Hi, everyone. Welcome to today's webinar. We're going to give everybody just a minute to log on here, so please be patient. We'll be with you in just a second. Okay, we're going to get started here. First with some housekeeping items. Today's webinar is Redefining Independence, Sharing the Independent Practice Perspective. This is hosted by Cardio One, one of Medaxium's industry partners. Before we get started, I just want to go through a couple of housekeeping items. If you look down at the bottom of your screen, you're going to see a couple of different areas. If you want to pose any questions, what you'll do is you'll pose those in the Q&A button. Click on that. You can send us a question. We'll be moderating that throughout the webinar, and then posing those to the panelists at the very end. Also, in the chat section, you're going to see a button. If you click on that, you'll have the access to all the slides to today's presentation. You can download those, share those with your colleagues, et cetera, and they'll be made available to you. With that, I think let's go ahead and get started again, Redefining Independence, Sharing the Independent Practice Perspective. Today's host will be Jason Gunderson, MD. Jason's the CEO and co-founder of Cardio One. Jason, I'll let you introduce your panelists. With that, Jason, welcome. Thanks, Chris. Thanks, everyone, for joining our webinar today. Excited to chat with you about the role of independence. Chris, I think you wanted me to introduce the panelists before, or do you want to switch that after I just tell us? We have three of our partner physicians. Really excited to have them with us. We have Dr. Sunil Kaurielis, who is our practice owner at Kaurielis Cardiology, Dr. Barbara Hutchinson, practice owner at Chesapeake Cardiac Care, and our first partner to sign up and join us and is really one of the founders, and then Dr. Paul Raj Samuel, who is the owner of Samuel Family Cardiology. I know he's currently tied up with patient care, so he should be joining us momentarily. I'm sure our fellow clinicians in the audience know how patient care goes and things run behind. So we'll jump right in. I've got a little kind of intro on the path to independence and just how we came up with the idea and just some thoughts around it. So we'll move on to the next slide. The whole concept of ... Perfect, there we go. We've just had rapid growth of hospital employment in cardiology. I think a lot of specialties have been going through employment by health systems, and it seems like every day there's a new practice that's being sold across a number of specialties. Cardiology has been heavily consolidated over the years. You can see even since 2019, we've had an appreciable increase in hospital employed, but most importantly, a kind of a drop in just pure private practice. I'm going to put a short plug in now. For those that are interested in independent medical practice, there is a great organization that started a little over a year ago called the American Independent Medical Practice Association. It's made up of physicians from pretty much every specialty. There's now almost 11,000 physicians represented. I sit on the board of that. Some great work being done there, and you're going to see some study data coming out of that. But one of the things that I think most people know that are either employed or currently independent that there's a lot of benefits that go to both sides, and I think figuring out what works best for you and your practice is key. On the independent side, you've got autonomy, you've got an opportunity to build equity in your practice for future sale or later decisions, but being independent is very difficult. You've got payer contracting and challenges, probably the biggest one that we all face. I would argue that every physician faces this because the payer world is just very difficult. Administrative management, just so much to do and just lack of scale. Employment comes with stability, compensation, hopefully lack of administrative burden. Some health systems are better at that than others, but the challenges in that are you really don't have a decision on the autonomy of your practice. It's really driven by the direction of the health system. Your pay is dictated by the health system, and so you just don't have as much control over what you want to do. Move on to the next slide. One thing we've seen, this is from an internal ENY survey, is just burnout is prevalent in healthcare, let's be honest. We know it's very difficult work, but the sense of negative views and burnout is actually much higher in the employed world versus the independent world. Now, I know my colleagues, Dr. Corrales and Dr. Hutchinson, Dr. Samuels, will all tell you that there's challenges that come with being independent that they obviously work through, but just a greater sense, and I think it's a sense of autonomy, as you can see, that drives better feelings around that. Some feel the better pay because they can control more of that. Just the ability to really drive their clinical practice. Move on to the next slide. And then this is a very interesting study. As I mentioned, the AMPA group, the American Independent Medical Practice Association, just commissioned and released a study a few weeks ago from Avalere Health, which looked at, purely at Medicare service line, or Medicare expenses as it relates to independent PE-backed MSOs and hospital employees. It looked at five major specialties, cardiology was a significant component of it. But I think this is things that many of you already know. Please look up the study. If you need to get it, you can shoot any of us a note, and I can get you a copy of it, but it's available on the AMPA website or via our LinkedIn page. But hospital acquisition of independent cardiologists and just hospital acquisitions of independent practices in general increases Medicare costs per Medicare beneficiary per year of almost $4,000. And that's in Medicare, which is pretty remarkable. So it really drives costs up. And when you look at the study that's out there, not only are independent physicians lower total costs of care, but have lower utilization rates and lower readmission rates. So some pretty interesting data to support that independent practices are really a great opportunity for, you know, go forward. There's a way to work through this, and there's a great return on investment for the patients and the payers, rather than some of the larger areas. And then just something to look at, which I'm always really blown away by, is just the difference in costs when hospitals use hospital outpatient department billing versus what the reimbursement is for an office-based procedure. It's always amazing to me that a procedure done in the exact same procedure, just because we designated an HOPD or an ambulatory, has radical difference. And I like to tell stories of my $5,200 echocardiogram that I got at an institution in my city, which I will not name, was pretty profound to me when I saw that bill come across because they did it in the hospital outpatient department, not in an office. So significant opportunity, I think, for independent physicians to lower costs of care, provide services to patients, increase their own autonomy. But it's a difficult world out there. We're seeing a lot of movement and a lot of interest in physicians reclaiming their independence. We're working with a number of practices, either currently independent, helping them stay independent, and then we are working with employed physicians looking to reclaim their independence, and actually took our first group of employed physicians from employed to fully private in the first week of September. So with that, that's my overview. Heard enough from me. I'm going to hand it back to Chris. I really will think the best people to hear from are actual physicians that are practicing on their own in an independent practice, and I'm proud to partner with them every day. So I'll hand it back over to you, Chris. Thanks, Jason. Yeah. Welcome, Dr. Samuel, Dr. Hutchinson, and Dr. Cori Ellis. I want to start out talking about independence, if I could. There's been so much consolidation in the market over the past 10 or so years. I'm just curious as to your primary motivation and factors that came into your decision to remain independent. So I'll open it up to the panel. Any of the three of you that would like to step up and answer these questions in order, I'd love to hear your responses. Sure. I'm happy to jump in unless anyone has anything pressing they want to say immediately. As Jason and others had mentioned, I'm Dr. Paul Raj Samuel, and I'm in practice in the North Houston area. Probably the biggest thing that we were considering, we had been working with another larger group and were in a position to make a move to reestablish ourselves together as an independent practice. Really the thing that I think a lot of us will talk about, and I think will echo with a lot of folks who might be listening to this or considering making a move, was we really wanted the ability to not only provide the top quality of care to our patients, but we wanted to do so in a way where we felt like we could tailor what we felt was best for patients without specifically feeling like there was a tremendous amount of burden being placed on us by larger institutions. We did not necessarily want to feel as though we were being pushed to focus on certain things. There's a lot of times when you lose that autonomy that does end up affecting the way that you make clinical decisions, and we really did not want to go down that route. For us, having been in our area and grown a patient base that felt very loyal to us as providers, we really wanted the opportunity to maximize those patient relationships and involve ourselves with people on a real direct level so that we didn't have to think about other factors that might get in the way of that direct patient-provider relationship. Without talking too much, I suppose that we feel like one of the great assets of our practice, as opposed to potentially larger practices or specifically university-based or hospital-based practices, is that for us, it really is just myself and, quite frankly, my dad, who's my cardiology partner in this enterprise, who take care of all of our patients. They get to know us over the course of years. They don't necessarily have to worry about getting into a health crisis where they're going to be meeting some kind of stranger for the first time who doesn't know their history, their cultural values, what they hold dear, and who's involved with their healthcare decision-making. Wrapping that all together is really why we felt independent practice was the best choice for us. That's great. Dr. Sutchinson or Dr. Coriolis? I can go next. Could you hear me? Yes, ma'am. Great. Again, I'm Barbara Hutchinson, a cardiologist practicing in the DMV area for 23 plus years. For me, I think by nature, I'm an innovative type of person. Being independent for me enabled me, like Dr. Polarad stated, enabled me to provide care that I could control. That was very important for me. The other thing, as I said, I'm innovative and I often have ideas. Having a partner or someone that can come along and help me build on those ideas such that I can grow the practice was very, very important. Prior to interaction with Cardio One, everyone that approached me always wanted to buy my practice. What was very interesting is someone coming along saying, I don't want to buy your practice. I'm interested in you staying independent, developing, but how could I help you grow from where you are? That was very important to me in terms of staying independent, being able to make decisions, keeping my autonomy, and being able to do innovative things. I want to jump in and add some nuance to this, Chris, if that's okay. I am Dr. Sudol Koyelis, as was mentioned previously. I am in private practice here in Philadelphia. I will say that I agree with what's been said by Dr. Samuels and Dr. Hutchinson in terms of the values for them for being independent. For me, I will say that it is really what drives me to becoming independent and staying independent is the very reason why I became a cardiologist, became a doctor to start out with. That is to be able to be there for my patients and formulate a very strong patient-doctor relationship. In my experience, I have worked previously as an employed physician. I saw the difference that I was not able to be there for my patients and spend the time and be able to forge that relationship with them to the point where they could come to me and know that I will be able to take them to the full extent of their concerns and be able to get to their needs. Patients come to us in the majority of the time as cardiologists at the time when they are really concerned. They have concerns that need to be met. They are at a very vulnerable time of their life, and they want to know that they can rely on us. They can feel that sense of comfort when they come in and be able to be cared for all throughout the experience. That is what being independent is allowing me to do, to be able to work my patients through the journey, the experience of being able to help them understand the symptoms to the diagnosis and through the treatment and beyond that, being able to show them the way to a better health, to a wellness, and knowing that they can always come back to me and that I'm going to be there for them to be able to help them through. Being able to be partnered with Cardio One, as it was mentioned, is really allowing me as a physician to have the confidence with all the different resources that I was lacking to be able to continue to deliver that full spectrum of continuity of care to my patients and be able to deliver. So very excited to continue to be independent in partnership with an organization that I know is there not to, again, as Dr. Hutchinson mentioned, to buy my practice, but to be there to help me to be efficient and effective in the care that I deliver to my patients above and beyond. Dr. Coriolis, you make some great points. Let me build on that a little bit and ask Dr. Samuel and Dr. Hutchinson, just really about what you find the benefits of, aside from the relationship building, you say that you said you develop a stronger relationship with your patients, Dr. Coriolis, but how do you differentiate yourself from the larger employee groups in the community? And what do you feel helps differentiate your practices? Well, I think in our situation, and I don't mean to speak over Dr. Hutchinson, please take this. No, go ahead. Go ahead. All right. I think, yeah, please, we'd love to hear from you. No, I was going to say, I think the, for me, as everyone pointed out, the personal care, somehow patients always feel that they often describe, they don't feel like a number in a cube. They feel they get that personal care. We know them because we spend time with them. I also think there's also some flexibility in terms of scheduling, in terms of scheduling these patients. Sometimes it's easier to get them in for either a followup visit or a consultation visit than waiting sometimes six to eight months, as I've heard recently. The other thing that they often describe is that in our smaller groups, although we have, may have physicians assistants and NPs, they often describe when they go to the doctor, they hardly see the doctor. Most of their visits is with the nurse practitioner and never with the physician. So I think there are a lot of differences in terms of the smaller groups, but I would be remissed if I didn't say that being an independent physician is difficult because there are a lot of downsides and we can talk about some of this later, but for now I'll talk about what sets us apart, I think, from some of the larger groups. And the other thing that I often thought of before was that a lot of times people thought in the larger groups there was that stability in terms of their salaries and that's why they went with larger groups, except during COVID. I think that changed a bit and a lot changed during COVID, but that was one of the things that people often associated with larger groups, that more stability, but that recently has changed. So I'll stop there and let Dr. Samuel chip in. Yeah, I think those are tremendous points. I think our experience mirrors that of Dr. Hutchinson's for sure. I think for our purposes, one of the things that comes up a lot is that, certainly in larger groups, university-based practices, hospital-employed practices, there can be some degree of turnover of providers and that is inherently built into the nature of the type of care and the quantity of care that they provide over a larger segment of the population. For our practice, again, it's myself, it's my father, our name is Samuel Family Cardiology and what the patients notice very quickly, look, we put our name in the logo, our phone number for this practice hasn't changed in almost 30 years, we've got nowhere to hide. If you've seen us once and you wanna see us again, it's going to be us, it's going to be not somebody that you might see one time and then get passed off to one of 15 to 18 other partners. It is us taking that accountability to try to provide the maximum benefit of those personal relationships to move people forward through their disease and truly to try to move them from where they meet us, as Dr. Correlius mentioned, they sometimes meet us in the worst moments of their lives and we try to work with them over a period of time to move them not just out of their crisis but into a longer vision of health. And since it's just us, we know that we are conveying to our patients that we're always there for them. That's fantastic, I'm also curious just about how you are able to compete with the larger network of independents. So with that in mind, what are some of the benefits that you have of being part of a larger network of independents? What type of leverage do you now have that being part of Cardio One that maybe you didn't have before it? Dr. Correlius, would you like to start on that? Yes, yes, absolutely. I think there are many benefits to being part of a larger network of provider groups like that Cardio One is afforded us to do. And before I go into those benefits, I wanna piggyback on the easy access point that Dr. Hutchinson mentioned to be able to really get our patients in to our office, into our clinic and be able to have that continuity of care and being able to deliver on getting them in swiftly at the time of need, as opposed to them having to go through a long waiting period during that anxious time. And also being able to provide the services within our office, the full diagnostic spectrum of cardiovascular care that we're able to deliver for them so that it is almost like a one-stop shop, whereas they don't have to go from this place to that place to get this test done and having to go through all the running around at the larger group practices at health systems present to them. And so with that being said, certainly we need that to be able to be swift in our processes, in the delivery processes to be able to really coordinate that patient journey so we can deliver on that promise that we make to the patients. And so that's where CardioOn comes in to help us to be efficient and effective in that process delivery. It really process improvement, going through that process improvement and also getting the technology support that we're able to follow through and deliver on the better outcome, on the optimal outcome that we're able to deliver for our patients. So that is I think where the sweet spot of being with a larger network comes in and also being able to share best practices, share our experiences, what works, what doesn't work. I mean, Dr. Hutchinson and I talk very often about, okay, our practices, what we're experiencing, what are some of the roadblocks, what's best services to partner with to deliver some of those different diagnostic testings that we provide for our patients. So essentially, I think I want to pass it on to Dr. Samuels and Dr. Hutchinson to jump in, but really I think I've said it before, being part of the network, being part of Cardio One is almost like a breath of fresh air for an independent physician trying to really deliver the best outcome for the patients that we care for. I also think when we think of, to appreciate the resources in a larger network, we have to talk first about what are some of the challenges? What are some of the things that keep you up at night? And two things I think of immediately. One is technology. A lot of times when you're independent, sometimes the cost of technology is prohibitive as opposed to if you are in a larger group of hospital-based or employed where they have all those resources. So that's a big thing, the technology. The other thing is workforce. You have a small practice. If one of your employees are out, then you have to make do. Sometimes in larger organization, they can switch up. They can pull someone from another department to run for the day. The other thing is equipment. Sometimes the equipment you need, you can't afford because of the resources. And then finally, the buying power. When you are independent, the cost that you pay, let's say, of buying supplies, it's higher because it's just you as a smaller group. So having a larger group like Cardio One can help us one with the technology because if we think in the future, it's all well and good for you to know what you do, but other people need to know that. And the only way they would know what you do is if that data is available for someone else to look at. And you have to have good, a basic technology platform. And so that's number one. Number two, it's often difficult to attract physicians to come to an independent practice because the salaries may be lower. They think their benefits may not be as good. So if you're in a larger network where you can have resources, where the insurance could be better, may be able to attract physicians to even an independent group. And as I said, a buying power where you have several groups coming together to purchase office supplies that could really be a cost-saving. And just having a partner that could come along and help you as you grow with things like process improvement, things that you can do in the office to increase throughput. All these things add up to make for an overall efficient workflow, efficient system that could result in better reimbursement. Dr. Samuel, anything to add to that? I'm hearing that physician recruitment comes with being part of an independent network of physicians like the Cardio One has to offer. Also reducing supplies, process improvement. What else can you add that would be a benefit of being part of a larger network of independents? And I don't want to undermine the emphasis here, but certainly in our practice, the technology piece really took on a major sense of significance. When we decided to go independent, we of course were facing the challenge that a lot of providers face and the folks here have discussed specifically, which is that we believe strongly that our patients benefit from access to the best type of testing, to the most appropriate diagnostic modalities. And sometimes getting those off the ground can be challenging from an independent perspective. In our practice, we were able to benefit from the fact that Cardio One could partner with us as we went to the table for negotiations for bringing some of these services into our practice. Because instead of just saying, well, we're talking about two cardiologists, we could have the overall negotiating weight of the full complement of folks that work under the overall Cardio One banner so that we could negotiate more directly with providers of technology to say that we may be pioneering this for say in our practice, but should this go well? Should you provide appropriate and competitive marketplace value? We also wield with us the possibility to help unlock the possibilities of partnering with cardiologists, not just in town, but throughout the country. And that chip being able to offer certainly offers a lot of value to ancillary service providers and has really helped our practice quite a bit. It allows us to not just have to focus on really what the bottom line is with some of these decisions, but really empowers us to give access to the best types of testing for our patient base as a whole. Thank you very much. I do wanna move on and talk a little bit about value-based care. And I'm just curious from your perspectives, whether you feel that healthcare providers today are ready for value-based care and how it's gonna impact your independent practice. I think if you look at the average independent practice, I don't think the average independent practice is ready for value-based care because they're not thinking about value-based care. They're still in the fee-for-service mode. But if we're going to look forward in terms of where healthcare, first of all, the fee-for-service, I don't think it's sustainable. So there's gonna be change coming. And I think if you look ahead in anticipation of that value-based care, just being able to be compensated for taking care of populations, we have to have a very, very efficient technology platform that could gather this data such that we could present this data to the insurance company, proving that we can do what we say we are able to do. And that comes with data. And so to answer your question, I don't think the average independent is ready, but could we get ready? If we have the right partners that could help us lay the groundwork such that we are ready and prepared when that comes. That's terrific. Dr. Coriolis or Dr. Samuel? Yes, I'll have to say that in my experience, independent primary care physicians are actually getting the message. They're getting the message that being independent fee-for-service is not the way of the future. And as such, what I've seen is that there's some initial movements towards independent physicians coming together and forming organizations like IPAs and MSOs that is going to help them to align together their resources and towards better patient outcomes. And that's where the dialogue comes in with us as independent cardiologists to help them to meet their goals, to meet their outcomes. And really strategically partnering and deliver on those goals is really what Cardio One is really setting us up to being able to do because we have the technology support that we need. We have the right processes in place. We have the staffings as Dr. Hutchinson outlined. All those benefits of being part of that larger network is really helping us to be in a position where we're going to be the best partner for those independent physician associations or MSOs to really help them deliver on better patient care and really help them with the benefit of why they formed that organization that came together to start out with. So it's coming, I think we are ready and it will be great for all parties involved, especially patients. Anything to add, Dr. Samuel? That's kind of captured it all. I think for the most part that captures it, I would just say that prior to our involvement with Cardio One, we probably did not really focus on this because we were so, you know, in many ways entrenched in kind of older patterns and also with a lot of the work that needs to get done on a practice level that ultimately could be maximized in efficiency by partnering with an organization like Cardio One. So with those things a little bit out of our day-to-day task list, we're now able to really sort of move ourselves forward as we look to the future. And how about private equity? Let's move into that a little bit, if you don't mind. Obviously, there's been a lot of private equity acquiring independent practices. And I'm just curious about each of your experiences. Have you been approached by private equity and what's been your general sentiment on these PE firms acquiring practices? Well, I think in America and the economic system and a climate in which we operate, the private equity interaction will always remain an option for healthcare as it's currently constructed. I think it probably has a role for a lot of practitioners. It probably has a lot of roles in certain aspects of cardiovascular care. I think for us, our main concern would be that we would be hesitant just to see if there was a solution for us to maintain our autonomy. And I think as we prioritize that and the specific ways in which we practice medicine, sometimes those can feel at odds with a traditional private equity-based model of acquisition whereby care may be specifically quantified based on the bottom line, which is not in any way a criticism of private equity as a whole, but rather a overall condition of the way they do business. And so I think for us, there has been a role through Cardio One for us to perhaps access some of the benefits of what private equity can bring, simply because we, and switching my hat here a little bit, switching to talk more about maybe Cardio One specifically as opposed to our practice, we, Cardio One, have obviously tremendously benefited from private equity and the flexibility that their partnership has allowed for us to look at different systems of healthcare management, for us to look at opportunities for technology and to gain direction for how to practice medicine overall. It has not touched our specific practice in a direct way. And in doing that, we feel like we've benefited from some of the aspects of what private equity can offer without necessarily having to balance their concerns and their mission against what we do on a day-to-day basis with patients that might be sitting in front of us. I agree completely. Your initial question was, have we been approached by private equity? We're all in Cardio One, and Cardio One essentially is backed by private equity. So there are different types of private equity, and I would say private equity is here to stay. And one thing as independent physicians, we have to recognize when we talk about private equity, they can bring a lot to a practice. They can enable you to add resources, add equipment, all those things, but understand that with that infusion of resources, there has to be a return on that. And so the question is always, how do you accomplish that? Do you work harder to generate more money, to be able to pay that money back? So that's the thing about private equity. As you look at it, you have to be able to understand where the money is coming from that's helping you and the return on that investment, it's real. So it's no free money. You have to be able to pay it back. The other thing, when you look at the way we operate now in practice, the margins are very small to start with. And if you add private equity, having to repay private equity, you then have to answer, how are you going to make up that difference? Does that mean increasing the cost to your patients? How is it going to trickle down to your patients after private equity is involved? Are prices going to go up? Is it going to be, is the environment going to change in any way? Because now, as Dr. Polaroid mentioned, the bottom line now becomes the top priority, as opposed to, in some cases, patient care. And that's the trade-off when you look at private equity and just knowing exactly your involvement and how are you going to pay that money back? Anything to add, Dr. Kurielos? I will say, Chris, that I agree with everything that's been said there by Dr. Samuel and Dr. Urchinson. And certainly, private equity is part of the dynamic of the environment that we are in. And we have to be cognizant of that. And certainly, I have been approached previously, but certainly, it's not about being approached, it's understanding how a partnership with private equity will help us move forward, move forward with our mission. And a lot of times, it may not be fully clear. And if it's not clear and it's a deterrence to the patient care that we have promised, the outcome that we have promised to the patients, then we know that's not the right fit, that's not the right time. So while this is an ongoing thoughts, but it is also an issue that I think is to be weighed, as was mentioned, with some of the other consequences that come with it and making sure there's no compromise to the patient care that we are delivering, ultimately. That's critical. Yes, thank you very much. Before I ask for final thoughts, just a couple of things I wanna remind everybody that if you go to the chat section, today's presentation is there, you can download that. You can reference that at a future time. Also, Jason's shared a couple of papers that are also available in the chat for downloading. I'm gonna ask Jason to come on. And we've had a few questions come through the Q&A button. Jason, I don't know if there's a few you'd like to answer, and I'll leave that to you. Yeah, so I have a couple of thoughts. I can talk a lot, so I'll try not to talk too much. But first, thank you to my partners, really appreciate it. Second, I wanna just hit the topic of private equity. Private equity means a lot of things to a lot of people. Our company is, we have a great investor through Winrose Health. They're technically private equity. I think when people think private equity, they think the acquisition roll-up model. What I wanted to share was, there are some great companies out there. I always had the pleasure of being at a meeting last week with Tim Atterbury, who's CEO of CBA USA, and Robbie Allen, who's CEO of U.S. Heart & Vascular. We have a great working relationship. Just sharing that I think people need to find what works best for their practices. I think we provide alternatives to working for large health systems, and if you look at the Avalere paper, that's better in general. So I'm not anti-private equity. One of the things that would make us kind of different than your traditional model is, is that Dr. Hutchinson, Dr. Corrales, Dr. Samuel, they own their tax ID number. They own their contracts. We are merely a partner to help them on kind of the administrative tasks. It's a pretty significant difference between how we work and how Tim or Robbie work and those two other entities. So I just in general like, for our physicians out there to know that they have options other than maybe just working for a big employed health system, and that there are folks working to kind of move the needle along. Roger Perez asked a question. We do do, just because we don't own tax ID numbers and we work in our arrangements, we do have significant resources and capital for investment in, and we are doing advanced imaging, things like PET CT and CT NGOs. Haven't done cardiac MRI yet, but we know we have the resources to do that. We're certainly very interested and helpful in wanting to work on ASCs and OBLs. So that's one of the advantages of an organization like ours is while having a, technically having the investors behind us, we can help support practices in ways that are slightly different than kind of your traditional model. So we're just, you know, our goal is really to help our docs retain their independence. And for those out there very interested, we're here to help you reclaim your independence from working in employed environments so that you can do what our partners have said. And, you know, I think the most interesting thing is, is every one of our practices has a slightly different flavor. People have interests in, we have practices that have almost half are EPs, and we have practices that work in more underserved areas. We have practices that want to, you know, Dr. Hutchinson does sleep. I mean, it's really interesting to see how the practices have evolved to meet the professional interests of the physician while meeting the needs of their patients. So appreciate everybody's time. That's kind of my ending comments. If there's any other questions, happy to answer them. Thanks, Jason. And Jason, to you, my final question, and this could be to you or anybody else and any of the panelists, but what advice do you have for other physician practices that are either trying to survive and remain independent or conversely those physician practices that are now part of a larger health network that are looking to unwind and become again independent? There are options. And I think there are lots of options. And I think people have kind of just like, I'm married to an academic, so all of her students and residents haven't really thought about anything other than just going and being employed. And that's why I would say, you know, 80% of cardiologists are employed today. I just want cardiologists out there to know you've got options. Explore, talk to people, talk to, give me a call, talk to Tim, talk to our partners and just, you know, I think that there is a different way to practice than what we've kind of all been kind of walking down towards so that's my biggest advocacy out there is I'm on the board of AMPA. I'm a huge proponent of independent practice and just like to see it move forward. So take a look at the study. I know we posted it up there. It's pretty interesting. We've got some other, even more interesting projects in the work as part of AMPA that'll be coming out in the coming months. Really cool stuff. So just appreciate the time and the partnership from Medaxium and all of our team here on the call today. Thank you. And for the panelists, any final thoughts, comments or advice for those that are attending today? So, oh, someone just, I got a quick question I can throw on here. Someone just asked, how do you handle the hospitals who feel threatened? All hospitals feel threatened all the time. They kind of all feel that way. I think we've, I don't feel that we are, now they may totally disagree with me. Our goal is not to be competitive to hospitals. I think in general, healthcare has become so competitive around, I have to have this and hold this. And that's why I live, where I live, I have three Epic logins because you can't just have one. So I think there's always that. I think we can find ways to partner. For instance, Dr. Samuel does interventional procedures at a number of hospitals. You know, we can cover hospitals, we can work with them, we can partner with them. And I think finding ways that are collaborative, that meet the needs of patients is really the right way to work with those hospitals. And it shouldn't be threatening. It should be, how do we find a way to drive care to the best possible point for what patients need? And how do we lower the total cost of care? Look at healthcare GDP in the country. It is completely out of control. And so how do we all work together to try to find a way to lower that, make it more affordable, make it more accessible, and just help improve the patient experience? I am a cardiology patient. I have had terrible experience trying to access care. Actually, Dr. Samuel, I was visiting and was gonna do my echo because it took me so long to get an appointment at home and I didn't take him up on it. And I should have, because I would have been in and out the door right away. So I think- I wasn't gonna bring it up, Jason. I know, but that's the model. So I think, I don't view it as threatening. I think we have to stop. We in healthcare just globally have to stop viewing as threatening and space control. And how do we all work together in a way that drives the outcomes better? Because our outcomes versus our spend in GDP do not make sense. Forgive me for being overly political on that one. Jason, go for- I'm sorry, go ahead, Dr. Samuel. No, I was just gonna say that, Jason brought up a good point. There's one word that has not been in my lexicon for 24 years, and that's competition. So I have blinders on, so I don't really even think about the other practices around me, the hospital. I'm just focused on providing the care. But in terms of those listening that may be independent, if you're really passionate about providing good cardiovascular service and you're doing that now, and you wanna continue doing that, you can with the right partner who is able to help you grow, help you to improve your workflow, work processes, so that you're ready for value-based care and you don't exclude yourself from that in the future. So that's what I'd say to those that are independent that might be on the fence. And I would say the only thing I would add, as Jason kind of mentioned, if there is a message that I think I would want to move forward or advance with regard to the dialogue, I think ultimately every practitioner really needs to think to themselves about how their practice can more directly align with their own core values. I think many, many cardiologists align from a mentality standpoint, from a career goal standpoint with partnering into a larger group, partnering into a university-based practice, a hospital system. There are options for all of those folks. But that being said, speaking from personal experience, when I think about the goals that we hold very close in our hearts and in our minds as a practice, when I think about how my own personal story and personal experiences have pushed me to care more about some of the things that traditional cardiology practices may ignore, like mental health, resource allocation, like thinking about how to not just chase an LDL, but really how to push people towards a larger understanding of health and happiness, I think those goals aligned much more closely with remaining independent. And I think when you start to see a separation between your own personal values, your own personal goals, and the way that it's playing out in your career, that can significantly foster discontent, accelerate burnout, and really undermine everything you've probably spent your life working for. So I think when we looked at it from that perspective, the choice to remain independent and to work with those who would help us achieve that status really took the forefront. All right, Dr. Coriolis, any other comments at all? There's another question in the chat to Jason. Dr. Coriolis, anything to add? Oh, you're on mute, sir. You're on mute, sir. Oh, sorry. I could not agree with Dr. Samuels more than really, there's gotta be, at the end of the day, really the personal reason, the cause that brought you into becoming a physician to start out with is really what's going to govern you to be able to make that decision to becoming independent. And so when there is a disconnect, that is really the time to be able to start reassessing and see how you're adding value to the cause of why you became a physician to start out with. And to the issue about competition, I think we are in the care delivery. We are physicians because we care, because we, again, it's part of our personal mission goals. And so I think there's an opportunity there for the hospitals who are in our network to see us as allies in caring for patients. A lot of times, patients will go to the hospital for an acute event and they don't go back. And so rather than trying to channel that patient to try to come to hospital, we can be a great resource to be able to help align with the hospitals and be able to provide that care, comprehensive care, to keep the patients to continue to be healthy, to meet their health goals. And so I want to end with that. It's really, that's where the joy comes in for all involved. That's great. I'll tell you, today's conversation has been exciting. It's interesting to see that there are options out there for those practices and those members of ours that are looking to remain independent. Before we close, I'd love to turn this over to Jason for any final comments. Also, Jason, I think it'd be important if you don't mind sharing your contact information. Those members of ours that do have questions or follow-up discussions they'd like to have with you, what's the best way to- I just put my email in there. It's pretty simple, it's jasonicardio1.com. So please feel free to email me, happy to answer questions. There is a question in the box about value-based care. Now this is, I call this the tan on the doorknob question. So for those of my physician colleagues that are listening, you know how you've met with your patient and then you put the hand on the doorknob to leave and they go, oh, I have crushing chest pain. And you're like, oh my God, we spent 20 minutes and we kind of got that. So not to, I'm just kidding about that, but value-based care, all right, means a ton of things to a lot of different people. I feel like we throw the term around way too much. I will give you my high level view and I've actually managed patients in varying degrees of value-based care. Value-based care is a continuity. It is basically getting paid for outcomes. It starts off with something as simple as pay for performance, moves itself into bundles and the rest. We need to find a better way to care for patients at lower costs, which is pretty simple. And you can do that contractually 8 million different ways. And I think that's where people get confused about it. I would just tell you that for us, our goal is to help our independent physicians thrive and survive in today's environment, build the tools for value-based care. I would tell you value-based care starts with access. If you call any of our partners, I know they'll get you in like today or tomorrow. It starts with having testing where you're not charging. Look at that chart of those hospital outpatient department charges for all those procedures. You can't do value-based care when you're charging so much more than what the test would cost in an ambulatory environment. So that's what we're looking to do. We find ways to do that. We are talking to payers. Anybody that's talked to payers know that it's a long conversation with payers to move forward on those things. So we can talk a lot about value-based care. I'm always open for the conversation. I think there's lots that can be done there. It is confusing right now because it means so many things to different people. I view it as how do we find getting our physicians paid for outcomes and lowering the costs? There's some pretty simple ways to do that. Don't do hospital outpatient department procedures that we could do in an office at substantially lower costs. So I'll just leave it at that. Okay, with that, I really want to thank Dr. Jason Gunderson and Cardio One for sponsoring today's webinar. This webinar will be made available to the membership. We'll be pushing this out for you. I also want to thank Drs. Hutchinson, Corey Ellis, and Dr. Samuel. So with that, we're going to close. Thank you all for attending. Have a great day. Thank you.

independent medical practice

cardiology

autonomy

personalized patient care

Cardio One

technology costs

value-based care

private equity

healthcare partnerships