The Ortho Show
Interview with Scott Becker
Dr. Sigman: Okay, everybody its Fro Time. It is your favorite opioid-sparing orthopedic surgeon Dr. Scott Sigman here to host another episode of The Ortho Show Podcast. Again, we have a very special guest today. We have Scott Becker who is I believe a titan of industry within the publishing world. He is an attorney. He is a partner at McGuireWoods LLP and he is the publisher of Becker’s Healthcare, which includes publications, conferences, print digital, live events… He does it all. Welcome to the show, Scott.
Scott Becker: Scott, a pleasure to visit with you today. What a great pleasure. And it is good to see you. I know you are working very hard and doing a lot of it virtually. What a fascinating chance to visit with you. Thank you so much for having me.
Dr. Sigman: Yes, we got you. I am still in the master bedroom closet suite at this point, still getting all our information out. It has been working well for me, so we are going to stick with it. So look, I was on with Mike Redler the other day. We actually just posted his podcast where we were both chatting about how proud we are that we made it to one of Becker’s lists and that we were prominently up there. So you are the master of lists. I want to tell you something right now before we get started. This is the fifteenth episode that I will be taping as the host of The Ortho Show and I want to promise you, you are going to make the top ten list, I guarantee you.
Scott: At least I know if there are fifteen episodes, I will make the top fifteen. I will be in good shape.
Dr. Sigman: No, I am really confident that you will be in the top ten. I think you are going to be awesome. Alright, lots of fun. Look, we have a lot going on with this whole COVID thing, but we are away from that, we are moving on, we are trying to get out and see what is going on… I want to talk a little bit about how you got started… You graduated from Harvard Law School in 1989, and why Healthcare Law? Why did you go in that direction?
Scott: That is a great question. I ended up in healthcare while I was working my first few years at a large law firm and what really happened – I cannot sort of out-credit this to a great compassion of wanting to solve the legal problems of the ill or solve the health problems of the world. What really happened is that I started working on a few healthcare related transactions and deals and regulatory issues and so forth. It was a really interesting area. I went straight from college to law school. I did go to Harvard Law School, but I did not know what I really wanted to do. That became more and more clear after two to three years of practicing law at a large law firm. You practice at these large law firms where it is like living in a residency… You work extremely hard, you work a ton. For three years of law, I was as burnt out as you could be. I wanted to make sure I had done some work in healthcare and I wanted to make sure that as I moved forward, I had a chance to re-setup myself, because I really wanted to do transactional work, relative work, litigation work, and healthcare was an industry versus necessarily a legal area.
A legal area would be litigation or corporate or regulatory… An industry area would be energy, healthcare, one of a whole bunch of areas that are organized by industry, and healthcare was perfect. It composed eighteen, twenty percent of the economy, even then it was fifteen, seventeen percent, and it gave me plenty of chances to explore a lot of different things and more fully figure out what I wanted to do. At the time I was in my late twenties, and it provided lots of opportunities to learn and grow and figure things out. It has been a magnificent area to get into. It was just magnificent.
Dr. Sigman: Alright, so you decide you are going to do healthcare. For whatever reason, it found you. You were not necessarily looking for it, and then you talked industry which is interesting because what you have done is really quite remarkable and I want to talk about that. You have created this space within healthcare that really did not exist where, if you need to know what is going on in healthcare right now – ASCs, hospitals, insurance – everybody is saying the same thing: Becker Publications, Becker this, Becker that. Where did you get the idea to create this?
Scott: Sure, so probably like you, I am a builder by nature. I am a learner by nature. I am not bright enough to see the end in mind as well as I would like to, so what happened was we started gradually building a following with newsletters and websites and small conferences – literally 30 years later, we’re at the 28th year of our ASC Conference – it was not intended to be the media company that it is today. I was learning, I was growing, I was developing a brand for what I was doing and just sort of learning. What happened was, about thirteen years into it, it was going very well. We had one conference to the surgery center sector, we had outsourced almost everything in that company – we were outsourcing almost everything. We started to, at that point, look at this and say, “This is interesting. This is exciting.” Certainly, I still practice law in my own way… But in some ways, this is more compelling than and a lot different than law. I talk to the most interesting people every day, people like yourself, people like Dr. Redler, people like lead executives of the largest health systems, people that are major celebrities… It allows me, in the healthcare world, to do so many interesting things. So it started to get more and more interesting.
At that point, I started to hire full-time employees in the business. There is a great theory that most of us have, that nothing gets done that is significant today without teams. So it was not until I started building a team about fifteen, seventeen years ago that Becker’s Healthcare became much closer to what it looks like today. At that point I hired a number of different people and sorted them out. One of them that stuck with me from the get-go is our President/CEO, a woman named Jessica Cole. Jessica Cole, when she started with me, she was in college. She started with me as an intern working part-time and I had hired eight to ten full-time employees and Jessica was an intern and was outperforming all of the eight to ten full-time employees that I had hired, from her apartment in college. I had to beg her to come to work for me full-time. She came to work with me full-time, became a partner and she really became the commercial officer. She is now the CEO and President and my partner, and I became the content person.
We started off in surgery centers. Then we at some point looked at – this is going back fifteen, sixteen years ago – she had started to establish herself as incredibly valuable. We started looking at strategy. We started to think, what are we going to be as a company, what are we going to do? There were different types of media companies out there. There was one that we competed with, and it was so deep, but just in one area, and that one area was not big enough to really support the kind of company we wanted to build. The flip side is that there were other companies that were in twenty different areas, and they would be typically good in three to five areas. That is where all their money would come from. At some point we made the decision. We wanted to be somewhere between those two. We wanted to be deep in three to five areas and not in twenty areas, but not in only one either.
So that was back fifteen, seventeen years ago… Now we have expanded into orthopedics and spine, and into hospitals and health systems. For a period of time, we were at surgery centers, which was the original place for orthopedics and spine, and then hospitals and health systems. Hospitals and health systems became the biggest part of our business for very basic reasons. It is the biggest market out there. Orthopedics and spine is still very, very critical to what we do. There are our surgery centers, and then health IT, which we added on about eight to ten years ago, has become very important too. The story and the evolution of how it got going… I really credit it to Jessica and then some of her editorial leadership - Molly Gamble, Laura Dyrda and there is another woman, Katie Atwood, who is the Chief Operating Officer who has been with us for ten plus years now too. Those are the people who really built a team around what we do. Now we have a large company, but very focused on four areas or so.
Dr. Sigman: It is funny. In law school, they do not teach you how to open a business. They do not teach you how to be an entrepreneur. Obviously you had to learn this on the fly. You sort of found the space where you wanted to build something… There had to have been some failures along the way too, right? It is not ever so smooth and perfect, is it?
Scott: Sure. That it is a great question. There were multiple different failures of course. There were multiple lessons learned from those failures. I grew up in a legal culture. Originally, the method of management – and if you went back thirty years or so, this was common – was the yelling and screaming method of management, versus the coaching and development method of management. You are probably around my age, maybe a little bit younger, but the gist is, if you went back thirty years, management styles were very different. So as a third or fourth year lawyer, I was one day screaming at a young lawyer for not getting anything done or not getting it done how I wanted, or for whatever reason. Another lawyer, Marcella Corpus, was bright enough to pull me aside – also a very young lawyer – and say that even though that may work for the moment, to get him to do what you want him to do, this is horrible for our entire team and culture and everybody hates it. And it was a positive learning experience – I was able to change on a dime, and ninety-nine percent get out of the yelling business. My kids might argue differently, but largely I was able to understand what she was saying and get it right away. There were multiple failures like that.
People would say, you were a genius for becoming the leading warrior in surgery centers before surgery centers were a thing. Like everything else, it was not genius. I was testing three or four different areas. Surgery centers was the area that took off. What I am good at is recognizing trends and then doubling down on those trends. I am constantly a believer in doubling down on talent, doubling down on people, doubling down in an area, doubling down on niches… We are a big believer in long-term relationships. People we connect with – we stay connected for a very long time. We enjoy people. There are a lot of lessons that have come over the years and of course lots of failures and errors.
Dr. Sigman: Yes. I mean, there is never a cookbook. Nobody says, here this is how you are going to do this, this is how you are going to build a business. You have to move forward. You take a step backwards. You make a step forward. I think relationships are huge. That is such a major thing, to be able to maintain relationships throughout your lifetime. You are never sure when that person is going to help you out again down the road.
So, look, there is a lot of concern right now about how we are going to communicate as professionals. We have all gone to the meetings. I have been very fortunate to be a member of faculty for several of your meetings. And I enjoy them immensely. I am not just there to teach but I am also there to learn, and the question that everyone is asking is: when are we getting back together? What are your thoughts? What do you think?
Scott: Sure, what I think is as follows – and it is a complicated set of thoughts and it is politicized, so you have to be careful about what you say and so on… The bad news is that I do not see us getting fully back to meetings until there is a vaccine of some sort. The good news is, the vaccine is not a cancer vaccine, it is not an AIDS vaccine. They are making progress on cancer vaccines of multiple different types, which many of us are aware of – AIDS not so much – but it is not that kind of vaccine. It is not a polio vaccine. This is more, in my view, an advanced superlative flu vaccine and you almost have to view it like that. The flu vaccine works as follows: the flu vaccine works for thirty to seventy percent of people a year and it greatly reduces the spread. You end up with a flu that is a very modulated flu, meaning it will still kill a couple hundred thousand people internationally, but it is not like the Spanish flu. It is not like what we have now, where COVID kills four hundred and sixty thousand people internationally. If we have a vaccine that works for fifty percent of the people or more, and you distribute it broadly… What will happen is you will still have a virus. You will still have a problematic virus, but you are likely to have one that spreads to a much lesser extent.
If you look at a place like New York, in places like New York where it spread aggressively and thirty percent of people got infected – at least the antibody test showed that twenty to thirty percent of people have been infected in some way or another… What you are likely to have in New York – and we’ll come back to the meeting question in a moment – is that because thirty percent or more people have been infected, you are less likely to have the next surge, at least until those antibodies wear off. In places like the southern states where they have had almost no infections, we are suddenly seeing surges, and part of the problem is that there are not a lot of people that have been infected, and so if not a lot of people have been infected, there are a lot of people left to be infected. So, you are seeing surges in Texas, Arizona, a number of places.
I think the fascinating thing about the Swedish approach – and again it is highly politicized, I do not want to talk positively or negatively about it but because a lot of people are getting infected, very negatively of course… Something like now 4,700 people have died from it in Sweden, a higher percentage in some places, a low percentage in other places… They did better than most of Europe but not as well as some of the Scandinavian countries, but because so many people have already been infected, they are likely going to be in a spot where it does not spread as quickly anymore. And it is a very complex thing. Nobody knows how long the antibodies will last for… We have a challenge in that you have a president that, whether you like him or not, he is not a particularly focused, competent leader. He is doing some things right but some of those things get distracted in his message, he is hard to follow and listen to, and then you have a left that so hates the president – and not wrongfully so, not rightfully so – [but then it becomes hard to come up with competent plans going forward].
What I do know that is great news, politics aside – the president is largely not very competent, very combative, the left-wing that is so feisty and cannot focus on just core government – is that we are already in a spot where twelve different deep human studies are going on right now that are already in human testing for vaccines. [One of the studies] is fixing to test some ten thousand people, tens of thousands in six months. They are making great progress on that. It is not the complication that you have with cancer or AIDS. The [COVID] vaccines are already showing that they create the antibodies you need that will create some immunity for some period of time. I am confident that this is a lot sooner than many of us might have originally projected. I certainly did not think it would be this quick.
With the likeliness of vaccines within the next year… Remember with the flu, they are doing a new vaccine every single year for the flu, mainly because there are different strains every single year. So, we have to understand that it will not be perfect. We also have to ensure that we don’t do too high of a dose – and you are a doctor, not me – that we do not do too high of dose, that we do not cause people to get the virus versus just create the antibody. So, there is a dosing issue and a number of safety issues. I think [once we have a vaccine], then you will start to see meetings reconvene fully… Then we are also dealing with an economic recession, which will mute the meetings to some extent. That is a long answer to your question. Sorry about that.
Dr. Sigman: That is ok. So, are we going virtual? I mean, there was the TOBI Conference – that was the regenerative conference that I was a part of – and they actually did a pretty good job and people were able to pop in and out and were able to go various lectures. I mean, what is Becker’s strategy going forwards until that vaccine happens?
Scott: Sure. As a company, we were already fifty percent digital. Now of course, for the moment, we are one hundred percent digital. What you are in for in the next year, and if we have meetings planned for this fall… We are not confident, in the current atmosphere of uncertainty, as to what will happen with those meetings. We almost see it as, when live events start to happen again for sports, that is when they will happen for all of us. At least, it will be the first test of being able to do it or not do it. Then the second test will be a review of people’s confidence in their economic ability to go. So we are still holding out hope. I would not say we are cautiously optimistic, but we are hopeful to start meetings late this fall, and we are very confident about meetings starting again next May or so. If you end up virtual to some extent… The good thing is that virtual is getting better and better, and people are getting better and better at it. You see it through digital health, you see it through all kinds of telehealth. Everybody that did not do it before, they now have to do it, and patients like it. Virtual conferences obviously do not provide the same complete ability to connect with people – I mean so much of being in a meeting is, as you said, it is not just the learning, it is the networking. And it is like anything else. You could talk by phone, but when you sit down with a close colleague, you really get a sense of what is going on – here is what is going on in their practice, here is what is going on in my practice and so forth – it is much harder to do virtually.
Dr. Sigman: Yes, and I think there is also a lot of pressure – especially for the doctors that are part of academic centers, there is concern… Is there going to be another surge in the fall? I do not think a lot of the academic centers are going to allow their doctors to travel. They are just going to say, you cannot go to a conference that has more than thirty people because if you do, you are going to be quarantined when you come back and you will not be able to go to work. That is what happened before, that is when they finally shut down all the big conferences, all the academic services. It is a challenge, it is different. But at the same time, you guys are positioned well. Like you said, you were fifty percent digital before this happened. You will make it work and we will figure out a way, whether it is in antibody testing, vaccines, and surveillance and all of that, but we will eventually get there.
Scott: Yes, but we are thrilled with the leadership of the company that we have had – Annie, Kate, a whole number of people – Emma, Margo, Scott – who have done this magnificent job of just really pivoting to double down our digital efforts. I believe what you said about academic medical centers, and hospitals and health systems… They are going to be cautious about sending their people to meetings. And it is what it is. And this is normal and natural. There is also going to be economic pressure not to send people to meetings for a while. And so all of those things will probably plant a cautious rebound into meetings, but there is pent up demand for meetings like there is for everything. You can see it when people have been locked up for three months and now the bars are overflowing even though people know there is some danger with that. People are anxious to meet in person, so I think in the long run it will be fine, but it will take a while.
Dr. Sigman: Yeah, I agree. It’s pretty fascinating – when did you get started with ASCs? What year?
Scott: Our October surgery center conferences are 28 or 29 years old. What’s fascinating about the surgery center business is, we saw rapid growth for a period of time, then we saw much slower growth, now we are seeing some growth again. It has been fascinating to see the different participants and players changing it. The biggest procedures are still ophthalmology, gastroenterology, orthopedics and pain management, those are the four big procedures by volume for surgery centers. They are still what drives a ton of surgery centers, and you have seen just a lot of changes… The big companies – some of them have gone in and out of business, they have sold themselves, [the biggest distinction between them and hospital systems being] outpatient surgery versus inpatient surgery…
What is interesting about surgery centers is that they were driven a great deal by relatively independent surgeons. The fact that gastroenterologists, ophthalmologists, orthopedic physicians, pain medicine physicians, etc. did not become a hundred percent employed is what led to surgery centers surviving through a long period of time. They have continued to survive in part because those key specialties, at least relatively, have stayed independent while primary care physicians have largely become employed. It has been a fascinating sort of Saving Grace of surgery centers, and even as it evolves and changes… You have had payers for a very long time who were adamantly against surgery centers and there is a good reason why they were. In fact, I’ll explain it, it is perverse. It is a backward reason but it is a good reason. What happened with payers is that their biggest supplier was the local health system. Any dollars that came out of the local health system, even though it might have helped them pay less for outpatient surgery, it caused local health systems to charge them more for other things. So, ASCs might have been a way to save money for payers, but because the payers were so dependent upon local health systems, it was sort of, they would save money with surgery centers but lose money on their hospital contracts… And as long as hospitals and health systems remained that very important part of the payer universe – often thirty to forty percent in a specific market of the dollars that payers were paying was going to the hospital – it was a very strong incentive not to take money away from the hospital, because the hospital can just charge in other ways for it. You finally have now a situation where payers are much more open and interested to working with surgery centers, at least in some markets.
Dr. Sigman: Tell me – what is next for Becker? What is the next major event? What is coming down the pipeline? What are we going to see next?
Scott: Sure. So we always start with a core strategy of eighty percent of our resources going to doubling down on what our core things are. Before we look at the new things we always spend – and this is core to our living and being and how we work – eighty percent of our efforts go to doubling down on hospitals and health systems, health IT, orthopedic and spine, and surgery centers. Those are the four areas that sort of pay the bills, that drive our traffic… [Because we are] the business place for those areas, the business and information source for those areas. We start with that, then we will look at – there is still lots of room in those four areas, and then we will look at cardiovascular, oncology, pharmacy… We are doubling down there because there is just a lot of interest in those areas. One of our health IT meetings revolves around health IT and clinical leadership, our other health IT meeting focuses on health IT and the revenue cycle, but it’s these areas of cardiovascular, oncology, pharmacy… Pharmacy is such an expensive spend for hospitals and health systems – they are very focused on controlling pharmacy spending, so we are working hard in that area. Then we have a lot of work around cardiology, oncology and so forth, where there are big, interesting markets and people trying to connect and learn.
Dr. Sigman: So virtual meetings – I know you still have a couple of meetings planned for the fall, but is that where we are right now? We are sort of waiting to see what happens?
Scott: Yeah, I think so. What we are really looking at are virtual meetings, but for the virtual meetings, we will have shorter, smaller virtual meetings. When we do our regular meetings, we often have two to four day events where we get a chance to bring in lots of magnificent speakers like yourself who speak about opioid-sparing strategies… We try and bring in lots of great speakers to create a great environment for networking and sharing and learning and so forth. In the audio context and the virtual context, my impression is that it will be more like our newsletters – our newsletters are always short, concise, get to the point and get you what you need. I think that people are much more likely to stay engaged in virtual meetings if they are relatively short and to the point. I mean, if you sit over a virtual three day zoom meeting, you may literally, there are the suicide statistics all over the country… I mean, they are just brutal to do, and so what we are likely to end up with are lots of short parts. We will do longer meetings with lots of short parts where people do not need to sit through all of that. The way I think about everything is, would I want to do that? If somebody asked me, do I want to sit through a three-day meeting that is virtual, that is on zoom on the computer? I cannot even listen to myself for three days, let alone other people.
Dr. Sigman: [The long ones] are not going to happen, but you can do it in the evening, a couple hours over an evening when people are home and it is a good time, you discuss an exciting concept and make it interactive… Get away from the didactics, but you have conversations going back and forth – those are always very exciting. I have been a part of a number of those webinars where it has been a lot of fun to participate.
Scott: There is a great appetite for it. I think there is a great appetite for them, particularly the ones where there is some back and forth, and where you are in and out within X period of time, but if you keep somebody on a zoom for four hours… It’s impossible.
Dr. Sigman: Yeah, and I am standing in my closet so I cannot stand still for four hours. So that is not going to happen. Hey man, I cannot thank you enough. This was fantastic. Everyone, this was Scott Becker, a leader in the publishing industry and in the medical space. It is just amazing to have had you on. We really want to thank you for all the hard work that you are doing that allows us to network, to gain the information that we need to move forward and really make a difference on the planet. So thank you very much.
Scott: Scott, it is a great pleasure. You are one of the greats. It is a pleasure to visit with you. It is fantastic. Keep doing what you are doing. You have saved so many people’s lives through your opioid-sparing efforts – that is more valuable than anything that we do, it’s magnificent. Thank you so much for having me.
Dr. Sigman: Fantastic. I want to thank our sponsor OrthoLazer orthopedic lazer centers. This is Dr. Scott Sigman, hashtag follow the fro, host of The Ortho Show.
Till next time.
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