Latest / Becker’s Healthcare Podcast / Building a Physician Led Orthopedic Platform with Alejandro Fernandez, MBA, CMPE

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Building a Physician Led Orthopedic Platform with Alejandro Fernandez, MBA, CMPE · Becker’s Healthcare Podcast

• 0:02
  - Just five years ago, a big portion of
• 0:04
  - what's now being done in ambulatory surgery centers
• 0:07
  - wasn't considered outpatient work. The cases have changed,
• 0:10
  - the tech has changed, the patient expectations have
• 0:13
  - changed, and the leaders who are thriving are
• 0:16
  - the ones who saw it coming.
• 0:18
  - Becker's twenty third annual Spine Orthopedic and Pain
• 0:21
  - Management Driven ASC Conference
• 0:23
  - exists for exactly that kind of forward looking
• 0:25
  - practitioner.
• 0:27
  - Here, Becker's hosts more than 1,000 attendees, 275
• 0:31
  - physician and ASC speakers, and three days of
• 0:34
  - sessions that move between the clinical, the operational,
• 0:37
  - and the strategic,
• 0:38
  - and the CME credits to show for
• 0:40
  - it. Join us June eleventh through the thirteenth
• 0:42
  - at the Swiss Hotel in Chicago, and come
• 0:45
  - ready to think about what's next. Register on
• 0:47
  - our events page at beckershospitalreview.com
• 0:50
  - by clicking on the events tab in the
• 0:52
  - upper right.
• 0:54
  - This is Scott Becker with the Beckers Health
• 0:57
  - Care Podcast.
• 0:58
  - I'm thrilled today to be joined by one
• 1:00
  - of the most talented leaders I know in
• 1:02
  - health care and just a wonderful person.
• 1:05
  - We're joined today by Alejandro Fernandez,
• 1:08
  - and and Alejandro's had great success
• 1:11
  - both in the GI space and running and
• 1:13
  - helping to grow
• 1:15
  - one of the best GI
• 1:16
  - national practices in the country.
• 1:18
  - Now he's working the orthopedic space and doing
• 1:21
  - a wonderful job there.
• 1:23
  - Alejandro,
• 1:23
  - take a moment if you can and tell
• 1:25
  - us a little bit about your career,
• 1:28
  - and how you got so deeply
• 1:29
  - invested in health care leadership.
• 1:32
  - Excellent. Well, thanks, Scott. Thanks for inviting me
• 1:35
  - to on the podcast.
• 1:37
  - You know, my career started about thirty years
• 1:39
  - ago, literally just in college trying to,
• 1:42
  - make ends meet as I was putting myself
• 1:44
  - through school and, just started as a
• 1:46
  - Clark. And from there, learned all the ropes
• 1:49
  - and, eventually got my bachelor's care
• 1:54
  - administration. But I always say I could've done
• 1:56
  - anything. I mean, with in in business, could've
• 1:58
  - done, other gone into other careers. But what
• 2:01
  - really
• 2:02
  - continues to keep me in health care is
• 2:05
  - that passion to provide excellence in medical care
• 2:08
  - and assisting independent physician practices and providing a
• 2:11
  - quality medical experience.
• 2:13
  - That that's really the love that I have
• 2:15
  - for for health care.
• 2:17
  - And, and throughout that, you know, over the
• 2:19
  - last thirty years, just, you know, helping,
• 2:22
  - physician led organizations build operational infrastructures
• 2:25
  - around
• 2:26
  - what can now be,
• 2:27
  - something that you can't do in order to
• 2:29
  - grow, without losing what's good about them. You
• 2:33
  - know, the building as well, as you stated,
• 2:35
  - I,
• 2:36
  - I was the CEO for GastroHaul for many
• 2:38
  - years, built it into the first p platform,
• 2:41
  - for GI,
• 2:42
  - north of a 100,000,000 in in business. And
• 2:45
  - and I also worked in dermatology in New
• 2:47
  - York City with Navoderm.
• 2:49
  - And as as you also mentioned, I'm today
• 2:51
  - the CEO for Synergy Orthopedic Specialists in San
• 2:53
  - Diego. We're an independent
• 2:54
  - physician led MSK platform,
• 2:58
  - and over 60 providers, surgery center. We own
• 3:01
  - our own anesthesia,
• 3:02
  - advanced imaging, DME,
• 3:04
  - and, physical therapy clinics
• 3:07
  - all throughout the San Diego and also, and
• 3:09
  - crunching into the northern counties
• 3:12
  - outside of San Diego. So the idea eventually
• 3:14
  - is to to have an integrated MSK all
• 3:16
  - under one roof owned and governed by independent
• 3:19
  - physicians.
• 3:21
  - And and tell us the most interesting thing
• 3:24
  - in in in being involved in gastroderm
• 3:28
  - and orthopedics. Let's start with those three. And
• 3:30
  - we'll talk a little bit about the career
• 3:32
  - trajectory because it's literally remarkable from desk clerk
• 3:36
  - to college degree to University of Miami MBA
• 3:39
  - to leading one of the largest gastro platforms
• 3:41
  - in the country, and now we have a
• 3:42
  - fantastic ortho platform. But but I'm gonna ask
• 3:45
  - you this question.
• 3:46
  - I'm gonna ask you this. The most interesting
• 3:49
  - or surprising thing you learned about gastro, the
• 3:51
  - most interesting or surprising thing you learned about
• 3:53
  - dermatology,
• 3:54
  - and the most interesting or surprising thing you
• 3:56
  - learned about orthopedics
• 3:58
  - in your
• 3:59
  - different stints as a leader of different great
• 4:02
  - platforms and practices.
• 4:04
  - So just give us, you know and I
• 4:06
  - know this is,
• 4:07
  - you you weren't planning on this question. Yeah.
• 4:09
  - No. I I got them laughing as you're
• 4:10
  - saying it. But but the most interesting thing
• 4:13
  - or surprising thing you learned about gastroenterology
• 4:15
  - other than all the gastroenterologists having arthritis from
• 4:18
  - doing so many GI procedures, or the most
• 4:20
  - interesting thing in derm, you know, or the
• 4:22
  - most interesting thing in orthopedics.
• 4:24
  - Give us a little bit of each.
• 4:26
  - Yeah. I I would say GI, I I
• 4:28
  - was fortunate to be involved in GI around
• 4:31
  - that that period of time
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  - where the the event of, colonoscopy
• 4:37
  - screening
• 4:38
  - was really
• 4:39
  - being discovered. I was around a lot of
• 4:41
  - thought leaders. I was really involved at a
• 4:43
  - national level. So,
• 4:45
  - GI, you know, being able to be,
• 4:49
  - in in GI, particularly, be able to, have
• 4:51
  - the the opportunity
• 4:53
  - to be around that that time. And I
• 4:55
  - think people kinda take it for granted that,
• 4:58
  - maybe, you know, twenty, thirty years ago, people
• 5:00
  - were just it was one of the largest,
• 5:02
  - I mean, it still is one of the
• 5:04
  - most prevalent cancers
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  - that people die from,
• 5:07
  - particularly one that could be,
• 5:09
  - discovered early.
• 5:11
  - So being around that, but the business around
• 5:13
  - that as well, being able to have,
• 5:16
  - you know, the physicians, the the ASC, the
• 5:20
  - anesthesia, even in in Gastrohealth.
• 5:23
  - We started a a pharmacy, and we dispense
• 5:25
  - the products. So we literally own the overall
• 5:29
  - program and and and and, you know, the
• 5:31
  - the integrated delivery around
• 5:34
  - screening colonoscopy,
• 5:35
  - in our marketplace.
• 5:37
  - And then,
• 5:38
  - derm,
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  - I think derm, you know, no offense to
• 5:41
  - to other physicians and other specialties.
• 5:44
  - They're really smart people. They they the conversation
• 5:48
  - I get and, again, all the doctors that
• 5:50
  - I worked with are are really outstanding and
• 5:52
  - great,
• 5:53
  - leaders and and great thought leaders, but, you
• 5:56
  - know, dermatologists
• 5:57
  - are are are really smart people. It just
• 5:59
  - the conversation I get into, it doesn't really
• 6:01
  - matter the field or what we do.
• 6:03
  - You know, from a business angle, I think
• 6:05
  - they get a bad rap particularly around,
• 6:08
  - when they built out their integrated,
• 6:10
  - pathology labs and, you know, they get the
• 6:13
  - bad rap. It's like, oh, they they they
• 6:14
  - take a million specimens and, you know, they're
• 6:17
  - trying to just make money,
• 6:18
  - whether it's cosmetic or whatever. I'm just like,
• 6:20
  - no. I tend to think that they they
• 6:22
  - really love their and they're passionate about what
• 6:25
  - they do, and, they're always trying to figure
• 6:27
  - out what their, you know, what can make
• 6:29
  - their their business better.
• 6:31
  - And and lastly, orthopedics. Orthopedics,
• 6:34
  - you know, it's funny. GI, I think of
• 6:36
  - them as as plumbers,
• 6:38
  - and g and orthopedics, I think of them
• 6:40
  - as our carpenters, you know, just in the
• 6:42
  - way that they they they go into their
• 6:44
  - their their passion.
• 6:46
  - Again, really smart people. I've worked with with,
• 6:49
  - orthopedic doctors in my group that are all
• 6:51
  - in into AI or three d printing and
• 6:54
  - just they they really look at how they're
• 6:56
  - gonna develop and and and execute
• 6:59
  - and get that person back in motion, get
• 7:01
  - them back to better than they were before.
• 7:05
  - So, and also on the business side, similarly,
• 7:07
  - then GI
• 7:09
  - has all those tools. We have the ASC.
• 7:12
  - We have,
• 7:13
  - we're we're bringing anesthesia into the platform where
• 7:15
  - we have the DME and and pain management
• 7:19
  - and everything that comes into its spine. You
• 7:21
  - know, our our group is multi specialty, so
• 7:22
  - we bring in all the different facets of
• 7:25
  - integrated delivery systems.
• 7:27
  - I think, again, that their their biggest,
• 7:31
  - strength is,
• 7:32
  - you know,
• 7:33
  - just in Southern California, the payer market is
• 7:36
  - is really tough, and I see that in
• 7:38
  - other markets. It's a little bit
• 7:40
  - easier to manage,
• 7:42
  - than than in other markets. And, again, I've
• 7:43
  - worked in Florida. I worked in New York
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  - or the Northeast New York, New Jersey, and
• 7:47
  - now in in Southern California. Very, very distinct
• 7:50
  - markets. But, yeah, those are the three things
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  - that I would say different about the the
• 7:53
  - specialist.
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  - I I I love that. And and I
• 7:56
  - take it at the end of the day,
• 7:58
  - you can't be a
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  - a leader of physician practices,
• 8:02
  - leader of physician groups. It it with without
• 8:04
  - ultimately liking physicians
• 8:06
  - and the bright driven people that you work
• 8:08
  - with, I I I take it that must
• 8:10
  - be a fair statement. I remember a Yes.
• 8:12
  - A hospital leader years ago saying,
• 8:15
  - if you're
• 8:16
  - a lion tamer and you hate lions, it's
• 8:18
  - no good to be a lion tamer. If
• 8:20
  - you're a physician leader or working with physicians,
• 8:23
  - you better like physicians and you get so
• 8:25
  - many you get some hospital leaders, not as
• 8:27
  - many as you use, there's some practitioners
• 8:29
  - that that almost viewed physicians as a necessary
• 8:31
  - evil. But do this right, you better really
• 8:33
  - like and connect and and and be in
• 8:35
  - a,
• 8:36
  - in a leadership and a service role. Right?
• 8:39
  - Yes. Yes. I think that, you know, again,
• 8:41
  - going back to what keep me keeps me,
• 8:44
  - staying in in health care is that idea
• 8:47
  - of
• 8:47
  - of providing medical care. I I know I
• 8:49
  - don't touch the patient. I'm not really involved.
• 8:52
  - The docs are the main drivers of that,
• 8:54
  - but I think the the ecosystem that we
• 8:56
  - develop
• 8:57
  - allows the the physician to to thrive,
• 9:01
  - whether it's picking the right staff, picking the
• 9:03
  - right billing,
• 9:04
  - team,
• 9:06
  - just all the different things, technology, etcetera. Just
• 9:09
  - my goal, I think it's more around,
• 9:11
  - I'm more like the producer of the show
• 9:13
  - or the guy that's running the circus more
• 9:16
  - than the lion tamers.
• 9:17
  - The the you know, always people tell me
• 9:19
  - how do you get,
• 9:21
  - you know, birds to fly in a straight
• 9:23
  - line or something like that. I would say
• 9:24
  - eagles. It's hard to get eagles to start
• 9:27
  - to to all work together and go in
• 9:29
  - the same direction. And I think that's,
• 9:31
  - a a thesis I bring to groups right
• 9:33
  - away where I feel like you have to
• 9:35
  - all be, in the same boat, rolling in
• 9:37
  - the same direction, showing the same flag with
• 9:40
  - the same vision and mission. And if we
• 9:42
  - do that, we can accomplish anything we want
• 9:44
  - in any market at any time.
• 9:47
  - Yeah. And I I love that perspective. If
• 9:49
  - we're not getting we're getting Eagles we're working
• 9:52
  - with Eagles and getting them aligned or letting
• 9:55
  - them align and thrive. I love that. Talk
• 9:57
  - a bit about Alejandro.
• 10:00
  - Talk a little bit about I'm gonna ask
• 10:02
  - you about two subjects. First, what you're most
• 10:04
  - focused on and excited today,
• 10:06
  - and two,
• 10:07
  - about the career journey from desk clerk to
• 10:11
  - leader.
• 10:12
  - And maybe we'll start there, desk clerk to
• 10:14
  - leader. I I guess the first question and
• 10:17
  - and, you know, I I I'm probably a
• 10:19
  - little bit older than you,
• 10:21
  - but, you know Not much. But but my
• 10:24
  - my
• 10:25
  - my parents,
• 10:26
  - you know, as I moved out of straight
• 10:29
  - being a lawyer into media,
• 10:31
  - were like, you know,
• 10:33
  - what's wrong with you? Would you stick to
• 10:34
  - being a lawyer? Were your parents, in contrast,
• 10:37
  - so proud of you for moving
• 10:40
  - up this professional ladder from desk clerk to
• 10:43
  - getting an MBA to running major groups.
• 10:46
  - And I I you know, and and again,
• 10:48
  - I'm fortunate my parents are in their late
• 10:50
  - eighties and nineties. They're still alive. My dad's
• 10:52
  - got dementia, so not really with it. But,
• 10:55
  - ultimately, we're very proud of the evolution of
• 10:57
  - myself.
• 10:58
  - Your folks must have been thrilled. Can you
• 11:00
  - talk about that a little bit? And was
• 11:02
  - that heartwarming, or how did that look? Yeah.
• 11:04
  - So, I mean, I you know, my my
• 11:06
  - story from from my parents'
• 11:09
  - side is is very different.
• 11:10
  - My parents are Cuban, both born in Cuba,
• 11:14
  - left the Castro regime in the in the
• 11:17
  - sixties to through Spain.
• 11:19
  - And my my first instance that I that
• 11:22
  - you know, outside of my personal health care,
• 11:24
  - but, you know, my my dad always talks
• 11:26
  - about my dad my grandfather, which I've never
• 11:28
  - met, dying of lung cancer in Puerto Rico.
• 11:30
  - That's how they ended up in Puerto Rico.
• 11:32
  - That's where I was born. I was born
• 11:34
  - in Puerto Rico originally with my brothers. I
• 11:36
  - have two other brothers. And I'm the oldest
• 11:38
  - of the three. So my my dad always
• 11:41
  - they they had they have bridal stores. So
• 11:43
  - that that was the the family business. That's
• 11:45
  - where I would I spend my summers, you
• 11:46
  - know, doing learning how to answer the phones
• 11:48
  - and doing sales and the cash register. So
• 11:51
  - I lived in a very entrepreneurial
• 11:53
  - family. So it was always expected to a
• 11:55
  - degree,
• 11:57
  - from, you know, having three brothers that the
• 11:59
  - the oldest would take over the business or
• 12:01
  - or Dee somehow involved in a very entrepreneurial
• 12:03
  - business. And I've always taken,
• 12:06
  - my my my, you know, my course or
• 12:08
  - my life in in health care and that
• 12:11
  - I've never seen myself as the just the
• 12:13
  - administrator or the office manager or even the
• 12:16
  - health care executive. I always see myself as
• 12:18
  - somebody who's very entrepreneurial,
• 12:19
  - helping, working with teams, working with a lot
• 12:22
  - of people, and building something bigger and better.
• 12:24
  - And, of course, they were very proud of
• 12:26
  - me, particularly
• 12:27
  - the first one to graduate, you know, from
• 12:29
  - college. Both my my mom and my dad
• 12:30
  - just basically had a a high school degree,
• 12:32
  - again, immigrated from from Cuba into The States.
• 12:36
  - And, and, you know, part of the story,
• 12:38
  - again, for them, it's it's really cool because
• 12:40
  - they helped not only my my my my
• 12:43
  - cousins and my uncles,
• 12:45
  - leave Cuba
• 12:46
  - in, in in the, early eighties.
• 12:50
  - But they went in they went to Cuba.
• 12:52
  - They got the fishing boats and and pulled
• 12:54
  - all these people out, not just my family,
• 12:55
  - but hundreds of people. So I've always seen
• 12:58
  - this this thrive to be better.
• 13:01
  - I guess, it's the typical immigrant story. I
• 13:03
  - didn't really lived it. They lived it, but
• 13:04
  - I always feel like a second generation
• 13:06
  - Cuban American, you know, even though I was
• 13:08
  - born in Puerto Rico. It's just the the
• 13:09
  - idea that you always have to excel and
• 13:12
  - grow. So when I took this first job,
• 13:15
  - and I was just basically
• 13:17
  - doing front desk and kinda, like, just needed
• 13:19
  - money to to put my myself through to
• 13:21
  - college,
• 13:22
  - I saw that the opportunity to to learn
• 13:25
  - more, to see how the business ran, how
• 13:27
  - do you improve it, how do you make
• 13:28
  - things different, how do you create something bigger
• 13:31
  - and better than what it is today.
• 13:33
  - And from there, I went, you know, from
• 13:34
  - a small clinic in in Miami to then
• 13:37
  - running my first administrative,
• 13:39
  - group, which was also in gastroenterology. I spent
• 13:41
  - a lot of time in gastro. And then
• 13:43
  - I did some some stent in allergy and
• 13:46
  - and asthma and so on. And then when
• 13:47
  - I bit went back
• 13:49
  - to to GI Care, which was the the
• 13:51
  - founding group of Gastro Health. So I was
• 13:53
  - I've been in Gastro on and off probably
• 13:55
  - around fifty years,
• 13:56
  - and I I really love the idea that
• 13:59
  - I I grew from in the business, not
• 14:01
  - I was an executive that just finished in
• 14:04
  - a master's degree and then went through some
• 14:05
  - type of fellowship. If I would have done
• 14:07
  - that, I probably would have been a hospital
• 14:09
  - administrator, but I I really love the independence
• 14:11
  - of physician practice, the entrepreneurial
• 14:14
  - life that they live.
• 14:15
  - Physicians, you know, have
• 14:18
  - to thrive
• 14:19
  - and and or die. The business dies through
• 14:21
  - their p and l, through cash flow. They
• 14:23
  - have to they have to succeed, and the
• 14:25
  - pressures that are being put on them and,
• 14:28
  - you know, whether it's the government or the
• 14:30
  - payers or just expenses. I mean, we live
• 14:33
  - in this economy where our our our revenues
• 14:36
  - is fixed or or or or basically managed
• 14:39
  - by somebody else, and then the the expenses
• 14:41
  - continue to to go higher based on, you
• 14:44
  - know, the the market and the economy.
• 14:47
  - So, Alejandro, let me ask you this question.
• 14:49
  - What a magnificent career,
• 14:51
  - magnificent
• 14:52
  - growth,
• 14:53
  - so much to be so proud of. Just
• 14:55
  - a fantastic
• 14:56
  - another fantastic story
• 14:58
  - of we're all immigrants here. We're second or
• 15:01
  - third generation, not first generation, but my grandparents
• 15:04
  - immigrated here. My parents are born here than
• 15:06
  - me. But it's all of us come from
• 15:08
  - similar but different backgrounds and fascinating. I love
• 15:11
  - that. Take a second on what are you
• 15:14
  - most focused on and excited about as we
• 15:15
  - finish 2026
• 15:17
  - and head into next year? Yeah.
• 15:20
  - The the biggest thing is are is what
• 15:22
  - I'm building with with the an amazing team
• 15:24
  - of physicians and
• 15:26
  - executives and and staff,
• 15:29
  - particularly around the integrated platform,
• 15:32
  - the surgery center especially,
• 15:33
  - but bringing in surgery, anesthesia, imaging, PT,
• 15:38
  - DME, all under one roof,
• 15:40
  - under a physician led model.
• 15:43
  - You
• 15:44
  - know, the operational is is brutal. The staffing,
• 15:46
  - the workflows, the payer, our relationships, governance amongst
• 15:50
  - the partners, all of it at once. So
• 15:53
  - always looking to,
• 15:55
  - you know, the one concrete win, I would
• 15:56
  - say, is, we brought imaging in house,
• 15:59
  - reduced times. We brought in a Seashire in
• 16:02
  - house, with a shortage of physicians
• 16:05
  - out there and the whole program on, stipends
• 16:08
  - being paid by both ASCs and and hospitals
• 16:11
  - being able to do that,
• 16:12
  - and and control that that that cost and
• 16:15
  - also be able to thrive from it as
• 16:17
  - an ancillary revenue stream.
• 16:19
  - We did partner with USPI on the operational
• 16:22
  - scale. As you know, I've been involved with
• 16:24
  - many ASCs, but I tend to thrive mostly
• 16:26
  - around the physician practice management side of the
• 16:29
  - business. Plus we wanted somebody,
• 16:31
  - that allowed physician ownership and and clinical control,
• 16:35
  - but at the same time brought in all
• 16:37
  - the the economics
• 16:38
  - and improved the integrating everything that we're doing.
• 16:41
  - You know, so just building a generally
• 16:44
  - physician led, physician aligned organization that,
• 16:48
  - overall will make it very doable in the
• 16:50
  - future.
• 16:51
  - Thank you so much. Alejandro, I it was
• 16:53
  - so nice to see you in Chicago recently.
• 16:56
  - You're one of the best people I get
• 16:57
  - a chance to visit with. Love getting a
• 16:59
  - chance to talk to you. Thank you for
• 17:01
  - taking the time to join us today on
• 17:02
  - the Becker's healthcare podcast. What a pleasure to
• 17:05
  - visit with you as always. Thank you so
• 17:07
  - much. Thank you. Thank you very much. Thank
• 17:09
  - you, Scott.