Dutch Rojas
Appearances
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I think from a macroeconomic perspective, why don't we have more supply? That generally brings prices down, right? There's people that argue that. And I'm like, well, it's not arguable. When you have more of something, you have more competition.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And so I would think that the federal government, everybody that's on Ways and Means, and certainly at CMS, would say, hey, the ACA 6001 that put this moratorium on existing hospitals and certainly prevents new hospitals, that was really an old communist way of thinking. We're not going to think that way anymore. We need to bring prices down. And the evidence is clear.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
You look at the last 15 years. We haven't seen premiums drop in price. So I'm an advocate of more supply, Scott. I want more insurance companies. People don't like that idea. I want more of everything because I think that's when competition begins.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And in the age of high deductibles, that was a big deal. And he kind of exposed price discovery, which for me as a capitalist is the number one thing. It's the number one signal I use to determine the value of a good or service. And so – Keith is entirely responsible for starting that movement.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
The number one thing I'm truly focused on is getting independent physicians to compete where they want to compete and where it's important, but to collaborate where they need to collaborate. So here's an example. In Phoenix, we were there last week. I did get to go to the Open, so that was fun. But in Phoenix, we've banded together almost 340 independent physicians and surgeons, and
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And we said to them, listen, why don't you guys start working together? You don't have to be owned by each other, but you got to work together. And this is what I mean. Like, why do each of you have an accountant? Why do each of you do payroll? Why do each of you have 16 lines of PNC that somebody at your office has to negotiate? Why do you have employee benefits that you change every year?
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Like, why do you have all of these administrative functions that eat up a significant portion of the 2,200 hours you have to expend every year? And so what we were able to do is form a coalition around them, build in a managed services organization, and reduce all of their expenses by about a third. Right. And then I go, OK, look, now you got more money to go home.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Now you got more retained earnings. Now you have a better chance to compete against the marketplace. And so I think we'll form probably eight to 10 of these coalitions this year. I'm really trying to help docs understand the fundamentals of insurance, of business, of coverage, risk transfer, and to really get them to understand how this works so they can better compete.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
You know, it really, I think early on, it used to be the product. By the way, I'm a terrible investor in startups. I had a chance at Uber. No one – when I was living in San Francisco, no one liked Uber. No one liked Travis. I met him, thought he was fabulous. And then at the end of the day, when I had to write the check, I didn't write it.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
But like top three mistakes I've ever made in investing, so maybe I'm not the best. But I will say this. For me, it's always the founders. I never do a solo founder. Always do two co-founders at least, if not three. And I find that if their hearts are good, that means completely subjective, and they're going after the right things, then I'm in.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Just because it's a really good business idea, that doesn't make it exciting for me. I'm the guy that wants to see a deck that talks about who the kids are. I mean, because a lot of them are, you know, 23, 25, 27. They've really just kind of had a first job and they're trying to kind of figure it out.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And I'm interested in the talent because what happens is generally the first one or second one don't work. But the third and fourth ones work out really well. I mean, our little company has made a significant amount of money, well over $100 million, just by investing in great personalities and great people.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I know there were people probably earlier than him, but he took his – I've been to his surgery center many times. He took his surgery center. He took his 214 partners, and he allowed them to do bundled prices, meaning like – anesthesia, facility fee, pro fee, and any other DME, implant fee, put it together as one price and offer that to the community. He does not accept network rates.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And so I'll always be a culture people build person first, and then secondarily, like, how can you execute and deploy this plan?
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
To me, it is.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
He doesn't participate in any carrier rate transactions. And he was the first to do it. He started in 97. I met him around 2008. And one of the first conferences I ever saw him speak at was yours. He was on a Saturday and he was in the main room at the Swiss Hotel. And I still remember there being like seven people in the conference room and I was at the front.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And, you know, it was life changing for me. It was absolutely life changing for me that someone would introduce these types of ideas into a place where we are largely dominated by third third party payers. Now, Andrew's a whole – I mean, you had him as a keynote speaker for how many years at Becker's ASC?
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
So I first saw him I think in 2008 or 2009 at the first Becker's conference I ever went to. You introduced me to him, and he was really the first person that took – I'd owned independent ASCs by then. I'd helped develop them, worked with independent physicians around the country. But I think in 2008, I was maybe up to like 27 or 28 ASCs. I'd never been exposed to the –
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
In fact, before I went to your conference, I didn't even know that it was an industry. Back then, doctors would yell at me and say, I can't believe you're an accountant and a business guy. Why are you building these and why are you helping doctors extract money from a system when the money needs to go to the health systems?
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I remember having conversations with Andrew about doing total joints in an outpatient area. People were very upset that we would even propose these things or talk about them. He was really the first guy in private equity to understand private equity and use it the right way. He was the first one to partner with Optum. I mean, he was kind of a first in so many ways, and he was young.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I mean, when I met him, he was in maybe his late 30s, early 40s. He's still, I mean, I don't know how old he is now, 52, 54 or something. I mean, he's a young guy. And he was really the first visionary I met that really changed the landscape. I mean, he took SCA from very little to very big very quickly. And he spoke the language of independent physicians, and he truly was a partner to them.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Well, I have to tell you, this is the greatest introduction I've ever had. That was so generous and so kind. I feel like saying all those things back to you. You're the reason I met Hayek, and then you were the reason I met Keith Smith. And so those are two very influential people. One, because I'm very involved with overseas missions, building surgery centers for people that don't have anything.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And that was always the difference. Business guys in my world were always like, if you're a business person, then you're anti-physician. And I was like, no, no, no, we don't have to be that way. If we want to make the world better and we want to make – healthcare better for people, then we're going to have to figure out how to trust each other and work together, right?
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
We'll set up systems of accountability. We'll use great operating agreements and we'll kind of put those together and then we'll do the right things. And Scott was certainly a leader in that. And then of course, One World Surgical. I mean, what a fantastic organization. And then he worked at Optum Ventures. I mean, he's just been a great person to know and watch.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And when I tell young people about him, I'm like, look, you're not going to find much information about this guy, but like, Find people like him. He is an inspiration and he ought to be followed. Like you want you want you want to walk in the footsteps of a great person. He's there and he's super humble. He'll never say, oh, yeah, I did all this. Like, he's just not like that.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
He's like, well, it's it's it's really been the great people around me. I mean, he's just such an effective leader. I mean, I think the guy's great.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Number one is we are running a – we started a consulting agency for physician-owned hospitals and large private practices. There are so many ideas, right? I went to a small school called Cambridge in the UK. And, you know, there's so many business ideas that haven't trickulated down to that level, right? What we categorize as the mid-markets, right?
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
You've got very sophisticated strategies within health systems, certainly PE-backed health systems you've got very highly sophisticated, but you don't have that level of sophistication down to the level I like. The surgery center partners, the large ortho practices, the physician-owned hospital world, you just don't see it.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And so one of the things we started working on was we built our very first captive a year ago March. So we built our first captive to do some property and casualty lines and to help physicians understand that they don't have to pay premiums every year if they understand how captives work and the captive strategies. Right.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
So I started bringing in friends from EY and Accenture and a bunch of other kind of consulting houses and saying to these docs, listen, you're already paying all these fees out of OPEX. Let me show you how to turn an expense using some financial engineering into assets.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
So this is something that really excites me because now we're teaching docs the power of the balance sheet when generally speaking, this doesn't go for everyone, they've been focused on just being a pass-through entity. Like I made $100,000 this month, I'm going to take it all.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And I'm like, hey, you know, if you don't do that or if you're not fully insured here, right, then what you could do is you could build up this beautiful asset. You can invest with this asset. And then eventually, maybe it's three years, five years, seven years, ten years. I don't know. It's dependent on what strategy you choose. All of this stuff comes out of the investment.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I love that. It's the thing that really makes my heart happy. And then Keith Smith really helped me propel Price Transparency. And so those two things, you were responsible for the introduction of both of those people, so I'm forever grateful.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
You no longer have to pay these expenses, meaning your business flourishes. And so I'm super focused on helping these private practices in the mid markets and certainly physician owned hospitals. I saw you this summer or this past summer at the physician owned hospital meeting. Yeah, I love them because, you know, they're so hungry. Their margins are thin and they're trying to figure out.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And in earnest, they generally want to be great physicians and help take care of patients. And so I'm like, maybe I can be that partner, right? So I have a team of 16. I can be the partner to help them. And then the other thing I'm working on, which is super exciting, is the Physician's Capital Fund or FICAP Fund, as we call it.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And we're investing in a bunch of small startups, which is largely the space I've been in for 15, 16 years. I'm personally invested in about 36 healthcare startups from an angel investor perspective. Some have done really, really well, as you know, and some have totally bombed. But when they have great people, I think it's one of the most wonderful recruiting tools I've ever had.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I found really good people in these startups, really smart young people that give me a lot of hope. And we take them out and we go, hey, why don't you come work on this new project for us? And on the other side, we're getting a chance to really help physicians build some true equity, right? They've always been W-2 labor people.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Even if they work for themselves through an LLC, it's always been about their labor and their hands. And so it's like, hey, guess what? Let's build a portfolio. Here's where we can help you. This is what private equity is. That's not me. This is what venture capital is. This is how venture capital works. This is these types of opportunities that you can be an investor in.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And they have asymmetrical returns. And so, Scott, this has been just an absolute fabulous deal. I think you had Dr. Paul Slosar on it. He was my co-founder. We have eight GPs, all docs.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Well, look, I think it's really tough. Like I have two small kids, three and seven. Like most professionals, I'm on the road Sunday to Wednesday, Sunday to Thursday, pretty much every week. And look, I think this whole Maha movement to me is super exciting because it's finally saying to people like, hey, you can be healthy. We're going to empower you.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And more importantly, we're going to enable you to be healthy. And I love that. So look, I don't go out to dinner with clients anymore. When I'm in Chicago, I really want to go to dinner. I might go to dinner one night out of the three, but I won't go with clients most of the nights. I'll go back to the hotel and I'll go to the gym. Nobody wants to do these things. I'm not a gym rat by nature.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I don't think it's fun, but I did play D1 soccer, and I did serve in the Marine Corps for six years, and so I've got some level of fitness that's pretty important. I think, man, your body is a temple. God gave it to you. People don't agree, but I do. You know, he created you in his image. He wants you to take care of your body. And so I'm like, hey, let's do it together. Like my kids do it.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
My wife does it. Right. We all do it. And no, sometimes do I want a hamburger? Do I want, you know, a Philly cheesesteak like I did last night? Like, yeah, of course. But what you really want to do is, you know, I walk every morning. I run every morning. I get up super early. I'm up by three thirty or so. I go to bed by nine. Right. I just want to live the most of life that I can live.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And this is how I found to live it. Like keep a really disciplined schedule. Don't eat junk and really try, you know, to laugh a whole bunch and to say thank you. I wake up every morning because I'm – I'm not a – I wouldn't say that I'm the nicest guy by nature, but I've tried to just be positive in the mornings and say everything I have is a gift.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I got to make the most of what I have, and how can I help people today? Now, I fail at that a whole bunch, as you know, because on Twitter or X, I am as transparent as it comes. And sometimes I kind of get into it with people. But, you know, I mean, you know, then I got to forgive myself and be like, OK, dude, like apologize and move on.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Yeah. So Keith Smith's really the father of price transparency. He made it so that not only individuals or consumers could shop and compare prices on an array of healthcare treatments and services, but he also allowed employers to do the first direct contracts. Meaning you have a plan that's a PPO. He allowed you to build a tier one network on top of that. So you had first dollar coverage.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
One of the things I'm seeing, like I was in New York two weeks ago for I think almost six days. And seeing a bunch of old friends, like we ran together in the morning. And it's cold. And these, this group of guys that I've hung out with since the late nineties, we all got together and you know, you, we used to go out for dinner and drinks and it was like, now let's go for a run.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Then let's go for coffee. I found it so enjoyable. We told old stories. We laughed. We had a great time. And we were all out doing something, getting that good fresh air, getting your body moving. I think it's super important. And again, I've never seen the joy of fitness and being healthy as much as I have in the last 18 months.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
I think the United States is really kind of turning the corner and saying, Hey, you know, we really have to take responsibility for ourselves and we really need to do this for the next generation because not not not being healthy. We're going to have more chronic issues. Health care is going to be more expensive. Right. And all of these challenges that you and I talk about pretty regularly.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
So I'm excited to see people kind of getting in shape and getting to it.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
Is it ever-changing? I mean, wow. My wife asked that December of – 2023, I came home from D.C. on the 18th and I told her, I said, I don't think this is ever going to get done. I think that's the first time I've ever been. I've never been accused of being a pessimist. Right. I'm always the over idealistic optimist, which I'm happy to take that title.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
But sometimes I don't think it's going to get done. I think that it's gonna be really difficult. Look, the lobbyist is powerful, right? And it's entrenched and it works really hard. Regulatory capture, Bill Gurley did probably the best presentation I've ever seen on that. You can look it up on YouTube. And I think Washington, D.C. has fully embraced regulatory capture.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
It is a work of government corporations working together so they don't have to compete. I don't like that. I naturally and instinctively fight back on that. My whole thesis, and this has been my thesis since 1990, summer of 97, when I got into health care, is that physicians on an unencumbered basis produce better outcomes. Now, I had a thesis. I didn't have any empirical evidence to prove it.
Becker Private Equity & Business Podcast
Entrepreneurship, Healthcare, and Capitalism with Dutch Rojas of Physician Capital, Inc. 2-17-25
And then as I kept working, probably by 2011 and 2012, I'd read enough about the independent practice of medicine to say, wow, these physicians who operate in a group of five, a group of 12, a group of 30, why do they have better long-term healthier outcomes on patients? than everyone else, right? And so that's what started me on physician-owned hospitals.