts based out of our New York office, 31 00:01:36,530 --> 00:01:38,550 all of our physician advisory efforts. 32 00:01:38,730 --> 00:01:41,270 And we've had the privilege of working with, 33 00:01:41,270 --> 00:01:46,270 with nearly 60 private practice physician groups across the country on 34 00:01:46,370 --> 00:01:50,550 all kinds of different partnership options. Everything ranging from mergers, 35 00:01:51,080 --> 00:01:54,550 PSSAs, joint ventures, sale transactions, 36 00:01:54,550 --> 00:01:58,670 private equity transactions, investment transactions. You know, we, 37 00:01:58,730 --> 00:02:02,990 we get engaged as the advocate of the private practice to help them 38 00:02:03,520 --> 00:02:06,350 understand what they're worth, understand their options, 39 00:02:06,770 --> 00:02:08,350 and really be their advocate, 40 00:02:08,610 --> 00:02:12,150 making sure they get fair value for what they bring to the table, 41 00:02:12,370 --> 00:02:16,830 and obviously negotiating on their behalf to get the bo best possible terms. 42 00:02:17,050 --> 00:02:19,710 And it's, it's really been a privilege getting to, 43 00:02:19,770 --> 00:02:24,350 to work with so many entrepreneurs and, and, and really exciting, 44 00:02:24,770 --> 00:02:24,990 uh, 45 00:02:24,990 --> 00:02:29,190 opportunities across the US and getting to meet and work with physicians really 46 00:02:29,190 --> 00:02:31,910 across all different specialties, you know, 47 00:02:31,980 --> 00:02:34,710 ranging from primary care to radiology, 48 00:02:35,050 --> 00:02:39,630 to orthopedics to cardiology to urgent care 49 00:02:39,890 --> 00:02:44,070 and, and telemedicine businesses. But obviously a a lot of focus in, 50 00:02:44,070 --> 00:02:46,910 in recent months and years on, on cardiology, 51 00:02:47,000 --> 00:02:51,990 which is why we're here today and a and a particular focus of ours as we think 52 00:02:51,990 --> 00:02:55,830 about strategic initiatives going forward and where we plan to invest a lot of 53 00:02:55,830 --> 00:02:57,030 our time and resources. 54 00:02:58,170 --> 00:02:59,020 Yeah, absolutely. 55 00:02:59,110 --> 00:03:03,310 Thank you so much for giving us all that background that will be useful for this 56 00:03:03,310 --> 00:03:04,590 conversation. Surely. 57 00:03:05,010 --> 00:03:08,310 And you kind of already looped us into the first topic I wanted to discuss 58 00:03:08,320 --> 00:03:12,790 today. Cardiac procedures are continuing to migrate to outpatient settings, 59 00:03:13,430 --> 00:03:15,110 succinctly opportunities here. 60 00:03:15,650 --> 00:03:19,430 Can you share the key trends and challenges you're seeing in the market right 61 00:03:19,430 --> 00:03:20,263 now? 62 00:03:20,760 --> 00:03:23,970 Yeah, absolutely. I'm gonna kind of start us more at the macro level, 63 00:03:24,100 --> 00:03:27,890 which is record amounts of consolidation going on in healthcare. 64 00:03:28,590 --> 00:03:29,730 In 22 alone, 65 00:03:29,730 --> 00:03:34,210 there were over 550 physician m and a transactions over 66 00:03:34,210 --> 00:03:37,970 $300 billion in, in total value. And, 67 00:03:37,990 --> 00:03:42,490 and the landscape is just really changing very rapidly around us. You know, 68 00:03:42,500 --> 00:03:47,370 we've got a bunch of new entrants coming into this space. You know, Optum, 69 00:03:47,460 --> 00:03:51,930 which is the United subsidiary, it's a $460 billion enterprise, 70 00:03:52,430 --> 00:03:52,690 you know, 71 00:03:52,690 --> 00:03:57,050 they're now the largest physician employer in the country with over 70,000 72 00:03:57,050 --> 00:04:01,890 physicians. They've spent over $20 billion on un aggregating physician 73 00:04:02,330 --> 00:04:06,890 practices. Uh, you've got C V S Health now with their purchase of Oak Street, 74 00:04:06,890 --> 00:04:10,490 over $10 billion in signify of 8 billion. Um, 75 00:04:10,490 --> 00:04:15,090 they're certainly building a formidable empire across their primary 76 00:04:15,280 --> 00:04:19,610 care and obviously with their integration with Aetna really have the payer 77 00:04:20,010 --> 00:04:24,850 provider angle as well, similar to Optum and United. Uh, you've got Village md, 78 00:04:24,850 --> 00:04:28,770 which is now partnered with Walgreens, and they recently bought Summit Health, 79 00:04:28,770 --> 00:04:33,730 which is a multi-specialty model all across the New York City market. 80 00:04:33,870 --> 00:04:38,850 And they just invested about $9 billion into that summit investment. Um, 81 00:04:38,960 --> 00:04:43,210 they, they're obviously gonna be leveraging about 9,000 Walgreens locations. 82 00:04:43,270 --> 00:04:45,530 And then most recently is, you know, 83 00:04:45,530 --> 00:04:49,810 really interesting is the Amazon purchase of one medical for almost $4 billion. 84 00:04:50,150 --> 00:04:50,983 And, you know, 85 00:04:51,190 --> 00:04:55,570 Amazon touches about 60% of all US households call it 86 00:04:55,570 --> 00:04:58,050 200 million Americans. Um, 87 00:04:58,150 --> 00:05:02,770 so it'll be really fascinating to see how that changes the prevalence of, 88 00:05:02,830 --> 00:05:07,050 of telemedicine and, and really the, the access to care. And so, you know, 89 00:05:07,050 --> 00:05:09,490 with that backdrop, I just think it's, it's, 90 00:05:09,490 --> 00:05:11,530 it's relevant as to why we're here today, 91 00:05:11,620 --> 00:05:16,170 which is there's just so much new investment and activity going into healthcare, 92 00:05:16,170 --> 00:05:21,170 really changing some of the core, uh, stakeholders, right, 93 00:05:21,230 --> 00:05:26,090 beyond just the traditional local health system relationships and payer 94 00:05:26,090 --> 00:05:30,650 relationships to now some of these really large strategics that are moving into 95 00:05:30,650 --> 00:05:34,090 the space. You know, that coupled with the fact that, you know, 96 00:05:34,250 --> 00:05:39,210 C M S and Medicare is continuing to enable more and 97 00:05:39,210 --> 00:05:43,850 more reimbursement of these procedures to be done in an outpatient setting. Uh, 98 00:05:43,850 --> 00:05:48,810 you know, cardiology in in particular was, was a big, uh, 99 00:05:49,170 --> 00:05:53,530 re recipient of that as, as you saw a lot of that initiatives, you know, 100 00:05:53,530 --> 00:05:56,050 over the last couple years. And, you know, 101 00:05:56,050 --> 00:06:00,960 certainly a big driver I think in 2018 was about 23 codes 102 00:06:01,590 --> 00:06:03,680 that are, are gonna be, you know, 103 00:06:04,000 --> 00:06:08,760 reimbursed in an outpatient setting over about a billion dollars in savings that 104 00:06:08,760 --> 00:06:12,960 that's estimated for moving those procedures into an outpatient setting. And so, 105 00:06:13,420 --> 00:06:18,400 you know, that's been a real big catalyst behind why private equity has 106 00:06:18,800 --> 00:06:23,200 targeted cardiology is the prevalence of these procedures that can now be done 107 00:06:23,660 --> 00:06:28,200 in an outpatient setting a specialty that historically was pretty 108 00:06:28,630 --> 00:06:31,080 tied into the acute care hospital world. 109 00:06:31,190 --> 00:06:34,240 Most 70% of cardiology groups have, 110 00:06:34,240 --> 00:06:39,120 have historically been more hospital oriented or p s AED with hospitals. 111 00:06:39,140 --> 00:06:43,960 And so there's now this big opportunity for them to, to really, you know, 112 00:06:44,010 --> 00:06:47,920 build more independent ancillary initiatives, uh, 113 00:06:47,920 --> 00:06:51,840 build out ASCs or OBLs and cath labs and, 114 00:06:51,840 --> 00:06:53,360 and private equity is, 115 00:06:53,380 --> 00:06:57,760 is really helping fuel a lot of those initiatives and it's kind of a win-win 116 00:06:57,780 --> 00:06:58,920 for, for both sides, 117 00:06:59,070 --> 00:07:03,160 enables the cardiologist to build a sense of independence and drive some 118 00:07:03,160 --> 00:07:07,640 ancillary income and, and patients prefer it 'cause it's a more efficient, 119 00:07:08,020 --> 00:07:12,920 higher quality, uh, more convenient and, and obviously lower cost of, 120 00:07:12,920 --> 00:07:14,720 of care. So, um, that, 121 00:07:14,720 --> 00:07:19,200 that's what we're seeing is really the big driver for a lot of this new newfound 122 00:07:19,200 --> 00:07:21,320 investment interest in the cardiology space. 123 00:07:22,240 --> 00:07:24,690 Yeah, absolutely. Thank you so much for all of that insight, 124 00:07:24,870 --> 00:07:29,850 the telemedicine and the impressive growth and Amazon and Walmart and, 125 00:07:29,850 --> 00:07:30,210 you know, 126 00:07:30,210 --> 00:07:33,890 those alike are definitely making a difference in this space rather quickly. 127 00:07:34,120 --> 00:07:34,790 Also, 128 00:07:34,790 --> 00:07:39,450 how do you recommend practices approach growth and scale strategies as well as 129 00:07:39,450 --> 00:07:42,050 staying resilient in a dynamic market like you are? 130 00:07:42,600 --> 00:07:45,610 What KPIs should they focus on and why? Yeah. 131 00:07:45,980 --> 00:07:49,260 So the first place we recommend starting is doing a, 132 00:07:49,380 --> 00:07:52,660 a real thoughtful SWOT analysis. And, you know, 133 00:07:52,660 --> 00:07:56,220 typically we will start with that, you know, at no cost to, 134 00:07:56,240 --> 00:08:00,940 to practices that that come to us and just do an initial assessment and, 135 00:08:00,940 --> 00:08:04,300 and do a, you know, a benchmarking review and look at, you know, 136 00:08:04,510 --> 00:08:07,420 where their rates are relative to the market, 137 00:08:08,010 --> 00:08:10,580 what their overhead is as a percentage of revenue, 138 00:08:11,010 --> 00:08:15,260 what their physician productivity is relative to market from an R V U 139 00:08:15,260 --> 00:08:19,500 perspective and dollar per R V U as well as, you know, 140 00:08:19,680 --> 00:08:24,460 how efficient they are at leveraging extenders and, and mid-levels. 141 00:08:24,930 --> 00:08:29,140 What their opportunity is for passive income and, and driving, you know, 142 00:08:29,170 --> 00:08:33,140 ancillary income growth and how much are they taking advantage of 143 00:08:33,330 --> 00:08:36,500 opportunities to gain ownership in, 144 00:08:36,500 --> 00:08:41,260 in technical earnings that they may not be benefiting from versus, you know, 145 00:08:41,300 --> 00:08:44,620 a pure professionally oriented group. Uh, and, 146 00:08:44,700 --> 00:08:47,020 and helping them evaluate that, um, 147 00:08:47,020 --> 00:08:51,460 helping them think about market demand in their area for, uh, 148 00:08:51,460 --> 00:08:53,820 some of these outpatient cardiology services, 149 00:08:53,970 --> 00:08:58,760 even some of the cardiovascular opportunities is, is, is a big opportunity. 150 00:08:59,220 --> 00:09:00,640 And then doing, you know, 151 00:09:00,880 --> 00:09:04,640 somewhat of a market heat map where we look at kind of what capabilities they 152 00:09:04,640 --> 00:09:07,440 have, what capabilities competitors have, 153 00:09:07,820 --> 00:09:12,600 and then thinking about what are some logical additions that that might 154 00:09:12,600 --> 00:09:15,600 make sense from a capability perspective, 155 00:09:15,740 --> 00:09:20,600 and are there local providers or other independent groups that may be 156 00:09:20,920 --> 00:09:25,160 interesting, uh, targets to, to merge or add together with what they're doing. 157 00:09:25,620 --> 00:09:26,320 And so, you know, 158 00:09:26,320 --> 00:09:31,120 looking at that all together and then really putting it into ideally a five-year 159 00:09:31,580 --> 00:09:33,520 growth plan. You know, I'm, 160 00:09:33,620 --> 00:09:38,560 I'm often surprised when I meet with most practices that they really only 161 00:09:38,670 --> 00:09:41,640 have, you know, a one year budget at most. And, 162 00:09:41,660 --> 00:09:45,960 and most groups that I meet with don't even have a budget. And you know, 163 00:09:45,960 --> 00:09:50,800 I think for any business of these size and scale of of these practices, 164 00:09:50,900 --> 00:09:54,760 it really is prudent to have a longer term strategy. 165 00:09:55,700 --> 00:10:00,080 The other piece that I often see is just an underinvestment in 166 00:10:00,080 --> 00:10:04,280 infrastructure and resources. You know, there's, there's often this tug of war, 167 00:10:04,300 --> 00:10:09,160 if you will, between kind of taking capital out of the business and really 168 00:10:09,290 --> 00:10:13,880 maximizing distributions versus making investments in the practice. And, 169 00:10:14,140 --> 00:10:15,680 you know, often I see there, there, 170 00:10:15,680 --> 00:10:20,520 there is somewhat of an underinvestment in in the practice and I think that can 171 00:10:20,520 --> 00:10:23,240 be detrimental to the long-term growth of the practice. 172 00:10:23,740 --> 00:10:27,080 And that's something where we tend to be pretty upfront when we, 173 00:10:27,080 --> 00:10:28,520 when we meet with groups and, 174 00:10:28,520 --> 00:10:32,000 and give them an evaluation is where there areas that, 175 00:10:32,000 --> 00:10:36,520 that we think there might be room for investment, be it technology, 176 00:10:36,940 --> 00:10:40,320 be it artificial intelligence or AI capabilities, 177 00:10:41,060 --> 00:10:44,200 be it even just administrative, uh, personnel. You know, 178 00:10:44,210 --> 00:10:49,120 often we see there being, you know, an underinvestment in leadership and, 179 00:10:49,120 --> 00:10:53,160 and and senior management across these organizations. And you know, 180 00:10:53,160 --> 00:10:57,320 a lot of times the difference between a really successful practice and one 181 00:10:57,320 --> 00:11:01,720 that's maybe more mediocre is one that really has a full-time 182 00:11:02,640 --> 00:11:07,040 c e o or administrative lead that that can really wake up every day thinking 183 00:11:07,040 --> 00:11:11,440 about how the practice is gonna keep growing, how to forge new relationships. 184 00:11:12,260 --> 00:11:15,960 And then lastly is really what's the strategy for value-based care? 185 00:11:16,510 --> 00:11:21,280 It's one thing to be successful in today's fee for service environment 186 00:11:21,280 --> 00:11:23,880 where you're just billing per procedure. 187 00:11:24,550 --> 00:11:26,360 It's another to be thinking about how, 188 00:11:26,420 --> 00:11:31,000 how do you fare in an environment where you're moving into more either capitated 189 00:11:31,160 --> 00:11:35,800 payments or uh, bundled payments. And then, you know, 190 00:11:35,940 --> 00:11:39,120 is there a strategy for more of a multi-specialty play? 191 00:11:39,180 --> 00:11:43,440 How do you think about the interplay with primary care in the market? You know, 192 00:11:43,490 --> 00:11:48,360 we're seeing a lot more move towards these large primary and multi-specialty 193 00:11:48,360 --> 00:11:53,360 groups going to plans and, and structuring contracts where, you know, 194 00:11:53,360 --> 00:11:57,400 they get a, a, a capitation or a premium uh, dollar, 195 00:11:57,540 --> 00:12:02,480 and then they're kind of sub aggregating it from there. Um, and so, you know, 196 00:12:02,480 --> 00:12:06,240 as a specialist, I think it's really important to be thinking about how, 197 00:12:06,300 --> 00:12:08,680 how do you fare in those, in those discussions and, 198 00:12:08,680 --> 00:12:13,400 and how do you really set yourself up to be able to help 199 00:12:13,460 --> 00:12:17,340 manage the, the largest possible pool of funding dollars. 200 00:12:17,560 --> 00:12:22,460 And obviously cardiology is, is one of the areas where there's, you know, 201 00:12:22,620 --> 00:12:27,220 a a very significant, uh, need just given our, our, our population and the, 202 00:12:27,220 --> 00:12:29,460 and the demographics and you know, 203 00:12:29,660 --> 00:12:34,660 really an under underinvestment in providing some of those longer term 204 00:12:34,770 --> 00:12:38,100 care management initiatives. And quite candidly, the, 205 00:12:38,120 --> 00:12:42,540 the compensation just isn't always where it should be, which is, you know, 206 00:12:42,540 --> 00:12:46,300 helping ensure some of the medication, uh, 207 00:12:46,300 --> 00:12:51,260 adherence and best practices around follow-up and care management and 208 00:12:51,260 --> 00:12:55,900 things like that. Uh, and that's where a value-based model obviously, you know, 209 00:12:55,970 --> 00:12:57,460 effectively pays to, 210 00:12:57,520 --> 00:13:02,340 to manage a population and keep patients out of a hospital as opposed to paying 211 00:13:02,400 --> 00:13:06,980 for, for procedures and services provided. And that's where I, I I see the, 212 00:13:07,160 --> 00:13:09,900 the opportunity going forward is, you know, 213 00:13:10,060 --> 00:13:13,860 'cause unfortunately I think there's gonna be call close to 80 million patients 214 00:13:14,050 --> 00:13:18,100 with some sort of cardiology or cardiovascular disease, um, that, you know, 215 00:13:18,100 --> 00:13:22,700 that that, that are at risk of, of that, you know, by, by 2050, which is, 216 00:13:22,960 --> 00:13:26,700 you know, the number of Americans that are gonna be over the age of 65, right? 217 00:13:26,700 --> 00:13:30,380 And so it's just a, it's just a massive number and a huge, 218 00:13:30,540 --> 00:13:35,260 I think it's about $215 billion a year that the US health 219 00:13:35,260 --> 00:13:39,900 system spends on, on cardiology care. And so there's obviously, you know, 220 00:13:40,010 --> 00:13:43,940 most of that going to the hospitals and health systems, 221 00:13:44,460 --> 00:13:49,220 but really the opportunity is for cardiology groups to start taking more of 222 00:13:49,220 --> 00:13:53,980 those dollars and managing that spend themselves as opposed to just 223 00:13:53,980 --> 00:13:58,540 getting the 20 or 30% that they get for providing the professional services. 224 00:13:59,680 --> 00:14:01,210 Yeah, that's really interesting. 225 00:14:01,360 --> 00:14:04,890 When you speak about budget and having a long-term strategy, 226 00:14:05,450 --> 00:14:08,450 I know a lot of people say, you know, one day at a time, but you know, 227 00:14:08,450 --> 00:14:10,650 when you're talking about growing a company or a health system, 228 00:14:10,840 --> 00:14:14,690 looking ahead five years sounds extremely important and logical. Um, 229 00:14:14,710 --> 00:14:16,970 and also speaking on technology for you, 230 00:14:17,360 --> 00:14:21,730 what role does technology play in helping practices grow and enhance care 231 00:14:22,090 --> 00:14:24,410 delivery? Are there any examples that you can share? 232 00:14:25,800 --> 00:14:29,520 Absolutely. I mean, I, I see technology really as, you know, 233 00:14:29,600 --> 00:14:33,880 a huge opportunity for innovation in healthcare. I mean, think about, you know, 234 00:14:33,880 --> 00:14:35,760 banking for example, right? It, it, 235 00:14:35,760 --> 00:14:40,680 it wasn't long ago that we all literally went to 236 00:14:40,840 --> 00:14:44,440 the bank every time we got a check. And now, you know, 237 00:14:44,640 --> 00:14:48,640 a physical brick and mortar bank is almost becoming obsolete where you can, 238 00:14:48,980 --> 00:14:52,440 you know, literally do all your banking on your phone. You know, 239 00:14:52,560 --> 00:14:56,880 I see healthcare moving in that same direction where, you know, 240 00:14:56,880 --> 00:15:01,520 with your phone and other devices and wearables, uh, you know, you're, 241 00:15:01,520 --> 00:15:05,640 you're gonna really be only stepping foot in a clinic when you absolutely need 242 00:15:05,640 --> 00:15:10,480 to. Um, you're gonna be engaging, interacting with clinicians, 243 00:15:10,660 --> 00:15:11,493 you know, virtually. 244 00:15:11,860 --> 00:15:16,680 You're gonna have a care team that's gonna be able to talk to each other. But, 245 00:15:16,680 --> 00:15:20,160 you know, obviously one of the biggest challenges, interoperability, right? 246 00:15:20,160 --> 00:15:22,800 There's no common standard language or system. 247 00:15:22,860 --> 00:15:25,520 And so all these systems are disparate. So, you know, 248 00:15:25,710 --> 00:15:30,440 investing in tools that can pull data from these disparate systems, 249 00:15:31,140 --> 00:15:32,880 uh, investing in, in, in, 250 00:15:33,180 --> 00:15:38,000 in tools that can provide that really seamless interface 251 00:15:38,190 --> 00:15:42,920 with the consumers. Um, and, and really, you know, most importantly, you know, 252 00:15:44,130 --> 00:15:48,320 developing that relationship with the patient, right? I mean, I, 253 00:15:48,480 --> 00:15:49,600 I think at the end of the day, 254 00:15:49,600 --> 00:15:54,120 when you think about who's gonna be the most valuable group of 255 00:15:54,120 --> 00:15:56,360 physicians over the next 10 years, 256 00:15:57,350 --> 00:16:01,240 it's gonna be whatever specialty really owns that patient relationship, 257 00:16:01,870 --> 00:16:06,520 they're gonna be the ones that are gonna be kind of sitting at the center of the 258 00:16:06,520 --> 00:16:10,440 circle. And so if I, if I'm a physician group right now, 259 00:16:11,240 --> 00:16:15,560 I want to be thinking about how do I make sure that I have this real 260 00:16:15,790 --> 00:16:17,910 captive, you know, 261 00:16:18,480 --> 00:16:23,470 engagement with my patients such that they'll follow me 262 00:16:24,530 --> 00:16:29,230 if I move between health plans, if I move between contract models. 263 00:16:29,930 --> 00:16:34,030 Um, and, and obviously I think technology is a critical piece of that, 264 00:16:34,030 --> 00:16:37,630 which is really tying the link between the patient and the provider. 265 00:16:39,250 --> 00:16:42,690 Absolutely. Thank you so much for all of that insight. Before we wrap up, 266 00:16:42,690 --> 00:16:45,010 there's a couple things I wanted to ask you. 267 00:16:45,740 --> 00:16:49,490 Where do you see cardiology headed in the next five years? Um, 268 00:16:49,610 --> 00:16:53,850 I know we just talked about technology and how it can really grow so many 269 00:16:54,170 --> 00:16:56,810 practices. Um, is there anything that's exciting you right now? 270 00:16:59,020 --> 00:17:00,350 Yeah, so, you know, it's, 271 00:17:00,350 --> 00:17:04,910 it's been amazing to watch just how much investment has gone into cardiology, 272 00:17:05,140 --> 00:17:07,870 just literally in the last three years. I, I count, 273 00:17:08,150 --> 00:17:13,120 I think seven large private equity backed platforms in 274 00:17:13,120 --> 00:17:17,730 the cardiology space since 2020. And, you know, 275 00:17:17,730 --> 00:17:22,730 these are platforms that have invested hundreds of millions of dollars into the 276 00:17:22,730 --> 00:17:25,570 sector. And I, I, 277 00:17:25,850 --> 00:17:30,810 I see this continuing to advance the aggregation of 278 00:17:30,880 --> 00:17:34,810 cardiologists into these larger aggregated models. 279 00:17:35,430 --> 00:17:39,010 It doesn't mean this is necessarily the right play for every group, 280 00:17:39,190 --> 00:17:42,290 but I do think it's an interesting option. Uh, 281 00:17:42,430 --> 00:17:47,010 my biggest advice for a cardiologist that might be out there listening is, 282 00:17:47,390 --> 00:17:47,760 you know, 283 00:17:47,760 --> 00:17:52,560 have someone that's your advisor that guides you through this process and 284 00:17:52,560 --> 00:17:57,160 gives you the really the full spectrum of options and, and is really, 285 00:17:57,340 --> 00:17:58,173 you know, 286 00:17:58,370 --> 00:18:02,640 advocating on your behalf as opposed to just evaluating one 287 00:18:03,270 --> 00:18:07,880 potential option in a vacuum. I've seen that to be really detrimental. Uh, 288 00:18:08,140 --> 00:18:12,280 the other advice I would give is just you've got one shot when you go through 289 00:18:12,280 --> 00:18:14,280 this process. Um, you know, 290 00:18:14,280 --> 00:18:19,280 you've got one opportunity to really maximize your pro your practice 291 00:18:19,340 --> 00:18:22,840 and really present yourself in the best possible light. And, you know, 292 00:18:22,840 --> 00:18:27,640 you don't want to, you don't want to really miss that opportunity or, or, 293 00:18:27,700 --> 00:18:29,560 or stub a toe, if you will, 294 00:18:29,820 --> 00:18:34,760 by sharing the wrong set of data or not presenting your practice in the 295 00:18:34,760 --> 00:18:39,640 best possible light because that first impression really does carry the day. 296 00:18:39,660 --> 00:18:44,560 And so making sure you're really thoughtful with how you approach 297 00:18:44,560 --> 00:18:45,393 these parties, 298 00:18:45,500 --> 00:18:50,000 how you package yourself up and having a sense of what you think you're really 299 00:18:50,050 --> 00:18:54,280 worth before you go into those discussions is, is, is really, 300 00:18:54,280 --> 00:18:56,000 really important. Um, 301 00:18:56,170 --> 00:19:00,920 while also thinking through a broader strategy of are there other local 302 00:19:00,920 --> 00:19:05,560 groups that you can merge with? Does it make sense to consider hospital PSSAs? 303 00:19:05,710 --> 00:19:09,240 Does it make sense to consider joint ventures? Um, and, 304 00:19:09,260 --> 00:19:12,760 and all of the other spectrum so you can look at it holistically, 305 00:19:13,090 --> 00:19:14,160 would be my advice. 306 00:19:17,250 --> 00:19:20,200 Great, great, great advice. Thank you so much for sharing that. 307 00:19:20,400 --> 00:19:22,280 I know that's probably gonna help, um, 308 00:19:22,910 --> 00:19:26,840 some of our listeners listening in right now. Before I let you go, Andrew, 309 00:19:26,840 --> 00:19:28,560 is there anything else that you'd like to share? 310 00:19:30,910 --> 00:19:34,560 Just that it's gonna be a really dynamic next couple years and my, 311 00:19:34,660 --> 00:19:38,840 my biggest advice would be don't sit back and just, 312 00:19:39,500 --> 00:19:42,120 you know, let the next couple years go by, 313 00:19:43,420 --> 00:19:47,680 by kind of assuming things are good and, and kind of, 314 00:19:48,380 --> 00:19:50,240 you know, enjoying the status quo. 315 00:19:50,360 --> 00:19:54,440 I think that's the single biggest mistake a group can make is, you know, 316 00:19:54,610 --> 00:19:59,240 rates or reimbursement is favorable in just riding that out. 317 00:19:59,700 --> 00:20:02,080 Uh, you know, when, when, when, when things are good, 318 00:20:02,980 --> 00:20:07,920 that's the exact time you want to be thinking about investing in the 319 00:20:08,010 --> 00:20:09,760 operations and, 320 00:20:10,020 --> 00:20:14,840 and building that strategy plan so that you've got a real defensible 321 00:20:15,670 --> 00:20:20,040 long-term plan as opposed to until you hit that 322 00:20:20,270 --> 00:20:22,800 precipice. And at that point, unfortunately, it's, 323 00:20:22,800 --> 00:20:27,240 it's really too late to position yourself from, from, from a stage of, 324 00:20:27,240 --> 00:20:29,160 of leverage. And so, you know, 325 00:20:29,160 --> 00:20:32,920 we just look forward to having conversations with groups that are, uh, 326 00:20:32,920 --> 00:20:35,640 curious about the options and interested in, 327 00:20:35,860 --> 00:20:38,680 in learning about the market and learning about what, 328 00:20:38,750 --> 00:20:43,520 what potential options might be and what the values, uh, could be. 329 00:20:43,660 --> 00:20:45,080 And, uh, look, 330 00:20:45,080 --> 00:20:49,010 looking forward to just being a sounding board and an educational resource. 331 00:20:50,030 --> 00:20:52,010 Yes, absolutely. Thank you so much, Andrew, 332 00:20:52,010 --> 00:20:55,410 for your time and a great discussion today. We really do appreciate it. 333 00:20:56,390 --> 00:20:58,950 Likewise. Thanks for having me on the show and, 334 00:20:58,950 --> 00:21:00,590 and looking forward to the follow ups. 335 00:21:01,310 --> 00:21:02,143 Yeah, of course. 336 00:21:02,260 --> 00:21:06,440 And I also like to thank Ziglar as well for sponsoring today's episode. 337 00:21:06,780 --> 00:21:09,920 You can tune into more podcasts from Becker's Healthcare by Visitor, 338 00:21:09,940 --> 00:21:13,040 our podcastPage@beckerhospitalreview.com.