February 16, 2023

Episode #67: Tom Haithcoat – Ceptor Consulting

Tom Haithcoat is the President of Ceptor Consulting, LLC, a PAC Physician Practice consulting firm focused on Growth, M&A, and Value Model selection & strategy. Tom has over 25 years of senior living experience in both Nursing Home management and Post Acute Care physician practice management.

In addition, Mr. Haithcoat is the President of Physician Services for Careline Health Group. Careline is a Michigan headquartered Hospice and Physician Services practice servicing 4,500 patients in 250 AL/SNF/LTC facilities throughout Michigan with expansion offices in Indiana and Ohio. Our hospice practice has an average census of ~450.

Tom sits on the Board of Directors for AMDA-The Society for Post Acute and Long Term Care Medicine where he also Chairs the Practice Management Section, leads the Chief Medical Officer Leadership Meetings and Co-Chairs the Membership Committee.

Transcript

hello this is coach Tim Campsall and I’m your host for the self-made as a myth make a difference together show where we are talking with successful business owners about their journey to building their business and because we know that success in business is not something that we could do on our own we’re taking some time to recognize the folks who have come alongside of us and helped us through our journey to excelling today I’m excited to have a fellow business owner from Indiana with us today my guest has been uh check this out this is funny married to improving health care for The Elder and frail longer than he’s actually been married and in his downtime he enjoys camping and hiking and he is proud of his family who are also all in the health care field it is my pleasure to welcome Tom to the show today hello Tom hi Tim thanks for having me absolutely well hey let’s start with uh having you introduce yourself tell us a little bit of your personal story like where you were born where you live in a little bit about your family yeah so Tom Faith good and I have been in healthcare the vast majority of my life not necessarily just career but but when I say all I know is Healthcare it’s really all I know um so I was born in Cincinnati and we did a little bit of moving around to parts of Kentucky Louisville and Lexington before settling pretty early in my life so it’s still pre-teen in Indianapolis and have been there since fantastic and tell us about uh the hiking and the things that you enjoy doing as Hobbies where do you go hiking where’s do you have a favor I do so so my wife and father-in-law is an elementary principal so they had growing up they had Summers off where they would leave for a month and and go out west east to multiple national parks so when I first met my wife she uh convinced me that that was a good way to spend vacation and so I was like okay well we’re courting so I’ll go along with it and sure enough fell in love with it and so you know I always say that we kind of met in a in a two-man tent and we kind of did so it went out on the last traveled around in an old rickety rental car that we picked up out in Vegas and drove to all the national parks oh wow that was quite an experience and I’ve done that ever since so we went from the two-man tent to a larger tent to a pop-up to a camper to and now it’s uh at least probably a couple weeks a year we try and make it to at least one National Park the Grand Tetons is by far my uh my my favorite area it was one of the most peaceful places I’ve ever been fantastic so um is there a funny story Tom that your family likes to tell about you that you’d be willing to share with us today there and it actually has a little bit of a crossover to what we’re talking about today as far as being in healthcare that’s what got me into Healthcare is somewhat of a funny story no one really remembers the details of what I said to my grandmother but but whatever it was it led to me at about 11 years old to volunteering at a local County home and and so the county home was taking care of a lot of patients and that’s ultimately what led me into Health Care was um whatever it was I said to my grandmother led me to a lot more in parents and and so you know learned a unique language from the guys and unique skills from some of the ladies and then it was I just had a ball so it was a great way to um extend the Social Circle to helping frail elderly people at an age I didn’t realize I was helping them I thought they were helping me it’s a good entryway yeah that’s amazing so tell us a little bit more about how the business came about and at what point did you have the confidence that you could run your own business yeah to you know looking back over Health Care over the years and having that Foundation of volunteering in a nursing home for a decade before ever really realizing it was a business is when I started realizing that there’s problems in healthcare and and at that same time I was you know either just getting older or maybe the business was getting more complex or more public that I realized that there was a business of healthcare right it always just thought it was um more fortunate people in a community taking care of less fortunate people in a community but the reality of it was is it was a business and and so it was a business that I realized I wanted to be a part of but that I didn’t necessarily like and so I realized that one there’s problems and what do you do with a problem you try and solve it and and so that was when I got into the nursing home management side around Indianapolis and we’re working together with regional management companies and trying to improve systems improve throughput of patients and then went to more Regional and then National I just got tired of traveling and and had a young family at the time and you know kids in diapers and a wife at home and me being on the road was not exactly parallel to what she thought she was getting into and so ultimately came off of the road and started working together with a post acute care physician that was in Indianapolis Dr Linda strobes who’s somewhat legendary in my little world and and started working with her practice and basically under the pretense of I’m going to get you safely into retirement and and and then we’ll figure out what to do with everything next throughout that time started realizing there were complex problems in health care not just superficial you know oh focus on on a Friday and by Monday it’s fixed and these were issues that were substantial right and and so at that point um started really working closely with our national trade Association amda the American medical director Association at the same time that’s a very clinical driven trade Association that’s for Physicians and nurse practitioners Physicians assistants that are working in the space of Post Acute Care and how do you clinically do things better what are new things that are coming to Market what are things that they can do to improve the outcome and ultimately decrease costs to Medicare for taking care of these patients right and so once I started establishing a network of different post-acute care groups and getting and earning trust among peers that that were other physician practices that were going on around the country my role was all the business aspects of how do you successfully operate a practice that maybe in fee for service looking to get into more value or maybe in value but struggling and that was when um kind of took that network of facilities connected with a group of investors and we formed one of the first um post-acute care Centric accountable care organizations which were acos to try to improve patient outcomes at a decreased cost then of course a worldwide pandemic hits and and primarily impacts the patients and our in our Arena right and so at the time I was working in Southern California and doing the long commute from Indiana to California pandemic hits trying to operate something with travel restrictions seven states away had elected to step down as the Chief Operating Officer into a Consulting and advisory role and others started calling and and going over what their issues were and what my skill sets was and put those together um and and now I’ve been amassing a healthy following of people that have identified issues that scepter Consulting is able to help address that was my Gateway into getting into Consultants yeah fantastic well tell us a little bit more about the company and uh more specifically how do you help folks through your Consulting yeah so it’s uh it’s very much a boutique consulting firm so it’s a very narrow sliver of health care that I’m trying to improve and and that is I think it’ll be the third time and likely not the last time I’ll say it is that we’re trying to improve a patient’s outcome at a decreased cost to Medicare so they’re just that sentence alone has societal issues that people tend to be very afraid of dying and the decision maker is likely one at the worst time of their life to be making a decision like that because they’re making a decision at an age that they’re likely more afraid of passing away than anyone else in this history kids tend to be immune they they don’t view death as anything that but way down the Horizon elderly patients are getting tired they’re now they’re very much involved in the Health Care system and going back and forth between appointments and then you’ve got a son or a daughter that at 50 years old is likely about the time that you start really fearing mortality and and so that can be very complex conversation for both the provider who’s taking care of Mom or Dad working together with a son or daughter and so that really was how um scepter came about was identifying physician practices that are in the Post Acute Care space and are trying to make that step from what’s called fee for service medicine which is you go in you see a patient and you get paid 70 and if that led to a hospitalization that’s fifteen thousand dollars but the doctor gets paid 75 dollars and and so that creates somewhat of a perverse environment that the more a physician does the more Revenue they have coming into the practice but nobody was really looking at the outcomes of what what that amounted to could be really expensive to Medicare the doctor’s doing really well and but there’s no measurable or discernible value to the system either through improving that patient’s outcome than what was expected or doing it at a decreased costs so as accountable care organizations started to become pretty prominent what I realized in building the post to keep carecentric ACO is that our problems were very different than a traditional ACL and that’s because of the cost of a patient in the last year of life where they’re spending about 60 percent of total Medicare dollars are spent in that last year right and you’re trying to improve that communication trying to get the physician to understand that they can not just get the the 75 for seeing the patient with disconnected from the outcome of it but if they avoid hospitalizations when they are avoidable then they can participate in the overall savings generated to Medicare while also improving outcomes very cool so Tom tell us tell us um tell us about a story where someone pushed you or inspired you that you could do it even though maybe you weren’t sure that you could and the impact that that person had on you and it’s really really two that that stand out in my career one was Dr Linda strokes and a bit bit of a legend in Our Little World in the Indianapolis Market where she grew a very large practice on an inability to say no that that was her um fault if you will some an administrator or another physician practice would call and say I understand that you’re covering patients in a nursing home I can’t cover X Y and Z can you do that and never never failed by the end of that call she would say yes I will I will figure out a way of being able to get there whether it was an hour drive four or not she just couldn’t sleep at night thinking that there’s patients that a Physician Group has already said they’re not doing a good job of covering right she knew that she could improve that and so with that coming in and helping to operate that she really stretched my abilities to um one find other providers that are interested in kind of being her and learning from her so that we could have a second generation of providers coming into this not just one and so that was she’s definitely pushed and pulled and stretched and tried to figure out you know how do we put systems around a post acute care physician practice that can both promote new providers coming into the space as well as to support her and her passion to not say no and so that was a big one and then the other one is Dr Carrie weiner he was the chief medical officer for IPC which was at the time the largest post-acute care practice because America has the largest posted acute care system was the largest post-acute care physician practice in the world and and so as they were going through a sale and an acquisition to a group called team Health they started working with Kerry and he was the chief medical officer for me with care connect which was the ACO we had formed together really stretched my thinking and an ability to kind of just through conversation be able to stretch me from a belief that I had was thought was ingrained to new levels of thinking and thought on these types of patients how do you go from me being at ground level for the most part in my career and working together with individual patients and working together with individual providers to thinking more like a population you know it’s very different to start thinking about 25 000 patients and their improved outcomes at a decreased cost than it is a patient or a couple hundred patients that a physician practice may be following in this space so there was a lot of push and pull to get me from where I was to where I’ve ultimately been fantastic awesome I love that the impact that those two had on you so um over the years what’s been your biggest learning as a business owner wow that that it’s you know more complex than just going through and and registering with the secretary of state and it’s like oh okay so now I have an LLC what do I do with it and it was some of those pain points that for the most part someone else was handling in my career and I I just knew did my little sliver of work and then would go home and develop good about it most days and then wake up and wash and repeat yeah on the Consulting side it was that whole it took all the bandwidth to kind of get the business of it set up but at the same time trying to identify clients that had a very shared vision and that were I had identified problems in that very narrow sliver that I had a skill set sure yeah and so there were certainly challenges with that I appreciate you saying that because the education system teaches us how to be employees right and then as employees we learn how to be better employees and for those of us who go out on our own we’re we’re not prepared for everything that’s needed and required to be a business owner there’s a significant learning curve uh to be able to do that so I thank you for sharing that for for folks listening that who are pondering going out on their own you do want to invest in you know learning how to to build a business how to create a business how to start a business and and there are folks out there that can help you with that if if you are struggling and not sure you know all the different things that you need to do to even just you know get the business set up

Indiana University School of Medicine now has a an executive physician MBA program it’s it’s sorely missing from medical schools across the country and Healthcare in general is to understand that this is a business and it’s not something that we should hide behind it’s something that we should leverage and help and and but it needs to have physician leaders in the market that understand the business aspect so that you can hit those two pillars of improving patient outcomes at a decreased cost and do that responsibly yeah that’s awesome we know that business success doesn’t happen in isolation Tom so tell us about one of your biggest challenges uh during the years and maybe a fellow business owner who came alongside you and helped you through it

um it’s been the most disruptive aspect of Health Care that I’ve ever seen you know there were a career worth of changes in the regulatory environment of both the physician practice as well as the post-tq care segment that I’ve ever seen within a couple of weeks I saw more changes coming out of Medicare than I had seen in my entire career some of which I’ve been asking for my entire career and so I wished I wouldn’t have asked for that that ended up becoming much more disruptive than I originally had thought and so as we started developing that network of people from around the country that were also impacted by covet um it was really an impressive challenge to work together with some of the Physicians that were very early in the impact so the first U.S citizen who passed away in a nursing home in Northwest in the northwest and how emotionally charged as it was kind of making its way across the country from the West to the East and then ultimately the East to the to the Midwest was disheartening as well as the amount of challenges that the facility that the groups that anyone in the healthcare space was faced with during coven that has to be the the big pinpoint on a map to say this is when things change and was there someone that uh that you relied on to help you navigate through that I don’t know if it was an individual as much as it was an industry yeah so so the industry was really trying to unite the information coming out of the CDC the information how that was getting interpreted at the facility how that was getting relayed back to the physician practice the amount of confusion around these new things that we could do old things that we shouldn’t do right and that really fostered a very close network of people that became the interpreters they became more or less all the information that was coming down was really getting distilled out by 15 20 of us that were hashing out and what our interpretations of these things were and then be able to roll that back out to the industry um was one rewarding but two it was comforting it was it was a time of Crisis that instead of just kind of waiting for it I felt like we were a handful of people pulling on levers that were really helping people yeah that’s awesome I one of the things I hear a lot with from business owners is that it’s Can Be Lonely at the Top right as an employee we always had a manager or somebody to go to to think it out loud and talk it through and then we become business owners and that person’s gone so it sounds like that group that you just described was that right in terms of having somebody to think it out loud with and bounce ideas off of and and double check stuff before you know making decisions and then feeling better about the decisions you’re making because you’ve had different people’s points of view and perspective on it again that’s it I think that’s a a good uh I don’t know besides the right word but but a good way of I’ve always said that if I walk into a room and I’m most intelligent person there I have to be in the wrong room yeah to me that relies on always wanting to learn at the same time you’re trying to teach what you’ve learned but it’s always learning it’s always trying to take in more information so that then you can distill it down into its simplest form in order to have other people um gravitate toward that I’ve always said that if you teach the impossible the Practical comes natural and so we talk about health care there’s some impossibilities in that but there are some real practical applications and pretty much everything new coming out it just takes distilling it down to what is actionable sure yeah it makes sense um if I asked you to pick three people in your business owner Journey that you’re most grateful for them being there to help with your business’s growth uh who are those three people and how they help you yeah so two of them I’ve talked about so so when The Strokes and and Carrie weiner both Physicians of the space but really much earlier in my career my first um conference with amda the American medical director Association was in 2008 in Salt Lake City I kind of knew that that was going to be my trade Association home but to sit through a four hour purely medical clinical conversation was way above my pay rate so I’m not a clinician I I simply look at different aspects of Health Care than what a prescriber would and trying to improve that outcome into med together while I was there with two other people that weren’t going to the sessions but I kept seeing them in the hallways it’s ultimately we got to talking and that was Rod Baird and and Brad Markowitz so so at the time they were also on the business aspects of running post-acute care practices or working together with various practices once I once I felt like we’ve formed a little bit of a network you know there were three of us that would hash out business ideas on on what do you think what do you do to counter this what do I do to counter that ultimately that became known as what was the Vision Group which were people that were running post-acute care practices but wanted to know more about the business aspects of successfully running a Post Acute Care practice and ultimately The Vision Group came to represent about 5 000 Physicians around the country where we merge that into a practice management section to which I’m the chair for amdim so we moved the Vision Group from just peripheral to the clinical embodiment of amda and created a new section with them to oversee the business aspects of operating a practice so today the Vision Group is now known as The Practice Group Network okay wonderful oh that’s awesome what a great story Thomas you think about the next three to five years what are the biggest challenges that you see that you’ll face in hitting your company goals and who are the types of people you’re going to need to overcome those challenges yeah so it’s um and this is probably a little bit more grainy or than what what people would want but because my knowledge base is in a very slivered area some things I say may not mean much to the to the population Maxes but but mean a lot to our industry but what what I think we really need to do both societally is in a better understanding of the dying process and what that last year of life looks like in both a torturous environment which is a patient going in and out of the hospital in and out of the hospital procedures and then ultimately passing away to a much more involved and interactive experience between the clinician and the patient and family on that collective decision making the the other area is on the I.T side um almost every industry except for health care has really put tremendous amount of thought into their I.T infrastructure in healthcare it’s it’s untouched I mean there there are there are so many silos of information that don’t talk to each other the physician comes in they have no idea what other Physicians have done so they just kind of recreate the wheel and how do we become more interoperable between EHR systems that may not be under the same umbrella working with the same patient right wow that that’s a uh that sounds like a big hairy audacious goal I love it

if I can get that fixed before I leave this industry uh I will be uh very happy yeah awesome uh last question here Tom Jim Rohn says that we become the average of the five people that we spend the most time with so as you think about um that quote and what advice would you have for the business owners out there who are trying to do it on their own who who think that they need to do it on their own that that believe that that they can’t or shouldn’t ask for help um first off always ask for help even when you don’t need it that’s when you tend to learn the most and and have a have a big Network have people that you can count on to kind of leave the competitive Tendencies at the door and improve health care and that’s that’s I think it is I’ve had challenges with that in my career that that you know when I’m working together with a logo in the industry it can be very challenging it’s like well we’ve improved all of these Health Care Systems they’re proprietary and they’ll talk about them that that has never made sense to me because of doing something better for elderly patients in America why not speak to the masses and so that’s always my prerequisite is that I don’t look at competitiveness at all in this industry and if there’s anything that I can highly recommend and probably people in any industry is to have a network of similar minded people but that are not so similar they don’t stretch your own thinking sure I like that idea of not being not keeping it to ourselves so you know that there’s a couple you know competitive is the word you use and then what we’d like to talk about is coopetition instead of competition right it’s like hey we all we all are better if we raise you know that we raise the level for everyone versus a scarcity mentality of hey I have to take from you and therefore I have to protect right my knowledge and and keep my information proprietary versus hey if if we just do good for everybody right then there’s more money available to pay us all and and uh so that abundance mentality I think is similar to what you were just describing is that does that resonate with you it does absolutely fantastic so hey Tom um it sounds like you’ve been blessed with some incredible people that have been part of your journey and and helped you in your business so if they were all here on the show today what would you like to say to them thank you that that’s that’s the the easy one there were always various pain points you’re usually coming from an industry or working together with another industry which would be like nursing home operators that created pain points and without that Network without the people that have had a significant influence on what I do professionally um couldn’t have gotten here on my own I know that yeah awesome Tom it’s been a pleasure speaking with you today thank you so much for being on the show thank you Tim to everyone who tuned in thanks for listening to self-made as a missed show with your host coach Tim cancel be sure to help spread this Movement by liking the show and posting about it on your social media and to join our movement go to be mad together.com all right folks that’s a wrap make sure to pay it forward and I’ll see you all next time take care