This week I talked to Dr. Brian Cohen about his experience in different anesthesia practice settings, the practice landscape for anesthesiology in the state of Florida, how he launched his own anesthesia practice and kept it afloat amidst their hospital going out of business, and how he developed a platform called Adaptrack to provide CME to physicians and reduce likelihood of medmal claims. Lots of great stuff in this week’s episode!
I had a conversation with Dr. Brian Cohen and really enjoyed it. He’s another one of these physicians who has a really broad ranging experience, and he’s found specific opportunity through his exposure to working with a med mal insurance company and looking at anesthesia claims to be able to start a business that not only reduces the likelihood that an anesthesiologist is going to have a claim against them, but also integrate CME into a really cool tech platform that is going to hopefully combat burnout, reduce events of med mal as well as reduced insurance premiums.
Justin (01:00):
So a lot of innovation, a lot of exciting things in addition to working in a number of different practice environments that Dr. Cohen’s going to talk about today as always, thanks for tuning in hello, and welcome to another episode of APM success. This is episode 90 hard to believe we’re closing in on the century. Mark. I’m very pleased to be joined today by Dr. Brian Cohen, Dr. Cohen is an anesthesiologist in Florida. He’s an entrepreneur, he’s a great critical thinker and a businessperson. And I keep saying this, I’m really excited for this conversation, but it is again true in this case, Dr. Cohen, thanks for joining.
Dr. Brian Cohen (01:36):
Absolutely. I’m excited to be here.
Justin (01:38):
So you’re, you’re a man with, I think a lot of talents and a lot of things going on. Give us a little flavor right now for all the different things that have your attention professionally.
Dr. Brian Cohen (01:48):
Sure. So I am a practicing anesthesiologist administrative chief of a anesthesia company called Miami anesthesia services. We’re down here in South Florida, really ranging anywhere from Palm beach down to Miami. I can get into, to sort of where we’ve, where we’ve landed within that company and what our focus is, what our focuses are. You know, that opportunity to, to have my own anesthesia company has also led to a color, a couple of other opportunities and just sort of opened my mind to getting, having the ability to, to think and to do and to create. And that’s what opened the door for me, really.
Justin (02:28):
When you were exiting training, did you envision that you would one day be like launching a practice, the handful of your friends?
Dr. Brian Cohen (02:35):
No way, no way. Honestly, when I was finishing training, you know, I had this, I grew up in the Midwest in St. Louis and I had this vision of like living this beach life in Florida, and I thought I’d be happy having a small practice, you know, working in the hospital going home to the easy beach life. And I was very wrong. Tell us those first
Justin (03:00):
Clinical years. And what, what did you do transitioning out of training?
Dr. Brian Cohen (03:03):
Sure. So I did my training in anesthesia at Washington university in St. Louis very intense program, as far as the academic setting and the mindset of the people that kind of pass through there. And honestly, I assumed that’s what all anesthesia and all operating room settings were like you know, leaving there. I wasn’t sure I could survive that for the rest of my career. And I was actually very pleased when I landed in Houston for my first year out where my wife was finishing her residency training there and started working with the group which is now part of USAP, which was then greater Houston anesthesiology, where I literally walked into a scenario where there were 26 partners in a group where all 26 of them were like a real team. And where you walk in and the surgeons speak to you and ask about your family, you know, instead of dictating to you exactly how it went and where to do what they need you to do.
Dr. Brian Cohen (04:04):
And it really was such a positive change for me. I said, maybe I can do this the rest of my life. So it was a great way to exit training and inter kind of the real world and see what, what what’s really out there. What specialties are wife physical medicine and rehab. So it’s funny, we’re from a personality point of view, we are the exact opposite as far as career choice, meaning we push a drug, we get an immediate result, she does a treatment and she just watches any vow over months to years as the patients improve. And I think that you can then tell like who the patient one is in the relationship also.
Justin (04:44):
Yeah, that’s, that’s funny. I I know that’s one of the things that my wife likes about anesthesia too, is the sort of the interventional you do a thing and see a result, and it certainly does attract a certain personality. And it’s funny to map that onto that onto relationships. And so, you know, that was a, it sounds like it was a private group. It was purchased. Tell us a little bit about sort of that acquisition and what it was like being in a group that went through that type of
Dr. Brian Cohen (05:09):
Sure. So, you know, it’s interesting cause I, I was only there for one year. Well, my wife finished and then we moved up to Fort Lauderdale. When I joined a group in Fort Lauderdale, it was again a private group pre-acquisition however it was five years into it acquired by Mednax. I was the classic example of always the next guy up, you know, Oh, you’re going to be partner, but then I’m sorry, we just got bought out. And that probably had a little bit of an effect on me and kind of lit a fire under me to, to say, you know, I, I saw what the definition of partnership was. I saw that when I went to Houston and I saw those 26 guys and how they really literally worked as a unit when one person needed something, the other guys jumped and, and it really was the exact opposite of every man, every woman for themselves.
Dr. Brian Cohen (06:04):
So, you know, to, to go into another experience and miss out on that feeling of, of having that kind of intense relationship where, where, you know, you can rely on each other at any time and again, anesthesia, you know, it can get critical at times it can also get you know, long hours we get worn down, we have life outside also. So you want to rely on the people around you. And I think that did light a little bit of a fire underneath me, but remember, I, I was practicing down here in South Florida. You know, we are, as we like to say, we’re the belly of the beast as far as large corporate anesthesia, you know, in Sheridan to start with here, which is now envisioned Mednax headquarters is here. USAP executive offices are here. I didn’t know that there were opportunities outside of that. So it was what it was. And I was, I was employed and I went to work each day and that was what I did.
Justin (07:02):
I want to zoom in for a minute on sort of that the Houston experience in the way you described, you talked about partnership, not only, I think in like the legal sense, but in the sort of collegiality, are there any anecdotes or specific instances that come to mind where you thought this is, this is medicine, the way it was meant to be where your, your colleagues were helping one, another productively to move patient care forward? You know, I think it was,
Dr. Brian Cohen (07:26):
I mean, if you can visualize that, you know, the Texas medical center is a huge system, right? And, and I was in the St Luke’s system there. And again, this was a long time ago, but it’s still visually sticks out in my head very well that, you know, you can have 50, OARRS going all around offsite, main operating room. And the anesthesia office was the size of a utility closet. And at any time of day, we were all kind of just sandwiched in that utility closet waiting to do our next task. But the amazing thing was if anyone was out already and they, and the call came in, Hey, can you do this? People just jumped up and went. So it was this constant shuffling of people through this utility closet, but it wasn’t just doing what they had to do. It was doing what the group had to do as a whole and just jumping in at any time to fill in. And, and it was I mean, it, it, it definitely left an impression on me, no complaining. It was just what they were there to do.
Justin (08:27):
I know w when we spoke previously, one of the things that you talked about was the idea of culture, like a company culture or a organizational culture. It sounds like this was a pretty healthy and positive life-giving even culture. Would you say
Dr. Brian Cohen (08:42):
It, it was, and it it, it definitely translated when, when the time came and the opportunity came where I got that phone call Hey, do you want to start anesthesia group for a new hospital? We’re starting in Miami. And I said, no, you’re crazy. But when I started to, to actually have that conversation and really contemplate what that meant as an opportunity that was the driving force was the fact that we could sit there with, with a blank slate with three other individuals and say, what do we want to create? So what do we want, what do we all want to take from all of our previous experiences? They had worked in the envision world. I had worked in men next. We had been private. One of my partners was in private practice in DC at the time. What do we want to take from all of our past experiences and what didn’t we like? And let’s do the opposite. Okay. Now what did we like? And let’s build on that. And because you have one shot, you know, you can be in a health system and you can have ideas and you can try to change that culture and good luck. It’s, it’s like, it’s very difficult to move and to change culture, but when you start off with it, you can create anything you want. And that was really the opportunity that clicked for me to say, let’s, let’s do this.
Justin (10:05):
So talk a little more about the Genesis of this, cause this, obviously this sounds great. Like there’s probably people out there listening, thinking, well, I wish my friends would start a hospital and call me up to build the anesthesia program. That sounds like a good gig. How did that come up?
Dr. Brian Cohen (10:17):
Yeah, but they see the, I don’t know if you can see that this is great. There was, again, South Florida is a unique setting for healthcare. And there years had gone by because we’re a certificate of need state in which a new hospital was literally started in this area. Because based on population and current beds, you can never prove that need for, for more beds. Until a project came up as a joint venture with physician owners, along with Miami children’s hospital a large MSO called vital MD and a management company out of Kansas. And the idea was they, they bought an existing hospital is the way that, that, that was acquired. They bought that existing hospital and they shut it down and we’re going to rebrand it as this physician owned concierge surgical and OB hospital, which was, was the right thing to do.
Dr. Brian Cohen (11:27):
Everything about it spoke to what was needed in healthcare, especially down here. I, I, and again, this is, this is my opinion only. And, and, you know, I felt that healthcare had become very average and that was okay. Anesthesia because of being 90% employed model here. It was okay to just go and your thing, you didn’t have to do anything more. You didn’t have to doing less. You just, it didn’t matter as much. It wasn’t driving anything. And, you know, the, the greatest example of that is I could be an anesthesiologist in go to a surgery center or a hospital and do one case and cancel 90, or I could do all 90 and cancel none. And I went home with the same paycheck each day. Well, that doesn’t, those incentives don’t align. And, and that mentality of, of kind of going above average and above and beyond just didn’t exist.
Dr. Brian Cohen (12:26):
And this hospital was changing everything about that. By putting the ownership in the hands of the physicians, by making them proud of what they were creating and bringing the patients in which they really wanted to have this experience, the experience was incredible. We had, you know misuse for the patient’s family members while they are waiting, there was a Butler service to the patients. There was, you know, an organic chef though. I mean, now I tell you this and the hospital closed in 20 months. So all that sounds great. But it didn’t make it in incredible. We could probably spend a couple hours just talking about some of the lessons that I learned watching that process happen. But you know, long story, a little bit shorter is being the anesthesia group for that hospital. And forming for that hospital really tied us to every aspect from wall to wall, floor to ceiling.
Dr. Brian Cohen (13:28):
We were involved with the care of this surgical hospital, all of the other surgeons and physicians. This was one of their many places. They went, this was our home, right. We lived and died with this place. And every case that went through my family depended on that. My partner’s family is depended on that. We all had small children married, we needed to make this work. And we found the right people in our anesthesia world to partner with. We, we, we interviewed 43 CRDs before we hired our first one. And again, this comes down to culture and what we wanted to hear was why they wanted to come into this. Why do you want to take the risks? I mean, this hospital doesn’t even exist yet. We hadn’t had our first patient, our group, we’re not even a real group. We haven’t done a case yet.
Dr. Brian Cohen (14:15):
This is just an idea. Why are you willing to do this? And then to hear the response of, you know, well, I’m, I’m, I’m tired of doing what I’m doing and not getting what I should be getting out of it. And I’m actually discouraged from doing more because then that means everybody else has to do more. Right. So just come back down to average. And when people didn’t want to hear that, those were the people that we wanted, and we built this incredible group of people. And even though the hospital closed after 20 months, and that really was based on some of the challenges of, of facility contracting with, with payers in South Florida and, you know, a, a company from Kansas trying to understand that we walked away saying, wow, we have 35 providers. We’re in network with every major insurance company in the country, and we can start anywhere tomorrow, where should we go? And so that’s what allowed us to branch out and to survive you know, post hospital and land all in the outpatient surgery world. So, you know, now to kind of fast forward, we’re in six different surgery centers in South Florida, I’m in partner with another company in three more and that’s in that, the one thing is the culture and you know, of who we are and why we started as is what we’ve carried through. And it’s been a roller coaster, but it’s been rewarding.
Justin (15:41):
I’m really enamored with this idea of just the, the we’ll call it HR getting the right people on your team. And if you’re building your own practice, that’s very important. I’m curious, how did you kind of share your vision or your values, or how did you assess the fit of this first CRNI, you know, it sounds like you hired, you know, 2% of the people you talked to roughly how did, how did that, how did you kind of develop that methodology or did you kind of just go with your gut?
Dr. Brian Cohen (16:11):
No, my gut was wrong too many times. I couldn’t do that. To be honest with you, it was finding the right leaders, you know, once we found the leaders that believe in the same priorities that we did and really wanted to do this together they became extensions of us. And so for every person we hired, they thought of two more people that fell into that bucket. And they became our best recruiting tools. To be honest with you, Justin, as crazy as we were for the first hire, by the time we got two years in, we didn’t even have to interview people anymore. We, we trusted the people that we had already hired enough to trust their recommendations of who they were going to bring in with us. So it was, it was really kind of a unique hiring scenario.
Justin (16:59):
Yeah. Wow. I, I’m curious to know, as you know, things are winding down at the hospital, you can probably see the writing on the wall. You see the, you know, the P and L month over month and things aren’t, you realize that perhaps there’s a an inflection point for you guys approaching, how are you strategizing in your group and what did it look like to, I mean, to take 35 people working in one place and then transition to like, are you doing RFPs or are you just like, how are you, how are you evaluating other opportunities to try to keep the group together?
Dr. Brian Cohen (17:28):
So that’s a great question. And I think the easiest answer is we didn’t know we were board members. Like I said, we were involved in every single thing we had one day notice the hospital was closing.
Justin (17:40):
Wow. Okay. So you didn’t see the writing on the wall. It was just,
Dr. Brian Cohen (17:45):
We knew from a financial point of view, what was going on in the hospital, but there, there were a lot of possibilities that were out there to come in and, and, and essentially flip the switch and, and create a savings. We had one day notice of the hospitals closing. So to, you know, to open up about that, how I reacted, I kind of gave up, I, I kinda said I can’t do this again, like, because I’m I’m and we talked about this a little bit. I’m very type a, like for me to do this initial jump off the cliff to start my own group with, with my partners was very difficult for me because that’s just not my personality. I like to know what’s happening every day and I had no idea what was happening any day. And so it, it physically and emotionally, it took so much out of me that when that happened, I’m like, I don’t think I can do this again.
Dr. Brian Cohen (18:40):
And actually, you know, considered moving over to the medical malpractice world completely, which was you know, another thing to talk about it as that I was doing alongside with that. And until, you know, the same partner that convinced me to leave my first job and join into this adventure, you know, sat me down and said, look, when, when are you going to have that chance to go out and say, we can start tomorrow with a group? I’m at home, man. You’re right. You know, so here we go again. And in the process from that point on really just became telling our story. And it’s amazing when you go out and meet face to face with owners of surgery centers. And, and again, it’s taking it down a level to be a little more personal, right? These administrators and owners, it’s their own blood, sweat, and tears, these surgeon, investors, it’s their own blood, sweat, and tears. They want the same out of you. And they saw that what was happening in the current anesthesia landscape down here was the exact opposite of that. And we said, look, man, we got it. It is all on the line right here. We are going to make this work. This is going to be the best anesthesia experience you’ve ever had because we have no other choice. And and it was true. And, and it, you know, it, it just kept going from there.
Justin (19:57):
How did you get that first contract? How did you get connected to somebody that was potentially open to swapping out their existing providers? I feel like anesthesia services are sticky there’s contracts as lead time. There’s surgery scheduled.
Dr. Brian Cohen (20:09):
That’s exactly the word I was going to use. They are very sticky. So it it’s really planting a seed and waiting for the timing to be right. It’s, it’s, even though it’s a large community, it’s a very small community. There, you know, there’s some other factors that go into it. If, you know, at that time, there were still a lot of groups that were billing out of network for the benefit of, of the dollars coming back to them. But at times that put the facility, the surgeons and the patients at a little bit of a bind the fact that we could come in and say, we are all in network, played a big role in that in, in a couple of the contracts. And you know, each one was a unique each one was a very unique scenario and I think it was just taking the time to understand what was most important to them at that time. And seeing if we could fit that fit that role for them.
Justin (21:04):
You mentioned this med mal endeavor happening in parallel. Tell us about that.
Dr. Brian Cohen (21:10):
So when, when I, when I jumped off the cliff to start my group again, I’m kind of nervous cause I have no job. We have no hospital was delayed for nine months, you know, so I, I luckily was connected at the same time to a medical malpractice company called AMS RG that the executive branch is based out of South Florida. And my role was to come in and help be the specialty medical director for anesthesia and pain management for their existing book of business. So that means really taking the anesthesia and pain world and looking at it in a little bit of a a deeper sense to, you know, if we look at a group on a more personalized level in regards to risk what they are and what they aren’t doing can we optimize that more and can we help them be better? Can that then help the company be better? And really it’s adding a physician specialist layer to a book of business that, that wants to grow that specialty
Justin (22:16):
Book of business, who are the clients of this company,
Dr. Brian Cohen (22:19):
Physicians, they invest both individual physicians, practices, small, large everything in between. They’re in all 50 States in the country they’ve been around since the early two thousands and had a very, again, lessons learned about how to approach business in the right way. They, the insurance, the medical malpractice insurance industry is cyclical, right? As, as policy pricing increases, decreases over time, they had a very strategic, slow and steady approach to it. They didn’t have to grow 50% each year. You know, they grew a couple percent year, but when the market softened and everybody else dipped down, they were able to stay steady. So, you know, an interesting business, you know, trick to pick up is, is just to appreciate that that slow and steady growth. I think for me, the way medical malpractice companies and underwriters look at risk in, let’s just say an anesthesia specifically super different than the way I looked at it as an anesthesiologist.
Dr. Brian Cohen (23:29):
So I would go there and I would evaluate applications and work on some of the underwriting and evaluate some of the claims coming in. And I’d go back to my partners at Miami anesthesia services. And like, guys, we can’t do this anymore. We gotta look at it like this. And did you know that this could happen if you do this? And then all of a sudden I’m like I, you know, this isn’t really fair. I’m the only one that gets to absorb this material, non passing it to my partners. And now we get to extreme, but God, this, if we could get this out a little bit more, this is something providers really don’t tackle on a day to day. And, and in the next endeavor that we talk about and adapt track, that’s what we call these, you know, these blind spots that exist in physician’s lives.
Dr. Brian Cohen (24:13):
You know, we’re so busy doing other things that we have, these blind spots that come in, and sometimes it just takes an awareness factor. You know, somebody to kind of push that in front of you instead of kind of in the, in the blind spot to make you aware of it and that awareness can change your entire behavior. It can change your practice, it can change your habits and it can change your, you know, how you practice on a day to day. I saw that happen on a micro level, you know, with myself between the two companies. And, and again, as we, as we talk about adapt track a little bit, that’s really kind of what we’re doing there just more on the macro level.
Justin (24:58):
Can you give a couple, just practical examples of some of the things that you saw and then you brought it back and you’re like, we need to revise, you know, best practice or policies and procedures to adapt to the things that we’re seeing in real time claims that are happening with other anesthesia anesthesiologists or other providers.
Dr. Brian Cohen (25:15):
Yeah. Some of it is just exactly what you said, policies and procedures, you know, sometimes just having I’ll give one example that that really has come come in handy when talking about interactions between anesthesia and ambulatory surgery centers or, and, or hospitals and policies. Again, anesthesia, we’re very detail oriented, right? So we think if we’re going to write a policy, we’d want to write everything in between, right? You should do this, this and this. If you want to create discharge criteria, don’t discharge a patient unless the blood pressure is less than one 50 over 80 and blah, blah, blah, heart rate is less than this. And you put it in Harlem. That’s, that’s how our minds work. You know, very algorithmic from a liability standpoint, what you’re doing there is you’re creating a nightmare for yourself because there’s lots of exceptions to the rules.
Dr. Brian Cohen (26:13):
So if you were creating a policy, you know, of course create a policy that, that creates a backbone of safety and guidance, but don’t lock yourself in because what if that patient who, you know, was perfectly stable, had a blood pressure of one 60 over 90, and let’s say they went home and had a stroke or had an EMI and they come back and they said, well, you just discharge the patient, even though they did not meet your discharge criteria of one 50, over 80, you clearly went against her policy and your even more responsibility. So it’s just that a different way of thinking where it’s actually counterintuitive. And, and that, that helped me going into these surgery centers and really working through some of the policies and procedures that they had in place to put protections, not only for us as a group, but them as a, as a center. So that’s a big part of anesthesia is you want to show your value, not just to yourself and your patients, but you’re there, you have to understand the fact and get, check your ego at the door and you’re there for your patients, the surgeons and that center. Right. And, and it’s a, you’re a vendor. And that’s okay. As long as you’re providing good service, that’s okay. You know? Yeah.
Justin (27:29):
One of the themes that has come up on the show in the past is the idea of sort of the intersection of two different specialties. You could call it. So, and the value that you can provide, if you learn one skill set, and you’re really obviously an expert in clinical anesthesia, and then you get this other perspective, the risk mitigation and management and analysis of being ingrained with the med mal company and how that totally changed your paradigm and the, the, the intersection of those two perspectives creates this. I mean, it’s immensely valuable for your peers and from it was birth, this company called adapt track. So talk a little bit about what you’re building there.
Dr. Brian Cohen (28:10):
Sure. So adapt track is a digital risk awareness tool. And Niraj Swami is a CEO of adapt track. And he is a serial entrepreneur who is one of the most incredible minds and people that I’ve interacted with. And I say that because he is someone who truly, he holds true to his vision of using technology for the good of human behavior, and how can we use technology to change human behavior and, and having a positive impact with it. So, you know, Neeraj from a tech standpoint, you know, has this vision and has this tool. And as, as myself and the COO of the company, Sam Taggart meet him from the medical liability world, we see this tool and we see healthcare written all over it. And you know, the three of us together really started going down that path of how does healthcare and more specifically risks play into this incredible vision that he has with, with behaviors.
Dr. Brian Cohen (29:22):
And you know, the, the behavioral science behind the whole platform is a very simple learning and it’s, you know, track learn and earn. So if you’re tracking data if you’re learning from these awareness pieces of content and recall nudges, and you’re earning something from it, so, you know, what do you earn or what are these rewards that we can bring forward? Well, what the simplest one that we have is CME credits. So this has become just an enormous CME engine. That’s really changed the way in which people engage with learning and rewards and that’s, that’s the backbone of it. And we can get into a lot more about kind of where we’ve seen it come into play and how we’re, how we’re rolling it out. And some of the different interactions that, that, that are, that are, that it’s capable of. So,
Justin (30:14):
Yeah. Why don’t you tell us just sort of how the, so you said something when we spoke previously, just I I’m really, I thought this was an interesting idea. There’s a lot of software, and we’ve actually talked in the past on the show about how basically any, most like a lot of medical software has to do with, it’s all about the economics of healthcare and like tracking how, how much a payer is going to pay for a certain number of procedures. And like, everything kind of comes back to tracking the cash, and it’s not necessarily like a patient care centered approach. And so there’s a lot of software out there for hospitals, a lot of software out there for insurance companies, even some, I think for patients. And what you said was, there’s not a lot of software out there built for the doctor, which I, as I was thinking about that, obviously I’m not super familiar with all the healthcare it and tech infrastructure, but I thought that was a really interesting idea. So talk a little bit about that and how that has shaped that value has shaped the approach with adapt track.
Dr. Brian Cohen (31:08):
Yeah, absolutely. The way you set up set it up is exactly right. Justin, what we found was nothing was provider focused. You know, we’re all trying to change healthcare, you know, this huge industry, but no one’s looking at the engine, which is the physician or the provider in the middle. And if they are, they’re just giving them like 20 more things to do click here, do this, do that. So my biggest job in adapt track was being the provider. So being the mind of the provider, what do we want, what don’t we want? We don’t want anything else to do. We want, we’ve already, we’re already doing things. Honestly, we’re already learning constantly. We’re having, you know, curbside conversations with, you know, with, with consultants, we’re, we’re on zoom calls here, we’re researching this. So we’re already doing that. Why, why not have something meet you there and reward you for you’re already doing?
Dr. Brian Cohen (32:06):
And the, the key to being able to drive any kind of change or behavior is really having the engagement of the user, getting a physician to engage with one more thing right now is super tough, super hard. And I learned that when I, when we tried to demo this with, you know, all my buddies and they’re like, you know, I can’t, I can’t right now. I don’t want anything else to do, but then when you brought it to them, you know, it started to make a little more sense. And so everything that we’ve done along the path of the DAP track is to really meet that provider where they are, and to be in their space and to understand what’s important to them. So do I really want or need, or even have the ability to sit in another one hour grand rounds? Not really, but that information, that contents important to me.
Dr. Brian Cohen (33:04):
So why not start breaking it up? And that’s really what we started doing. And this is a little bit more that behavioral science has been proven to be more effective is micro learnings. So we’re taking content in all. This is tying back to risk in our medical malpractice, stays in, there’s just tons of historical data. And that historical data tells us everything you’d ever don’t want to know about. What’s driving, why you get sued and why you burn out and why you’re documenting in an efficient way, and your day becomes longer and you can’t see your family and all these things that all exists there is just, we’re not shuffling through it and finding what that is. And so if we can do that for you and then present it to you in 30 seconds or less, again, absorb it, take actionable insight on it.
Dr. Brian Cohen (33:56):
And that’s the other portion of the app is really taking the information and reflecting on it and journaling. And you can either type that out. Or you can just do a quick response that it’s useful and saving that in you earn CME credit. So now you’ve triggered a positive response to actually learning, and it’s much more powerful and it’s much more effective. And you can literally, if you think of it with a half a credit, each learning nudge, you can jump on for 30 seconds one time a week for an entire year, and you’ve earned 20 CME credits. But the more powerful thing is you’ve done two more things. You’ve created awareness about what’s driving all these risks. So you’ve in the background actually changed your behavior on it. And you’ve created this incredible risk profile on yourself, which shows what topics you’ve engaged with and all of these are tagged.
Dr. Brian Cohen (34:47):
And the topics that we know drive claims, and this is now presented to medical malpractice companies, where you’re now earning premium discounts on your medical malpractice. So you become a safer provider, you’re saving money and you’re saving time. And when you talk about speaking the language of the provider, that speaks to me, you know, I want my time, I want my work-life balance. I’m tired of dishing out thousands of dollars for these courses that can be consumed in shorter amounts of time, where I am. And, and again, that’s not to disrupt what exists it’s, you know, it can be complimentary to what exists there’s roles for lots of different ways of learning. But this may speak more to people in different scenarios.
Justin (35:32):
As you’re describing this, I’m thinking, Holy cow, my industry needs this because I’m a certified financial planner. We CME, I don’t know if
Justin (35:38):
You’re already working on something or the finance industry, but this is like, at the end of it, it’s like, it’s between Thanksgiving and Christmas. It’s like, Oh crap, I gotta get my 30 credit hours in. And then there’s these arcane, you know, you’ve got to watch this webinar and then do the little quiz. And like all the research that I do for my clients and solving complex and dynamic problems, like I don’t get credit for any of that. That’s what actually makes me a better advisor. And it’s totally wasted time for CME purposes. So I loved the fact that you’re harnessing, like not only real world experience, but actually the point that data has shown that like liability exists. People make mistakes here. This is where you need to pay attention. And then you use that just organically to bring it to the attention of the physician in the moment. I, I mean, that’s, that’s brilliant.
Dr. Brian Cohen (36:21):
Yeah. You know, medical malpractice, doesn’t speak to everybody, you know, if, if you’ve gone through your career and you’ve never gotten sued and you’re kind of like, well, so what, but 50% of our riders are sued in their career. So you’re still kind of playing Russian roulette. The other, the other example is some clinicians don’t absorb that direct cost of men. Now it exists in the employer level above, and they never really see it. What does speak to physicians regardless of, you know, your, your medical malpractice setup is getting sued and the experience it has on you, what, even aside from the financials, you know, it’s a, it’s a two to three-year process of just it’s pain. And it’s, it actually alone has driven people to leave medicine. They, they have this insanely sick ability to really make you feel like you’re a terrible person and you’re a terrible provider, even though you could have done everything. Right. And so instead of being reactionary to something like that happening to somebody, you know, being preventative is, is super valuable. And, and that’s really one of the goals here. You know, again, I’m living the day-to-day life of a provider, you know, this is, this is what our goal is, is to make, you know, my life and my colleague’s life. Just like, just a little bit better. We’re not solving everything, but if you can take a couple of things off the plate, you know, it, it helps.
Justin (37:47):
Absolutely. And this is the kind of thing there’s a lot of, well, I should say there’s a few different stakeholders that would benefit from this. I mean, obviously like everyone benefits from this at some level, but there’s some stakeholders that are like, this is so valuable to me. Like, I will pay for this. I will help you implement this because this impacts our organs. And obviously like med mal is sort of the first the, the insurance companies to have to pay out the claims. There probably a big one organizations that, you know sights of the hospitals were, who could also be on the hook and a med mal case. That’s probably another one. Have you found institutional buy-in for this type of system for those reasons?
Dr. Brian Cohen (38:22):
Yeah. Yeah, you’re exactly right. And this is where again, I have no business background. This has been sort of trial and error for me every single day from starting anesthesia group to going into, to, to adapt track with my partners here. It’s so I’ve had to rely on picking up business tips. I can learn along the way, right. And one of the things I learned and appreciated in the anesthesia startup was, you know, making sure if you’re gonna, if you’re going to do something, make sure everybody at every level and every direction gains. So everybody there has to be, you know, mutual incentives to, to move forward with something. When we went down this path of the dab track, how that came into light was very excited because all of a sudden you found once you have that engaged physician who feels like he or she is, is gaining time, money, less risk, whatever it may be.
Dr. Brian Cohen (39:27):
Now, you also have a less risky, more efficient, less burned out physician. So from a company standpoint over top, that’s a win, you know, you’re, you’re looking at a million dollar liability when you combine the cost of the average med mal claim turnover of a team of a team member in an inefficient practice, it adds up to a million dollars. So yes, there has been, there has been corporate support from that point of view. Also before I moved past the corporate side, one of the big games they’ve had is there’s, there’s been a very positive feedback to the other aspect we worked in to adapt track, which is the smile bank. And again, this is just trying to get in the head of physicians would, what do we need? You know, occasionally throughout our day, I want to take a deep breath. I need something positive.
Dr. Brian Cohen (40:22):
And you know, what, what we saw during COVID was re it really added a special part of what we were doing. And, you know, you remember the early days of, you know, March, April, may of last year and all the video of it, which I know which was the videos of, you know, strangers standing on their balconies and applauding, it changes seven o’clock, eight o’clock four, four, the strangers of the frontline workers walking into hospitals, doing their jobs. Now this is stuff we do all day everyday, right now I saw that. I mean, it gave me chills, but at the same time, like how, how would we make that sustainable? Cause that’s going to go away. We know that’s going to go away. And so we created the smile bank. And so within the app, you know, you have the ability to click into your smile bank at any time.
Dr. Brian Cohen (41:16):
And it’s filled with positive messages. It’s filled with songs you know, some speeches, some personal messages from strangers that are literally telling you, we love what you do. Keep, you know, keep up the good work and also customized, you know, you, you can invite friends, family, peers, or corporations and employers over the top, messaging their workers, and really trying to lift them up with something active and positive. So all those little aspects have really spoken to the, the leaders at top, who at times struggled to get the ear and reach the physician. Right. We speak a little bit of a different language with the suits in the office sometimes. And that’s okay. But maybe we can help bridge that a little bit, you know that, that third level that you mentioned as far as aligning incentives is just as you alluded to the medical malpractice company.
Dr. Brian Cohen (42:06):
So how do they win? It’s interesting men, male companies already have systems in place to reward physicians for engaging with risk reduction activities, oftentimes in the form of CME activities and things of that nature. But we are, we are able to go in and say, we can show you that ours is more effective and that our users are actually engaging in this kind of aggregate data. And this amount of time on these specific topics that are tied to these specific risks. And now you actually can hold in your hand, the fact that your insured physicians are less risky than they were before they use the, the app. And so for that, the med mal company gains, but they also pass that savings back to the physician in, in the form of, or back to the corporation. Whoever’s holding that premium policy in the form of anywhere from two and a half to seven and a half percent off your premium. So that’s when I got excited when we walked through and I’m like, okay, there’s three stakeholders here. Who’s getting screwed. Well, no, that’s the fun part. You know, we found a ways that everybody really does gain them. So beautiful.
Justin (43:20):
Yeah. Yeah. It’s like the it’s like the safe driver discount where you like stick that thing on your dashboard. And then also you can tell if you break too hard or
Dr. Brian Cohen (43:28):
Exactly, that’s exactly what it is and actually the way it was created. Again, this is part of Niraj is brilliant in the, in the tech world is the more data and API hooks you bring in to adapt track whether that’s your calendar. So I know when you’re on call, I know how busy you are, how many meetings do you have? What’s your patient schedule, or you bring in your electronic health record. Now we know the types of ICD, 10 codes, the CPT codes, all these things that are going on in your day to day, the more data hooks you bring in, the more powerful and specific it gets just like the safe driver. Right? So again, if we’re, if you’re able to track and you choose to share that you should be rewarded for that because there’s reason to be, you know, you’ve proven that you’re less risky.
Justin (44:16):
How does a user interface with this? Is it on their phone? Is it like embedded in the EMR? Is it a combination of things?
Dr. Brian Cohen (44:23):
So we it’s a web based app. So it can be access from your phone, from your iPad, from your anywhere. The other thing we did was, again, we’re, we’re, we’re, we’re trying to be almost hyper aware of our pain points. Like, do I want another screen to stare at no problem, probably not. Especially if I’m doing like telemedicine or this other stuff, you know, it’s it’s enough already. So we actually made it a hundred percent voice voice activated as well. So I can click a button and you know, Alexa essentially calls me, or at least it’s her voice and walks through the entire experience on my phone. So by voice, so I can engage with the content I can reflect by voice. I can leave my, my journal, my thoughts, and that’s all captured and that’s all stored on my account. And I’m meeting CME the same way in which is if I was doing it on the screen, the other, the other way in which we’ve really found value. And again, trying to be respectful of what physicians and other providers one right now is, you know, we, we just integrated into clubhouse. I’m not sure if you jumped on that fun yet.
Speaker 4 (45:37):
Somebody invited me the other day. I actually have an Android and an iPod touch, and I’m not sure I’m going to be able to get in with that combo.
Dr. Brian Cohen (45:44):
You can get in with your iPad. So, you know, clubhouse is just an example of there’s. There are incredible conversations going on in there. It’s all audio based and they’re, it’s, it’s essentially in open rooms. And the healthcare population on clubhouses is insane and really good content. That’s super relevant to what we do everyday. And so why not, why not earn something for participating in that. So we actually are the first company to integrate into clubhouse and generate CME from the meaningful conversations and learnings you’re already doing. So in that respect, you get a text while you’re in the clubhouse conversation and you can text a reflection back and now you’ve earned CME credit. Same thing we’re doing with, with Disney as physicians go to Disney, they’re able to Lincoln and reflect on work-life balance. You know, these are activities. We have nature walks and partnership with the Morton Arboretum in Chicago.
Dr. Brian Cohen (46:44):
So these are activities that actually are driving value to physicians because they are, they are helping reduce burnout, create moments of mindfulness help with work-life balance, which, you know, burnout is not just a risk to myself, but it’s actually been shown. You’re going to make more errors at work when you’re hitting that wall, those errors are gonna lead to claims. So, you know, it’s putting these pieces together and finding ways to reward physicians for what they’re already doing. And it’s, it has been very exciting to see people respond to that in such a positive way and shift out of that mindset of, yeah, but I’m not sitting in a room for an hour. How can you do this? Well, because the ACC actually, you know, really supports active learning and reflective learning. And what you’re reflecting on is how you’re going to take this information and how it’s going to change what you do in your breakfast. Day-To-Day so you know, it, it’s, it’s powerful.
Justin (47:44):
What’s been the hardest part of making this work.
Dr. Brian Cohen (47:47):
Oh, this meaning like life.
Justin (47:50):
Well, yeah, you can, I’ll leave it open ended. I was thinking of like constructing adapt track, getting it from a thing in your brain to being accessed by a bunch of physicians.
Dr. Brian Cohen (48:01):
The, the, the hardest part you know, one of the hardest parts is me finding my own balance and trying to do it, you know, I am still in clinical practice five days a week, you know, with, with my anesthesia services and, and have been fully engaged with adapt track, you know, for the past few years as well. So one challenge is this is just the hours in the day. But at the same time, I feel like I’m focused and driven driving value in each side. I can’t stop either one right now. It’s from, from specifically from, from an adapt track side as fast as we have moved being that it’s, you know, that startup kind of mentality, you know, here’s an idea, okay. Neuron is just built it in three minutes and now I can see it on my screen.
Dr. Brian Cohen (48:53):
That’s incredibly fast, but the process of getting from thought to product to in the hands, you know, it’s been almost a three-year process. And again, circling back to one of my earlier comments, you know, in the anesthesia world, we, we don’t do well waiting three years for things like we push a drug and it works. So just finding patients and being patient on, on watching something evolve and letting it evolve in the right timeframe. Because I think if we, you know, if we would have rushed this and this would have launched before we saw what happened with COVID, it would have been a very different product. And, you know, along the same lines, I think we, as physicians have changed in a very positive way at post COVID, you know, imagine telling an orthopedic surgeon in 2019 to go practice mindfulness for a minute and, you know, concentrate on work life balance.
Dr. Brian Cohen (49:51):
You know what I mean, most will grow you out of the room, but, but for about, you know, at least seven weeks, last year, we were forced into one of two camps. We were forced to either plant our butts at home and not leave and be with family and appreciate friends and appreciate everything that we had missed probably since high school. Right. and that opened our eyes to something. Or we were in the other camp where we were literally locked into that hospital or renting an apartment because we were afraid to go home to our families. Right. And we were missing that part so much, but we had a dedication to what our career was and what we were doing for our community that, you know, you know, you, you, you still shifted that mind, your end point, regardless of what camp you fell into, that end point is the same. We all came out changed and realized, you know, there’s a lot more out there, right? Work is super important, but so is the rest of life. And there is a way to start kind of balancing that a little more, you know, maybe not overnight, maybe not with one solution is going to fix it all. But, you know, it’s, it’s a little more top of mind, I think for us now.
Justin (51:09):
So there’s definitely people listening to this who were thinking, Holy cow, I’d love for all my CME to be covered in my med mal premiums to go down. That sounds amazing. Where do I sign? What’s the, what, what if somebody’s listening and is interested? What, what should they
Dr. Brian Cohen (51:22):
Sure. So you can go to the website adapt track.com. From there, you know, you’ll get a little more information on it. There’s also a button that can, you can click into and start the onboarding process. We’re very, again, conscious of onboarding. You know, we’re not going to make this drawn out into a 30 minute session. It’s pretty much 20 seconds in you’re on. The things you need to onboard is your phone number, your email address, and your NPI number. And we have a link in there to look up your NPI. If you don’t know it, the reason we linked that is that’s our, for our first data source for you. So that’s what drives all the content to be specialty specific for what specialty you’re in. And after that you’re on and you’re a user and it’s free to be a user.
Dr. Brian Cohen (52:07):
You can engage with as much content as you want. You can rack up as much CME as you want, when you choose to claim that CME certificate it’s 20 bucks. And then that CMS should have, it can be printed, downloaded, and it’s saved forever on your account. There, you can go back to it if you want, and you can continue working towards your next DME goal. That entire time your risk profile is building and that shareable as well. We actually have a way you can, you can contact us. We can help you reach out to the medical malpractice companies, or you can share it directly with them. But again, we, we tried to make it pretty intuitive on there so that it’s easy to drive and you can find all this stuff. You know, again, being respectful of the amount of time that physicians are actually gonna want to dedicate to one more thing. So it’s all kind of easy, quick, and right there for you.
Justin (52:59):
Absolutely. Well, as a physician spouse, I have a vested interest in your success. I love this idea. I love it’s, it’s the innovation, it’s the practicality, it’s the acknowledgement of the physician plight and it’s, it’s the rising tide raises all ships. It’s good for insurers. It’s good for the patient because their doctors are not as burned out. And it’s good for the physicians who are getting time back in their day and in their calendar. And I, I, I’m just really excited to thank you, Dr. Cohen for joining us for telling your story.
Justin (53:30):
It’s been a pleasure speaking with you today. Thank you so much. Appreciate the platform, Dustin. If you liked what you heard this week, head on over to APM success.com, where you can find more content and free resources to help you build a successful career in anesthesia and pain management. If you want it to leave a review in iTunes, that also really appreciate it. Thanks for using some of your valuable time to join me today on APM success.
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