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Podcast: Dr. Harvey Hanlen

I recently sat down with Past AOA President, Dr. Harvey Hanlen to get his perspective on:

  • Private Equity

  • Medicare

  • Meso-xeazanthin

You can check out our conversation here, by searching "Eyecode Media" in your favorite podcast app, or you can read it below:

Christopher Wolfe: [00:00:00] . Hello and welcome to the Chris Wolfe podcast on EyeCode media. Today I had on Dr. Harvey Hanlon, who is a past president of the American optometric association. He has been in group practice, private practice, and at 70 years old, that's what he's doing currently and he's, he's thoroughly enjoying it. This sort of wraps up.

[00:00:23] My three-part discussion with people, really four-part part discussion that really extends back into November with people interested in private equity. As I've tried to explore this topic to really try to figure out what is the end game or private equity within, within the profession. I think, his perspective is probably the most similar to mine, in terms of all the people I've had discussions with.

[00:00:48] I hope you enjoy it. It was a fun discussion to have with Harvey. We kind of talk about his progression through the AOA, what was happening when he was chair of federal relations committee back in the 80s, to, to his progression into becoming a solo practitioner, into a group practice and that evolution.

[00:01:05] And then, and then starting a new practice after he had retired for a while. So it was a fun conversation. I hope you all enjoy it. As always, please subscribe to the podcast. Give us a five star review. And support those who support us. One of the things that it took me a while to wrap my mind around was the need for utilizing a silicone hydrogel lens for my patients who wear daily contact lenses.

[00:01:26] Nearly all of my patients who were a frequent replacement lens where a Silicon hydrogen material, however, until a few years ago. Very few of my one day lens prescriptions were for silicone hydrogels.

[00:01:38] Christopher Wolfe: [00:01:38] Part of this was the options we had available and part of it was cost, at least my perception of the cost.

[00:01:44] What I was forgetting is that patient's wearing a one day lens are still wearing their lenses for 14 to 16 hours and they would benefit. From a more oxygen permeable lens, you may have the perception as I do that a one day lens made with Silicon hydrogen material are going to be too costly for our patients.

[00:01:59] However, studies show that patients want us to offer them the healthiest options regardless of price. I make it simple to the patient. I explain why I'm prescribing a particular lens based on their complaints or based on what I'm seeing clinically. It sounds like this, Bob, you're wearing a contact lens for most of your day, and in the past we didn't have as many options for putting you in a daily lens.

[00:02:18] That also allows for optimal oxygen transmission. We now have an option that does this, and is this cost-effective as older lenses that you're in, I would love to see how this lens feels to you and looks on your eyes. Done. That's the conversation. And I haven't had one patient who is not wanting to try it.

[00:02:35] Clarity one day from CooperVision is an affordable silicone hydrogel lens. Our patients are thankful. We discussed with them. Check out the show links for references, and see for yourself how to move beyond cost and focused on what's best.

[00:02:57]you know, one of the things that. impressed me when I met Frederick for the first time. Was that. it was actually at the last administrator meeting and he, he actually presented the Goldman Sachs kind of ultimate outcome. He used to

[00:03:13] Harvey Hanlen: [00:03:13] work for Goldman Sachs. No, he worked on wall street though.

[00:03:15] Christopher Wolfe: [00:03:15] You worked on wall street. Yeah. So, so then, so I think, I think Harvey, what you and I were talking about before, I kind of want to pick up that conversation, but we'll go back a little bit. you made the comment. That, it amazed you that younger doctors had no idea that we didn't have the ability to build Medicare at some point in time.

[00:03:35] Yes. So talk about that.

[00:03:37] Harvey Hanlen: [00:03:37] Well, you know, I've been in practice a long time and in practice, 46 years, been very active in AOA and the state association. And back when I was involved, we didn't have any, any rights to bill Medicare or any medical, any commercial medical insurances. Because they didn't recognize optometrists as physicians in their categories.

[00:03:57] So in a late a late 1986 we were successful in passing Medicare privilege for optometrist. Thanks for the help of Senator Barbara Mikulski from Maryland. And it actually started April 1st of 1987 where optometrists could bill for medical services as physicians under Medicare. Well, today, you know it.

[00:04:21] This is. You know, 30 years later, 33 years later, and the average younger doctor makes the assumption we've always been able to do that when in fact, when I started out, we couldn't even use diagnostic agents back when I graduated school. So going from diagnostics, the therapeutics to becoming physicians under both Medicare and commercial medical insurances.

[00:04:42] It changed the entire scope of what we could do as independent private doctors.

[00:04:47] Christopher Wolfe: [00:04:47] I mean, that's, that's kind of what we were talking about today is that, you know, we have these large scope of practices in many States and we've got these continued advancements, but, but the limitation in some States is really, it's real where you've got, you know, scope of practice that allows you to do something, but effectively you can't do it because you can't get paid for it.

[00:05:04] Correct. And so, to, to forget. The ability, even just with Medicare, that that parody is, is pretty staggering.

[00:05:12] Harvey Hanlen: [00:05:12] Oh, it is.

[00:05:13] Christopher Wolfe: [00:05:13] How long did it take, sorry to interrupt, but how long did it take to actually pass that bill?

[00:05:18] Harvey Hanlen: [00:05:18] Oh, AOA probably worked on that bill for almost 20 years. Wow. So they started in the, in the late sixties early seventies.

[00:05:26] And, we got shut out. You know, the, the, the, both, the ophthalmological in the, in the medical lobby in Washington is huge. And, it took a real, a person that was really willing to fight the fight for us and be with us, to be able to get that passed and so fine. Finally. And it's the same thing as the States, but at a smaller level than you're dealing with it in the federal level.

[00:05:48] Yeah. But you know, we all went through these battles in our state associations, and we're still going through those battles. You're going through another increase in your bill where we have a scope bill in our legislature right now. And, and, and yet you have States like Massachusetts still can't treat glaucoma.

[00:06:04] I mean, they're still fighting that fight and they've been fighting it every session. And, and so. Up to an optometrist is not enough. Thomas interest is not an optometrist. We all have similar educations, but you can go from not being able to treat anything to be able to do surgical skills.

[00:06:20] Christopher Wolfe: [00:06:20] Yeah. Yeah. It's, it's crazy.

[00:06:23] I mean, one of the things, Daniel Carrie and I, who's the director of, of state government relations committee, and I told Daniel, I said, you know, Daniel, they're probably going to get tired of me as chair of SDRC sometimes. So, you know, we're, we're talking actually in Arizona a couple of months ago. When I was down here for a, a meeting with, some AGS.

[00:06:42] And, and I said, you know, I don't know how much longer the board's going to kind of tolerate me and I, I do believe that I have a shelf life. And at some point, at some point then I've, I've used that shelf life and they're gonna and that's okay. It's okay. But I said, yeah, I'm not sure what, what will happen.

[00:06:57] You know, the emails will stop. You're getting used to kind of that constant flow. You got it as president, you got it as board of trustees member, you got it as, as FRC member. And he said, well, you know, maybe you would want to do like. A federal relations. I said, man, that moves so slow. I mean, 20 years. I mean, they've been fighting for the dock access bill right now for, since I was in school.

[00:07:18] You know, I was probably, I remember at first, probably 13 years ago.

[00:07:22] Harvey Hanlen: [00:07:22] Yeah. So

[00:07:24] Christopher Wolfe: [00:07:24] that, I mean, so how long were you chair of FRC?

[00:07:27]Harvey Hanlen: [00:07:27] I was chair a total of five years. I had a year break in between when I was the chairman of the Patel outcome study, which is the study that came out on postoperative care post cataract surgery, postoperative care for optometry.

[00:07:39]so I was a total chair five years before I got on the AOA board.

[00:07:42] Christopher Wolfe: [00:07:42] And so that, that, talk about that study, that was probably a pivotal study that showed that outcomes were equivalent, whether an optometrist, yes.

[00:07:49] Harvey Hanlen: [00:07:49] Yeah. We were able to show that we provided not only as good but better care for the post cataract patient.

[00:07:55] And, and we're very successful in the outcome of that. And I was a chair of that study utilizing the Battelle Institute for this day

[00:08:02] Christopher Wolfe: [00:08:02] when before you could bill Medicare. Tell me about how you would manage patients once they got to 65 about how, I mean, there's, there's. Yeah. I mean, people always work for an ophthalmologist.

[00:08:14] I mean, what you talk about you,

[00:08:16] Harvey Hanlen: [00:08:16] well, anytime a patient had a medical condition, first of all, back then, we couldn't really treat a whole lot. Right. Because we didn't even have the scope of practice in Pennsylvania to do it back then. So what you were doing was referring all these patients out. The problem with that is when you refer patients out, rarely did they ever come back.

[00:08:35] And that's, that's still an issue today when you're, when you're sending a patient to another, what I call general ophthalmology to me is primary eyecare.

[00:08:45] Christopher Wolfe: [00:08:45] It's optometry that does a little surgery to the side

[00:08:48] Harvey Hanlen: [00:08:48] and an 80% of the ophthalmologists, general ophthalmologists don't do any surgery. They practice optometry.

[00:08:53] Is that right?

[00:08:54] Christopher Wolfe: [00:08:54] Oh, you're in Pennsylvania?

[00:08:55] Harvey Hanlen: [00:08:55] Yeah. Wow. Yeah. So you know when they've said this for years, 80% of the surgeries done by 20% of the doctors.

[00:09:02] Christopher Wolfe: [00:09:02] Well,

[00:09:03] Harvey Hanlen: [00:09:03] I believe that. So therefore you have them practicing basically optometry as an ophthalmologist

[00:09:09] Christopher Wolfe: [00:09:09] and not even as good.

[00:09:10] Harvey Hanlen: [00:09:10] Oh, not nowhere near as good.

[00:09:12] They spend five minutes with the patient. Their tech does all the work. They see 60 patients a day. Quality of care is really not there. There's no patient. trust because there's not enough time to create that, that relationship that we've had as optometrists.

[00:09:28] Christopher Wolfe: [00:09:28] I was talking to my dad on the way down here, and a lot of this was fresh in my mind because we just went through our hearing yesterday.

[00:09:34] But, you know, what an advantage ophthalmology has. I mean, forget about, I mean, on the one hand, they have the advantage of, Oh, I went to medical school with all my buddies, and so they're just going to feed me patients throughout my entire practice. But, you know, we have such a disadvantage because. Not even just that, but you know, you talk about Medicare parody and the reality is, is that, there are a lot of insurance plans that optometrists still can't get on that, that it's pervasive.

[00:10:01] The only eyecare you can have is ophthalmology on those plans. Correct. And, and I mean, what an advantage. Like what a clear advantage that they've got. And there's no reason for that advantage except for they are part of the establishment. They're

[00:10:15] Harvey Hanlen: [00:10:15] part of the family. The MD, MD does not mean major difference, by the way, contrary to what they've said for years, and that's what it stands for.

[00:10:24] It does not stand for that at all. It's a fraternity. Yes. And that's problematic. Let me give you an example today. even to this day in the state of Pennsylvania, Highmark, which is one of the biggest insurance companies, does not pay up Tom Iteris for postoperative care in the commercial side. Under the age of 65 every other, every other commercial insurance company in the state of Pennsylvania, we'll pay optometrists for postoperative cataract care.

[00:10:55] For patients under 65 and of course they go into Medicare advantage plans or Medicare over 65 we get paid hi, Mark still doesn't pay it. In fact, I got reinvolved in our legislative committee this year after being the chairman 25 years ago because of not only our scope bill, but we're now working with within the third party committee on our state to try to do that.

[00:11:18] They have a meeting with Highmark next week. To go over these things again. Yeah. And we're trying to uncover all those things so that they can have a meeting and see if we can't get some of this repaired because it's crazy.

[00:11:30] Christopher Wolfe: [00:11:30] Yeah. What's your PR? So Bob's on that is Bob chair again? Bob Bidel.

[00:11:34] Harvey Hanlen: [00:11:34] Bob middles act, chairman of our scope of our legislative committee.

[00:11:38] I'm Bob asked me to serve within this year, and so I'm back on that. Greg Callwell is the chairman of our third party committee, and so he, Greg is having meetings with these carriers to discuss issues that we're having.

[00:11:52] Christopher Wolfe: [00:11:52] Yeah. Do you think. Is it? Is it? So we've seen a couple of these things. So like in Nebraska for example, there was a payer that was men just mandating discounts like that weren't coverage, non-covered services, discounts as a medical payer.

[00:12:05] So they say, we don't want, we want you to have 70 17% off of any materials that you sell in your practice. And, and they, you know, on the one hand, they didn't really care about it. They were sort of, it was in the, in the provider manual. but they weren't marketing it, you know, I'm sure they weren't marketing it to people.

[00:12:21] And so it was just a throwaway for them. And, but it was like actually sort of a big issue that went away with just a meeting, just like letting them know and they, it quietly went away. They didn't come out and say, we're going to do this. But yeah. You know, he said, look, this is not right. And I think they probably saw like, yeah, we don't really care about it.

[00:12:36] We're not using it to sell the plans. We're just doing it. And nobody's complained about it before. Is that what's going on in Pennsylvania or is that there's a deeper kind of underlying stuff that's

[00:12:46] Harvey Hanlen: [00:12:46] going on? I believe there's a deeper underlying issue that goes back many, many years. And nobody really has brought it back to the table.

[00:12:55] So it's sorta been laying there for a long time. So I have a local ophthalmologist that I work closely with and he's a corneal specialist, sends me a lot of scleral lenses. I do a lot of that kind of work in my practice. And, We know that if the patient is 64 years old and has high Mark, he's going to do the postoperative care cause it's silly for me to do it and not get paid.

[00:13:14] And my attitude is just finished the patient and he'll send them back to me. But it's illogical because

[00:13:20] Christopher Wolfe: [00:13:20] pay you for the other care. So, Oh yeah, the post-ops done. They come back to you and they'll pay you for the

[00:13:25] Harvey Hanlen: [00:13:25] prior primary to that. If they have a dry iron treating glaucoma, they pay me for all of that.

[00:13:29] Right. It's only post oper catechetics that care for under the age of 65 it's not logical. It hasn't been brought up in a long time. We want to bring it up in the third party committee's going to bring it up next week. Maybe we can finally resolve that issue.

[00:13:44] Christopher Wolfe: [00:13:44] Well, in theory, it could cost them even more money because if the patient seeks your care during that postoperative period, rather than going back to the surgeon because perhaps you're more convenient or they like you more they or they want your opinion, they're going to pay for that.

[00:13:58] Right? because it's a with a, with a separate modifier. Right. Cause it's, even though it's in the postoperative period, they sought your care and they're not covering that.

[00:14:06] Harvey Hanlen: [00:14:06] Only if the care was not related to their postoperative surgery. So if it was a dry eye issue, corneal abrasion issue, things like that, of course you modify it.

[00:14:17] You get paid within the postoperative period. If it was related to their cataract surgery, they're not going to pay. And I'm not going to

[00:14:24] Christopher Wolfe: [00:14:24] get paid right. Right. Yeah. That's interesting. Yeah. Well, so then, yeah, that's an interesting dynamic to be in because then you have a patient that's reaching out to you during the postoperative period as your, as their physician, and.

[00:14:37] You can't know for sure whether that is related to the, the operation or if it's related to one of these other conditions. So you're obligated to probably manage the patient at least, or figure out a way to triage them back to this. I mean, that's a challenge.

[00:14:51] Harvey Hanlen: [00:14:51] Sure. But, but what do we do?

[00:14:53] Christopher Wolfe: [00:14:53] You take

[00:14:54] Harvey Hanlen: [00:14:54] care of them.

[00:14:54] You take care of the question because they're still the most important. Person in your, in your, in your life at that point in time. You know, the patient in my chair is the most important person I see. Yeah. And I know doctors worry about schedule. I never worry about schedules because if I'm late and I'm in an ER, I say to a patient.

[00:15:10] Sorry, I was finishing up with another patient. And by the way, now you're the most important person to me, so, so you're going to take care of them so you don't get paid for it. But the point is there's something that's right and something that's wrong. We have to fix the wrong and make it right. And that's what the goal is.

[00:15:27] Yeah.

[00:15:27] Christopher Wolfe: [00:15:27] You know, one of the things I think about with, and this is more related to scope, but I've been thinking about it, obviously a lot. For a long time, but the idea of Medicare and actually the parody that we get with Medicare speaks volumes. In my opinion. What that says is that when I deliver care, and this, I'm sure this rubs off them ology just raw, but when I deliver care for a specific patient with a specific condition, and I understand the value of that care, and I bill Medicare for it.

[00:16:00] They view my services as being just as good because they pay me just as much as they pay the ophthalmology. Correct. And, and that actually speaks a lot. And as far as safety and effectiveness, of our profession from a scope of practice standpoint, look, Medicare is saying we are every bit as valuable as ophthalmology is when they're making those, if they didn't think so, they would pay us less.

[00:16:26] Harvey Hanlen: [00:16:26] No question about it. Let me give you a, a historical thing. You, you'll get a kick out of. So back in 1986 of course, we passed a law. We, in 1987 we implement Medicare. So now we're going over to, to CMS in Baltimore and talking about payment for postoperative care. And at that point in time, I was on federal relations and the liaison to CMS.

[00:16:52] And I would travel with our AOA Washington office director at that time was Jeff Mays, good friend of mine for many, many years, and we would meet with them and we said, we really don't want 20% of the co-manage care. What we want to do is pay for the visits. We see the patient and they said, well, dr Hannon, we can't do that because we only pay 80 20 on postoperative care.

[00:17:18] He said, but why wouldn't you want that? He said, remember cataract surgery, they're paying $2,100 and both Jeff Mason, and I said, because in the future it won't be $2,100 it's going to force. And so we said, and this is back in 1987 we said 20% of four of $2,100 is a good number right now. 20% of 800 or $900 isn't such a good number for the same care that we render.

[00:17:48] And of course, what is reimbursement for surgical care today? Yeah, it's under $800. Okay. So we tried to negotiate that back in 1987 but said, look, your, you know, your physicians under Medicare, we do 80 20 and we said, okay, then, you know, we'll take it, but we know it's going to happen. Yeah. And

[00:18:07] Christopher Wolfe: [00:18:07] it did. Yeah.

[00:18:08] Interesting. Interesting. Well, I mean, it's, it is definitely changing the dynamics of, you know, if you're a. Right now, if you're a general ophthalmologist that doesn't do a lot of surgery, I'll see these GoSee patients that, that's the, a general ophthalmologist. And then they come to me for another opinion and, and they've got, you know, 2080 cataracts or 2070 cataracts.

[00:18:29] And, they've got, you know. Couple of pairs of glasses. I'm like, what the heck is this guy doing? Is he just not looking or, and I actually think what happens is they've realized their surgical skills aren't that good, so they're going to wait until this patient's really, really, really, really needs cataract surgery.

[00:18:47] And. And so in doing that, but they can also sell them a pair of glasses. Correct. And selling them a pair of glasses is worth more to them than doing the cataract surgery that they're not very good at doing. Correct. And that's what they'll do.

[00:19:00] Harvey Hanlen: [00:19:00] Oh, absolutely. My whole outlook at cataracts has changed. and I, I used to hold onto the patient longer before I sent them.

[00:19:08] And my whole outlook changed about a year and a half ago when I had my cataracts removed and I went, wow, this is great. I love this. And I say, basis, look, I had it done. You know, I went through in my career after 46 years when I got hard contact lenses, my patients wanted hard contact lenses when I want to soft contact lens, they wanted soft contact lenses.

[00:19:28] When I had LASIK, they wanted lace. Now I had cataract surgery and they come to me and say, Harver my cataracts ready yet, I want to have my cataracts out. So, you know, you can develop these relationships with your patients. And they figured, Hey, if you did it, and then they say, who does yours? That's who I want to be mine.

[00:19:45] And that's the other thing. So it's a trust factor course, you know? And, and you've been part of their family for a long time and you get to know them. Yeah. So it's. Listen, private practice uptime of Jews is amazing.

[00:19:58] Christopher Wolfe: [00:19:58] Yeah. Well it absolutely is. And that's, I think that's kind of, it's a good segue into the next, into the next stance.

[00:20:03] And that's kinda why I wanted to have you on, is that, you know, I've had these kind of over the last few weeks and actually a few months on the podcast, people talking about private equity and, and, and then, you know, your perspective is really valuable because you've got the kind of whole swath of seeing.

[00:20:20] Where the profession has come, what we've had to struggle through, as, you know, as a, as a past day away president, as being involved in your state as having, my understanding is you were in a large practice and then you sold it and then you opened up on your own again. And so like all that perspective.

[00:20:37] Yeah. I'm trying to, I guess so. And then we have private equity and that's, that is a hot topic. It is just what I'm interested in, cause I'm just trying to figure out what is the end game, the end end game, right? Not the first spinoff, not the second spinoff. What's the end end game? What happens. So, so we can talk about all of that.

[00:20:56] Wherever you want to start.

[00:20:57] Harvey Hanlen: [00:20:57] Well, I think, well, first of all, I was in a, in a two doctor practice. I came out of school, went into a partnership with a doctor 25 years older than me. It was a wonderful partnership, worked out great. it was like my father practicing with my dad and which was nice. And of course he retired.

[00:21:13] I was in private practice by myself for a year, and then I put a group together. We merged four practices and created a large practice in state college, Pennsylvania. And, unfortunately after about 10 years, we had six partners. Very difficult to manage. little frustrating.

[00:21:32] Christopher Wolfe: [00:21:32] Let me stop you. Tell me about that.

[00:21:34] Yeah. I don't want you to bad mouth your partners and I know you wouldn't do that, but tell me about why does that happen? So, because I've seen this, I've, I've, I have seen it, where it, it wa it did spin off into private equity and I'm seeing it again. I wish the best for them. I hope. I hope it works out really well.

[00:21:51] But. I look at that and I'm like, man, that, that seems like it's not going to, it has a, it's rot with potential, issues. So tell me about that.

[00:21:59] Harvey Hanlen: [00:21:59] Well, when we merged the practice, there were four doctors and we were colleagues in an area, and we said maybe we could, consolidate our expenses, provide the good care, and, and be able to, to make something a little bigger, do a better job for patients.

[00:22:13] So we merged practice state in our locations for about two years. Built a building, a beautiful new building, and merge this all together in the building. And then we needed another doctor. A new doctor came in. Mmm. I would have waited a little longer to have that, to have that doctor, buy in as a full partner.

[00:22:33] But they wanted an equal say. And that's, that's what happens. And then we did it again. So there ended up being six partners in it. Well, the difficulty I think is when you have such a tremendous difference in background where you came from. When you were educated and what you learned, that there became a real separation of where the practice should go, and it really separated more on age lines than it did on anything else.

[00:23:00] We did have an older doctor that tended to side with the two younger doctors, so we were stuck in a three to three situation constantly. And, and we provided great care. That wasn't the issue. The issue was the frustration of trying to deal with it every day was one that finally got to me. And, and, and I said, you know, I, I, I'm just not having as much fun as I used to.

[00:23:23] And, And at that point in time, I opted to, to retire because that was in our contract, sell my practice. I had a restrictive covenant, which I'm a firm believer. If you have a contract, to me, it doesn't have to be in writing. If I shake your hand, it's contractors. I'm old school, as I say, as I like to say, I'm old school, classic ESPN, you know, that's just the way I am.

[00:23:44] And, and then I decided I really. Really miss seeing patients. So I, my wife and I bought a building and what I've learned in that we are now our 10th anniversary in March of opening the new practice. So at age 60 I opened a new practice cold. And although I'd been in that town for a long time, people still think you're retired.

[00:24:04] They don't know where you're at. We see them in the grocery store. He says, how's retirement? I said, well, I've been in practice for five years. They had no idea. Yeah. So the practice continued to grow, but it's hard. That's difficult. we've been very successful. We, I like the kind of care we provide. I don't see tons of patients because I spend a lot of time with my patients.

[00:24:23] But, there's, there's a phrase I use that I learned from a gentleman in Florida when he said, I finally learned in my life what partners are good for. And generally it's dancing. and I told my wife, you're the only partner I want to have for the rest of my traditional life. So. That was just for me.

[00:24:37] And, no, nothing negative about about large groups. It's just I felt that I wanted to spend more time. And spend. See fewer patients provide better care. We have a very high tech practice. Everything's computerized, electronic. I spared nothing. They now

[00:24:56] Christopher Wolfe: [00:24:56] have some AI.

[00:24:57] Harvey Hanlen: [00:24:57] We now have a little artificial intelligence.

[00:25:00] People think that's me, but it's not. It's a piece of instrumentation. I do a lot of work with macular degeneration. I happen to believe retinas, the next horizon in optometry. I've felt that for a number of years. And, it's fun. It's fun for me. This is, I was always in the political side of optometry. I now I've gotten more into the research side, which has been really a lot of fun.

[00:25:20] Yeah. So it's been an interesting evolution over the last period of time.

[00:25:24] Christopher Wolfe: [00:25:24] Yeah. Well, I've seen, I've seen, you know, big practices work and I, I think they can. I think it's just, you have to have a really, you have to really be cautious, I think, about that dynamic.

[00:25:33] Harvey Hanlen: [00:25:33] Well, I think you need. You have to have a management style that, that can control how things go.

[00:25:40]it can't be a freewheeling kind of thing where there's not controls over that. I think it could work. Yeah. And I was hoping it would work and it worked for awhile and then it just got too big for me. Do you

[00:25:53] Christopher Wolfe: [00:25:53] still, do you still get along with your old partners.

[00:25:56] Harvey Hanlen: [00:25:56] Or is there, is there enough? I get along with most of them.

[00:25:59] There's a couple that we don't really see eye to eye, but, but that's okay. Yeah. So there's no, I don't bad mouth them. They don't provide, they provide good care. you know, I don't look at as, as colleagues, as competitors, I look at them as colleagues. Yeah. I've always felt that way. You want to open next door to me.