Thank you for joining us for today's webinar, Partnering for Growth, Unlocking Value in Cardiology with Capital and Operational Partners. We are just gonna wait for others to log in a little bit longer, so please stay tuned and we'll begin the webinar in about another minute. Hey, everybody. Thanks for logging on. We're going to give it about another 30 seconds to see if some more attendees are joining in and then we will begin today's webinar. Thanks for your patience. Well, let's begin today's webinar. My name is Joe Sasson. I'm the Chief Commercial Officer at MedAxiom and appreciate everyone joining us for today's webinar. It's entitled Partnering for Growth, excuse me, Unlocking Value in Cardiology with Capital and Operational Partners. And as you can see, we have the team from Heart and Vascular Partners here with us today. You'll be hearing from the CEO of HVP, Bill Dracoff, Peter Burr, the COO, and Aaron Petrie, who is the VP of Revenue Cycle Management. And they've got a lot put together for you today, so we don't wanna waste too much time in getting started. I do wanna point out before we begin that the way that you will communicate throughout this webinar is going to be through the Q&A button and the chat button at the bottom of the page. Now, the chat is where you're going to find the presentation slides. So it's not a place where we're gonna be able to communicate with each other, but it is where you'll find the slides for downloading. The Q&A button is how you can send questions in to the presenters and we will field those as appropriate either throughout the presentation or most likely hold those till the end of the presentation and take your Q&A at that time. I'm excited about today's webinar because the world of cardiology has really changed and the requirements on independent cardiologists specifically have really grown to a point where managing all of the HR and the legal and the accounting and the IT changes and reimbursement changes and new technologies, it's really become fairly overwhelming. And to band together under kind of a capital model and an operational model with someone who can help you to navigate those new waters and provide additional resources to the practice is really become a new option for folks that wanna maintain independence yet have a wider resource base. And when looking at capital and operational partners, there's a number of choices in the field, but they're all very different. And so it's kind of like saying a Ferrari and an F-150 are both automobiles, which they are, but they're incredibly different. And so what you're looking at in terms of value-based care model, the size of practices that you wanna be joined with, what type of culture that platform has and how they're going to really manage some of those back office functions, how they're gonna integrate your staff and physicians, everyone has a different method and a different methodology about who they wanna partner with and how, especially when it comes to regionality. So there is not a one size fits all. So today we wanted to make sure that we were able to kind of learn a lot more about what these partnerships can look like and even more specifically how Heart and Vascular Partners approaches the marketplace with these and how it chooses to partner with practices across the country. So with that, I'm thrilled that they're able to bring us this education today. I thank the team for being here with us and I'm gonna turn it over to Bill Dracoff, the CEO of HVP to take us away. Bill, thanks for being here and please get us started. Yes, thank you, Joe. And thanks to the MedAxiom team and community for joining us this afternoon. It's our privilege and pleasure to tell you a little bit about, as Joe said, one way that resources and teams like ours partner with cardiologists to support them in their growth. On the next slide, we give a few stats and some figures in terms of our company and why we exist and where we exist. We're focused on supporting independent practice of cardiovascular medicine. And we do that in a model that we built that's fairly operationally intensive. And we'll talk a lot more about that as we go through the discussion today, both within the four walls of your practices and helping unlock potential there, and also in the development and management of ASCs. And you'll see that in our team and some of the work we've already done. Our approach, and you can see kind of where we've already planted some flags thus far. We tend to go to secondary markets, not huge metros, where we can find clear clinical leaders, whether they're in a health system arrangement or independent, and partner with them to extend their advantages and position that they've built. A lot of the work that we'll do, whether it's an independent group or health system affiliated, relies on a lot of operational intensity, right? So we're gonna do fewer, deeper investments with the physicians we partner with, as opposed to broad and wide. That enables us to facilitate de novo operations and start things from scratch. On the next slide, you'll see our mission and values. This is important for me at our board meetings and our management meetings and for things like this, just to share a little bit about who we are in our culture. And speaking of starting from scratch, this was the first slide we wrote a couple of years ago as we were getting started. The only two points of our values that I would highlight here are the intellectual honesty and the rigor. You'll see some examples of that today in terms of the data, how we approach problem solving with our physician partners and how we work hard and in a dedicated fashion to deliver results for them. The next slide begins to talk about planning and preparation, free partnership, free investment. And that's really the meat of the discussion today what are the tools, the opportunities that we have to deliver value for our partners and how in somewhat tactical way, how do we go about doing it? A few highlights as it relates to HVP, our management team and the group that we've assembled has lots of experience in evaluating and investing in healthcare platforms and practices. That's not our financing partners, not the board who of course do, but the team itself, the folks who are showing up on a Tuesday morning to help you through a problem. We've done this work and we've done these sorts of decision-making processes ourselves. And it's really rooted. Every time we're making the decision or advocating to invest millions of dollars in a practice, it's rooted in this shared vision of how we're gonna deliver value together. And we don't start talking about that after the closing. We don't have like a light idea of it and then we validate it later. It starts months before we'll transact and it starts with a conversation between the physicians and our management team. And we build a hypothesis, if you will, or a set of assumptions that we validate together about how we can unlock the value and really bring our capital and our execution resources to your benefit. Time is valuable. We don't wanna like start day one and kind of dust things off. We wanna be hitting the ground running and able to deliver results as quickly as we can. We also think that alignment and the upfront investment that we make in the dialogue, in the data, in the planning, in the operationalizing of these initiatives reduces execution risk as well. There are fewer variables to deal with on the other side. And as in all partnerships, business or otherwise, getting alignment and really understanding the intentions, the will, the motivation of partners on all sides of the transaction is really, really critical to assess and validate upfront. So we're gonna spend a lot of time with our physicians, with their teams, with the administrators, their practice leads to get a better sense of where they are, what strengths they have, where we can come in and support them. And as Joe alluded to, a lot of the, I'll say back office or administrative functions, certainly we take that on and we provide scalable support there. A lot of times that gets overlooked. Those are critical areas to create capacity in the leadership and the management of the practices. So we do that and then we turn around and apply our capital and operational expertise to deliver the value that we described and aligned on. So to talk a little bit more about what are those levers that we pull and what's the process through which we deliver on those promises that we make together and those commitments that we make, I'm gonna hand it over to my teammate, Peter Bird, who runs our operations and is really the captain of the organic growth engine at HVP. Peter. Thanks, Bill. Good morning, good afternoon for all of you, depending on where you are in the country. Oh, does everyone have me? Great. So like Bill mentioned, a big part of our focus as an organization and as a platform really often is geared towards how do we partner with the physicians who lead the practices that we work with around the creation of long-term value. Bill mentioned a little bit about what often in webinars like this gets a lot of attention, which is the process of going through a transaction, aligning on financials, getting integration put in place so that we have the ability to provide that back, quote unquote, back office support. Our real focus oftentimes though is saying, great, we're partnered. We wanna be able to hit the ground running day one post-transaction. Oftentimes what that requires is a rigorous approach to value creation planning. So a couple of things. First, I'm gonna walk through what our approach is to value creation, how we think about different buckets of value creation with partners that we work with, either in our first year of partnership or two, three, four years down the line. And then we're gonna talk about a few specific examples, tying back to themes of operational efficiency, revenue cycle management process improvement, and then physician recruitment, which are three representative areas that we typically attack. But what you see here on this page is more representative of a full suite of operational engagement that we bring to play. But first I wanna back up a little bit, talk about what HVP's philosophy is. And as a group, and I'm sure the folks represented here in the attendees of this meeting, not to mention all of those folks who aren't, would say that no two cardiovascular practices are created the same. There's a different mix of subspecialties within each group. There's a different mix of experience. There are different markets that they serve, which dictate the way that a group has to operate in order to be successful. What I would say is that the way that we think about this is we wanna get a good sense of the group that we're going to be partnering with. But then HVP brings an awful lot of data experience in order to assess and provide what I would call a third-party lens on a group that's been existing for a long time. Now, don't take that as us saying, hey, we're gonna come in and do a whole bunch of consulting work and make a number of recommendations and then go hands-off. Instead, we try to focus as much as we can on things that are actionable and areas where HVP can directly interface with physician and practice leadership to take action that has a benefit both from a quality and a workflow perspective in order to improve physician quality of life and or patient experience, but also improve the financial output and performance of the practice writ large. Bill mentioned a little bit that physician alignment's critical. So we don't go off and create these plans in a vacuum. Typically, when we first partner with a group, we'll go all the way from obviously initial conversations that are one-on-one in person over Zoom, phone conversations, in order to understand the culture of the group and what different growth initiatives have been attempted over the years, what's worked, what's failed, where the group thinks that they have opportunity of things that maybe they haven't had the time or resources to get around to. Capital has been a risk. Underwriting from a data perspective is a challenge. And we wanna bring that into our analysis. We also look at all sorts of data from the practice before we even work with the group to understand what's driving the group's earnings. How does that measure up against either industry benchmarks or other groups that might have similar dynamics and how they're performing? Because that oftentimes might make an opportunity apparent to us. Typically, once we go through that analytical and fact-finding process, before we ever formally partner with a group, we'll align with them on an actual value creation plan that is grounded in data, supported by process and those conversations that we have, and ultimately agreed upon as our initial execution plan, call it 90 and 180 days after we partner with the group. It effectively gives us a roadmap to what we're gonna go out and do. Now, this value creation plan, which I'll flash up a couple of slides here in a minute or two, typically involves things that are much more action-oriented towards the actual operations of the practice. Bill mentioned at the top that integration is also a critical component of this. I just wanna focus the group collectively on integration is something that's gonna happen regardless when we partner with a new group. It's gonna entail IT, human resources, revenue cycle, and all of those support modalities that the MSO provides to practices with which we partner. But the value creation planning is a lot less standardized. Typically it's focused on what are the biggest opportunities and over to the right of this page, you see the different items that we typically look at. Now, this isn't a comprehensive list of all the different things that we look for, but it really falls under four categories. One is performance enhancement. How can we make sure that we're providing data, creating incentives, and working with the physician leaders to manage the group to be as efficiently performing as possible? The next is operational efficiency. Oftentimes this is stuff that could include revenue cycle, and that's everything from patient scheduling all the way to billing and collecting, inclusive of authorizations, making sure that we're in network, contract optimization, you name it. There are a lot of things that fall under that category. Second piece of that's process improvement and streamlining. Oftentimes there's an awful lot of growth, even for established practices, where simply by changing the way that the practice does things allows for an increase in capacity and throughput for the clinic or individual providers on their own. The third category is growth investment and program development. Now, these are typically higher dollar investments, but they typically come with outsized returns from a health perspective. This can include anything from physician recruitment, whether that's adding on a new subspecialty within the group, whether it's adding to the roles and or replacing retiring providers. It also includes ancillary development, whether that's simply adding a number of echo machines or ultrasound machines, or if it's upgrading from a PET to a PET-CT or adding nuclear imaging in a second location. So it's really critical to making sure that we're optimizing the throughput of a practice and capturing all of the opportunity within the four walls of the practice as possible. The last piece is around referral relationship expansion and clinic expansion. Most of the practices that we work with oftentimes have very, very strong relationships in their market. Some of the biggest things that HVP can help with is along the lines of marketing, but also going out and selecting the appropriate market, sub-markets within your market where you can continue to grow your presence. So that's a general overview of how we approach value creation. I'd like to flip through the next three slides fairly quickly in an effort, just to give a simple example of what a value creation plan looks like. These are real value creation plans that have been sanitized for the purpose of this presentation, but you can see that we typically start with a hypothesis that then leads to analyses that we're gonna perform, which then leads to an understanding of what data do we need to gather in order to have this conversation with the group? And then we start to look into, okay, who's gonna lead that project? And what do we expect the overall impact of this project to be on the practices financials once we partner with one another? So here you see a first example talking about operational improvements really around headcount workflow vendor changes. The second is around expanding footprint actually by working to fold in smaller practices within a sub-market under the umbrella of a larger practice that we were about to partner with. In each of these instances, we're pulling data from information that's made available prior to working with a group, but also taking third-party information and data from HVP's own sources to identify and accumulate what the actual benefit is gonna be to the group post-transaction. If you could flip to the next slide, it'd be great. We also talk about scheduling and migration improvements from an ASC perspective, and I'll talk about this example in particular in a minute or so, but we're pulling from multiple data sources. So EMR data, site of service analysis from ancillary billing, trying to get an understanding of what are the barriers to optimization within the group, being able to hone in on specific actions that we can take, whether it's scheduling, whether it's contracting. These are all important things that we do, and we try to set out in a high level of detail before even starting execution what we plan to do and the data that backs it up. Next slide. And then talking a little bit about commercial contract renegotiation, supply sourcing initiatives. These are all individual examples of value creation plan. Now, when we go to work with a group, Typically, we focus on four, five, maybe six items that are going to be achievable over the course of the first 90 to 180 days of partnership, or at least allow us to start capturing some of that value creation early on. But these initiatives don't stop at six months, at a year, or what have you. And on the next slide, I'm going to walk you through a couple of examples with groups that we partnered with in the first year, but then talk a little bit about what growth looks like for groups that we've been partnered with for multiple years in the second or third year of partnership. The beautiful thing about the cardiovascular space is there are so many heavy levers for growth that oftentimes are sub-optimized by the groups that are working on it, either because of resource restrictions, time restrictions is actually the most common part, but also the availability of benchmarks and experience in actually implementing change in a focused and coordinated way. So like we've talked about a little bit, HVP leverages our data and experience to try to quickly identify and address opportunities for more improved efficiency. Oftentimes when people talk about taking on a capital partner or something like that, they'll think operational efficiency, and your mind will immediately go to headcount reductions relative to productivity or something like that. Our approach actually tries to focus an awful lot more on opportunities for growth by changing process. So typically, you would look at, hey, how can we cut down on variable expense supply for supplies or something like that? Those are absolutely things that we're going to look at and we're going to suggest to a group, and that might drive some financial improvement just by removing expense out of the P&L. But oftentimes, the bigger opportunity with groups that we work with are really more oriented towards growth. And I'll walk you through a few examples of what that looks like here. I have six listed on the page here, but there are countless others that we can talk about, but diagnostic imaging workflow. There are a lot of groups that do, almost everybody's doing echo and vascular ultrasound in your clinics. A lot of folks are doing some version of nuclear imaging, but the question often is, are those services being maximized? Number one, are you able to serve your patients to the best of your ability with limited wait times, really good patient experience? But also, are you capturing as many of your patients as possible in your clinic setting versus having to send that to a third party or what have you? Really, really big opportunity often there. There's also ASC and OBL throughput maximization. These are things that we often see even with well-established, highly efficient surgery centers that are operating at 85, 90% of their overall capacity. Oftentimes, they're still sub-optimized, either because of the way that they're engaging with contracts, schedules, or what have you, and there's often a lot of opportunity there. The third piece is around devices. I know this is a topic with a lot of different folks and some consolidation in the market, but many groups are still managing all sorts of devices, either on a limited basis because it's challenging and resource-intensive in order to do so yourself, you might be contracting out to a third party, might not be leveraging technology to its maximum extent. It's a huge opportunity to continue to grow there. Provider and APP scheduling, efficiency, maximization. We have folks that are working really, really hard, but sometimes they're not working smart. It's all about how do we figure out how to get the productivity out of the same amount of output from a physician or a provider in the same amount of time, but actually make that time spent more useful. Staffing ratios to support that productivity. Oftentimes for us, we think about what's the right recipe of staff to help support a physician or a provider do the work that they need to do in order to be successful. For us, oftentimes this means addition of staff, or it might mean reassignment within the clinic. A great opportunity for us to continue to grow. I'll talk a little bit now about the three things that you see across the bottom of the page. The first is around pet workflows. There's a group that we had partnered with, and within one year of partnering with them, we saw a 35% increase in their overall pet volumes. This was a longstanding program. It had been around for five plus years within this clinic. They were scheduling at six or seven a day when we started working with them. Oftentimes, they would have two or three cancellations per day, which is not atypical, either due to patient prep, authorization issues, you name it. HVP immediately identified this as an opportunity, both through experience data, industry benchmarks that oftentimes if workflows are optimized, you can see north of 10 patients per day in a standard pet program. We very quickly worked with them to change the technician workflow, but also change how we were thinking about the authorization process to increase the amount of yield that we had on the daily schedule. We were able to decrease the overall patient time per test by 40%, and then we expanded the template, refined the authorization process, and we're in a position now where we're scanning eight to ten patients a day. What that's allowed for is this clinic's overall patient wait time was close to three months for a pet, and they were sub-optimized from an overall volume perspective. So there's a benefit to the patients. There's also a benefit from a clinical perspective for physicians, getting the testing that you need on your patients within a good time frame, but also from a financial standpoint, they're leaving dollars on the table, and it was all due to inefficient workflow driven by really only knowing what they had known since they started the program. The second example here is around ASC and OBL scheduling. We took a facility that was operating at 85-90% of their overall capacity, had a lot of variable payer contracts based on the ASC and OBL side of service. There were some minor contracts that were in network or out of network, and there was a lot of opportunity for optimization there. So what we walked in and did and agreed with the physicians to do was to develop a contract database. This is a group that had probably north of 40 different payer contracts, but they were all in different places. They were in their original form. There was nowhere that we could look at a singular fee schedule across all payers across different sites of service by CPT to understand what different payers actually reimbursed for different services. So that was step one. The next piece was developing an analytical tool set for the site leaders and physicians to utilize to determine site selection, what was appropriate based on where we had an in-network contract versus where we didn't, and it really helped to mitigate a lot of the errors that were happening in the scheduling process. Then there was a process with schedulers in order to ensure that there were no barriers to procedures being scheduled in the surgery center, created some back-end tracking to create a reinforcement loop with physicians to help them understand how the process was working and how it was generating improved efficiency, and then taking the contract database and working with individual payers to whether it was adding codes to a contract that the group had been doing for some time and the contract hadn't been updated or otherwise, and it all led to a 15 percent revenue increase on about a four percent increase in volume over the course of the first year of partnership, which was hugely beneficial for that group. The last thing that I would call out is around device monitoring, and speaking specifically to implantable loop recorders, we were working with the practice. This was actually one that we partnered with for quite some time and a little bit further down the path, and their ILR device monitoring typically had been handled on-site by members of their clinical team, and they were still relying on device vendor platforms, which they were using four different device vendor platforms, which required logging in individually, checking alert status, filling out the reports, sending them off to the physician for signature before they could get billed. At the time when we started this initiative, their billing compliance rate for these procedures was 32 percent of the available. Best in class in this area, typically we see quoted around 85 to 90 percent of a billing compliance rate. What we worked with them to do was to implement a pretty novel third-party technology solution. Many groups simply outsource this to a third party, effectively takes the global fee off the table, and the practice gets great service, but from a billing standpoint, they're only capturing the professional portion of the billing code for them. This allowed us to pay a nominal fee from a platform perspective in order to monitor alerts, and then we were able to maintain in-house alert processing from a clinical standpoint, and then start to deploy a significantly improved billing compliance rate. We actually, over a six month time period, went from a 32 percent billing compliance rate to a 55 percent billing compliance rate, which is an increase of 73 percent over the baseline. This is something that we're excited about, and we actually see opportunities not only with all the groups with which we work, but really many that we work with, to continue to implement this, and oftentimes it's not a one-size-fits-all. There's not a straight-shot third party that's going to magically create this. It's the interdependency between practice operations, the right technology solutions, and then some global processes that that HVP puts in place. So this is a pretty good example, I think, of where we try to think about not necessarily having folks work harder in order to generate more productivity, but having them work differently in a way that removes some of the barriers and hassle, and allows for more efficiency from more of a growth perspective, versus simply from a cost containment perspective. So I'm going to stop right there, and I'm going to kick it over to Erin to talk a little bit about one of the other areas that we typically address with groups when we first start working with them, which is revenue cycle management. Thank you, Peter. Good afternoon, everyone. We can go to the next slide. Oh, never mind, that's the right slide. Sorry, you can go back. Okay, well, in revenue cycle, our role is really to enhance the overall revenue and improve speed to collect, to create value for our physician partners. We do that in a lot of ways, but I'm going to walk through some of the primary levers that we pull on this slide. Denials being the first, it's a major obstacle to timely payments and improve net collections. Primary reason we've seen for denials is really, being challenging is really lack of visibility into data, particularly it can be difficult to translate claim level data into actionable reporting. So our team's invested really heavily in identifying the best denial data sources for our practices, and that can be different depending on the system and the access that we might have. And then once we do have access to that data, we really begin the process of organizing remark codes into denial categories that allow us to identify opportunities within specific areas of revenue cycle. For example, if you have high volume of eligibility or patient demographic authorization denials, that might indicate issues in your workflows in the front office. And kind of digging in there a little bit more, since so much of denials management is really reactive to trends in the data, it's very important to have good workflows to manage the incoming claims appeals process. So we've worked really hard to define work queues for our teams to help ensure that all the denials are worked timely. In some cases, that's not even functionality that's built into the billing systems. So this can be another opportunity to leverage the denial data tracking. Additionally, resources like standardized appeal templates have been really successful for us and just making sure that all of our staff are really taking their best shot at every appeal attempt. The ultimate goal of denials management really is to proactively avoid the denial rate. So at HVP, we analyze the denial data and dig in to determine the root cause of the trend. That can be a lot more challenging than it sounds. Sometimes the remark codes might not even accurately reflect the true reason for the denial. Generally, this process takes a lot of legwork just to research the trend and then definitely in the collaboration with operations, clinical, and RCM teams to resolve the issue. That's why we found that it's really critical to review our denial trends by order of magnitude. Typically, highest revenue impact is the winner, but it's also helpful to look at trends by age and volume of tonight's claims. We went to payer contracting. This is another area of importance for a successful revenue cycle. For HVP, the issues that we experienced in this area ranged from practices having limited to no access to their payer contracts to contracted payer networks not lining up between, say, a practice and the ASC, which limited the possibilities for patient scheduling. What we found is that gaps within your payer networks or payer credentialing can be incredibly costly. Increases in out-of-network or provider credentialing denials, they end up creating really high demands on the RCM and practice resources. Oftentimes, the appeal attempts aren't successful. Payers typically just don't want to backdate. For HVP, we found that there was a lot of gaps in the payer network. For that reason, access to the payer contracts and fee schedules is critical. Our credentialing team organizes that data into a master file. I think Peter just referenced that. That can be used not only to prevent the gaps in the payer network and within credentialing, but also can be leveraged in negotiations with commercial payers. Looking forward into patient responsibility, successful management of the patient component of reimbursement is really vital to both the speed to collect and the net collections. Many of our practices struggled early on to implement financial estimation and financial counseling processes. This ultimately inhibited their ability to improve their and this ultimately inhibited their ability to improve time of service collections. We see that patient AR tends to have the longest tail to collect and is usually the greatest source of bad debt for the practice. Just trying to address those concerns, we've partnered with our physicians and practice leads to set standard policies on managing patient responsibility, which has been critical to our success in improving time of service collections. Looking forward into our new service line integration, this is really an opportunity for RCM to collaborate with the clinical and operational teams at the practices to ensure that our workflows are developed proactively to support initiatives like the rollout of, say, a PEP program. We tend to see things like workflow considerations pose the greatest impact to effective billing and coding and collections of the service. Many times these services require special billing system builds that will impact the standard process for the auth and coding teams, so it's really important that we do spend that time looking at the system and the process and investing in getting it right from the get-go. Through that collaboration, we have created playbooks for each of our new service lines that allow us to minimize interruptions and cash flow by defining workflows for each revenue cycle team and helping us identify and resolve potential issues early on. These playbooks have helped us work through things like documentation and clinical requirement issues with providers as well as addressing variability in payer requirements for each initiative. We can go to the next slide. So, I have a few real examples of how we have successfully created value for our practices through our approach to revenue cycle. This particular graph outlines the improvement in E&M distribution and coding accuracy. Through just regular auditing process, we identified a significant opportunity with this particular practice to enhance not only coding compliance and accuracy but also to improve their revenue. Ultimately, we ended up improving that by approximately $325,000 annually, and that was really just through provider education and coding support on the most current E&M leveling guidelines. So, there's just lots of opportunity within coding to ensure that you are staying current and auditing and just reflecting upon the work that's being done. Go to the next slide. This chart looks at our sort of early success in defining patient financial policies. The HVPRCM team worked closely with practice leadership and front desk staff to educate on new policies and provide resources, really things just like measuring time of service collection so the staff's aware of where we're at in our success rate, to scripting to help them kind of deal with maybe uncomfortable conversations with patients around what might be due at the time of service. This particular practice that we're looking at really had not traditionally focused on patient collections. Their overall time of service collections were very low, you know, just kind of occasionally collecting co-pays, but we were able to add the support of our benefits team to determine estimated patient responsibility, and then counsel those patients prior to the date of service, it made it much easier for the front desk at the practice to collect at the time of service. With that, I will hand it back to Peter to cover our approach to physician recruitment. Thanks, Erin. So continuing on a little bit of a theme discussed earlier, physician recruitment is something that there is not a single group that we speak to or that we hear about that isn't having challenges with physician recruitment in the current landscape. You know, cardiology and cardiovascular specialties in particular are experiencing shortages. We've got a high number of providers who are retiring over the next five plus years, and physician recruitment is a real challenge. Not only is it competitive, but it's also particularly challenging to find physicians that are the right fit for our practice. So I want to talk a little bit through HVP's approach, first of all, and then a little bit of a case study talking about the way that how we engage impacts physician performance, both during and after the time that they're recruited to join a practice. So a short version of how we think about things is, you know, we do look to attract top talent that fits with an individual group. So, you know, oftentimes there are physicians and providers that might lend themselves better towards an academic medical setting than an independent physician group in a smaller market. You know, oftentimes the groups that we partner with have a very clear perspective on what they are as a group, the types of providers that are successful in that model, and that's something that we aim to be incredibly responsive to in the search process. Not only bringing the right types of candidates so that we're not spending a lot of time and wasting the candidate's time, wasting the group's time from an interview perspective and all the discussion that goes into it. You know, we really want to make sure that we understand what type of candidate is going to fit the best. Second thing is we really hope to create what I would call a white glove experience, not just in terms of the recruitment and sourcing of a candidate, which oftentimes folks can get from a third party, but really around everything from planning onsite visits to offer generation to the constant contact that's required in order to recruit high quality physicians into your practice. That's something that HVP looks to provide throughout the process in order to assist the practice in looking like a first rate organization that has the time and capacity needed in order to do the right thing from a recruitment standpoint. The third piece is around administrative burden. Every practice manager or practice administrator knows that bringing on a physician isn't just as simple as bringing them into your market, having a nice dinner, sending them a contract, and you're off to the races. There is an awful lot of administrative burden, oftentimes that goes without much notice on the part of operators from an individual practice. Our model looks to help support that, not to replace it because local facility and practice administrators need to be at the center of physician recruitment, but they don't need to be doing 100% of the work. We think that it allows us to, A, accelerate the timeframe with which you perform the recruiting function. Number two, it helps to prepare and make sure that there aren't any gaps that end up showing themselves once a physician is onboarded and looking to ramp up their business. The third is really, hopefully, creating a better communication line between the candidate physician, the practice leadership, and the physicians within the practice to make sure that everybody's up to speed on what's going on during what typically can be a pretty busy three to six month period through the recruiting and onboarding process. We really think about the recruitment process in four different steps. The first is a coordination meeting with the practice, and this is something that every new practice that we work with where we're talking about new physician recruiting, we'll spend a long time making sure that we understand what that practice's needs are, what's worked well, maybe what hasn't worked well with bringing on new physicians in the past, subspecialty, training preferences, et cetera, are all really, really important to making sure that we're focusing a search in a right way where we're not having any wasted movement. This is also something that we do for every new physician search that we help open up. It's not just a one-time, hey, it's set in stone, but it's saying, hey, if a group's looking to recruit an electrophysiologist, that might be different than the general cardiologist that we just recruited to the exact same group, and those requirements and market understanding might change. Then we initiate the sourcing. Typically, we work with a third-party national recruitment firm that allows us to get access and data for potential candidates beyond just the scope of the physicians within a group professional network or what have you. It allows for proactive contacting of people who meet the profile that we've established, but one of the other things that we do is we tap into HVP's network for some proprietary sourcing. Folks with whom we might have a better relationship, maybe they had contacted another group about joining and it wasn't the right fit, but we still maintained a strong relationship with them. Those are really important parts of what we do. The last piece is that we actually facilitate the screening interviews and candidate feedback loops. Oftentimes, we'll coordinate getting one of the physicians from the practice on the phone with the candidate and having a conversation back and forth. That's something that we look to provide through this process. The next piece is typically an on-site interview. Bringing a physician in for a day and a half or two days or something like that and meeting with anywhere from 5 to 10 to 15 different physicians within a group through an interview process is a lot of planning and a lot of work. That's something that we look to provide through a lot of the process. We try to make sure that that physician, when they're making the most out of that 24 to 48 hours that they're on site, they're seeing everything about the practice. Whether that's the hospital environment, an ASC, outpatient imaging capabilities, the way that clinic flow works, multiple clinic locations to understand how the practice actually works is really critical for us making sure that we present the practice the best that we possibly can. Also, that the candidates get all the information that they're looking for. We'll plan a group dinner, hotel stay, real estate tour, all that kind of stuff as well. Then, HVP's team also generates an offer letter, candidate communication. We'll gather all the physicians within the group to vote on whether or not they want to extend an offer to a particular candidate. HVP handles a lot of the back and forth as far as negotiations with the candidate are concerned. Oftentimes, physicians within our groups don't want to be directly involved in that. This is a future partner of theirs that's going to be a clinical colleague, and we'll work to fulfill whatever the practice's preferences are along those lines. Then, the candidate accepts the offer, signs agreements, and then we start onboarding, which is where we get into the next slide. As we think about onboarding, oftentimes, folks think about that in terms of the raw basics of what onboarding looks like. Over to the left of this page, you'll see some of the things that are typical. Obviously, you're going to do a press release website. You're going to want to make sure that a physician is ingrained and has the ability to accept new patients with your business office. They have the ability to schedule and what have you. You're also going to do some operating-related work, so payer credentialing, hospital credentialing, system access setup, all that kind of stuff that are the nuts and bolts that just allow a physician to be able to start working. Those are standard. Everybody's going to do that. HVP's approach to onboarding actually goes beyond that. Typically, we want to be a partner in making sure that these physicians are successful right out of the gate. One example of a new physician that recently joined one of our practices has to do with a physician that joined a practice where he was bringing a new skill set around peripheral vascular disease. Not only new to the practice, but also really new to the market in terms of the unique skill set that he had and treatment of these conditions. Within four months of starting, this physician is already performing within the top 20% of his well-established and pretty big group. A couple of things that HVP has helped to do beyond what's on the left side of the page really come down to some events that we look to try to plan for these new physicians, particularly in this type of situation. We had a new outreach market where this outreach market has a specific need around peripheral vascular disease. It's one of the top rates of amputation for patients who have peripheral vascular disease, largely because of a dearth of available physicians that are proximate that can help to treat the disease. HVP's team, once this physician came on board, developed a target list of providers that we wanted to talk to as potential referring providers. We set meetings with all those providers, breakfast, drop-in meetings, and lunch, all within one half of a day of this physician's time in the first month that he was in practice. We developed the marketing materials, contact information, coordinated meals, provided driving directions, things like that, to where all that the physician had to do over the course of three and a half hours was show up, educate providers that he was talking to. This effectively led to him filling his schedule from his first month within the practice to where we're expanding his clinic templates, making sure that we have the adequate support for him, really a home run. The second piece that we're focused on is how do we take a physician that's doing well but has a new skill set, new techniques, and things like that, and really engage with the referring community. One of the big parts of this that we're planning is really what I would call an educational series around, call it a 40 or so attendee dinner, to talk about how the practice that this physician works in actually operates, but also the way that this provider takes care of patients in a unique way can help solve the problems of referring providers, whether they're primary care or otherwise, is going to be hugely valuable. Interest in that event has actually outstripped our capacity for it. We're really excited for a lot of those things, and I think that closely summarizes what our approach is and how we think about value creation and working with the groups in some pretty high-stakes areas. I'll flip it back. I don't know, Bill, Joe, who's going to be taking this. Really appreciate everyone sticking with us through that. Thanks, Bill, Peter, and Erin for that. Appreciate all of your perspectives and for taking the time to share those and really for us to understand how HVP operates, but also what it looks like in kind of joining a platform and what kind of resources are available and things of that nature. Thank you. I want to remind everybody, we've got about six minutes left for questions, and I'd love it if, at the bottom of your screen, you have the Q&A button. Feel free to hit that button and submit some questions there, and I'll take those as they come in. One came in a little while ago, but I didn't want to interrupt the presentation to ask it, but the question, I think, came up when you were talking about all the different things that you can put into practices and PET and ASCs. The question is, how are those growth initiatives financed? So what does that look like from a physician responsibility and HVP's responsibility as you bring in these new service offerings? Yeah, I can field that one quickly, Joe. There is a lot of capital intensity in addition to the operational depth that I hope you all got an appreciation for. The short version is that HVP uses our balance sheet to fund these projects or capitalize them. However, we will then amortize or allocate the physician's portion of that economic responsibility through the compensation plans that we have in place with them over several years, which is to say physicians don't have to show up with cash and write checks to buy new equipment. But we also cannot, for a variety of reasons, just buy equipment or build a new facility and just hand it over. So it's all governed through the compensation agreements that we have with our partners. Okay. Perfect. Thank you for that. And I think that probably sums up. There are probably not a lot of different perspectives on that answer. I had one question come through. And again, take a look at the Q&A at the bottom and feel free to submit questions there. I think this one's more directed to you, Peter. And it's about when you partner with a practice, is there an order of which you will start to focus on some of those different operational components like RCM and service line and cost control or payer contracts? Is there a certain attack plan that you have in terms of how you bring some value to practices? Yeah. So, Joe, what I would say is that that's determined on a case-by-case basis and often in partnership with the physicians and practice leadership within a group. So when we present our initial thoughts on a value creation plan prior to partnering with the group, we'll want to understand what the barriers within the practice might be towards executing them. We also want to make sure that we're validating the impact of each one of the initiatives with the physicians to make sure that we are aligned collectively on what the highest impact and highest value initiatives for us to pursue are. So I wouldn't say that there's any one particular formula that we use. Typically, we try to prioritize based on the impact to the practice from a quality operational and financial perspective, as well as what I don't necessarily want to call it the ease of execution. None of these things are easy. But the ability to address it without significant interdependencies and or change to the workflow of providers. Basically, we don't want to blow up the entire operations of a practice when we first work with it. We want to find things that can be solved on a specific basis with a really high rate of success that have an impact on the way that a practice is caring for patients, but also obviously performing. Great. Any other chime ins on that answer? Okay, I've got another. I've got a question that's coming through here. Another one. And it's a little bit of a touchy one, I think. It's about decision making in the practice. So the question is, what kind of decision making does the physician retain and what decision making goes over to HVP and what is done jointly? That's the essence of this question. Yeah, I'll give the broader kind of governance answer and Peter and Aaron can amplify if there are any specifics. But the short version, or at least the design principles, we're a partner just as many of our, you know, they have other physician partners. So we sit in the same room and we'll have discussions about different opportunities, many of which we just went through. And there's not ever a situation where HVP gets to act on something over the objections of the physicians. There are certainly opportunities, particularly in clinical decision making, where we don't have any input or vote in those sorts of governance decisions. The physicians drive that bus, right? But what we will have some control over, meaning, you know, we have a vote in whether we do it or not, is the expansion of capital, right? So particularly if we're financing it, if physicians want to go buy everyone a new car on the practice balance sheet, like we have a vote in those sorts of things. But we really, there's no practical situation where if we're not arm in arm with our physician partners, that something's going to get implemented or executed, right? Even if I had a piece of paper that said I could go, you know, buy a new piece of equipment on our balance sheet, but the physicians weren't supporting it or it wasn't something that they felt excited about doing, we're not going to do that anyway, right? It's kind of paper over a practice. But the short answer is it's a partnership. There are some areas of decision making where HVP is a meaningful partner in the practice, we'll have a vote on. In anything clinical, anything to do with the hiring, as you heard from Peter, those are all physician led decisions that we just support. Yeah. Well, I think that Joe and it ties back to the values that Bill shared at the beginning of the presentation. Our values are all oriented towards HVP playing the role of a trusted partner that can provide information and help to influence physician decision making. We don't view our relationship with physicians as command and control. Frankly, we accept and take the responsibility to utilize data and experience to work with physicians and provide an honest and substantial accounting of what an opportunity is so that we can discuss it as partners and make decisions jointly. Philosophically, that's really what drives all that we do. Excellent. Well, we're at time. I want to encourage everybody that if you have questions that did not get answered, please feel free to follow up and you can respond to the email you'll get after this webinar because you will get a follow up email from us with the slides and feel free to respond and we will get all of your questions answered there very quickly. So thank you, Bill and Peter and Aaron for joining us today. Thanks for sharing. Thanks for educating us and we look forward to seeing you again soon and certainly seeing you in Orlando in April. Right. Thank you. Everybody for being here. Thanks for attending and we will see you all soon on a future webinar. Thank you. Thank you. Bye bye.

cardiology

operational efficiency

capital investment

healthcare partnerships

revenue cycle management

physician recruitment

strategic growth

administrative burdens

diagnostic imaging

patient financial accountability