Dr. Michael Owens: “What would I do with my time if I am not doing as many colonoscopies? It’s an interesting thought experiment”.
Dr. Michael Owens:
“What would I do with my time if I am not doing as many colonoscopies? It’s an interesting thought experiment”.
Gastroenterologist Dr. Michael Owens did a thought experiment during the pandemic period. He asked himself, what would I do with my time if I’m not doing as many colonoscopies?
That question led him to leave his large GI group to start up a multi-specialty GI group that takes advantage of the trends shaping the future of GI. For example, trends such as value based care, the microbiome, AI, colonics, single-use devices, genomic tests, liquid biopsy and so on. As he implies, Mike literally implemented the central premise of the book Scope Forward to build future on his own terms. He stands as a great example for GI 2.0.
We often limit our choices to what’s prevalent in the market. Join a hospital. Join PE. Merge with a large independent group. Kudos to Mike and his partners at Pearl Health Partners for having the courage to go against the grain and take a different, innovative approach.
Praveen Suthrum: Dr. Michael Owens from Pearl Health Partners. Thank you so much for joining me on The Scope Forward Show. I’m really looking forward to our chat today.
Dr. Michael Owens: Good to see you, Praveen. Thanks.
Praveen Suthrum: Mike as we get started, I want to first introduce you briefly and I’m taking this off from your LinkedIn profile. So you’re now the co-founder of Pearl Health Partners and you’re also the director of Digestive Health for this new company. But by way of background, you’ve had a long career in interventional gastroenterology and now you’ve built this new organization. It’s an independent health organization that’s focused on value-based care. You’ve got two surgery centers and you’re working with multidisciplinary specialists. And you say you have a novel model for the business of medicine, which I’m really looking forward to learning. And then you’re expanding in the Portland metro area. What is fascinating for me from your profile is that now this is your former private practice GI and now you’re part of this whole multispecialty GI entity. So I’m looking forward to learning all about it. But as we get started Mike, what is the backstory here? How did all this happen?
Dr. Michael Owens: Thanks for giving me a chance to talk to you again. I think that we have a lot in common and I think we shared some conversations that were pretty interesting so far. After reading your book Scope Forward, there were other people out there that pre-pandemic who had similar thoughts to me. And I wasn’t really aware of that until very recently, but that’s a part of it. I think that there’s obviously been pressure the past four or five years in many regions. I think the Northwest has been somewhat excluded from a lot of the MnA that’s been going on and a lot of the PE involvement. But it’s happening especially up north of us in Washington, what used to be how do we kind of build out our indoor lab and how do we get in our ancillaries and how do we look at our service lines and how do we bring some of the tertiary care into smaller places? The conversation started changing. It was a lot more pressure from outside institutions that they were aligned with. But things were changing in the employment models in hospitals wanting to joint venture more and more and a lot of money exchanging hands in different arrangements. And along with that, I noticed that there were pressures on the revenue models that we’d all expected. And I think we’ve all thought about this for a long time. And I’ve always been a look down the road, two to five years kind of person. It’s maybe my sweet spot. And thinking the larger organizations were getting, the more complexity was coming into what the doctors wanted to do every day. And it’s what we’ve all felt, we can’t get the extra nurse that we need, we can’t get that extra amount of time to do the other thing. And so we all feel like the glory days maybe of independent practice started to make us feel a little bit of anxiety about where things were headed. And I realized there are so many physicians coming out of training who are really kind of embracing the employment model because on the surface, it appears easy. A lot of the headaches are not there, a lot of the worry isn’t there. It’s secure. And if there’s anything the past couple of years have taught us, the securities of employment and salary seem wonderful, especially when there’s so much upheaval. So I had been a therapeutic endoscopist for almost 20 years. I’d spent three days at the hospital and really enjoyed that world to the point that I did a lot of extra work in different aspects of interventional. Throughout the year, we helped work on service lines, building an advanced endoscopy center. We became one of the 30 pancreas centers in the country. Our ripple volumes were doubling. We brought in more surgeons. So I really wasn’t sitting in the normal space, I think, for gastroenterologists during this time. So 2021 or so, I have an opportunity to join some other docs in buying into a surgery center and seeing what was happening in the surrounding states with PE and not knowing with my position previously where all that was headed. The desire to take control of your own situation sometimes kind of bubbles up. You hear a lot of people coming out of the pandemic have said, I just wanted to try this, and if it doesn’t work, it doesn’t work. But if you don’t do it now, when are you going to do it? And so we spent about six months playing with the idea, making an offer on a surgery center that had not really got up and running before the pandemic hit, and it was sitting unused. We had a small plan at first about how we might turn this into an interesting opportunity, and it grew fast. We ended up bringing in a number of different people who were very similar in their experience and age, but were surgeons, many of whom I’d worked with for a long time. And these are relationships maybe because I was doing interventional work. I think interventional and therapeutics may be a different world a little bit for many people and maybe that’s where the outbreak came from. All of these ideas when you start to put yourself into how would I do things different, how would I do things better? What do I think the risks are? Your whole book is in my head as I’m looking at, okay, colonoscopy 2021 probably is going to impact, who knows, 20% to 30% of our recall cases when the new USPSTF guidelines come out. We’re hearing alternative ideas anyways. We’re watching Cologuard and we’re watching a lot of the world shift in all of the genomics that are happening. And I really thought there’s a good chance that we’re over utilizing Colonoscopy, that the world is coming together to probably impact that in the next how many years on a two-to-five-year thinker kind of. And it seemed like it was going to hit in that window because of that and because it did not been like the mainstay of my day to work, I felt like there were more opportunities here to look outside. What would I do with my time if I’m not doing as many colonoscopies? And it was refreshing. It’s like a thought experiment, right? So I really was excited about what was happening with the microbiome. I was very interested in weight loss and our failures as GI doctors to really spend time on it. I think a lot of people thought that that was a primary care diagnosis and treatment algorithm, right? I was very interested in how I can work on service lines with these other doctors that I used to have to send patients to and it would take them forever to get seen and they were in a different institution. So we started looking at pelvic floor, pelvic floor dysfunction. We started looking at women’s centers and what are their needs and all these overlap ideas started to happen. There were some business thoughts there too. When you have a primary care market that’s a bit controlled by health systems, some of the women’s clinics are kind of a backdoor. They have tens of thousands of patients, but they’re really being asked to provide the primary care. And I think that there was overlap with a lot of the surgeons working with who I’ve worked with for years, who do endoscopy. And we started looking at what else can we do in helping our ENC docs and our folks that have issues with sleep apnea and hydro hernia and they need weight loss. Again, it kept coming back to what if this all was kind of a new way of working together. We had the benefit of, OK, let’s build this around a surgery center. We saw the problems with the hospitals being able to provide access to care and we thought, okay, we could be the last man or woman standing in this ASC if we build this right? So that more procedures move to that space, everyone wins.
The co-founder of Pearl Health Partners is a dominant named Richard Rosenfield. He’s a GYN surgeon who pioneered outpatient Laparoscopic Hysterectomy same day discharge. He’s worked on other aspects of medicine for a long time relating to the business of medicine and a lot of it repairs, bundles, ERISA plans, things that I didn’t know much about. But as we started looking at how value-based care is or isn’t really value based care, and we saw people bantering about transparency, we saw hospitals not complying, we saw payers that kind of wanted to comply. We started entering relationships with some of the organizations that are doing deep data mining and cleaning of the data and they’re doing different market analysis now. And we all realized we kind of know our numbers and we think we know what our price targets could be to be cheaper for the patient and the payers, even if it’s just a high deductible situation and colonoscopy is a little different, it’s a high-volume situation. But some of the other things we’re doing in weight loss aren’t they’re kind of a little more surgical and putting together a bundle that is going to be something that is either a cash pays or you’re going to build it into new things. We’re going to find a way to get to payers and say, look at what we’ve done. We now have long term results that are worth us considering some of those things. So we had a component here of the business that was 15 years into the process of trying to deliver care in a more affordable fashion with high quality. And we were right at the peak of when transparency was finally starting to get to some real hooks, I think. So all that kind of came together into these big ideas of what if we took the best folks we know that we’re kind of aligned and we work together and we had a very easy entry into a surgery center. Can we make something like this happen? We then went to a bunch of consultants, and we started kind of getting an idea about who we might want to talk to, who would be a corporate partner that was thinking a little different in the space. We are intending to use our existing business to build out as a business service, all under a tax ID, slowly assimilate the practices as much as we can. You want consultants that have done this a lot. You want people that can guide you and not down the wrong path and pivot if you need to. And I think that’s been very key. We would like to see that. At the end of the day, we’ve executed our steps and our business model has exit ramps. We thought long and hard about this and we do think that you get a target on your back for acquisition when you do this. No matter who you are. Maybe because the way that PEs approach different specialties they’ve gotten through Derm and Opto and Ortho, you know, and their GI was the hot girl at the dance for a while here and it’s going to move on. I mean, I think that there’s going to be other things. So multi-specialty care, there are other areas in the multi-specialty space. When you look at who would you want to bring in like cardiology, there are definitely some things that are changing a little bit and you want to have enough autonomy to continue that path, enough ownership and equity to allow it to be a rewarding independent group. And then you’re going to have to figure out on the corporate side that there will be some ownership, there will be capital, there will be other things that come in for growth purposes and eventually you might end up looking a little more like another existing organization out there. But not GI single specialty probably.
Praveen Suthrum: Let me clarify a few things. So first things first. You didn’t go for a single GI specialty type expansion. You went the multi-specialty route. And I do not know of any other Gastroenterologists in the country who has dropped out of private practice and started up another entity with multispecialty group with the intent of focusing on value-based care. So congratulations on that. Now my question is how is this all funded? Is it all self-funded by the physicians? Did you have to raise money?
Dr. Michael Owens: So we were in this enviable position that our cofounder had an ASC that did mostly GYN, plastics and had done a number of other pain and a few other specialties over the years. It was already capitalized, it was already just went through recertification and contracts were already established. Now maybe contracts need to be renegotiated because we have a bunch of new things and that’s in the works. But we’re able to bring in investors at a pretty low EBITDA because the goal here is to allow more people to become involved because the end result is the key. So you don’t want like a high barrier to entry if you don’t need it and to immediately start work, you get credentialed there wasn’t a ton more capital in the or needed and immediately start generating revenue. We have our banking relationships; we have our next round of syndication closings will be round two. And so the physicians are basically funding the practice and then the remodel of a second center with their equity shares essentially. So this was tailored just to our specific instance. Would it work like copy and paste around the country? It will be very different. I mean, I think if you said let’s do this from a de novo pad out in the middle of a suburb and you were going to put 5 million into an ASC, you’re going to have a lot of different capital needs, right? We are in a situation. We’ve got confirmation today we’re going to be able to expand to our second center with the same tax ID under Medicare. So we have our contracts and it will really not slow us down as much as it might some other situations. So it’s kind of an expansion that is de novo situation. But we did go through a very lengthy process on articles of incorporation and the operating agreement to set up this particular version, I guess, of how you would model it.
Praveen Suthrum: Got it. And I’m assuming your partners I’m asking this because I’m sure other people will have similar questions. So the partners in this venture, I’m sure they were already part of other practices. There are other specialties, other practices. They might have been part of other surgery centers. So have they left that and come on full time this venture or are they still doing that and then this is part time? How does that work?
Dr. Michael Owens: They are all independent practices. So they each have, I think we have nine different practices now. And so they each have all the components of their practice. They each are very interested in the benefits of us taking over time, all those practices under one roof for reasons everyone can imagine, right? And I think that’s where more opportunity has presented itself. So we had these steps of one surgery center cranking you’re there. It’s not big enough for all of us. We’re going to have our expansion coming. We have the business putting our practices together. How is that going to benefit? As you can imagine, things that people really want. They want to get that network effect for leverage, for contracting. But we’re bringing in the transparency data. We’re going to try and look at this from a number of different angles because of our timing. We may try to align sooner than we bought on some of those things. But it’s been almost entirely group dynamics, opportunity, the people involved, and I think for innovative thinkers, but I think it made it easier for us to convince people to come together around this. And the pressure about that independent practice is not an insignificant part. I think the ability to say we all feel the same, many of us have been through similar kinds of things and see the opportunity to try, like it or not, to maintain an independent practice as long as possible is worth it.
Praveen Suthrum: Like you, your other partners also did not want to join private equity groups or the hospital or larger groups. They do not do that. Okay.
Dr. Michael Owens: No, they’re very much aligned around the idea that maintaining your autonomy and independent practices it is and how they’ve done things.
Praveen Suthrum: Now Mike, other than the business aspect or the business arrangement itself of coming together in a multi-specialty environment, are there any correlations that you’re seeing in terms of patient care itself? Are there any links that you’re seeing from GI to some other specialties or it’s too early to say all that.
Dr. Michael Owens: That’s been very clear with the women’s clinic and women’s care, whether there’s in total amongst a couple of the practices and there’s some things in development might be 10,000 patient lives and fatty liver is a giant issue, as you know. And that was an immediate alignment amongst four or five of us, the pelvic floor, endometriosis and our colorectal surgeon, our pain specialist GYN, GI, the way that our work in the microbiome overlaps in a lot of this care. But what’s missing, we are not yet looking at complex IBD, some complex liver disease. We’ve not built around those ideas because we really were required, and I think it was an intentional choice to build around outpatient procedural and surgical care first because that’s kind of where the business model evolved from. It is a little more surprising how much the clinical care aligned. It happens. I mean, our GYN surgeon just the other night was in late at the hospital taking care of a patient and just happened to bump into one of our foregut surgeons and was like, well, what do we think about this? And she’s like, Let me have a look. That’s like any good group, I think any larger multi-specialty group employed situations, you would see those interactions and alignment. I think the difference is we’re in control and I think when it comes to price points, we all can look at each other and say what makes sense? Because you have three hats on when you’re sitting there thinking about this, right? You want to deliver that value-based proposition. You got to support the centre so that it’s functional and you don’t lose money. So you’re trying to figure out where is that sweet spot? And we keep sort of finding it. I think that there is when you look at it from a procedural aspect, it’s easy to wrap your head around the costs and it’s easy to figure out how to bundle things together. It’s a little harder when you’re looking at it from a payer’s perspective or a hostel’s perspective and looking at the total service line as a silo. I just think there’s different inputs and outputs from those thought processes.
Praveen Suthrum: So you’ve talked about pricing transparency and negotiating with insurance companies and so on. So is this model lending itself better than let’s say a single specialty GI model to negotiate better with insurance companies. Or is it again.
Dr. Michael Owens: But I can say that the sessions that we’ve had on a system level with different people who are not physicians. Who are in administrative roles and financial roles. It’s very attractive when people are looking at strategy for their health systems and their health plans. They found this type of innovative thinking to be very attractive as it materialized in a way that I can give you numbers and like, everyone should do this. Of course not. And we’re aware that those are moving pieces and it’s very difficult right now because I think everyone’s trying to sort out what is the future and what do we do and if there’s any criticisms of what we’ve taken on. It’s like, okay, well, what about your Crohn’s patients? And it’s like, well, we’re just not yet building the program, but we’ll get there. What about other specialties that are not proceduralist? You know, well, that might be difficult because we’ve had to build this around the ASC space. Where will we bring those in? So, for example, Endocrinology makes a lot of sense in our comprehensive weight loss program. How do we bring them in? We’re going to have to wrestle with some of that piece by piece. If you’re an existing multi-specialty group, which there are many, you’ve seen how they run their ASC, how things move around in the financial pieces. So there’s some trade-offs and ideally there’s a different delivery system of healthcare in the US. And it’s not fee for services and a lot of this gets solved. But in the meantime, here’s what we can do. And so that’s what we’re putting our efforts into.
Praveen Suthrum: Can you outline what innovations are happening in your business that are different from other multispecialty or other private practice companies and so on.
Dr. Michael Owens: Other than, you know, bringing together all these specialists under one tax ID, working together to deliver care at lower cost, which is part of the biggest innovation. The GI related areas, I think that have changed because I got to rethink colonoscopy from the ground up. We decided to do things a little different. We don’t have like a group of 60 doctors with like three committees taking six months to pick which prep we use. So there’s benefits, right? We rejiggered our day around our ASC because there’s not as many people needing to get in to get their cases done from the physician like productivity side. We’re doing mostly same day preps and we’re doing that 5 hour before the two-hour NPO window. And it’s been going great. And patients love it. I love it. I’m not having people up all night. They’re not calling me all night; they’re not suffering all night. That has been wonderful. Now in the morning we’re doing uppers, we’re doing our diabetics, we’re doing our constipation patients, right? So we just kind of like piece that together a little bit different and then we’ve been able to move a little bit faster. We just saw and are going to do a little pilot with the happy colon, low residue food prep for people that don’t necessarily want to have clear liquid and then a morning day of prep high GI care, which is finally like a little bit more accepted. I know there’s some variability in the data of hydrotherapy for colon preps. We have people that are touted to be experts at colonics in Portland, Oregon. And so I’ve been learning all about that world and it’s fascinating that we were so against the idea of clinics and danger, and these are real concerns. But there are people who’ve been doing things in a way that, like, doctors in medicine just haven’t thought. And so will that become like, another great area of care while we’re getting data? Now we’re getting it from large PE firms and GI groups that are building centers for IG Fair. And it may not take off, but it’s starting. But what’s more interesting in our microbiome work, if you take the Effluent from a colonic and you study it with a spontaneously passed stool, the diversity of organisms is not the same. So we really kind of thought more about what can we do different for the patients, for their procedure. We looked at all the single use devices that are out there. We are waiting, really for the prototypes and then pricing to decide. Is that where we’ll head? But here’s an opportunity as we’re going from one to two to three to four rooms. What if we don’t want to drop three to $400,000 a room when colonoscopy volumes may go down 30, 40% in three or four years? Doesn’t make any sense.
The quality programs we’ve done all the ASGE basically level quality programs to maintain our data. However, I think that we’re being clear with patients already. Why do you want to have your colonoscopy 45, 55, 60 that first colonoscopy, and we’re seeing Cologuard. Now they’re doing 750,000 tests a quarter. You kind of know where that’s headed. There’s how many hundred? Some companies, 150 working on these approaches. Right. You’ve had people on talking about the RNA based approach and there’s folks looking at the microbiome and poly detection, which is insane, but it’s not bad. And we know these things will slot, and I think we have a lot of incentive to not do fewer colonoscopies out there. And, I mean, the PE world has brought that to the table and their arbitrage events and second bites and how that will look. And I think some of the folks that are national societies and point out, like, the flaws and some of the data which are real, but they’re not assimilating at all. I mean, there’s really no reason to think that someone who is put into a low-risk category with their first colonoscopy, which is like 90% right. AI altering like, 3% of the patients into like, a high risk scenario is not going to save us in colonoscopy. Right. And what’s even funnier about that, if you think about it, colonoscopy has a certain performance characteristic that it was only able to do so well at seeing so many polyps. And if that lower performance test saw three small polyps, that was high risk. Well, if you have a new test with AI that can double the ability to detect those little things, it doesn’t mean that person is high risk. When they get to three, it might be ten, it could be twelve. Because now you’re seeing the things that you didn’t know were there before. And with the old test, you knew you could now wait seven to ten years. You can’t say, well, I’m going to go find a few more with AI now I can say they’re high risk, right? It’s a different test. So I think that a lot of this is going to end up in two to three years people becoming more and more cognizant of alternatives. I think that if you read Exact Sciences quarterly reports and you listen to their earnings calls, you kind of get a hint on where they’re headed. They’re already saying, the Blue-C trial, they could stop today and probably use that data, but they’re going to keep going until next year. I think we should all be honest, really going to want to look at what we’re going to spend our time on. And so there’s a bunch of thinkers out there think, you know, are like me. They have the time. They don’t have that pressure to meet their RVU in an employee position or whatever their partners in their large group want them or their PE firm wants them to do. You’re bringing all these people together to think, okay, what do you do with your time? What are you going to do with the specialty? And it’s like, oh, my God, why have we not paid attention? The microbiome is enormously interesting. It’s like our world, and we’ve not yet really accomplished what we need to.
I just finished watching today, the Illumina Genomics conference. One of my colleagues from WashU, J. Wilson, at his CMO at Quest Diagnostics and just talking about where they’re headed, looking at Pharmacokinetics. And he said the problem is everything has been built for the provider in the hospital, but not the patient. So they’re basically getting pharmacogenetics to the patient, who then takes it to the pharmacist, who then says, here’s the drug issues, here’s the dose, here’s what you need. And then they’re calling the doctor to let them know, here’s what we found. They’re like in running around that to bring genomics to the masses. If we’re going to be doing Cologuard, you know, eventually if this is a part of the primary career world, we’re going to get cut out from the decision making and then think about how they’re delivering panels. So you may not really like the Cologuards out there or the next epiphy propoline, but it’s a panel now with 15 other common cancers. So parent care not going to do that. And maybe they still believe in colonoscopy, but now you have this result from the genomics test, and the patient wants that, where are we going to fit? And I think it’s going to be patient risk stratification. There was a recent study from Asia where they tried to kind of do a little bit of high risk, low risk. Where stool testing with entity A go into the algorithm? And it was 75% accurate for advanced polyps in low-risk people, right? So I love the idea of thinking about these combination strategies, risk stratification as the performance characteristics of these nonvisual tests go up, which they will because the science is real, the cost goes down and all of a sudden your compliance goes up and then it’s a win for the disease management and it’s a win for the patient. And I think GI docs is going to have to think about this is win for you. This is time for you to like, let’s look at the bigger picture of what else can we do.
Praveen Suthrum: It’s concerning. It’s amazing. It’s all these things together, right. Final question, Mike is, and you’ve been talking about it, I think you dropped enough clues throughout this conversation. But if you look ahead, not just two to three years, but let’s pick a number like five years from now, okay. What changes do you see in private practice, Gastroenterology or GI as a space as a whole?
Dr. Michael Owens: Well, if I were I don’t think he was pessimistic, but when Larry was on recently and he pointed out, you know, people have their head in the sand and the colonoscopy factories, et cetera, I would wonder about five years, I think for sure. I would wonder what are we going to do with all those GI rooms and what are half of my partners going to be doing all day? And I think that one thing that maybe a little cynically makes me feel like this model we’re building is interesting. I have seven people doing endoscopy and colonoscopy, but half of them do surgery. And we used to look at that as competition. We used to look at it as turf battles. The training is different, but it’s changing a little bit over time in big centers. And the trainees coming out are really somewhat very talented endoscopists, but they can do a lot more than I can do as a GI doc, too. They have this whole other area that I don’t have now, probably that’s complimentary because I’m going to have a GI team that is way down the road on the microbiome and Chrons. We’re not going to be ignoring it anymore, as you pointed out, I think in your newsletter right, there’s already almost a $2 million raise for the Gusto the probiotic like proprietary mix and the mouse model benefits are all that we have. But the data is kind of sound. It’s been there. That will probably get there. Therapies and monitoring are going to finally address weight loss, right. And it’s not just genomic, right. We know that there’s these phenotype variants that are happening somewhere between nature and nurture that we’re going to need to figure out and we’re starting to sort out some of those different phenotypes, right?
I think that there’s going to be areas of therapeutic endoscopy that are very specialized and are really going to continue to move towards working more and more with a lot of people that are not really just gastroenterologists of the old version. Like we mentioned, I think once in our last talk, AI is going to be just sorting a lot of the complexity for us. I don’t think we’re going to be finding a lot of little polyps that really aren’t going to make a difference. It will be this person doesn’t need a colonoscopy because these panels from the microbiome are telling us this person is okay and we changed their diet and they got more bacterias and the thermophilities is lower. Right. I think those are probably the angles we should look at and maybe we’re spending a little more time with the patients. We’re going to be comfortable with a little less revenue because our quality life and our intellectual stimulation is going to be so high. We’ll have less repetitive motion injuries. I think those are all very possible. Will there be independent practices still? I don’t know. We’re going to try.
Praveen Suthrum: No, I’ll reserve my thoughts for later on whether there would be independent GI practice, but just very quickly. Yeah, that would be there will always be the old with the new because there will be some aspects of any industry that will not change or that will take a really long time to change. But in closing, Mike, any final words of wisdom, like in a minute or two to people who are out there who might be in your shoes from, let’s say, 2020, from a couple of years ago when you were contemplating reflecting and you were at crossroads deciding what to do, what would your advice be to them?
Dr. Michael Owens: Because I think I’ve had these conversations lately. I think if you’re bringing on capital, if you’re going to bring on a liquidity, you’re going to bring on other people that are non-clinical. Think hard about that because you really can and maybe should maintain ownership amongst people who are providing the care and generating. And you really have to think carefully about the value of large sales where you’re losing autonomy and what the value really is. And I think that the PE firms and VC that’s coming behind them are thinking that way. And I think that if you’re in a situation where your group does still decide to go down that path for maybe the typical reasons of exit strategies for some of the older docs we’ve seen down the road, what kind of happens. Start thinking about these other models where you maybe two or three of your other aligned physicians in your doctor group start looking at what else could we do here? Right? So try and maybe not give away the whole boat. And if you’re in a group where you do start talking to your folks that you think are aligned about what are we going to do next?
Praveen Suthrum: Mike, this was fantastic. I really enjoyed listening to your views again and some of these conversations we’ve had before. But the way you’ve outlined and connected the dots, I’m sure many in the audience would benefit from it. Thank you so much for coming on The Scope Forward Show.
Dr. Michael Owens: Thank you so much. It was a pleasure. Thank You.
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