Richard Helppie's Common Bridge
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Richard Helppie's Common Bridge
Episode 321- Leadership in Action. A Disruptor Who Defied the Odds. With Dr. Imamu Tomlinson
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The emergency department is where America’s healthcare system tells the truth. It’s the hospital’s front door, it can’t turn people away, and it absorbs every crack in primary care access, insurance coverage, and patient flow. I’m joined by Dr. Imamu “Mu” Tomlinson, CEO of Vituity, to talk about what actually works when the waiting room is full and the incentives are misaligned.
We start with Mu’s path from a Canadian teenager dreaming of rap and basketball to a night-shift ER physician leading a 6,000+ doctor partnership with no private equity. From there, we dig into the leadership model behind Vituity: equal physician ownership, transparency with health systems, and a focus on improving lives instead of chasing a single revenue target. Moo makes a sharp distinction between physician satisfaction and physician fulfillment, and explains why autonomy, mastery, and agency are the real antidotes to burnout.
Then we get operational. We talk about the payer mix reality in emergency medicine, why stipends are harder to secure, and why diversification across hospital medicine, anesthesia, and other specialties can keep coverage stable. Mu shares ideas for redesigning emergency department throughput, including continuity-based staffing models, plus practical inpatient tactics like reverse rounding to reduce boarding and speed discharges. We close with a big-picture take on healthcare reform that refuses to blame only hospitals or only insurers, and one word of advice for patients: agency.
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Welcome And What The Show Is
SPEAKER_01Welcome to this episode of the Healthcare Bridge, where we explore the vital connections shaping our healthcare landscape. Hosted by Nathan Kaufman, Managing Director of Kaufman Strategic Advisors, the Healthcare Bridge is dedicated to improving healthcare delivery by strengthening the strategic and financial performance of healthcare providers. As part of the Common Bridge family, our focus is on fostering insightful, nonpartisan conversations that drive meaningful change in the healthcare industry. We invite you to join us as we build bridges toward a healthier future. The show is available on Substack, YouTube, and your favorite podcast platforms. Search for the Common Bridge and stay connected.
SPEAKER_02This is Nate Kaufman with the Healthcare Bridge, a brutally honest and unscripted discussion with the leaders in healthcare around the country. And
Moo’s Origin Story To CEO
SPEAKER_02today I am excited because I have as a guest Dr. Imamu Tomlinson, aka Moo. Moo is the CEO of Vituity. He is a best-selling author and a podcaster. Welcome, Moo. Why don't you tell us your origin story? How'd you get here?
SPEAKER_03Wow. Well, how far do you want to go back? As far as you want. Yeah. So uh thank you for having me, Nate. Amazing. Always amazing to talk with you and really talk about healthcare, but talk about lots of things and disruption and everything. But my origin story is kind of crazy. Uh I was born in Toronto, so I'm Canadian. Um, you know, moved to New York when I was 18, thought I was going to be a rapper and a basketball player, um, but then decided on medicine. I loved, always loved science. Um went to residency uh in medical school in Cincinnati and Dayton, uh, Ohio, and then was in California for 20 years uh in the central California where I practiced in one of the poorest actually regions in the nation as an ER doc, mostly a nocturnist ER doc, then matriculated up in this amazing organization, which is Vituity, which is a you know multi-state, multi-specialty national partnership with no private equity, um, you know, just a bunch of docs trying to 6,000 docs trying to make the world a better place. And then we moved our headquarters to Dallas, Texas, and I kind of was flying into Dallas a whole lot. And so I live in Dallas now. I've been I lived here for about two years. So that's I I can tell you more, but uh I don't want to uh let too much out.
SPEAKER_02Right. Well, well,
Why “Less Than One Percent” Matters
SPEAKER_02uh you you also wrote a book uh called Less Than One Percent, How Disruptors Defy Odds. So can you tell us a little bit about that?
SPEAKER_03Yeah, thanks, Nate. Yeah, so I um I'm kind of in that world uh, you know, like Malcolm Gladwell, where everything in the world is wrong and here's why. Um and in my journey, my leadership journey, uh what I realize is we we we really put people in boxes. We try to pick the winners and losers of the race before the races even run. And so, you know, it's not necessarily a book about my story. I do start with um this unlikely CEO was able to be in a position to really impact 14 million lives. Um, but I talk about a lot of things. I talk about Steph Curry, I talk about Surya Bunnelly, the skater that did the first backflip. Um, I talk about Bob Marley and a lot of businesses where we try to put people in boxes, we try to, you know, really force people into an area, and I believe that we can disrupt that mindset uh through three things disagreeableness, optimism, and relentlessness, and how much more greatness would there be in the world if we did that. So, you know, um I'll tell you the story a little later if you want, Nate, but I hold grudges, and so less than 1% really describes one of my biggest grudges in the world.
SPEAKER_02So I I meet one of those. I'm disagreeable, so that kind of works for me, but you know, what the heck?
Inside Vituity’s Equal Partnership Model
SPEAKER_02Um, so you have how many physicians in Vituity right now?
SPEAKER_03Yeah, we right now I think we're up to like 6,200, 60 somewhere between 62 and 6,300. Um, and you know, Nate, as you know, all of us are equal partners. So the the doctor that just joined two years ago has the same ownership structure as I do. Um so we all own equally, equitably, which is, I mean, I didn't create it, but it's fascinating uh to watch how that impacts the way you manage your business.
SPEAKER_02I can remember meeting your predecessor many years ago, and I said to him, like, so what do you want to do? Do you want to go public? You want to do PE? Do you want to, you know, what? And he said, no, we just we just want a doctor. I mean, it is that basically the philosophy.
SPEAKER_03Yeah, I mean, I think, you know, my I think, and you know this as we've talked over the, you know, over the years, but I've uh my board holds me accountable to a lot of things. But the three major goals are are number one, improve lives. So every year I have to improve more lives than I did the year previous. It we don't even have a top-line revenue number. There's not none of that. It's really just about how many more lives can we improve. The second is we call ourselves Vitans, kind of a cool name. So the second goal is to help Vitans do what they love. You and I both know how much more vested, productive, um, you know, how much more caring can physicians be when they feel like they have a stake in the care that they're delivering. Of course, the third goal is I got to make sure the trains are on time. You know, I can't run the thing off the track. Um, but those are the three goals. So I don't have top-line revenue numbers, I don't have any of that. And to your point about my predecessor, really inherited uh the mindset of let's help doctors deal with all this complexity in healthcare. But ultimately, the increment of our business nate is that space between the patient and their health. And we that can't be monetized, that can't be digitized, you know, that can't be uh, you know, parsed out because if you have a good relationship with a patient, you're gonna get um good outcomes.
SPEAKER_02So before
Fulfillment Autonomy And Lower Burnout
SPEAKER_02I get into uh the your business units, because I'm very interested, um, one of the things that the Bain company did is they did an analysis of physician groups that were employed by hospitals and those that were employed by just fellow physicians like yours. What they found was that the satisfaction rate for physicians in physician-owned groups was 51%, I believe, which means 49% are going to be unhappy. That's the bar you have to hit, um, at least if you want to hit the national average. With health system-employed physicians, they were only 19% of them were happy. So, what do you see as the difference? What's your secret sauce with respect to how you can operate your physician group and keep the physicians engaged and as you said, have the trains run on time?
SPEAKER_03So I think right now I'm on a campaign, Nate. Like I'm I'm on this campaign to move away from, you know, you're laughing at me because you know how crazy I am. Um I listen, I don't I don't know if I believe in satisfaction or engagement. I know we use those as measures, and I think a lot of the you know, the big companies that manage this stuff, but I think in healthcare we have it wrong. You know, you're you and I didn't start this trek into healthcare based on something that we'd be satisfied at. We had a calling, and so I think to move away to your point in a roundabout way, I'll get to the answer. But medicine is a calling, and so we have to remember that as we especially when we deal with physicians. So I believe in fulfillment. And I tell everybody, as a parent, man, I am not satisfied, but I'm always fulfilled. And so I think that's what you're keying into. When physicians own the group, when physicians own the ability to, and when you empower them to care for people, they come at it with a different mindset that is more about fulfillment and less about just being satisfied. And so, and what we do, Nate, is we use the Medscape version of that tool that evaluates all physicians around the country. We found our our and they call it burnout score, which I hate, but our burnout score was like 50% lower than the rest of the country. And I think it's because of that focus on just improving lives and fulfillment. And so 100%. I mean, it, you know, everybody, you'll see my LinkedIn posts or healthcare is broken, it's all this, and it's terrible. You know, it may well be, but if man, if you engage physicians and patients, by the way, and you give them agency over their jobs, they're gonna do an amazing job because they want to do well. They want to do well for the patients, for the community, for the health system. So sometimes we don't empower them.
SPEAKER_02In that book, Drive by Dan Pink, he talks about you have to give them the ability to master uh and you have to give them the some autonomy, if especially physicians, when they lose their autonomy and become RVU generators. What I found is that medicine is no longer a calling, it's a job. Absolutely. And that's that's the difference.
Emergency Medicine Pay And Payer Mix
SPEAKER_02So the group was originally called CEP, it was an emergency physician group. And so that's kind of your backbone. And I have some questions about emergencies operations. Last time I checked, about 40% of the patients that come through the emergency department are Medicaid. They can't find a doctor, they go to the emergency department. About 10% are no pay, and then there's some Medicare and there's commercial. Somebody ran those numbers in 2020, emergency room doc. And what he said is if I just got Medicare and Medicaid, basically I would be underpaid by $100,000. How does Vituity deal with the issue of compensation for emergency physicians is not sufficient based on the work that they have to do and the reimbursement that they get?
SPEAKER_03Yeah, 100%. I think, you know, if you look at um, you know, there are reasons for this, and you know, you and I have talked about them over the years, them Tala, right? There's other ways that I think emergency medicine is at the forefront of like, I can't decide who I see. And we actually love that. It's the beautiful, you know, sort of the it's the equitable thing. You know, if you come to see me, Nate, or if someone from across the street comes to see me, I have to keep, you know, care for them and treat them in the same way. So in that respect, I love it. The challenge with that, as you mentioned, is this you know disparate payer issue, and also the fact that you know, we don't have a you know, uh a rubric for every patient to decide on that the emergency department is actually the right place of care. So all of that history sort of, you know, that backstory sort of in place. Um, I think when you look at it, yes. I mean, I think in in, you know, we're at Howard University, you know, you know the payer mix around that community is challenged. Um we love being there, but we know that it's a challenge to get enough money, you know, from the payers to be able to pay a reasonable doctor to do an amazing job. My answer to that really is diversity, Nate. I think that if you look at it, the reason we get around it in a in a way is because we have a diverse portfolio. You know, we're in communities where there are lots of commercial patients, and that's okay. And we're in communities where there are lots of Medicaid patients, and that's okay because we feel it's our calling to treat everybody. The other thing we've done, Nate, you mentioned emergency medicine. We've diversified across the care continuum. So anesthesia, hospitals, medicine, psychiatric, psychiatry, neurology, and we've even ventured outside the hospital to take care of patients in new and innovative ways. Right?
Diversifying Beyond The Emergency Department
SPEAKER_03I think that emergency medicine, just the way it is, might be at risk. But if we are able to diversify the portfolio and the work opportunities for ER doctors, that skill set can be applied in other venues.
SPEAKER_02So you mentioned my wheelhouse, hospital-based physicians. I usually uh, well, I'd say about 80% of the time negotiating on behalf of a health system with hospital-based physicians, about 20% representing the docs. Um, and it's not uncommon more for hospitals to provide stipends to subsidize the difference between what it costs to staff a unit and what you are receiving. Are you seeing that as a more common uh element in terms of your business?
SPEAKER_03Yeah. I would say what I am seeing is emergency medicine, there's no longer the interest or the ability for health systems to help with emergency medicine. Which I think for rural communities and some of the poorer communities is challenging. There you it's rare that a hospital will say, hey, I'll support you in the emergency medicine, because they sort of see it as a per-click model where you can ramp up and wrap down as you need. So I think the financial pressures, as you mentioned, on emergency medicine are much, much more severe than they were 10 or 15 years ago, uh, even five years ago. Um, we know that uh, you know, hospice medicine and anesthesia in some cases are 50% or even more stipended. I think in those, in I think those stipends are being affected, but I think that hospitals can better tie supportive groups to their metrics when it comes to hospital medicine and anesthesia, obviously, number of surgeries, right? Most hospitals generate revenue through the their surgeries. And then obviously, if you can decrease the length of stay in a hospital, you're you're saving billi millions and then you're you potentially uh you know affecting their profitability. So that's sort of my overall thing. I think um stipends are harder to come by. I think hospitals are being really prudent in sort of where it's needed. Um, but I think emergency medicine, it's it's really rare. Last thing I say, Nate, run on sentence here. I think that our the fact that we're transparent with health systems makes the conversations we have much different. So they know how much we make, they know our overhead, they know how much we collect. We share that openly with them, and we also share it with our partners. So when there are times that we do need help, they're fully confident that that money is going to the physicians who are doing the work. And not to a PE firm or some other Well, I tell everybody my daughter goes to Boston College, she's on a basketball scholarship. It's not, it's not, it's not hospital systems that are funding my daughter going to Boston College.
SPEAKER_02Recent New York Times article talked about the fact that 75% of all patients are admitted through the emergency department. I think it's higher because you have to take out obstetrics. That's kind of an elective kind of thing. It never happened, but anyhow. So they come to the emergency department. Um, and we're seeing longer and longer waits. We're seeing more people off the Medicaid roles as a result of that wonderful bill. We're seeing people not signing up for the Affordable Care Act. What is your corporate or personal vision about the future with respect to the hospital's front door?
SPEAKER_03Yeah,
The Hospital Front Door And Care Navigation
SPEAKER_03I think appropriately so, it is the hospital's front door. I think people are desperately trying to figure out how to get the right care at the right place at the right time. And I think we've been involved in that conversation. We're a little bit different, Nate, as you know, that even though there are times where decreased volume can decrease, you know, sort of the working capital that I have in the emergency department, we do the we try to do the right thing. And if it's an opportunity to, for example, you have a patient come in and CHF exacerbation, right? There's the typical way I learned to take care of that is snap your fingers and get them to the floor. But direcing that placing a patient aggressively in the ER, making that ER stay a little longer, can decrease the length of stay on the back end and get this the whole system can work better in that regard. So I think that ER physicians, um, you know, specifically to Vituity, but other, you know, other people are trying to do this also, is try to get the, you know, try to create systems that get those patients to the right place of care because we can't just trust the system to do that for us. How can we create, you know, things like, you know, we've talked about Rely, which is a company that we started that really works on care navigation, both on discharges from the ED and from the inpatient realm, so you can navigate that patient and get them to the right care at the right time. So they don't believe that anytime I need something, I go through the ED. That said, to your point about the front door to the hospital, if you can uh, you know, sort of if make it as efficient as possible for patients to come in and get the appropriate care so they can get admitted and you speed up that process, you actually free up the emergency department. So I would say more than just being inundated, which is I think that the where you're going, it's like, oh my gosh, are you gonna be inundated? I think there are ways to get efficiencies and manage patients differently to disrupt the current paradigm. Because in the current paradigm, you're just gonna get a you know, sort of a glut of patient flow and it it won't be the best. But you know, Nate, the whole thing I do is I love disruption.
SPEAKER_02Well, that's what I was gonna ask you. So
Rethinking ED Flow With The Waterfall Model
SPEAKER_02how do we how are we disrupting the emergency department? I go, I go to these hospitals, and what I see is they hire the ED docs, there's people waiting, 2% leave without being seen, everybody gets CT scan. I mean, how do you disrupt the ED?
SPEAKER_03And you know that we've done a sort of a we've iterated on disruption through our 50 years of being existence. We started RME, which is that rapid little medical evaluation that a lot of people are doing now, where you kind of push the provider up to the front. And that sort of that stops the clock, right? But it's only partially what you really need. You really need to create flows throughout the entire course of the patient's um stay, and then you need to stagger it based on acuity. Obviously, you want to see the heart attack really, really, really fast, and you want to get them to the cath lab. So we have a couple of different things that we're doing, Nate. We have something called a waterfall, um, which is a which is a rendition of RME, where we actually take physicians and advanced providers and start their shift in the front. And so we start them in the front, they start, they stop that clock, you know, the clock of the patients waiting, but then they manage them through the process. You know, you think about going to an ER and going through shift change, right? You have a different doctor, a different nurse, you got all this different things going on. But if you can create that continuity, we find that when providers have continuity in that ER state, the patients go out uh quicker, they're admitted quicker, they are more the patients are happier because they've only seen one provider. So that's kind of the kind of disruption we're doing is really, can we flip the whole staffing model and care model on its head and not just do the whole triage? I mean, think about it, Nate. I I write about this in the book. Triage was started in a war, you know, in a war zone. And we're just sort of tagging people and saying, oh, you'll live, you'll die, okay, you might be saved, right? So we still have that model today. So the idea is to kind of upend that. Um, really treat all patients as efficient as efficiently as you can, but then don't just let them get stuck in the quagmire of, oh, we're waiting for tests.
SPEAKER_02So you mentioned earlier that you express a lot of dissatisfaction with the current non-system that we have in LinkedIn.
Breaking Healthcare Verticals With Shared Metrics
SPEAKER_02I think I beat you, by the way, in terms of the intensity of dissatisfaction. And one of my big dissatisfactions is what I call verticals. You know, you go into a health, first of all, on a big scale, we've got pharmacy. All they care about is pharmacy. You have health plants, all they care about is health plants, and so on. So the whole system doesn't worry about the patient, like you talked about. But within health systems where you work, you've got HR and you've got supply chain, and you've got this institute model, and you've got the, you know, all these different components, and they're all worried about their own vertical performance, not worrying about how well the health system is operating. Uh, one example, which you may be somewhat familiar with is this one hospital said, okay, supply chain, reduce the cost of implants, and they did, and as a result, a thousand surgeries walked out because they limited the implant selection, and the doctors didn't want those implants, so they left. So, how do you work with health systems and deal with the inherent vertical organizational matrix structure that doesn't seem to be able to get a lot of things done quickly?
SPEAKER_03Yeah, you you mentioned uh matrix, right? So in our organization, I still get a lot of flag for it from my team. We're still figuring out pieces of it, but I I don't like heads heads of anything. And so if you look at we split the country up into divisions, and our divisions are led by a team. And those team members, there's no hierarchy between them. And they actually report up through function. And I think that's a model in healthcare that to your point that we can move to. You know, if you didn't have these heads of department, or in some ways they were accountable to each other, you know, for example, if you made the lab person accountable to the time to provider, or you made the radio, or you made the uh physician accountable for CT throughput time, you would see very, very different um outcomes. And we do some of that with integration on HM hospital medicine and ED. We have shared incentives and shared metrics when we have the ED and HM. So one plus one equals three, right? And so that way I'm incentivized by length of stay in the hospital. And I say, well, you know, Nate, that has nothing to do with me. I just make the decisions on whether they need to be admitted or not. That's one mindset. Or you could say, hmm, what can I do so that my partner, when he's he or she's in the hospital, has a better throughput of that patient. So I think shared incentives, um, you know, in the in sort of though in those verticals, that's where you could start. But ultimately, if you could create some matrix reporting, I think that's where you go. It's complicated. Don't get me wrong. It's hard to manage, but I think that's the answer.
SPEAKER_02Well, you mentioned the answer earlier, I, which I believe in, which is why don't you talk to the doctors and nurses? Right. Talk to the doctors and nurses as opposed to meeting with each other day in and day out. And I guess that's an area of frustration. And the biggest issue now is boarding, right?
Boarding And Reverse Rounding For Discharge
SPEAKER_02Um uh it's a it's considered a national crisis. And one of the reasons it's a crisis is there's not a forcing function that says this patient is at 7 a.m. is ready to be discharged, discharge them, get that bed ready, right? Um, are you guys dealing with that since you're in the hospital medicine side of this?
SPEAKER_03Yeah, absolutely. I mean, the traditional model, um, we we've been able to flip it on its head, but the traditional model, what do you do? Right? You start rounds at seven in the morning, you see the sickest patients first, and somewhere around 5 p.m. is when you end up seeing the patients that need to go home and find out they can't get a ride till the next morning and all those things. So we reverse round. We reverse round. We know the sick patients are gonna be there. We, of course, we tidy them up, make sure there's nothing you know acutely going on, but then we quickly go to the patients that could go home today and they want to leave, they're ready. And you round on those patients first. And the other thing, too, I think Nate, we try to do is we and we've learned this over times and mistakes and iterations, is you probably need to round with the whole team. I mean, that's where you sort of you write the discharge. Hey, discharge home. Oh, they need a new wheelchair, oh, you know, this, you know, all these things. And so rounding together and then and then flipping the flipping the uh sort of the the way you round.
SPEAKER_02So if you have any advice for health systems, because you work in how many hundreds?
Advice For Health Systems Leaders
SPEAKER_03So I think we have 900 practices, and I'd say we're probably in 60 health systems.
SPEAKER_02So if you do you have any advice for health systems about, okay, we're in the gutter doing the hard work, taking care of patients. Is there any advice you would give them so that they could operate a better, more patient-oriented institution?
SPEAKER_03The first thing I'd tell them is call Nate. You want to know what to do, call Nate Kaufman because he'll tell you what to do, and it'll be right. And you may not be, listen, you're not, I'll just let you know, you're my friend. It's not going to be fluffed at all. It's going to be very straight and to the point, and that's why we love you, Nate Kaufman. Right. I think the other thing that um, you know, what what they should do is, and I know they I know they're busy and I know they're worried. Um, you have to really focus on the patient processes, the patient flow. I know the the CFO is staring down their necks. You got to put the CFO on hold for a minute, find out what is best for patients. I guarantee you, if you figure out satisfaction flow and doing quality care, the finances will work itself out. The second thing I would say, and you mentioned that earlier, is you gotta get doctors on board. Number one, you have to hear them out, which can be difficult because they're very opinionated, but you just gotta sit back and listen because even when they're just complaining, there's one nugget that you can find that's gonna make the care better. And then after you listen, you can't just go back to the lean six sigma people and figure it all out. You got to get them in the process and make sure that they are the ones, because I'll tell you, if they're walking down the halls talking to nurses, talking to department heads, talking to the head of radiology, and they're excited about your process, I guarantee you they'll be successful.
SPEAKER_02I can't disagree with that. It's amazing how many organizations have forgotten about the physicians and the nurses in particular as the people that know what's going on.
SPEAKER_03You know, Nate, it's historic. I think physicians, I mean, myself included, I've I've learned. I mean, uh fortunately, Vituity has a great leadership development program. So I'm much more refined than when I started. And I think physicians can do it better. We are doing it better, but we still can get better about how to communicate in a way that advances the ball instead of sometimes just, you know, just being, you know, uh not having all those leadership qualities. So I think that's something that I've seen more. I've seen many, many more um CEOs who are physicians. I've seen many, many more physician leaders, and I think that's a good sign for a future where the care is better.
SPEAKER_02I remember many years ago I attended a Vituity, I think I spoke at a Vituity conference, and I was impressed with how many leadership meetings you had going on, training people on how to be better leaders and do the do the right thing and those kinds of things. I think and and and and where I see that different is hospitals kind of have general overall leadership stuff, but yours can be targeted to the specific specialty.
SPEAKER_00Yeah, absolutely.
SPEAKER_02And there's a lot of issues that need to be resolved in those individual specialties. Just a couple more questions about um one of the things I'm curious about is because you expressed dissatisfaction with the system and you're a big thinker, and you've been on podiums with Scottie Becker and all these other folks and all that, and you talk about um disrupting to defy the odds. What's your solution for our nation's healthcare system?
Fixing Healthcare Without Partisan Blindness
SPEAKER_03Oh man.
SPEAKER_02Or what incremental things do you think need to change sooner rather than later?
SPEAKER_03I mean, the first two words that came to my mind were reflecting pool. Um, but that's um but I think I think so I think there's a couple things that to be honest. I think, and this is a Canadian response. So I, you know, I apologize. I I think that I think that healthcare is not is is not political. I think that healthcare is not political. And I think that the solution for healthcare is people who want to solve problems in healthcare, want to do amazing things, and are able to speak to anybody about it, no matter what team anybody's on. And I think there are solutions out there in the middle or that can bring people together, but I don't think people are schooled um in that way of thinking. Um I think the second thing, how do we solve healthcare? And you and I have talked about this, and I don't, you know, and I think you you talked about this with Mark, Mark Eugen, right? Like, how do you create a financial model that is everything else, especially in America, is structured in a way that I will pay for better, I will pay for faster, I will pay for whatever. And healthcare is this model where you know I serve you dinner and you think it's great, and so you give somebody else the money, and somewhere down the line I get paid a percentage of that. That that model, it just it's uh you know, people talk about single payer and all these different things. I think I'm I grew up in single payer, I know the pros and cons of that, but there is a modeling here around compensation that can still allow you to grow and retain and recruit amazing physicians, not be honorous to the patient, but also be more consistent with the care you received and not just necessarily what zip code you're in or you know what you do for work.
SPEAKER_02You know, my pet peeve right now is is this whole price cap thing that first of all, some hospitals deserve it. There's no question. Some hospitals are mismanaged and need better management and are inefficient. Some hospitals are promoting sports teams when maybe they should have invested in uh other things besides that. Um but um the the issue that I have is you can't talk about reforming healthcare and just look at one vertical. And you can't say, well, the way we're gonna reform healthcare is we're gonna cap commercial rates, but you're ignoring the unethical behaviors of the insurance companies denying care and disrupting care and keeping people in pain. How can you talk about healthcare reform and not have both of those things in the same sentence? And the only way I can think of that is you're hired by a lobbyist who wants to puke on hospitals.
SPEAKER_03Right. I mean, it's uh I went to um we don't have a lobby, we don't have a we don't have a an advocacy wing of our partnership, so to speak. I mean, we do like to be involved in communities and make sure we communicate with our our leaders, uh politicians, what's going on. But I decided, Nate, that I'm gonna go to Washington. You know, it's like this is um and I went and I went and I I didn't go with a team, I went with just by myself. I was able to uh I have some friends who were able to get some meetings with people. And everybody I talked to on both sides of the aisle, they were like, oh my gosh, like you're dealing with a lot of stuff. And so to your point, they they were talking to a night shift ER doc who happened to be the leader of a 6500 physician partnership, and they were intrigued by the conversation. And and the reason I got to this story is because one of the politicians said to me, Well, how much profit do you make when you see a Medicare patient in the ED? You know, and so their their mindset to really understand the breadth of the fact that, hey, I have all this uncompensated care, I have all this low-paying care, and then I have people who will give me more than I deserve to offset that. They it's hard for them to really see that. And then they also think, well, Moo, why do you need more money? Or make people on your podcast would say, Moo, why do you need more money? The only reason we need money is to make sure we can get an amazing doctor there. So we don't have anybody, anybody else, any other mouth to feed. And so that that concept to them, you think that they would know it. They they still are struggling through, especially in emergency medicine, but also in any of the hospital-based medicines, the fact that uh it's more than just, you know, one for one. Where I think obviously in the outpatient realm, you know, it's a little bit different because you can choose who the provider you see, you can choose when you have that mole removed and things like that.
SPEAKER_02So you mentioned the reflecting pond. You know, at the end of the day, when you think about it, most of the policies that we live under, those of us, you especially, that deliver health care, are policies made by people that are picked based on a popularity contest that has nothing to do with their competency in understanding healthcare. And the nuances of healthcare are so complicated that if you create a policy and you don't understand the nuances, you're probably gonna make things worse. And that's what we're seeing with rural hospitals as an example. I mean, the policy is just leave them alone, kind of throw them a few bucks. But the problem actually in rural hospitals is in order to for them to survive, they have to have enough revenue, and that revenue's got to come from the private payer because they don't have the volume. So then you're and who who gets paid the least for emergency services and other services, it's the rural hospital. So of course they're gonna go out of business. But if you don't understand those nuances, uh you're probably gonna get influenced by somebody who has some knucklehead idea, and things are actually gonna get worse for patients.
SPEAKER_03I I 100% agree with you. I mean, I what I try to do with these things is blame myself, you know. Um I blame myself, and so that's why I kind of took it upon uh myself and others in the partnership to say, let's let's educate, let's teach, let's communicate, um, in a way that is, you know, um I was gonna say so, you know, growing up in Canada, I learned how to say things that were terrible that made everybody feel like they were amazing. Um so how do you how do you communicate with people in a way that lets them know how much you care for the community, um how much you care for America and how much you care for providing the best health care? Um, I you know, I think we'll always have the politic stuff, but I do think, and maybe I'm naive to say, I do think that somebody like Mark or me or a combination of different people, they're gonna figure out a way to disrupt it. And um hopefully they talk to physicians, but I think they're gonna figure it out.
SPEAKER_02So, you know, as a patient, maybe because I'm on the in the secret society, but I can tell when there's a good doctor. You know, you can tell when somebody's a good doctor. They know how to communicate with you, they they're not just interested in the visit. Um, it's a it's a huge difference. Uh and um, you know, my feeling is whoever has the best doctors wins, right? Yeah, uh in the long run. And you de Fatuity definitely has a lot of the best doctors for sure. Two last questions. No one,
One Word For Patients Agency
SPEAKER_02any advice for patients?
SPEAKER_03The advice for patients are almost the same as the advice for physicians, agency. It's it's one word, agency. We're in a the the big one of the biggest disruptions to healthcare today is the fact that patients can uh take control of their care. And we're seeing this in the longevity space, right? We're seeing people that are um trying to figure out exactly what's going on with their body in these tests that may be different, and they're doing treatments that aren't approved, but they want agency, they want control. So the the recommendation I have, especially with AI and a lot of other knowledge-based support, is take agency, ask questions, talk to people, you know, talk to your physician about the choices you're making, because at the end of the day, it's your care.
SPEAKER_02Yep, absolutely. And anything we missed, did we cover everything pretty well?
SPEAKER_03Well, we didn't
The Grudge Behind Less Than One Percent
SPEAKER_03cover your spoke. I mean, did you did you want the less than one percent story or not?
SPEAKER_02Yes, yes, absolutely. You know, you bogarded me on that.
SPEAKER_03So I didn't know what the heck you would well, you know, I was trying to stay, I was trying to stay healthier focused. So, so Nate, part of the, you know, part of my whole mindset now is that again, you you know, my predecessor, and I was in no way interested in being the CEO of i2D. I was in what you call a reluctant leader. I had a coach that uh pushed me to decide, hey, you gotta think of something more here. You can't just keep working night shifts and just you know, coaching your kids in basketball. So he challenged me and I said, Well, I like that CEO thing. That's kind of cool. Um, it's like being a point guard, and I was a point guard in college, and he said, There's no chance. I said, Well, what's you gotta give me a percentage? Give me some odds. And he said, less than one percent. So I hold grudges and I built a whole brand around the idea that we should never pick winners and losers before the races even run.
SPEAKER_02So that's it, huh? So you're one of the less than one percent.
SPEAKER_03No, I would say, you know, it's I don't, I don't know if I am. I just know that there's so many people out there that are underrated and that are that are that feel like they could have a greater impact than they are having. And I want to be an advocate for those people who feel like that.
SPEAKER_02Yeah, I think that's a great uh, I mean, especially doctors. Again, down in the trenches, if we can be an advocate for advocate for them, we're advocating for patience and we're advocating for better care. Absolutely agree. And it is an Amazon bestseller, if I'm not mistaken.
SPEAKER_03Yes, sir. Yes, sir. It's done well. Congratulations. I appreciate it. I appreciate it. Yeah, it's it's it's if of course I'm I'm uh not where I want to be, so I'm writing in second book.
SPEAKER_02So what is this one about?
SPEAKER_03Or can you say my next book is a is called Almost, The Other Side of Winning. Um, it's really talking about the idea that we believe greatness happens when people win or when businesses win. But there's a lot of grace, there's a lot of greatness in people who come second and third, and there's a lot of greatness in people who just don't ever happen to get on the podium. And so, how can we look at more of those individuals uh and really find greatness uh in them? So again, same theme uh of trying to find untapped greatness, untapped success.
SPEAKER_02Well, you've done a great job. Uh for sure. Vatuity has grown under your leadership. Um, and it is I it has to be the largest independent physician group in the country at this point. Uh that's not backed by any financial PE firm or whatever. Is that probably true?
SPEAKER_03Yeah, I think I think that's definitely true. I mean, with the number of physicians, I mean, our revenue was 3 billion, uh, you know, it's close to 3 billion a year. So yeah, I think we're we're definitely the biggest. Um, but I don't think we've strived, we we it I don't think we decided that. I don't think we tried to be. You talked about the growth, uh Nate, I appreciate it, but I didn't try to grow that rapidly or that fast. It just that the model resonates, um, resonates with with health systems and resonates with doctors and ultimately resonates with with patients. So as long as it resonates, I feel like we'll we'll continue to grow.
SPEAKER_02That's great.
How To Connect With Vituity And Moo
SPEAKER_02So um, if they need want to get in touch with Vituity, I'm sure they can go to your website.
SPEAKER_03Yeah, vituity.com. Um, you can also check out our our not-for-profit Vituity Cares, where we provide uh care for people in 60 clinics around the country. If you want to volunteer if you're a clinician or a non-clinician, go out there. We just take care of people for free, mostly unhoused communities. So that's something that's real passionate uh to me also. And you can find me at my name is imamutomlinson.com. You can, you know, email me, text me, LinkedIn, Instagram, everywhere if you just want to talk or just want to you know talk about healthcare or if you want uh to hear um you know crazy stories about growing up as a rapper and a DJ and a basketball player.
SPEAKER_02That's great. That's great. Good luck to your daughter at uh BU, right? BC, BC, yes.
SPEAKER_03She's in her junior season, and uh hopefully we got uh new coach. And uh, you know, I just wanted to have fun and and excel. So it's amazing.
SPEAKER_02Great. Well, this is Nate Kaufman thanking Imam Tomlinson for uh taking time out of his extremely busy day to have an unscripted, brutally honest chat about healthcare. Moose, thank you so much, and uh hope we can connect at some time in the future. Definitely I appreciate you, Nate. Thank you so much. All right, Moo, thanks.
Closing Thoughts And Subscribe
SPEAKER_01Thank you for joining us on this episode of the Healthcare Bridge. We hope you gained valuable insights into how strategic and financial analysis can transform healthcare delivery. Remember, building stronger connections in our healthcare system is a collective effort, and we're honored to be part of that journey with you. Be sure to subscribe and stay tuned for more conversations that aim to bridge gaps and create a healthier future for all. You can find all your healthcare bridge episodes at the Common Bridge on Substack, YouTube, and your favorite podcast platform.