Latest / The Operator | Healthcare Business / EBITDA Took Over Healthcare (And That’s the Problem)

Transcript

EBITDA Took Over Healthcare (And That’s the Problem) · The Operator | Healthcare Business

• 0:02
  All right,
• 0:02
  today we're going to talk about a phrase
• 0:04
  that everyone who's ever worked inside a
• 0:06
  large healthcare organization has heard at
• 0:08
  least once.
• 0:09
  And maybe you Googled it to see what
• 0:10
  it meant.
• 0:12
  also usually a little bit of dread
• 0:14
  attached to it.
• 0:15
  And the phrase is,
• 0:17
  what's the EBITDA impact?
• 0:19
  Now, if you're a clinic director,
• 0:20
  a regional operator,
• 0:21
  or someone working inside a PE-backed
• 0:23
  healthcare organization,
• 0:24
  the size doesn't matter.
• 0:25
  You know exactly what that question means.
• 0:28
  It means the conversation has just shifted
• 0:30
  from clinical care to financial
• 0:33
  performance.
• 0:35
  Now,
• 0:35
  Larry's been watching this happen across
• 0:37
  healthcare for years, not just in PT,
• 0:39
  but in dental service organizations and
• 0:41
  other consolidated healthcare models.
• 0:43
  And his argument is simple and pretty
• 0:45
  provocative and likely to make some people
• 0:48
  uncomfortable.
• 0:49
  EBITDA was supposed to be a reporting
• 0:52
  tool.
• 0:52
  And somewhere along the way,
• 0:54
  it became the mission.
• 0:57
  So today, let's unpack how that happened,
• 1:00
  what it's doing in physical therapy,
• 1:03
  and what a better scoreboard might
• 1:05
  actually look like.
• 1:07
  So Larry, let's start here.
• 1:10
  EBITDA, what is it?
• 1:11
  Because I'm sure clinicians out there
• 1:13
  probably heard their director say it,
• 1:15
  but if you were going to explain it
• 1:16
  to an eighth grader, how would you?
• 1:26
  Yeah, thanks, Jimmy.
• 1:28
  EBIT was born, first of all,
• 1:30
  EBIT is a non-accountant accounting term
• 1:33
  because it's not a generally accepted
• 1:34
  accounting principle,
• 1:35
  but we'll get to that maybe.
• 1:36
  But it was born out of a legitimate
• 1:39
  need when private equity really started
• 1:41
  rolling up fragmented industries well
• 1:43
  before physical therapy got in the mix.
• 1:46
  We're talking like in the eighties and the
• 1:47
  nineties, cable companies,
• 1:49
  those kinds of things.
• 1:51
  you know, basically healthcare,
• 1:52
  then dental, then PT.
• 1:53
  PT was a lagger.
• 1:55
  They needed a common, you know, language.
• 1:57
  Think of it as a currency to compare
• 1:59
  different businesses, you know,
• 2:01
  a small practice, for example,
• 2:03
  in rural Texas and a twenty location group
• 2:06
  in New York have very,
• 2:07
  very different tax jurisdictions,
• 2:10
  different financing structures,
• 2:11
  different depreciation schedule.
• 2:13
  If I buy a computer versus I have
• 2:15
  a fifteen-year-old chair, for example,
• 2:18
  What EBITDA does is it strips the noise
• 2:20
  out of that and lets you make as
• 2:22
  best you can an apples to apples
• 2:24
  comparison across that portfolio.
• 2:27
  So that's sort of the narrow context.
• 2:29
  It's genuinely useful.
• 2:32
  And our lenders requirement,
• 2:35
  our leverage covenants are demonstrated
• 2:37
  based on EBITDA multiples or the capital
• 2:39
  structure uses that language.
• 2:41
  You know,
• 2:41
  the shift happened when the metrics
• 2:43
  stopped being descriptive and became
• 2:45
  prescriptive or became what people chase.
• 2:48
  That's when I started noticing it.
• 2:49
  When everybody was using that language is
• 2:52
  when you start to notice it.
• 2:54
  When clinic directors stopped being asked,
• 2:55
  how's the clinic performance doing?
• 2:58
  And they were starting to be asked, well,
• 3:00
  what's your EBITDA?
• 3:01
  You know,
• 3:01
  like that's the end thing to say.
• 3:02
  And that's the moment the tool became the
• 3:04
  mission.
• 3:05
  And that usually happens when compensation
• 3:08
  structures get tied to it.
• 3:10
  And once you pay people...
• 3:11
  you know, to produce against the metric,
• 3:14
  you've told them what the organization
• 3:15
  actually, you know, values.
• 3:18
  I think, you know, as a whole,
• 3:19
  EBITDA is a great common language,
• 3:21
  but if it's the only language that you
• 3:22
  speak,
• 3:23
  you're going to have a lot of misdiagnosis
• 3:26
  over a lot of problems.
• 3:27
  Yeah.
• 3:28
  In the article that you just wrote,
• 3:30
  you can find it on LinkedIn and on
• 3:31
  your sub stack.
• 3:32
  You talk about how adjusted EBITDA has
• 3:35
  almost become what you call this fiction
• 3:37
  contest,
• 3:38
  where companies start adding back more and
• 3:41
  more things to make the number look
• 3:44
  stronger.
• 3:44
  So what kind of adjustments are we talking
• 3:47
  about?
• 3:47
  And why does that make the number even
• 3:49
  less reliable than you just mentioned?
• 3:53
  Yeah,
• 3:53
  so if you walk into any kind of
• 3:56
  management presentation,
• 3:58
  what they're going to try and show you
• 3:59
  is I think it's mostly referred to as
• 4:01
  a bridge.
• 4:02
  It's effectively a slide that starts with
• 4:04
  sort of the gap net income,
• 4:06
  not to get too much in the weeds
• 4:07
  here,
• 4:08
  but it walks you through step by step
• 4:10
  to the adjusted EBITDA.
• 4:11
  Then it has the add backs and they
• 4:13
  sound reasonable.
• 4:16
  and isolation, restructuring charges,
• 4:18
  M&A transaction, audit fees, you know,
• 4:21
  de novo losses during kind of an initial
• 4:24
  time period while they ramp up,
• 4:25
  management fees, COVID impacts,
• 4:27
  storm impacts, you know, snowstorm,
• 4:30
  owner comp that's considered above,
• 4:32
  you know, normal compensation.
• 4:36
  And some of these obviously are entirely
• 4:40
  legitimate.
• 4:40
  The problem is that there's no
• 4:42
  standardized definition of adjusted
• 4:43
  EBITDA.
• 4:44
  It's a non-GAAP measure.
• 4:45
  Every sponsor defines it a little bit
• 4:47
  differently.
• 4:48
  Everybody takes liberties with that.
• 4:50
  Your covenants from the bank allow certain
• 4:52
  things and don't allow certain things very
• 4:54
  inconsistently.
• 4:55
  Even USPT,
• 4:56
  which is a company that I love and
• 4:58
  have been big fans of them and their
• 5:00
  founders and now their CEO, Chris,
• 5:04
  And it's one of the only publicly traded
• 5:07
  PT companies we have,
• 5:08
  and soon with select medical going
• 5:10
  private, the one,
• 5:11
  is they're legally required to disclose
• 5:14
  that this adjusted EBITDA number should
• 5:15
  not be considered in isolation from GAAP
• 5:19
  measures.
• 5:20
  And they would never say that,
• 5:21
  and almost nobody in the room would pay
• 5:23
  any attention to it,
• 5:24
  but it's required because, as I said,
• 5:26
  GAAP
• 5:27
  generally accepted accounting doesn't
• 5:29
  recognize EBITDA.
• 5:31
  And then I love the other term,
• 5:32
  adjusted EBITDA.
• 5:34
  It's like a double entendre.
• 5:39
  So one of the more uncomfortable ideas in
• 5:41
  your piece,
• 5:41
  and I know you're not shy about making
• 5:44
  people uncomfortable,
• 5:44
  especially when you have the receipts,
• 5:46
  is that EBITDA doesn't just measure
• 5:48
  performance.
• 5:49
  It can actually change behavior.
• 5:51
  This is where I feel like it starts
• 5:52
  to get dangerous.
• 5:53
  What kinds of decisions start happening
• 5:56
  inside clinics when EBITDA is the main
• 5:59
  target and not clinical care or clinician
• 6:02
  health?
• 6:05
  Yeah, that's the question.
• 6:08
  start making decisions based on EBITDA.
• 6:11
  So EBITDA is a lag measure.
• 6:13
  And typically what we like to see in
• 6:14
  physical therapy are lead measures.
• 6:16
  As I say to all my managers,
• 6:18
  I'm a data guy as well,
• 6:20
  but you can't have a quantitative data
• 6:22
  without also giving me qualitative data.
• 6:24
  And you can't have a lag measure like
• 6:26
  EBITDA without a lead measure like call
• 6:29
  rate, acceptance rate.
• 6:32
  And we can talk about that.
• 6:33
  But what I see people happening is chasing
• 6:35
  the target.
• 6:36
  EBITDA results
• 6:38
  from doing other things right,
• 6:40
  rewarding your clinicians,
• 6:42
  being centric around the physical
• 6:44
  therapist and PT assistants,
• 6:46
  or in the dental world,
• 6:47
  our dental professionals,
• 6:49
  our dentists and our hygienists,
• 6:51
  And how do you enable them?
• 6:53
  How do you gauge them?
• 6:54
  What is your retention rate?
• 6:56
  How are they, you know,
• 6:57
  how many owners do you have in the
• 6:59
  particular clinics?
• 7:00
  And so when you start chasing EBITDA,
• 7:02
  you're chasing a number.
• 7:03
  And so what I've seen unscrupulous CEOs do
• 7:05
  is, you know,
• 7:06
  I heard about one recently that got rid
• 7:08
  of their PTO policy.
• 7:09
  In other words,
• 7:10
  if you leave or you get fired,
• 7:11
  you take no PTO with you.
• 7:13
  Well, why is that?
• 7:14
  Because now you could take the PTO,
• 7:16
  adjust it back,
• 7:17
  and all of a sudden your EBITDA climbs,
• 7:18
  right?
• 7:19
  The good news is the sophisticated
• 7:21
  investors, the sophisticated buyers,
• 7:24
  they can now sift through this.
• 7:26
  And now what I hear is a new
• 7:27
  term.
• 7:27
  And it's a term I actually use.
• 7:29
  It's called clean EBITDA.
• 7:31
  Clean EBITDA is without all these bullshit
• 7:33
  and all these other kinds.
• 7:42
  Obliquely, you know, by not paying it.
• 7:47
  of other things right.
• 7:48
  And as you saw from my article,
• 7:50
  there was a hat that Greg White, Dr.
• 7:53
  Greg White gave to me and say,
• 7:54
  you know, people over EBITDA.
• 7:56
  You get what you emphasize in business.
• 7:58
  You know,
• 7:59
  everybody says you get what you measure.
• 8:00
  You actually get what you emphasize.
• 8:02
  If you emphasize EBITDA,
• 8:03
  you're not going to get EBITDA.
• 8:04
  Every CEO that I know that chased EBITDA
• 8:08
  has failed.
• 8:09
  Everybody who's chased,
• 8:10
  and this is why PTs make great
• 8:12
  entrepreneurs and make great leaders of PT
• 8:15
  organizations,
• 8:16
  because they know in order to keep their
• 8:18
  clinicians,
• 8:19
  they got to approach things clinically.
• 8:21
  They got to approach what drives a
• 8:22
  clinician.
• 8:23
  No physical therapist, no dentist,
• 8:25
  no doctor ever went into business to chase
• 8:28
  EBITDA.
• 8:29
  They did it to do meaningful,
• 8:30
  impactful work.
• 8:31
  They did it because they wanted to help
• 8:34
  people.
• 8:35
  And so that's what we have to remember.
• 8:36
  It's really the basics and common sense.
• 8:38
  And we have to make common sense,
• 8:39
  common practice.
• 8:41
  Now,
• 8:41
  you make a pretty strong argument that
• 8:43
  EBITDA treats clinicians as a cost line,
• 8:46
  when in reality, they're the business.
• 8:48
  They're the thing providing the service
• 8:51
  that is our profession.
• 8:53
  So how does that disconnect show up inside
• 8:57
  physical therapy organizations
• 8:59
  specifically?
• 9:00
  Yeah, no, that's the real question.
• 9:02
  You know, physical therapy companies,
• 9:04
  their assets wear shoes.
• 9:06
  They go home at night.
• 9:06
  They go to bed at night.
• 9:08
  Right.
• 9:08
  And they're the ones that produce
• 9:10
  revenues.
• 9:11
  That is the first start of the equation.
• 9:13
  You know, I used to have this sign.
• 9:14
  I'd have all clinics put on their wall.
• 9:17
  It was a picture of our patients.
• 9:20
  And underneath, as it said,
• 9:21
  we eat because of you.
• 9:23
  The patients come in.
• 9:25
  We produce the revenue.
• 9:27
  It's a conduit.
• 9:28
  And then we produce enough profits to keep
• 9:31
  everybody employed,
• 9:32
  keep the lights on and everything else.
• 9:35
  And what you see start to happen is
• 9:37
  they start to have morning productivity
• 9:38
  meetings.
• 9:39
  They start to have morning meetings.
• 9:40
  optimization, units per visit,
• 9:43
  all of these metrics,
• 9:45
  they're not qualitative,
• 9:46
  they're quantitative,
• 9:47
  and they frankly drive physical therapists
• 9:49
  nuts.
• 9:50
  Now,
• 9:50
  the art and science of all this is
• 9:52
  how do you balance it?
• 9:53
  I'm not by any means suggesting you
• 9:55
  shouldn't use sound rationale, dashboards,
• 9:58
  and appropriate metrics to drive your
• 10:00
  business or to measure your business.
• 10:02
  It's when the measurement becomes the
• 10:04
  driver of the business rather than the
• 10:07
  driver being the absolute embodiment of
• 10:10
  caring for your employees and caring for,
• 10:13
  in turn,
• 10:14
  your patients that drive the results.
• 10:16
  So I just see this all the time.
• 10:19
  They create these committees.
• 10:21
  They terminate founders and PTs that drive
• 10:24
  the business.
• 10:26
  And all it becomes is a dumbing down
• 10:28
  of the profession.
• 10:29
  They make PTs into widget makers,
• 10:32
  and they forget that PTs are the drivers
• 10:34
  of the business,
• 10:35
  not the standby byproducts of the
• 10:37
  business.
• 10:39
  Well,
• 10:40
  you pulled out a story and an analogy
• 10:42
  that I'd never heard of,
• 10:43
  but it's pretty simple to follow,
• 10:44
  which is the Soviet nail factory story.
• 10:47
  Can you explain that idea?
• 10:48
  I love it because it's pretty obvious,
• 10:50
  it's pretty quick,
• 10:51
  and I feel like it applies really well
• 10:53
  to healthcare metrics.
• 10:55
  Yeah.
• 10:56
  So the Soviet nail factory is a really
• 10:58
  interesting one because I used it
• 11:00
  actually,
• 11:00
  I think in my last Substack post to
• 11:02
  illustrate the point about Goodhart's law.
• 11:04
  And it's the perfect illustration of it.
• 11:07
  The Soviet factory managers were basically
• 11:09
  given a production quota, make nails.
• 11:13
  So they made the quota work.
• 11:14
  When the target was the number of males,
• 11:16
  they produced thousands of tiny,
• 11:18
  useless nails.
• 11:20
  We're producing hundreds of patients that
• 11:22
  aren't
• 11:23
  coming back because they were moved too
• 11:25
  quickly because they were used to
• 11:26
  measuring units per visit and how much
• 11:28
  turnover in patients could I have?
• 11:31
  So the factory produced a small number of
• 11:34
  enormous, completely useless nails.
• 11:36
  And that's what happens when that's the
• 11:38
  target,
• 11:38
  but the target was hit and they were
• 11:40
  rewarded for it.
• 11:42
  We reward PTs for hitting or their
• 11:44
  managers for hitting EBITDA when EBITDA
• 11:47
  doesn't really respect free cash flow.
• 11:50
  Most of the PT platforms I know now,
• 11:51
  particularly the larger ones,
• 11:53
  aren't producing enough cash to even pay
• 11:55
  the interest on their debt.
• 11:56
  I mean, these platforms are in trouble.
• 11:59
  And so what you have to do is
• 12:01
  you have to realize it's ruining your
• 12:03
  healthcare organization.
• 12:05
  Set EBIT as the target and the rational
• 12:07
  operators will hit it.
• 12:08
  They'll do it by suppressing clinical
• 12:10
  compensation.
• 12:11
  They'll do it by really suppressing CapEx
• 12:13
  and other kinds of expenses that you need.
• 12:15
  Then they'll come up with all kinds of
• 12:17
  things to be under or non-recurring ad
• 12:20
  backs.
• 12:21
  They may even make
• 12:22
  sign-on bonuses, you know, and add back.
• 12:25
  They may even make certain benefits and
• 12:27
  add back.
• 12:27
  Now, enough years, you know,
• 12:29
  there really has been a materially large,
• 12:32
  you know, materially producing, you know,
• 12:34
  platform acquisitions in the last two
• 12:36
  years.
• 12:36
  And it's because of this,
• 12:37
  not just in PT,
• 12:38
  but in healthcare and even in dental.
• 12:40
  And so your sophisticated buyers and
• 12:42
  investors are sifting through this and
• 12:45
  they'll make their own adjustments.
• 12:47
  They won't take your word for it.
• 12:48
  That's what quality of earnings and all
• 12:50
  these checks and audits are all about.
• 12:53
  So yes,
• 12:54
  the giant useless nails in healthcare,
• 12:56
  and I would put EBITDA at the top
• 12:57
  of that list.
• 12:59
  Yeah.
• 12:59
  I mean,
• 13:00
  the people who you're looking to invest
• 13:02
  are now savvy enough to see how you're
• 13:04
  gaming the system.
• 13:06
  Hopefully this leads to less people gaming
• 13:07
  the system because it's sort of not
• 13:09
  fooling anybody.
• 13:10
  So, all right, well,
• 13:11
  then we got to hold your feet to
• 13:13
  the fire then here, Larry.
• 13:14
  Here's the last question.
• 13:15
  If EBITDA shouldn't be the North Star,
• 13:17
  the next obvious question is, well, great,
• 13:19
  what should be?
• 13:20
  What would be a healthier,
• 13:22
  what would a healthier dashboard actually
• 13:23
  look like specifically for a physical
• 13:26
  therapy organization?
• 13:28
  Yeah, so let me set some context.
• 13:30
  The business of physical therapy is not
• 13:32
  that complicated.
• 13:33
  We can make it complicated,
• 13:35
  and we do by having much too large
• 13:37
  of a dashboard, in my opinion.
• 13:39
  We have way too many BI tools.
• 13:40
  We have way too much data,
• 13:42
  but not enough caring.
• 13:43
  We have way too much numbers,
• 13:45
  but not enough compassion.
• 13:47
  We have way, way,
• 13:48
  way too many streams of emails on
• 13:51
  productivity without fundamentally
• 13:54
  listening and understanding the heartbeat
• 13:56
  of, in our case, physical therapists.
• 13:58
  but what i've proposed is what i really
• 14:00
  refer to as a four pillar you know
• 14:02
  framework because there are some
• 14:04
  differences that you can take into account
• 14:06
  amongst these four pillars and again two
• 14:09
  two premises don't give me a you know
• 14:12
  an objective data without a qualitative
• 14:14
  one and the second one is
• 14:17
  You know,
• 14:17
  don't give me a lag measure without a
• 14:19
  lead measure.
• 14:20
  And so you have to have a,
• 14:21
  you know, a flavor of all of those.
• 14:24
  But if I was defining the four pillars,
• 14:25
  and since we're talking about financial,
• 14:27
  I wouldn't put that number one,
• 14:28
  but let's talk about it first.
• 14:30
  I would lead with unlevered free cash
• 14:33
  flow.
• 14:34
  So it's EBITDA minus CapEx minus working
• 14:37
  capital, you know, now it's again,
• 14:39
  gets in the weeds,
• 14:40
  but what it really tells you is what
• 14:41
  cash you really have that is, you know,
• 14:44
  over and above, you know, your spending.
• 14:47
  You know,
• 14:47
  that's the number that tells you where the
• 14:48
  business really can sustain itself.
• 14:51
  Even it tells you what it looks like
• 14:53
  before the bills come due is how I
• 14:55
  refer to that.
• 14:55
  So that's kind of the financial side I
• 14:57
  would use on lever-free cash flow.
• 14:59
  On the operational side, there's a lot,
• 15:00
  but I like same growth, store, you know,
• 15:03
  increased organic.
• 15:04
  Everybody talks about wanting to buy
• 15:06
  things.
• 15:06
  Well,
• 15:06
  show me a company that can grow
• 15:08
  organically first and then let them buy
• 15:09
  things, right?
• 15:11
  That's the lead measure is can you grow
• 15:14
  a clinic organically?
• 15:15
  before you can buy something and then you
• 15:18
  maybe earn the right to buy things.
• 15:20
  Yeah.
• 15:20
  Now a new patient volume.
• 15:22
  I like that because it goes to throughput.
• 15:24
  You know,
• 15:24
  are you growing the number of new
• 15:25
  patients?
• 15:26
  What are the number of new patients per
• 15:27
  PT that they see in a day?
• 15:30
  As you well know,
• 15:31
  I like PlanetCare completion rate.
• 15:32
  It's it's a tough one,
• 15:35
  but it's a good one.
• 15:36
  I liked, you know,
• 15:37
  the number of patients that kept their
• 15:39
  visits, you know,
• 15:40
  that didn't that didn't you know,
• 15:42
  I think it's a proxy for quality almost.
• 15:45
  And, you know,
• 15:46
  these are sort of the leading indicators
• 15:48
  that predict the future of EBITDA than
• 15:50
  what EBITDA stands for.
• 15:51
  Then I think a third category is clinical.
• 15:53
  So again, financial, operational,
• 15:55
  and then I like to refer to it
• 15:57
  as clinical.
• 15:57
  And this is a real outcomes, you know,
• 15:59
  scorecard.
• 15:59
  You can use whatever third part validated,
• 16:02
  you know, measure you want, photo,
• 16:05
  promise, functional improvements,
• 16:07
  all these kind of,
• 16:08
  there's a bunch of them.
• 16:09
  You know,
• 16:10
  if the C-suite can't tell whether your
• 16:12
  patients are actually getting better,
• 16:14
  EBITDA number serves without a purpose,
• 16:15
  right?
• 16:16
  And so you have to live with that.
• 16:18
  You have to have that clinical one.
• 16:19
  In fact,
• 16:19
  I'd move clinical to the first of the
• 16:21
  four pillars.
• 16:22
  And then, you know,
• 16:23
  then I would call the fourth pillar
• 16:25
  people.
• 16:25
  You know, in fact,
• 16:27
  I would have people first, probably,
• 16:29
  clinical second, operational third,
• 16:31
  and financial, you know,
• 16:32
  fourth on my four pillars.
• 16:33
  And other people, it's retention rate.
• 16:36
  It's those engagement scores.
• 16:39
  um i i like to call them inspiration
• 16:41
  corey we used to measure patient set or
• 16:43
  you know employee satisfaction and i went
• 16:45
  to employee engagement now i actually
• 16:46
  think it's employee inspiration which
• 16:49
  keeps them inspired or how do they keep
• 16:51
  inspiring i like you know stay interviews
• 16:54
  how many of you completed in a given
• 16:56
  year these are people who are actually
• 16:57
  staying you finding out why these aren't
• 17:00
  exit interviews, which is very HR-ish.
• 17:02
  These are people, you know,
• 17:03
  getting to know why people stay,
• 17:05
  what's working, what's not working,
• 17:06
  what we need to start doing, stop doing,
• 17:08
  and keep on doing, you know,
• 17:09
  that kind of stuff.
• 17:12
  And all those things give you a chance
• 17:13
  to fix something before it becomes a
• 17:15
  problem.
• 17:15
  So that's the dashboard that I'm fond of,
• 17:20
  and certainly in the organizations I've
• 17:22
  been blessed to run,
• 17:24
  and I'm currently working in a leadership
• 17:26
  role,
• 17:26
  and those are the things I look at
• 17:28
  first.
• 17:28
  Yeah, I like how you flipped that,
• 17:30
  where the thing we're talking about
• 17:31
  EBITDA, or even the financial metric,
• 17:33
  that comes fourth out of four.
• 17:34
  It's got to be there,
• 17:35
  but fourth out of four.
• 17:38
  I do like this conversation too,
• 17:39
  because it's not anti-capital or
• 17:40
  anti-growth.
• 17:42
  It's really about just understanding what
• 17:44
  we're measuring, what we produce.
• 17:46
  I always like to say,
• 17:47
  what game are we actually in?
• 17:49
  Are we understanding what game we're
• 17:50
  actually in?
• 17:51
  And then what measurements are pushing the
• 17:53
  organizations to do that better?
• 17:55
  correctly or do that well,
• 17:57
  and then you get to sort of define
• 17:58
  what well looks like.
• 18:00
  Absolutely.
• 18:00
  It's all about culture and people.
• 18:01
  You know,
• 18:02
  culture is not the enemy of EBITDA.
• 18:04
  Culture is the engine of EBITDA.
• 18:06
  Absolutely.