Latest / Becker’s Healthcare Podcast / Dr. Lee Kojanis of Premier Oral & Maxillofacial Surgery in New Jersey

Transcript

Dr. Lee Kojanis of Premier Oral & Maxillofacial Surgery in New Jersey · Becker’s Healthcare Podcast

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  - There's a small circle of people who truly
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  - understand what it takes to lead a health
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  - system right now. The decisions are enormous.
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  - The variables are constantly shifting, and the stakes
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  - of getting a call wrong don't stay contained.
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  - That's not a complaint. It's a structural reality.
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  - And it's why the most effective c suite
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  - leaders are deliberate about where do they go
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  - to pressure test their thinking.
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  - Becker's fourteenth annual CEO and CFO roundtable
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  - brings together more than 1,500
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  - executive level attendees
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  - and nearly 400 speakers for four days built
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  - around growth, financial sustainability,
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  - workforce strategy, and the leadership questions that don't
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  - have easy answers.
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  - Join us November second through the fifth in
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  - Chicago.
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  - For the agenda and event details,
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  - visit beckershospitalreview.com
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  - and click on the events tab in the
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  - upper right.
• 0:51
  - Hello, everyone. This is Cameron Cortejano with the
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  - Becker's Dental and ESL review podcast.
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  - I'm thrilled to be joined today by Doctor.
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  - Lee Kajanes of Premier Oral and Maxillofacial
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  - Surgery.
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  - Doctor. Kajanes, thank you so much for being
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  - here today.
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  - Thank you so much for having me.
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  - Just to start us off today, can you,
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  - introduce yourself and tell our audience a little
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  - bit about your background?
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  - Yeah. Absolutely. So my name is doctor Leko
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  - Janis, and I'm a board certified
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  - oral and maxillofacial
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  - surgeon.
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  - I'm also co owner of Premier Oral and
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  - Maxillofacial Surgery Group. We have three office locations
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  - throughout Bergen County, New Jersey.
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  - I'm also on staff at several hospitals in
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  - the area,
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  - Lenox Hospital in Manhattan,
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  - Bellevue Hospital, where I'm also a clinical assistant
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  - professor where I help train the residents,
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  - and a local hospital,
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  - Englewood Hospital and Medical Center in Englewood, New
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  - Jersey, where I serve as section chief of
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  - the department of dentistry and oral surgery.
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  - Awesome. Thanks so much for that introduction. I
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  - know a big topic today
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  - in dentistry,
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  - especially with all the DSO and consolidation
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  - going on is,
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  - that idea of local ownership.
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  - And I know that's a top top of
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  - mind for a lot of dental providers
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  - is the importance
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  - of, of being locally owned. Can you, tell
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  - us a little bit and share more about
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  - some of those benefits of maintaining local ownership
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  - in dental and oral surgery practices?
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  - Yeah, absolutely.
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  - Private equity has become increasingly
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  - involved in almost all aspects of American life,
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  - from
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  - housing to retail, consumer brands, professional services,
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  - tech and manufacturing,
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  - and obviously healthcare.
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  - With healthcare, however, there's a fundamentally different
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  - component here relative to all those other industries,
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  - and that's that we're dealing with people and
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  - humans, and we're responsible for their lives and
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  - well-being.
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  - Our decision making on a day to day
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  - directly affects their overall health and well-being.
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  - Private equity firms are composed of investors,
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  - and investors
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  - understandably expect a return on their initial capital.
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  - Doctors, meanwhile,
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  - we have an obligation to put the interests
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  - of our patients first,
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  - and those two objectives can coexist,
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  - but there are circumstances
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  - where they also come into tension.
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  - And the example I like to use
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  - with business in general is that there's really
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  - only two main ways to become more profitable.
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  - You either have to increase your revenue or
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  - you have to decrease your expenses or cost.
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  - And in healthcare,
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  - increasing revenue
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  - essentially means seeing more patients
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  - or performing more procedures
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  - or emphasizing higher reimbursing procedures or, frankly, just
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  - increasing your fee. Reimbursing procedures
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  - or, frankly, just increasing your fees.
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  - And if taken too far, that can mean
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  - that physicians are being expected to see more
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  - patients in less time, and you feel the
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  - subtle pressure to prioritize
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  - productivity metrics over
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  - individualized care.
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  - On the cost or expense
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  - side, you know, one of the largest expenses
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  - we have in health care is labor,
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  - right, and physicians are expensive,
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  - and experienced physicians are even more expensive,
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  - So larger health care organizations,
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  - therefore, have an economic incentive to recruit younger
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  - doctors coming directly out of residency
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  - who can generally be employed at a lower
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  - compensation level.
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  - Now that's not to say that there's anything
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  - inherently wrong with hiring young doctors. I was
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  - one of those once,
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  - and I've hired them, but
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  - the concern is when that becomes
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  - a model of creating a revolving door where
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  - physicians spend a few years at a private
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  - equity owned practice. They then leave, and they're
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  - replaced by another group of young doctors,
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  - which makes it much harder to create that
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  - type of long term relationship between a physician
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  - and a practice and the community
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  - that traditionally defined a private practice.
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  - You also see
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  - these pressures
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  - infiltrate elsewhere
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  - in the practice dynamic.
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  - You see a lot of automating of front
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  - desk functions,
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  - a lot of outsourcing of administrative jobs.
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  - You're often reducing your staffing levels to save
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  - costs.
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  - You can negotiate aggressively on supplies with larger
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  - distributors. In dentistry, Henry Schein is one of
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  - the major ones,
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  - or you tend to limit your capital expenditures.
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  - So when you have a locally owned, small,
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  - private practice like Premier
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  - and others that are becoming,
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  - unfortunately,
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  - fewer and further between,
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  - you, as the doctor, have all the autonomy.
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  - I mean, you make every decision from hiring
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  - to firing
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  - to price points
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  - to the type of procedure you want to
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  - perform, how you want to perform it, when
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  - you want to perform it. And, ultimately,
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  - we're looking at the patient's best interest first
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  - and everything else secondarily.
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  - And the trend has started to shift, unfortunately.
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  - Yeah. When you talk about,
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  - the the impact of private equity and you
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  - as a
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  - independent practice still, how do you, I guess,
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  - kinda compete with
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  - these huge DSOs? A lot of them are
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  - private equity backed and they have those economies
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  - of scale.
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  - As an independent practitioner, how do you kind
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  - of deal with that, I guess?
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  - Yeah, it's a great question.
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  - I mean,
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  - it's becoming increasingly
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  - difficult
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  - to compete against these private equity backed groups,
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  - namely because they're able to offer
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  - more to
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  - residents coming out
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  - of a residency program. They have a good
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  - amount of fringe benefits. They capitalize on that.
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  - But
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  - they also tend to have deals made with
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  - larger distributors.
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  - I use Henry Schein, for example. There are
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  - also large implant companies, and they're able to
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  - buy in bulk because they have all this
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  - outside capital investment
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  - and money coming in,
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  - and they're able to throw a ton of
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  - money into marketing,
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  - and it kind of drowns out the little
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  - guys, so to speak.
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  - So it's becoming increasingly difficult to compete with
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  - them.
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  - So our ethos is
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  - we've got to go back to the basics.
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  - We've got to go back to the fundamentals
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  - of what makes medicine and dentistry and health
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  - care in general so unique, and that's the
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  - bonding and connection we make with patients.
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  - And patients need to be educated that there
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  - is a dichotomy
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  - of private owned versus non private owned and
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  - what that means.
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  - And
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  - patients are smart. They feel it. They sense
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  - it. They may not be able to define
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  - it because
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  - it's not very well known yet,
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  - but
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  - they know the difference between
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  - a community based private practice and a larger
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  - corporate chain.
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  - So we stick to the basics. We treat
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  - every patient the way a patient should be
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  - treated. We don't think about profits over patient
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  - health and care.
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  - And eventually, by doing the right thing for
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  - the customer and the patient,
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  - we believe it'll pay dividends in the long
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  - run. At least we hope so.
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  - Yeah. I think
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  - everyone
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  - I talked to in in dentistry and health
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  - care, it always really comes back to,
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  - how
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  - dentistry and oral surgery and health care is
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  - is really such a people and relationship
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  - based business. And it's... That's not something you
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  - can just, like, drown out with private equity
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  - funding and stuff like that.
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  - Yeah, absolutely.
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  - And to double tap on that,
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  - dentistry specifically
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  - is a very
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  - anxiety inducing
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  - industry for a lot of patients,
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  - unfortunately.
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  - A lot of patients have had bad pediatric
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  - dental experiences, which manifests as
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  - late stage phobias or fears or anxieties in
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  - their adult life,
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  - and the last thing they want to see
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  - is a new provider every time they walk
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  - into the door.
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  - They feel comfortable developing a rapport with
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  - the general dentist or their surgeon, and
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  - it helps.
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  - So, yeah, I agree. I think dentistry
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  - in particular is one of those,
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  - specialties
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  - where
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  - seeing that same face kind of puts your
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  - mind at ease.
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  - Yeah. I think that's a great point.
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  - Something that I'm curious about and and wanna
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  - get your thoughts on are what are you
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  - most excited about, in the oral surgery or
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  - or dentistry or even health care
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  - field as a whole right now? And if
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  - there's anything kinda on the flip side,
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  - that that makes you a little nervous about
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  - where the industry is headed.
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  - Yeah. Absolutely. So in terms of excitement,
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  - there's definitely been this movement towards
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  - patient specific surgery or custom surgery.
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  - We're seeing really incredible advances in digital treatment
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  - planning,
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  - where you plan the surgery digitally.
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  - You compose custom surgical guides that are patient
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  - specific,
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  - and then you have three-dimensional printing that prints
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  - out those custom guides or those custom implants
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  - that you plan on using.
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  - This allows for
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  - a lot more precision and accuracy,
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  - typically
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  - saves time, and time in surgery and medicine
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  - almost always
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  - corresponds to cost. So if you could save
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  - time, you typically save cost.
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  - One of the
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  - major surgeries we do in our practice is
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  - known as all on X surgery.
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  - You probably heard it as teeth in a
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  - day
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  - on other networks, but
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  - essentially, a patient comes in with terminal dentition,
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  - so none of their teeth can be salvaged,
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  - and
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  - we take out all their teeth. We place
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  - implants at the same time. Now, this is
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  - all treatment plans digitally,
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  - and
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  - we
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  - use what's called photogrammetry,
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  - which is a high end
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  - photo system, a digital photo system, and everything
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  - is superimposed, and we three d print teeth
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  - within several hours. So we've had patients in
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  - their 60s or 70s that have had dentures
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  - or really poor dentition for their entire life,
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  - which undoubtedly affects their self esteem and their
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  - confidence,
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  - and literally within four hours, they leave the
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  - office and they have permanent teeth,
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  - non removable,
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  - and it's an absolute game changer. And technology
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  - has allowed us to do that.
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  - So that's the exciting stuff. The not so
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  - exciting stuff for the stuff that keeps me
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  - up at night
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  - is kind of what we touched on, and
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  - that's the
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  - increasing consolidation of health care and the possibility
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  - that efficiency and financial metrics begin to overshadow
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  - our clinical judgment as
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  - practitioners.
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  - When a doctor is deciding how much time
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  - to spend with a patient,
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  - what procedure
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  - to recommend, what technology to use,
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  - that's the way it should be. But when
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  - there's some other entity, a third party involved
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  - that is thinking about financial interests over patient
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  - interests,
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  - that's when things could get clouded. So that's
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  - my concern. And unfortunately, the trend, at least
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  - in oral surgery, has definitely started leaning towards
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  - more of that
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  - corporate style.
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  - Yeah. I think, we've seen in oral surgery
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  - and dentistry as a whole, just over the
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  - last couple of years continued
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  - increase
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  - into consolidation.
• 13:04
  - To close this out, the last question
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  - I wanna ask you today is just what
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  - will the most effective healthcare leaders need, in
• 13:11
  - order to be successful over the next two
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  - to three years, especially
• 13:15
  - in a in a field like oral surgery
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  - where the the consolidation is just continuing to
• 13:19
  - increase.
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  - What do the independent providers,
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  - need in order to to stay independent and
• 13:26
  - and keep providing the level of care that
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  - that that they want to?
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  - That's a that's a great question. I think
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  - we could probably have 10 more podcasts dedicated
• 13:34
  - to to just this question alone.
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  - But
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  - I I think there's three main points here
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  - that that we need to strongly consider.
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  - And this is really gonna have to happen
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  - from the top down.
• 13:45
  - To
• 13:47
  - start, we have to lower the cost of
• 13:49
  - our health professional schools and
• 13:51
  - advanced education generally.
• 13:54
  - Young doctors are graduating
• 13:56
  - with hundreds of thousands of dollars in debt
• 13:59
  - upon completing their training.
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  - Just as an anecdote between my wife and
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  - I, my wife's a pediatric dentist,
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  - we left with over $1,300,000
• 14:09
  - in student loan debt upon graduating from NYU,
• 14:13
  - and
• 14:14
  - interest accrues the minute you take out the
• 14:17
  - debt,
• 14:18
  - typically anywhere between 68%.
• 14:21
  - There are no tax deductions when you pay
• 14:23
  - this back.
• 14:24
  - So the interest starts accruing the day after
• 14:26
  - you take it out and
• 14:29
  - you finish all of your training,
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  - making oftentimes
• 14:33
  - very little salary
• 14:34
  - in your training. Sometimes you have to pay
• 14:36
  - to train,
• 14:38
  - as my wife did for pediatrics,
• 14:40
  - and you've got several $100,000 or a million
• 14:43
  - plus dollars in debt. I mean, how are
• 14:45
  - you supposed to enter the workforce
• 14:48
  - and be honest
• 14:50
  - and ethical and
• 14:52
  - look for the patient's best interest
• 14:54
  - when every day
• 14:56
  - you're thinking about
• 14:58
  - this gorilla on your back?
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  - So it's a huge issue, and we're not
• 15:02
  - going to be able to address all these
• 15:04
  - other problems until
• 15:05
  - that issue is addressed.
• 15:08
  - Secondly, the elephant in the room here, and
• 15:10
  - you could talk to any doctor and they'll
• 15:11
  - tell you the same thing,
• 15:13
  - We need our policymakers
• 15:14
  - to completely reshape the medical and dental insurance
• 15:17
  - landscape.
• 15:19
  - Each year on average, patients are paying more
• 15:21
  - in insurance costs
• 15:23
  - and doctors are receiving less in reimbursements.
• 15:27
  - Dental and medical claims are at all time
• 15:29
  - highs in terms of denials,
• 15:31
  - which
• 15:32
  - ultimately leads to delays
• 15:36
  - and higher patient out of pocket costs.
• 15:40
  - When you try to work with these insurance
• 15:41
  - companies from the doctor side,
• 15:44
  - contracted rates
• 15:45
  - rarely ever go up. It's extremely difficult to
• 15:48
  - negotiate with them, and it's stagnant.
• 15:51
  - So the paradigm needs to shift back into
• 15:53
  - the patient and doctor's favor because right now
• 15:55
  - the only ones benefiting are the insurance companies.
• 15:59
  - The last thing,
• 16:01
  - which I was actually quite content to see
• 16:03
  - last week, I don't know if you saw,
• 16:06
  - there has been some legislation
• 16:07
  - out there
• 16:10
  - with a new proposal
• 16:11
  - known as the Stop the Corporate Takeovers of
• 16:13
  - Physicians Act. A few lawmakers put it in
• 16:16
  - place, which essentially seeks to limit
• 16:19
  - outside corporate and private equity control of doctor
• 16:22
  - led practices,
• 16:24
  - which is exactly where we're touching on. So
• 16:26
  - the conversation is happening and it's great because
• 16:30
  - it wasn't too long ago where
• 16:33
  - nobody knew what a DSO or an MSO
• 16:36
  - or
• 16:37
  - what any of these acronyms meant.
• 16:39
  - And now we have policymakers and lawmakers
• 16:42
  - composing bills that could potentially
• 16:46
  - move the pendulum back into the doctors and
• 16:49
  - patients' favor. Doctor. Whitfield (zero fifty seven): Yeah.
• 16:51
  - I think it'll be super interesting to
• 16:54
  - see how
• 16:55
  - this all
• 16:57
  - gets legislated
• 16:58
  - and where
• 17:00
  - the field will be in terms
• 17:02
  - of that side of things and governance and
• 17:04
  - stuff within the next couple of years.
• 17:07
  - Yeah, absolutely.
• 17:09
  - Well,
• 17:10
  - thank you for joining us, today, Doctor. Kajanis
• 17:13
  - and sharing your expertise
• 17:15
  - and insights.
• 17:16
  - Really appreciate it. It's been a pleasure speaking
• 17:18
  - with you and I look forward to connecting
• 17:21
  - with you again in the future.
• 17:23
  - Yeah. Thank you so much. I appreciate the
• 17:25
  - time.
• 17:26
  - Absolutely. Thank you. Take care. Bye bye.