David S. Chernow 0:03
We made a decision to take on all COVID patients immediately. And we worked with our partners and dedicated units and one of our four key results, my five plus six equals for is bad math. Our four key results are to keep our patients and each other safe, to create an exceptional patient experience, to create an exceptional employee experience, and then and only then to meet our annual business plan.
Gary Bisbee 0:30
That was David Chernow, President and CEO, Select Medical, discussing how Select’s decision to accept all COVID patients was pre-determined by their corporate strategy. I’m Gary Bisbee, and this is Fireside Chat. As David described Select Medical, he provided an excellent outline of the post-acute care business, as well as the rationale for expanding into homecare, Select medical operates nationally, and David provides color on growing a large and diverse business. He spoke about where scale matters in the post-acute care business, what are the keys to successful partnerships and where solid operations make a difference. Let’s listen to David respond to a question about characteristics of a leader during a crisis.
David S. Chernow 1:13
Everybody’s relying on you. They’re looking to see how you respond and how you respond will help others respond accordingly. I’m a big believer in servant leadership. I believe that making other people successful, having them be successful will drive the success of your organization.
Gary Bisbee 1:30
David has a fascinating personal background. Spoiler alert, he was a ball boy at UCLA and one of the great John Wooden’s basketball teams. Don’t miss David sharing his favorite John Wooden story. delighted to welcome David Chernow to the microphone. Well, good morning, David. And welcome.
David S. Chernow 1:51
Thank you, Gary. And I’m very pleased to be here and I appreciate the time.
Gary Bisbee 1:55
We’re pleased to have you at the microphone for sure. Let’s kick right off here. Some of us are more familiar with Select Medical than others? Could you please describe Select Medical for us, David?
David S. Chernow 2:05
Sure. Select medical is a post-acute care provider to companies. Now it’s grown quite a bit over the last 10 years in particular, although we’re 22 years since our founding by Bob and Rocky Ortenzio. When I say post-acute, we provide four levels of services in the post-acute arena. One, we’re a provider of what we call critical illness recovery hospitals or long term. Most people know them as long term acute care hospitals. We actually have 101 of those hospitals around the country in 28 states. We’re also a large provider, I think we’re the second largest provider of inpatient rehab hospitals, where currently we have 29 of those specialty hospitals operating in 12 states and we have 17 partnerships, which I think we’ll talk about later on in our podcast here. We’re also a provider of outpatient services, physical therapy, occupational therapy and speech, and we have 1750 locations around the United States in 37 states in the District of Columbia. And then we’re also providers of occupational medicine, with Concentra and more recently, the acquisition of US Health Works. We have approximately 525 centers in 41 states so that rounds out sort of our post-acute services I will say also, some people ask us if we’re in the skilled nursing facility business, we are not, but we are in just venturing into the home health business in a partnership with a entity called A.S.H.N. which is alternate solution Health Network, a terrific provider of home health, who shares our mission, vision and values.
Gary Bisbee 4:02
So quite an extensive operation. Why did Select Medical choose to focus on post-acute care, David?
David S. Chernow 4:09
It’s interesting, Rocky or Rocco Ortenzio, who’s really one of the great pioneers of inpatient rehab has had four companies over the span of close to 50 years and his son, Bob, or Ortenzio, who’s been in the business close to 40 years with him. They were really rehab guys. Started out in the rehab business and through merger, consolidation and the like, over 20 years ago, decided to start Select Medical, that’s really their background, but the quiet corner of healthcare was nobody really knew about long term acute care, although it was similar, not exactly the same as inpatient rehab, and ironically, I think there was probably a non-compete way back when and they ended up going into long term acute care, but their real background/passion was inpatient rehab. So I think once the non-compete went away, they started getting into the other areas of post-acute including inpatient rehab and outpatient. Ironically, Rocco is a PT by background. So it’s really his first love, and we started venturing into the – not only LTAC, but inpatient rehab, but getting into outpatient and I believe it was in 2003. We got into the outpatient business with the acquisition of Nova Care, which you may know about in the Philadelphia market and then really have expanded the services there. So post-acute has always been our laser like focus. And as you know, Gary, it hasn’t been the focus until more recently, of a lot of health systems
Gary Bisbee 5:49
For sure. Actually, quick story on Rocky, when I was at Kidder, Peabody investment banker at Kidder. Rocky came in and we were talking about possibly doing a deal with what I think was probably his first company at that point. And we covered the post-acute business on the research side and Rocky spoke at several of our meetings, so small world. But back to your point about post-acute care. What’s your thought about that? It has never been the darling of healthcare. In fact, you could argue that it really has been under resourced. What do you think about that? And why is that? And how’s that changing, David?
David S. Chernow 6:29
Yeah, it’s a great question. And I would tell you, I’ve been here 10 years now, and things have changed over the last 10 years, even though the company’s 22 years old. I think, with the evolution of healthcare, where, as you know, a lot of the health systems are trying to get away from hospitalization, which is the highest cost service in the healthcare continuum, of course, post-acute getting patients out of the hospital sooner. Hopefully getting them home and healthy, but having specialized services has really become the priority. And so most health systems who are trying to deliver high quality cost effective care, there really hasn’t been that focus once they get discharged, how do we treat those patients in a cost effective and a high quality way? So I think now, with the whole look towards value based purchasing, and the like, the opportunity to really explore how we can provide all those services. You know, I’m an old healthcare guy, where it always used to be the focus was oncology, orthopedics and cardiology in the service world. Now, as you know, what’s happened is, I think post-acute has become a very high priority for most of the systems, especially as they’re trying to figure out how to manage the patient population in our population health strategies that most health systems have today.
Gary Bisbee 7:59
I’ll be interested to follow your home healthcare initiative because it strikes me that it’s a terrific addition just when you think about the continuum of care.
David S. Chernow 8:09
While we’re on the topic, let me just share with you you know, since I’ve been here, and I’ve learned a lot since I’ve been here, I was a board member for seven years prior to joining in leadership back in 2010. But ever since I came here, I know Bob and Rocky, were always talking about our goal would be to get people home and healthy. And it was a missing piece, and of course like every health system, there’s always the challenge of how do you develop that service line. We stick to our knitting, we know what we’re good at, and we know what we’re not necessarily good at, and we’ve been laser like focused with long term acute care critical illness that we call inpatient, rehab and outpatient, but all of our partners have been asking us: “if you’re a post-acute preferred partner, why aren’t you in home health?”. And so for several years we’ve been looking at: Okay, do you build it? Do you buy it? Or do you partner? And we made a strategic decision with the input of many people who, you know, on our board, they gave us the advice and counsel that we need to figure out a way to get in that business. And so we literally went down the road of evaluating, do we build it? No, really hard to develop. Do we buy it? As you know, there’s a lot of good players out there, but it’s difficult to buy in the prices that were out there, it was potentially risky to purchase. And then we decided, let’s find somebody who has the same culture, the same values and the same business model. And that’s what we did. And so we were fortunate enough to partner with A.S.H.N., Alternate Solution Health Network out of Dayton. And literally, they have the same operating, centralized operating model, high quality provider, already existing partnerships. And so we’re trying to leverage that relationship and bring that to the benefit of our partners in local markets.
Gary Bisbee 10:05
That sounds terrific. Another question, David. So how to Select medical work with physicians?
David S. Chernow 10:11
So unlike other organizations, we do employ in some markets, but it’s a small amount. But what we do do is we have about 130 specialty hospitals. 130 of them. In each one of those hospitals. We have medical directorships. We have affiliations with directors of quality, directors of wound care. We have medical directors, typically in pulmonary critical care, a lot of specialties PM&R physicians – physical medicine and rehabilitation. So we have relationships where we engage the physician community to provide high level services, and we work very collaboratively with them and develop standards of care and make sure that we’re operating at the highest quality. So, physicians are critical to our delivery of our services in the post-acute. It’s just that it’s more of a, if you will, arm’s length and it’s not an employed, perfectly employed model like some healthcare systems.
Gary Bisbee 11:15
You made reference to Select Medical growing through the years, particularly the last 10 years. Where does scale matter in the post-acute business, David?
David S. Chernow 11:24
I would tell you, just to give you sort of a sense of things when I came aboard, we were about at 20,000 employees, and about $2 billion dollars in revenue. Currently, today we’re over 55,000 employees, and approximately five to five and a half billion of revenue. I will tell you and it sort of goes maybe to some future questions that you may have. Bob and Rocky have developed over the years a great centralized business model that allows us to scale, quickly. And as you know, one’s ability to scale, a business is based on leadership, and having a strong bench and having a really great strong mission and vision and values and a great culture. And so, scale does matter to us because our ability to leverage our infrastructure, from an IT perspective, from a billing and collecting perspective, from a procurement perspective, all the things that drive efficiency and healthcare, we’ve been able, fortunately to do a really good job. We are operators by heart. That’s really who we are. And I remember early in my career, Pricewaterhouse was always doing things on how you integrate in scale. There was “Five Frogs on a Log”. I don’t know if you remember the book, but execution is the key to success in business, in general and in healthcare, in particular. And I think we’ve been honestly pretty darn good. Even when I was a board member, they were always doing great jobs of integrating new businesses, new services, and new partnerships. And so, scale does matter. Not that bigger is better. But I’m proud to say that we’ve delivered a high quality service line in all of our four business lines or service lines. And we’ve been able to do it efficiently because of our centralized business model.
Gary Bisbee 13:27
The scale question might lead us into the next section, which would be the COVID crisis. And of course, that’s hit all providers. What did the COVID crisis present for Select Medical either in terms of challenges or opportunities, David?
David S. Chernow 13:41
With COVID, I will tell you, I joke about this, Gary, and it’s not really proper math, and some people say it’s probably stupid math, but I talked about how five plus six equals four. And people will say, what does that mean? And I said, Well, I know it’s not very good math, but what it does mean is that our five core values, plus our six cultural behaviors equal our four key results and why I bring that up in COVID is our five core values are delivering superior quality and all that we do, treating others as they would want to be treated, and being results oriented and being team players, but most importantly, especially in this environment of the pandemic COVID-19 is we’re resourceful in overcoming obstacles. And we’ve been challenged like we’ve never been challenged in the history of the company. And it has provided us with not only enormous challenges, but enormous opportunities. The major challenge for Select was, how do we take on that patient population, the COVID-19 patients and every health system had a decision to make, do we take them on? Where do we put them? How do we tackle the problem? We have a terrific chief medical officer and chief quality officer Dr. Hammerman, who happens to be a critical care and pulmonologist who helped us define the standards by which – obviously following CDC and other things, but we made a decision to take on all COVID patients immediately. And we worked with our partners and dedicated units. And one of our four key results, my five plus six equals four is bad math. Our four key results are to keep our patients in each other safe, to create an exceptional patient experience, to create an exceptional employee experience, and then and only then to meet our annual business plan. Well, that first key result, which is to keep our patients and each other safe, has been the complete focus of our company for the last four months during COVID. And I’m happy to say that with that challenge was an enormous opportunity. I think I mentioned we’re in 28 states with our critical illness recovery hospitals. We’ve been asked by partners and non-partners to stand up units in local markets to be able to address the problem. I interviewed Bob Ortenzio on our own podcast, our executive chairman, and he reiterated which I will reiterate to you. We’ve never been more proud as a company in our ability to treat patients and deliver on our mission and our vision relating to this COVID pandemic. So it’s been a great challenge, but I will tell you, some of the other things that have happened in major cities in this country, not only have health systems come to us, but state health departments have come to us and said, “Can you help us?”, because I think I mentioned this to you before, we’re one of the largest providers of ventilator care in this country. And so while people didn’t really understand what ventilators meant, or what intubation meant, I think everybody now understands what that means. And so we’ve been very fortunate to be able to step up, and be a solution provider to be a problem solver in many of the markets around this country, providing the level of care that gets us up each and every day and makes us excited to be part of the solution in this country of providing good care to the patients who need us the most.
Gary Bisbee 17:17
David, how did the PPE supply chain hold up?
David S. Chernow 17:20
Again, we were pretty fortunate. I mentioned to you our business model of centralized procurement, because we have over 100 long term acute care or critical illness recovery hospitals. We had a pretty strong supply of ventilators in the normal course of our business. And when we started hearing about some of the things going on, we were relatively proactive in making sure that we had not only surgical gowns and masks, but maintained our high level of ventilators. So we’ve never been, if you will, caught with a delay, and of course, keeping our patients and each other safe is critical. So Having the PPE was critical to our success of being able to not only address the issue and to treat the COVID positive patients, but also to keep our employees happy or safe in this environment.
Gary Bisbee 18:15
What was the policy for relatives and visitors?
David S. Chernow 18:18
It’s a great question, Gary. We had a no visitation policy. We followed CDC guidelines, we were pretty conservative on our approach. I will tell you we also, just like any good partner, in any good partnership, we’re also in a lot of host hospitals. Of those hundred and one hospitals, over 80% of those hospitals are “HIHs” or hospitals within a hospital. And we got partners in many of our hospitals who we were following their guidelines, which may have been a little inconsistent with our standard policy. So if you can imagine if a post hospital has no visitation or has visitation and we have no visitation, there’d be a bit of a conflict. So we just worked through in every one of our relationships. We took a policy of no visitation and where there was, quote, unquote, a difference of approach. We work with our host hospital or our partners and make sure that we are consistent with what was going on in the local market. By and large, though, there was mostly no visitation initially.
Gary Bisbee 19:26
Well, that’s a good lead into partnerships, which are hard work in the best of circumstances and Select medical has been quite successful at them, what are the key principles that make a partnership work for both sides, David?
David S. Chernow 19:41
I don’t mean to make light of this, and Gary, I think you know this. I’ve been blessed and personally, I’ve been very fortunate that Bob and Rocky are vice chairman and executive chairman and co-founders and have allowed me the opportunity to be front and center of most of these partnerships in the negotiation. And I’ve been able to work with my contemporaries, fellow CEOs and health systems to help drive the post-acute strategies of these partnerships. And what I would tell you is I tell every one of them that the best advice I ever got was from my mother-in-law, who before I got married, she said, the key to a great marriage is three C’s. And I said, What are you talking about? And this is before we got married, she said, Well, if you practice the three C’s, you will have a great marriage. And I sort of look at marriage like partnerships, by the way the three C’s are, and we’ve extended it to the four C’s, but the three C’s were compassion, communication, and compromise. And we added a fourth which was collaboration, but I will tell you in each and every one of our partnerships, there’s trust, there’s confidence and there’s the four C’s. There’s A great deal of communication. There’s a great deal of compassion and understanding of what the needs are of our partner. There’s an enormous amount of compromise in my definition. I don’t know about yours, Gary, my definition of compromises that nobody’s happy. But the truth of the matter is with those four C’s, and of course, there’s collaboration, you’re never going to face a problem you can’t handle. And I will tell you that some people have asked the question, have you ever walked away from a partnership? We do believe in the sanctity of partnerships. And I will tell you that it has to have a basic fundamental concept to make the partnership work, and that is that we have common values and a common culture. And by the way, this is not a criticism in any stretch of the imagination, but we as an organization, really look at that first and foremost and say: Do they believe in the things we believe in. I told you about the five plus six equals four – are their values – do they believe in delivering superior quality in everything they do? Do they want to treat others as others would like to be treated? Are they results oriented? Do they believe in results? Do they believe in team play? Do they want to overcome obstacles? And the answer, invariably, with all these great institutions, most of them, are is they’re exactly like us. And I think that’s what’s made us successful. We’ve never had a problem. We always can work through the issues. And I will tell you that the reason the partnerships work is I think we’re solving a problem or have laser-like focus in a particular area that our partner maybe did not. And that’s what makes for really good partnerships is that we’re able to have shared culture and values and we’re able to deliver a service that maybe is not their priority, but now is.
Gary Bisbee 22:56
So I was going to ask what are the reasons a large health system pursues a partnership and you pretty much answered that. Let me ask a different way, which is how do you connect with these large systems? Do they reach out to you? Or do you reach out to them?
David S. Chernow 23:09
I will tell you that, like everything in life, it’s just relationships and people we know. But I will say that more recently, with the change in sort of strategy and population health, value based purchasing, getting people out of hospitals, I think the changing healthcare environment has really pushed many health system leaders to look at post-acute in a different way. And I think most of them have had the challenge of saying, I want to get people home and healthy, and I can’t send them home. And I’m not delivering and not focused on these post-acute services. How do I get into that? How do I deliver that service which is so well needed in my community? And they either have to make the decision or I’ll build it on my own. Maybe I’ll buy it in service. And ironically, Gary, most of our partnerships are with not-for-profits. So a lot of them may need capital. A lot of partners come to us and they say, I currently have a small unit or rehab unit or an LTAC unit. But I need my beds for inpatient medical surgical, can you help me deliver that service outside my hospital, so I can free up those beds. And by the way, I need capital. And I need a real high quality provider to provide the service and do it in a way that we’re accustomed with high quality and cost effective care. So they’re looking for someone who shares the mission, vision and values but can also provide that level of service with a laser-like focus that they’ll be proud of, and that’s sort of what we’ve been fortunate to do. I will say that I’m pretty involved like you in VHA and we’re with Cleveland Clinic and UCLA and Cedars, and I think sometimes word of mouth helps, right if we’ve done a good job with Emory. And they’ll say, they’ve delivered the service and they’ve done what they said they’re going to do. So that always helps. But we also identify which markets may have a need for post-acute services that’s underserved. And we may go out and approach a health system that says they’re not delivering the service that needs to be done in that market, and we’d love to figure out a way to partner. We’re not a greenfield go in, establish a foothold and do something independent. We do love partnering. It’s really who we are.
Gary Bisbee 25:38
Let’s turn to your personal background, which is quite interesting. And it’s always fun to learn about a CEOs background. You graduated from UCLA, graduate degree from Pepperdine. Did you grow up in California?
David S. Chernow 25:50
I joke about it. My father went to UCLA. I’m a twin. So my twin brother and I both attended UCLA. Little known fact about me: I did grow up in California, I’ve always been a UCLA Bruin supporter. My only claim to fame, Gary, is that I’m actually looking at the picture. I was a ball boy, John Wooden. You’re talking about leadership, so he inspired me when I was 13-years-old — There’s a famous picture. I joke with everybody. It’s a famous picture of Bill Walton, who’s above the square fly swatting a ball out to his point guard, to lead a fast break, and everybody looks at the picture and says, oh, wow, that’s great. Who’s that? Says Bill Walton. I tell them they’re not looking at the right person, because underneath his foot is a kid who’s ready to dry up the sweat off the floor. I grew up there. I went to law school. My dad was a lawyer, worker’s comp lawyer, my twin brother’s a lawyer, but he sort of followed the family footsteps and not to get too personal but at a very young age right after graduate law school, I ended up getting cancer. And that’s what actually pushed me into the healthcare world and I got treated, ironically, as I told the CEOs of both UCLA and Cedar Sinai. I’ve been in all their hospitals and been treated. And it was destiny that we were going to do something together. But thankfully, I had great care. And it got me into the oncology world where I started my career in helping put together what later became US Oncology, but I loved UCLA. I grew up in California and my own health issues when I was 23. And going through some struggles, is what prompted me to get into healthcare.
Gary Bisbee 27:41
Well, I’ve got to ask this story, David. So what’s your favorite John Wooden story?
David S. Chernow 27:46
My favorite John Wooden story is – and by the way, I think I have every one of his books and I believe in his pyramid of success and leadership. Interestingly enough Bill Walton, many of your listeners may know who was a pretty Radical young man – superior athlete. One day he went up to John Wooden. And he said, sir, I believe in freedom of speech, I believe in freedom of expression. I know you have a policy of no facial hair, and I believe that I should have the ability to express myself and be able to grow a beard and do what I need to do. And John Wooden looked at him and he said, I agree with you, you should have the right to express yourself and you should have the right to look the way you want to look. And Bill it was a pleasure having you on our team. Obviously he shaved his beard and was national Player of the Year but Wooden is an idol of mine and a mentor. I have two great mentors. Rocky Ortenzio is a great mentor of mine and John Wooden is more of a leadership mentor to me.
Gary Bisbee 28:50
That’s an absolutely terrific story and both those gentlemen are top notch for sure. Looking at your professional background, you could be viewed as an entrepreneur. Or an operator? How do you view yourself David?
David S. Chernow 29:03
Interestingly enough, Gary, in my background – I always thought – I was a tennis player. By the way, when I went to UCLA, I played tennis there for my first year, and then had Tommy John surgery ironically. So my career ended quickly. And I always thought I’d want to be a sports agent. I grew up, dreaming of that. And ironically, I ended up being in the healthcare world, professional services working with physicians through most of my career. And so I found it to be an interesting similarity of representing and working with highly professional, highly talented individuals, which sort of marked my career but I’ve been fortunate that I’ve had some entrepreneurial ventures and ironically I talked to you about Rocky and Bob Ortenzio. They actually gave me my first start, I came up with an idea way back when in the late 80s that I thought we could develop a physician practice model in oncology and build cancer centers. And they gave me the original money with Russ Carson to start what later became US Oncology. Honestly, this isn’t false modesty, I didn’t really know what I was doing. But sort of learned along the way, but had great mentors and people like Ross Carson, and Rocco, and Bob, who believed enough in me to do something. So I would have to say I’m a bit entrepreneurial. Although I’ve learned to become an operator, I’m more of a development entrepreneurial type of guy. I will tell you that all kidding aside, you know, the joke is that David can’t keep a job because he’s had about four different careers. But this may get into our leadership discussion, but I had one of the great jobs ever in the world, if you will, when I was recruited to run Junior Achievement in the United States as the CEO and then I became the head of JA worldwide, but I did that for about six years, which was to educate and inspire young people to be successful in life through free enterprise education, involving entrepreneurship, financial literacy and workforce readiness. So I’ve seen the great side of people, and had one of the great jobs in America and worldwide, which was educating and inspiring young people around our great democratic and American free enterprise system.
Gary Bisbee 31:26
You’ve had an interesting background. This has been a terrific interview, let’s move to leadership to wrap up. What do you think the characteristics of a leader during a major crisis are?
David S. Chernow 31:36
I think the ability to maintain a coolness calmness, a rational approach to things to not get too high, not get too low is critical, I have to say is I had this fantastic father, who was just a brilliant guy and just seemed to have that calmness that steadiness that is required in adverse situations. One of our core values is being resourceful and overcoming obstacles. And I will say two more personalize this. When you’ve had some really difficult things happen in your life, and one of mine was losing my father at a young age and also having cancer at a young age. I think you build up this sort of strength and this resolve to be able to deal with problems and adversity. And so I know that Bob Ortenzio and Rocco have these great qualities and I try to be the same, which is, keep a level head, be calm, and make sure that you’re addressing the problem. You’re not getting too worked up over things because everybody’s relying on you. They’re looking to see how you respond and how you respond will help others respond accordingly. I’m a big believer in servant leadership. I believe that making other people successful, having them be successful will drive the success of your organization. While I have a great title and a great responsibility. It’s really not about me. And one of the great things I love about Select and most of our partners know this, is that there’s a humility and humbleness that emanates from Rocky and Bob and throughout the organization. And I’m proud to be part of that in part of a humble servant type organization that our whole goal is to make others successful.
Gary Bisbee 33:26
Great point of view, and you do it very nicely. I’d like to wrap up with a final question if I could. You made the point that you’ve learned to be an operator, what lessons did you learn that make you a good operator, David?
David S. Chernow 33:41
It’s interesting for me, because I’m more of a development, maybe try and be strategic, try and be a bigger thinker. On the one hand, on the other hand, Select has always been an operating company who’s delivered results. And the thing that I’ve learned is that not one week, not one month, not one quarter necessarily dictates how good an operation can be, you got to have the long term view. And the key to being good operators is to treat people well. And to make sure that you educate, inspire and motivate your workforce to deliver the four key results, which again, are keeping our patients and each other safe, delivering exceptional patient experience, delivering employee experience, because if you don’t have happy employees, you’re never going to deliver a great patient experience. And then and only then, and remember, there’s four key results, but then and only then can you deliver on your business plan. And I will tell you that delivering on the business plan, you have to have those other three elements – those other three key action items, and what we’ve learned being operators is that we have to be sensitive to other people and every market is different, and you can’t just make a blanket statement as to why things are happening. You have to really dig deep into the reasons why things aren’t happening and be willing to make corrections and be a good listener to your employees. That’s what I learned is being an operator.
Gary Bisbee 35:19
David, thank you so much for the time today. Just a terrific interview and continued success at Select Medical.
David S. Chernow 35:28
Thank you, Gary. It’s a pleasure and stay safe and stay healthy.
Gary Bisbee 35:32
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