28 - Paul Vanchiere and Pediatric Management Institute ၏ စာသားမှတ်တမ်းအပြည့်အစုံ

sent me he sent me a fax. That basically said, you're burning up the toner on my fax machine. And I'm like, sorry about that. but anyway, so yeah, that's how it all started. And the reason it started is my my father passed in January of 2000. And within a couple of weeks of his passing, him and I believe Dr. Richard Tuck and Dr. Moltini were scheduled to go to Arizona. to do a coding workshop. And at the time of his passing, no, every coding workshop, the big ordeal was how do we get these big three-inch thick binders, one binder for each attendee out there and all the cost of it. So that's sort of where all this started was seeing my father, you know, put on these coding workshops and practice management workshops at different parts of the country with some of his buddies. I think Dr. Stalzman may have been involved with it as well. sort of the who practice management back then. And so that's where my interest in not only practice management but education came in. And I think a large part of it dovetailed very nicely with what you for a while you me, you and Suzanne Madden were doing one day workshops in different parts of the country and we started building crowds and then we started kinda landing in on an annual event every year instead of five or six regional events. so it really to your credit as well, we were able it's just kinda funny how things unfolded, but that's kinda we're how we've landed where PMI conferences today. So yeah. speaker-1: it's ultimately the whoever at the AAP and and it had to be people like your dad who they the people who saw the demand for this content PMI is proof that that they were right and and I've I would I you know I have to give maybe the most credit to Rich Lander on all of this only because he kept the torch burning the whole time and didn't stop. yeah speaker-0: Yeah. And Dr. Lander was instrumental on certain pivot points in PMI evolution, encouragement, support, variet many levels of support, to to to keep me to keep me keep me going, to be very candid. so very appreciative for his efforts and and and introduction to my brother from a different who eventually became a brother from another mother. So speaker-1: Well, you mean Brandon. But exactly. So, Paul, you just alluded to it a little bit and you just sort of weighed in up but I would like there's so many people who know about PMI. There's so many people who come to PMI, but at this point PMI is like bigger than you, all right? And in a lot of ways. I mean you know because people have been calling it a big family reunion. They go there to see their friends, which is per which is The dream. but they don't necessarily know, you know, just you just got to describe how you got to watch your father building, you know, the beginning of the pediatric practice management concept. and you and you alluded ever so lightly to your former employment. All right. We we don't need to dwell on that, but why don't you why don't you give the desiring audience a little

bit of an a a biography, like how how you got here. Because no one ends up in this business deliberately. speaker-0: And and look, there are there were many opportunities in my career to go outside of pediatrics. And you know, you and I could probably have made more lifetime money working in other specialties than pediatrics. speaker-1: No probably. It's no probably. It's absolutely speaker-0: I think for me it the influence, you know, of my father watching him practice, watching what he built. he ventured I mean at at one point they were the it was cited it was the largest private practice in Louisiana at that time. Now we'll gone back to the nineteen nineties. but growing up in his office was really interesting. I'm the baby of five. All my siblings at some point worked in my dad's offices. And you know, when I was younger, like five or six, maybe even s no, seven, once a month we would go to the office, all five of us, we would print off all the statements on this big, huge dot matrix printer. And we had to fold and stuff every single statement before they went out the door. And I knew I was moving up in the world when I got to run the stamp machine and sit there and run them through and everything else. So so my sister worked in the office. She room patient. my brother Andrew worked in the office. he worked in the file charting, file you know, pulling and putting charts back. my two older siblings worked in there in various ways. But I spent a lot of my summer working in the office during college. And my dad tucked me up in the billing hour in the billing department. so that was sort of my beginning of understanding that hey, there's this is really interesting. But I will say, and you might appreciate this, when I was around 10 or 12, we had this is early 80s. My father began to computerize things. So he started with appointment scheduling. And so he had in his office a deck computer, mainframe computer. They had to rip out the doorway and cut a hole in the wall in order to get it into the room. And I want to say this big white box was probably eight feet wide by about eight feet. Deep. this thing was massive. Yep. And that is what ran scheduling. Now, he had a guy named David from New Orleans who would his programmer. So Dad and David worked together to build an appointment scheduling system. And David would come in on Fridays after they closed, he would shut it all down and he would program all weekend. The dad put a couch in that room so he could take nap through the weekend. And then by, six o'clock on Monday morning, he was putting everything ready back to go. My dad would be visiting through the weekend and that. and and helping him to to craft it. And then eventually they got to eligibility tracking, tracking their insurance. And then we got to billing. It's like, okay, how can we generate a HICPA farm? and began customizing all that. So there there are some very strong parallels from the stories I've heard of PCC's beginning and watching what my father did. And it really got me interested in computers and data and all those types of things. And so that's probably what sparked my interest in this the area. And then pediatrics specifically it's it's it's seeing what my dad went through, you know. I understand you have to remember back in the day when my father had come out of the army. He joined the practice. He was doing a little moonlighting before his official discharge. And him and my mom decided to move to Lake Charles, Louisiana. And he grew to practice with them. And so I got to see in my recollection foggy at times, but I my recollection is his involvement with the community. he joined the Quranic Club. He got to meet families. He was on school boards. He did other things. He was really engaged in the community. And and and that's really what life is about. But the the the c the spinoff of that was is that that's how you really grow and develop a relationship, which is the foundation of pediatric. it it really is relationship. Sadly, today it's become more transactional. Practices would rather throw money at Google and SEO than, you know, take that long approach. And I would say that pediatricians who are involved in their communities, you know, sincerely, not only do you enjoy life more, but it does help to bring in the patients. You know, you develop those relationships. there's a strong relationship between those who have younger children and going to events and being involved in schools and you know, it it it's about developing relationships. But it's yeah, yeah. So at any rate you know speaker-1: Yeah. It you're in the relationship business. speaker-0: Yeah. and so but at any rate, so I so there were different things that I did through the years. After I graduated from college, I was thinking about going and working for him. He convinced his partners to have me come on sort of to help with projects and things like that. And so I went where I was most comfortable, which is building a self spreadsheets for him. His practice already had an internal had an accountant on the payroll. he invested a lot of money and resources into the accounting side, making sure all the expenses were properly accounted for, making sure the billing was done correctly and really invested and that's really what provided the financial stability for them was, you know, they say accounting is the language of business and he really duh dove into that. And so I got to do, more reporting stuff off of that data and to understand the business. and so after his passing, I took a I stayed a little while and then I ended up working in pathology for a group, an independent anatomic and clinical pathology group. they had contracts with three of the hospitals in the community doing all the pathology work. I worked I was there probably two or three years. And then worked for a computer company and then I ended up in Houston working for a company that was founded by a guy named Dr. Denton Cooley, who

did the first heart transplant in the United States. and what was interesting, it was a large billing department and they would package no cardiotherapic procedures for insurance companies, Medicare, and large employer group. So for example, Shell Oil Company had a contract that if anybody needed a heart bypass, they would go to St. Luke's in Houston, they would have it, and then they would get one bill. And the one bill covered the surgeon, the hospital, the percusionist, the anesthesia, everybody involved in the care. They were packaging the care. And They're still around today and that's what got me to Houston. I worked there for a couple of years and then an opportunity work opened up at Touches Children's Hospital managing one of their location, one of the outpatient pediatrics. I left there briefly after a few years, worked for Methodist Lamoa Herman Hospital. and then I ended up going back to Tech's Children's Hospital working in finance department doing physician compensation stuff and really enjoyed it but at that time is when I started thinking about you know doing more things on my own and you know doing passage assessments and things like that and that's really where it all started. a week before Ellie was born was my last day at work at Texas Children's Hospital. I took the plunge and my wife was behind it and so we started doing that full time and so it between the seminars, educational seminars and do an assessment that's where everything went off. and just grinding away. speaker-1: And and you you know, you inherited your dad and your mom. You inherited your parents' hustle. speaker-0: So well, we like we said about relationship before. I could not have done this without the relationship that my father had put out in place. Whether it was relationship with people like L Doctor Lander, Dr. Chip Hobaugh, Doctor Richard Tuck, Doctor Maltini, P Doctor Peter Rappo, some of those other people. It was through their relationship that I convinced them I was just crazy enough to give me one chance. And then it ended up, they the it it ended up being a very no very long, fruitful relationship that allowed me to expand into other areas. speaker-1: Well, I I I would say, once a week, once every two weeks, Paul, you give me a call and you're like, Okay, here's my dumb idea of the week. It's always he's always got something cooked up. He's like, What if we took this thing and then we added this to it and you know, I'm a I'm a big fan of you you plant as many seeds as you can 'cause you net you don't know what's gonna sprout. speaker-0: Yep. Yeah. Because in the beginnings of PMI, there were probably a dozen different things that we had to do because each of those items wasn't enough to really be sustainable. And then over the last several years we've dialed it in to four or five major things that, keep the business going. so you know, you're right. You It you you gotta be ready to do everything. And that's just a basic consultancy type mentality

is that while I wanna do certain things, there are other things you have sometimes you do have to clean the toilet to keep the place going. speaker-1: Yeah. That's what every every owner learns at one point or another. All right. So in your in your role as a ultimately a national pediatric consultant, what's keeping you up at night? What's making what makes you anxious? speaker-0: I think the changes that I I think what's going on in Washington DC, the anti vaccine sentiment is problematic on many levels. I think that there are I do have some concerns about the messaging of the financial reality is is that practices who are well run do make money on vaccines. Not to the extent that some people in the media are talking about. But it has had a negative effect on practices. more resistance. that's why they put out a code, counsel but not given. and it you know, the variety of things there. But yep. The reason it keeps me up at night is that there are certain parts of the country that are looking at universal vaccine. That has a significant financial impact on practices. because it's really the lack remaining ancillary profit center that can be beneficial. Add to that, you have the pressures from outsourced batsine companies. Can I say their name? Sure. you have people like Batscare that are potentially removing also putting pressure and encouraging practices to give up their lack remaining profit center. Now hear me loud and clear. There are certain situations where it makes sense. Dr. Fost Labine was beat us to the punch on it. She realized she was paying a certain percentage of her revenue for to use Athena. And by the time you do the math, it's just not worth paying them a percentage of your drug revenue. And yeah, it makes sense for some people if you're in in certain situations or you're a practice startup. There is a role for them to play. But not necessarily for a general pediatric practice who has the ability to manage their vaccine properly. so that's probably the first thing that keeps me up at night is where is all this headed? Because if you take What they spend on the drug minus what they bring in, we'll set aside all the math of what the true carrying cost is. But off the surface, that's a big chunk of what practices split up among the partners at the end of the year when you dial it in. I think that that's gonna have some effect. speaker-1: Okay. speaker-0: I think we'll go ahead and general I think the general business understanding you have a lot the lack of interest from younger positions in becoming partners or owners in the practice is problematic. It's putting a lot of pressure on practices because what does that secession plan look like? and that's where, you know That's why private equity is doing, is able to be to get into pediatric because single owners, two owner practices, they don't have you without a secession plan, you're sort of left with private equity as an option. And I'm as pro-independent as they get and While we

do we have represented practices and those types of transactions, I'd rather be a part of the conversation and help them avoid mistakes. that it I think we're gonna start to lose some of that independent. There will be less independent practices in the future than there are today, because of less interest from thirty to forty year old people interested in being owners in a medical practice. The complexity is very great. So how do we fill that gap? We fill that gap with education. And so that's why we had the PMI conference. That's why PCC is so focused on practice management as part of your user conference. That's why we have the CIPO program, certified pediatric office executive. That's why we have the new boot camp. To because look, Chip, if you and I can figure this stuff out, pediatricians can too. speaker-1: Yeah. People who went to med school should be able to handle it. Yeah. speaker-0: So that being said, that's why education is a big part of what PMI is all about, to help empower the physician to say, Look, if you and I can figure these numbers out, they can too. They just need to know where to look and that's where we spend half our time. speaker-1: Yep. I'm with you. okay, so I and by the way, I'm just thinking like if someone were to ask me the same question, how what would I how would I have answered differently? I'm not sure I don't know if I would have. but that said, now question number two What are you excited about? What are you looking forward to in our business? What's you know, what do independent pediatric practices have in store for them that's exciting? speaker-0: Well, in two years we do get a new administration in Washington D C. speaker-1: Which could be really exciting. It'll be exciting one way or the other. speaker-0: no, in all seriousness, I think technology is a big play. there I think you know, PCC, ECW, Athena, OP, they've all leaned into the technology piece. I think artificial intelligence is here. I think that we need to embrace it. I'm excited about potential efficiencies. I think it can look very different in a year. I It is my belief that there could be the potential for people to better under to more effectively learn about how to run a practice as a result of AI and educational opportunity, but also the efficiency within officers to make sure that claims are being followed up. It may be by a bot instead of an individual picking up the phone. so I'm excited about the coming changes and what EMR companies will allow AI to do in terms of integration. There are a lot of third parties out there that'll try to do some things, but so in general, I'm excited by I'm excited by some people yeah. I'm excited by some people like Dr. Christophe Diazio in North Carolina putting together a supergroup, CIN supergroup. However, you want to frame it. physic pediatricians realizing that you have to band together in order to effectively negotiate with payers, not just for financial reasons, but to improve the quality of life for children. You know? That's an example where if you build the financial foundation, it allows you to be a medical home. to provide better care for children. So those are the two areas I'm probably most excited about in general. speaker-1: Okay. I like that. I I would add to yours, just because of all the people I'm I'm gonna interview, you're like the one where you you you might ask me the question. I'm I'm interested in some of the clinical things. I think okay, absent the nonsense that's happened the last couple of years, we were on a huge pendulum upswing of vaccine research. I don't know if you saw just like yesterday too or just this week, there's a there's a A personalized skin cancer vaccine that just just showed a huge promise in trials. So the idea being that we might be able to eliminate or avoid a some portion of the the skin cancer problem that you know we all have, and that's only gonna get worse because of climate. speaker-0: I'm surprised you didn't leave with T Ziel. speaker-1: Well that's my that was where I was that I was that's my punchline. I think sorry. Yeah, speaker-0: They mean to steal it. speaker-1: no, no. No, you're but you were on the same wave. The I think the next two or three years we're gonna see universal type one diabetes screening for a variety of reasons. including the fact that if we can identify kids with type one diabetes before they get to DKA, we can actually not only save a bunch of them, I'm not just talking about saving lives, but get them on T-Zieled and maybe change their lives. But those are the kids we need to study. The any cure for diabetes is going to happen for with kids who still have endogenous cells. And those are really hard to find because by the time you realize someone's got type 1 diabetes, historically it's too late. So but not only that, and this is a this is a lesson that Katie Schaeffer's already taught us. If you go do you do the type 1 diabetes screening for every for every kid you find with type 1 diabetes, you will find I don't know what's her ratio right now. 10, 20 kids with celiac who didn't know it. All right. Yeah. she's basically keeping her the GI wing of the hospital open right now by finding these kids with celiac. And this is like, look, this is preventive care 101. And the testing isn't that expensive. The United States ought to be figuring this out. So anyway, as I look to the future, I'm looking forward to some of the clinical improvements. All right, so Polly, I have one more question. You ready? If you could go back, if you could talk to yourself when you were in your twenties and give yourself advice, what would it be? What would you tell? There is that. speaker-0: Sure part. milkons. If I could give him my strawberry bite or get go back in time. I think that When chaos I I think I've said it a lot of time, where there's chaos there's opportunity. Yep. And There were opportunities in our career where there was chaos and there was an opportunity to get out

and meet people. and it wasn't for people to learn about us, but take advantage of those opportunities to help other people more. You know. and and not to sound hotty totty or anything, but you know, when COVID first came out, you know, when when things were well well I I remember the day, I can't remember the date, but I remember the day sitting there thinking, you know, w what's gonna happen? You know? and so and and that's where it was through relationship with people like you and others that we were able to scramble the jet And you know, start doing some weekly webinars. And like and for me, I was trying to figure it out on my own too. All I had to do is be ahead one step ahead of everybody else and say, look, this is what I did, this is what worked, and what didn't work. Where I'm going with this is not to toot our horn, but to to recognize that there could be there could be more when it it let the focus be helping people. And everything else will work out. My dad used to say, you practice good medicine, everything will work out. That's exactly right. speaker-1: Where's going? Yeah. That's ex that's a huge lesson. Yep. speaker-0: you you gotta it's not about playing the long game. It's not about anything else, but just trying to be a steward for others as best you can. And take advantage of those opportunities because that's where the reward comes from. You know, that's what motivates you is feeling like, hey, I I I'd like to think that we've made a difference. and take advantage. of those opportunities more when they come to help others. speaker-1: Yeah, I think Neem, first of all, I think you and I are fortunate to work for a group of people for whom yeah it's very rewarding to work for the are the people we work for. They directly change lives and save lives every day, even though they don't know whose life they're saving necessarily. They save speaker-0: They're doing the hard they're then frankly, like you said, they the I've heard you say a million times, they're doing the hard part. Right. speaker-1: Yeah. We just talk about stuff. Maybe do some spreadsheets. Like no, look at how hard I worked to do this spreadsheet. But the the reason I'm still in this business, the same reason you're in this business, is that there's intrinsic reward for helping people. For d for doing things that other people don't have the time, inclination, or capacity to do for themselves that makes their lives better. And the the lesson we learned here from our from our first client is Dick Narkowitz, who was the who was the AAP president at the time, he said to John Canning, Take care of the kids and the money will take care of itself. And I still we still follow that. It's a big thing we talk about at PCC. Just do the right thing and i things will take care of themselves. And and and that's a hard that now n at no time in my career has it been harder to say that with a straight face than the last two years. Yeah. Because our clients do the right thing twenty

five times a day and it is getting harder and harder to do that. But boy, all the alternatives seem a lot worse to me, speaker-0: I think part of our the relationship between me and you is when I've run into issues, whether it's a conference or a set of circumstances with a client or even in my day to day life with my family, you you have been rock solid in saying what's the right thing to do. And not to say that I've never gone against it, but just being more cognizant of that thought process. Yep. And let that be your guiding light of what it no, what is the right thing to do. And it it sounds generic, but that's definitely something to lean into because it helps you to make decisions. speaker-1: well, guess what, Paul? We are going to have a webinar soon. Yep. We're gonna have PMI in a few months. You're in the middle of the boot camp. let me ask you this if someone someone if this is the first time someone's ever seen or heard of PMI or the boot camp or C PoE or anything like that, where should they go? How do they find out more? speaker-0: So originally the place to go were pediatric management institute dot com. But that's a lot to type in. So we changed it and said, okay, what are we in the business of? We're in the business of supporting pediatrician. So our website is pediatric support.com. We keep it really simple. we've got online calculators, we've got educational resources. we recently with gotten a lot of interest in our website or partnership information. I'm not an attorney, I'm not a CPA, but I've read a lot of partnership agreements, as have you. And so I've been keeping this running list of all the things to look for, and it ended up being like a hundred and ninety seven things. Well, we made that available on the website. I don't even ask for their email addresses. drive to marketing people crazy, but that's just the way we roll. but, you know, there are resources like that to say, okay, what's missing? How much do I need to pay a provider? How much can I afford to pay a provider? how much do I want to make? Those are all online calculators on our website. we we try to push it, we we push out everything we can to make it available to be a resource. and this would up until a year ago, that was a great way to do business. Now AI is figuring out a lot of things for people. But it's a resource that's there that's narrowly tailored to pediatric practices. So speaker-1: All right. And I and just for the record, I've already used it multiple times. So it's very handy. All right. Well, Polly, thank you. I appreciate it. yeah. speaker-0: No, I appreciate it. Yeah, no, I appreciate the opportunity to chat and visit. And I'm sure if anybody has any question, you and I are fairly easy to find. If you don't have our email address, you got LinkedIn, you got everything else, or you know, dollar friend, they probably have our email address. but if you need it, it's really simple. Paul at pediatric support dot com and you know, chip got an even easier email address. Ship at bc dot com. So no, but speaker-1: Yeah. speaker-0: I appreciate a chance to chat. speaker-1: Yeah, my pleasure as always and thank you. And if there's anyone if anyone here needs something, if I don't know it and Polly doesn't know it, we probably know who does. So reach out. Thank you very much. speaker-0: Right here. speaker-1: Thank you for listening. More information can be found in our show notes. Production and editing by Chip Hart, Allie Squires, and Chris Forlio. Music by Challenger C. I'm Mark Herney.