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4/20/2023

Chris Greenman

Vail Summit and Orthopaedics

Section A:  Problem Definition

Vail Summit and Orthopedics has a great tradition of excellence where physicians share the value of a laid-back lifestyle clinical excellence an experience that patients chose to come back to with some of the best outdoor sports including the best powder in the whole country there in the Arapahoe basin.  I won the Aspen High Country Triathlon years ago and also biked to the top of Mount Evans while Resident there.  

VSON was Founded by Dr. John E. Gottlieb, Dr. Peter Janes, Dr. Paul Abbott, and Dr. Lonnie Chipman in 1979, VSON (then Vail Orthopaedics) was the first orthopaedic clinic in Eagle County.  Prior to then, all orthopaedic injuries were sent all the way to Denver for treatment in a troubling wilderness medicine impasse for the otherwise hugely civilized and sophisticated people of the High Country. Despite the challenges of starting a practice in the mountains, VSON worked alongside Vail Health to bring a high standard of orthopaedic care to the local community.

We share your VSON mission; At Vail-Summit Orthopaedics & Neurosurgery, we at profee.me are dedicated to providing our community (residents and visitors) with the highest quality of musculoskeletal care; we believe that the sophistication of your practice of medicine benefits from equal proportion in sophistication in operations in management in this shred journey in Perfecting the Brand of American Medicine at Vail Summit Orthopaedics & Neurosurgery.  Where your physicians individualize treatment for each patient, taking their lifestyle, fitness goals, and the unique presentation of their injury into consideration.

We share your mission; Every day, the staff at VSON provides our patients with compassionate treatment and follow-up care because we care about their personal circumstances and goals.

We share your ​Through innovation and ongoing education, we use evolving and pioneering techniques to improve the patient outcome and experience. VSON contributes to the communities in which we serve, believing to effectively care for a community, we must actively engage with its residents and contribute to its organizations. 

We share your principles: As the demand for orthopaedic care grew, Vail Center for Sports Medicine opened a clinic in Summit County, rebranding to Vail-Summit Orthopaedics. With the addition of Dr. Ernest Braxton in 2017, VSO added a much-needed neurosurgeon to its team and became Vail-Summit Orthopaedics & Neurosurgery.

WE share your belief in your independent brand choice and world-class care.  In 1989, Vail Orthopaedics became the Vail Center for Sports Medicine, growing so much that additional physicians were invited to join the practice. Dr. Scott Raub joined the organization in 1999, followed shortly after by Dr. Richard Cunningham in 2003.  Today, the doctors and staff at Vail-Summit Orthopaedics & Neurosurgery continue to provide world-class care to area residents and visitors, practicing in seven clinics across Colorado.

Would you be willing to permit me to Ordain a Chief Resident in this medical sect from applicants in each  of your residencies as part of Scythian Metabolic Topology Lithuanian Health SMTLH evangelizing our mission throughout American through G5 throughout the world?  Other nations are willing to make the change as part of the Hippocratic movement that had seven liturgies the seven prioritizations of the Hippocratic Oath prior to the 1910 Flexner Report when physicians were asked to be everything to everybody and they are burning out and Emergency Room physician life expectancy is only 58.7 years[1] which out of 202  countries is shorter than all but 8 of them (Chad, Lesotho, Nigeria, CentralAfrican Republic,South Sudan, Somalia, Eswatni, Namibia) where physicians are a diaspora a nation and emergency physicians are epidemiologically getting sub sahara African in life expectancy for being asked to be everything to every one.  Would you be willing to let me Ordain a Chief Resident in the seven medical sects that were there prior to the Flexner Report.  

ADDING THE ORTHO OATH SECTION ON PRIORITZING THE OATH

PRIORITIZING ANOINTING OF THE SICK, PROFEE.ME#24 BASED ON OATH

There are international patients in the High Country there  are national patients in the High Country which results in complexity and registration in the business office.  This is complicated by the roster issues in the Colorado high country labor market where the best people at the lower job functions often cannot afford to live there - the people that live there are highly valued in the labor market.  This problem has been described in my book Perfecting the Brand of American Medicine where there are 

You’re not gonna want roster sourcing from cowboy Arizona or from big cities like Chicago where they don’t share your values where they don’t share your tradition and they don’t understand your patients your payors your place.  Me?  I was a Resident at Kaiser Permanente right in Colorado where I released resources for physicians and providers like you.  We have serviced private physician groups in Colorado keeping them independent with the laidback lifestyle the Colorado tradition of chivalry and physician centered practice of medicine.  

I understand that your very busy & prestigious orthopedic practice is taking off which seven clinics, you’ve hired a skilled business administrator that has been successful with us in multiple ways and multiple goals.  I am aware of some of the strategic challenges you are facing:

·       Lack of an updated strategic plan for tailored to the injured worker, lack of payor mix, in light of the patients that come to you from all over the world from all over the country

·       Lack of market research insight at the right level of income per zip code, HDHP, Payor Mix, and workers comp in light of the health plans data available

·       Lack of a personalized marketing plan for each physician with a profee.me personalized menu of operations of how to operationalize your practice.

·       Lack of future-oriented registration to serve the strategic plan in a way that changes the way that medicine is practiced for the better.

·       Yield to an operating plan for physician compensation at market pay for market work in light of the work needed in recruiting for tough to get people the cost of housing being so high and the rising cost of front line labor. 

·       Lack of a business office function that has oversight over the administrator as a check and balance

·       Lack of SEO for key search terms for the business as it exists today

As a fellow medical scientist in MSK I understand your mission and can help you shape your scientific ideas into practice.  As a fellow entrepreneur I share your desire for a personalized business that impacts science medicine and patients.  What I believe that during this time it is especially important to have an independent advisor committed to your goal of independence and suitable for the revolution in MaaS:  to define your mission

Michael Porter defines value as the sum of clinical quality + patient experience for the price; the prices that you charge ought to be competitive based on the experience you provide.  The beauty of increasing value through an experience is that every customer knows how they feel when they experience your vision, you can increase willingness to pay, cross sell, & will help you grow market share by customers recommending you to others. 

“You can’t do energy architecture engineering separate – these require a Jagiellonian Law” which we now offer as a Calculus Doctorate.  Our suite of services puts the power into the hand of the physician to control a practice with his lifestyle his specialized Medical Sect.

Section B:  Proposed Scope of Work

1.     Business Office Manager

o   Chris Greenman and us have successfully implemented Business Office Manager in a way that has transformed the operations of a practice in a similar sized group with a market that is tough to get people

o   Thought leaders just like physicians will rise again by building relationships with employers while confronting the rise of insurance gated-keepers, deniers, & procedure authorization.  Our Business OfficeTeam organizes employees in a step-wise process to optimize collections, expertise, & fairness. 

o   The ambulatory surgery center is a point of strength.  The High Countryfinds it tough to get people were the cost of housing is really high and it is even harder to find a roster of people that are professional that share the Vail Summit and Orthopedics - Me I lived in Colorado three times with sophisticated knowledge of the roster and recruiting issues there. 

2.     The recruiting industry is a fraudulent intrusion into the licensed practice of medicine where these individuals are not engaged in the mission the values the needs of the physicians

o   Just as the ambulatory surgery center is a second procedure mechanism the work of recruiting in a practice that is in need of tough to get people market with high cost of housing and many high quality personalities of physicians inside the practice.  Our Medici Prime Bank is offering a mechanism for the physicians to be compensated internally for the work of recruiting and developing talent in the practice at a market rate.  The High Country is harder to find a roster of people that are professional that share the Vail Summit and Orthopedics - Me I lived in Colorado three times and it is analogous to our tradition in Florence where we would provide procedural compensation for work inside the family outside and lower than your scope of practice with sophisticated knowledge of the roster and recruiting issues there.

3.     A mission vision and strategic plan with the right data

o   Our experience is that mission statements are sacred and critical to the success of any organization. 

o   Best in practice publicly generate companies $2 in revenue per $1 of asset; hospitals don’t do half that number. Hospitals have too many assets & physicians have too few.  Hospitals will be forced to right size their space & spin off their doctors.  Physician groups under Pro Fee can beat these revenue benchmarks while keeping medicine independent.

4.     Ways for Vail Summit Ortho to get paid market work for market pay

o   Overhead has escalated throughout the electronic medical record era.  Staff productivity has declined 1% per year in healthcare while it’s increased 5% per year in manufacturing & 3% in retail.  Fixed costs like marketing, compliance, technology, & real estate have escalated faster than physician salaries.  The rise of hospital employment has increased the total wage + benefits of employees, but the bond rating risk of hospital physician salaries puts physicians in line behind the creditworthiness of the hospital.  Patients will pay more for quality service user-Xperiences, more accessible practices, & better trained staff.  Brands will grow word of mouth referrals & benchmark the prevalence of customer emotions disgust, contempt, fear, anger.

5.     Opportunities for personalizing marketing for Vail Summit Ortho.

o   Medical secretary training and Psychometric tools can be effective as a diagnostic for physician and leadership development, recruiting of key personnel for fit, awareness building as individuals & as a learning organization, & reducing destructive conflict between individuals & departments. 

6.     Jagiellonian Registration

o   Patient registration is often completed in triplicate; by fax machine, by phone call, & in person.  Stop the madness!  Patient portals such as with Centricity have digitized the experience for established patients but gated-keepers & required fields haven’t differentiated practices in ways to attributing new members, new patients, nor the management tools for auditing upfront cash collection nor insurance verification despite the rents physicians have paid to software promising to do so.  Join our movement automating the registration of readers and patients. 

7.     Marketing PowerPlay

o   ProFee is able to cull the patient registration list into a marketing plan for GeoSurgeon.

o   Physician Supply has been mal-aligned consumer demand block by block & town by town.  Physicians & medical scientists haven’t been afforded peer review on the independent practice network that’s made America great.  Dr. Eisenhauer has something great to offer with his book & care.  Our physician supply calculation is built on actuarial tables & mapped to your marketplace. 

8.     Personality testing of your supporting Caste your Roster of employees

o   Chris Greenman and us have done a masterful job of assessing personality types of employees and creating personalized development plans that elevated employees to their very best where this display is of your employees’ personality.  

9.     New Hippocratic Medical Sects

o   America was founded by physicians with the promise of there being an ecosystem of different Medical Sects for ruling the country.  The Dutch-Prussian-Lithuanian-Russian Knights that came to America as Founders were often trained in Hippocrates as in superior in horses where those that trained to provide medical care for horses Caste systems were deemed acceptable for providing medical care to homosapiens.  The Medical Sects collapsed into just two Medical Sects focused narrowly on the practice of medicine.  The East Germans experienced a collapse in the number of private practice physicians where they did not diversity protect the Hippocratic Oathed from the intrusions of government and the United States has seen similar declines

East Germany[1]

By Year

Doctors in Private Practice

% of Doctors in Private Practice

1965

2524

35%

1979

1888

18%

1980

863

5%

1989

340

2%

Section C:  We Understand You

There are Vail Summit and Orthopedics doctors that say they want to keep like back in time the field of dreams scope of practice with percent of charges contracts - that’s what we do at Profee.me - my great great grandfather Greeley Whitford was a pioneer there who arose to be the Chief Justice of the Colorado Supreme Court - we’ve been executing the laid back lifestyle in Colorado since Wyatt Earp and all the other cowboys - Greeley married Dr Martha Berry Spaulding’s daughter who graduated from the University of Iowa Medical School and cared for Abraham Lincoln in Mount Pleasant Iowa - at todays $20/hour on down you get some gems you get folks sent off to Arizona or cowboys sent meat packing to Chicago.  

Pro Fee was founded for independent physician groups as part of our tradition as Batavian Knights in our shared tradition of superior in horses that the Ancient Greeks have called the Hippocratic Oath who ruled over 2000 years ago our tribe includes a Caste of Jagiellonian Knights that complimented the physician caregiving side and dominated together.  The Jagiellonian Law Principle of Depositus for a Knight was how to care for an empire of Hippocratic horses and himself.  The cities fed the Rangers within a ridable distance just like you where the High Country orthopedic cases chose to stay in Vail Summit and Orthopedic.  The ascent to seven clinics exceeds the Jagiellonian Law that the fourth clinic of yours was critical to stabilizing the availability of services throughout your service area your market.  That maturing of your operation requires as a partner in the engineering of operations.  Jagiellonian Law is a the Ancient Law of Natural Law of defending your Hippocratic Kingdom based on the 2000 years old tradition of Knightcraft we Batavians have kept secret from others for all these years.  Our practice of administration is fueled by our voracious appetite for matching the perfection of physician practice of medicine with administration that is equally Hippocratic equally physics intensive including my own Kyrios Relativity which is a three book set describing errors that Einstein left us in Relativity and how

We Batavians were a dominant tribe buried like Knights each with their horses together in archeological Citadels including Mints along the Batavian Rhine Principality for protecting the business office functions for trade between nations and tribes included a Oaths of professionals from physicians all the way down to the bottom of your caste system of calligrapher scribes at registration.  We had methods for negotiating with the Riparian pirates that would come from down river such as the insurance companies where our tribe was laidback gentlemen benevolent dictatorship at confronting these threats where we carefully managed what tribes could buy a horse from us what tribes could have an empire of horses from us and what tribes could have none  – our Rengen our horses our knights rolled right up to the ramparts along the Rhine River and if the pirates dared come up stream we dropped the camouflage and blew them into the stone age and convert them to our faith or set their boats on fire with artillery. 

for domestication and shepherding of horses for commerce and for defending the kingdom against instructions of Riparians pirates into our Ancient trade corridor between the Rhine and the Danube over 2000 years old that where our shared use of Rengen along the ancient ramparts were central to the stability of the economy in modern Germany which are some of the Orthopedic places that American Orthopedists respect clinically just as the Regen in the Dutch are known as Regenten who you know today as United States Marine Corps where my tribe insourced the Dutch Merchant Marine into the United States at the collapse of the Dutch Golden Age as part of this experiment we call America – do not let Vail Summit and Orthopedics be at the twilight of the Gilded Age of High Country Orthopedics – invest in a relationship with profee.me.  Other independent groups are  facing flat & declining reimbursement, aging demographics, increasing time burden due to dozens of quality initiatives, the alphabet soup of regulatory burden (going back to MU, PQRS, etc.), rising physician dissatisfaction with their profession, employee retention / engagement issues, and a growing administrative burden.  These problems can be resolved with a professional management partner as a compliment to your team.    

Many physicians point to the need for more administration:  COO, CIO, CFO, and other layers of functional full time management to help meet these objectives.  Profee offers a management as a service model to you with a menu of services that you want in your management that can be customized to the physician level on a product by product basis to demonstrate a value that is structured in a mutually beneficial way that is designed to provide long term value & insight.  Pro Fee was founded for independent physician groups as part of our tradition as Batavian Knights where Vail Summit and Ortho so to superior in horses that the Ancient Greeks have called the Hippocratic Oath who ruled over 2000 years ago our tribe includes a Caste of Jagiellonian Knights that complimented the physician caregiving side and dominated together buried like Knights each with their horses together in archeological –Batavian Rhine Principality included Mints for protecting the business office functions for trade between nations and tribes included a Oaths of professionals from physicians all the way down to the bottom of the caste system of calligrapher scribes at registration.  We had methods for negotiating with the Riparian pirates that would come from down river such as the insurance companies where our tribe was laidback gentlemen benevolent dictatorship at confronting these threats where we carefully managed what tribes could buy a horse from us what tribes could have an empire of horses from us and what tribes could have none  – our Rengen our horses rolled right up to the ramparts along the Rhine River and if the pirates dared come up stream we dropped the camouflage and blew them into the stone age and convert them to our faith or set their boats on fire with artillery.    

The First Knight “the Jagiellonian Law Principle of Reparius for a Knight was how to care for a port a river a creek and where the low lands of the United States from Harvard on up from Columbia on up have their practice of medicine under a kind of admiralty law that the Founders of the United States where those that have fewer than four ports are at a disadvantage getting goods from the global market and onto the global market where back to the American Revolution story in the American Continent where adding the fourth port in Philadelphia was critical in defeating pirates as exporting nations and immigrating Shepherds had the irreducible Reparian scale of safe options for goods for people to arrive in.  The ports brought the Good Shepherds to America including livestock that stabilized food availability and brought the Dutch Merchant Marine to America that brought her above the King of Britain where Jonas Batulis arose triumphantly as King of English as in the language under Sir Henry Vane in Heaven whose language was hegemony on the seas and sealed the fate of America as a naval power.  Your series Metabolic Topology shows that the fourth city was critical to stabilizing the availability of food in the New World.” 

The Hippocratic Horse didn’t domesticate itself and didn’t ride it to the top of the High Country – bronze didn’t smelt itself – iron didn’t smelt itself.  The pioneers that came to Colorado did that work and we Jagiellonian were there to run the low class play out of the professional roles in Colorado back under Greeley Whitford who was Chief Justice of the Colorado Supreme Court. 

“In engineering in Validoral Relativity the arrival rate of international trade yaknow the Jagiellonian Law Principle of Riparius for example does not gain scale and stabilize until the fourth warm water port cooccurs in place until the fourth port city occurs in a linguistic nation in place.  Everyone knows that landlocked nations have huge disadvantages but Economics has not embraced this Riparian theories of economic development where it not a theory but rather a logical deduction proven the America proven in queuing technology in telephone switchboard by Agner Erlang.”

The Ports posed an opportunity for the Batavians U.S. Rangers to either learn new tactics or elaborate on where there were early successes by some of his recruits in action south of Harlem Heights – the Hudson River had some positions where U.S. Rangers artillery proved unbeatable but the width of New York Harbor exceeded his range, ports had guns, and the American Revolution importance of the port including the relationships with merchants fishermen in this principle of Riparius as in the arrival rate by sea.  “The ports in the Americas have to become open to global trade – the British inspect every vessel and tax them.  Our strategy is to continue opening ports down the coast to stretch out their Riparian lines and end the embargo.”

There are those Riparians such as Harvard Business Schools Michael Porter who have failed in their work to rid America of the British admiralty law that you see in insurance companies such as the McCarran-Ferguson Act robot Lien; The McCarran-Ferguson Act is an example of that remnant of admiralty law of Riparian Law that implies despite the fact that a physician is the highest expense person to train in our society and carries that debt load and contributes to society that uneducated pirates claim the physician is alone at sea when he’s the one on solid ground and in the case of Vail Summit & Ortho 8000 feet above sea level.   The art of the pricing of the work of medicine should be as artful as the therapeutic work of medicine.  The insurance company is trying to say the physician is just in a dingy and that the patient you are caring for is just some seabass caught at sea that the insurance company doesn’t even expect to come back next year.  This kind of Riparian Law trace back to the British Caste system that we resisted in the American Revolution and it will go away when professional arise to the occasion to confront it the way that Batavians did. 

Physicians in practice today are aware of the public term “value-based care” and perhaps less aware of the hypothetical construct “Virtuous Cycle” which has been a kind of “religion” that has committed many logical, actuarial, and common-sense sins to the detriment of physicians: 

·        Value-Based Care has not accomplished what it promised.  Life Expectancy has waned since 2014 with mandated compliance with EMR mandates; not all technology is effective in extending life expectancy. 

·        Value-Based Care has an over-reliance on “private sector rivalry[2]” over medical science in extending life.  “Value-based care” depreciates the importance of basic science & medical training in extending life.  Aseptic technique for example has been central throughout the history of Perfecting The Brand of American Medicine; we didn’t get the Mayo Clinic by asking customers of 19th century surgical barbershops if the floor looked clean on a five point Likert scale[3] mandated from the federal department of Barber Health and Human Services (see Seven Topologies in Chapter 3). 

·        “Compliance” scoring has resulted in care models that repeat the façade from the Medical Expectations Topology (Chapter 4) of moving patients at the margin equivocal or close to threshold rather than those most at risk.

·        The "Virtuous Cycle" presupposes the Fallacy of “process efficiencies.”  Both medicine and operations include reversable knowledge bridges and cycles beyond process. 

·        Health System Reputation doesn’t spontaneously cause greater sickness.  You can’t sell sick to healthy people as the "Virtuous Cycle" presupposes.

·        The going concern of “value-based care” increases the likelihood of an East German model where consumer options for physicians.  The Berlin Wall went up in 1961, where in 1965 35% of East German doctors were private and by the time The Wall came down 1989 it dropped to 2% as life expectancy had fallen behind West Germany (Chapter 3).

Section D:  Term & Termination

1.     Term – This general service contract shall exist for 12 months with an automatic renewal for 30 years unless terminated by either party.  Vail Summit & Ortho is building a brand ProFee like Marriott like U.S. Army Rangers knows how to build a brand over a prolonged period of time. 

2.     ProFee is agreeable to providing any services listed in Section B to Vail Summit & Ortho.  This list may be amended & renegotiated at any time by mutual agreement.  Vail Summit & Ortho (customer) agrees to provide necessary access to data so that ProFee may use their qualifications & experience to provide deliverables.

3.     Waiver – Vail Summit & Ortho agree as ladies & gentlemen to hold ProFee LLC, owners, & heirs harmless. 

4.     ProFee exists as a MaaS, management as a service and media as a service software company.  Vail Summit & Ortho agrees that ProFee exists as a software vendor and not as an independent contractor nor as an employee as defined by the US department of Labor & other regulating bodies. 

5.     Confidentiality & Anonymity – Vail Summit & Ortho agrees to keep all ProFee data sources, methods, dashboards, and deliverables confidential beyond the length of this agreement with the exception of potential vendors & potential contractors as needed.  Vail Summit & Ortho agree that ProFee may use anonymous or “blinded” deliverables from this project in marketing material up to and including testimonials of ProFee for other physicians.

6.     Business Associates Agreement – supplement to be attached for data-sharing agreement of Vail Summit & Ortho reader customer and EMR lists. 

Section E:  Data & IT Request

·       Access to reporting, NPI, or bookkeeping services of Vail Summit & Ortho

·       Best practices guide for Vail Summit & Ortho

·       Any business plan, mission, and vision for Vail Summit & Ortho

·       Access to roster, facility plan, staffing plan, existing strategic plans

Section F:  Qualifications –David Batulis, MHA, CALCD                  

Administrative Experience

·                 Orthopedic, Internal Medicine, & Gastroenterology practice experience with solo physicians up to 110 providers in a multi-specialty clinic.

·                 (co) Founder of Periodic Journal of Physiology, ProFee, Food for All.

·                 Healthcare leadership including full spectrum revenue cycle experience & accountability over $3M to $50M medical practices.  Functional titles include Business Manager of Surgery, Director of Clinics, Chief Operating Officer, Chief Financial Officer, Board Treasurer

·                 Founder Leading Expect Lean Six Sigma & Change Acceleration

·                 Certified Myers-Briggs Administrator

Revenue Cycle Experience

·                 Over three years of Centricity software experience including reporting & workflow

·                 Led an $8M+ turnaround across a multispecialty practice from four merged practices using decision support & employee alignment to improve financial controls

·                 National benchmarking committee member for specialty physician executive

·                 Experience as guest lecturer to physician residency financial element of medicine

Optimal Diplomacy

·                 David also brings founding Group of Four hotel leadership & revenue audit experience at both midrange and luxury hotels.  From his hospitality experience he’s cultivated a Practice Branding Map SM for segmenting service delivery that is often absent in the healthcare industry

Education & certification

·        Board of Directors Fellowship

·        Tackling the challenges of Big Data

·        Myers-Briggs Certified Administrator

·        Masters of Healthcare Administration

·        Calculus Doctorate (CalcD) in Kyrios Relativity

·        Highest expert Latin (Latvian, Medici Latin)

This Agreement will commence with these terms if signed on or about:  October 27, 2024

Owner & Managing Partner,

Vail Summit & Ortho                                                              David Batulis, ProFee LLC

[1] Kibele, E. (2015) “Regional Mortality Disparities in Germany”

[2] Porter, M., Teisberg, E.  (2006).  Redefining Healthcare

[3] Likert scales are often qualitative ratings from patients, customers, or research subjects