Latest / Becker’s Healthcare Podcast / Payment Reform, Physician Independence, and Rebuilding Healthcare’s Architecture with Dutch Rojas

Transcript

Payment Reform, Physician Independence, and Rebuilding Healthcare’s Architecture with Dutch Rojas · Becker’s Healthcare Podcast

• 0:00
  This is Scott Becker with a special episode
• 0:03
  of the Becker's health care and the Becker
• 0:05
  business podcast.
• 0:07
  We're thrilled today to be joined by Dutch
• 0:09
  Rojas.
• 0:10
  And for people that don't know Dutch, Dutch
• 0:12
  is one of the most interesting,
• 0:14
  smartest,
• 0:16
  people in health care who looks at the
• 0:17
  health care industry.
• 0:19
  He's got a point of view on a
• 0:20
  lot of things, which makes him particularly interesting
• 0:22
  and just a terrific leader.
• 0:24
  I'm gonna talk to Dutch today. He does
• 0:26
  a number of things. He consults with physicians.
• 0:28
  He invests.
• 0:29
  He he's a thought leader. And we're gonna
• 0:31
  talk to him about different trends he's watching
• 0:33
  in health care, and he's an a keen
• 0:36
  observer of the health care system. He does
• 0:38
  a lot of keynote speaking. He's got his
• 0:40
  own newsletter called the the Rojas Report, which
• 0:44
  is fantastic.
• 0:45
  And I don't agree with everything that Dutch
• 0:47
  says. I agree with probably 95% of what
• 0:49
  he says, but I love the fact that
• 0:51
  he's got an ardent and consistent point of
• 0:53
  view.
• 0:54
  Dutch, can you take a second and introduce
• 0:57
  yourself and tell the audience a little bit
• 0:59
  about what you do and the different things
• 1:01
  that you do?
• 1:02
  Well, that seems overwhelming, but, yes, I'll I'll
• 1:04
  do it. Hey. Listen. Thank you for having
• 1:06
  me on. It's always a joy. I love
• 1:07
  talking to you. I love your
• 1:10
  audience.
• 1:11
  What do we do? Well, I think we
• 1:12
  tackle the the the architecture and the structure
• 1:15
  of health care. We look at what's going
• 1:17
  on today. We say,
• 1:19
  can we build a company? Can we invest
• 1:21
  and deploy capital towards companies that begin to
• 1:23
  solve the challenges?
• 1:25
  I think it
• 1:26
  took probably like most people, it took twenty
• 1:28
  or twenty five years to figure out what
• 1:30
  the problems actually were. I think that was
• 1:32
  a really difficult discovery.
• 1:34
  I certainly made an inordinate amount of mistakes
• 1:37
  thinking, okay, I've got it solved now. Right?
• 1:40
  I and I think that's typical, like, high
• 1:42
  education person, like, hey, I'm smart. I've got
• 1:45
  it figured out. If you guys just do
• 1:47
  this, this, and this. And then, of course,
• 1:48
  you find out, you know, there's 20 things
• 1:50
  you didn't know. And not only did you
• 1:52
  not know, but you had no like, you
• 1:53
  didn't have any notion of knowing.
• 1:56
  And so you learn those things and you
• 1:58
  move on. And I think, I know we've
• 2:00
  talked about this before, but I think I
• 2:02
  turned 50 this year and I think,
• 2:04
  man, I think I finally,
• 2:06
  you know, kinda can look back and say,
• 2:08
  I think building ASCs, developing ASCs, working at
• 2:11
  practices, helping build not only small practice but
• 2:14
  large practices, consulting for
• 2:16
  physician owned hospitals,
• 2:18
  rural hospitals,
• 2:19
  community hospitals,
• 2:21
  university academic centers. I think it's giving you
• 2:24
  a good perspective on
• 2:26
  what do we do from here and how
• 2:28
  do we move forward.
• 2:30
  And so I I love that, and and
• 2:32
  you do have a keen perspective.
• 2:34
  Talk a bit about The US health care
• 2:36
  system today.
• 2:37
  Where is it structurally misaligned right now? Where
• 2:41
  where is it I mean, and and that's
• 2:43
  a broad question because you might say it's
• 2:45
  every place, but is it payment models? Is
• 2:47
  it workforce? Is it incentives? Is it something
• 2:49
  else? Where do you see it misaligned?
• 2:52
  I I do think the the right answer
• 2:54
  is payment, and I think everything else is
• 2:56
  downstream.
• 2:57
  I I think, again, that's back to architecture.
• 3:00
  Look. The system pays for site of care,
• 3:02
  not quality of care. Right? A knee replacement
• 3:04
  at
• 3:05
  an HOPD
• 3:07
  pays more or is reimbursed more by CMS
• 3:10
  than one at an ASC.
• 3:12
  And I think that's inherently
• 3:14
  incorrect. I don't think that's how market structure
• 3:17
  works. I don't think that's how,
• 3:19
  price dynamics work. I don't think that's how
• 3:21
  mean reversion works. I don't think that's how
• 3:22
  any marketplace works.
• 3:24
  And and so I think, yeah, everything else
• 3:26
  is downstream from there. I think you look
• 3:28
  at site neutral payments, we're we're getting some
• 3:31
  work on that,
• 3:33
  but we've got a large lobby,
• 3:36
  that works against it. Look. We had we've
• 3:39
  had two or three chances
• 3:41
  to, defeat site neutral payments, and we haven't
• 3:44
  been able to do it. And so I
• 3:45
  think until you start paying the same price
• 3:48
  for the same thing,
• 3:49
  we have real challenges.
• 3:52
  Thank you. And and what would you say
• 3:54
  people talk a lot about transformation in health
• 3:57
  care, and it seems so challenging right now
• 3:59
  because it seems like when you look at
• 4:00
  the Triple Aim, you know, lower cost Yes.
• 4:03
  Higher quality, better access,
• 4:05
  it really does feel like we're going in
• 4:07
  the wrong direction on all three of those.
• 4:09
  But but can you tell me
• 4:12
  what's actually are there things going right? What's
• 4:15
  going right? What do you see? What encourages
• 4:17
  you?
• 4:18
  Oh, I gotta tell you. And and this
• 4:20
  is you know, I I mean, I don't
• 4:21
  know if I travel as much as you
• 4:23
  do. I'm gone a couple days a week,
• 4:26
  but my heart
• 4:27
  had a moment. And and for those people
• 4:29
  who know me, you know, I have, like,
• 4:30
  no feelings whatsoever. I'm completely a Dutch guy.
• 4:34
  And
• 4:35
  what I'm seeing is I'm seeing physicians return
• 4:37
  to independent practice.
• 4:39
  Look, the the Avalere study, which I really
• 4:41
  like out of DC, said that 12%
• 4:43
  are truly independent as of 2024.
• 4:46
  I think by the end of 2027,
• 4:48
  we're gonna see,
• 4:51
  greater than 20%
• 4:52
  return
• 4:53
  to the independent practice of medicine. The physicians
• 4:56
  that sold five to seven years ago, they're
• 4:58
  out of their non competes, and they're not
• 5:00
  going back. I mean, I'm having I had
• 5:02
  discussion in San Francisco about it. I had
• 5:03
  discussion in, Seattle about it, and then I'm
• 5:06
  having those discussions in New York. I had
• 5:08
  one in Wisconsin last week, then you're having
• 5:10
  them in Dallas. And I think one of
• 5:12
  the things that, you know, that I've always
• 5:14
  appreciated about you is you pay attention to
• 5:16
  the signals.
• 5:17
  Like, one conversation in one isolated place might
• 5:19
  be something.
• 5:21
  But when you're visiting with vascular surgeons, neurosurgeons,
• 5:24
  ENTs,
• 5:25
  primary care across the spectrum, and then you
• 5:28
  do that in different parts of the country,
• 5:30
  and then they're kind of starting to say
• 5:32
  the same thing, you have to kinda look
• 5:34
  at that and go, well, that's a good
• 5:35
  signal.
• 5:36
  I'm very happy with the DPC movement, direct
• 5:39
  primary care movement.
• 5:40
  I'm seeing more independence move to the cash
• 5:42
  pay surgery model.
• 5:44
  I largely tell physicians that the reason we
• 5:47
  didn't have large scale adoption of direct contracting,
• 5:50
  meaning
• 5:51
  employer
• 5:51
  to physician contracting, was because of the physicians.
• 5:54
  They wanted to hire an attorney and beat
• 5:56
  the daylights out of the agreements,
• 5:58
  but that's changing.
• 5:59
  We're seeing more movement towards concierge medicine.
• 6:02
  I I would probably argue that none of
• 6:04
  that's at scale, but I think the trajectory
• 6:07
  is real and it's accelerating.
• 6:09
  The things that
• 6:10
  maybe
• 6:11
  are also changing are value based care.
• 6:15
  We've had great conversations. I was in New
• 6:17
  York recently.
• 6:18
  We had great conversations
• 6:20
  around, can we commoditize
• 6:23
  labs, imaging,
• 6:24
  PT,
• 6:25
  gastro, like, very low on the innovation poll,
• 6:29
  but can we can we commoditize them in
• 6:32
  a structure that allows us to build a
• 6:33
  commodities exchange?
• 6:35
  So one day, employers
• 6:37
  and physicians
• 6:38
  can
• 6:39
  offer their treatments and services on an exchange,
• 6:41
  and we can put,
• 6:43
  pharmaceuticals on an exchange. I think that's a
• 6:45
  pretty exciting talk, and I think that's where
• 6:47
  we're moving. So I'm I'm I'm pretty happy.
• 6:49
  You know? I think three years ago, I
• 6:51
  was pretty down.
• 6:52
  And and since then, it's kind of moved
• 6:54
  moved uphill.
• 6:55
  I think a fantastic perspective and such a
• 6:58
  positive perspective. I I love that. Let let
• 7:01
  me ask you. If you were advising congress
• 7:03
  today,
• 7:04
  what would you tell them has to be
• 7:06
  fixed? And you might have alluded to this
• 7:08
  already when you talked about the payment system.
• 7:10
  Where do you start?
• 7:12
  Look. I think number one, and you you
• 7:14
  know this about me, I think you repeal
• 7:16
  the physician owned hospital ban. Like, you have
• 7:19
  to get rid of it.
• 7:20
  When you look at rural, right, I live
• 7:22
  in Oklahoma,
• 7:23
  it's rural.
• 7:25
  When you when you drive through Kansas, Missouri,
• 7:29
  Alabama,
• 7:31
  Georgia,
• 7:32
  Mississippi.
• 7:33
  All of these states have massive rural areas,
• 7:36
  and many of them, as I've said them,
• 7:38
  as I've as I've named them, are certificate
• 7:40
  of need states.
• 7:41
  Many of them, right, they all have the
• 7:43
  physician on hospital ban. So people will say,
• 7:45
  well, we want physicians to go to these
• 7:47
  rural areas. And I'm like, well, you took
• 7:49
  away the equity piece. That's 80% of the
• 7:51
  of of the dollars they could earn. Right?
• 7:54
  Pro fees are at an all time low.
• 7:56
  If you if you repeal the physician on
• 7:58
  hospital band,
• 8:00
  look, we do I deploy capital today through
• 8:02
  our fund
• 8:03
  to physician owned hospitals.
• 8:05
  So why wouldn't we deploy more at scale
• 8:08
  towards those efforts
• 8:10
  if the physician owned hospital ban was repealed?
• 8:13
  So I I I think that's number one.
• 8:14
  I'll be I'll be in front of congress
• 8:16
  on Wednesday next week and Thursday next week.
• 8:18
  This is this is all I talk about.
• 8:21
  Of course, we talked about site neutral payments,
• 8:23
  same procedure, same complexity, same outcome, same payment.
• 8:26
  Scott, sometimes I feel like I say these
• 8:28
  things so many times that they just come
• 8:29
  right out.
• 8:30
  Like, Like, I just said the site neutral
• 8:31
  payments thing, and I'm like, how many times
• 8:33
  have I said that?
• 8:35
  But but it's but it's so healthy because
• 8:37
  more and more people have to hear that.
• 8:38
  Obviously, there's gotta be some contagion to it
• 8:41
  for it to work. But you talk about
• 8:43
  the rural health crises
• 8:44
  and and not being able to track doctors
• 8:46
  back, not be able to to bring nurses
• 8:48
  back, and that starts to be the death
• 8:50
  note of a rural community. So he he
• 8:52
  can't have health care. People can't really live
• 8:54
  there, and young families won't go back there.
• 8:56
  But your point on physician hospitals is so
• 8:58
  well taken.
• 8:59
  Just another avenue to make it more attractive
• 9:02
  for physicians to be in business and and
• 9:04
  to be able to to fund and and
• 9:05
  do things in other communities, not just the
• 9:07
  50 biggest metro communities. I I could not
• 9:10
  agree more.
• 9:11
  That's right. Well, look. You you asked about
• 9:13
  health systems.
• 9:15
  I wish I had a more amicable
• 9:17
  relationship with them. I I do,
• 9:20
  probably not on social media, but offline,
• 9:23
  I do. And and I think, you know,
• 9:25
  you're you're you're a business person too.
• 9:28
  I think there's other
• 9:30
  architecture that would help them.
• 9:33
  I think that, you know, when I studied
• 9:36
  mergers and acquisitions in undergrad and then of
• 9:38
  course in graduate school,
• 9:39
  there was this idea that you needed a
• 9:42
  lot of capital.
• 9:43
  Right? So I started studying probably ten or
• 9:45
  fifteen years ago, like, capital light movement.
• 9:48
  Well, just like we ended up with the
• 9:51
  PE model, right, which was probably PPE in
• 9:54
  02/1516.
• 9:57
  You you've now seen what's happened. Like, people
• 9:59
  are transitioning.
• 10:00
  Companies are PE offices are transitioning to family
• 10:03
  offices, where they basically have more control over
• 10:06
  what they can invest in versus a very
• 10:09
  singular thesis. Like, hey, we're just gonna do
• 10:12
  x y z.
• 10:13
  And I think health systems,
• 10:16
  unbeknownst to them, could deploy some of these
• 10:18
  models which are incredible,
• 10:21
  but they create a win win between the
• 10:23
  independent physician
• 10:24
  and the health system, and they bolster
• 10:27
  both
• 10:28
  on the balance sheet. And physicians have traditionally
• 10:31
  not had a balance sheet. And, of course,
• 10:33
  that's a whole other topic. But but health
• 10:35
  system CEOs sit in a place
• 10:37
  where they don't have to raise additional capital.
• 10:39
  They don't have to go out to the
• 10:41
  debt markets, which are
• 10:42
  have been completely annihilated as far as I'm
• 10:44
  concerned,
• 10:45
  especially on the health system side, and they
• 10:47
  could actually create a win win. So I'm
• 10:49
  hoping over the next couple years to have
• 10:51
  these conversations with the larger health systems. I've
• 10:54
  been having them for about six months.
• 10:56
  And get them to understand finance,
• 10:59
  economics, capital markets, and say, you know,
• 11:03
  you can control or win market share, but
• 11:06
  you can do it really in a win
• 11:08
  win avenue,
• 11:09
  and that will help you. Now you can
• 11:11
  do that, or you can wait for Congress.
• 11:14
  I I think the federal government,
• 11:16
  if if the health systems don't begin to
• 11:18
  act more rationally,
• 11:20
  I think then you're gonna see what
• 11:22
  AOC,
• 11:23
  doctor Murphy, guys like Mark Cuban are asking
• 11:26
  for, which is break them up.
• 11:28
  That is not something that I ever want
• 11:31
  the government to do, but, you know, everyone's
• 11:33
  entitled to their opinion, of course. But but
• 11:35
  I think, like, health system CEOs have a
• 11:37
  real opportunity to help the country and make
• 11:40
  significantly more money
• 11:42
  while helping independent physicians. They just have to
• 11:44
  choose to do that. So if I was
• 11:46
  talking to a health system CEO, that's absolutely
• 11:48
  the first conversation I would have.
• 11:51
  Love it. And and talk about you see
• 11:53
  leaders do great things.
• 11:55
  You see leaders get caught up in sort
• 11:57
  of playing business
• 11:59
  or political
• 12:00
  bureaucracy. You know?
• 12:02
  And talking about leaders in the not forever
• 12:04
  to Stratford sector sector, not politicians.
• 12:07
  But what separates leaders that you admire
• 12:11
  that are impactful and and doing well versus
• 12:14
  those that don't? What what do you see
• 12:16
  as differences?
• 12:18
  The ones that I really like, and there's
• 12:20
  quite a few of them,
• 12:21
  understand
• 12:23
  and probably have a lot of experience basic,
• 12:26
  you know, in lots of industries. So so
• 12:28
  they understand capital markets.
• 12:30
  They understand governance.
• 12:32
  They understand,
• 12:33
  human resources. They understand, like, different pieces of
• 12:36
  the business, and they know the difference between
• 12:38
  complexity and complication.
• 12:41
  Right? So, like, I always say health care
• 12:43
  is complicated,
• 12:44
  but don't confuse that for being unsolvable.
• 12:47
  Right? Like, let's get it down and simplify
• 12:50
  it. And simplify it relentlessly, like, don't stop.
• 12:54
  I I think too many executives that I
• 12:56
  meet around the country,
• 12:58
  they're too caught up in believing that they're
• 13:01
  not these problems aren't solvable.
• 13:03
  And what they don't do is they they
• 13:06
  live within the restraints
• 13:08
  of of a lane of a driving lane,
• 13:10
  and they don't just so well, what if
• 13:12
  those didn't exist?
• 13:15
  Right? And so I I think the ones
• 13:17
  that are stuck in the noise really substitute
• 13:19
  kind of process for accountability.
• 13:22
  They wait for something else and they wait
• 13:24
  for someone else to move. They look for
• 13:26
  empirical evidence, and I think real and there
• 13:29
  and there's a there's a bunch of them.
• 13:30
  There's real visionaries
• 13:32
  in health care that say, no, no, no.
• 13:34
  I'll take the first step and I'll lead
• 13:35
  everybody else.
• 13:37
  Those are the ones that I think are
• 13:38
  gonna make real progress coming out, and I
• 13:40
  think you and I are gonna see it.
• 13:41
  Look,
• 13:43
  we haven't had a discussion about AI, you
• 13:44
  and I, but
• 13:46
  I mean, that's just gonna rip roar
• 13:49
  through this industry,
• 13:51
  and I don't I've seen very few that
• 13:53
  are ready for it.
• 13:55
  Or or that can deploy it well in
• 13:57
  enterprise level versus a a one off level.
• 14:00
  Dodge, I should ask a question because one
• 14:01
  of the things you do tremendously well is
• 14:04
  simplify.
• 14:05
  And as a leader, people know where you're
• 14:06
  coming from.
• 14:08
  You
• 14:08
  you you you believe the physician owned hospital
• 14:11
  restrictions should be prohibition should be removed.
• 14:14
  You believe there should be site neutrality.
• 14:17
  You believe that some health systems are are
• 14:20
  wasting a ton of money and spending too
• 14:22
  much money on top executives.
• 14:24
  Whether I agree with this all this or
• 14:26
  not, one of the things about being a
• 14:28
  leader that is fantastic about yourself is people
• 14:31
  know where you stand and what you think,
• 14:33
  what your point of view is. How important
• 14:35
  is that for leadership? Not so much they
• 14:37
  know what your political points of view are,
• 14:39
  but the people know where you stand and
• 14:40
  what has to be accomplished by the organization
• 14:42
  that you could simplify that and somebody knows.
• 14:45
  This is what our system's trying to do.
• 14:46
  We're trying to provide great care. We're trying
• 14:49
  to be fantastic in cardiovascular. What whatever it
• 14:51
  is that the mission is, How important is
• 14:53
  it that is a leader like you? Is
• 14:55
  that clear about what trying to accomplish?
• 14:58
  Well, I'll start by saying,
• 15:00
  I think I'm highly biased. You you have
• 15:02
  to remember, like, I grew up,
• 15:05
  went to school and then played soccer half
• 15:06
  the day. Right? I went to soccer school.
• 15:08
  I grew up in The Netherlands.
• 15:10
  Dutch people are,
• 15:13
  probably not as direct as the Austrians and
• 15:15
  the Germans, but we're fairly
• 15:17
  fairly
• 15:18
  unconstrained in what we wanna say to other
• 15:20
  people.
• 15:21
  And I and then I was in the
• 15:23
  marine corps.
• 15:24
  And I think the Marine Corps is a
• 15:26
  lot like the OR.
• 15:27
  Right? When rounds are coming down range, you
• 15:29
  begin to take life very seriously.
• 15:32
  And you realize it's not a game.
• 15:34
  And and I found that
• 15:36
  in a constrained environment, ambiguity is very expensive,
• 15:39
  and it costs lives.
• 15:41
  And I think there's a level of seriousness
• 15:45
  that you have
• 15:47
  when you've experienced these things. I've been in,
• 15:49
  I mean, I've spent an inordinate amount of
• 15:51
  time in the OR with physicians, and you
• 15:53
  know when it's a life threatening emergency.
• 15:56
  In the marine corps, when rounds are coming
• 15:59
  at you, like, you know exactly what's gonna
• 16:02
  happen. Like, you don't know if you're gonna
• 16:03
  live or die in the next three seconds.
• 16:05
  Right? I was a radio operator, and they
• 16:06
  always said we had four second life.
• 16:08
  And so I think you get really precise
• 16:11
  about who decides what, and you eliminate the
• 16:13
  consensus, you eliminate theater.
• 16:15
  Like, I want very fast execution.
• 16:20
  Right? I don't want a weather report, I
• 16:21
  want production.
• 16:23
  And I think a lot of organizations
• 16:25
  double meetings,
• 16:27
  they they they they do things that sound
• 16:30
  like best practices,
• 16:32
  And you have to realize when you're running
• 16:34
  a world class organization, you can't compromise
• 16:37
  on what you produce.
• 16:39
  This is why I've always been for physicians.
• 16:42
  In the the equation sometimes gets left out,
• 16:44
  people say you're a physician advocate, which I
• 16:46
  am, But I'll say it starts with the
• 16:48
  patient.
• 16:49
  Like, you spent time at Harvard, I got
• 16:51
  lucky and got to spend some time at
• 16:52
  Harvard, and what you learn is, well, you
• 16:55
  work backwards.
• 16:56
  And what we said is, well, what's the
• 16:58
  best way to get the best
• 17:00
  the best outcomes for patients and the lowest
• 17:02
  prices?
• 17:03
  Well, if you work your way backwards, it
• 17:05
  always leads to independent physicians.
• 17:07
  That that's how it works.
• 17:08
  And so, I don't know if you can
• 17:10
  cut your way to clinical excellence.
• 17:13
  I think that that leaders who who
• 17:16
  focus on the mission and put the mission
• 17:18
  first,
• 17:20
  I think they produce.
• 17:21
  And I and I think that's where,
• 17:23
  you know, this is a real business where
• 17:25
  people's lives are
• 17:27
  are are in our charge. I Man, I
• 17:30
  I don't think I don't think I chose
• 17:31
  to be in this business. I think God
• 17:32
  put me in it. And I just kinda
• 17:34
  said, okay. Well, if this is my lot
• 17:36
  in life, like, I gotta do the best
• 17:37
  I can. So,
• 17:39
  yeah. That that's that that's the best way
• 17:41
  I can put it. So I'm not it
• 17:43
  and and and don't be ambiguous.
• 17:46
  Don't be the corporate guy. I I I
• 17:48
  love that. I love that. And and I'm
• 17:50
  gonna give you one more question, Dutch.
• 17:52
  What are you most focused on and excited
• 17:54
  about this year? Where are you most focused
• 17:56
  and excited currently?
• 17:59
  You and I have talked a little bit
• 18:00
  about it, but it's all structure. Right? So
• 18:02
  what I'm trying to do is teach physicians
• 18:04
  that you've got to cooperate,
• 18:06
  and you have to continue to compete.
• 18:09
  And so what I mean by that is,
• 18:11
  I'm seeing physicians for the very first time
• 18:14
  understand captives,
• 18:16
  understand commercial lines of insurance,
• 18:18
  understand medical malpractice.
• 18:21
  They're beginning to understand
• 18:23
  capital markets in in terms of what are
• 18:26
  the debt markets, how do the debt markets
• 18:28
  work, what does it mean. One of my
• 18:30
  most exciting and thrilling events was
• 18:33
  we had a conversation about boards.
• 18:35
  And as you know, most physician on hospitals,
• 18:37
  surgery centers,
• 18:38
  partnerships,
• 18:40
  and medical practices, it's like a couple of
• 18:42
  older docs and a couple of younger docs.
• 18:45
  Well, somehow,
• 18:47
  we've convinced a whole bunch of them, call
• 18:49
  it a 100 plus practices, that they needed
• 18:51
  a real board.
• 18:53
  And they've been able to structure
• 18:55
  a real authentic board by having lots of
• 18:58
  divergent opinions on it, that all come from
• 19:00
  experts in their communities.
• 19:02
  These are the things I'm most excited about.
• 19:04
  I think teaching Physicians how to build a
• 19:06
  balance sheet,
• 19:08
  how to fortify the balance sheet, and how
• 19:10
  to understand the intrinsic value that they have
• 19:12
  in their practices,
• 19:13
  and how that bolsters the balance sheet and
• 19:15
  makes them stronger so they don't have to
• 19:17
  sell, but they can create win win environments
• 19:19
  for themselves and their fellow physicians. It's probably
• 19:22
  the probably the greatest thing I've gotten to
• 19:23
  work on and and will continue to for
• 19:25
  a couple years.
• 19:27
  Dutch, I absolutely love that. Again, we're talking
• 19:29
  with Dutch Rojas today. He's an investor.
• 19:31
  He's the author of the Rojas Report.
• 19:34
  He writes. He speaks. He's a preeminent voice
• 19:37
  in health care.
• 19:38
  Dutch, thank you so much for joining us
• 19:40
  today on the Becker's Health Care at the
• 19:41
  Becker Business Media podcast. What a great pleasure
• 19:44
  to visit with you. Thank you very much.
• 19:46
  Thank you, sir.