1 00:00:00,160 --> 00:00:03,000 This is Randy Homan with the Becker's Healthcare Podcast. 2 00:00:03,420 --> 00:00:05,920 I'm thrilled today to be joined by Lawrence Epstein. 3 00:00:06,070 --> 00:00:10,680 He's the CEO at Pediatric Urology Associates, PC Lawrence, 4 00:00:10,680 --> 00:00:13,680 would you please introduce yourself and tell us a little bit about your 5 00:00:13,680 --> 00:00:14,513 background? 6 00:00:15,340 --> 00:00:16,670 Well, I go by Larry. 7 00:00:17,180 --> 00:00:21,710 I've been in ambulatory physician practice management 8 00:00:22,160 --> 00:00:26,510 as I've been told to reference it these days for the last 32 years. 9 00:00:27,320 --> 00:00:32,190 Uh, my current role is as a CEO of a subspecialty pediatric practice, 10 00:00:32,590 --> 00:00:37,430 which is a dinosaur in the field and we'll get into that more detail, uh, 11 00:00:37,430 --> 00:00:42,350 as being independent for the last three and a half years in the tri-state 12 00:00:42,350 --> 00:00:45,940 New York area with a specific emphasis in urology. 13 00:00:46,510 --> 00:00:50,140 Perfect. Thank you. What are your top priorities today? 14 00:00:50,960 --> 00:00:52,130 Well, today our, 15 00:00:52,130 --> 00:00:56,530 our real top priorities are building back are base provider 16 00:00:56,770 --> 00:00:57,970 group. Uh, 17 00:00:57,970 --> 00:01:02,570 we've lost a couple of providers recently due to a variety of functions, 18 00:01:02,570 --> 00:01:07,450 some of them pre pandemic changes into practice as well as post 19 00:01:07,770 --> 00:01:10,930 pandemic, uh, stress on the group. Uh, 20 00:01:10,930 --> 00:01:14,250 and that that's not just physicians but uh, 21 00:01:14,250 --> 00:01:17,850 nurse practitioners and PAs who are independent providers under our specialty. 22 00:01:18,860 --> 00:01:23,410 Uh, as well as just trying to manage our cash flow, 23 00:01:24,020 --> 00:01:28,850 uh, to meet the needs of a growing cost base and a growing, 24 00:01:30,020 --> 00:01:34,370 uh, employee request base for more money on a day to day basis for the obvious 25 00:01:34,370 --> 00:01:38,450 reasons of heightened inflation and heightened cost pressures. 26 00:01:39,430 --> 00:01:41,760 Mm-hmm. , definitely. How are you trying to do that? 27 00:01:42,770 --> 00:01:44,560 Uh, variety of ways. Uh, 28 00:01:44,560 --> 00:01:49,360 we're going back for the nurse practitioners and looking at not keeping them 29 00:01:49,490 --> 00:01:53,400 as uh, base salaried or hour lead employees, 30 00:01:53,460 --> 00:01:55,150 but uh, 31 00:01:55,150 --> 00:01:59,670 putting them on some type of productivity arrangement which that we had gotten 32 00:01:59,670 --> 00:02:04,510 off of, uh, pre pandemic due to really equal, 33 00:02:06,000 --> 00:02:09,310 uh, allocation of, uh, time and scheduling. 34 00:02:09,690 --> 00:02:12,750 But the pandemic has really thrown out for a loop. Uh, 35 00:02:12,750 --> 00:02:17,550 and we have a lot more part-timers who are not working the same level and some 36 00:02:17,550 --> 00:02:22,070 of the more senior people are working full-time are causing some concern that 37 00:02:22,070 --> 00:02:26,310 they're just not getting fair share of their, their dollars worked, 38 00:02:27,240 --> 00:02:29,230 uh, for the physicians, um, 39 00:02:29,880 --> 00:02:33,830 we are looking at a lot of capital infusion alternatives from either health 40 00:02:33,830 --> 00:02:38,230 systems or private equity or venture capital. Depending on, uh, 41 00:02:38,310 --> 00:02:42,590 different opportunities that are placed on my desk on a day to day basis or 42 00:02:42,590 --> 00:02:46,590 things that we search out, uh, we are looking to, uh, 43 00:02:46,670 --> 00:02:51,470 build some other product lines or ancillary service lines in non-contiguous 44 00:02:51,470 --> 00:02:56,390 states that don't compete with us in the tri-state area. Uh, 45 00:02:56,390 --> 00:03:00,130 we can go into that a little further in a little bit. And uh, 46 00:03:00,330 --> 00:03:03,610 we're just looking at trying to cut our cost base, uh, 47 00:03:03,610 --> 00:03:08,610 our base fundamentals in rent and supply costs and whatever we can do to manage 48 00:03:08,610 --> 00:03:10,970 our expenses as best we can. 49 00:03:12,370 --> 00:03:14,300 Mm-hmm. great goals, I would say. 50 00:03:14,480 --> 00:03:19,220 How do you anticipate your role and teams will evolve over the next 18 months? 51 00:03:21,110 --> 00:03:21,710 Uh, 52 00:03:21,710 --> 00:03:26,220 my role is probably gonna change depending on our merger partner or or practice 53 00:03:26,220 --> 00:03:29,340 partner. Uh, to be honest with you, uh, 54 00:03:29,340 --> 00:03:33,100 if we do merge into a health system and I've gone through these MNAs and over 55 00:03:33,100 --> 00:03:36,180 the past 10 to 12 years and, uh, 56 00:03:36,580 --> 00:03:40,620 those relationships change dramatically depending on the need of the, 57 00:03:41,000 --> 00:03:43,020 and the value structure of that health system. 58 00:03:43,600 --> 00:03:48,380 But we're also trying to find ways to strengthen our human 59 00:03:48,700 --> 00:03:53,380 resources so they're not stretched as far as they would be cuz we've 60 00:03:54,100 --> 00:03:58,540 probably thinned down our administrative infrastructure a lot since the pandemic 61 00:03:59,040 --> 00:04:03,380 and we're using a lot of technological toolkits to help improve 62 00:04:03,930 --> 00:04:07,420 data gathering, uh, revenue recovery, et cetera. 63 00:04:08,070 --> 00:04:10,480 Mm-hmm. . And then our last question, 64 00:04:10,480 --> 00:04:13,640 what are you most excited about right now and what makes you nervous? 65 00:04:14,680 --> 00:04:19,570 What I'm excited about is that there still seems to be a growing need 66 00:04:19,570 --> 00:04:24,370 for our services. Uh, even within heightened competition in our market. 67 00:04:24,490 --> 00:04:26,130 We're probably in the most, uh, 68 00:04:26,320 --> 00:04:29,570 aggressive market in the country in terms of medical services. 69 00:04:30,310 --> 00:04:33,650 And what makes me fearful is the same thing because of that heightened 70 00:04:33,650 --> 00:04:36,930 competition in our market, uh, we have, uh, 71 00:04:37,390 --> 00:04:42,000 had to react to just to keep up with technology 72 00:04:42,500 --> 00:04:44,680 and other facets of, 73 00:04:45,010 --> 00:04:49,920 of investment that some parts of the country have had not to do as much 74 00:04:49,920 --> 00:04:52,320 cuz they don't have the same level of competition. 75 00:04:53,100 --> 00:04:53,950 Definitely. 76 00:04:53,970 --> 00:04:58,150 And do you wanna say a little bit about where pediatric associates are so that 77 00:04:58,150 --> 00:05:00,710 people understand why this competition is so fierce? 78 00:05:01,240 --> 00:05:05,410 Okay. So we are in tri-state, New York, Metro New York area, 79 00:05:05,540 --> 00:05:10,450 so we are surrounded by pretty much every academic medical center from 80 00:05:10,450 --> 00:05:14,130 Philadelphia up through, uh, Hartford, Connecticut, and pediatric urology. 81 00:05:14,850 --> 00:05:19,450 While there's only approximately 800 practicing pediatric urologists in the 82 00:05:19,450 --> 00:05:23,770 United States, about 20% of 'em practic in this area. 83 00:05:24,660 --> 00:05:26,210 So that, 84 00:05:26,350 --> 00:05:31,090 and the population doesn't account for having enough base of disease 85 00:05:31,260 --> 00:05:36,090 to help feed your, uh, doctors and especially in high end surgical cases. 86 00:05:36,910 --> 00:05:38,890 But at the same time, uh, 87 00:05:38,890 --> 00:05:43,810 the incidents of some other services have have grown and the needs have grown. 88 00:05:44,860 --> 00:05:49,570 Uh, so we're just trying to keep pace with those academic medical centers, uh, 89 00:05:49,740 --> 00:05:51,570 so they don't even tear away at our, 90 00:05:51,570 --> 00:05:56,450 our patient base and or invade our patient base to a point where we 91 00:05:56,450 --> 00:06:00,040 have to move our service to this to another location or another area. 92 00:06:00,820 --> 00:06:03,230 Mm-hmm. , definitely. Well, Larry, 93 00:06:03,280 --> 00:06:06,710 it was a pleasure speaking with you today and I look forward to connecting with 94 00:06:06,710 --> 00:06:07,543 you again soon. 95 00:06:07,660 --> 00:06:09,830 Been a pleasure. Thanks again. Be well.