Latest / Becker’s Healthcare Podcast / Dr. Wael Barsoum, Professor of Surgery at Cleveland Clinic Lerner College of Medicine and President and Chief Transformation Officer at HopCo

Transcript

Dr. Wael Barsoum, Professor of Surgery at Cleveland Clinic Lerner College of Medicine and President and Chief Transformation Officer at HopCo · Becker’s Healthcare Podcast

0:02
This is where health care leadership comes together.
0:04
Becker's sixteenth annual meeting brings more than 3,500
0:07
hospital and health system executives and nearly 800
0:11
speakers to Chicago April.
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This series event includes keynote conversations with Dallas
0:17
Cowboys legend Troy Aikman and former president George
0:20
w Bush. For the agenda and event details,
0:23
visit beckershospitalreview.com
0:25
and click on the events tab in the
0:27
upper right. We're looking forward to hosting you
0:29
in Chicago.
0:32
This is Scott Becker with the Beckers HealthCare
0:35
podcast.
0:37
I'm thrilled today to be joined by one
0:39
of the smartest physician leaders that I've had
0:42
a chance to work with over the last
0:43
thirty years or so.
0:45
We're joined today by doctor Will Barsoum,
0:48
and doctor Barsoum's got this fascinating career. He
0:51
was a Cleveland Clinic physician for a long
0:53
time, and I think he still teaches and
0:55
is affiliated with Cleveland Clinic.
0:57
He also was the president of Cleveland Clinic
0:59
Hospital and led some of their endeavors. Just
1:02
a fantastic career at Cleveland Clinic.
1:04
I talked to him years ago when he
1:06
was the CEO of,
1:08
Cleveland Clinic Hospital and Operations in Florida, I
1:10
believe.
1:11
Currently, he serves as the president and chief
1:14
transformation officer of HOPCO.
1:17
And HOPCO is
1:19
the largest, I believe, orthopedic
1:22
specialty
1:23
group in the country today, and he'll talk
1:25
to us about that in his his transformation
1:28
and the work that he does with HOPCO
1:29
and a lot more. Doctor Barsoum, I'm sure
1:32
I've not hit all that correctly.
1:34
Can you do me a favor and and
1:36
and just give us a better introduction of
1:37
yourself and and tell us a little bit
1:39
more about about you and your background?
1:41
Sure. Thank you very much, Scott. It's a
1:44
a pleasure to to be with you. It's
1:45
always a pleasure to chat with you and
1:47
and to learn from you, so thanks very
1:49
much for having me.
1:51
So, I I did start my, my clinical
1:53
career with Cleveland Clinic and had an
1:56
I should say I'm having an incredible,
2:00
career there in that. I still operate there
2:02
even though I don't hold any administrative,
2:05
roles. That's still where my clinical affiliation is
2:07
and my academic affiliation
2:10
as a professor of surgery at the Cleveland
2:12
Clinic Lerner College of Medicine at Case Western
2:14
Reserve.
2:15
So I I did residency there, from '95
2:18
to 2000, and I did my fellowship in
2:20
hip and knee replacement in Boston at New
2:22
England Baptist Hospital,
2:24
and then went back to the Cleveland Clinic.
2:26
Initially, in Naples, Florida for about a year
2:28
and a half and then to the main
2:29
campus. And
2:31
really
2:32
just loved my time at main campus.
2:35
You know,
2:36
it it kind of makes me think of
2:37
the importance of mentorship. And when I was
2:40
at the main campus, I was mentored by
2:42
some really amazing people. Joe Iannotti, who is,
2:45
you know, perhaps the most well known shoulder
2:48
surgeon in the world, certainly one of the
2:49
most innovative orthopedic surgeons,
2:52
in history. He was, our department chairman.
2:55
A gentleman named Joe Hahn, who initially was
2:58
the chief of neurosurgery, then the chief of
3:00
surgery, then the chief of staff,
3:03
opened lots and lots of doors for me.
3:05
And, finally, a guy named Mark Harrison, who
3:07
became our chief medical officer. You may know
3:10
Mark's name from his time as the, CEO
3:12
of Intermountain Health,
3:14
as well as the CEO of Cleveland Clinic
3:16
Abu Dhabi. He's really the guy that built
3:18
Cleveland Clinic Abu Dhabi and and made it
3:20
what it is today.
3:22
After,
3:23
spending many, many years in Cleveland
3:25
in 2014,
3:27
I remember vividly standing,
3:29
backstage at a conference in New York City.
3:32
I was getting ready to get up and
3:33
give a a presentation, and my phone rings,
3:36
and it was Joe Hahn, who was our
3:37
chief of staff.
3:38
And when doctor Hahn calls you, answer the
3:41
phone. So I answered, and, and he said,
3:43
Will, do you have a few minutes? I
3:45
wanted to run something by you. I said,
3:47
you know, I'm about to give a a
3:48
lecture. Do you mind if I call you
3:50
back in about forty five minutes? And he
3:52
said, yeah. No problem.
3:54
But, just, you know, wanna let you know
3:56
what we're gonna be talking about.
3:58
Toby Cosgrove and I would like you to
4:00
go down and be, the CEO of Cleveland
4:02
Clinic Florida. And I said,
4:04
okay.
4:06
I'll I'll call you in forty five minutes,
4:08
and I guess we can we can talk
4:09
about that more.
4:11
And I had a great career, with the
4:13
Cleveland Clinic in Florida.
4:15
Stayed there as CEO,
4:17
and president from 2014
4:19
to 2020.
4:22
Had a lot of fun actually growing the
4:24
health care system and, and and working with
4:26
some unbelievably talented individuals.
4:29
And then in 2020,
4:30
joined one of my closest friends in the
4:32
world, who had started HOPCO.
4:35
Believe it or not, it's it's now been
4:37
HOPCO's been around now for, over twenty years.
4:39
So he had started about fifteen or sixteen
4:41
years before,
4:43
and,
4:44
we'd been in in close contact. And and
4:46
he said, listen. You gotta come and join
4:49
join me. We're gonna do great things. So
4:51
for the last five years, I've been with
4:53
health care outcomes performance company, HOPCO, and it's
4:55
just been an absolute whirlwind. Lots of learning,
4:59
lots of growth, and, we're now in 30
5:02
some states, eight countries,
5:04
and just having an absolute blast. So I
5:06
have to say I've I've I've had a
5:08
lot of fun doing the things that I'm
5:10
doing.
5:11
And and and talk about that because that's
5:13
such a not a maverick move, but such
5:15
an exciting move. You go from sort of
5:18
the
5:19
best, you know, one of the top,
5:21
always ranked one to two health systems in
5:24
the world. Cleveland Clinic, or Mayo Clinic always
5:26
seem to sort of
5:28
be in
5:29
in competition or or both in
5:32
flourishing as the top one or two systems
5:34
in the world.
5:35
And, yes, amazing what
5:37
doctor Harrison and and so many others have
5:40
done there and and doctor Cosgrove and more,
5:43
and then make the switch over to Habco.
5:45
And now it's been a few years.
5:48
But talk about sort of the
5:49
that that's somewhat people would think of as
5:52
entrepreneurial,
5:53
almost risk taking.
5:55
Talk about that decision to make that transformation
5:58
or that transition in your own life and
6:00
then about some of the things you're most
6:02
proud of as to what you're doing at
6:03
Hopco.
6:04
Sure. No. I'd be happy to. So,
6:07
you know, I'll tell you, the real maverick
6:08
was was David Tchaikovsky who founded HOPCO. So
6:11
I in in '2 it was around 2025,
6:15
David called me. He was at the Mayo
6:17
Clinic.
6:18
He was one of the youngest, if not
6:21
the youngest, section head that the Mayo Clinic
6:23
ever had,
6:24
musculoskeletal
6:25
oncologist, traumatologist.
6:27
I was at Cleveland Clinic. We were kinda
6:29
both,
6:30
you know, bucks
6:32
in in each of these two organizations. And
6:34
he called me. He said, listen. I'm gonna
6:35
leave the Mayo Clinic. I'm going to Arizona.
6:37
I'm gonna start this company. I want you
6:40
to come with me. And he'd started talking
6:41
about value based care and how he was
6:43
gonna work with health care systems and payers
6:45
and take risk and manage musculoskeletal
6:48
spend and improve quality outcomes.
6:50
And keep in mind, I mean, this is
6:51
in 2025.
6:53
For me,
6:54
the,
6:55
epitome and the definition of success as a
6:58
hip and knee replacement surgeon
6:59
was how many cases you did and what
7:02
your outcomes were. This whole idea of talking
7:05
about value based care and partnering with health
7:07
care systems and payers, it was a completely
7:09
foreign concept.
7:10
I remember trying to talk him out of
7:12
it. Said, man, you're you're crazy. You're gonna
7:14
leave the Mayo Clinic and do this.
7:17
And he did.
7:18
So when I left the Cleveland Clinic in
7:20
2020
7:21
to join him, I wish I could say
7:23
I was as much of a Maverick as
7:24
as David was, but, you know, 90% of
7:27
the risk had already been taken out. Now
7:30
that being said,
7:31
it was definitely an entrepreneurial move. It was
7:34
definitely a risk move because,
7:36
you know, you're really leaving
7:39
a true blue chip
7:41
organization
7:42
in a place like a Cleveland Clinic to
7:44
go and and and do something that is
7:47
you know, at that point, it was probably
7:49
a large
7:50
start up is what I would what I
7:52
would say we were.
7:53
We were at that time about 800 employees,
7:57
and today, we're up to over 5,000
8:01
employees just in five years. I mean, our
8:03
growth has been has been pretty astronomical.
8:05
But I think there are a lot of
8:07
things about it that I'm really proud of.
8:08
Right? A lot of people can talk about
8:10
improving,
8:11
you know, increasing revenue and increasing contribution margin
8:14
and increasing,
8:16
EBITDA and net income and things. And I
8:18
I think listen. I think that's all great.
8:21
But, you know, like you, Scott, I I
8:24
kinda have a a feeling I have a
8:25
this sense that we owe more
8:28
to society,
8:30
than just being kind of,
8:33
money making machines in health care. And and
8:36
and I think we we need to
8:39
be able to truly improve outcomes. We really
8:42
need to bend the cost curve in terms
8:44
of the cost of care in The United
8:46
States. I mean, we live in what most
8:48
of us would agree is the greatest country
8:49
in the world, but we spend on average
8:52
well over twice
8:54
what every other
8:56
highly developed country spends per capita for health
8:59
care.
9:00
And our outcomes,
9:03
sadly, are not the best. You know, when
9:05
you look at things like infant mortality, when
9:08
you look at things like administrative burden, when
9:10
you look at things like,
9:12
management of chronic disease,
9:14
we don't do very well. So I tell
9:16
people all the time, look. The United States
9:18
is a great place to get really, really,
9:20
really sick in.
9:22
If anyone can get you better, it's us.
9:24
It is not a great place
9:26
to be really, really healthy in. And although
9:30
we are very, very good
9:32
at innovating
9:34
sick care, we have not done a great
9:37
job in truly innovating
9:39
health care,
9:41
or health care delivery.
9:43
You know, you've talked about things like like
9:45
health care education
9:46
and the fact that
9:48
in this country, you know, we're right for
9:50
changing
9:52
the way we train our doctors. The training
9:54
programs are too long.
9:56
We spend too much time learning things that
9:59
are honestly not terribly applicable to 99%
10:02
of doctors and 99% of patients,
10:05
and we don't train enough doctors. We have
10:07
a big shortage. I mean, these are the
10:08
kind of problems that we need to solve.
10:11
And and one of the things that excites
10:13
me most about HOPCO
10:15
is we've taken this sliver of musculoskeletal
10:18
care, and we've said, we are going to
10:20
be the leaders
10:21
in this
10:22
one area. We are going to help
10:26
develop
10:27
higher quality,
10:28
lower cost infrastructures
10:31
for musculoskeletal
10:32
care. So if you as a patient
10:35
have a shoulder ailment
10:36
and you enter the system
10:38
in an emergency room,
10:40
in a orthopedic surgeon's office, in a primary
10:43
care sports medicine doctor's office, in a physical
10:46
therapist office, however you enter the system in
10:49
a in a in a, remote,
10:52
digital health mechan
10:54
manner, you are going to get the same
10:56
care
10:57
from that provider
10:59
the first time.
11:01
And and we're going to make sure that
11:03
your care is the right care,
11:05
so that you get the highest likelihood of
11:08
a good outcome,
11:10
and it ends up costing society.
11:12
And in many cases, you as the patient,
11:15
given the fact that so many of us
11:16
today have high deductible health care plans,
11:19
that it will cost you the least that
11:21
it could possibly cost. And that's what I'm
11:23
excited about because that
11:25
is the sliver of health care that we
11:27
are
11:28
absolutely
11:29
focused
11:30
on solving.
11:32
And
11:33
talk a little bit about the growth of
11:35
HFOTCO over the years,
11:37
and
11:38
and I I know that things are going
11:40
really well. I know from the physicists that
11:43
have joined HFOTCO that it's going really well.
11:45
But but talk about where you see
11:48
making the greatest impact and how that's going.
11:51
Sure. Sure. So, you know, in terms of
11:53
the growth, so the the company was started
11:54
in 2005
11:57
with,
11:58
three doctors and one employee.
12:01
Today, we have over a thousand providers that
12:04
are managed by HOPCO.
12:07
We have,
12:09
thousands and thousands and thousands. I mean, probably,
12:11
I I would say,
12:13
maybe six, seven thousand
12:16
providers that are involved in some kind of
12:19
risk taking arrangement with HOPCO through a clinically
12:22
integrated network. We work with over 25
12:25
hospitals and health care systems around the country.
12:28
We have,
12:30
the largest,
12:31
musculoskeletal
12:32
platforms in several states,
12:34
and we work with we're working in England.
12:37
We are working in Australia.
12:38
We work in France. We work in Germany,
12:41
you know, all in different ways.
12:44
In some cases, it's with managing a musculoskeletal
12:47
practice. In in other ways, it might be
12:49
managing a surgical facility site, whether it's an
12:53
ASC or a or a or a a
12:55
hospital musculoskeletal
12:57
specialty hospital.
12:58
It might be in in working with a
13:00
payer to take risk on the delivery of
13:03
musculoskeletal
13:03
care.
13:04
It might be with a health care system
13:06
to improve their musculoskeletal
13:08
service line.
13:09
And over time, we've kind of slowly,
13:14
expanded into what we call adjacencies. Right? Other
13:17
areas
13:18
that affect the musculoskeletal
13:20
system, but may not be
13:22
what a traditional orthopedic surgeon
13:24
or a neurosurgical spine surgeon does. So those
13:27
types of areas, things like vein health, for
13:30
example, pain management,
13:33
neurology.
13:34
I mean, these are all areas that are
13:35
so intertwined with musculoskeletal
13:38
health that it makes sense for us to
13:40
be in those spaces.
13:41
But, you know, we're not looking to be
13:44
the world leader in women's health or cardiology
13:47
anytime soon.
13:49
It it it really is kind of this
13:51
pinpoint focus on saying,
13:53
this
13:54
area for HFOTCO, we can we can really
13:57
solve. So from 2005,
13:59
again, starting with three providers and and and
14:02
one,
14:04
administrative leader, today, to to have,
14:08
over a thousand providers, to have all kinds
14:10
of channel
14:11
partnerships with national physical therapy departments,
14:15
digital,
14:16
partners, you know, big names, you know, like
14:19
like Oracle and Microsoft
14:21
and Dialpad.
14:23
These are all groups that that we are
14:24
partnered with.
14:26
It it really gives us the the ability
14:30
to make a meaningful
14:33
dent in
14:34
the challenges that we're trying to solve in
14:37
terms of cost and quality of care.
14:40
Thank you. And talk about, doctor Versum, as
14:42
you go towards this next year to 2026,
14:46
there's been fantastic growth so far.
14:48
What are you most excited about going into
14:50
2026,
14:51
and and where are you most focused?
14:54
Yeah. So so I would say it's a
14:55
few things,
14:56
Scott.
14:58
I I think, you know, first and foremost,
15:00
you know, you mentioned it earlier. We are
15:02
really,
15:03
really quite good at managing musculoskeletal
15:06
practices and and managing hospitals. And and it
15:09
used to be that that much of that
15:11
work was done
15:12
through,
15:14
you know, kind of, you know, roll up
15:16
your sleeves, dig into all kinds of details,
15:19
pouring through paperwork
15:21
to figure out operational opportunities and quality metrics
15:24
and whatnot. We have become an extraordinarily
15:27
digitally enabled
15:29
company. You know? Meaning,
15:32
almost all of our practices and soon all
15:34
of our practices will be on our proprietary,
15:37
electronic medical record. Through that electronic medical record,
15:40
we pull all kinds
15:42
of operational data. So I can actually tell
15:45
you in your if we manage your surgery
15:48
center, for example, or if we're involved in
15:49
your surgery center or in your practice, whatever
15:51
it is, I can tell you what the
15:54
contribution
15:55
margin
15:56
per OR minute for every surgeon
15:59
in your group is in your owned ASC.
16:02
Right? And you might say, well, look. Is
16:05
that just a way to make more money?
16:06
It's not. It's a way for us
16:08
to manage resources.
16:10
Right? If we have ASCs that can be
16:13
better managed, run
16:15
for longer
16:16
periods of time into the night, running them,
16:19
you know, in the weekends. Like, our surgery
16:20
our surgical hospital that we own in Arizona
16:23
operates on Saturdays.
16:26
It's the most expensive square footage in health
16:28
care.
16:29
We want it to be run extraordinarily,
16:32
effectively, and efficiently.
16:34
So in the grand scheme of things, that
16:36
actually ends up taking cost out of the
16:38
health care system because when you operate the
16:41
facilities that you have at peak efficiency,
16:44
you can build
16:45
fewer facilities, and that ends up saving money.
16:48
And in a country where we are probably
16:50
40%
16:51
over bedded when it comes to hospitals, it
16:53
really is important that if we're not going
16:56
to,
16:57
continue to build new hospitals, which I would
16:59
argue we probably don't need to right now,
17:02
we can instead optimize the hospitals we have,
17:05
close older hospitals that require massive amounts of
17:08
recapitalization,
17:10
and run more effectively in lower cost of
17:12
care sites like surgery centers
17:14
and and office
17:16
procedural rooms. So, you know, this digital enablement
17:19
that we have in terms of this insight
17:21
into
17:22
how hospitals run, how practices run,
17:26
And and finally,
17:27
on the payer side, the ability to ingest
17:30
raw claims data into our proprietary
17:32
claims analytics tool and look and see in
17:35
this region,
17:37
your utilization of advanced imaging is too high.
17:41
For example, we can help you bend that
17:43
cost curve, not through things like like,
17:46
utilization management, but through education.
17:49
Right?
17:50
That is that's pretty differentiated. So this digital
17:54
enablement
17:55
is a major move forward. You know, everyone's
17:57
gonna talk about how excited they are about
17:59
things like, you know, artificial intelligence, but but
18:02
the reality of it is most companies that
18:04
that use some kind of an AI platform
18:07
or new AI platforms that are out there
18:09
are not really
18:11
significantly improving operations. For them to improve operations,
18:15
you have to have really clean data. You
18:17
have to have the ability to get really
18:19
crisp answers out of that data, and you
18:22
have to figure out how to apply
18:24
those answers in real time. So, you know,
18:26
is there kinda low hanging fruit in areas
18:28
like revenue cycle, call centers? Absolutely. Those are
18:31
great areas to take out cost and whatnot.
18:34
But do I think that that that, you
18:36
know, really exciting terms like artificial intelligence are
18:39
going to massively reinvent
18:42
health care over the course of the next
18:43
five years? Absolutely not. Do I think that
18:45
they're gonna help us get some cost out
18:47
and maybe improve
18:49
outcomes
18:50
a little bit? Yeah. I do. And I
18:52
think that's appropriate.
18:53
But and so I think we have to
18:55
be really thoughtful
18:57
about when we talk about things like digital
18:59
enablement,
19:00
artificial intelligence,
19:01
the role of the provider in terms of,
19:03
you know, the the connection to a patient.
19:06
Those are the things that I think,
19:09
I'm most excited about because I feel like
19:11
we're very well positioned
19:14
to be able to take care of our
19:16
patients better than anybody else when it comes
19:18
to musculoskeletal
19:19
care.
19:20
And and doctor Musil, let me ask you
19:21
this question.
19:23
You've had the,
19:25
this great career in leadership. You've made this
19:27
incredible transformation,
19:29
and and you've done it with great aplomb,
19:32
meaning fantastically well, because I never used that
19:34
word actually. But but tell me, doctor
19:37
tell us a little bit about what advice
19:39
would you give to emerging leaders,
19:41
to physicians,
19:42
particularly
19:43
physician leaders, trying to have satisfying careers as
19:46
professionals, as leaders?
19:48
How do you look at that?
19:50
Yeah. Look. I I think it's a few
19:51
things. I think,
19:54
I think that there are different reasons
19:56
to go into
19:58
kind of leadership roles. Right? If if the
20:00
reason is because
20:02
it makes you feel really good about yourself
20:05
and it's kind of a feather in your
20:07
cap,
20:08
I don't want this to sound cliche, but
20:10
that's obviously the wrong reason. Right?
20:12
If you're if you want a leadership role
20:15
because you believe that you can make your
20:17
organization better
20:19
or you can make sure that patients get
20:22
better care,
20:23
then
20:24
by all means, that's what you wanna do.
20:26
And and I think,
20:27
you know, whether we like it or not,
20:29
by definition, once you have a medical degree,
20:33
you're kind of seen as a leader already.
20:36
So whether you're, you know, a sole practitioner
20:39
running your practice I mean, essentially, you're the
20:42
leader of that practice. Right? Patients that come
20:44
and see you see you as the leader
20:46
of their health care. Now it's clearly a
20:48
partnership, but they see you as the leader
20:50
of that health
20:52
care partnership.
20:53
So I I think it's important to recognize
20:56
that whether you're leading a team of three
20:58
or four or whether you're leading, you know,
21:01
a team of 80,000,
21:03
you know, if you're the CEO of the
21:05
Mayo Clinic or the Cleveland Clinic or whether
21:07
you're leading a team of hundreds of thousands,
21:09
if you're the CEO of of CommonSpirit
21:11
Health. Right? You can still play a really
21:15
meaningful role. And as a
21:17
clinician,
21:18
you have a very real voice that people
21:21
listen to. So be thoughtful
21:23
of how you choose
21:25
to use that voice. If it is
21:27
for the improvement of the lives of our
21:30
patients, those who, you know, put their trust
21:33
in us, that's very, very different
21:35
than,
21:36
it's because you wanna see your name up
21:38
in lights. And I think I think if
21:40
you're really honest with yourself about the reason
21:44
that you want to play a leadership role,
21:46
I I think you will find that it
21:48
is a lot more satisfying.
21:51
But I think that's so important.
21:53
I I assume that
21:55
at least only a couple times in my
21:57
career in
21:59
you know,
22:00
I I've been in spots
22:02
where I thought it was the right thing
22:03
to do
22:04
versus really wanting to do it and thinking
22:06
that I can contribute to it. And what
22:09
I found was and is that if you're
22:13
in a role that sounds right, but it's
22:15
not really where you think you could really
22:17
contribute greatly,
22:19
then you're often doing yourself and your organization
22:21
a disservice.
22:23
And and I think that aligns well with
22:25
what you're saying about,
22:27
you know, can you really make a difference,
22:28
or do you wanna do it just because
22:30
you wanna do it? And there they could
22:32
be two different things.
22:34
Yeah. Look. I I think that's a 100%
22:36
right. Look. A a good example that I'll
22:38
share with you very, very directly was the
22:41
insight that that I had, and it took
22:43
me time, I I think, really, to build
22:45
this up personally.
22:47
When I made the decision to leave Cleveland
22:49
Clinic Florida as the as the CEO, I
22:52
mean, I had a CEO title,
22:55
and I stepped into a president role instead
22:58
of another CEO title. And at that time,
23:01
I was getting offers,
23:03
and opportunities
23:04
all around the country
23:05
to lead other health care systems. And my
23:08
thoughts around that were,
23:10
you know, as a CEO, you should have
23:12
a pretty good understanding
23:14
of
23:15
finance, legal, compliance, right, all the things that
23:18
that that,
23:19
that are important for a CEO to be
23:21
successful with. And it was evident to me
23:23
that in a place like Cleveland Clinic, we
23:25
had an incredible finance department that that essentially
23:29
took care of all things financial
23:32
for us. So I didn't really need to
23:35
understand things like, you know, what does it
23:37
take
23:38
if you're going to go out
23:40
and, and sell hundred year bonds for Cleveland
23:43
Clinic, which, by the way, we did.
23:45
But I didn't have the knowledge base
23:48
that most corporate CEOs would have around that.
23:53
Look. I could read a p and l.
23:55
I could understand a, you know, a,
23:58
you know, a p and l statement. I
24:00
certainly understood what our assets were, what depreciation
24:03
was, and things like that. But but but
24:05
I didn't have the financial
24:07
background that I thought I would need to
24:11
really kind of take the reins of a
24:13
company like a HOPCO.
24:15
And for that reason,
24:17
I passed up other CEO jobs,
24:20
and instead took kind of a number two
24:22
job as the president and chief transformation officer
24:25
at HOPCO. Now over the last five years,
24:27
what I've learned
24:29
about
24:30
the financial,
24:32
implications
24:33
of decisions that we make,
24:36
is incredible. And and, again, keep in mind,
24:38
when when you're at a Mayo Clinic or
24:39
a Harvard or a Cleveland Clinic and you're
24:41
sitting on a 7,000,000,000
24:44
endowment or a $10,000,000,000
24:46
endowment that is spitting off
24:48
literally
24:49
hundreds and hundreds and hundreds of millions of
24:51
dollars every year
24:53
in income.
24:54
You can afford to make mistakes.
24:56
When you are in a private equity backed,
25:01
large startup, you can't really afford to make
25:04
lots of financial mistakes because there is no
25:08
big,
25:09
pot of money kind of waiting there
25:12
to make up for your operational losses.
25:15
So those are things that that I've learned
25:17
in the last five years that I think
25:19
make me a much stronger leader today
25:22
than I was
25:23
five years ago.
25:25
And I think it takes
25:27
that insight for folks, you know, regardless of
25:29
what kind of a leader you are, you're
25:30
gonna have strengths and weaknesses.
25:32
So figure out what your weaknesses are and
25:35
put yourself in a position
25:37
to be to strengthen those areas instead of
25:40
just to focus on all
25:42
of your strengths or or the strengths that
25:44
people perceive you to have. I think that's
25:46
that's kind of an important piece of advice
25:48
for folks. And it's not necessarily the easiest
25:51
piece of advice to take, but I think
25:53
it's an important piece of advice if you
25:55
really wanna make a meaningful contribution to an
25:58
organization.
26:00
Thank you very, very much. I'm gonna ask
26:02
you
26:03
one question or a comment there. I think
26:05
that just is, this advice about you were
26:07
CEO of Cleveland Clinic Florida,
26:10
and he had plenty of opportunities to be
26:12
CEO of another company or or another situation
26:15
or another health system.
26:17
But but chose to take the number two
26:19
spot here.
26:21
Talk about that piece of advice because because
26:25
that's sort of a lateral move,
26:27
obviously, a thoughtful, intelligent,
26:30
brilliant move. And so many people get this
26:32
horrible advice that they've gotta go for the
26:34
next highest salary. They've gotta go to the
26:36
next highest position,
26:37
that they can't take lateral steps, that somehow
26:39
or another that's
26:41
a negative.
26:42
Talk about this concept of what you're really
26:44
trying to do is grow as a leader.
26:46
If you grow as a leader and do
26:48
great work,
26:49
then and you're really doing great work.
26:52
Opportunities tend to evolve over time when you're
26:54
making the right contribution.
26:56
Talk about that versus some of the standard
26:58
advice that people get about you gotta take
26:59
the bigger sale or you gotta take the
27:00
bigger title. Because that's such bad advice often.
27:03
Oh, I I couldn't agree with you more.
27:04
Look. I mean, I I I wish I
27:06
could tell you that from a financial perspective,
27:08
this was a lateral move. I took a
27:10
major pay cut to come to HOPCO. As
27:12
you know, in the private equity backed world,
27:14
right, you're you're usually paid,
27:16
more in equity
27:18
and, and profit units or stock options than
27:21
you are in salary. So from a salary
27:23
perspective, I took a a a pretty major
27:25
pay cut. Now I I more than made
27:27
up for it in terms of equity and
27:29
and stock options and whatnot, which which has
27:31
worked out, you know, I think pretty well,
27:33
but but there's clearly a risk there. I
27:34
mean, that's a very
27:36
calculated decision to make.
27:39
You know, as I as I kind of
27:41
looked at things, Scott, my feeling was,
27:44
it would be hard to go from a
27:46
Cleveland Clinic
27:48
even though I mean, obviously, I was the
27:50
CEO of Cleveland Clinic Florida, not the Cleveland
27:52
Clinic health system. But the brand is still
27:55
an incredibly strong brand, whether you're in Florida,
27:57
whether you're in Abu Dhabi, in London, in
27:59
Cleveland, but The brand is great. And I
28:01
I kept thinking, you know, am I really
28:03
going to leave this premier brand
28:06
to take a more senior kind of CEO
28:09
role? It may be a bigger health care
28:10
system, but a but a health care system
28:12
that doesn't have this
28:13
cache. You know? Maybe kind of a
28:15
a a b plus or an a minus
28:18
rated health care system as opposed to an
28:20
a rated health care system. Right? I mean,
28:22
that was kinda my sense, and it just
28:23
didn't make sense
28:25
to me.
28:26
You know, the other thing I looked at
28:27
is there are 5,000 hospital CEOs around The
28:30
United States today. Am I really
28:33
differentiating myself
28:35
that much? So I kinda did an inventory
28:37
of the things that I felt that I
28:39
was good at. Right? I'm kind of an
28:40
innovative guy. I have a lot of patents.
28:43
I you know, I I'm a very operationally
28:45
minded. I love growing things. I'm a strategically
28:48
minded individual.
28:50
And and a lot of things that I
28:51
learned at Cleveland Clinic, like corporate governance,
28:55
corporate culture, those were things that I thought
28:58
I could really
28:59
apply
29:01
in in a role like my role at
29:02
Hopco. So, again, kind of looking at where
29:04
my strengths were and where I could be
29:07
better
29:08
made me feel like this is kind of
29:10
the right move for me for this next
29:12
stage in my life. If I had just
29:14
left Cleveland Clinic to become the CEO of
29:17
a large regional health care system,
29:20
I'm not sure that I really would have
29:21
grown
29:22
very much,
29:24
as a leader, to be perfectly candid with
29:26
you. So this move has helped me grow
29:29
a tremendous amount. And and, again, you know,
29:31
to be clear,
29:33
I don't know that that's the right decision
29:35
for everybody. Right? I mean, I think for
29:37
for many people,
29:39
you know, being a a health care system
29:41
CEO somewhere else would be a fantastic opportunity.
29:43
I have friends that I see in large
29:45
health care systems, you know, like CommonSpirit, like
29:48
like Ascension that are continuing to grow in
29:50
those organizations,
29:51
and they
29:52
are absolutely
29:53
doing an amazing job. I mean, they are
29:56
making a real impact.
29:58
And and and, you know, they're probably, you
30:01
know, more well rounded than I was five
30:03
years ago, to be perfectly candid. So I
30:06
I think, again, you have to really take
30:08
this inventory of yourself to ensure
30:10
that it's the right decision
30:12
for you. It may not be the right
30:14
decision
30:15
for for somebody else, but it but, you
30:17
know, is it the right decision for you?
30:19
And I think I think that takes a
30:21
a level of of experience and and to
30:23
some degree, some level of of introspection and
30:26
maturity to be able to say,
30:29
you know, maybe some folks would see this
30:31
as as as a lateral move.
30:34
But for me, I actually see it as
30:36
a massive promotion
30:38
because I'm going to get to,
30:41
delve into something that I will never
30:44
have the opportunity to do if I stay
30:46
where I am. And and that's and that's
30:49
that's kinda what drove me.
30:51
And I think there's so much there because
30:53
one part of professional life is keeping it
30:55
interesting, but but I love the self awareness.
30:57
I mean, this concept that look. If I
31:00
go to a next tier health system,
31:02
a mid sized health system, which might be
31:04
just fantastic,
31:06
there are
31:08
a couple thousand people doing that.
31:10
And how could I really be a game
31:12
changer
31:13
at another health system?
31:15
And
31:16
and and maybe you certainly could be. Certainly
31:18
could incrementally,
31:19
greatly improve another health system someplace,
31:23
but but there's there's lots of midsize health
31:26
systems and great midsize health systems. We're here
31:29
coming to HOPCO.
31:30
You were sort of, in some ways,
31:33
one of a kind in the largest orthopedic
31:36
sort of growth practice, muscle cell skeletal practice
31:39
in the country
31:40
and a chance to be a very different
31:42
animal. And I think that takes a tremendous
31:45
amount of self awareness
31:46
to be able to say strategically,
31:48
this sounds like a more interesting choice for
31:51
me to make an impact
31:52
than doing this, which would be the natural
31:55
stepping off point for many people that were
31:57
running one of the divisions of Cleveland Clinic.
31:59
I think it's just a fascinating amount of
32:00
self awareness.
32:02
No. You you know, I I I appreciate
32:03
that you said it. And the other thing
32:05
I'll I'll tell you very candidly
32:07
is is I think today,
32:09
if I
32:10
ever decided, you know, I wanna go back
32:12
to running a health care system again, I
32:14
think I would be
32:15
a
32:17
significantly
32:18
better
32:19
leader
32:20
today as a health care system CEO than
32:22
I would have been five years ago
32:24
because of the financial acumen
32:27
that I've learned, the strategic
32:30
planning that I've learned for a rapidly growing
32:32
business. I mean, look. Let's face it. Right?
32:34
I mean, most health care systems are not,
32:37
quote, rapidly growing
32:39
unless they're growing through mergers and acquisitions.
32:41
HOPCO is a rapidly growing company organically
32:45
and through m and a. That organic
32:48
growth
32:49
is really missing in most health care systems.
32:52
And it's because, as you know, most health
32:54
care systems operate on razor thin margins.
32:57
So unless you've got a huge endowment that's
33:00
spinning off enormous amounts of money, you have
33:03
to be really, really thoughtful about your growth.
33:06
And everybody seems to to think, you know,
33:07
well, you know, the one tool we've got
33:09
is just see more patients, see more patients,
33:12
see more patients. You know, to some degree,
33:15
that clearly works, but you can also,
33:18
kind of manage
33:20
your systems more efficiently and more effectively. You
33:22
know, Toby Cosgrove used to always talk about
33:25
top of licensure care. Right? Is your advanced
33:28
practice provider essentially acting as a really expensive
33:31
scribe, or are they seeing patients independently? I
33:33
can tell you, when I was at Cleveland
33:35
Clinic, I worked with with with my PA
33:37
in Cleveland, a guy named Mike Dombrowski.
33:39
Patients prefer to see Mike over me. He
33:42
what I mean, he's the sweetest, nicest guy,
33:45
and and they love meeting him. I like
33:46
to think I'm a sweet, nice guy, but
33:48
he's honestly sweeter and nicer. So patients love
33:51
to see him. You know, there's kind of
33:53
this sense that many of us have as
33:54
doctors that, you know, the traditional way of
33:56
delivering health care is the only way of
33:58
delivering health care. I'm the doctor people wanna
34:00
see me. Yes. Sometimes they do. But is
34:03
that really the best use of your time,
34:06
of your organization's
34:08
time, of this patient's time, or can we
34:10
provide
34:11
higher quality care for a lower cost for
34:13
them in a different
34:15
environment
34:16
that allows you as the doctor to be
34:18
working at your top of licensure.
34:20
So these are the kind of things that
34:22
I think I've gotten better and better at
34:24
at understanding
34:26
through this role,
34:29
because
34:30
we have to. I mean, candidly, you have
34:32
to as a large
34:34
start up and, again, we're not really a
34:36
start up anymore. I mean, we're, you know,
34:38
a, you know, a couple billion dollar company.
34:40
But but as a
34:42
as as a company that is still privately
34:45
held in the size that we that we
34:46
are,
34:47
you have got to be really, really
34:50
thoughtful about
34:52
resource utilization,
34:53
cost of capital because you just don't have
34:56
the ability
34:57
to make bad decisions. Right? Very, very few
35:00
companies. If I remember correctly, you probably know
35:02
this better than I do.
35:06
Scott, I think I think it's, like, point
35:08
00006%
35:11
of startup companies
35:13
become,
35:14
a billion dollar business. HFOTCO is one of
35:17
those companies. It has made it to that.
35:19
Right? It's a unicorn.
35:21
And it's a unicorn, I would say, because,
35:24
you know, David Joukowsky, who's the founder, has
35:26
had this
35:28
unrelenting
35:29
vision
35:30
and mission.
35:31
And, you know, I I don't know if
35:32
you know this, but David is is an
35:34
ex mixed,
35:35
martial artist.
35:36
He has this this crazy drive
35:40
around push push push push. Don't take your
35:43
eye off the off the prize. He's almost
35:45
kinda like Elon Musk in some ways in
35:47
terms of this this this insane focus,
35:51
that he has. And and it's it's, honestly,
35:54
it's kind of contagious. And and you've got
35:56
this executive team and group of of of,
35:59
caregivers there
36:01
that are all, I think, equally
36:03
devoted to to being great
36:06
at what we do,
36:08
and and find meaning and purpose in this
36:11
greater calling of driving
36:13
higher quality, lower cost care in the musculoskeletal
36:16
space. So people are just driven to be
36:19
great at this, and I think it's really
36:21
exciting.
36:22
No. It's it's literally a remarkable story. And
36:25
your point on David is that the amount
36:28
of drive it takes
36:29
to move a company from a start up
36:31
to a billion dollars
36:33
valuation, revenues, whatever it is,
36:35
takes incredible
36:37
drive. And you're right. They call me unicorn
36:39
for a reason, but the relentless drive and
36:42
focus is is and and the right strategy.
36:44
It's it's really an amazing thing and then
36:46
building the right teams. Doctor Bursum, what a
36:48
great pleasure to visit with you today on
36:50
the Becker's Healthcare podcast. I know we kept
36:52
you longer than I expected.
36:53
Thank you so much for your time, and
36:55
it is really remarkable to visit with you.
36:57
So thank you very, very much. Scott, let
36:59
me tell you. It is it is absolutely
37:00
my pleasure.
37:02
And, you know, just to take a moment
37:03
just to congratulate you on the great work
37:06
that you're doing, you know, with with Becker's,
37:08
I I always love getting my my, my
37:10
emails and seeing what's going on and and,
37:13
attending,
37:14
your meetings around, around the country and getting
37:16
to speak at them. It's, it really is
37:18
a, an honor and a pleasure to be
37:20
able to chat with you today.
37:22
Thank you so much.