As a part of my interview series with leaders in healthcare, I had the pleasure to interview Sanjiv Lakhanpal, MD, FACS. Dr. Lakhanpal is the Founder, President and Chief Executive Officer of Center for Vein Restoration, the largest physician-led practice treating vein disease in the country, and Founder, President & Chairman of the Board of Center for Vascular Medicine. A practicing physician and recognized Glassdoor Top CEO, Sanjiv is a trailblazer in the field of venous medicine and in his revolutionary approach to practice management. He is a strong believer that success in healthcare is achieved only through a very passionate focus on the mission at the core of our work: Improving lives in the communities we serve by providing state-of-the-art care in a compassionate and affordable manner.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
I grew up in India in a tight-knit family where both of my parents were physicians, as was my brother. Having witnessed from a young age how my parents impacted the lives of so many with so little, I knew I wanted to study medicine and make a difference in the world. As I began to pursue this line of work, it was my father who helped me to understand that it is your responsibility, after having taken care of your family, to contribute to the greater good of those around you. In addition to providing direct clinical care, he also recognized that advocacy and publishing can be powerful tools for advancing the medical community. As my career evolved I was exposed to other passionate, committed professionals like myself, which helped me to realize that the best way to ensure a lasting impact is to channel the collective investment of driven, well-meaning folks with a diverse set of core competencies and a shared understanding of purpose.
So while cardiac surgery is still a passion of mine, venous insufficiency management presented me with an opportunity to lay the groundwork for a truly lasting impact at the right time in my career, and I seized it. In the years since, I have been able to collaborate with a diverse group of world-renowned physicians, researchers, educationalists and other clinical providers. Critically, we have also had the backing of equally committed financial, operational and marketing expertise, which has enabled us to maximize and amplify our contributions to the field. We set out to expand provision of high-quality treatment and care to a growing and underserved population, and I know our team can really make a difference and leave a positive impact in this space, because we already are.
Can you share the most interesting story that happened to you since you began leading your company?
A couple of years ago, with my fiscally responsible CEO hat on, I signed off on a change in policy that I believed to be logical and justified: that surgeons would get a surgical assistant, and not the surgical assistant that they are accustomed to. Such a change promised to decrease the cost of surgical assistants by a staggering 30 percent; the Excel spreadsheet swore by it! The next day in the OR — with my ‘surgeon hat’ on — I worked with a surgical assistant who I had never seen before, and who knew little about the idiosyncrasies that I believe make me a more effective and efficient surgeon. Surgeries that day took twice as long, and palpable unease in the room ultimately caused patients to lose faith in the abilities of the organization. The entire team had a miserable day. The next day we reversed that decision, winning kudos from the clinical team for clearly demonstrating our prioritization of them and our patients over the bottom line — a reaffirmation of the mission at the core of our work. The fact is, by intelligently balancing in-depth clinical knowledge with an appreciation for the engines of business that be, we are able to maximize benefits for patients, staff and our bottom line.
What makes your company stand out? Can you share a story?
What makes any company stand out is always the product. At the end of the day a substandard product will always lose its appeal in the eye of the consumer, and if it does not, then shame on the consumer! Venous insufficiency is a woefully underserved area in modern medicine, despite the fact that nearly one in five Americans suffer at some level. We believe that a lot of good venous care is provided by the friendly local vein doctor, but we also believe that there’s a great opportunity in communities nationwide for local, specialized medicine to complement the care people traditionally receive in larger institutions. We are committed to modernizing healthcare to make service more efficient and accessible to patients in need.
As the largest physician-led clinic treating venous disorders and diseases in the United States, the Center for Vein Restoration has been a pioneer in doing precisely that for thousands of patients nationwide. In the past year alone we expanded our presence and ability to serve patients in communities ranging from Arizona to Alaska. Our physicians and staff nationwide completed almost 200,000 patient interactions, 40,000 of which were with new patients. That’s almost 200,000 lives impacted, in a single year. Add to that our research program and industry leadershipin forums like AVLS, our Venous and Lymphatic Fellowship Program, and nationwide public advocacy initiatives aimed at educating the public as well as the next generation of doctors. We are truly redefining the care of patients with venous disorders. More importantly, however, we are driving establishment and legitimization of the business, medical and academic frameworks necessary to meet growing demand for venous medicine in the years ahead, in particular as our population continues to age.
One of the core elements that has enabled us to achieve so much is our attractiveness to patients, employees and investors alike. Our clinical excellence is evidenced in our contributions to multiple peer-reviewed publications, and in our NPS (Net Promoter Score) in the 80s. We’ve maintained a 98 percent patient satisfaction rate, and have simultaneously grown at a profitable and sustainable rate for over a decade. I’m proud to say that our staff are truly our biggest advocates for the mission-driven work that we do on a daily basis, and our patients regularly praise them and our professional, informative physicians when asked about their experiences at CVR. Without the trust of our patients, employees or investors, we would not be able to do what we do and to achieve the outcomes we have. Their collective support — be it in the form of patient testimonials, physician research, or strategic investments — is also what propels our broader efforts to advance the field. We have great respect for the power of this cohesive ecosystem, as well as for the foundational relationships upon which it relies.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
CVR’s practice management model is unique in its core focus on a “people-centricity” mentality. In practice, this manifests in a combination of advanced centralized technology and data management at the corporate level, and softer approaches to employee support systems and physician autonomy on a practice-by-practice basis. This model has already been proven to enhance the quality of care provided and boosted patient satisfaction scores, while simultaneously improving physician and staff quality of life, organizational efficiency and overall profitability. And we’re just getting started!
Our success thus far has demonstrated that specialty practices don’t have to be procedure-oriented to generate revenue — and that an ability to serve more patients doesn’t have to come at a cost to quality of care, physician quality of life, or resources elsewhere in a practice. Our approach enables practices to grow profitably and sustainably, while also empowering physicians to focus on what they love doing and what they do best. This emphasis on collaboration, camaraderie and mutual support has enabled us to advocate for and provide care for more patients than ever. When we think about the trickle-down effects of a shift towards more holistic, value-based care, the potential for improved outcomes is endless.
It is also important to note that, at its core, our model addresses the chronic epidemic of burnout in the medical field. Recent studies from Medscape and UCSD remind us of the persistent threat of physician burnout and high suicide rates among nurses, underlining the pressing need for industry reform. As I’ve asked before, how can anyone be expected to deliver on providing high-quality care for others when they are consumed with concern for their own well-being? If we’re going to improve our healthcare system, we must first focus on providing the next generation of healthcare professionals with the resources, confidence and freedom that they need to be able to succeed.
What are your “5 Things I Wish Someone Told Me Before I Started” and why.
- The importance of a well-rounded staff | As a surgeon, it can sometimes be easy to slip into the perception that your performance — and yours alone — determines the organization’s effectiveness. In truth, excellent clinicians, while critical, are just one of the eight engines needed in an impactful healthcare organization. Without the support of physician liaisons, IT, and so many other critical functions, physicians are left encumbered and unable to focus on delivering the quality outcomes desired.
- Leaders create leaders — not followers | Though one sign of a leader might be how many followers they have, far more important a metric is how many other effective leaders they create. The ability to push and inspire, while remaining humble and collaborative, is a rare one, but it is that balance that cultivates visionary qualities in every employee and elevates an organization to its next level.
- Learn to unlearn | As one evolves as a professional, and ultimately as a leader, it’s important to recognize that the learning process must also entail a constant process of unlearning. Refusal to take a step back and hear new ideas is the root of intellectual stagnation, and organizations must embrace the potential for disruption and new ways of thinking if they are to remain relevant and competitive.
- Lead as a listener | Nobody ever learned anything when they were talking. To that effect, a successful meeting is one in which the chairperson does not hear themselves talk for more than 10 percent of the time. Effective leaders understand what drives employees and customers, and understanding is not gleaned from prophesizing but rather through listening and appreciating.
Let’s jump to the main focus of our interview. According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?
One of the primary reasons for our nation’s poor healthcare ranking is the challenges to access — financial, geographic, and otherwise — faced by patients on a daily basis. Confusing reimbursement systems, unreasonable wait times and surprise billing practices have all left many Americans averse to engaging with the healthcare system for fear of the unmanageable costs they may incur (knowingly or otherwise). Of note is the fact that, while many stakeholders play a part in creating this environment, physicians are not one of them. On the contrary, physicians suffer tremendously under the complex and incomprehensible systems currently in place, which is a separate concern in itself.
Another issue is the extremely litigious society within which we currently live, and the misguided incentive system that unfortunately compels physicians to operate in an uncertain, defensive manner for fear of “ambulance chasers” and similar opportunists. These practices help push the already skyrocketing cost of healthcare upwards, in addition to impeding physicians’ wellbeing and ability to deliver the highest quality care possible.
Third, a lack of focus on holistic health and preventive careinadvertently increases unnecessary burden on the entire healthcare system. While there are of course countless ailments that are unavoidable and do require serious medical attention, an increased emphasis on preventive care and healthier lifestyles — even steps as simple as washing one’s hands or walking for 30 minutes daily — would enable a broad swath of the population to improve their overall wellbeing and reduce system utilization. Many people do not prioritize spending on preventive care, and that’s a problem. When people decline to address their health proactively, they are actually increasing the costs they will face down the road. Educating patients and ensuring they understand their condition and their treatment options helps to instill trust, and also mitigates the frequency of unnecessary emergency room trips and other costly inefficiencies.
On a related note, there is also minimal incentive for payers to invest in preventive care. Major insurers are aware of the fact that patients may choose to enroll in a different plan as soon as the next subscription period. As such, their investments in preventive care — in ensuring the long-term health of patients — get watered down. Such investment has to be mandated by regulators if we hope to see progress. This failure to look at personal health in a truly holistic manner has produced a system of siloed, procedure-oriented experts, and patients who lack a confident, comprehensive understanding of what treatment path is right for them. Consequences of this fragmentation range from fee-for-service clinics to the patient who invests aggressively in physical exercise or dieting, only to be undermined by intensifying mental health concerns.
You are a “healthcare insider”. Can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
Due to its size and importance, there is no one person or organization who can unilaterally implement all of the changes necessary to improve and repair the U.S. healthcare system. Change will only come if all players come together and do their part. With that insight in mind…
What Healthcare Providers Must Do:
- As I noted at our recent clinical retreat, VISION2020, playing the game well is our top priority — the goals will follow. Patient-centricity must be a top priority of any healthcare organization. In order to achieve this standard, healthcare systems need to adapt to their needs and wants, accounting for communication and convenience just as much as fundamental medicine and overall care. Patients must first feel welcomed, and second, feel heard. A standard of care instills trust and guides patient understanding of an organization’s core mission. No patient that walks in the door should feel rushed or ignored. They need to understand that you’re there for them; that you’re actively listening and want to generate the results they ultimately need, above all else. Ensuring staff are trained to provide this same standard of care on a consistent basis is critical to success. A great way to accomplish this is through post-visit patient surveys and satisfaction reports, which can be used to continually enhance the patient experience.
- As I’ve already mentioned, health illiteracy continues to be a topic of concern throughout society. Communication is key across the entire healthcare landscape. Doctors need to engage with patients as well as their caregivers, in order to connect acute care and community care and provide a more holistic experience and higher levels of overall patient satisfaction. As a trained cardiovascular surgeon I look at the venous system in its entirety, from the toes to the head, rather than as an isolated issue independent of the rest of the patient’s health. This perspective enables me to contextualize issues of venous disease, and context is similarly integral when diagnosing patients and communicating those diagnoses in a widely and readily understood manner. It is also imperative for providers to keep caregivers in the loop during every stage of the care process, to ensure patient-centricity and complete care.
What Healthcare Regulators Must Do:
While I do not feel that a single payer system is the way to go for our robust capitalistic economy, all players must adhere to certain basic rules:
- The consumer must be able to understand very clearly how much their care is going to cost them. The current veil of secrecy at all levels of hospitals, throughout insurers, etc., is deceitful, and this lack of patient knowledge produces opaque inefficiencies and reduces the public’s ability to “see the full picture” in assessing their healthcare options.
- All insurance must cover not just pre-existing conditions, but also a basic level of preventive care. Such measures can include incentives for patients to take better care of themselves, a reason to keep their weight within a certain range, exercise more, maintain their blood sugars, etc.
What Healthcare Investors/Leaders Can Do:
- We are wired according to the field we grow up in, and as we mature that “hardwiring” becomes more and more entrenched. Consequently, by the time we are in decision-making positions we are deeply wed to our perspectives — which can cause an accomplished surgeon and an accomplished investor to find it impossible to be in the same room. At the same time, a true leader understands that a company aiming to have lasting impact not only needs these people to be in the same room, but also needs them to be collaborating productively. Any controlling investor can find a more flexible physician partner, and it may work better in the short term, but failing to serve the interests of patients and the community at large will ultimately cost them the longevity of the company. Healthcare investors need to be fundamentally oriented around a physician- and patient-centric system in the long term if they hope to ensure stable, sustainable growth.
- Once you have the right physician leadership, it is their job to take care of physicians the same way they take care of their patients. As studies have shown for some time, physician burnout is a very real threat to the wellbeing of medical professionals. Providing doctors with a delicate balance of support and autonomy enables them to focus their energy on the task of utmost importance: providing high-quality care to their patients. Additionally, providing doctors with the best tools available to manage their practices with ease is of the utmost importance. Too many independent physicians are bogged down by the complexities of marketing/PR/social media, bookkeeping/accounting/billing/claims, human resources, IT, and so on. Medical professionals need to be supported by an internal system that can mitigate the administrative complexities of day-to-day operations and minimize the amount of time spent on non-medical tasks.
What Patients Must Do:
- Take responsibility for your health. Patients must be willing to hold themselves accountable and actively participate in their own health journey. As a society we must begin living healthier lives, not only for our own benefit as individuals — medically, and financially — but also for the sustainability of our system and all those who truly need affordable access to the services it provides. To that end, patients should not wait for systemic change and instead must be proactive in establishing a confident, comprehensive understanding of where their health stands and what best practices are right for them.
What We All Must Do Together:
- One of the most impactful ways to improve the healthcare system is to address physician shortages and grow the clinical workforce. This can be done by expanding the number of available slots in medical education residency programs, but also by expanding the specialties studied to include evolving and emerging fields, such as venous medicine. On this point, CVR is proud to lead the largest ABVLM-approved fellowship in the United States, as well as standardized onboarding training for all of our employees, through which we are able to bolster our ranks in a supportive and structured manner. Broadening school loan forgiveness initiatives can also encourage and incentivize those who are truly interested in improving the state of modern American healthcare by removing barriers to entry for education. Additionally, expanding telehealth and remote patient monitoring is essential. Such measures are cost-effective, reliable, help expand capacity, and provide a simple, streamlined method for payment and communication to minimize visits and reduce overall burden on the system.
All stakeholders working in unison will lead to mutual trust, and that is the stable state we would all like to get to: A place where patients come to physicians they trust, knowing precisely what the out-of-pocket cost to them will be, without them or their providers having to spend an arm and a leg to get that information. Let’s shift the paradigm of legal activity in healthcare too: minimize the occurrence of frivolous lawsuits by correcting incentive structures, and instead encourage lawyers to police the healthcare system in return for standard fees. Restoring trust is a collaborative process that requires buy-in from all sides, and such a clean start will foster trust for the next step, and the next step, and so on.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
Sapiens by Yuval Noah Harari and Conquest of Mind by Eknath Easwaran are two of my favorite books, and I would recommend either to anyone. The latter in particular provides an insightful perspective on how to distinguish between directing and leading, in that leading involves inspiring people to do better than yourself. Leaders need to keep the welfare of the team above the welfare of the self — and this does not come naturally to anyone; it is simply not how our primitive brains were wired. We have to purposefully change to seek such an evolution, distancing ourselves from our ego in order to redefine what brings joy to our being. If you genuinely feel that your role on this earth is to selflessly move humanity forward, even though it might just be an infinitesimally small push, whatever you choose to invest your free time in should further reinforce that belief.
How can our readers follow you on social media?
You can follow me on LinkedIn, where I regularly comment on the advancement of venous medicine, best practices for clinical optimization and issues facing the healthcare industry more broadly.