How a CA Privacy Law Could Affect Your Marketing Plans

ep. 21

How to Leave Hospital Systems and Go Independent

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In this episode of the Growing a Successful Orthopedic Practice Podcast, Jonathan Yerasimides, M.D., Orthopedic Surgeon at Louisville Hip and Knee Institute, and Alice Shade, CEO and President of 4 A Ventures, join Keith Landry, to offer orthopedic physicians and practice managers a blueprint to leave the hospital system and open an independent practice.

Dr. Yerasimides says physicians going independent have to let go and let a business operations expert put the details in place to establish and scale an independent practice. Shade says it’s important to surround the surgeons with strong legal, human resources and information technology teams so they can focus on doing surgical procedures.

Tune in to discover:

  • Things independent physicians never thought of until they already took the leap
  • Be willing to use different systems in an independent practice than at the hospital
  • Exercises to see how employees interact as a team to achieve best results
  • Two reasons why some orthopedic physicians should stay put within the hospital system

About Jonathan Yerasimides, M.D.

Jonathan Yerasimides, M.D. is an Orthopedic Surgeon at Louisville Hip and Knee Institute. He specializes in primary and revision hip replacement procedures. Dr. Yerasimides performed the first anterior approach hip replacement in Louisville. He performs more anterior approach hip replacements each year than any other surgeon in the United States, with more than 9,500 during his career. Dr. Yerasimides regularly travels across the United States, Europe, Asia and Australia to demonstrate the anterior approach hip replacement to other surgeons.

About Alice Shade

Alice Shade is CEO and President of 4 A Ventures. She is an Executive, Advisor, Founder and Strategist with extensive experience in establishing vision, building companies, creating revenue, developing teams, forging strategic partnerships, and producing results. She helps independent practices with program ideation, development and execution focused on data, outcomes and technology driven solutions.

How a CA Privacy Law Could Affect Your Marketing Plans

About Keith Landry

Keith Landry is Director of Public Relations at Insight Marketing Group. Keith has been a public relations consultant since 2010. He has more than 26 years of experience as a news anchor, news reporter and public affairs show host, which he uses to implement innovative public relations strategies for medical practice clients.

Sponsored by OrthoLive

Episode Transcription

Jonathan  Yeras…:         We didn’t know what the hell to do or how to even start it. I’d been employed for 12 years and I didn’t know the first thing about starting a business. We’re surgeons…

Speaker 2:                    Welcome to the Growing a Successful Orthopedic Practice Podcast. Join us every episode to hear from fellow medical practice administrators, staff, and physicians as we break down current issues affecting the industry and share real stories from guests on their way to growing a successful orthopedic practice. Let’s get started.

Keith Landry:                Hello, everyone. Welcome to another episode of the Growing a Successful Orthopedic Practice Podcast. I’m your host, Keith Landry. And this episode is brought to you by our friends at OrthoLive. And today, we’re talking about, wow, it’s a big decision, the decision to leave a hospital system and go independent. And we’ve got two experts with us today to give you some insights on that. Dr. Jonathan Yerasimides with Louisville Hip & Knee Institute, and Alice Shade, CEO and President of 4A Ventures. I want to thank you both for carving some time out of your schedules to give our listeners some insights today. Welcome.

Jonathan  Yeras…:         Thank you.

Alice Shade:                  Thank you. Glad to be here.

Keith Landry:                All right, let’s do a little background on why you are the two featured experts on the other side of the microphone today. Dr. Jonathan Yerasimides is a orthopedic surgeon specializing in primary and revision hip replacement, performed the first anterior approach hip replacement in Louisville, and is quickly become an authority on that procedure. He performs more anterior replacement each year than any other surgeon in America with more than 9,500 of them under his belt so far. Dr. Yerasimides is considered a top authority on revision anterior approach hip replacement, pioneering new techniques, publishing articles, writing chapters and further moving the field along. He travels regularly across our country to lecture and teach the procedure to other orthopedic surgeons. He also takes that overseas to Europe, Asia and Australia to lecture and demonstrate procedures for surgeons interested in learning more about it. So, we have a highly qualified surgeon with us today.

And Alice Shade, CEO and President of 4A Ventures, is a founder and executive with extensive experience in establishing vision, building companies, creating revenue, developing teams, forging strategic partnerships, and producing results. I think I need a drink of water already. She’s an innovative health care executive with demonstrable achievement in program ideation, development and execution focused on data, outcomes and technology driven solutions. And honestly, I could read their bios for another hour, but we’d run out of time. So I want to thank you both for being here with us and for sharing some insights with our orthopedic physicians and their practice managers. So let’s start with you, Dr. Jonathan. You’re with an independent orthopedic group in Louisville, as we mentioned, the Louisville Hip & Knee Institute. Why do you prefer to be independent as opposed to working with a hospital system?

Jonathan  Yeras…:         Well, the system I came from, I was employed for 12 years in that system, and had a very good experience with the system. I had good experience with the hierarchy in the system. So, it wasn’t anything necessarily negative about the employed system. It was more about starting my own business and being an owner in something, being able to build equity over the years of actually having something tangible that at the end of my career I can own and possess and not instead of renting a car, I’m buying a car. And so, I actually have something at the end of the day other than just being on a payroll for the rest of my life.

Keith Landry:                And Ms. Shade, when you talk to physicians about going independent, is that a similar story they tell you?

Alice Shade:                  Yes, it is very similar. And I think too, it’s also the desire to have a little more control over the patient experience, and what the patient experience is coming in, and trying or thinking about it in a different way, and wanting to influence their style and their manner in the way the patients are treated and the experience that they have in their practice.

Keith Landry:                That makes a lot of sense. Dr. Yerasimides, the trend across America is for large hospital systems to buy up these private practice or just gobble them up and envelop them, but your team moved in the opposite direction. Why did you and your colleagues decide to leave the hospital system? I know that Dr. Greene was involved with that decision to leave the hospital system.

Jonathan  Yeras…:         Right. And I think Alice actually gave me a good segway into my comments because we wanted to… We noticed because we travel nationally, and for me internationally, trend six or seven years ago in orthopedics, where across the country hip and knee replacements were being done as outpatient. And so, we want to bring that to Louisville because Louisville didn’t have anybody doing outpatient total hips and total knees. So first approach to our previous employer in 2015, and our approach to them was we want to partner with you on an outpatient surgery center because we think this is the future. And at that time giant corporations with inertia, they’re not going to move and change directions easily.

And so every year for five, six years, we tried to get them to partner with us. We thought this was the way it was going to go. We actually started an outpatient joint program out of a hospital setting about four years ago and grew that. We designed the whole thing. And this past year, 90% of our total joints were going outpatient. And so, we finally just got tired of trying to get this giant corporation to change direction and change vision of what we thought hip and knee replacement was going to be. And so, we decided just to break off and start it on our own.

Keith Landry:                Courageous decision. No doubt.

Jonathan  Yeras…:         Yeah. It took me a long time to actually pull the trigger on it because I’d get stuck in grooves and I’m kind of a animal of repetition. And it took me a while, but eventually I broke out and I couldn’t be happier.

Keith Landry:                Yeah. Routines feel safe sometimes until you bust out of them. All right. Ms. Shade, tell us how you help orthopedic practices go independent because we got some people listening right now. They’re orthopedic physicians. Maybe they’ve been in the hospital system a long time. Medical practice managers listening as well. Maybe they’ve talked about it at lunch or had several meetings about this. How do you help them actually do it?

Alice Shade:                  Well, I think there’s so many components to building an independent practice. Coming from a hospital-based situation really adds additional complexity, I think, because you’ve been in a system that has structure and processes that sometimes are behind the scenes and you don’t necessarily see. But it also comes with a big step from a risk perspective, both financially and from a reputation. And so, that’s important to understand when you’re talking and working with folks like Jonathan that want to step away. And so, what I bring in my team, we bring this experience of strategy, financing, operational expertise along with the systems that need to happen to make a successful transition. And so therefore, I think it gives the confidence to make that leap. So, we kind of help take some of the risks out of that decision.

Keith Landry:                Awesome. And we’ll talk a little bit more in depth as we go throughout this episode. Dr. Yerasimides, what were some of the biggest challenges that your team faced leaving the hospital system behind and starting out on your own? Let’s face it, there is a certain amount of safety being enveloped by that huge institution. So what were the some of the challenges you all faced?

Jonathan  Yeras…:         Well, I guess in short, we didn’t know what the hell to do or how to even start it. I’d been employed for 12 years and I didn’t know the first thing about starting a business. We’re surgeons, we go to school for sciences and then we go to residency and we learn how to be a surgeon. I don’t know the first thing about business. And that’s what bringing somebody like Alice and her partner [Denise] on. There’s no way we could have done this without their help. We didn’t know anything about even where to start.

Keith Landry:                I think I’m going to declare you more honest than Abraham Lincoln. That was absolutely exceptional right there. Alice, what do you want to add to that?

Alice Shade:                  Well, if you get to know Jonathan, you know that’s his style, which is incredibly refreshing and we’ve enjoyed working with him. Yeah, I would say one of the biggest things that kind of tripped them up is, what is the first step? How do you break this down, this big elephant? And how do you take step one, step two? And taking some of the mystery out of starting a business. It’s not easy work, but that’s kind of what Denise and I kind of bring to the table is just kind of outlining the steps that need to happen.

Keith Landry:                Well, let’s build on that a little bit. Ms. Shade, what are the biggest concerns that you hear from the orthopedic physicians and their managers as they move through the process of going independent? It’s one thing to make the decision. We’re going to go do this. And you set out in the sailboat for The Bahamas. But, what do you hear through the process as the pain points are setting in?

Alice Shade:                  Well, I laugh because sometimes I think the fear is that boat to The Bahamas becomes a car that you’re living out of the trunk because you’re just not quite sure where you’re going to end up, right? So, I think the leap is a financial risk leap. I think that’s one of the biggest concerns is starting over. You’ve worked really hard to establish a referral base and a patient base. And so starting over, it is a leap. And so, I think that’s it. I think establishing really good financing partners is really important along with a very clear strategy on how this new practice needs to grow organically and the marketing and strategy around that.

Keith Landry:                And that’s a lot to cover. By the way, you’re trying to make sure you do the best procedures while you’re doing all that, right? So John, tell us a little bit about that just for a second. All of the things she just talked about. How do you sort of compartmentalize that while you’re trying to do the best procedures for your patients and you and your colleagues are worried about all the other stuff she just mentioned?

Jonathan  Yeras…:         Yeah. And fortunately, we’ve got two consultants with us that can look around corners and we have weekly meetings. We still have weekly meetings for over a year. So that they can feed us information because we’re trying to work every day, seeing patients and operate, and it’s impossible to keep track of all the emails, and to all the meetings that need to be done, and the t’s that need to be crossed, and the i’s that need to be dotted. And so, you have to really rely if you’ve got people, as fortunate as we do, like Alice and Denise.

You rely on them and you trust them that they’re out there while you’re in the hospital. They’re out there getting all the tiny things that you didn’t think about organized, and they bring them to you every week, and make calls and have emails in between that just to let you know what’s going on, guide you on where they think that we should go with these pluses and minuses. And you really have to have a team to do this. This isn’t something that I think that 99.9% of surgeons are qualified to do or should try to do because it’s just not what we do.

Keith Landry:                That’s great advice there. And so, that leads me to the thought about specialized knowledge. It’s really about the specialized knowledge that Ms. Shade has. And you have that very specific detailed knowledge about helping the practice make these transitions. What are the things that trip up these groups as they launch that independent practice and work to scale it after they’re established? Because let’s look at this, it’s really a two point question. Number one, they decide to do it. And maybe they start it and they’re doing it, but they just don’t scale it well, right? So, there’s really two steps they need to worry about.

Alice Shade:                  Yeah, it’s really important. And I think for my team, Denise and I, it’s making sure that the physicians are doing their work in an environment that they can continue to do their work. So, it’s important that they get in the operating room and do the work that they do best because that’s what drives the revenue for the practice. So, our goal is to make sure we put the systems in place that help facilitate that. Now, you kind of got to crawl before you walk and before you run. And so, part of that job is putting in systems that work.

I think what trips them up sometimes is to say, “Well, we did this here. Let’s use this system I used before.” Not realizing it was part of a bigger ecosystem. And so, there’s better other tools or systems that could be used. And I think sometimes it’s easier to put a shortcut in place for a short term solution. Part of our job is to say, manual paper is really not a scalable solution, and so keep your eye on the ball long-term on where you need to be, so you can move that into a more repeatable, scalable process. And so, what’s immediate today and what do you got to do next week and six months from now is on how we find that out.

Keith Landry:                Great points there. So Dr. Yerasimides, you’re obviously a very intelligent, highly qualified surgeon who has a lot of education. When you have a group of really smart orthopedic surgeons, how do you convince each other to just let go and not be control freaks and let Ms. Shade implement her expertise? Is that a challenge or do you guys just feel like, nope, that’s why she’s here and that’s what she’s going to do?

Jonathan  Yeras…:         No, I think that’s definitely a challenge because I think surgeons in general kind of have an attitude. They feel they know everything and they’re so smart and they can do this, that, the other. I fortunately don’t have the problem of being able to turn it over to somebody else and be like, I don’t have any idea what the hell is going on. You got to take this for me. But a lot of guys, they want to control everything from what color the trash cans are going to be to the signage on the outside.

And for me, I just know that there are places where my knowledge that I have from school and residency just doesn’t apply to these things. And you have to find somebody you trust and then you have to let yourself trust them. You have to be able to turn it over because yeah, surgeons would go to a lot of school and it’s difficult and bloody blah, but we don’t know how to do so, actually we don’t know how to do 99% of the things that are required on earth. So you have to be able to let go and let somebody else do it for you because your best job is being done in the operating room and seeing patients, it’s not taking care of business decisions.

Keith Landry:                Alice, how needed do you feel right now?

Alice Shade:                  Well, he’s very generous in saying that. What’s interesting and what I would say is, what’s really important when you’re supporting and helping in a situation like this is understanding what, in this case, [Joe] and Jonathan’s vision for the practice was, what their mission statement, what they wanted to achieve. And getting really clear on that. I think they probably were like, why is Alice keep asking me this? Why she keep asking me what our mission statement is? But it became really important because it then framed up what we then needed to achieve to make the practice run efficiently, and make those decisions, and bring forth options to consider that would align with the vision that they came together with.

Keith Landry:                So, I want to ask you Alice about intentionality. Real fancy word for setting things up differently in the independent practice intentionally compared to in the hospital system. What is it you coach these groups to intentionally do differently from the hospital system?

Alice Shade:                  Well, it’s a change in mindset because you’re coming from an employee-based arrangement to a business owner and it changes the way you need to think and approach and make decisions. So to me, the intentional part is understanding that the decisions that you make come from an owner, not necessarily a participant. And then, from what I said before about establishing the vision, that’s very intentional. And I think if you can get those pieces right that’s different than a hospital system because you’re coming in as part of their vision, not yours. And so to me, those are really things that have to be intentional in order to set the course of what you want to see.

Speaker 5:                    Today’s episode is presented by OrthoLive. Designed by an orthopedic surgeon for orthopedic practices, OrthoLive is a comprehensive telemedicine platform that puts the features you need front and center, increasing practice revenue without adding to your already full plate, like consent forms and patient readiness indicators that visually guide patients to fill out the necessary legal consent forms before an appointment can begin, and then automatically save them, so you don’t have to. When a patient is ready for their appointment, you’ll see a green indicator light. If there’s no light, that means your providers can focus on other patients on their schedule until the icon turns green. For more on how OrthoLive can increase efficiency, practice revenue, and patient satisfaction, visit today. OrthoLive, the world’s leading orthopedic-specific telemedicine platform.

Keith Landry:                And you just taught me something I never knew. I never knew that intentionality equals gray hair. I just should never put the tables together.

Alice Shade:                  That’s true.

Keith Landry:                But now, I get it. All right. Let’s talk a little bit more. Doctor, how does your team have to manage your practice differently now compared to when you had all of that support that came with being part of the hospital system? There might’ve been some things you guys actually took for granted, right? Because you just had this stuff handed to you from the hospital system. Talk to us a little bit about that.

Jonathan  Yeras…:         Sure, yeah. In a hospital system, you’re just a little piece in a big nanny state, and everything’s given to you, and you don’t have to hire employees, and you don’t have to know how many FTE do you need to run a practice. What’s too many? What’s too few? So now, we’re starting to get exposed to this. Well, how many secretaries do we need answering the phone? Do we need two people up front checking in people and a third person just answering phones? And, how many nurses do we need? And, how many this, that? How many X-ray machines do we need? How many rooms do we need, office that we’re getting ready to build? So everything you have to think about, whereas before you just showed up to work.

And the hospital system I was in was giant and the office was giant. And frankly, it was just a revolving door. Every month there’d be five new employees and five more would be gone. So in a small setting like we’re in now and having a small business, I think it’s more about hiring people that can kind of be a family. And that’s what we’re looking for is to try to create something where it’s not just a revolving door of employees in and out, and it’s creating something where people want to come to work because they want to be a part of this office and they’re happy to be there. And it turns into good patient care because then patients feel that and they feel important and they feel the office is not just a giant department store that they’re going into like a little mom-and-pop place and makes them feel good.

Keith Landry:                All comes down to the patient experience in the end. So Alice, talk to us a little bit more about that. Jonathan gave us his insights on no longer having mom holding your hand, mom being the hospital system. How do you coach these new independent groups to adjust to that? What is the specific advice you offer them?

Alice Shade:                  I think you have to kind of you go into it with an acknowledgement. You don’t know what you don’t know. And that it’s necessary to understand what the various pieces need to be, and then understand what’s necessary and what’s not. Jonathan talked about building trust and having a family type environment with the team. Well, that’s really critical. So you need good human resource support to do that, right? Good benefit and creating that infrastructure. So to me, it’s kind of what are the pieces that are really necessary and putting a support team around them. So it’s putting a good legal team around, and an accounting team, an HR team, an IT team.

When you move from a hospital system into your own independent practice, those are the things that are kind of behind the scenes. But you have to have a good team to give you good, solid advice. You don’t need to hire them all on your payroll, of course. That doesn’t make sense. So, you find good partners that can help you bring that to life. So for example like IT, you don’t need an IT person because not one IT is specialized in knowing the hardware you get, and the infrastructure to set up, and the security. But you hire a team that can do that, then you get the benefit of collective base of experience. So, that’s kind of how we’ve approached this transition.

Keith Landry:                Good advice. Stuff I wouldn’t have thought of. All right. Dr. Yerasimides, what are some deal breakers for physicians who are thinking about leaving the hospital system to form that private practice? In other words, what are some reasons why they should just stay put and not jump over the bridge?

Jonathan  Yeras…:         I think in order to have a private practice nowadays, you have to have some kind of ancillary income, whether it’s you own a MRI, you own a physical therapy facility. In our case, we own a surgery center. I don’t think it’s possible anymore because of high overheads and decreasing reimbursements for insurance that it’s even possible to go hang a shingle and just expect to make a good living or collections that you have from seeing patients and doing surgeries. So if you don’t have some other ancillary service that’s bringing in additional income to offset all the overhead, I think it’d be very difficult. And that’s why hospitals are gobbling up so many positions in practices because the hospital, they can actually afford to pay you a little bit more than what you’re actually bringing in as a surgeon in surgeon fees.

And you ask, well, how do they do that? Well, they’re going to pay you a higher salary than you actually bring-in in surgeon fees because they’re guaranteeing that you’ll do all your surgeries out of their facility. And that’s where the real money’s at. So, the money is there. So they can offer you $115 if you only make a 100 a year and you’re like, man, that looks really damn good. I’m going to take that. But they’re doing it to guarantee that you’re going to be using their MRI machines, using their PT, using their surgery center. And so, they ended up still making a profit off of you. And then, the surgeon makes a profit. They don’t have any other ancillary. So, it’s a win-win for a lot of guys. So, it’s not a bad thing. It’s a win-win. But there’s also some benefit to owning your own business and having something small and nimble that can change directions and isn’t just a cog in this giant wheel.

Keith Landry:                Flexibility and independence. All right. That sounds great. Alice, let’s talk for a minute. I like this question. I can’t wait to hear your answers. What are the couple things that newly formed independent practice managers and the physicians just never think about in terms of running their own practice until they leave the hospital and they’re already in the boiling water?

Alice Shade:                  Yeah. That’s a fun question. And with this, just kind of be in top of mind. We’re now in spring. Thank goodness. But we had kind of a fun winter where we had quite a bit of different snow days and it was, what’s our snow policy? What do we do? How do we call our employees? And that’s not something that they had to think about before. Other things like appointments scheduling, and who’s covering the call afterwards, and where’s the phone calls go. Those are things that while they sound small and [inaudible], they really matter to the patient, right? Those are things that matter to the patient to be informed about what’s going to happen to their appointment that day or et cetera. So, those are the things that kind of pop up. Jonathan, you might have one or two too.

Jonathan  Yeras…:         No, it’s all those small details. You have this idea in your head. Okay, I know that we need an office. I know we need computers, and a EMR, and a X-ray machine. But those are the giant obvious things. It’s the little things that we have no idea.

Keith Landry:                Where do we get [crosstalk]?

Jonathan  Yeras…:         Yeah.

Alice Shade:                  Right.

Jonathan  Yeras…:         Oh, yeah. There’s so much. It’s mind boggling how many decisions need to be made about starting a business. And for the last year, I bet I get 10 emails a day and have at least two phone calls a day about something to do with the business. It’s exhausting. Hopefully, I’m like, oh my God, is this going to ever get on a regular pace where I have to stop making so many damn decisions?

Keith Landry:                You pull your teenage daughter in to start making some of those decisions for you.

Jonathan  Yeras…:         But yeah, it is a lot of work. It is a way more work than I thought when I dip my toe in the pond over a year ago.

Keith Landry:                Awesome insight. So obviously, the single most important phrase, the most important two words in the medical world these days is the big buzz phrase is the patient experience. In the end, it’s really almost all that matters. So doctor tell us how you approach that every day when you go to work, and what you guys talk about in your staff meetings about consistently creating the best patient experience. Is it a vision? Is it a habit there?

Jonathan  Yeras…:         Yeah. I think it’s extremely important and that’s the whole reason that we broke off from the hospital system was to create this outpatient joint practice for patient experience because outpatient surgeries are much better performed at outpatient centers that are smaller, where someone can go in and there’s only two or three nurses there. And the patient feels the more one-on-one care and they feel more important rather than going into a hospital that has 20 ORs and you’re sitting in the recovery room next to one person who got their gallbladder taken out and somebody who just had brain surgery, instead you’re in a small center where all the patients are having the same procedure done. It’s more of a one-on-one care. The office the same way. Instead of walking into a office where there’s five surgeons going at the same time with 45 rooms and people everywhere. It’s a nice small environment where patients feel cozy, and they feel they’re getting a one-on-one care, and they feel in that, to them equates to better care because they feel they’re more important. They feel it’s not just a giant machine just churning people out.

So the whole goal of this thing to break off was to create this niche environment than niche business here in Louisville that didn’t have anything like it, and to try to make people that need our services feel this was the best place to go for the services because it’s got the surgeons that this is all they do and not somebody that does 45 different procedures on hands and ankles and backs and all this. It’s a very niche thing. And when you come to see me in the office, you know this is all I do, and that you’re going to get the best care possible. And that the people that I’ve employed at the surgery center and the office, this is all they do too. So you’re getting the best possible care you can get by coming to see us, if you need my services. If you need a hand surgeon, don’t come see me.

Keith Landry:                Okay. I’ll remember. So Alice, how do you coach practice managers to keep the staff on board with that vision of creating the best patient experience? I was sitting here thinking boutique surgery experience in my mind. Well, how do you coach the practice managers to repeat that message daily, I guess?

Alice Shade:                  And I would add too, Jonathan’s passion comes through as he talks about how he want his patients to feel and what he wants them to experience. And that translates to how he speaks with the staff and carries that vision forward. And I think too, this vision is how to be more transparent for a better patient experience as well, right? We’re living in or we’re moving into more price transparency and all these things is that this now affords us the opportunity to demonstrate what those are.

But I think when it comes to the staff too, it’s they’ve been very involved in the hiring of the team, making sure that they understand the vision, and consistently and continuously look at the patient through the lens of the patient, and how they feel as they go through that process and experience. And then, we’ve done a number of team building initiatives that bringing awareness of what their operating styles are, the way they interact as a team, how they need to, or what blind spots they might have just so that they are continuously kind of thinking about, what is the patient experiencing? What and how would they receive this information? And, can we do it better?

Keith Landry:                Good deal. I want to switch gears just a little bit because this is, hopefully, we get some golden nuggets out of this one for our listeners. Alice, how do you coach independent physicians to build their referral networks after they leave the safety of that hospital system now that they have to compete with the hospital’s patient referral machine? And then doctor, I’ll ask you to answer that afterwards as well.

Alice Shade:                  Yeah. It’s a great question. The physicians that I’ve worked with have fundamentally understood that relationships are personal and they had invested the time to build those relationships. And that has been inside and outside the walls of the hospital. And then, it’s part of the marketing strategy, right? It’s how to continue to build upon those relationships and let people understand what your vision is and what you want to do differently. I think too, their reputations have preceded themselves as they’ve moved away that and so patients have actively sought them.

But I think when you think about the referral machine within a hospital, we’re finding more and more that really what drives new patients is patient to patient referrals and patient testimonials. And they and of themselves is kind of what is bringing the volume to the independent practice. So one leaves with a great experience, they’re going to tell their friend that needs another hip replacement, and then the next one comes in. And that has been what I see has been most valuable. But it really is a reflection on these too, particularly on how they’ve already built relationships over the years as they built their own personal practice and profession.

Keith Landry:                And Dr. Yerasimides, what are your thoughts on that, building the referral network as an independent guy?

Jonathan  Yeras…:         Yeah. And that’s a scary thing, it is. Even someone like myself, I do over 900 total hips a year. I’ve done 9,500 over the past 15 years. And they’ve all been here in Louisville, so I’ve obviously put a lot of patients out there into the community. So, my reputation was good and I was well-known. I was getting lots of business. But still you worry when you break off. What’s going to happen? Monday, I spent four hours driving around in my car. I’ve visited primary care offices, pain management offices, PT, chiropractors.

I went in person to all these offices trying to sell the new practice and trying to get it kick-started. So, I’m just out there doing cold calls. So it’s a scary thing, but I know it’s going to be fine in the end. I don’t have any doubts about that whatsoever because we’re turning out a good product and we’re providing a good service. So that’s a really big leap of faith that and I think losing patient referrals and the financial risks are the two things that would, at least in my mind, make me worry the most or made me worry the most and probably most surgeons the same.

Keith Landry:                I can imagine the irony of that. They’re asking you to travel to Australia and Asia and all over America to lecture highly skilled surgeons on your procedures and then you’re driving around the streets of Louisville handing out Starbucks cards.

Jonathan  Yeras…:         Yeah. But you do what you got to do.

Alice Shade:                  You did. I mean, you’ve been willing to do it.

Keith Landry:                So [crosstalk] Starbucks cards next time. All right. Next question goes to you doctor. So, you guys have taken the bold step. You’ve built your independent practice. You got the doors open. You think you’re doing everything right. You’ve got wonderful reputations in the community. What are you doing to scale the practice in addition to driving around handing out whatever it is? But, what are you doing to scale the practice and to adapt to the changes of the future of orthopedic medicine?

Jonathan  Yeras…:         Yeah. The whole Genesis of this practice was our vision of the future of orthopedics. And one that we tried to get the hospital to join us with. Like I said, 2015 was the first meeting we had about this because we see the future as these joint replacements hip and knee becoming outpatient. It’s obvious Medicare took total hips off the inpatient only list in 2019. The year before that Medicare took total knees off the inpatient only list. Even the gigantic bureaucracies like CMS are recognizing these procedures can be done out of outpatient facilities. And so, that was what we had in mind on creating this thing. And if 10 years from now there’s something else that appears to be on the horizon, we have a small and nimble enough practice that we can change directions easily. I think I’m lucky in the aspect that I do get to travel a lot to teach and consult.

And so, I get flavors from all over the country about what’s going on in different areas of the country. And so, that helps because if you get stuck in just one place and all you know is your own box, then you don’t have any reason to change or you may not see the things that somebody in California is seeing or somebody in Chicago or Florida. So I’m lucky in that aspect that I constantly monthly get to talk to different people from different areas and figure out, hey, what are they doing that’s different? And if it sounds good, I have the ability now, instead of trying to combat levels of administration, I’ve got the ability to change directions on my own.

Keith Landry:                Great points. All right. Dr. Jonathan Yerasimides with Louisville Hip & Knee Institute, and Alice Shade, CEO and President of 4A Ventures. How can our listeners follow up with both of you, connect with you? Just maybe they heard something super interesting to them, they want to follow up on. Doctor, we’ll go with you first. And then Alice, if you give your info, that’d be awesome.

Jonathan  Yeras…:         Well, our website is You can go to the website. Got email address on there that can be connected to. And shoot your questions or comments to the website and I’d be glad to answer them.

Alice Shade:                  Yes. And for me, you can go to my website as well, it’s And you can submit a question that way as well to me. I’m happy to answer questions that your audience might have.

Keith Landry:                All right. Brilliant insights from both of you today. And Dr. John, next time you’re driving around the streets of Orlando looking for patients, you can feel free to drop off the Starbucks card in my house. All right. Thanks everybody. Another awesome episode of Growing a Successful Orthopedic Practice Podcast. I’m your host, Keith Landry. This was nothing short of absolutely fun today. And we’re going to do it again soon. Thanks so much for being with us, everyone.

Alice Shade:                  Thank you.

Jonathan  Yeras…:         Thank you.

Speaker 2:                    Thanks for listening to the Growing a Successful Orthopedic Practice Podcast. Please consider pressing subscribe on your podcast player, so you never miss a future episode. And if you haven’t given us a rating or review on Apple Podcasts already, we ask that you take a spare minute to help us reach and share our medical practice growth stories with peers.

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