Transforming your business vision into reality might seem like a daunting task when you’re running a medical practice. That’s especially in the face of so much uncertainty about where healthcare is headed. But with the right tools, your practice’s potential can become its future.
Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, shares his thoughts on what it takes to turn ideas from dreams to reality in healthcare practices.
1:43—Dr. Brabec on the importance of leadership with healthcare experience
4:20—Seizing opportunities for growth
7:52—Understanding the past to plan for the future
11:22—Overcoming resistance to change through education
- In addition to business-mindedness, experienced physician leadership is key to successful practice growth.
- Planning for the future of your practice and knowing when to seize opportunities for growth requires an understanding of past trends in healthcare.
- Providing opportunities for education and involvement can help hesitant providers become more open to change.
CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec.
Dr. Brabec, can you give us an introduction to who you are and what you do?
Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Lincoln, Nebraska. The practice is called Complete Children’s Health, which I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.
With regards to this practice, we have taken it from one office location into, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Nebraska.
Combining Business And Healthcare Experience In Leadership
CHN News: One of the things you mentioned was the importance of clinicians as leaders. You mentioned having that business management experience. And you mentioned that, so many times, there are great ideas from clinicians and great strategies that may even come about. But the execution piece is missing — they don’t always come to fruition.
So, for those independent physicians who are looking to grow — or for physicians who are looking to establish their own independent practices or even become leaders in a hospital system, what do you think is the reason that so many good ideas never actually make it to that execution step and actually become real?
Dr. Brabec: I think that nowadays in some of our hospital systems and commercial carriers and managed care organizations, finding leadership — and not just an executive type of leadership, like someone who has a lot of business experience or a Master’s in healthcare administration or anything like that — but someone who has physician leadership is becoming key.
When you have that experience of having actually been in the trenches, so to speak, and having cared for patients and seen what that takes in terms of the time and effort to provide good customer service and good quality care for your families, I think that physician leadership is more and more key nowadays.
Organizations have to provide not only good business-mindedness, but also the clinical side of healthcare and experience in delivering that, too.
You’re seeing a fair number of physicians nowadays who are going off and getting Master’s in healthcare administration, which is certainly very helpful as well. And then you see physicians who have surrounded themselves with good people who have good business experience.
And that’s what’s been key for our practice in particular: having a good business-minded healthcare administrator who is very strong financially at forecasting and helping develop the business plan in terms of growth and how you look at your practice’s statistics.
So, I think having a good chief financial officer of sorts has been very key for our practice in terms of our ability to do forecasting and sort of predict that growth — and then hit it accurately.
If you just try to go about blindly without looking at numbers and statistics and information that’s coming in, you’re not going to be very successful. You have to be very calculated about growth in medicine today.
Planning For Growth
CHN News: You are a doctor, but you also own several practices. So, you’re also an entrepreneur. How on earth do you balance those two? Do you have certain days where you have your administrator hat on and then other days when you have your physician hat on?
Dr. Brabec: We just recently had a retreat to address that. We went from being a practice with myself and four employees in one office to, currently, four offices with 140 employees: 17 pediatricians, 9 physician extenders, 5 child psychologists, a couple of hospitalists.
That desire to grow came from my former partner in Seattle who was very business-minded. So, when I moved back home, my initial desire was just to move my family back here to raise them around family.
But then I saw that I didn’t have an opportunity to get into any of the other practices. They said, “We need more pediatricians but right now we just don’t have any more room to grow within our practice.”
So, I set out and went to the bank to borrow so money to open up my own practice. I spent time talking to some of the local commercial insurance carriers about products they were offering and how they were having a hard time getting some of the pediatric practices to sign up for their products — particularly an HMO product that was first offered in Nebraska.
I could see that there was opportunity to grow and develop practices.
And the other big experience I brought from just being in a practice where my fellow partners had that entrepreneurial spirit, was that we had also built our own office building out there in Washington.
So, part of the business plan when we built our third office location in Lincoln, Nebraska — after initially being in a couple of buildings where we paid rent to somebody else — the idea was “we’re going to be at this for a while, so why don’t we just pay ourselves?” So, we currently own three of the four buildings.
We’ve also developed a real estate entity for what we’re doing. We’ll basically own four buildings and one of those will be paid off in a couple of years.
Again, that comes from experiences I had with prior mentors to see that opportunity.
Then, in 2006, I also developed a company called Midwest Children’s Health Research Institute that currently performs clinical trials — in particular with regards to vaccines, drugs, and various commercial products like baby formula or diapers that also provides a revenue stream.
Adapting To Change
CHN News: There are so many things you’ve already mentioned that you’ve done: “We want to buy a building for our practice. We want to open more locations.” For so many physicians, those stop at the idea stage. They don’t necessarily keep moving forward. What steps can doctors or practice managers take to make sure that their projects do indeed move forward and become actual goals?
Dr. Brabec: Again, I think the most important part of that is really being very careful and calculated in the things that you do in this day and age. Compared to 28 years ago when I started to do this, and seeing that we weren’t going to head into socialized medicine, we’ve kind of circled back around now with different terms and mnemonics: Integrated Delivery Systems as opposed to Health Maintenance Organizations, and PPOs and PHOs.
I think of us as physicians feel like we’re just circling back around to what already was in the mid 90s and what was being described back in the 70s. I think the difference today with regards to what’s going to happen with healthcare — and the concerns in the 90s were the same: that I’d have to do more but get paid less — but this time I think people really mean it.
CMS means it, Medicaid means it, our commercial carriers mean it. We have to mean it on behalf of our patients and the cost of care more than anything else. We cannot continue to sustain the level of cost of care that’s occurring and how strapped it is for some families as well.
In terms of these opportunities to own your own building and still have your practice exist, I think you’re going to have to be very cautious about growth. I think we’re going to see a fair amount of our care being replaced with telehealth.
I actually foresee that potentially in 3 to 5 or maybe 7 years at the latest, I’m not going to need four office locations anymore. I think I’ll need maybe only three office locations.
Why? Because the care management that I’m going to have to start to deliver to my families — what’s known as the patient centered medical home — and PCMH came about because of the American Academy of Pediatrics being started on behalf of children with chronic healthcare needs — is going be to care management on steroids, if you will.
We’ll start to deliver more and more of that care through telehealth and working to keep patients from having to come into the office. So I think I’ll be delivering even more effective, higher quality, lower cost care by means other than having the patient come to my office all of the time.
CHN News: Whenever goals are set or a vision is put out there, there’s always resistance to change. Healthcare is known as an old, stodgy industry where people often don’t embrace change and innovation as quickly as the market does. How do you counteract that?
When you put forth a vision to your team members and say, “Here’s the direction we’re going,” how do you deal with those folks who may not be on board or may be resistant to change?
Dr. Brabec: Well, I think what’s most important when you see that happening is to try to engage them the best you can to help them understand the change and why it has to happen.
When you look at approximately $9,900 per capita cost in the United States compared to some other countries whose longevity may even be a bit longer than ours but with per capita costs being half of what we spend — though many of those are socialized medicine — I think it’s important to engage and educate rather than letting people sit back and formulate their own opinions that allow their fears to happen.
I think it’s important to be involved wherever you’re at — in particular with an organization that’s going to continue to provide you with the education that’s going to help you evolve towards less fear and less panic in terms of what’s happening with medical care in the United States.
And I think the more informed you are by being involved in an organization that gives you that opportunity and, to some degree, hopefully help to shape what happens, will result in a lot less fear and panic than if you just sit back and let it happen to you.
Right now, there are, unfortunately, a lot of physicians who are close enough to retirement who I have seen even at some of the local hospitals here, when they switched to electronic medical records, and these were good physicians, but they said, “I’m done. I’m not going to do this. It’s just not what I’m used to.”
So, constant education and getting them involved rather than all of sudden — for lack of a better way of putting it — ramming it down their throats and forcing it at them is going to result in a lot less anxiety and fear.
Our medical schools also have to to be involved at the forefront by providing some history of medical care in the United States as well. I think that they will be better prepared. I never had that in medical school. But if I could have seen how the terms and the type of care and how insurance even came about, that understanding would result in a more well-rounded and better prepared physician for the changes that this industry is undergoing and will continue to undergo for years to come.