Episode 002: Key Ingredients to a Successful Infusion Practice

Dylan McCabe: WeInfuse Podcast episode number two. Welcome to WeInfuse Podcast, where we take the confusion out of infusion and our whole goal with this podcast is to equip you with tools, tips, tactics, and a roadmap to really just have a successful infusion therapy practice, whether you’re provider office, the standalone infusion suite, or whatever the case may be, maybe even thinking about opening an infusion practice. That’s our goal is to equip you and really create a place for just a platform for the infusion industry to keep you guys up to date with the latest information and tactics on this incredibly conflict complex, but exciting industry and today I have a special guest with me who also happens to be my other boss, Reece Norris. So Reece, thanks for being on the show, man.

Reece Norris: Great to be here, Dylan. Thanks so much for having me.

Dylan McCabe: Awesome. For those of you that listen to the last podcast, we did mention we’re going to bring Brian Nyquist on. We decided we’re going to postpone that interview to be in person at the FSR conference, which at the time of the recording of this podcast is in the future. So we’re going to interview Brian Nyquist in person, live at the FSR conference coming up very soon. But in this episode, we’re going to kind of get into the background of Reece’s story with infusion, what got him into the infusion space and kind of where we’re at today. So Reece just share with our audience kind of your background in infusion and what got you into it.

Reece Norris: Dylan, it’s funny. We’re in my dad’s office and the Genesis of WeInfuse can ultimately be traced back to my dad who started an infusion center management company back in the early two-thousands. Bryan Johnson and I who’s my co-founder at WeInfuse were both in college at the time my dad started the infusion center management business. He was a very small player in the infusion center management space. So you’ve got the big dogs today, like Healix and Alice and infusion and then there’s a lot of smaller players as well. Our roots can trace back to when he started the infusion center management business and basically recruited Bryan right out of college to come work with him, Bryan Johnson that is, and then ultimately I went on to grad school and then came full circle back into the infusion center business after grad school and after I spent a few years working in corporate law.

Dylan McCabe: Interesting. So you went to school to be an attorney. Your dad starts this infusion practice. Bryan Johnson gets involved. What calls you to go from being trained as an attorney to get into the infusion space?

Reece Norris: It’s been an interesting journey and definitely fun. So when Brian and my dad were growing the business running with boots on the ground, rolling up their sleeves, it just inspired me that I wanted to be involved mean one of my closest friends from college was doing it. My dad was doing it, and so I was just always involved in the periphery. I just wanted to take a deeper dive into the business. Through some changes in management, there was an opportunity for me to step in and really when I stepped in my dad and I really turned the keys over to the business of Bryan and I. That’s where Bryan and I really transitioned the business from being a manager of infusion centers to being an owner. We felt with the new reimbursement challenges, as Bryan mentioned in the last podcast and medic Medicare modernization act of 2006, really had some reimbursement changes that made us have to move from a very high margin business to a very low margin business and to do that, Bryan and I thought we would be best suited instead of as managers that we would own the actual infusion centers. So we went through an entire business model transition of ending our current management contracts with physician offices to actually opening up our own infusion centers that we owned.

Dylan McCabe: Interesting. So you went through this journey from law school to seeing an entrepreneurial opportunity with Bryan, your dad, you’re switching business models, you’re bringing about new revenue streams, new challenges, new opportunities, and all that stuff with your training as an attorney and your own skill set. I mean, what everybody had a different role. What would you say was your main area of expertise and all that?

Reece Norris: It was really, obviously providing leadership. I mean, Bryan, I really ran that organization day in and day out. But also knowing kind of the best path forward after the 2006 reimbursement cuts again. They really didn’t take effect until 2008, which is about the time I showed up and so we really had to reinvent ourselves. I think when you’re doing that, there’s a myriad of challenges. When we own infusion centers, we hire nurse practitioners that created its own challenges. We had never done that before. We were very well versed in hiring nurses and registered nurses, but we hadn’t stepped foot into hiring actually actual nurse practitioners. Then just transitioning the entire business model. It was really challenging, we moved offices, we moved from Fort Worth into the mid-cities, which was an own set of challenges as well in terms of our corporate infrastructure. Then we decided to close a lot of our remote facilities that were lower volume and bring them in, bring those patients into our higher volume, larger facilities that were more centrally located within the city, and then once we did that, we were really able to streamline the business. Then ultimately we built, uh, our own legacy proprietary software system. Again, that helped us scale as well. So we had a proprietary software system that helped us operate more efficiently.

Dylan McCabe: Interesting. So you guys had an existing management company, you switch gears, changed business models, dealt with scaling staffing, a changing business model, a different way to run things. I know from working with you, obviously your strengths were leadership, tightening operations, thinking ahead, strategically. So going through, you said it a couple of times, it’s challenging. It’s we have doctors listening to this podcast. We have nurses listening to this podcast. We have business people, people in many different roles in the infusion practice in general, listening to this and with your leadership and focusing on operations, tightening things, streamlining things. What’s one big lesson that you would want our listeners to take away from what you went through and all that?

Reece Norris: There’s a lot of lessons I learned, but I think the major lesson is, I’m thankful obviously to have a great team. I think you build a team, you build the foundation, and you ultimately begin with the end in mind and our end was to transition out of the managerial model into the ownership model where we own the actual infusion centers. Once we made that determination, we all really knew where we were going. When everyone has the same common goal and the team that’s, hugely beneficial. I mean, I still remember the core team. It was Steph Parks, leading billing and reimbursement, Brian leading operations, and leading our software development really honing in on our systems. Then we had Kendall Brown really leading our marketing and PR efforts up here in the Dallas Fort Worth area. Just kind of switch on Austin and we had a really good team. I think that when you have all when you’re firing on all cylinders like that, we obviously had an incredible clinical team. That goes without almost saying, because you shouldn’t be in healthcare if you don’t have a great clinical team. So Amy Aradondo was really instrumental in helping us on the clinical side and we also had a lot of new nurse practitioners that were willing to roll up their sleeves. So in healthcare, like in any business, there’s a ton of moving parts. You have to really have a great team, but you’re doing all these things, but you’re having to maintain clinical excellence. I think that can never be compromised nor can they never been, be lost on anyone and so again, kudos to Amy. Kudos to our nurse practitioners and our nurses are really stepped up because they really, through all that transition really kept a clinical solid, and our clinical excellence. I think was first in class best in class.

Dylan McCabe: From that experience. Obviously it was a success, you guys had a very successful business. We infuse has been an exciting journey. That’s growing, we’re growing, getting new partners all the time. What would you say though, everybody is going to, you know. When you listen to a podcast or you see a company from the outside, you see a successful person, but we all know, we both know. Any successful entrepreneur knows that you fail forward and your journey is full of failures and successes and really all success. All failure is a stepping stone on the way to success. Share maybe a challenge that you guys faced in the infusion practice. One of the biggest challenges you guys dealt with as you did own infusion suites.

Reece Norris: When we were owner owners and operators of infusion suites, one you got referral sources, referring patients in. So our target market was gastroenterologist, neurologist, rheumatologist, and immunologist. So our marketing team or sales team went out to those asking for referrals. Well, the biggest challenge is meeting those expectations from the referring providers and setting expectations from our patients because these drugs are exceedingly expensive. It takes a long time sometimes to get authorization, I say long a few weeks. Immediately we had to train our team on how to handle those expectations and set expectations, not only for a new referring provider but also for a new patient. I think again, going back to having a good team and good communication, you have to have each department. So marketing is doing a great job out being your public-facing, strategy. Then you’ve got your billing and reimbursement team. So billing the claims out, making sure you’re getting reimbursed for actually the services you’re actually providing. Then you’ve got the clinical team and they’re actually doing hands-on patient care. Then you’ve got a procurement side of the business we’re actually getting the inventory. So there’s just so many moving parts and in this business, one of the key challenges is the specialty pharmacy and buy a bill inventory. So you really have two inventories you’re managing. There’s just a myriad of different things going on, especially when you’re transitioning from one entire business model to another, just have to be really careful that you’re paying attention your legacy business model, but you’re also thinking forward and your team’s thinking forward about how to take care of these patients and getting paid for your services in the new model.

Dylan McCabe: That’s a lot of moving parts. So tell us briefly, if you can, about one story in particular where you dealt with an instance or a situation that was a big challenge, maybe you guys didn’t see coming that you really had to push through and deal with, that you learn from it’s made you a better business person today.

Reece Norris: Well, I think some of the challenges, not only are the challenges operational, which we just talked about also there is an external challenges, pen stroke risk, or the government, changing things or external auditors. So one of the things we faced during the midst of all this business model transition, not only it was lower reimbursements, which does it already pass in 2006, we were just responding to them in 2008, through 2012 when we sold the business. We had to deal with external influence and one of those things was rack audits. There was our new audits, recovery audit contractor. I believe what that acronym stands for and it was basically Medicare coming and challenging some of your past claims. Well, we found an instance where they were doing this more broadly than they should have been, and actually targeting some actual claims where we had built everything correctly and we found out that it was a really global issue. So not only were we the only ones facing this issue, but at many infusion centers, physician offices or standalone infusion centers were facing the same issue and so what we did is we actually started an organization called the national infusion center association where we could pull together even as competitors, a voice for the entire industry, the niche. So from there, the National Infusion Center Association actually started because we had an issue with a specific audit that was affecting us globally. We responded by starting an entire organization. That’s now a nationwide organization called the national infusion center association. So we could have one voice. So it’s a really long way of me saying when you get into a business, any business you can see the infusion center, a few miles away as a competitor. But they also can be a great ally, especially as you battle similar challenges.

Dylan McCabe: That’s so interesting. What I like about that is it really speaks to be ready to have curve balls thrown at you as a business person. Because we have heard it, you can have a situation like a provider office where the income is, is high, but there’s a risk. If you don’t have your business processes nailed down, or if you’re not ready for curve balls, it can have a substantial financial impact and really cause trouble. That’s interesting to me that you said tying together with other practices through the national infusion center association because there’s no reason to go it alone. Even if you have competitors, that’s the goal that I’m mine from that comment from you is that even if any of those of you listening, we’ve got CEOs listening to these CEOs providers, you do not have to do this alone. There’s really no need to there are resources out there through the National Infusion Center Association, its infusioncenter.org, right?

Reece Norris: It’s infusioncenter.org.

Dylan McCabe: Right. Okay. So yes, you can become a member of that. You can look at the website, get resources, but since this is such a unique, we’re talking to the business side since it’s such a unique business model. If you’re a doctor or a group of doctors or CEOs or whoever is listening to this, it’s just great to know there are resources out there and there’s no need to do this alone. There’s a lot of equipping. There’s a lot of strength and that comes so you can be ready for those changes and turns in the journey.

Reece Norris: Just to put a plug in for a great resource is our blog, so WeInfuse.com. You can find our blog, Bryan Johnson writes most of those articles and he does a great job outlining a lot of the issues, clinical financial process operational. I think it’s a great resource as well.

Dylan McCabe: Absolutely. Shameless plug to WeInfuse. This is the WeInfuse Podcast. Let us share another story with what you guys have been through, what you’ve experienced share with our listeners, just maybe one of the light bulb moments you’ve had because you’ve been exposed to this industry. You’re obviously a thought leader and an expert, we get calls. I know from being in our office, we get to call so many calls for people asking us for help with their current practice or with help trying to open practice from the clinical side, all the business details that are involved. Everything with drug companies, distributors, payers, all the details that you have to consider. What’s one of the biggest light bulb moments you’ve had that Reece Norris has had in this industry?

Reece Norris: It really comes down to when we transitioned from the managerial model to the ownership model, I was reading in the Dallas business journal, how I think it was Tom thumb or some grocery store chain was starting to open their own clinics and they were able to build Medicare by using nurse practitioners. I really opened my eyes to, gosh, we really we’re onto something here. If they are allowed to do it, why couldn’t we open our own clinic, just focus on infusion and also be able to build Medicare and private payers as well and so from there just started lots of research, meeting with healthcare regulatory attorneys to ultimately get that green light. So again, transitioning from the manager model to the ownership model, knowing that we could go at this alone, and I say alone, we obviously need the help from the community in terms of referring providers. But that, we can own our own infusion center. I think from there, it was really off to the races for us. I think that was a light bulb moment, for sure.

Dylan McCabe: For those of listeners that listening, they don’t really know the big difference between the opportunities that are there for ownership, owning, and infusion suite. Why are there such benefits to that?

Reece Norris: For us managing the fusion center just had its own unique challenges. It was hard for me to envision how to scale the business cause you’re managing infusion centers, but therefore for individual physician offices, which has its challenges when you’re dealing with each client has its own unique set of processes, et cetera. So I was always struggling with how do we scale the business? I mean, there are obviously companies that have figured it out. I just mentioned three-helix all to Senator Fusion have definitely figured out how to scale their model to multiple physician groups, but we were struggling with it. But I thought if we could develop our own processes, make those uniform across all of our infusion centers that we could scale the business. We could provide a higher level of service to our patients, ultimately that will translate it into better business and it did. Unfortunately, Brian and I were correct when we made that bet and that took that risk, but it paid off.

Dylan McCabe: I love that. I mean, it’s all about just running in your lane and you guys found something you were really good at, you saw an opportunity and you went with it and going back to your comment before about building a great team, I mean, you guys just found something that really worked and it’s been really neat to see it all unfold to this point. I know some of our listeners right now or are encouraged by that because it’s a risk. I mean, you take a calculated risk, but it’s still a risk when you venture out in a business-like that and you guys have really tried to be flexible and pivot where you can and learn all you can and going back to the creation of the National Infusion Center Association and all these things, it’s just an exciting journey. As long as you’re willing to connect with other people and get strength from other organizations where you can and run in your lane, do what you can do and if you’re not good at it, like was John Maxwell say, surround yourself with a bunch of smart people who are really good at doing what you’re not so great at doing.

Reece Norris: Absolutely.

Dylan McCabe: You guys have done that. Well, then let’s fast forward to today. I mean, that’s an awesome story. It’s really encouraging and inspiring. Tell us about today. What are you most excited about in the infusion industry today?

Reece Norris: Yes. So when we sold our business in 2012 and we actually have a really good story, I mean, most folks that sell their businesses, they have horror stories or maybe not horror stories, but just stories that don’t end at least the way they wanted it to. We sold to Paragon Healthcare, our infusion centers, and we had a great transition. Rick Allen and his team took good care of us, lived up to the promises they made. Fast forward to today, we built WeInfuse, that’s an infusion center app software application dedicated to infusion centers. So we like to say we systemize our expertise and we like to leave behind our expertise into a platform that users, whether they are from the billing team on the clinical team on the managerial team can use to optimize their infusion center of the hottest topics today and infusion. Some of the things have changed, some still the same, reimbursement. There are always those challenges with reimbursement pears as more and more drugs are launched. Payers are paying more and more attention to space. The authorization criteria are getting harder. What we call utilization management. So payers applying different techniques to make sure the patient is actually qualified or actually deems necessary for the actual infusion. Those processes are getting more and more difficult to get a patient actually on the drug and so you’ve got to cross your T’s and dot your I’s when you treat these patients because the drugs are super expensive and you don’t want to be left with the bill. There are regulatory and governance challenges. Penn struck risk, I mentioned it earlier. Who knows how the Trump administration, where the Trump administration will land there are conversations about moving drugs from part B to D. So they’re moving from part B as in boy to D as in dog, potentially, and what’s that going to look like? Are those going to be in the infusion drugs as well?

Reece Norris: Obviously the NICA, National Infusion Center Association, is really working on that issue to make sure providers are, can continue to build on fusion through part B as in boy. Then there are just other new drugs which are challenges, but also exciting whether it’s the drugs that are in the pipeline for Alzheimer’s, whether they’re the drugs that are in the pipeline for Parkinson’s. So it’s an exciting time. I mean, we’ve just launched Ocrevus, which is a great drug for Ms. Patients and since I’ve sold the business, multiple drugs have been launched. I think the last drug that was launched when we sold was Actemra now there’s, Intivio, there’s been less, there’s Ocrevus. I mean, the list continues to grow truly.

Dylan McCabe: It is a constantly changing landscape and when I asked you what you’re most excited about today, you mentioned, WeInfuse, which is awesome because we truly are excited about WeInfuse and just total shameless blood. For those of you listening, if you haven’t done it and you haven’t seen the software, please go to WeInfuse.com, schedule a demo. We will get in touch with you because at the right time or the recording of this podcast, we’re the first and only software solution for the entire infusion center workflow. I held another demo today with a company that was comparing us to another major EMR out there and they said right out of the gate, we want to know what the difference is between we infuse in the CMR. I said, great. Went through the demo meeting and every step of the way, I said, how does this software platform that you’re comparing us to do this 10 minutes later? How does it do that? And at every point of the way they said, well, it doesn’t do that because with WeInfuse like you can explain better than I can reach the challenges you guys dealt with. But you guys looked for when you had your stand-alone infusion suites, a solution to handle everything from initial patient intake to the whole benefits investigation process, to a chair based scheduling a way to schedule to a nurse away for the nurses to chart electronically to inventory management and ordering all in one place. So stay tuned for that. But what’s one parting piece of advice for our listeners, knowing that many of our listeners either own or play a very important role in their infusion centers.

Reece Norris: I think the most important takeaway here is to make sure, make your infusion center process dependent and not people dependent. People make mistakes, I included. So try to rely on a process, whether it’s, you’re using a piece of software, as we infuse, or other pieces of software that you’ve connected together to accomplish some of the things that we infuse can do, you make it process dependent. I think so many times infusion centers and in healthcare organizations, um, you know, there’s that key person and if that keep person leaves, then no one else really knows what the left hand with the right hand is doing, you know, the phrase. I think it’s really important that you develop and continue to hone in your processes and you’re never done improving and so just when you think you refine one process, you can always refine another and so that’s kind of how we always approached our business for better or worse. I mean, we made a lot of mistakes, but we tried every day to improve.

Dylan McCabe: I love that because the process is repeatable, the processes are trainable, and a process makes it to where there’s strength for the whole team. Instead of like you said you have one person that maybe they leave, or maybe they can’t ever go on vacation because they’re so critical to the flow of the infusion suite. So that’s great. Great piece of advice. Well, Reece, thank you for joining us today and we’re excited to keep this podcast going. We really hope that this has been an encouragement to you guys. You can say thank you by going to iTunes and please rate and review the podcast that helps us just get exposure, get the word out. Also, as I mentioned, we are going to be interviewing Brian Nyquist who runs the National Infusion Center Association, and especially when it comes to those policy issues that are coming down the pipe headed our way, he will be an expert on that. So you will absolutely get the latest and greatest details on things that affect us all and we’ll do that interview live at the FSR conference 2018 coming up. So thank you for joining us today. This is Dylan McCabe and Reece Norris with the WeInfuse podcast signing off and we will catch you in the next episode.