MedChat - With Michael Bennett

Welcome to the pod.

Dana Jacoby is a national thought leader across numerous healthcare specialties and is passionate about helping providers and investors learn about valuations, mergers, and acquisitions.

Dana has experience guiding her companies through multiple mergers and private equity transactions and consulting on billions of dollars of merger and acquisition deal flow, making her one of the most sought-after healthcare and business specialists in the country. 

Dana’s experience bridges large corporate healthcare companies and individual providers. This has included positions with General Electric Healthcare and Johnson & Johnson, as well as working in the pharmaceutical sector with the Allergan company, where she was tasked with launching and growing the drug Botox in Asia. Her work has included project development, market analysis, design implementation, and service delivery in hospitals and health systems in nearly every state in the United States and internationally in Asia, Europe, and Canada.

Ms. Jacoby is a trusted advisor to C-Suite Executives, Boards of Directors, and Physician Leaders. Her expertise is focused explicitly in in the areas of strategic planning, mergers and acquisitions, private equity and investment banking, alternative payment models, financial management, operational efficiencies, service line development, and process improvement. She has spent thousands of hours improving medical practice pharmaceutical/device company strategy/planning, primarily focusing on product market development, medical practice management, provider compensation strategies, efficiency metrics, and process improvement.

Dana has also committed to a life practice of philanthropy. Her charity of choice is the international healthcare organization Project C.U.R.E. Founded over 30 years ago in a garage in the mountains of Colorado; Project C.U.R.E. has saved lives and eased suffering by delivering medical relief to people in over 130 countries. She invests her spare time as well as money by traveling to recipient hospitals in the developing world and personally helping to deliver medical supplies and equipment to the people who need it most.

Ms. Jacoby graduated from Louisiana State University, holds a Master of Management from Tulane University, and a Master of Health Systems from the University of Medicine and Dentistry of New Jersey. She is a Wharton Fellow Inductee from Wharton University and the author of several books, numerous articles, and white papers. She is regularly a featured keynote speaker, panelist, and moderator.

Dana makes her home in Denver, Colorado. An avid runner, Ms. Jacoby is a Boston Marathon qualifier and has run 68 marathons, one in each of the States in the United States and on each of the continents except for Antarctica.

In this episode, Dr. Foran and I discuss dwindling reimbursement rates and how that ties to physician burnout. It's not a "woe is me" complaint session on how surgeons are not making enough money; it's a larger systemic issue and what it means to the quality of care for patients and little things to "fix" the system.

Dr. Foran is an orthopedic surgeon with Pure Orthopedics, a Panarama Company. He has a resume almost a mile long It's 14 pages. He attended medical school at Berkeley, his internship at Johns Hopkins, a Residency at the University of California San Diego, and a Fellowship at Rush in Chicago. See his full write-up after the show timeline below for his background and education.

0:00 - 0:38 - Intro

0:38 - 1:36 - Opening comments

1:36 - 3:58 Opting out of Medicare

3:38 - 6:26 - Inflation and its effects on the practice

6:26 - 8:58 - What does opting out mean

8:58 - 9:50 - A day in the life

9:50 - 11:48 - PE purchase

11:48 - 15:38 - Challenges to Growth

15:38 - 18:34 - Thoughts on fee for service moving to value-based care

18:34 - 20:56 - Burnout

20:56 - 23:46 - Show me the $$ - Is opting out of Medicare the new new thing

23:46 - 27:34 - Why doesn't Medicare pay a fair wage? What can make it better

27:34 - 32:16 - What would you do to "fix" healthcare

32:16 - 35:50 - Insurance companies

35:50 - Closing remarks

Jared Foran Resume

License and Certifications                                                                                                    

Board Certified, American Board of Orthopaedic Surgery                                          2012-Present

Medical Licensees: California, Colorado, Illinois, Texas                                              2003-Present

 Education

Rush University Medical Center, Chicago, IL

Joint Reconstruction Fellowship                                                                               2009-2010

UC San Diego Department of Orthopaedic Surgery, San Diego, CA                          2004 2009

Resident Physician in Orthopaedic Surgery

 University of California San Diego, San Diego, CA                                                    2003 -2004

Internship in General Surgery

Johns Hopkins University School of Medicine, Baltimore, MD                                 1999-2003

Doctor of Medicine

UC Berkeley, Berkeley, CA                                                                                        1996 -1998

Bachelor of Arts in Molecular and Cell Biology

Professional Experience

Co-Founder Pure Orthopedics                                                                                   2023- Present

 Founder, Chief Medical Officer                                                                                  2017-Present

ForCast Orthopedics, Inc

forcastortho.com

                                                                       Orthopaedic Surgeon                                                                                                  2010-Present

Panorama Orthopedics and Spine Center, Denver CO

 UC San Diego Department of Orthopaedic Surgery, San Diego, CA                       2004 -2005

Research Fellow, Muscle Physiology Laboratory

Preceptor: Richard Lieber, Ph.D.

 Johns Hopkins University Department of Orthopaedics, Baltimore, MD                   2000-2003

Clinical Research Clerkship

Preceptors: Michael Mont, M.D and David Hungerford, M.D.

 Johns Hopkins University, Department of Orthopaedics, Baltimore, MD                  2002-2003

Clinical Research Assistant

Preceptor: Paul Sponseller, M.D.

Current Research Interests

Principal Investigator, “My Mobility Study with Apple Watch,”                     2019-Present

A prospective randomized controlled trial for the use of

the “My Mobility” application for rehabilitation following primary

hip and knee arthroplasty. Sponsor: Zimmer Biomet, Warsaw, IN.

• Principal Investigator, F14 randomized controlled drug trial. A                      2017-Presentprospective, randomized single-blinded controlled drug trial on
• an investigational long-acting, injectable novel celecoxib formulation. Sponsor: AIC, Toronto, Ontario

• Principal Investigator, Zimmer Persona Partial Knee. A prospective              2016-Present

multicenter study on the performance of a novel unicompartmental knee arthroplasty. Sponsor: Zimmer Biomet, Warsaw, IN.

Distinctions

§ 5280 Top Doc Orthopaedic Surgery 2017                                                      2017

§ Chair Knee Arthroplasty Program, ICJR Resident Course (ORTI)

Philadelphia, PA, May 2016                                                                            2016

§ Chair Knee Arthroplasty Program, ICJR Resident Course (ORTI)

Philadelphia, PA, April 2015                                                                           2015

§ Fellow American Academy of Orthopaedic Surgeons (AAOS)                                  2014-Present

§ Director Total Joint Service St. Anthony Hospital, Lakewood CO                 2013-Present

§ Co-Surgeon, Operation Walk, Panama                                                           2019

§ Director Total Joint Service OrthoColorado Hospital Lakewood CO            2012-Present

§ Editorial Board/Elite Reviewer the Journal of Arthroplasty                         2012-Present

§ Reviewer for Orthopedics (Journal)                                                                2012-2015

§ Co-Surgeon, Operation Walk, Tanzania                                                          2012

§ Co-Surgeon Nigeria Medical Mission, GEANCO Foundation                       2011

§ Member Colorado Medical Society                                                                 2012-Present

§ Section Editor of AAOS: “OrthoInfo” Hip and Knee Arthroplasty               2010-2022

§ President, Rush Adult Reconstruction Fellowship Alumni Association          2010-2012

§ Member American Association of Hip and Knee Surgeons (AAHKS)           2010-Present

§ Course Physician, BMW PGA Championship, Cog Hill, IL                            2010

§ UCSD Department of Orthopaedics Executive Committee                           2008-2009

§ WOA, San Diego Chapter, UCSD Resident Representative                            2008-2009

§ Participant, Operation Walk, Vietnam                                                            2008

§ Physician at “Camp LT” Ladanian Tomlinson’s charity football camp            2008

§ Elected UCSD Administrative Chief Resident                                                2008-2009

§ Selected AOA-OREF-Zimmer Resident Leadership Forum,                          2008

Quebec, Canada                                                                                           

§ Fellow 3rd Annual Joint Arthroplasty Young Investigators’ Conference,         2007

San Diego, California                    

• Member Orthopaedic Research Society                                                          2004-Present
• Member American Academy of Orthopaedic Surgeons                                  2004-Present
• Resident Physician Council, UC San Diego                                                    2005-2006
• Joint Health Coordinator, Community Care Initiative, Baltimore                   2002
• Curriculum Committee, Johns Hopkins University, School of Medicine         1999-2000
• Founder of Women's Suitcase Clinic (homeless women's healthcare clinic)    1997-1998
• President, UC Berkeley Pre-Medical Honor Society                                        1998
• Senior Class President, Yuba City High School...

In this episode of MedChat we sit down with Shane Seitz, a Senior Investment Officer at Ventas REIT.

You can also check it out on YouTube - https://youtu.be/A-LNavfKDUY

Mr. Seitz rejoined Ventas, Inc. in 2019, after spending just over a year with CBRE Healthcare & Life Sciences Capital Markets where he formed the Debt & Structured Finance platform of their team. Before his role with CBRE, Mr. Seitz joined Ventas when they acquired Nationwide Health Properties (NHP) in 2011.  Before joining NHP, Mr. Seitz was a Senior Acquisitions Associate with InSite Medical Properties, a division of The Broe Group, handling the acquisition, equity, and debt financing of their medical office building portfolio. Before joining InSite, Mr. Seitz was with Hammes Company, a national healthcare development company focusing on development, facilities planning, asset management, and asset advisory services. Mr. Seitz received a BBA in Real Estate and Urban Development and Marketing from the University of Wisconsin-Milwaukee and an MBA from the University of Colorado-Denver.

In this episode, we discuss who Ventas is, what they look for in MOB investments, why healthcare real estate differs from other property types, capital issues, the need for behavioral health facilities, private equity, and what is working and not working in healthcare.

0:00 - 2:58 - Opening and books/articles Shane is reading (he does not have time for reading but likes to skim Fine Home Building. And although he does not give us the brand, other than they were $30, his favorite recent purchase is earbuds he bought at Best Buy.

3:04 - 5:31 - Shane's intro to real estate and medical office buildings

5:32 - 8:05 - Intro to Ventas & what they do

8:06 - 16:32 - Why healthcare real estate as an investment class? Why does it still make sense to invest in these facilities when hospitals are facing such economic headwinds

16:33 - 20:30 - What are a few capital issues, and solutions for health systems

20:31 - 24:00 - How does Ventas raise capital and structure their capital stack

24:01 - 32:26 - Behavioral health and its place in the healthcare continuum

32:27 - 35:00 - What is the new new thing in healthcare real estate? Where is the yield?

35:01 - 40:00 - What is working and what is not working in healthcare

40:01 - 47:00 - Private equity in healthcare

47:01 - 54:06 - Wrap up and summary, and a few random thoughts

54:06 - Closing remarks

In this episode, Dr. Mencias and I dive into various topics, from Covid-19 challenges to nurse shortages, scheduling, what it's like to run a private practice, reimbursements, and the difference between employed and entrepreneurial physicians. We talk about what is working and what is not and Dr. Mencias' desire to put the focus back on the patient.

Since I did not mention it during the intro, I have put a full list of Dr. Mencias' education and papers at the end of the show notes.

Based on some final edits, the time stamps for each topic may be a few seconds off and will probably start a few seconds before the times posted below.

And you can watch the episode on YouTube at https://youtu.be/R1Jyd6-L7DA

0:00 - 0:55 - Show Intro

0:55 - 1:55 - AJ Intro and Bio

2:20 - 4:25 - AJ's beverage of choice and book/purchase recommendations (Basil Haydens, No Easy Day - By Mark Owns, and Oofas Footwear)

4:25 - 7:27 - AJ's role and an overview of his practice, South Bend Orthopedics

7:53 - 11:10 - Covid Challenges

11:10 - 12:23 - Nurse Shortages and Scheduling

12:24 - 15:31 - Private Equity Investors buying practices

15:32 - 17:40 - Surgeons being CEOs, leaders of the business, and role of Private Equity

17:41 - 22:40 - What is it like running a private practice (hoops to jump through, peer-to-peer review, EMRs, employees, Insurance codes, answering the phones, etc.)

22:40 - 27:00 - Are insurance companies "the issue"

27:01 - 30:30 - Reimbursements

30:31 - 33:10 - The cost of healthcare

33:10 - 34:45 - What is working in healthcare

34:45 - 36:55 - Lack of doctors/loss of respect?

36:56 - 40:55 - Employed vs. Entrepreneurial physicians and physician-owned facilities/outcomes

40:56 - 48:30 - Technology with robotics, treatments, space utilization, and telemedicine, and call centers

48:31 - 51:29 - Health system financial commentary

51:30 - 52:05 - Retailization of healthcare

52:10 - 53:05 - Commentary on primary care and touching on the root of the pandemic of unhealthy people in the US

53:10 - Closing remarks and AJ's wish to see the focus back on the patients and providers

DR. AJ MENCIAS

Employment and Education, Other Elected Positions

**President, South Bend Orthopaedics and Sports Medicine, 2021-PRESENT

 Partner-Board of Directors, South Bend Orthopaedics and Sports Medicine (SBO), a division of

Ascendant Orthopaedic Alliance, South Bend, Indiana, 2004-current

           Executive Committee Member for SBO/Ascendant, current

           Secretary, Ascendant Orthopaedic Alliance, previous

           Chief of Orthopaedics, Memorial Hospital of South Bend, 2017-2019

                      Level II Trauma Center

           Vice-Chief of Orthopaedics, Memorial Hospital of South Bend, 2019-2020

 **Director, Hand/Wrist/Elbow Surgery, University of Notre Dame, 2016-current

 President of Medical Executive Committee and Board Member, Unity Physicians Hospital, 2022, 2023-current

**Vice-President Medical Staff, Unity Physicians Hospital, Mishawaka IN, 2020-2021

**Medical Executive Committee, Unity Physicians Hospital, 2020-2021

Select Health Network, Board of Directors, 2019-current

MedCraft Healthcare Real Estate, Medical Advisory Board, 2023-

Allied Physicians Surgery Center, Board of Directors, 2020-current

Fellowship, The Indiana Hand to Shoulder Center, 2003-2004

           Upper Extremity Surgery and Microsurgery

Residency, Indiana University Department of Orthopaedic Surgery, 1999-2003

Internship, Indiana University Department of Surgery, 1998-1999

Education and Honors

Indiana University School of Medicine, 1994-1998

           Doctor of Medicine (M.D.)

                      Alpha Omega Alpha (AOA)

                      Class Vice President (1994-1996)

The University of Notre Dame, Undergraduate (1990-1994)

           Bachelor of Science (B.S.)

                      Phi Beta Kappa

                      Magna Cum Laude

                      Notre Dame Scholar

 Roncalli High School, Indianapolis Indiana

           Valedictorian, Class of 1990 

Presentations, Research, Design Experience, and Consulting Experience

•      Design Consultant, Speaker’s Bureau, Skeletal Dynamics, 2022-current

•      **Consulting, Education, and Design Surgeon, Arthrex, 2018-current o Instructor, multiple educational courses, Naples, FL

§ 2018 ASSH Las Vegas, NV: NanoScope Presentation o NanoScope project, consulting surgeon

• FiberLock Thumb Suspensionplasty project, consulting and design surgeon, current
• Radiofrequency/Thermal Probe project, consulting and design surgeon, current

•      Consulting Surgeon, Stryker Orthopaedics, 2011-2018

•      Stryker Orthopaedics, Hand and Wrist Implants, Core Design Team, 2014-current o Wrist set o Mini-fragment set

•      2016 ASSH Annual Meeting Presentation, Challenging Cases and Case Controversies in Upper Extremity Surgery, Austin, Texas (On Behalf of Stryker)

•      2015 ASSH Annual Meeting Presentation, Care of Elite Athletes, Seattle, Washington

•      2015 ASSH Annual Meeting Presentation, Challenging Cases and Case Controversies in Upper Extremity Surgery (On Behalf of Stryker)

•      ASSH Commercial Support Committee, previous

•      Multiple presentations at Stryker Orthopaedics Resident and Fellow Courses, 2011current

•      Grand Rounds and Resident and Fellow Dissection Course, University of Kansas, Plastic Surgery Program (Sponsored by Stryker)

•      Keynote Speaker, Kansas City Hand Society, Orthopaedics and Plastic Surgery (Sponsored by Stryker)

•      Low Intensity Pulsed Ultrasound Bone Stimulation (LIPUS), Presented to University of Illinois Chicago Department of Orthopaedic Surgery, April 2010 (On Behalf of Smith& Nephew Orthopaedics)

•      Surgical Procedure Demonstration, Ascension Nu-Grip Prosthesis, Annual Miami Hand Surgery Meeting, March 2010 (On Behalf of Ascension Orthopaedics)

•      Lead Faculty, Ascension Orthopaedics Upper Extremity Workshop, Atlanta, Georgia, January 2010

•      LIPUS Presentation, Sacramento Hand Society, 2010 (On Behalf of Smith&Nephew)

•      Guest Lecturer, Puerto Rican Orthopaedic Society Meeting,  Fall 2010 (On Behalf of Ascension Orthopaedics)

•      Guest Lecturer, Elbow Anatomy, Indiana University School of Medicine at Notre Dame, 2004-2008

•      Research, Indiana University Department of Dermatology, 1995

•      Research, National Institutes of Health, 1993

 Professional Memberships and Board Certifications

•      American Board of Orthopaedic Surgeons (ABOS), Board Certified, General Orthopaedic Surgery, Current

•      Certificate of Added Qualification in Hand Surgery (CAQ-HS), Board Certified, Hand Surgery, Current

•      Fellow and active member, American Academy of Orthopaedic Surgeons (AAOS)

•      Fellow and active member, American Society for Surgery of the Hand (ASSH)

•      **Director, Hand/Wrist/Elbow Surgery, University of Notre Dame, Current

•      Former Consulting Physician, Integra/Ascension Orthopaedics

•      Former Consulting Physician, Smith&Nephew Orthopaedics

Board of Director Seats

•      Unity Physicians Hospital

•      **Select Health Network Insurance Company, Board of Directors, 2014-2017, 2019-current

•      **Allied Physicians Surgery Center, Board of Directors, 2018-current

•      Indiana State Physician’s License

•      Indiana State CSR license

•      Federal DEA license