Hello, everyone. Good evening or late afternoon, depending on where you are in the country. Thank you for joining us. We're going to just give it a couple of, I was going to say seconds, but we'll give it more than a couple of seconds. Give it a minute or two to wait to let some of our participants join in. That being said, we're looking forward to having this discussion. Give another couple seconds and then we'll break through this awkward silence and move on and move forward. All right, so why don't we jump in. So again, thank you for joining us. As you know, this isn't our typical MedAxiom WebEx timeframe, but we always like to try new things and see what works best. At the same time, we're always appreciative of our physician leaders and like to work around their schedules. So thank you in advance to everyone. So bridging the gap, modernizing clinical research to meet today's complex clinical practice. You guys all know MedAxiom. We have a deep knowledge, expertise in our clinical practice, governance, comp models. However, we're looking to expand into the research world. We know how important clinical research is and we're looking to give our members educational opportunities, introduce new companies, new innovative ways to do and to incorporate clinical research into their existing practice. This is a reoccurring question. So we're here to support our members. All right. Sorry. So some housekeeping. Again, to the left, the blue button, you'll find the link to access the presentation slides here if you'd like to see those. And to the right, send text questions to the presenter, please. We're asking, you know, this is, we want this to be an engaging conversation. If you're wondering about it, I bet you others are wondering too, right? So we encourage the questions and we will try to find appropriate times to stop to answer those questions. But if not, we will definitely leave some time at the end to go through those questions. So feel free to participate. And we actually quite encourage it. So clinical research, why is it important? So you guys all know, right? Clinical research helps to save lives. It helps to develop new treatments, new drugs, new procedures, new devices. In fact, the clinical cardiology that you guys practice is because of clinical research. And we also know the practices that incorporate clinical research have more to offer their patients, right? They have these new innovative drugs, procedure devices that they can offer patients that other people can't. So all the more reason why we need to expand clinical research into the communities. All right. So we talk a lot about this in our society, right? That we need to expand clinical research and into all of these neglected communities. And we know that that's true, yet we haven't really built the right resources and bridges to do that. I personally have spent a lot of time talking to industry, right? And everyone is investing in building new PIs, new sites. However, part of the problem, and I truly believe this, is that we're not actually tackling the problem correctly, right? We find or we try to identify new doctors to do the research, but we often don't build the infrastructure around them to succeed, right? And that's part of the problem, right? It's just like the clinic. The doctor can't run the clinic by themselves, right? They can't check in the patient. They can't room the patient. They can't take blood pressures. And we know sometimes they do. And those days we know are bad days, right? We know there's a problem. But that's the same thing with research, right? We can't expect the physicians and the researchers to do it all by themselves. We need to build layers around them to do it properly to be successful. And that's part of this problem, right? We talk about what to do in the clinical trials to be more inclusive, to have more diverse patients, but we don't talk about how to help the PI, the investigator. So that's really what we want to talk about today, right? What are these options? What do we need to do to help build more sites, right? And that's, in my opinion, it's the infrastructure around our physicians to help them do that. And sometimes we can't do it internally. So we need to go, we need to look outside our traditional four walls and expand and build new relationships to help us find the right companies to do research with. So why is traditional research so challenging? So we already know, even in these large, I come from academic medicine. We do a lot of research, huge research portfolio. But guess what? Most of our patient recruitment was outside, right? It was our subcontracts that were doing all the recruitment, right? But even within our own four walls, it's really hard to do clinical research, right? Contracting and the legalities of getting your contracts through the system is painful. Often some sites are done recruiting and we haven't even signed off on the contracts. And I hear this over and over. We also know patient recruitment is incredibly difficult. I mean, a lot of this is because the doctors and they don't have the right team around them, right? And then obviously this happens way too often is physician bandwidth. I always say it ends up being a hobby for them, right? If we don't incorporate it into their work schedule. And guess what? If you don't get paid and then it's a hobby and that eventually you don't have time to do it well, right? So that's part of the problem. And then of course the lack of the infrastructure, it truly takes a village to do this properly. So we have to find ways to make up for that lack of infrastructure. And then of course it's expensive. Everything is expensive now. We know that the margins are so thin on the clinical side to begin with, right? So obviously on the research side, all the more expensive it is to take time away from your clinical time to do the research, the clinical research. So for all these reasons, we need to kind of just think out the box and see what our options are because we have to still do research. But maybe we just don't do it in the traditional four walls of these large academic institutions, right? We need to look and see what our options are. So that being said, it's innovating clinical research, how we've historically have done it and creating new paths forward. And again, this isn't the only option, right? We're just looking at some options. And we also know that clinical research can be successful, right? There's a reason DCRI, TIMI, CRF, there's a reason these entities exist and have existed for so long now. It's because they've been able to figure it out, build the right teams and build the model to do clinical research, right? So keep that in mind. There are people who are doing it and making money. So all the more reason we should think about this, right? So with that, I'm absolutely delighted to introduce Dr. Stephen Smith. Dr. Stephen Smith is a vascular surgeon. So all the more, I always love the surgeon perspective because we often say the surgeons don't do research. It's the cardiologists who do the research. So all the more reason this is a fascinating conversation for me. That being said, he also started out in academic medicine. So I want to hoping he shares his journey from academic medicine into private practice, into equity-owned practice. And that from the MedAction perspective is another conversation by itself, because as you know, we have a lot of interest in that area right now. And then eventually being part of being a founding partner of Peak Heart & Vascular in Arizona. So, you know, again, this is quite the journey. He has seen lots of different models. And now we're looking to not only understand his journey, but understand where he ended up today, how he ended up here more specifically, and why. And then with that, we'll eventually introduce our other guest from Accendo, Dominic, to talk about it. So with that, Dr. Smith, thank you for being here. We look forward to hearing about your journey. Yeah, thanks. I appreciate the warm welcome. So we're going to keep your face up here, if you don't mind. Yeah, all good. So would you like me just to talk about my background journey a little bit? Yeah, from, you know, from starting out in academic medicine and what your experience was originally there and doing research, right? And then kind of over the years when you were in private practice, you know, how did that research happen, right? Did it happen? How did it happen and where you are now? Yeah, sure. Absolutely. So I started out in academic medicine. I was a young assistant professor at UT Southwestern, and they had a NIH K-12 clinical scholars program that I started doing after being, you know, in the program, you know, as an assistant professor just for a brief time. And my motivation to do that was that, you know, I felt kind of like, you know, if I was going to chase this dream of being an academic surgeon, that I was going to really go for it and try to, you know, get as much gravitas on the research side as I could and not just, you know, do, you know, random little case reports and that sort of thing. So this was a foundational research program that, you know, would teach you how to eventually apply for and run grants to, you know, all the way down to the nuts and bolts of programming your own SAS and doing statistics and writing reports and clinical trial design and all of this stuff. And so, I mean, the program was actually great. However, I experienced the difficulty of, you know, being a busy surgeon along with this because most of, you know, the reality of it is, is most of the people in these programs, they are doing it, their clinical side is more of the hobby and the research side is more of the full-time job. And, you know, for surgeons, it was the exact opposite. You know, I was the chief of a 800-bed hospital where something was always exploding, bleeding, something, you know, and would pull me out of class. And so, it became a situation where that would, you know, for me at least, it was just a little bit, you know, a little bit too much to try to do both. And so, that was my academic, you know, experience early on of, you know, of trying to go for broke on the research side. Always interested me to be able to do more on the research side. And, you know, and there's nothing, and a lot of the research, as you described, is done in the academic centers. And that's been historically the way it's just, it's all been done. So, you know, fast forwarding a little bit, you know, I made the decision to leave academic environment and go for the private practice for vascular surgery. This was in the era of being able to develop your own outpatient-based lab and ASC. And I have a business background, actually. So, all that kind of appealed to me on that side of things. And so, I came to Arizona to, you know, start that part of my practice. And in that, I kind of felt like it was going to be, you know, a very big challenge to try to do clinical research. And it is a very, you know, it's a big challenge to try to do it by yourself. You know, part of what I liked about academics was teaching and mentoring young, you know, young surgeons. And that sort of found me. And I pretty quickly started teaching in residence from one of the local programs in Arizona and helped a few people get into fellowship, become vascular surgeons, you know, that sort of thing. And part of that is why when the opportunity came available to start a vascular surgery fellowship with one of the local hospitals, they tagged me for that experience to come in and be the program director. Now, in our practice where I was in a multi-specialty group with cardiologists, vascular surgeons, cardiovascular surgeons, we were, you know, very busy, high RVU kind of practice, as a lot of people probably listening to this, you know, are. And we, you know, we dabbled in some research, but, you know, the way we would, you know, to do that, you know, we'd have a research coordinator as part of the practice. And they're, you know, trying, you know, they're typically just, you know, a one-person show, trying to get the study, you know, approved, do the contract, you know. Work through the IRB, help with patient recruitment, the follow-up, the surveillance, like all the steps. And really, I think that system, although that's probably not uncommon in the clinical practice world, it's very challenging to do it well, in my experience. And so, you know, we have recently partnered with a group that you're going to hear about a little bit here to help us, you know, do more robust clinical research in the private space. And I think that's how I got asked to give this webinar was that, you know, this is, you know, a little bit on topic for what Anna was describing of how, you know, the feeling of needing to have new avenues to do clinical research and, you know, maybe we could, you know, follow, you know, the path of how this gets developed. So you have a fellowship program in your practice, and now you're starting up clinical research, which obviously adds value to your entire practice. But at what point did you decide that you needed the help? Was it because Exendo came to you guys, or you guys were looking, or how did this come together, right, that you realized there are options out there? Yeah, so I think that there was a couple of things that happened almost simultaneously. So Exendo had approached another partner in our group, and we were beginning discussions on partnering with them. And then I had a study I was trying to, I had been approached by an industry to get a study off, you know, off the ground at our hospital site. And the hospital, you know, this particular hospital doesn't have a lot of infrastructure available to do it themselves even. And so they were, like, asking or begging me, essentially, like, do you have any, you know, clinical research organization or partnership where, you know, the resources can be, you know, shared and we can, you know, can do this because, you know, they're underfunded and under-resourced and, you know, all of this, you know, even on that site. And so all that kind of, like, coalesced kind of at the same time. Did that ever occur, let's just try to build it internally? No, not for us. I mean, I think that if you're, if you've got somebody that is, like, their primary interest is doing research, they could certainly build it. I don't think that that's impossible to do. But my group, our doctors, we are 75th to 99th percentile producers. Like we don't have time for that. That's not what we do. So, but if you had somebody that was their driving passion, I think they could do it, but that wasn't in the cards for us. So I love that you're speaking the MedAxiom jargon, right? About the percentile of RVU productivity. That's great. But how are you guys, how are you guys building research separate from the company, but allowing your practice, since you guys are high producers, to take on the clinical research, right? How do you account for that in general? What do you mean? How do we account for it? I guess often a lot of the doctors, a lot of the surgeons say I can't do research that's going to take away from my clinical productivity and I won't get paid, right? I'm going to lose money to do clinical research. Have you guys taken that into account and what are you doing about that? Yeah, so it's very, it's very, you know, that point is very important and you do, you definitely have to work that out in your practice because if you're, if you're asking the doctors to do something where they're not getting paid and it's not, and it's not their primary passion, then it's not, it's not going to happen. And so we, we, you know, we'll be doing research along with our clinical practice, but we will be, you know, you know, distributing the research, you know, monies, you know, what we have decided to do is do a split between the practice and the provider who is delivering the services. So there is some skin in the game and it allows people to be incentivized to, you know, to do the extra work. Excellent. So I'm glad you said that because again, this is a reoccurring question, right? And why people choose not to do it, right? So that being said, I think this is a great opportunity to introduce Dominic. Perfect, Ari, thank you. And talk about what some of these companies specifically Exendo, what they have to offer folks, right? Sometimes like Dr. Smith said, you just can't do it internally, right? And it's not worth it, not only financially, but just time-wise to build it internally, right? So what are those options? So Dominic, please tell us about your you and your company and your background. Yeah, thank you. And just every time Dr. Smith, I hear just more and more impressed with your journey and everything that you've been through to get here. But, you know, I think you were speaking to it exactly. Exendo Clinical and as Peak Heart's research partner, really what we do is we try to take on a lot of those burdens that the docs normally, if they were doing research themselves, trying to build it themselves, even within a group, with that one coordinator, there's a lot riding on that one coordinator and that infrastructure in these clinics a lot of the times. So what Exendo Clinical does is we try to take on those burdens, the financial burdens, the operational burdens. We do legal regulatory and compliance on our side. We hire the clinical research coordinators. We're the ones that go out and help find the trials. We have this centralized team that helps with recruitment and enrollment. And so we try to take on all of those things as the burdens of the docs, their data entry, their time, because we know that we want to put our investigators and our physician partners in the realm of what makes the most sense to them, which is treating the patient, seeing the patient, overseeing the patient. And so that's how Exendo Clinical as a research partner to Peak Heart really works. And so when Dr. Smith and his colleagues first came to us, it was so invigorating because the first thing, we asked them, why research? Why are you interested? And they said, we want to provide new therapies and treatments to our patients. And so for us, it's so exciting to hear that. And invigorating, like I said, because the striking difference is that if private practice groups aren't the one performing the research, generally their patients don't know that trials are going on. They're not associated with the academic medical center and these trials could be happening really nearby. And so for Peak Heart, for other physician partners and generally for private practice, partnering with somebody to do research is so important because those patients deserve access to those really cutting edge trials too. I mean, to make clinical trials look more like the people affected by the disease. So we try to take on a lot of those things to provide better access for the docs so they can do everything they do great without those burdens like we talked about before and access for the patients so that they can participate in these new therapies and treatments. So I'm glad you brought that up. I think that's a great point as to how to diversify clinical research trials in the future. A lot of these smaller clinics, smaller upper practices and out in the communities, out in the suburbs, out in these underserved communities are never going to have the resources to build the infrastructure. So companies like you guys are a perfect way to engage community, bring new devices, new medications into the community, right? I mean, there's obviously, it's more complicated than that. There's education, there's a lot of other aspects to it, but this is one of the aspects of it. So Dr. Smith, from your perspective, how do you hope, what do you aspire to build in your private practice, research wise, right? Well, I think the first thing that we want to be able to do is be able to bring new therapies into our patients and our practice. So new meds, new devices. So we did a lot of cardiology, cardiology interventions, electrophysiology, of course, vascular surgery. And so I think that's probably the first step. But as we get farther down the cycle, I think we would be interested in publishing results and being part of a trial where we're a bigger, more engaged player in the process too, as well. Yeah, and Dominic, you guys just aren't just cardiovascular medicine. Your portfolio is bigger, correct? Yeah, that's exactly right. So we work with docs from cardiovascular to pulmonology, nephrology, GI. We do a lot of that across kind of the heavy therapeutic areas where there's a lot of clinical trial volume and there's a lot of patients that can be on these new kind of cutting edge medications. So, you know, peak heart, just to go back to something that Dr. Smith said that was really interesting is that they've done such a great job in a lot of the private practices and people on the line here today have built themselves into these communities. They've embedded themselves into that. And so research is just another care option. It's just another way to get their patients to improve population health and health outcomes in general. And so as a lot of these groups have physician liaisons, are communicating in the markets, have these great referral patterns with family med docs, it's just another piece to that to say something like, hey, we can do a little extra and we can help improve things a little bit more for our patients. And with that, you know, the docs get to be able to do all that without once again, those burdens. But yeah, so we work in a number of different therapeutic areas, you know, obviously with peak heart and vascular on the drug device and procedural side though. And how does the relationship work? Do you, Dr. Smith, do you go to them with a trial or do they come to you with a trial, with a prospective trial? I mean, I actually, I think it's a little bit of both. So I think that, you know, primarily they are out there, you know, calling the industry, looking for different trials. They interview all of our investigators to ask them what their areas of interest are. And then they tailor make, you know, suggestions that would come to us for studies. But, you know, as what happens in the world, you know, the physicians, the busy physicians have their own, you know, relationships with industry as well. And so a lot of times, you know, we will get presented opportunities and then I would, you know, and then I go to Dominic and say, you know, can you help me get this off the ground? So I think it's a little bit of both, but probably the more common, you know, mechanism is they're out scouring, you know, the different options available and bringing them to us. Awesome. That's right. And I think that's, you know, we're certainly the ones as Accentive Clinical, we're building relationships with sponsors and CROs to go find the best trials that fit with each one of our physician partners. But to Dr. Smith's point, you know, the docs are constantly getting bombarded as well. And so we try to, once again, take that burden if there's something that they find interesting that they get presented a trial of, you know, like the one Dr. Smith that you were speaking of earlier with the hospital in town. And not to say that research and AMCs and hospitals, that'll be there. But how do we support that through trials like with Dr. Smith and his team? And who does the, do you guys, Dominic, recruit the patients or does Dr. Smith send them to you? Like, how does that work, that connection? Yeah, so that's a really important piece. I think one of the things with clinical research is that 80% of trials roughly fail to hit their enrollment goals. And so enrollment, recruitment, whatever word you choose to use is, it's gotta be a multi-pronged approach. And so the way that we see it over here at Accento Clinical, and I know other organizations do in this space as well, but it's kind of a multi-pronged approach. The most important relationship though is the trusted one between the patient and the physician. And so that's where we always start. We work with Dr. Smith, his colleagues, his team to make sure that we're looking through their EMR, to make sure we're identifying patients with upcoming visits that might fit for the trial. But then it's also, you know, how do we go out there and present these opportunities to the larger base in the community as well, through, you know, different, you know, social media, different kinds of direct to patient pieces, and also leveraging the current relationships that Dr. Smith and his team have built up over time as well. So, you know, enrollment's probably the toughest or maybe the last mile in research to get the patient on the study. It's a tough one, but it's gotta start first and foremost with that trusted relationship between the doc and the patient, and then the trusted relationship between that doc, the group, and the community as well. You know, I would just add to that, that we, you know, we actually, you know, are going out and doing the sort of, you know, boots on the ground, you know, grassroots marketing to practices in general to tell them about our group and what we do. But now we use the research as part of that as well. So, you know, we're involved in, you know, clinical research. We have, you know, access to, you know, cutting edge, you know, therapies and devices that maybe some other practices don't have. And we certainly, you know, we'll offer those where appropriate. And then we, you know, like you said, we'll, you know, directly have some patient facing, you know, information on screens in the lobbies, in the rooms of the patients, you know, in the rooms of the patients, as well as our, like, you know, social media. So they know that, you know, it's at least available, that they might get asked about, you know, certain, you know, research studies. So that way, when we, if, you know, we find a patient in our practice that we think is appropriate for a study, it's not like a, the process is a little bit smoother because they've already seen, they've already seen it, you know, some of the brochures, posters, it's on the, you know, the video screen. And so, you know, it's a little quicker, you know, discussion that, hey, you know, this is available, you might be a candidate, you know, so forth and so on. And I know that you said you were out doing, you know, network development, obviously, as all private practices do, which is, you know, critical to creating referral patterns, but do you think, or have you seen, and I know this is a relatively still pretty new relationship, but have you seen new referral patterns because of that? I think we will, I don't know if we have that, you know, data really like solidified, but it is an, it is a, I found already that it's an interesting talking point and people are interested in engaging in that discussion. Because that's not something they hear every day. Yeah, and that's typically what we hear, right? You just, there's, you end up creating new relationships indirectly because the potential of new, of your patients giving them alternatives, right? For the PCPs and for other general cardiologists when you send them to the surgeons and to the interventionalists. So yeah, I think that's, it would be fun to see that data in the future because again, that's the data you want to go back to administration with, right? And say why it's so important to do clinical research and why they should be helping to support it, right? It's stuff like that. It's all the intangibles around it. And you, I mean, you can't, you started this conversation with NIH, right? So clearly you're versed in clinical, in research, right? So for a lot of folks who say like, we don't do NIH, we don't have that background but we want to do clinical research. Do you think it's still viable for them having no experience to connect with a company like Exendo to start doing clinical research? I do, I do. I don't think that that background is, I mean, other than just kind of given, some foundation, educational foundation for it, I don't think it's necessary at all. And I think that the most important part of it is just being willing to look for patients that would be candidates for a study and then talk to them about it. The other things you can learn on the job and what you can't learn, you can hire out. Yeah, awesome. And Dominic, for you, Exendo isn't just in Arizona, right? That's correct. So as a site network, we're in, Phoenix is obviously a very, very important hub in a market for us. We're also in Houston, actually, that's where our flagship site was. So in both markets, we have similar cardio cardiovascular type investigators, pulmonary, nephrology, those other pieces as well. And so we try to replicate these markets, creating the depth and the standardization in each market so that what we do with Dr. Smith and the learnings that we have on his vascular studies, we can take those same learnings and work on those trials in our Houston market as well, and really be benefiting the most patients because we're learning from each doc in each one of these markets. And so that's been something really exciting for us as well as starting to get the docs to chat, not only within the markets, but across markets as well. So at this point, you're just working in Texas and Arizona? At this point, we're in Texas and Arizona. I think, like with any good site network, you wanna create, like I said before, some of that depth before you go into a new market because it takes resources from our side, extended clinicals to go in and start with a new doc, just like it did with PCART and all of our partners. So we'll be expanding into probably three new markets by the end of next year. Where we think, just like with Houston and Phoenix, there's a large population there that has the epidemiology and the indications of the patients that need to be treated for those specific trials. And they're diverse patient populations too, because once again, they're the ones who generally are the ones left out of research. So all of the mix aligned with the amount of private practice groups that are there that want to work in research and are therapeutically aligned. We kind of use a lot of data points to make sure we know what we're going next, but probably three new markets by the end of next year. So two questions to follow that up. One, I'm an operations person, so inquiring minds need to know. So when peak cardiology comes on board, do you automatically build a team for Dr. Smith of like, these are his research coordinators and this is his pre-award, post-award, or is it your entire team that kind of collectively works on all your different practices? Yeah, that's a really good question. So we have some things that are standardized and centralized. So some of those pieces, whether that be legal, regulatory, and compliance, whether that be our business development efforts, those are more of our centralized services. So we scale those based upon how many docs are in our groups, the different types of docs that we partner with. Some of those more site-specific resources, that's really, you know, we have resources, clinical research coordinators and assistants and leads in each one of our markets, but we build that as we partner with more groups and are working on more trials. So right now we have a couple people that are devoted to the PEAT-HEART relationship, but like with anything, it's important to be able to scale appropriately. So we will certainly, you know, continue to add staff as Dr. Smith and his team work on more and more trials. So stay tuned, we'll be at, you know, 100 people the next time we talk maybe, but now we have some staff, you know, in each market right now and that'll grow as we grow and as we grow our physician partnerships and the number of trials we work on. And Dr. Smith, what have been the biggest hurdles? I can't imagine everything has been completely seamless in this new relationship. Dominic, what are yours? Oh, I think that, you know, you're right, there's always hurdles. I think the most important thing, if a practice is going to set this up, is, you know, you've got to figure out what works for your group as far as setting up where the research money flows, because that's the first, that's the thing that's going to wreck it if you get people that are disgruntled because they're doing, you know, they're doing more of the work than Dr. B, but they're getting paid less or, you know, that sort of thing. And so I think if you're going to put money up, you're going to put, sorry, if you're going to put effort in up front, that's the first thing you got to nail down in your group. There's obstacles at every turn, contracting and, you know, just the paperwork, and you're, you know, you have to get, you know, equipment and clinic, you know, the budgeting, budgetary concerns, and just, you know, down the line. So there are always, there would always be obstacles. But I think that further on the practice side, at least, I think that's the first thing. That's the first thing we did. And I think that's, in my opinion, is probably the one thing that, you know, you got to get right at the beginning. Yeah, that's always money and effort somehow always are the disruptors, right? And you didn't say the biggest obstacle was me, Dr. Smith. Not yet. We're going to regroup. We'll see. Yeah. And how, what, how are you going to measure success? Obviously, you can't, it's not just, you know, how many trials you do. But what, you know, I know you're looking to be able to publish and hopefully, you know, be on, you know, I think all clinical research aspire to be able to be on the stage and be part of this, right? And be part of these trials. But how are you going to measure success? Because that's going to take time, right? Between now and at the end of year one, year two. Sure. I mean, I think that, you know, the metrics that we will be looking at will be how many patients we get enrolled, like patient engagement. And so if we're getting, if we're getting, you know, a lot of patients enrolled in these different studies, and, and we can make it work in our workflow without disrupting our, our, our standard processes too much. So in other words, like we can, we can continue to see, you know, 30, 40, 50 patients in clinic or whatever the doctor sees, but still be able to do the research. I think that's going to be a big, you know, part of it. And then, you know, looking at the patients, if, if we, if we can actually show that we're growing our, you know, referrals because, because the research people get referred to us because of a trial, because of a new therapy, I think that's going to be an important part of, you know, something that we would, you know, put in the big win category for sure. Yeah. I love it. Adding value to the whole practice, right? Yeah. And do you have, Dominic, do you guys have access to the electronic medical records of Dr. Smith's practice? We do, we do. We found that that's an important piece in this partnership because of the fact that there's just, you know, once again, taking on that burden of having to query and look for patients and match up ICD-10 codes and IE criteria. That's just something that we, we try to take on. So we do have access to that. Okay. I'm assuming all the more reason the private practice, smaller groups, it's a little easier to work through that hurdle than in these large institutions. That's, yeah, that, that is exactly right. Yeah. And then you didn't, did you, did you want to keep it a secret where the markets that you wanted, you were expanding into or are you able to share where you're, where, what's next for you guys? Yeah, good question. We're, we're pretty transparent of an organization here. It's on our website if you ever wanted to go and look, but yeah, really the next markets that we're looking into are going to be Las Vegas as well as Sacramento and probably San Diego. The reasons for that are what I mentioned earlier around, you know, patient populations around, you know, is it research saturated? Is it, is it the Boston's and the Florida's of the world, or is there actually opportunity to go in there and be able to partner with docs, you know, such as Dr. Smith to, to do that research in those communities. So those are the three ones that we're really looking at to expand into next. Okay. Yeah. That's unfortunate for us back here on the East coast. Right. But there are a lot of academic institutions out here. So I guess my, my so far Dr. Smith, what's the biggest lesson learned? Do you wish you would have encountered some company like this years ago, or is it the right time, right place kind of thing, or what do you think? Oh, you know, I, I think you're, you know, the journey, the journey sort of finds you, I think a lot of times, you know, and so I don't, I don't really like regret the way things have gone necessarily, but it would have, it would have been interesting to have started something like this, you know, a decade ago and be and see where it would be at this point now. But no, I'm excited about, I'm excited about this and where the, where the, you know, where this is going to go and what the, what the future holds for it. Because I think, I think it could, it could, it could definitely add a, you know, an integral, interesting piece to, to our practice. Yeah. Well, we look forward to hearing kind of a follow-up right to how it's evolved and answering all these questions. And Dominic for, what about for you? What's the, what do you hope the audience takes away? Yeah. I hope the audience takes away the fact that just because you maybe left academic medicine, it doesn't mean that you can't do research anymore. I think it's going to be very important for, you know, people on the line and for the word to get out that research can still happen in your private practice. It can actually help you stay private if that's what you want, by adding on this, this research arm, you know, you'll need to partner with somebody that, that can take on a lot of those burdens for you because it is financially constrained or operationally or from an infrastructure perspective, but research can still happen in your private practice. And I think that's best for the docs. I think that's great for the patients. And so I just hope people take away that, you know, research can happen, even if you're not in academic medicine. Agree. I'm incredibly hopeful that our members and everyone else who are thinking about doing research truly pursue it, right? Because we're obviously it's broken. We already, we know it's not, it's, it's not seamless and we know it's a big burden now. We need to be able to do better. We need to be able to enroll more patients, more diverse populations. So there's a lot of, you know, a lot of broken parts of the system. Then they think you guys are a solution to a, to a very dynamic problem, right? That we need to just work, you know, be more creative and recognize that the old way isn't the only way. Right. So I appreciate your guys's journey, Dominic, and I appreciate you, Dr. Smith and your group for, you know, tackling this in a more creative manner and, and, and trying it out. And I'm looking forward to, again, your story and hoping that you build out this dynamic research entity. Cause I loved it. I love these stories. Right. And I think people learn from it. And I think, and this is a reoccurring theme in MedAxium with our members, right? There's no perfect solution for anybody, right? Whether it's, you know, the clinical operation, the compensation model, the research structure, everybody kind of needs to build what's right for them based on their, their physicians, right. Their clinicians. And we know with now the, the population of, you know, calling it this new sandwich generation, right. We have our senior clinicians who taught and mentored a lot of the clinical leaders now. And at the same time, our clinical leaders are also forced to, to work with not force. And I don't mean that in a bad way, but, you know, integrating all this new generation of, you know, of cardiologists and vascular surgeons who are, you know, post 80 hour rule, immunization, very different training, right. And figuring out how we build this new model. And I think it's an ideal time to figure out how you incorporate clinical research. That should be part of the conversation too. It's not just OR efficiency, right. It should be, it's the entire practice. So I look forward to having more conversations with you guys. I'm looking to see if there's any questions. Oh, we do have a couple of questions. Let's see. Oh, so this is a big one. I think we touched on it briefly, but if you could elaborate on the profits from the research percentage hourly stipend, how do you share across your practice? Yeah, sure. So when we, when we get a study, the the cost, the cost, the, the, our Accendo will help negotiate a lot of the investigator billings or costs, you know, associated with our time. And, and Dominic can probably discuss that a little bit further, but then what, what money flows into our practice through research, what we decide as a group, and I don't think there's gonna be a right answer for every group, but you know, what, what worked for us is to do a, an even split between the practice and the provider who's doing the the work on the, on the, on the study. So because, you know, we're using practice resources to, to, to do the study. We're using our patients and we're, we're still using our MAs and our facilities and, and that sort of thing too. So that's, that's what worked out for us. But again, I think it's just, you know, that that's been very practice specific. And from an Accendo clinical side, the financial model on our end and how we partner with, you know, PCART and Vascular or any of our physician groups is really around, you know, we're the ones who go and do the contracting, negotiating the budgeting with the sponsors on their trials, but it's very transparent with our, our physician partners about, you know, this is how much it is for this activity versus this activity and making sure to pay them fair market value for their time and their effort. You know, as Dr. Smith mentioned, you know, you want to be able to still see your 30, 40 patients. You don't want to be disrupted, but these practices also don't want to be losing money on research, right? There's, there's an additional revenue stream that can be gained through research. So that's really our job to go and negotiate those contracts appropriately and correctly, bring that back to Dr. Smith and the team so that they can say, yes, this looks like, you know, the hourly rate or the per patient or the per procedure is the correct amount or, you know what, it's a little bit lower than we'd like. And so that's where Extended Fundable goes back to the sponsors. And, and once again, I think it's all around financial transparency and it's all around making sure that, you know, the groups are made whole and generating additional revenue for their groups. And at the same time, it's clinical research, right? It's a budget. There's no guarantees at the end of the day, right? So we all go into a very optimistic, but understand that it's all, it's a percentage, right? It's not a hard dollar at the end. So there's another question here, and I'm hoping I'm understanding it correctly. So I'm sure there's an opportunity to utilize some of the resources that Dr. Smith is using for another complementary practice in the Phoenix area would be good to, what would be good therapeutic areas that are complementary, pulmonologist, endocrine, et cetera. So I think, so Dominic, you guys are doing other clinical trials, other specialty areas in medicine and surgery, I'm assuming. And you have the bandwidth to continue to grow in those areas also, right? Yeah, that's exactly right. So if I understand the question, maybe it's around can CRCs and the staff support, you know, cardiovascular as well as additional therapeutic areas. And our answer to that is yes. Now these CRCs need to be trained up on the protocols and all of that, but yeah, we have our site staff supporting cardiovascular trials and pulmonology trials at the same time or cardiovascular trials and, you know, renal trials at the same time. It's just making sure that you hire the right staff, the staff that's willing to continue to expand and grow themselves. But it comes down to, you know, do you have the staff that can learn and train on these new protocols as well? So for scalability, we always look to have our staff be able to do multiple things and wear multiple hats. But I don't know if there's one therapeutic area specifically, I would say that kind of addresses it perfectly. I would say that a lot of our staff works across therapeutic areas. I hope we answered your question. If not, please feel free to email me directly and I'm happy to go back to the guys to get the answer. With that, there's no other questions. Again, thank you both for your time. This was very educational for me. I'm hoping our members also take away some learning, some, you know, interesting learnings from this. And at the same time, if anybody has any questions out there, feel free to reach out to me. And I'm happy to connect you with Dr. Smith or connect you with Dominic or connect you with any other resources, but also know MedAction is here to support you and find you the resources to help you build your practice. Thank you all. Good night. Bye guys.

clinical research

private medical practices

Accendo Clinical

patient recruitment

clinical trials

infrastructure support

diverse communities

therapeutic areas