Russ Cox 0:03
What we soon found out was that we were posting that on YouTube. Employees were watching it regularly. But what we also found out is it in a vacuum of information, they were forwarding the link to their family members and to other people. And it became a very good community communication as well. To the point we even had media watching it.
Gary Bisbee 0:22
That was Russell Cox, President and CEO of Norton Healthcare commenting on the benefit of his daily video for Norton caregivers, which quickly went viral in Louisville for their families, the Board of Directors, local media, and the Louisville community. I’m Gary Bisbee, and this is Fireside Chat. Russ is only the fifth CEO in Norton’s history. We’ll track Russ from his first job as a teacher and explore lessons learned that he uses to this day. All health systems have seen telehealth visits explode as has Norton. Russ provides a unique answer to the question of whether telehealth visits will recede along with COVID and which demographic will benefit from them and why? Let’s listen.
Russ Cox 1:05
You look at folks who have mobility issues, immunosuppressed people that have transportation issues. I think our patients have always had the muscle to do telehealth they’ve just never had to flex it. And COVID made them flex it and made them actually say I’ve got this I can do it.
Gary Bisbee 1:20
Our conversation includes reference to the community dismay at canceling the Louisville institution, the Kentucky Derby, the importance to maintain needed surgeries and treatments in the face of a crisis like COVID, how Norton invested in its employees so that they could focus on Norton’s patients, characteristics of a leader in a crisis, and the fundamental learning from COVID. I’m delighted to welcome Russ Cox to the microphone. Well, good afternoon, Russ and welcome.
Russ Cox 1:32
Thanks very glad to be here.
Gary Bisbee 1:55
We’re always pleased to have you at the microphone. Most of us are generally familiar With Norton Healthcare, but probably not in as much detail as we’d like to be so could you please describe Norton Healthcare for us?
Russ Cox 2:08
Yeah, sure, Gary. We’re in Louisville, Kentucky. We sit in a metropolitan area with a population of about 1.2 million people. We have five hospitals that are geographically located within 13 miles of each other, the furthest to reporter 30 miles. So we operate very much as a system where about two and a half billion dollar system that probably the most meaningful statistic for you to think about where Norton healthcare is in loyal is that we have about a 55% market share, which is really a good thing. It’s many things but it’s a responsibility when you really think about it.
Gary Bisbee 2:42
Right, but quite amazing. How would you characterize the culture of Norton Healthcare?
Russ Cox 2:49
The culture of Norton Healthcare really goes back a long way when you go back to the beginning of Norton Healthcare. We’ve only ever had five CEOs. I’m the fifth one. So there’s been very few CEOs, folks who stay around a long time, and we go back to Wade Mounts who was the first CEO who was the very first president of AHA and really did some great things in the Hall of Fame. And you come right on through to Jim Petersdorf who was very focused on measurable quality. Then come right on through that Steve Williams, the CEO prior to me, we were the very first organization to post every quality score on our website when we did that 12 years ago. So transparency is part of the culture, very community based, our Board of Trustees all sit right here and live in Louisville, Kentucky. So it’s a very community-centric, very transparent, very trusted asset in the community.
Gary Bisbee 3:40
Actually, I was at AHA when Wade was chairman officer so I go way back with Norton and your leaders.
Russ Cox 3:47
Sadly, we lost Wade this year.
Gary Bisbee 3:48
Russ Cox 3:49
We lost him the first week of March. He had a great life. He lived 93 years and he was healthcare through and through.
Gary Bisbee 3:56
We’ll get into the COVID outbreak in a little bit, but could you describe your main priorities before the COVID outbreak?
Russ Cox 4:03
We were in the beginning of a brand new approved strategic plan that really had great focus on extending access even further in our community and had a strong emphasis and platform on telehealth for convenience, for reach, for being able to extend our nearly 2000 on the medical staff 1500 employed position and provider platform that we really felt was a great opportunity. It turned out to be a great thing that we were because we certainly needed it sooner than we thought we would, but we were all about pushing access. We were all about looking for ways that we could personalize and make the convenience much better for the consumer. I think everybody had that focus going into it, but it just really was taking on a bigger role in how we advocate for patients and getting access to specialty services for patients who lived out further in Woodland in Kentucky. So again, it was fortuitous that we had such a focus on the virtual model. And we had already begun construction of that and already begun preparing for that way. So we were able to accelerate very quickly when this COVID-19 issue came about.
Gary Bisbee 5:14
Absolutely good timing. Let’s turn to you for a minute. Russ. It’s always fun to get the background of the CEO, the health system, so a lifelong resident of Louisville ever think about going elsewhere?
Russ Cox 5:25
Oh, sure. I had the opportunity to in my early days. I worked with what was Humana, the hospital company, and then it became an insurance company and then it became Galen. And then it became Columbia HCA and then it became HCA. I had the opportunity to relocate to Nashville, Tennessee with HCA and I actually did live there on a temporary basis for about a year and a half, two years. But I’ve always considered Nashville a very dynamic city from the standpoint of what the Frist family has done for entrepreneurship and healthcare and how so many interesting things have happened in healthcare in Nashville. So I’d say Nashville would be up on that list.
Gary Bisbee 6:02
Of course, we all think about Louisville we think about the Kentucky Derby. Seems like you and the Norton executives are all active in Kentucky Derby week. This year didn’t happen, probably what the first time in a long time that the Kentucky Derby wasn’t held?
Tim Pehrson 6:19
It absolutely was. And it’s just another one of those signs of how different things are because we can’t even imagine the first Saturday in May is just absolute tradition in our state and in the country. And for it not to happen this year was just devastating, both mentally and from a financial perspective to our community. So we’re certainly hopeful that it can be run in September, we’re not sure whether or not we’re going to be able to be there to watch it in person. But these are different times and we understand that we all have to adapt and adjust and we certainly are going to be supportive of fire brother and at Churchill Downs and hopefully we get through this and things get back to normal.
Gary Bisbee 7:00
Well, what do you like best about Louisville?
Russ Cox 7:02
You know, I’d have to say here that one of the things that have always attracted me to Louisville is the strong healthcare DNA and Humana. David Jones and Wendell Cherry started up a hospital company here from scratch that turned into what you still know is Humana but in a different configuration. It’s all about insurance and on the payer side and Medicare Advantage, we’ve had a lot of firsts that happened in this community in healthcare. If you go back to hand transplants and you know, a competitor hospital if you go to the first pediatric heart transplant that was done at Norton Children’s Hospital. And there’s been a whole lot of things that have happened in our community that have really made that DNA strong and such a vibrant part of the community. And I think that’s always been an attraction. I’ll tell you the other thing that you have to appreciate about Louisville is that it’s not a parochial community at all. We’ve had people we’ve had physicians relocate here, we’ve had all kinds of people relocate here. The one thing they say is you can be as involved in the city as you want to be. It’s a very welcoming, very open, very willing to let you be involved in anything you want. It doesn’t matter what your last name is here. It really just matters what your passion is. And it’s been a great thing for this community. I think it’s it’s helped us get through this particular time as well.
Gary Bisbee 8:14
Now, I know from past discussions that you were a teacher earlier in your career, was that your first job after college?
Russ Cox 8:22
Actually, it was, I was certain that I wanted to be an attorney. I had been accepted to three law schools. My father had paid a $500 deposit for me to attend one. I clerked the summer of my senior year in college and came home and said, “Oh my god, I can’t do this.” This is not like what lawyers look like on TV at all. And it was a good experience that I never will forget. My father told me that I said, I’ll pay you back to $500. And he said, don’t worry about that. $500 to find out what you don’t want to do is a good investment. I graduated from undergraduate and taught school for two years and taught Middle School of all things. So I often say that if you can be prepared five days a week for middle school students, you can do anything in healthcare, because it’s a different kind of challenge. But I did that while I went to graduate school and was able to then find myself working in the early 80s. For Humana in its early days as well, in the Human Resources function there. So I jumped into healthcare in 1982, after having been a teacher for two years and had a good background and obviously Training and Education and Human Resources area, and the rest was kind of history. It was such a growing company back then. And the opportunities for somebody to come in and really develop and really grow were great because it was growing so fast. They needed people and Mr. Jones and Mr. Cherry were not afraid to throw you in the deep end and help you learn how to swim. That’s exactly what they did with me and it’s been good for me, I still say that I call upon those teaching skills on a daily basis, Gary,
Gary Bisbee 9:55
Well, the other skill may be what you learned at Humana. Can you share with us? What lessons did you learn there that you’ve carried on to Norton?
Russ Cox 10:05
There’s so many things to transfer both ways, the investor/own side of it. And let’s just put this at the top of it. Both places put the patient at the very center of every decision that they make. And I never saw a decision made at Humana that was in any way detrimental to a patient. As a matter of fact, it was always about the patient. So there’s a lot of similarities that are there. I think the differences that you have to think because you have a responsibility to shareholders. We have a responsibility to bondholders, but we can be a little bit longer-term thinking the not for profit side. And I think that’s an advantage. You can be more strategic from the long perspective. I think that when you’re investor-owned, you have to think about what am I doing that will increase value over the next 90 days. Now, that’s not to say that everything’s that way. But you get a report card every 90 days, and that’s a pretty serious report card. So I learned to think in terms of how can we improve a situation and get it done quickly? How can we expedite? I think I also learned a whole lot about measurability because in the investor/owned side, it was very important that you be quantitative, that you get the right data to make decisions with. And I think that’s played over into the not for profit side, currently. But I think it took a little bit longer to get to that place. So there’s a lot of things that have transferability. But at the end of the day, we’re all very similar in how we approach patient care.
Gary Bisbee 11:30
Let’s turn to the COVID-19 crisis. What was the surge or the profile of the surge in Louisville?
Russ Cox 11:40
Well, it’s been an interesting time for us. Obviously, we anticipated a larger surge than what we actually experienced. And hopefully, if we’re going to want to say that we took enough very appropriate action quickly and made certain that certain things happen. We had a very, very strong, newly released Governor Andy Bashir, who really took a great leadership position in the state and made sure that while the decisions weren’t always popular to shut things down earlier to stop things from happening, that it was the right thing to do. So we were able to preempt a whole lot of what that surge could have been, we were all prepared for it. What we’ve really seen is more of a less than expected surge that we would hardly call a surge and it’s flattened into what we now are calling a steady plateau. We’re seeing about the same numbers come in and go out on a daily basis. So our new abnorma…l is I’m calling because I don’t think anything will be normal again… but our new abnormal is that we’re probably likely going to have in our system 40 to 50 COVID positive patients on the inpatient side, every day for a while. We were fortunate that we didn’t see a whole lot of event utilization. We were prepared for that. But we always had plenty events, most of our obviously more serious patients on the inpatient side, we’re in the ICU. So we monitor those days very carefully. But it’s been a pretty steady sort of run over the past two to three weeks. And hopefully as things begin to open up, we’ll be able to see that steadiness continues. We hope that it doesn’t create a spike. But we’re prepared for that. If it does, and hopefully by continuing to do the things that we’re doing, we’ll continue to see that gradual decline.
Gary Bisbee 13:20
Building on that we’ve seen that there’s a lack of information and probably disinformation going around how have you communicated with the community, Russ?
Russ Cox 13:31
Well, we’ve taken a multi-pronged approach to how we communicate. We knew in early March that this was going to be different and we were going to have to do some things very differently. So one of the things we did is I started recording a video once a day, about 10 to 12 minutes where I was 100% transparent with employees gave them exactly the numbers of people that were coming in. How many of them were positive, how many of them were impatient, where they were, how many employees we tested, how many employees were positive. We gave how many people were Were out on medical furlough, how many people have returned from furlough, then we would use what was left of the 10 to 12 minutes to talk about significant shifts in policy that we needed to make whether it be a restricting visitation, whether it be utilization of PPE. I took the last two or three minutes and we set up an email where people could send in questions and we just tried to run through questions that people had sent in as quickly as we could. What we soon found out was that we were posting that on YouTube. Employees were watching it regularly. But what we also found out is it in a vacuum of information, they were forwarding the link to their family members to other people, and it became a very good community communication as well. To the point we even had media watching it. And again, 10 to 12 minutes is about all you can do. The players don’t have time, but what we found was that people were watching it at home, letting their spouse watch it at home. And so it was a very effective sort of communication. We send it to all of our physicians, all 16,300 employees got link to that on a daily basis. This afternoon I’ll film number 72 in a row of doing that. And it’s been one of those good things that we’ve been able to do because people will watch that video, people tend to get an email and only glaze through it and not get some of the details. So we’ve really tried to extrapolate what is it that people really need to know to do their job the next day. So that’s been very effective. The other thing we’ve done is we’ve worked very effectively with local and state governments to make sure that they had our information that we were helping them in any way that they needed possible to get messages out. When you have 55% market share, you have an opportunity to leverage that. We’re an epic, EMR. We’ve got my chart, we were able to leverage my chart to really improve telehealth. We went from probably 250 telehealth visits in February to the month of April, we had 18,000 telehealth visits. So we were able to use that to communicate with patients as well. We did zoom media availabilities once a week where we would just again, be very transparent. Take any questions that the press had. I just felt like that our history of transparency and a responsibility that we have to make sure that we’re providing as much information as we can for the public really required us to take an hour out of a week or whatever, and just sit down with the media and say, here’s what we’re saying, here’s what we think, what can we answer for you? We leverage social media as much as it could be possibly leverage during this time, as I’m sure everyone did. But my goal for our organization was to be accused of over-communicating. I think that’s one of the things you learn for being a teacher sometimes is that sometimes you’ve got to be repetitive, repetitive, repetitive, as they say for students to learn and sometimes for the public to understand we have to just continue to they use that message I’d really like to have $1 for every time I said, make sure you wash your hands, make sure you social distance, make sure you cough it to your elbow. Make sure you don’t go to your eyes and nose with your fingers. I mean, I could give these speeches over and over again, but we just made it our goal to over-communicate. I also should add that we included our Board of Trustees in those videos. And that was probably one of the smarter things that we did because it sure made board meetings a lot easier. They would watch that video every day and be able to keep up with what we were doing and how we’re doing it. So we got a board meeting and we didn’t have to recreate everything that had happened over the past month. It’s an effective tool.
Gary Bisbee 17:26
Well, it’s 72 videos, you’re going to be quite a personality around Louisville. If you need an agent Russ just let me know I’m available.
Russ Cox 17:36
I didn’t say the news was always good. I was delivering. We did learn from that too, Gary. That if you are palms up with your employees and tell him exactly how it is and it’s pretty hard for me to stand in front of that camera last month and say, folks, the month of April, we’re going to lose $80 million. But it was very much a rallying cry for everybody to say hey, at least I know what it is. And at least I feel like we have a plan to figure this out. And we did our best to make sure that every day, and it got us through some PPE issues to hearing, because we had PPE problems just like everybody else did. I mean, I literally would go on the video every day and say, here’s how many of these we have, here’s what our burn rate is, we’re going to need to reuse these and we’re going to need to use ultraviolet rays to sanitize these masks, and you’re going to need to use them the next day and I bring in somebody from our infectious control to actually talk about this will work and you need to trust it. So it has so many uses that I would do it all over again, I think that was the one strategy that really did make a big difference for us.
Gary Bisbee 18:41
If we could dig into telemedicine, you made the point that your virtual strategy was a priority pre-COVID, and that played well into what came post-COVID. How do you see televisits growing from here?
Russ Cox 18:59
I think they’ll grow. There’s going to be circumstances where the face to face visit with a provider is always going to be the best possible way to do it. But there’s going to be a real need for telehealth and increase telehealth going forward because we have so many people who fit into this higher risk category. And until we have a reliable vaccination, we’re going to have people who shouldn’t be out and about. So leveraging this and the good news is one of those categories of at-risk are elderly people. The good news is that elderly people have been introduced to technology to communicate with their grandchildren and their children. So telehealth now feels very natural to a whole lot of people who in the past, wouldn’t it use telehealth? So, you look at folks who have mobility issues, immunosuppressed people that have transportation issues. I think our patients have always had the muscle to do telehealth, they’ve just never had to flex it. And COVID made them flex it and made them actually say, hey, I’ve got this I can do it. So we’re pretty excited. We last week announced a concept that I’m very excited about and really it just came from understanding more about telehealth. We’re building the first permanent drive through testing diagnostic site that I think we’ve ever seen. We certainly have none of them in this region. And I don’t know if there’s any in the country, but we saw how telehealth works so well. And we realized, hey, if we could almost if you could think of a Jiffy Lube concept, but for healthcare, we’re gonna have three bays where people could pull up, they can have lab work done. They can have diagnostics done. They can have tests, they can have vaccinations, and we learned a lot that if you can do it in your car, you can have a telehealth visit, get the orders, go get your lab work and your car and not have to leave your car and not have to come into medical office buildings or labs and interact with people. And we can put two people in Pampers for the whole day and save PPE. So we’re moving up telehealth to the next iteration of testing diagnostics for an express drive-thru and walk-up perspective that we think will help drive even more telehealth. So I think we have to look at how do we get ahead of the curve on this because the circumstances that we’re in may change, but the memory of the patient is not going to change for a long time. And if we have spikes, we’re going to need this capacity. If we have another virus of some kind, which is altogether possible, we’re going to need this skill set. We’re going to need these kinds of opportunities with telehealth and travel through testing to make people feel very comfortable with continuing to use. So yeah, I’m very bullish on telehealth and drive-thru and walk-up permanent testing sites. Be interesting to see how it works.
Gary Bisbee 21:35
Yeah, for sure. Well, that’s a terrific initiative and on Norton’s part, one quick question there. Do you think insurance companies will continue to reimburse for televisits the way they have during the crisis?
Russ Cox 21:48
We certainly advocated for this during the time we’ve worked with all of our political leaders that we know we’ve worked with our payers. It will be a shame if they don’t because we’re able to make a difference in so many people’s lives that otherwise won’t come in. And I’ve tried to convince some payers along the way that we will probably lost some people that will never get to come to again. And that’s going to be to their benefit. So hopefully, they’ll see the wisdom in continuing to invest in good reimbursement levels for telehealth, but I’m going to be honest with even if they don’t, the consumer is not going to let us discontinue this service. I really think that it’s a whole different world that we’re living in as it relates to patient and patient advocacy around how they want to receive health care.
Gary Bisbee 22:33
Let’s turn to a story that’s not quite as attractive and that is surgeries, particularly elective surgeries, you make the point that we might be a captive of our own terminology. Why don’t you dig into that a bit? If you could, Russ?
Russ Cox 22:46
We’ve always known the importance of surgical procedures, diagnostic procedures, and the like on hospitals. I don’t think in my careers, and I’ve been in it since ’82, that it’s ever been hammered home more than it was when we were forced to discontinue those kinds of services because it’s a severing of the cord, if you will, with the patient in many ways to not be able to do those things. Not to mention what it does to your revenue stream. But I really do feel like we’re a victim of our own nomenclature at times because the word elective, so often go to the mind of a consumer or the mind of the general public that all we did was cosmetic procedures. And that’s so wrong. All we did really was delay procedures that needed to be done. And they got categorized as elective and pretty soon everyone’s arguing over what elective is, and I think that was a learning for us all in this that we need to really examine how we define surgeries that need to be done. And all we did was delay which many times put the patient in a compromised position. What is elective about a person needing spine surgery with horrific back pain? What’s the elective about a knee replacement? If the person has a blood infection in that joint, there is nothing elective about that. But we found ourselves arguing about what’s elective and what is just really has to be done. It certainly was an eye-opener for us. As I mentioned earlier, we lost $80 million in the month of April. And a whole lot of that goes to the fact that we couldn’t do surgeries, we couldn’t do procedures. We never laid anybody off. We never reduced anybody’s pay, we made the conscious decision that we were going to invest in our employees and that we were going to ask them to focus on patients and focus on staying ready when the patients came back, and we were going to fight through it together. So it all added up to not a good financial result. But the culture of our organization is better for the fact that we stood by our employees and I think physicians have noticed that I think that as they make decisions as to where they want to practice in the future, they’re going to remember to take care of their employees. So we’re glad to see that we’re able to return to 100% of elective surgery starting tomorrow. We were at 50% for the past two weeks. We saw a very strong willingness for patients and physicians to come back. We were worried. I think one of the lessons I learned here is that you can’t just tell patients, trust us, it’s safe. They expect us to say that. They think oh, of course, you’re gonna say it safe. But what we have to do is tell them how it’s different. And so our communication strategy has been to communicate with patients how it’s different. You’re going to get your temperature taken before you come in the door, you’re going to be asked to put a mask on, you’re going to be asked to only have one visitor with you, when you’re here. We clean all of our areas with UV ray machines, we’re not going to have waiting areas with chairs that are not six feet apart. So we’ve worked very hard on building trust back by not just saying trust us, but by saying here’s what’s different. We’re encouraged our fear at times that what I’m seeing right now and feeling good about is just a backlog of necessary surgery that is enthusiastic, we come back so I think we’ll know a whole lot more over the next four to six weeks is to the general public’s willingness to read Return to those procedures. We’ve done a lot of research, I think that everybody knows that they’re more comfortable returning to ASC than they are to hospitals that have procedures. So we’ve done everything we can to communicate what we’re doing and how we’re doing it and to get people to places where they’re going to be comfortable with a procedure with the surgery being done.
Gary Bisbee 26:19
Following up on the economic story, how do you see 2020 ending up? And how do you see ’21 ending up given there’s so many variables here that it’s just impossible to figure out?
Russ Cox 26:32
It really is. I have to say that I’m very pessimistic for the rest of 2020. Simply because I think that it could have everything from spikes to another surge to still some reticence on the part of patients to come back as quickly as we would hope. I think it’s going to be a difficult slog for us. Well, let me say that the Cares Act has made a difference for us. For us getting $43 million is significant. It doesn’t make up for the revenue we lost. But it helps. And it’s certainly something that we didn’t count on or expect. So I think that’s been a good thing for hospitals and healthcare organizations to at least have that assist going forward. We don’t know how much more that’s coming if he’s coming. But that would always certainly be welcomed and help. I like to think that payers are going to understand that they’ve done very well during this time. And that hopefully, they’ll see their way fit to help us through this time as we go forward. So might be crazily optimistic on that. But I think these are different times. I think that it’s in everyone’s best interest to be some shared help along the way. So I’m more optimistic that if we’re able to do the things that we’re doing and sustain the behaviors and activities that we’re in right now that 2021 can be a year that we maybe not return to the levels where we have been in the past, but that we begin to calibrate more towards what we’re used to.
Gary Bisbee 27:54
We’ve touched on this several times before today, but let me ask that question directly if I can, what are the characteristics of a leader in a crisis? What should they be?
Russ Cox 28:06
I’m going to go back to what I said earlier, I think it’s number one, two, and three, a good communicator, and a communicator that’s willing to share everything that they know. And everything that I say, I think is important for people to know. And be willing to do it in a way that is very palms up, very transparent. And that creates a sense of stability and calm. I think the mistake that a lot of leaders make during this time is to get so buried in the details of execution on operations around things that they forget that just communicating that we’re going to be fine. We are going to get through this and that we do have a plan and that we’re going to tell you about that every day and be willing to say to people, it’s going to change because the situation is gonna change and just watch us every day. Listen every day and if you have concerns, we set up a hotline one 800 number for if you have concerns about PPE call this and it will get it resolved to date. If you’re not feeling good call employee helpline. It’s one central line here. But I think communication I just go back to, it sounds so easy to say all communication is so important. What I found during this time is you cannot communicate too much. And you need to be out there regularly. They need to be able to see your face and not just read an email, they need to be able to see the emotion that you feel. They need to understand that you’re very much into this and that you’re very much about making certain that they’re safe, that they have the tools they need to do their job, and that they can take care of patients. I’ve become a big believer in that anything in everything that you can do. To communicate is very important and I haven’t it hasn’t been lost on me that you’re not just communicating with your employees. you’re communicating with their families in the morning information they’re able to share with their families, the more secure their families feel about that person coming to work and putting themselves in harm’s way every day.
Gary Bisbee 30:09
Well said, Russ, this has been a terrific interview, we appreciate your time, I’d like to ask one final question. That is this idea of new normal, you make the point that we’re not going to see normal again. But what comes to your mind in changes in the delivery system as a result of COVID that you would like to see?
Russ Cox 30:29
Flexibility. I think there’s going to be a list of terms that we hate going forward and I’m going to put in an abundance of caution on that list. I hate that term. I feel like I’ve used it so many times and it’s become so trite but new normal is another one that I hate, but I think the new normal if you will, is flexibility. We’ve got to meet patients where they are. Some are going to want those telehealth opportunities, some are going to want to come to the office. Some are going to want to delay care. How do we stay in touch with them? Some are going to want to do it virtually, we established a virtual hospital during this time, it’s been a great success. We were able to discharge people into this virtual hospital where they had a virtual visit every day from their provider, and we were able to monitor their vitals remotely. So we’re just going to have to meet people where they are and have a flexible approach to saying, How do you best interact with us, and what makes you most comfortable, what makes you feel the best about it? What makes you feel the safest? So my new normal and the thing that I preach here every day is meeting that patient where they are and having a flexible enough model that we can accommodate whatever it is that they choose, and however it is they choose to interface with us,
Gary Bisbee 31:41
Russ, thanks so much for your time today. Norton is lucky to have you and we’ve enjoyed very much having you on the show.
Russ Cox 31:48
Appreciate being here. Appreciate the great work of the Academy and look forward to us all being able to get back together again someday.
Gary Bisbee 31:55
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