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Hello everyone. This is Mariah
Muhammad with Becker's Healthcare.

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Thank you so much for tuning in today.
We are thrilled to be joined by Dr.

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Jim Milton, vascular surgeon
and co-founder of the
Cardiovascular Health Clinic.

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Doctor, thank you so much for
joining us today. How are you.

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Doing Great. Thank you
for having us, Mariah.

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Yeah, of course. Um, well, to begin,

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we could jump right into
today's conversation. So Doctor,

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the first question I wanted to ask you is,

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can you talk a little bit
about your practice and why
you chose to open a hybrid

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OBL slash assc?

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Sure. Great question. I think that, um,

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we were founders of a
large hospital system, uh,

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that was physician owned in
Oklahoma City, built those in 2002,

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and we kind of, uh, felt like
there, there was a trend towards,

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uh, C P T codes and H O P D cases, uh,

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in the hospital space, uh, trending
towards the, uh, surgery center space.

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And we,

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we really were excited about seeing
this and the hospital system with its,

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uh, administrative heavy and heavy,
heavy overhead SI type of landscape.

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Uh, we decided to leave
there in 2014 and, um,

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and build, um, a surgery
center and O B L hybrid.

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And the reason we chose,
uh, a hybrid model was, uh,

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because of payers. And,

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and in 2014 anyway,

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not all of the C P D codes that are
currently available in the surgery center

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had moved over.

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So we had to have the capability of
doing those in the office based space

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as opposed to the
surgery center space, uh,

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or JCO accredited license
space. So we, we chose to, uh,

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invest in that on the front
end as opposed to, you know,

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some, some doctors and physicians
choosing to just go, uh,

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office based lab only. Uh, you know,

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there's a lot more investment and
a lot more, um, regulation on the,

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on the surgery side, uh,
and, uh, a lot more higher,

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higher standards, even though, uh,

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it doesn't matter what day our
particular facility is a, uh,

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O B L or an assc, it's the same
space, and the the standards are,

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are exactly the same. It's
just a matter of, uh, payers,

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uh, and what C P T codes
pay in which space.

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Yeah, absolutely. That is all amazing.

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Thank you for sharing a
bit of your story. Uh,

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I think you were definitely correct
about that trend. And as you know,

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private equity investments in healthcare
PA skyrocketed, uh, especially in,

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um, ASCs and cardio, uh,

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cardiology is expected to be the next
enticing investment from what we hear.

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Uh, for you, what is the
current LA landscape right now,

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and why are cardiovascular
ASCs enticing for investors?

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Yeah, I think that that
cardiovascular and vascular, um, uh,

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our particular model includes
three specialties that
work together real well in

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the space, uh, which include, uh, as
you have already stated, cardiology,

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vascular surgery, and
interventional radiology.

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So those are the three that
really mix well, uh, in the space.

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And I think that what you
see now is basically what,

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what happened in orthopedics, you
know, probably 10 years ago. So the,

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the slope we're on the very,
very low end of the, uh,

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curve as far as the slope
and the, and the, uh, the,

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just the awesome, you know,

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concierge type care that patients feel
when they come to a smaller space.

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And you know, that space just
because it is smaller, you know,

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it provides lower infection
rates, obviously lower cost,

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transparent cost, uh, and all of the
things that patients, you know, really,

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really love. And so I think that, uh,

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private equity has seen this as a very,
you know, incredible opportunity, uh,

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just like total joints, uh, you know,

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or majority of those are being done
in the surgery center space now.

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But that was, uh, a new thing,
you know, 10 to 12 years ago.

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So I think that you're seeing
a new field basically enter the

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surgery space,

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and it's obviously a lot
higher end with patient care

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and choosing the patients that
are appropriate for the space, uh,

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just like you would in an
orthopedic, uh, a s c. But, but, uh,

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even to a, even to a higher
degree, uh, I think that, uh,

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this is what has, you know,
brought a lot of interest, uh,

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from the private equity side.

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They see that same type
of slope and growth in,

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in the cardiovascular
vascular and interventional
radiology space that they saw,

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uh, in orthopedics, uh, GI and,
and those other type of, uh,

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specialties. But this
particular space has just, uh,

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a lot of net value, if you will,
or EBITDA involved, uh, just, uh,

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because of the types of procedures
that we do and the amount of money

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we save the entire system, including
Medicare and all commercial payers, uh,

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as opposed to, uh, the patients, uh,

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being placed in a hospital or
H O P D type of c PT or d r G

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code.

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Yeah, absolutely. Thank you so
much for sharing that insight.

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And since we're touching on
private equity, in your opinion,

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how does the interest from private
e equity impact patient care

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operations and finances?

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Yeah, so I mean, when we,

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when we decided to at least
look at private equity in,

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um, you know, 2120 and 21, right,

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basically in the middle of
covid, there was no financial,

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uh, need to do that. We, we,
we, we ran a good business, uh,

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and didn't really need capital
at all on the local level,

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but we are, uh, my partner
and I are, you know,

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towards the end of our
careers and, um, still very,

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very busy practitioners and
providers, but you know, we,

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we had already been successful
in our careers, but we,

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we really felt like we wanted to
leave a legacy of what we thought

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healthcare looks like in
the future. And so we,

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we went out in 2014 and,
you know, we took a,

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took some significant risk
at that time, um, and,

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and built a 40,000 square foot building
and, and, and the surgery center and,

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uh, and everything. So I think
that at the end of the day,

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we decided to partner with
private equity to try to

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try to develop this vision that we had
of spreading this, this model, you know,

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across states and that that's a
different type of capital. And,

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uh, and also it's, it's, uh, supportive
from the private equity side with,

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with a very strong, you know,
C-suite, which involves, you know,

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A C E o, A C O O, uh, C F O, uh, HR and,

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and, and marketing as well as,
uh, uh, r c cm cycle. So, uh,

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private equity, obviously,

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if you do not have that and it's not
working well or you need help with that

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particular, any of those particular
sides of the business, you know, the,

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the C-suite or the private
equity firm or, uh, ours is, uh,

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health and vascular
partners, H V P, you know,

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is always there to help you as
far as any kind of operations, uh,

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obviously capital, uh,
organic growth as far and a,

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as well as, uh, surgery
center, uh, builds and, um,

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um, the, the ability to, uh,
grow in different markets.

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Yeah, absolutely. That is
all super nice to know. Uh,

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thank you for giving us that impact about,

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or that giving us that
information about impact. For you,

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what are the advantages of working
with private equity in your lab,

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in your experience?

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Again, I think it's just defining,
uh, with mergers and acquisitions,

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finding like minds and like
physicians who practice, uh,

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good solid medicine, we get called
three or four times a week, uh,

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from groups and, uh,
we do a deep dive, uh,

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initially into their practice
and their practice habits and,

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and it has to be good medicine or
we're, we are not interested at all.

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Um, and so we, we,

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we do that first and then we find
like minds and like visions and we

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start to, to try to partner with
them across different states.

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And we have been very
successful with that taking, uh,

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cardiologist out of hospital systems
that aren't happy and majority

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of them aren't happy. Uh, if you
tru if you gave them truth serum,

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they would, they would say so.

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And I think that we have brought
them out of those systems,

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built them medical office
buildings, surgery centers,

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and partnered with them
and tried to emulate, uh,

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what we have here in Oklahoma City.

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So, quick follow up question.

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How does industry play a role
in your growth as a company?

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So I think it's real important, uh,
you know, who you partner with on,

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uh, your disposables that
you use in the cath lab

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and partner with a someone
who has the ability to

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leverage, uh,

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disposable items that you use against
capital that you need to build surgery

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centers. So with the private equity, uh,

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capital and private equity growth
throughout multiple states, uh,

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you don't o only have
leverage with payers,

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but you have leverage with,
um, partnerships with industry,

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uh, to let,

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to leverage your disposable items
that you use during cases against

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capital by equipment, which is, you
know, the most expensive part of,

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of the buy, obviously other than
the construction from the ground up.

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But once you start filling the space
with the capital needed to take, to take,

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uh, state of art care of
our patients, then, um,

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you know, heart and vascular partners, we,

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we pick our partners
very closely with, uh,

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regarding our vendors because
there's numerous vendors out there to

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include Phillips, uh, which can, uh,

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have the whole package because they
have a complete capital equipment, uh,

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division. Uh, so we, we, uh,
partner with them very closely, uh,

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which again adds value to the private
equity, uh, side of the, uh, equation.

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Now, I'd love to end with a question
specifically for our audience listening.

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So Dr.

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For practice owners looking to
partner with private equity investors,

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what is your advice for
choosing a partner? And also
how did you find a partner?

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If you could give us a little
story time, that would be great.

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Sure. Uh, that's a great question.

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And I think that you never know
about your private equity partner.

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It's kind of like getting
married without dating anyone,

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if that's makes any sense. But it's,

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you try to find personalities that,

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that match and you sometimes
need help with a banker,

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uh, for that transaction.
Sometimes you don't, uh,

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depending on the size of
the group and, and, uh,

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good attorneys on both sides,

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obviously your private equity side will
have their attorneys and you will have

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your attorneys and you try to
find that that private equity

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that fits what you want.

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I think that we chose a
private equity firm that, uh,

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was less ibida upfront
and more rollover or

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waterfall possibility down the road
because we believe in the model so much

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that, uh, we believe this is the future.

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And so we chose a private equity
firm assured, who now has,

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uh, you know, developed health and
vascular partners or H V P, uh,

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because of that vision,
uh, likeness as far as the,

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uh, ability to, to help junior partners.

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It gives you a great
ability to recruit extremely

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high talent because they see
the future and they see the

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ability to invest in something
very special. Uh, it's also on the,

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again, the low end of the growth curve.

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So they have a really great
chance of investing early in

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something that could, that, uh, could
possibly be very valuable down the road.

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Absolutely. Thank you so much
for final thoughts. Doctor,

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I want to thank you for sharing
your time and insights today,

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as well as Phillips for sponsoring
today's content to our audience,

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we hope you tune in to other Becker's
podcasts and have a wonderful rest of your

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day.

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Thank you.