Building and growing an IVF practice can have numerous benefits for both the owners and the patients they serve. But growth can sometimes lead to loss of patient-focused care. On this episode, Griffin Jones, CEO of Fertility Bridge and host of Inside Reproductive Health, talks to Dr. Alan Copperman, Co-Founder and Medical Director of RMA of New York, one of the nation’s largest IVF centers. Together, they discuss how RMA of New York was able to retain their patient-focused culture while exponentially growing the practice. Their approach to delegating important tasks, understanding the “new” patient, and finding the right, compassionate employees has greatly contributed to their success today.
To learn more about Dr. Copperman and Reproductive Medicine Associates of New York, visit their website at https://www.rmany.com/.
Visit fertilitybridge.com to learn more about what Griffin and his team can do for your fertility clinic and take the first step in building your marketing system with the Goal and Competitive Diagnostic.
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Welcome to Inside Reproductive Health, the shoptalk of the fertility field. Here, you'll hear authentic and unscripted conversations about practice management, patient relations, and business development from the most forward-thinking experts in our field.
Wall Street and Silicon Valley both want your patients, but there is a plan if you're willing to take action. Visit fertilitybridge.com to learn about the first piece of building a Fertility Marketing System--The Goal and Competitive Diagnostic. Now, here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones.
GRIFFIN JONES: Today on Inside Reproductive Health, I'm joined by Dr. Alan Copperman. Dr. Copperman practices in New York City where he co-founded and serves as the medical director of RMA of New York, which is one of the largest IVF centers in the entire country. He's also the vice chairman of the OB/GYN division and REI division at The Ichan School of Medicine at Mount Sinai. He also serves as the medical director of Progeny. He also serves as Chief Medical Officer of Sema4. Dr. Copperman has been named to New York Magazine's list of Best Docs 18 years in a row and has been recognized by his peers, partly for his publishing of more than a hundred original manuscripts and book chapters on Reproductive Medicine, and he's co-authored over 400 scientific abstracts on infertility, IVF, egg freezing, donation, and reproductive genetics. Dr. Copperman, Alan, welcome to Inside Reproductive Health.
ALAN COPPERMAN: Thanks for having me!
JONES: So in the intro, the pre-intro I should say, you said you think that this is the coolest field in the world. Maybe talk a little bit about that because I think it can guide the rest of the conversation.
COPPERMAN: I think the medicine, in general, has come to this great point where we can prevent disease, where we can personalize medicine, where we can use big data to drive better decisions. And nowhere is that more apparent than reproductive medicine, where a patient or a couple walking in can very quickly be diagnosed, triaged to appropriate treatment strategies for them, and ultimately, succeed in a time that is a fraction of what it used to be. So what I love about reproductive medicine is the personal, the scientific, the ethical, the hands-on and ultimately, the successes, and they're just so meaningful!
JONES: And you are in a lot of different adjacent verticals to the actual practice of REI medicine and maybe talk a little bit about why that was important to you. You know, Progyny is a household name in our field now and Sema4 is starting to get more notoriety. I don’t want to give many of these companies commercials, but I do want to hear about why that's important for someone in your position to do or why you wanted to also be a part of the growing branches that stem from the practice of medicine itself.
COPPERMAN: You know, I see a lot of these companies and businesses as being parallel and integrated with the delivery of personal care. So while my day job, or the most important part of my day job, is seeing that patient or that couple in front of me and helping them achieve all their goals. But I found that as partnering with the fertility benefits company to help employers pay for the treatments for their employees as Progyny does, is game-changing. And to work with Sema4, a genetics and information company to create information, for example the genetics test for a carrier screening to let a couple know what their risk of having a healthy baby or an unhealthy baby with a certain specific genetic disease, I mean, that is integrated with taking care of the patient part of me. And my role at Mount Sinai in Woman's Health helps create the environment of academia, and scholarship, and scientific inquisitiveness that helps us become better doctors, better scientists, and engage the next generation. So all this ties, I think, into helping the individual, but working with and not against industry I think has given us the skills and the tools to achieve success in our community.
JONES: Is it having too many irons in the fire?
COPPERMAN: No, all these go together. Using information, helping our patients get coverage, advocating for patients, teaching the next generation--those are the most exciting parts of the job that integrates so well with taking care of the patient in front of us.
JONES: How do you balance it? I think one of the challenges that a lot of practice owners have is--and we talk about it on every episode of the show, it’s essentially what they show deals with as a subject matter--which is we talk about the business of reproductive health, and the business of practices, and being a practice director or a medical director can be a full-time job in and of itself and one of the cautionary tales that I give to listeners, to clients is that whether we like it or not, the REI practice is an entrepreneurial endeavor, so we are in the field of business and I have a hard enough time counseling certain folks on how to be able to manage their own business as well as run the practice. You do both, plus these different ventures. How do you balance it?
COPPERMAN: Let's talk a little bit about the history of in vitro fertilization. Louise Brown, the first IVF baby in the world who is now 42 years old. it's only been really available United States routinely over the last three and a half decades and traditionally, IVF centers were in hospitals. The problem with putting an IVF center inside of a hospital is that the error in handling of it, the microenvironment, the purchasing of new technology even if it hasn't been budgeted for in a traditional traditional hospital budgeting center, the risk that's being taken of having eggs and embryos and sperm stored--all of that has been a real challenge for the traditional brick-and-mortar hospital. So over the last several decades, this branch of physicians, especially reproductive endocrinologists, that have found that building an IVF center adjacent to and integrated with the healthcare system and not within a hospital has given the freedom to hire the right embryology team, to retain the right nurse management, to bring in technology as needed. So I think that when you're talking about an entrepreneurial or business-oriented, I think that it became essential over the last decade or two to have the resources invested to deliver the optimal care that we can. And as far as the intersection of finances and medicine, it's a complicated one in America, and we separate the physicians practice from the financial team. We have a whole team that's assigned to coordinate care: concierge medicine pre-certification team and concierge financial coordinators for patients, so that when the doctors are in front of a patient, it's not about what billing code or what's covered, but that's really conversation with a coordinator whose job is not to collect money from the patient, but his job is to facilitate the treatment cycle and to optimize the way that that patient can gain benefits as available and minimize the out-of-pocket costs.
JONES: We've had Michael Levy from Shady Grove on the show and Lou Weckstein from Reproductive Science Center and among the topics that we talked about there is having an executive team that--or at least an executive officer, sometimes an executive director sometimes, the title is chief executive officer and the chief executive officer is not the medical director, is not the practice director, and is not a physician--so they have the bandwidth to focus on the business. Whilst the physicians are shareholder in that business and the physicians are, of course, medical director and practice director. How does your structure at RMA of New York compare to those?
COPPERMAN: I think there are specialized people that handle specialized function. Our scientific director is fantastic and she publishes scientific articles. Our embryology director handles compliance and regulatory issues. We have break down each section--my nurse manager handles her nursing team and the IVF coordinators. So I think it’s a very specialized field were we need the right people making the right decisions.
JONES: You were recommended to have on the show from a number of people just said that you like to stay on the pulse of what's happening in the delivery of care. That that’s very important to you and that practice culture is important to you. Practice culture is one of those things where everyone says that they have it, and some people do and some people don't. What is the ideal practice culture? And then how is it tangible to where it's just not something that the mission statement on a wall?
COPPERMAN: Oh, that's such a great question. Focusing on the individual patient, really asking what their needs are, meaning what are you here for? And family building doesn't necessarily mean having one child, or family planning doesn't necessarily mean trying to not get pregnant, but when we look at somebody who comes into our office, we really want to understand, do they want one child? Do they want two, do they want three children? Do they want a boy or a girl? Are they trying to prevent a disease? What is their name? What is their nickname? What is their preferred pronoun? What is the way that they want to be treated? How do they prefer communicating is it email? Is it voicemail? Is it face-to-face? So by understanding patient preferences, we can really cut through a lot of the angst and miscommunication and focus on that patient as an individual. But I like to think about our culture is that even though we may see hundreds of patients a day throughout our many offices, each one patient that walks in, we wanted to treat it as the most important day in the world because for many of them, it really is!
JONES: Talk a little bit about how you’ve been able to grow that? Because you're certainly not practice size that you started with. How does culture scale and how do you not lose it?
COPPERMAN: Well, we started in our practice in 2001 with four physicians, 21 employees, and 300 IVF cycles. And now we’re 14 physicians, seven locations, two countries, and hundreds of employees, and yet, the screening of each employee, the interviews, the cultural bit--this kind, compassionate, detail-oriented, patient-focused personality, we’ve maintained. We actually have 16 of the first 21 people that started with us 18 years ago still with us and they run a lot of the departments. So that core scientific excellence, compassionate care, patient-focused approach, I think we've been able to maintain throughout a much larger organization.
JONES: How have you been able to help other people in the organization manifest the culture and expand and resist the temptation to keep your hands in everything? Or are you able to keep your hands out of everything?
COPPERMAN: I think as you grow you just have to delegate to the right people, some of the decision making, some of the leadership, and then you build a team of people and we learn from each other. We do learning and development, we do team building, we try to flex with the time, and communication is key. There are regular meetings every Wednesday night--we have the Division of Reproductive Endocrinology from Mount Sinai--that's our team, that's our meeting and we bring up ethical issues and scientific issues and patient care issues. I think communication and being open to learning from each other and from the outside has really helped us stay fresh and patient-focused. But it’s work! Being patient-focused isn't an event, it's not a moment of time. It's like a full thickness commitment to patient care.
JONES: How have you noticed patient preferences change since 2001?
COPPERMAN: Today’s patient is so much more knowledgeable than they were before. They have read bulletin boards, they’ve Google-Wiki’d disease, they come with a list of sophisticated questions. And today's doctor and instead of being defensive and old school like a hierarchical doctor of decades ago saying, “Well, I'm the doctor and this is the way it's going to be done,” I think, learn from patients, too. And my team, and certainly myself, it's not uncommon to say, “You know what, I really hadn't thought of that. Let me do a little bit of research. We'll get back to you if this makes sense for your treatment strategy.” I think we're more open to integrative and alternative and complementary medicine. We’re interested in integrating with acupuncture studios. We’re just open to this wellness culture. Today's patient doesn't necessarily just want to come in and get a shot of gonadotropins or an egg retrieval, I think that they want to be heard. They want transparency. They want information delivered to them in a timely fashion. They’re digital, they’re sophisticated, and they’d like transparency. They’d like to know how many eggs, how many sperm, how many embryos, what’s the sequencing, where we're sending the sequencing, and see what the costs are going to be. So today's patient, I think is a self-advocate and it's up to us to meet their needs.
JONES: I think that all of the expectations that you mentioned are the frustrations of a lot of providers and practices. Can they be met? Can this exceedingly demanding expectation--especially for instant correspondence or instant results--are we now at a point where meeting many patient expectations simply isn't tenable?
COPPERMAN: It's tough to meet everybody's expectations and it’s tough to meet all the expectations for everybody. So what we need to do is to set appropriate expectations. And there are times when somebody wants that immediacy. And not every practice and not ever doctor is the right fit for every patient. But if we set realistic expectations of--what we can't do is tell a patient that she’s going to get a phone call back at 9 in the morning and not call her till five with the result because that uncertainty, that waiting period, creates such anxiety and frustration that by the time you do have that conversation, some of the trust has already lost. So I think setting realistic expectations is essential.
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JONES: It’s part of what I counsel on, no small part of what our company does now is help people reset those expectations. And this is something that in every talk I give is to say, we might not have been the ones to set the expectation, so it's not our fault in the field, but it certainly is our problem. If patients are coming with a certain set of expectations and they are untenable when we're unable to meet them. So one of the things that we counsel on that we create content for is helping to reset those expectations. So I always get people in the door of the world of social media and of content creation via marketing because you can assign a dollar value to it that returns the investment, but that's really just the tip of the iceberg. Creating content is a way of being able to--I'm also operating on the thesis that content is the solution to many of our problems, especially our patient-facing and public-facing problems, and that these expectations are really important to reset in the beginning. We could do that with video, with written word, with audio, with design, and through the channels of social media and our other web properties. I think one of the biggest expectations to reset is--or tangential to that--is humanizing our staff. That means supporting the staff. So can you talk a little bit about--you know, there's the old adage of the customer's always right and then there are people like me that think employees come first. Can you talk a little bit about that tension and how you support each side?
COPPERMAN: I think that it's important to have a team of employees in the field of reproductive medicine that don't escalate with the difficult situation, that are patient, that are compassionate, that can see from a patient perspective. Somebody who's being late, it’s not necessarily because they're disrespectful, but they may have had a tough morning, they may have come off the night shift. they may have had a difficult day. So patient who gets frustrated, they don't really understand the pressures that they're under and financial and emotional and physical. And people get fired, people have sickness, people have death in their family, so I think that just that moment of compassion for the patient experience. And people that deliver bad news can be a lightning rod for bad news, but finding a way to deliver it with that with kindness and support, that's essential. But sometimes, a patient does take out some aggression and that's not okay either because we have to support our employees and not subject them to bullying and harassment. So setting up a culture that is supportive that prevents forest fires rather than trying to put them out, I think is really important. There’s a lot of anxiety that goes from being an infertility patient. There’s uncertainty, the stakes are high, there is a tremendous loss of control, and all that stuff really just goes a long way towards putting pressure on every communication and people are afraid that they're going to hear bad news. Just setting expectations--and what are the right decision support tools? How do we set up realistic expectations so that people have a good idea--they’re gonna get 3 eggs or they’re gonna get 30 eggs? They're going to have a high likelihood of becoming pregnant or not? They’re embryos are going to thaw or do they have a lower chance? So we set expectations, we counsel people appropriately, we deliver on what we say what we're going to deliver. Hopefully, we can prevent those difficult interactions that are so hard for patients and frankly, tough for employees.
JONES: I don’t envy the position of providers because working in client services agency, in a consultancy, we don't need a lot of clients or any type of return of volume to have a really nice business and we get to be really selective of who we take on. That’s not the case when you're trying to provide care for as many people as possible that need it. And I think it can be harder to balance that.
COPPERMAN: Sure. I think that in any high volume situation, one needs to just work on process. One needs to measure outcomes and needs to constantly take the pulse of our patients and our own pulse to make sure that we're not in the red line I mean, we don't want our computers running at 90% of capacity because that doesn't give us the reserve. So what we try to do is keep everything on a calmer level, so that even when we do have minor escalations and anxiety or uncertainty or conflict that is certainly resolvable without a tremendous amount of effort--just a little bit of attention.
JONES: In the beginning of the episode, you mentioned employer benefits, you mentioned for the genetic testing, what other segments of the field are you paying attention to right now?
COPPERMAN: I think that the molecular aspects in our field are fascinating. In the field of reproductive medicine, we were traditionally trained as surgeons and now all surgeries being done in a petri dish on eggs and sperm and embryos. And in the future, as we sequence more and more, it’s going to be done on the genome, maybe CRISPR or related technologies that can not only identify problems, but maybe even fix them. But what's incredible in our field is the ability to use genetics to deliver better outcomes. So we thought of infertility as a binary--they’re fertile or they’re not fertile, or they’re pregnant or they’re not pregnant--and now we realize that it's a continuum. Our goal is a healthy baby, a healthy singleton baby, at term, in the parents’ arms and anything else of that--you know, miscarriages, twins, failed cycles, missed opportunities to diagnose a genetic disease--we have to really question whether we’re calling that a successful outcome. We’re very results-oriented using our molecular tools to deliver optimal outcomes. That's a huge change from the way we used to practice.
JONES: What does the field need to improve upon, in your opinion, in the next 5 to 10 years?
COPPERMAN: The next 5 to 10 years, we need more improved access to care. New York state finally signed and mandated to have many employers provide fertility benefits for their employees. I'd love to see egg freezing become more available. Right now, certain companies Facebook and Google through Progyny--or Amazon--certain companies are focusing on recruiting and retaining their female employees by providing reproductive benefits, but that has to just grow. We have to lose that word “elective” from egg freezing. I think that this is preventative health care--this is an important part of women’s healthcare. So recognizing the role of reproductive aging and preventing reproductive aging with promotion of fertility preservation. And recognizing the number of carriers screening--we've gone from testing for Tay-Sachs and Cystic Fibrosis, and a handful of more diseases and now to 300 diseases--why wouldn't we test prospective parents for all 5-10,000 genetic diseases to see what they’re at risk for. So we’re using science and technology and precision medicine I think to deliver better care.
JONES: It all know sounds expensive!
COPPERMAN: It's actually cost-effective to freeze eggs in a 34 year old compared to treating a 40 year old for fertility. It's cost-effective--costing pennies per disease to screen for thousands of diseases, rather than having a baby that's suffering a lifetime of a preventable genetic disease. And its cost-effective to take a population and help them have healthy singleton babies by using the best technology, rather than the old world triplets and quadruplets and octomom, which is creating maternal-rest, fetal-sickness, and tremendous societal cause. So I think with better medicine, we’re actually going to save money.
JONES: It’s such a compelling argument, and one that has been made on the show often, do you think the reason why insurance companies have not embraced it is because it’s not always the same persons cost, for example, the lifetime treatment cost of the genetic disease, for example might not fall on one insurance company. It could essentially be the passing of a buck, why I’d rather have lower--assisted reproductive technology costs are lower, birth costs, then for example, treating a genetic disease down the road because we may or may not be the insurance company responsible for that. Is that part of the reason why insurance companies don't seem to be the ones embracing the cost-saving argument?
COPPERMAN: I’m going to say some insurance companies are actually enlightened and some leadership of companies and some of the major insurers have said, “Wait a second, if we count the maternal-fetal benefit, mom's pregnancy and the baby’s cost; and we look at the MedSurg: laparoscopes and other surgeries; and the fertility benefit; and the pharmacy benefit; and we put it all together and we just some fancy math, then we could determine optimal path ways to minimize cost per carrier and improve a journey for the patient.” It's all doable. So I'd say that insurance companies that are part of helping design some of the benefits--they’re starting to get it. They’re starting to get that paying for an IVF cycle and screening an embryo and transfer of the single best embryo can actually save more money than all the traditional means of six months of inseminations, or fertility pills, or fertility shot and inseminations--those were actually costing more money. So I'd say that we're vectoring toward alignment of comprehensive cost with optimal care. I'm optimistic.
JONES: With respect to access to care, another topic that we talk about often is the interior of the country and how many younger fertility doctors are moving to the larger cities because they want to work for a place like RMA of New York and there are less that are opening up independent practices in smaller markets. Is that something you worry about?
COPPERMAN: I think access to care, as you said, is not just in a big city and it's not just for people who couldn't afford it, but access to care is meeting the needs. If there are seven million and fertile women in the United State, then why are there only 250,000 IVF cycles being done? So, how are we under-serving the population? Is it a knowledge gap? Is it a financial gap? Is it an access to care--geographically is not meeting the cultural needs? So there's tremendous opportunity to provide better care. And infertility is a disease and say it's something that breeds human suffering and we need to focus our efforts on delivering efficient care locally.
JONES: We’ve got an idea of your perspective on where the field is going and what's important for practice groups that focus on them, I’m interested a bit more in the story of how you built one of the largest practice groups in the country. Is that something that you set off to do from the beginning? Did you know that--okay, we're starting off with 4 docs, it’s 2001, and we want this to be a really big thing--how to did it grow into what it is?
COPPERMAN: I think that what we realized back in 2000-2001, was that it was tough to build the best IVF center possible while working full-time for a hospital because the resources needed to have the right equipment, the right incubators, the right air handling units, the right personnel, and going through procurement and waiting and justification--it was just a really cumbersome complicated process. And so we just set out to deliver great care to patients, to have a high success rate lab, to do things the best that they can do, and then it just grew over time.
JONES: What’s the next step for RMA of New York? If you wave a magic wand and everything's gone perfectly in the next three years, what has happened?
COPPERMAN: I think we continue to grow in a way that we make care accessible locally to the people of our regions. We continue to explore scientifically and try to understand what makes an embryo normal and how to identify the best embryo and how to time the embryo with the right window of implantation in the uterus. And so we just get better at delivering high success rates to our patients. And we build patient tools so that they can integrate more carefully and precisely and timely when the treatment’s going on, other words, the right patient portals, the right transfer of information in a way that we meet our patients’ needs. And then the languages, cultures, LGBT outreach, fertility preservation for pediatric cancers. I think this field is having so many opportunities to get better at what we do. So for RMA, it’s contributing scientifically and never losing sight of that individual patient in front of us.
JONE: So whether it’s about access to care or entrepreneurship in the field or maintaining the state-of-the-art and advancing the state-of-the-art for practices, how would you want to conclude with our audience?
COPPERMAN: I think whoever the audience is that's listening--self-advocating, demanding excellence, and insisting on transparency. What are my chances? How has your practice delivered results to patients who are like me-- my age, my hormone levels? How can I best communicate so that my needs are met when I walk in the door to my next visit? So for people in industry that listen to the podcast, I'd say never losing sight of the individual patient. And to health care providers that are listening to the podcast, put yourself in the patient's shoes and remember why we're here. We’re fortunate in this field to play a role in creating families and helping people through difficult times. It really is, I think, the coolest part of medicine.
JONES: And that it looked pretty cool phrase should go in your LinkedIn profile! Dr. Alan Copperman, thank you very much for coming on Inside Reproductive Health.
COpPERMAN: It’s really been a privilege participating. Thank you so much for having me.
You’ve been listening to the Inside Reproductive Health Podcast with Griffin Jones. If you're ready to take action to make sure that your practice drives beyond the revolutionary changes that are happening in our field and in society, visit fertiltybridge.com to begin the first piece of the Fertility Marketing System, the Goal and Competitive Diagnostic. Thank you for listening to Inside Reproductive Health.