Episode Transcript
[00:00:01] Speaker A: Welcome to Obesity a Disease, the official Obesity Medicine association podcast exploring the many facets of the disease of Obesity a Disease podcast is brought to you by the Obesity Medicine Association, a clinical leader in obesity medicine.
[00:00:28] Speaker B: As clinicians, we spend a tremendous amount of time learning our craft to effectively practice medicine. Where we receive very little training is on the business side of medical practices. Challenges created by this lack of training are magnified by the increasing complexity of medical practice management, especially over the last decade. This is especially true for the practice of obesity medicine, where multiple models of medical practice exist and issues with insurance coverage of patient care and medications only exacerbate the problem.
To help clinicians address this problem, the OMA is publishing the practice management algorithm for obesity medical Practice. I had an opportunity to review this document over the weekend and it's fantastic. Hi, I'm Dr. Nick Pennings, Director of Clinical Education for the Obesity Medicine association and professor of Family Medicine at the Campbell University School of Osteopathic Medicine. With me today on the podcast is the principal author of the practice management algorithm, Courtney Younglove, M.D. courtney, tell us some more about yourself.
[00:01:35] Speaker C: Thanks, Nick. So I began my career in obstetrics and gynecology. After finishing my residency I joined a private practice where I became partner after a couple of years and worked in that private practice for about 15 years.
Over the course of that practice I became interested in obesity medicine, got boarded in 2014 and opened up a small little cash practice on the side while I was still practicing OBGYN full time and really just fell madly in love with the field.
Eventually told my partners that that's what I wanted to be when I grew up and it didn't go over very well.
So I did some work and hung a shingle and left my job and started the first insurance based obesity medicine practice in the Kansas City area. We which was super fun and in hindsight very reckless but it worked and it just checked all the buckets of what I wanted to be when I grew up. So I did that.
Over the course of the past 12 years or so it has gone from this little cash practice to this big huge insurance practice and then I have scaled it back to a direct pay practice for the past couple of years and now I'm in the process of moving it under the umbrella of a large health system back into an insurance practice. So I think over the course of my career I've gone in circles and learned a lot about the business of medicine. How do you translate what you want to do in the exam room into a scalable model, what are the challenges?
And it's really become the passion of mine is taking one thing and making it more scalable and solving the problems.
So that's kind of why.
[00:03:18] Speaker B: Well, certainly obesity medicine practice is fun. It's, it's great to help people get healthy. It's a very rewarding and enjoyable area of medicine. But you certainly have had a diverse set of experiences and the types of practices, so you're well suited to be the principal author of this document. So what do you see the gap that the practice management algorithm feels and you know, why is it? Why was a dedicated publication needed to bring this information together?
[00:03:50] Speaker C: Well, I think what's really interesting about the field of obesity medicine is all of us that are doing it started somewhere else and moved over into this field. And I think when we are in our training initially we are plunked into a system where we not only learn the clinical aspect of the field, but we learn the operations in our training. I mean, during residency you spend year after year in these clinics learning the craft, but also being a part of a system that's already in place. And so the day to day routine feels comfortable and natural. And then we move on to the subspecialty of obesity medicine and we learn all of this clinical knowledge, but we really don't have the experience of working in the space to that same degree.
And so it's kind of a blank slate when we want to take our clinical knowledge and move it into an operations system where we do the thing.
So we find a lot of clinicians in the obesity medicine space really passionate about the field, but feeling really lost in how to do the thing.
[00:04:58] Speaker B: It's a bit of a square peg in a round hole, right. It doesn't quite fit. Right in terms of the flow and the, and the challenges. And so what were you hearing from OMA members that where this was needed?
[00:05:13] Speaker C: So I mean I've had so many over the years contact me and say, hey, I heard you started a practice, could you help me?
And so I did a lot of these one on one conversations year after year.
And I would say I can help you to a certain degree, but I don't know your space, I don't know your wants and needs and your market. And you know, I can tell you how I did it.
And it just seemed like people just kept asking and there wasn't much.
And so I know the OMA did some kind of focus groups to see what the clinicians were really feeling was a gap and this was a big one.
So props to the OMA for sitting down and saying, let's do something about this gap rather than just one off conversations happening on telephones and in meeting rooms in the corner.
So I think it's just you have a very passionate group of clinicians that wants to do something to make the world a better place, but they don't have the roadmap.
And you can't obviously create the whole roadmap, but you can kind of give them some stops on the way and say, here's, here's kind of a blueprint of how you begin your roadmap versus just go do the thing and good luck.
[00:06:21] Speaker B: And with your diverse experiences and different practices, you're certainly well suited to be the principal author, but you didn't write it alone. So tell us a little bit more about some of the, some of the other authors who contributed to this and what were their backgrounds?
[00:06:36] Speaker C: So again, props to the OMA for really doing some research and saying we need clinicians that have done this a dozen different ways and we want all of them to contribute and give their feedback. And so I don't, honestly, I think it might have been Robin, someone on the OMA staff really put a call out for volunteers saying, I need people that have built in a health system. I need people that have built in a direct pay model. I need people that have built in an insurance based model. I need someone who's built in pediatrics.
Really trying to gather together a group of people that has different experiences and then can answer a bunch of different questions from those different perspectives. So it was a jumble. I mean, it was a lot of inputs that we had to organize, but we really wanted the different perspectives. And as it came together, Robin and I would sit there and go, okay, it looks like we do have gaps. We didn't get enough about the health systems piece for this section of the document. Let's go back to them and ask them more questions.
We had a really good group of people that were willing to keep jumping in and filling in spaces as the spaces showed themselves.
[00:07:44] Speaker B: And you had different categories, Right? So you had the direct pay, you had insurance based practices and you had larger health system practices, is that right?
[00:07:55] Speaker C: Because they're very different journeys. Yes. And so what, what seems obvious to someone who's in an entrepreneurial journey here is very different from somebody who's building within a health system. And so we really had to, had to diversify our subject matter experts and really?
[00:08:11] Speaker A: Yeah.
[00:08:11] Speaker C: And pediatrics is very different. We had to go back to the pediatrics group and say, yes, this makes sense for an adult population, but what's different for pediatrics because, boy, they've got a whole different set of issues to navigate.
[00:08:26] Speaker B: I think that's another nice thing too. You have very pediatric specific content in this document.
So how is the practice management algorithm structured and how is it intended to be used?
[00:08:41] Speaker C: So it's intended to be pretty much a textbook. So it can be read, it can be read cover to cover just like a textbook would be, you know, if you were really wanting to sit down and read it that way. But it can also be opened up to chapter at a time and say, I just want to right now learn about marketing, or I just want to learn about billing and coding, or just the financial infrastructure, those kinds of things. Each section has overlaps with the other sections, but it can stand alone and really answer questions in a way that you can jump around.
It took some, it took some thought to get that in a system that made sense.
Our visual is kind of like a flower petal where there's eight different petals, but they do overlap with each other. And that, you know, patient, clinician, evidence based, solid practice at the center.
But it, it definitely can be read in a way of. I already, I already have that piece. I don't need that piece. This is what I'm looking for.
[00:09:44] Speaker B: And, and I did read it cover to cover and actually I found it very helpful to do that. But I can also see where you sort of can skip over certain sections if you're, if they're not relevant to you. But it's certainly worth reading through and looking through.
You also included some practice journey stories to complement that. What, what was the inspiration of that? And, and tell us more about that.
[00:10:10] Speaker C: I mean, we just have such cool people that had such good experiences to give and we played with this structure, thinking, should we just give little examples throughout the book of where it was relevant? And it just felt really fragmented.
So really taking people's stories and saying, let's condense it down to, you know, give us your story and then tell us what you wish you would have learned. Tell us, you know, where are you now and where do you want to be? And, you know, the stories, they make it more real.
You know, you can read a textbook about billing and coding or you can talk to somebody and go, wow, we tried it this way and it completely failed. So yes, academic knowledge is one thing, but here's what I did. So maybe don't do that next time or at least walk into it with eyes wide open.
You know, and be able to say, okay, I'm going to try it this way because that's how this one did it. But the other one, it didn't work. So I'm going to study and measure and those kinds of things. So it, there's just some really good stories in there and they really needed to be told in one big chunk instead of fragmented and dispersed throughout. We do have little lessons learned in each section that were, that are relevant to that section. But the bigger story of, you know, I went from one to 15 in two years, that's a story. And that story might scare people, it might inspire people, it might help them, you know, plot out their trajectory. Just looking at that, I felt that they were really important.
[00:11:37] Speaker B: I think it makes it very human and it was a good, good kind of reflection of how even people who are very successful practices failed in multiple ways along the way to get there. Right. And it was learning from those mist. And really that's a lot of, I think what was emphasized is, you know, recognizing, you know, where things go wrong and adapting and making changes and maintaining a quality, continuous quality improvement process that is very helpful. And so you had some particular challenges. You described them. You know, you've had multiple practice models.
What kind of experiences and challenges do you talk about in this, in this book?
[00:12:23] Speaker C: So I tried to keep my story as short as I could because nobody wants to read a 10 page novel about one person.
Yeah, I mean, I think I was early into this field and obviously I have, I didn't even know what the word entrepreneur was when I started my practice. I just knew I wanted to do my thing and serve people practicing obesity medicine. And I learned a lot along the way.
Thankfully, I joined a business group and I have read, I'm a speed reader and I've read probably 300 business books and I, I learned how to apply business to medicine and I wanted to really kind of share that with the readers.
That that's been a big part of my journey. That and that I didn't begin this as a business professional. I'm actually getting my healthcare MBA right now more because I want those letters to be credible at the table.
But there, there is so much learning to be done just from reading and watching and.
Yeah. And I feel like my story was just one of trying and not necessarily failing, but constantly pivoting. I think that's what I learned.
[00:13:26] Speaker B: Adapting to the environment that you're in. Because the medical environment changes continuously.
[00:13:31] Speaker C: It does. And this field changes fast.
[00:13:33] Speaker B: Yeah.
So what worked yesterday may not work tomorrow. And so you have to, you know, adapt to survive. And sometimes that those adaptations can be radical as you have had to experience in different scenarios.
So the practice management algorithm is really designed to help clinicians at different stages, right. Whether they're just starting or whether they're established.
So what do you see as some effective strategies for clinicians to use this resource to enhance their experience based on where they're at?
[00:14:13] Speaker C: I mean, the first avatar that we were writing this for, because when I write, I try to think of who am I writing this for for, right?
Was someone who's sitting in their clinic, who got boarded, who says, I want to do this thing, but I don't know how, right? They're sitting in an internal medicine practice or an endocrinology practice or an OBGYN practice, saying, I want to do it.
How do I start? What's the first step? You know, it's. And so that was kind of the first avatar because I feel like that's, that's a lot of who's reached out to me over the years saying, I need the first step.
But then it also, very quickly, just listening to all of the other subject matter experts talking about it, there's a lot of people who are being tasked by their health system or by their department to build an obesity medicine service line within an existing structure.
And that to me is hugely valuable. And those people have a very different task and they have different needs, but we, we needed to address those as well. And I didn't need to be two separate documents.
So those are probably our two biggest avatars.
But there's certainly people that have, you know, started a little solopreneurship, you know, lifestyle practice, where they just see patients and that's fine, but they're thinking, wow, this is full, I need another clinician. I, I've hit my ceiling of what I can do on my own. How do I take this to the next level? And so I think we're really trying to write for all those different people who are looking for growth, who are looking for pathways to move beyond where they are now.
So those are probably our three avatars.
[00:15:55] Speaker B: And that speaks to why you don't necessarily need to read a cover to cover, right? You can focus on those sections that are relevant to you at your point of practice, care, and those are very different.
When you work in a large health system and you want to go out on your own, it's very different, right. There's a lot of things that you have to learn about just, you know, whether it be office, starting an office, managing an office, whatever things credentialing, all the, all the things that you suddenly have are responsible for yourself. All the employment regulations. And yeah, it's nice that the document goes through so many different aspects of running a medical practice.
[00:16:37] Speaker C: Yeah. And that part of me also thought, you know, if you're building in a health system, you should still know some of this language because the people you're dealing with in the administration side are speaking this language of credentialing and, you know, marketing and KPIs and things. And even if you're being tasked as a leader in a clinical sense, whether or not that new service line fails or succeeds will have to do with some of these things that you may not have control over. But I think you should know that they exist.
[00:17:10] Speaker B: Right. And understand how they influence the decision making process.
[00:17:14] Speaker C: Exactly right.
[00:17:15] Speaker B: Right. You know, and it reminds me of Stephen Covey's 77 Habits of Highly Effective People. Seek to understand and be understood. And the better you understand where administration is coming from, the better you can address their.
[00:17:30] Speaker C: Yes. You can't just hire a dietitian and expect that person to be reimbursed because it should be so. I would love for it to be so.
It doesn't often get that way, you know.
[00:17:43] Speaker B: Yes. I think we've all learned that reimbursement is not really fair.
[00:17:48] Speaker C: It's not fair and it might look one way on paper, but yet it doesn't always go that way. And so I really tried to look at it that way of, you know, we can say we want these things and we could make a case that it's clinically necessary. But when you're talking to administrators that are clinicians, they don't always care that that's the clinical right thing to do. They have to see it on numbers.
And so really trying to understand that so you're not butting heads that you're, you know, you are on the same team. The goal is to really provide a service, but the service has to be cost effective. I mean, that's business. I mean, at the end of the day, healthcare is a business whether or not you want to think about it. That.
[00:18:28] Speaker B: Right. As the saying goes, when there's no margin, there's no mission.
[00:18:32] Speaker A: Yeah.
[00:18:33] Speaker B: So I think that's an important part. And, and like I said, the document is great at putting all that together. So where, where do you see it going from here and where, where, what's sort of the, the, the next steps that are happening within the oma.
[00:18:49] Speaker C: I Mean, I would love for this to be renewed regularly, just like the obesity algorithm that we do, because as things, I'm sure we're going to get feedback that we wish you would have addressed this or we wish you would have addressed this.
So I see this as we return to this regularly and review it just like we do our other clinical documents and say, what's changed? You know, where do we need rabbit holes? We're having our fall conference about practice management, which I think is really fun and timely. This is all coming out. So our fall summit is about the business of obesity medicine. And so, and I've been a part of that planning as well, of what do clinicians need to hear about. It's not a repeat of the algorithm. It's really a lot more of diving into deeper topics that require more thought and more operations and more lessons learned and more, you know, a deeper dive.
So I think hopefully those two will weave together very well. We've got some great speakers coming for that conference, and I'm hoping, when I think we're going to launch the algorithm right at that same time, I'm hoping we get feedback from our members that, you know, that let us know where do they need more. I mean, our original intent was to have a whole chapter on scaling, and it just didn't feel like it was that necessary. Right now that this is the beginner document, but I'd like to, you know, and some of our personal stories talk about scaling and the lessons learned there.
But it would be fun to also dive a little deeper into how do you take a smaller practice and amplify it? Because that's a. It's a different build.
[00:20:32] Speaker B: It is. And. But I think that's very exciting. The fall conference is going to be dedicated to practice management. It is something that our membership has sought after and something that I think will be a real asset to the.
To practices, especially those that really want to dive deeper into the nuances of running a practice, which is really essential for success.
And that fall conference is going to be September 24th to the 26th. Right. And the Hyatt Regency in Chesapeake Bay, is that correct?
[00:21:17] Speaker C: Well, you got me on that one. I do know it's about those dates, and I know it's, yes, a month away before I have to really start thinking about that one. But, yes, it's on the calendar and it sounds right. So, yes, I'm excited for it. I feel like, given just the lineup of the speakers, I mean, there's a lot to learn. There's a lot to learn from a lot of people. I mean, there's so many good money
[00:21:39] Speaker B: and it's a smaller conference that is more information where. And this is the kind of conference where networking is really helpful.
[00:21:47] Speaker A: Right.
[00:21:47] Speaker B: Where you can really tap into the experts and talk about, you know, the challenges. So I think that will, I think that will make this a particularly great conference.
[00:21:58] Speaker C: Yeah.
[00:22:00] Speaker B: So anything else to, to add? When, when will this be released and available?
[00:22:07] Speaker C: I think it should be out around the time of the conference. I know we're doing final edits. I mean, I have it pulled up right now on my computer for some more final edits and then it has to go back to copyright and I don't know, graphic design to make sure all of that's done and then put into an electronic format. That the tech stuff is beyond me, but there's still some things that have to happen before it can really be accessible to everyone.
So I think, I think we're probably going to look at September would be my guess that we'll see.
[00:22:38] Speaker B: Well, it is a fantastic document and I would encourage anybody in practice, no matter what type of practice you're.
[00:22:47] Speaker C: I was going to say it's really applicable to other practices. I mean, that's, that's, I think the fun part. You know, we don't go through what equipment do you need? But boy, as far as the how do you launch a practice or a brand new service line, I think much of it is applicable across disciplines and that's great.
[00:23:04] Speaker B: Well, thank you for all your hard work on that. It is a beautiful document and thank you for being with us today. If you like this podcast, please share it with a friend or colleague to help the OMA as we strive to advance clinician understanding of the disease of obesity.
[00:23:22] Speaker A: Thank you for listening to this episode of Obesity a Disease. For more information about obesity medicine, podcasts and other valuable resources from the clinical leaders in obesity Medicine, please visit www. Obesitymedicine.org podcasts. If you enjoyed this episode and want to listen regularly, head over to I iTunes where you can subscribe, rate and leave us a much appreciated review. The views expressed in this episode are those of the host and guest and do not necessarily represent the opinions, beliefs or policies of the Obesity Medicine association or its members.
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