Episode 34: COVID-19
We Are Open for Business
John M. Starcher, Jr., President and CEO, Bon Secours Mercy Health
itunes stitcher googleplay spotify

In this episode of Fireside Chat, we sit down with John M. Starcher, Jr., President and CEO, Bon Secours Mercy Health to talk about the characteristics of a leader during a crisis, telehealth services and the effects of the COVID-19 crisis on economics and capital expenditures.

Please note: The number of COVID-19 cases and the situation referenced in this episode were based on reported data at the time of the interview and are subject to change.

John M. Starcher Jr. is president and CEO of Bon Secours Mercy Health. As the leader of one of the largest health care systems in the U.S., Starcher oversees the development of system strategies and operations for 50 Mercy Health and Bon Secours hospitals and more than 1,000 sites of care across Ohio, Kentucky, New York, Maryland, Virginia, South Carolina and Florida, as well as five locations across Ireland. Read more…

Transcription

↓ scroll 

Gary Bisbee 

Good afternoon, John, and welcome.

John Starcher

Thank you, Gary. It’s good to be with you.

Gary Bisbee

We’re pleased to have you at this microphone. Let’s get right into Coronavirus and COVID. We’ve learned that COVID surge is highly variable by region. In your case, you’ve got eight states in two countries to think about. How do you think about the surge across all your service areas, John?

John Starcher  

Well, Gary, it’s absolutely variable to your point. But it depends across each of our states, within the states, each of our markets, obviously across the country with our presence in the Republic of Ireland as well. It’s been unbelievably variable. At the end of the day, we’ve treated about 4000 patients that have tested positive for COVID since early March, we currently have about 220 patients in-house today. But when you look at the surge to your question, I think what we do is in our bed capacity planning, we’ve been looking at the number of folks in the community that has been infected per 100 thousand in the population. And that shows just dramatic differences across our markets. We have some markets as high as 400 persons per 100,000 that have been infected in other markets as low as 50 persons 100,000. At the end of the day, we’ve got some markets that have seen more than 1000 COVID patients and other markets that have only seen about 40. So it’s extraordinarily variable and something that certainly one size doesn’t fit all when it comes to the management of these populations.

Gary Bisbee  

Let’s come back to that later. But why don’t we ask you to describe Bon Secours Mercy, of course, you went through an integration 18 months ago? So if you could just bring us up to speed on Bon Secours Mercy that’d be terrific.

John Starcher  

Sure Bon Secours Mercy Health is the merger between Bon Secours and Mercy Health, which happened in September of 2018. So to your point, we’re about 18 or 20 months into the relationship respectively. We were about $4 billion net revenue organizations that came together and formed an eight-plus billion-dollar organization. Today we are tracking over $10 billion in net revenue because we picked up the largest private system in Ireland as well as a handful of hospitals here in the United States as well. So all told today, I’ve described this as an integrated delivery network. We’ve got over 1,000 sites of care across seven states in two countries. We’ve got about 60,000 employees, we see about 10 million patients a year and give about $2 million a day back in community benefit. Obviously, since being a faith-based organization mission is at the heart of everything we do.

Gary Bisbee  

You were making a point that you were glad you got through much of the integration before the COVID crisis hit. How are you thinking about getting back to business, John?

John Starcher  

The integration between Bon Secours to Mercy Health is really something that we’re proud of and our board is proud of. I think it could be a test case for the industry. We put the merger together in less than nine months. And here we sit 18 months post-merger. And we’ve effectuated for the most part 95% of our integration plan, which was to take the better part of three years. And so we targeted coming in about $300 million in efficiencies by coming together. And we’ve already exceeded $285 million. The good news is that because we worked so quickly and moved with such speed and putting our respective ministries together, it put us in a really good position, operating as one to deal with a pandemic that has so many arms and legs to it as this one does.

Gary Bisbee  

What are you thinking about in terms of rebooting elective surgeries?

John Starcher    

Well, that’s been variable based on each of the seven states within which we operate. But currently, we’ve opened back up elective surgeries in some markets and some sites. We are preparing to do that obviously in the other communities that haven’t yet reopened, but I believe that I think many of my colleagues believe that this is the new normal if you will and that we’re gonna have to continue to effectively be able to operate in a world that has an infectious disease, communicable disease on the scale of which we’ve never seen before. We’ve got to be comfortable reopening. We’ve got to be comfortable that we’re providing safe spaces for patients to be seen, and safe spaces for our caregivers to give care to those patients. And we feel really good about where we’re at in our ability to reopen and time will tell as to how quickly the buyers will come back. But we are open for business.

Gary Bisbee    

Is it too early to tell or have you had any experience in figuring out how the consumers will be treating coming back?

John Starcher   

It’s a bit too early to tell, Gary. We began working on this problem, as you might imagine, at the same time we were canceling procedures back in early March. When we were canceling folks, we were already beginning to schedule them out into May in anticipation that we could hopefully rapidly move through the height of the pandemic and for the most part, have been able to do that. We have some markets and some practices within markets that are already very busy, and that have been scheduled out for the better part of the next three months. And then we have others that are limping along and struggling to get back on their feet and that are going to take a little bit more time. And so I think it’s highly variable just as the pandemic has hit us has been highly variable, but the manner in which we’re doing it across the board and preparing for it is consistent.

Gary Bisbee   

What’s been your remote working policies across your health system?

John Starcher    

We’ve embraced it fully. We, for the most part, closed all of our shared services and support services offices, both in Cincinnati and in Baltimore. And in Virginia crossed our footprint in mid to late March, depending on where you are located. We’ve transitioned now, over 6,100 employees that are working remotely today that were not prior to the pandemic. So you might imagine the yeomen lift that was both from an IT perspective and resource perspective to have over 6,000 associates translate working from home. But we’ve been successful in that effort. And I would say, for the most part, we haven’t missed a beat, certainly a new way to getting used to work. But we’ve been getting work done.

Gary Bisbee   

Excellent. Does that give you any opportunity going forward relative to facilities planning and so on? In other words, some of those 6,100, will they continue to work remotely?

John Starcher  

Yeah, I think there’s a very good possibility for that. Obviously, if folks are able to work effectively from home right now, we want them to be able to do that. That’s the prudent thing to do until we have vaccines for COVID-19. And that gives us a little bit of time to evaluate moving forward each of our workspaces and locations. We have a fairly new corporate environment built within the last five years that has open spaces and lots of cubicles that aren’t spaced 6 feet apart, as you might imagine. So we’re re-envisioning what those workspaces look like walking through just the building and looking at elevator management or plexiglass. I asked for the spacing of furniture, HVAC units or negative pressure areas, vending machines, sterilization procedures, and processes, you name it. All of that stuff has to be relooked at and we will do that, The good fortune is that because we have such a strong IT infrastructure and have enabled folks to work from home, there’s no rush for us to get our employees back to work until we can ensure that it’s a safe and appropriate environment. But invariably, it will affect how we use our business space and commercial real estate moving forward.

Gary Bisbee  

Communicating is always important, particularly in terms of a crisis. How did you think about Bon Secours Mercy communicating with its multiple communities?

John Starcher  

That’s vitally important and we knew that from the get-go. We’ve gone out of our way to make sure that we’ve been thoroughly and appropriately communicating with our communities. We established a covert hotline immediately on the first days of the pandemic to allow our patients to call in with questions. And to be triaged, based on their symptoms, launched video visits and have had literally thousands to tens of thousands of video visits since the early April launch. We put out a website which we have carried out in virtual triage capabilities. And we’ve seen since we put out that website and 80% reduction into the COVID hotline, so folks are beginning in our communities to get used to navigating the website in the virtual capabilities of chatbot. That’s been fun to watch. We’ve had a broad social media campaign, as you might imagine, with informational posts, and thank you campaigns for our direct caregivers. And we continue to drive results through our blog and website quite effectively. We’ve got a 340% increase to our website as a result of some of these social posts. So a comprehensive outreach to the community as you might expect.

Gary Bisbee   

What about the caregivers? How did you think about communicating with them?

John Starcher  

Just as important if not more important. Because we’re coming into this on the heels or in the midst of the integration of Bon Secours and Mercy Health, we’re always focused on communications internally. And so historically, at least over the past 18 months, we’ve been publishing a weekly newsletter, a couple governance newsletters each month, three monthly caregiver newsletters. But during the pandemic, we put those efforts on steroids, if you will. We’ve now established a pattern and a cadence for 25 communications each and every week. So we have daily leader updates. We have daily associate updates. We’ve got five times per week media and legislative updates. We’ve been doing podcasts five days a week hosted by various members of my senior leadership team. We have videos that go out to all associates once a week. So as you might imagine a heavy lift and we’ve been polling our caregivers to see how that effort is gone. And I’m very pleased to say I just got those results back last week. We’ve got 72% of our caregivers. They feel that they’ve been well informed about our COVID-19 approach and almost 70% have full confidence, our approach in response to COVID-19. So that’s, that’s quite positive compared to what you’re hearing in the industry is this.

Gary Bisbee  

It’s just terrific. Well done there. Let’s move to telemedicine. How has telemedicine grown over this time?

John Starcher  

Again, huge. There’s been rapid consumer adoption of our telehealth platforms. And we’ve experienced just dramatic growth in the platform. If you look at this time last year, Gary, we were seeing on average, less than 25 video visits per day. And currently, as we sit here today, we’re seeing nearly 9,000 video visits per day. So we’re doing more in a day than we did in all of the previous years. That’s just been phenomenal. And I think that you’ll continue to see that usage and I don’t think you’re going to see that go down magically anytime soon.

Gary Bisbee  

What about the caregivers manning the phones as it were? How have you been able to find enough people to handle all these telemedicine visits?

John Starcher  

Well, one, we’ve got a tremendous physician practice and grip leadership that works very closely with all of our physician practices primary care and specialty sites, we have the technology platform already in place and available. Some were using it, some were not all are using it today and using it quite effectively. So we’ve been tapping existing resources within each of the practices, again, with some very stellar leadership, both from our lay position group leaders and our key position leaders. We also had a couple platforms in place that were already plugged in play for this. We have a subsidiary company called Conduit Health. That was a 24/7/365 nurse triage center where we already staffed around the clock with nurse caregivers to assess triage and transfer patients. That’s been vital to us. Success and managing the COVID patient population and getting them scheduled during this period of time. And then I’m sure you know about ensemble Health Partners, which was our owned revenue cycle company that has done all of our scheduling and rescheduling, and certainly navigates the telehealth and telemedicine platforms extraordinarily well.

Gary Bisbee  

Speaking of revenue cycle, how important was CMS waivers and insurance coverage for telemedicine visits? How important was that in the increase?

John Starcher  

Well, I’m glad that the government led by examples. I had some early conversations with HHS when they were considering doing it. I’m glad that they did it. And I think we’re all seeing the benefit of it today. And for the most part, the commercial insurers have followed suit. And I think that’s a good thing. I want to get started on the things that commercial insurers are not doing that they can or should facilitate this effort, particularly at this time of crisis. But at the end of the day covering telehealth and telemedicine has been a very positive move, we can still do some more things in terms of accessibility across state lines. But nonetheless, it was vitally important to our efforts today.

Gary Bisbee  

Do we have to do anything to make sure that that is sustained? Do you think that they will automatically do that?

John Starcher   

I’m hoping they will automatically do it. But you don’t know what you don’t know. So I think we have to be vocal to the federal and state government, HHS, and locally with our departments of health and state Medicaid organizations. We also have to do so with our commercial insurers, hoping they see the success that the last two months have given us in terms of effectively being able to treat patients virtually, where they can appropriately be treated virtually and but we can’t take it for granted. I think we have to be out there actively advocating and lobbying for an ongoing position.

Gary Bisbee  

Let’s turn to the supply chain. How is supply chain holding up for PPE?

John Starcher  

Really well, I have to tell you, we’ve got a great team who saw this coming in early January. We have a bunch of horses in the supply chain department and we unleashed them and let them do their thing. And so we got out in front of it across the board with respect to face shields and masks and isolation gowns, gloves, you name it, they’ve really done a tremendous job and ensuring that at no time throughout this pandemic, were we short, that’s saying a lot. When an organization our size, we go through about 22,000 masks per day, about 10,000 gowns per day. That’s a big lift. I want to make it sound easy. It’s not been easy. It was because of their foresight, and the fact that we let them run. And the other thing that we’re proud of, I’m sure on the national news, you picked up the reprocessing capabilities for face shields and masks, at Mattel, which was a company located in Columbus, Ohio. We were integral in pushing that through HHS, and the Food and Drug Administration to allow that company to safely reprocess and sterilize face shields and masks. And so today, we’ve re-processed over 20,000 masks with them as well. And so that’s something we’re also very proud of.

Gary Bisbee  

You know, that’s just terrific. I’ve heard it around the circuit, people talking about the reliability of the supply chain and wondering whether we need to do anything as a country about the reliability of the supply chain. How do you think about that, John?

John Starcher  

Well, I fall in the camp that would say we absolutely cannot be dependent on foreign nations for our supply chain, especially China, for PPE or medical supplies or equipment or pharmaceuticals. At the end of the day. I believe, Gary, it’s a matter of national security. And I’ve been very proud of the entrepreneurial spirit across the United States here these past couple months with companies that have jumped in and stepped up to the challenge to manufacture some of these items urgently. I hope that we take a longer-term view of it because I do believe we need a more dependable and more reliable supply chain in healthcare.

Gary Bisbee  

But it does seem evident that public health is now part of National Security if it wasn’t known before it should be known now. And this is another question, what can the health systems do to make sure that our governments recognize that?

John Starcher  

There’s little question that public health is a part of the national security and fabric of this nation, I also don’t believe or agree that the government is best suited to run health care moving forward. And so I think we have to be careful. It needs to continue to be a balance, as it is today. And the government can and should employ appropriate oversight with respect to safety and limited but targeted regulations, they should allow for fair and free trade. But at the end of the day, we need the government’s assistance and support to ensure moving forward that, as I just said, in the prior question, that we’re not dependent upon foreign nations, for our pharmaceuticals or our medical equipment, PPE and that we don’t put the US or the US taxpayers in the position to subsidize the world for research and development or our cost in the distribution and use of all of these supplies moving forward. I do think there’s a role for government. And I think we have to continue to advocate for that. Particularly other things that could put us in a perilous position with respect to health and safety. But I also think we need to be careful that we don’t allow the government through some of the local subsidies that have happened to the distribution of the Cares Act or other things to overreach and begin to attempt to run health care because I’m still a firm believer in free enterprise. And at the end of the day, there’s no greater economic or efficacious engine than a free market. I think left to its own devices it will do better than anyone else.

Gary Bisbee  

Well said. You have a lot of support in the field for that, John. Let’s go to Bon Secours Mercy economics, which aren’t pretty for any of our health systems, really. But how do you expect Bon Secours Mercy to look in 2020 at the end of the year?

John Starcher  

Well, you got that right that it isn’t pretty. This is probably the most challenging financial situation that any of us as leaders have ever been through. The good news for Bon Secours Mercy is that we came into this pandemic in a strong position. We had over 250 days cash or debt to cap ratios for less than 40%. We’ve just been upgraded by Moody’s. So we were in a strong position coming in, which is going to allow us to effectively weather the storm. But it’s hard to tell at the end of 2020, what the ultimate damage will be. It’s going to depend on, as I said earlier, how quickly our communities open back up, How comfortable our patients and communities feel coming back into our facilities for care. But at this point in time, Gary, I believe we’re probably going to see 10 to 15% less annual net revenue than we historically would have for the US. That’s over a billion-dollar impact in net revenue. We’re used to operating at 3% operating margins per year, even through the merger this year, clearly not going to have a 3% operating income margin. It’s quite obvious to me and the team as we look at our financials that we’ll have negative cash flow this year, which is really tough to imagine when you think about, again, historically over the recent years running at greater than 9% cash flow margin. So you lose a billion dollars in revenue, we’re doing our best to mitigate those damages. But at the end of the year, we will lose 10s of millions of dollars. The good news is, we’re in a position to absorb it. And we believe we’ll come out stronger than most

Gary Bisbee  

Well, it’s a heavy hit for sure. What about cap-ex? How will that be affected?

John Starcher  

It’s certainly going to be affected in the short run. We’d probably pulled back our immediate plans by 25% to 30%. As we move forward, we’ll have to be pretty judicious about cap-ex and making sure that it’s probably got a greater emphasis on strategic cap-ex than it has in the past in terms of what we expect. On an ROI, we’ve always been systems and ministries that have made sure that our equipment and technology is the latest and greatest and up to date and that our caregivers have the resources they need to be successful in their environment. We’ll continue to do that. But I think you’re going to see us and many other large systems being judicious and much more strategic about the deployment of cap-ex and probably a lot more disciplined in the ROI that we go after in the allocation of those precious capital dollars moving forward.

Gary Bisbee  

Any sense of what 2021 might be at this point? I know there’s a lot of variables, including is there going to be another surge in the fall or next year, but any sense of that, john?

John Starcher  

Well, I just make a couple of comments to that one. It’s really tough to predict coming on the heels of 2020. You don’t have the typical run rate analysis and zero-based budgeting activities that you would ordinarily have in a normal year. I would say to you, Gary, a couple things. One is that we knew coming into the pandemic, we had a billion-dollar budget gap over the next five years as it was even before COVID-19 hit us. So the good news for us is back in January, our senior leadership team had a retreat. And we were already talking about how we’re going to bridge that billion-dollar gap over the next five years, what efficiencies that we need to take on automation, digitization, you name it, and then what growth that we need to offset the continuing declinations and reimbursement, continuing difficulties in recruiting and retaining a skilled workforce, all the other inflationary factors that we’re up against your year with supply chain expense increases and pharmaceutical expense increases and, you know, the gamut. So we were already preparing for that. This certainly has exacerbated that billion-dollar gap. So for us, it just accelerates the timeframe for which we were already looking at closing a gap and makes those efforts made that would have been spread over five years forcing us to frontload it more than we otherwise would have. But the good news is we were already out in front, already taking a look at it. The other impact, I think that we’ll all see, sadly, is given the general impact on the economy and the unemployment now, of what 25 plus million Americans in the last month alone have filed for unemployment. So the increasing numbers of unemployment are clearly going to swing folks from the commercial or private payer ranks into Medicaid or self-pay. I think that the payer mix shift is going to hurt us, obviously, more than we probably recognize or appreciate at this time since people are still on a continuation of benefits or COBRA. So that’s another headwind we’ll face in 2021. I do think we’ll be back to cash flow positive in 2021. We’re going to be doing our best to get back to what is our normal performance, even in some difficult markets to get back to nine or 10% cash flow And two to 3% operating income margins, but it’s going to be an uphill challenge. Make no mistake about it.

Gary Bisbee  

Let’s turn to a happier note. We always like to learn more about the background of our leaders. Let’s talk about you for a moment instead of all these crazy finances. When did you first become interested in healthcare?

John Starcher  

Well, you’re going back decades now. I became interested in healthcare when I was a junior in high school. I had a high school history teacher that was talking to us about the baby boom population. And so I started doing back of the napkin math, and said, You know when I’m in my 40s, there’s gonna be a lot of folks that are going to need health care. So I think that’s the space I need to run to. So I actually enrolled in Bowling Green State University in my freshman year in a healthcare administration program in the business school, and I’ve never looked back.

Gary Bisbee  

What was your first job?

John Starcher  

My first job was a result of a fellowship from Bowling Green State University at the Medical College of Ohio, which is now the University of Toledo medical call center and human resources and I worked there for a couple years straight out of college before I got my law degree in the evenings. I had a mentor there at MCI that had come from the industrial sector at Owens, Illinois that told me that if I really wanted to differentiate myself, I needed to be a doctor or lawyer. Not an MHA or MBA. And so I took his advice and got a law degree in the evenings. And then my next stage of my career became in House Counsel, doing mostly labor and employment law, but then gravitating over time to physician practice and M&A before I ultimately got into operations.

Gary Bisbee  

Well, the law degree definitely differentiated. Very few of our CEOs have law degrees. Now you also spent time in the investment sector. What lessons did you learn that you carried back to the nonprofit health systems, John?

John Starcher  

A lot of lessons. Probably two and a half to three of the most valuable years in my career is when I was at health management associates, which at the time was the fourth-largest publicly traded healthcare system in the United States. I came in as a Group President running about a third of its portfolio, and after being there only a year was appointed as the CEO of the entire company. Which had 71 hospitals over 15 states. So that was the result of both a hostile takeover by our largest shareholder and a brokered sale by our board at the time. There’s all kinds of details and nuances I could talk to you about the shareholder world and its impact on publicly traded companies, particularly in the healthcare space. Beyond making me a new and resilient leader, I think probably the thing that you learn more than anything else in the publicly traded space, you have an accountability to the market and to shareholders on a 90-day basis. With your quarterly earnings calls, there’s nowhere to run, there’s nowhere to hide, and your performance has got to be up to snuff each quarter. And so it ensures that you execute well. Then you execute quickly and you can’t drag your feet on decisions that need to be made. I learned the whole new paradigm about execution and the importance of speed and execution in that environment.

Gary Bisbee  

Let’s follow up on the leadership theme. What characteristics do you think a top leader needs during a crisis,

John Starcher  

I would say a leader brings stability in the face of chaos. Back to the old deodorant commercial, I guess, “never let them see a sweat.” You’ve got to be poised, you’ve got to be competent. You’ve got to know that you’ve got the right talent in the right places, doing the right things. And you’ve got to let those people and those leaders run. A crisis is no time for bureaucracy and you can’t have everything have to go back up through a chain of command to be approved. You have to give your leaders the freedom to fail, and the confidence knowing that they have the ability and the authority to make decisions at the end of the day. I’m a big disciple of Covey’s, “The speed of trust.” I genuinely believe that organizations only move as quickly as the trust that they have. And that’s a culture you either have or you don’t. Not one that you can create in the midst of a pandemic. Thankfully, at Bon Secours Mercy Health, we’ve always had that culture. We’ve heightened sensitivities around that culture over the course of the past 18 months in our integration, but to move at the speed of trust, you got to have integrity, you got to stick to your principles and be honest, you’ve got to do what you say you’re going to do. We’ve established a good track record of doing that. I think your organization has to appreciate that your motives and your behavior are positive and your intent is positive. They got to know that you have the capabilities. And like I said before, we’ve got an extraordinary team that is unbelievably competent. And for the most part, I just get to let those horses run. And I think you also have to have an established track record of success. And certainly, our results speak for themselves over the past several years. We do have a track record of being an organization that’s capable of executing on details capable of executing quickly and at the end of the day, speed matters. The speed of trust facilitates that, and I think that’s the type of culture you need to have in place to be successful in a crisis like this.

Gary Bisbee  

John, this has been a terrific interview. I have one last question. We’ve talked about the “new normal” several times today, what do you think will be the aspects of the new normal?

John Starcher  

I think there are the obvious things and that is, the new normal will be much more virtual than it has been historically. There will certainly be a push to automation, as all of us look to become more efficient and to take labor-intensive work off the table as labor becomes more and more short in supply, digitization can be another key component of it. I think the other aspect of new normal is what you’ll find are integrated delivery systems like ours, not just taking the learnings of the past two months and then putting them on a shelf and waiting for the next pandemic or infectious disease to hit. I think the lessons that we’ve learned is that we need to be pandemic ready at all times. And our facilities and the layouts of our workspaces need to be conducive to clean and dirty spaces, if you will separate entrances, separate hallways, ingress-egress a lot of the things that we already do and some of the ambulatory sites under HOPD rules, but I think what you’re going to see is a constant state of readiness. So that there isn’t this rush on the 11th hour to retrofit spaces or facilities. And hopefully, we’ll never again, be a movement to shut down services across the board. Who knows how many patients in our communities will be impacted by decisions delayed or denied? While some of our electric procedures and labs and imaging have been down the past few months, and so I hope our lesson is to be pandemic ready at all times so that we can handle the normal volume and the normal visits in addition to any type of search that might come our way.

Gary Bisbee

One follow up. What about consolidation? Do you think this will drive more consolidation either in the hospital or the physician group sector?

John Starcher  

It should. And let’s hope that it does. Anybody that knows me knows I’ve been speaking for some time about how absurd that it is the lack of scale that we have in our health system in the United States if you look at the largest provider among us in terms of acute care facilities, they’ve got about a 3% overall market share. Any other industry would look at a 3% market share is laughable. And we’ve convinced ourselves over the years that we believe that 3% is a significant scale, which is just really nonsense when you have almost 5000 hospitals, and the largest system only has a couple hundred. I mean, you got 1800 Health Systems still today, Gary and you’ve got only 80 that have more than 10 hospitals. So I think at the end of the day, there will be a lot more consolidation. I think that this is going to help prove that this scale does make a difference, particularly as it relates to PPE and testing and preparation and a balance sheet that can withstand setbacks like this. I’m hopeful that we can remove some of the artificial antitrust regulations that exist, that we can create a sense of encouragement, if you will, for a more efficacious delivery system, which I think by its very nature will lead to more m&a. So both in the physician practice space and in the acute care provider space, I only see benefits from scale at this time,

Gary Bisbee  

John, excellent job today. We do appreciate your time.

John Starcher  

My pleasure. Thank you for having me.

Gary Bisbee  

This episode of Fireside Chat is produced by Strafire. Please subscribe to Fireside Chat on Apple Podcasts or wherever you’re listening right now. Be sure to rate and review fireside chat so we can continue to explore key issues with innovative and dynamic healthcare leaders. In addition to subscribing and rating, we have found that podcasts are known through word of mouth. We appreciate your spreading the word to friends or those who might be interested. Fireside Chat is brought to you from our nation’s capital in Washington DC, where we explore the intersection of healthcare politics, financing and delivery. For additional perspectives on health policy and leadership. Read my weekly blog Bisbee’s Brief. For questions and suggestions about Fireside Chat, contact me through our website, firesidechatpodcast.com, or gary@hmacademy.com. Thanks for listening.