Why Tim Peck Built Call9 A Platform That Reinvents The 911 System
20 Minute Fitness Episode #54
We’re back again with a new episode on the 20 Minute Fitness podcast, but not just any episode. Today marks one of the most exciting milestones in the history of 20 Minute Fitness. We’re bringing you the very first episode of ‘Why I Built This’, a mini series introducing innovations that are revolutionizing the health & fitness industry and of course the master minds behind them.
On our first episode we had the pleasure to sit down with Tim Peck, who left his Chief Resident position at Harvard Medical School and moved to Silicon Valley to build Call9, a platform that can reinvent the 911 system. Although most people thought he “lost his sanity” at that time, Tim has proved all of them wrong. Call9 has already delivered life-changing care to over 3,500 patients and this is just the beginning.
Stay with us to hear about Tim’s journey and how Call9 is making a massive impact on the Emergency Care system in the US!
Three Things You Will Learn
1) How Call9 Works And Why It Is So Extraordinary
The systems of Emergency Care and Nursing Homes are fundamentally broken. These broken systems do not only result in extreme expenses, but on the more serious end they can also cost lives. Although many might have recognized the issue before, Tim was the very first, who was brave enough to actually act upon it.
Listen to the interview to learn about the shortcomings of Emergency Care and Nursing Homes and how Call9 provides a solution to overcome them!
2) Tim’s Journey From Harvard Medical School To The Silicon Valley And Living In a Nursing Home
Building such a radical innovation takes time and, of course comes with sacrifices. Back in 2015, Tim quit his job, moved to the Silicon Valley and decided to dedicate his life to Call9 and a greater good. Press play to hear about his journey including things, like living in a nursing home for 3 months.
3) The Future of Call9 & The Way Tim Predicts Healthcare To Change
Call9 has already reached amazing milestones and has proven to be a solution to the issues Nursing Homes are facing with Emergency Care patients. But it still has a really long way ahead of it with amazing potentials. Tune in to hear Tim’s vision for Call9’s future and also his predictions about the future of healthcare.
Sign the petition here to help Call9 achieve its mission & further revolutionize Emergency Care: http://www.rushact.org/#!/
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00:05 Martin Kessler: Hey everybody, and welcome to the 20 Minute Fitness podcast. I’m your host, Martin Kessler and you may not have heard about me before so allow me to introduce myself a little. I’m co-founder of Shape, the maker of ShapeScale that you may have heard about, you know, the 3D body scanner and fitness tracker. And I’m also a sports nutritionist with a passion for tough matter, and spot and obstacle course races, and I’m also a lot into things all around fitness technology and science. So including things like wearables, fitness trackers, sports watches to body trackers, all the way to body hacking and so forth, which is really why I’m here because as you may have heard already, we are launching a new mini-series called “Why I Built This” on 20 Minute Fitness and on every episode we attempt to bring to you the founder, the innovator behind an exciting startup that is revolutionizing the healthcare, fitness or personal health industry with fascinating new technology in one way or another.
01:04 MK: So today, in our very first episode, we’ve got Tim Peck, the CEO and co-founder of Call9. And it’s really interesting because he started out as an MD from Boston, whom even his own family thought he was crazy when he left his position as a chief resident at Harvard Medical School and then suddenly moved to Silicon Valley to build this new platform that was attempting to reinvent the 911 system. But you know what? He actually succeeded and today, Tim and his team have created a platform that has already delivered life-changing care to over 3500 patients. And so stay with us today to hear about Tim’s journey, how he got started, what challenges he had to go through to create Call9 and make a massive impact on the emergency care system in the US. Really interesting story, so… But before we jumped right into it, I would like to thank our sponsor, ShapeScale, a 3D body scanner and fitness tracker. You can step on it and it digitizes your body composition in photo-realistic 3D. Now available on pre-order on shapescale.com. Let’s get right into it.
02:09 MK: Yeah, so I’m here with Tim Peck. He’s the CEO and founder of Call9 and… Yeah Tim, why don’t you just introduce yourself a little bit to our audience and tell us a bit about yourself.
02:20 Tim Peck: Sure. So Tim Peck, I’m an emergency physician by training, New Yorker, went to NYE for med school. Up to Harvard for residency and stayed on as faculty there, and then left in early 2015, put academia behind me and moved out to Silicon Valley and joined Y Combinator summer 2015.
02:40 MK: To do what?
02:42 TP: I went in there with the idea to reinvent 911. That was the big pitch. We came up with a company and a concept called Call9. What we do is we deliver emergency medicine, emergency care to patients in nursing homes to give them the care they need in the moment of their emergency and avoid unnecessary trips to the hospital.
03:03 MK: So how does it work in practice? Walk me through it. Like, I’m in a nursing home, how… Where and how do you guys come into play?
03:09 TP: Yeah, certainly. So first starting with what the problem we’re trying to solve here is… It’s about 1.3 million transfers to the emergency department every year.
03:19 MK: Wow.
03:19 TP: And that’s just from nursing homes. If you look at it from the standpoint of where I was standing in the emergency department, 19% of the ambulances that come to the emergency department originate from nursing homes and rehabs. So one out of five of these patients that I was getting in the ED are super sick coming in, 50% of them or so are… Have dementia, most of them become delirious and confused and they don’t have their advocates and I don’t have time to call their families in the emergency department. We can’t really talk to the patients, so order every test under the rainbow, put people in hallways, they get bed sores, infections. It’s a pretty horrible experience for people who are over the age of 65. And then almost inevitably, they get admitted to the hospital as well, and this whole cycle costs about $15,000 to $20,000 every time it happens. And two-thirds of those trips to the hospital have been deemed avoidable by the government; did a big study on it. If only there could be a system to avoid them. So what we do is we put a paramedic in every nursing home that we’re in and that paramedic actually is there 24/7 staffing the nursing home. And that paramedic goes to the bedside whenever there’s any type of acute need for the patient, taps an app on an iPhone and connects to our emergency physicians who are also home 24/7 via a telemedicine technology that we created.
04:41 MK: So you have a paramedic for how many people in a nursing home exactly, on average?
04:47 TP: Yeah, so it’s usually an average of… The average nursing home in the US has about 115 beds, but we go into larger nursing homes, so our average nursing home is about 250 beds. We have nursing homes as large as 600 that we’re in.
05:00 MK: And how often do you get an emergency in a case like that?
05:03 TP: Yeah, so we see about two or three patients a day for critical care and then, as you might imagine, there’s a whole bunch of patients on our census because after they have their emergency and we treat them and stabilise them, we continue to treat them for days afterwards. They would have otherwise been in the hospital and needed more advanced care. So our on-site paramedics will continue to use telemedicine to tap back into the CAR positions and manage ’em for days afterwards. So, even though we only see two or three a day, the census is… Gets to be 10, 15, 20 patients.
05:36 MK: And how would it normally look like if there wasn’t a paramedic? They would just call 911 and… Just so that we understand the difference.
05:43 TP: Yeah, absolutely. I didn’t really know much about nursing homes when I started this whole process, believe it or not. I never once stepped foot into a nursing home, in med school I never went to a nursing home. It’s not part of our curriculum in residency, as a doc etcetera. So what I did is, I lived in a nursing home for three months, in a nursing home in Long Island, getting to do product and user research trying to make something people want.
06:09 MK: And that was when you were just starting Call9 at that time or?
06:12 TP: Yeah, that’s right, yeah. That’s and then I started seeing patients and learning the economics of nursing homes and the business models, etcetera, and looking at all these transfers and saying, “Why are they happening?” And it really came down to three reasons. The first is that nursing to patient ratio in nursing homes is one nurse to every 36 patients across the country. So if one patient gets sick, then you have 35 other patients for that nurse to take care of and that’s… They’re trained well, but they’re trained in chronic care, not emergency care. So they call 911 to get that patient out of the nursing home, thinking they’re doing the right thing for the patient. But I also described to you what happens to these patients when they’re in the emergency department. It’s not a good situation for them and it’s not any better in the hospital either. Again, about 40% of them leave the hospital worse than when they came in.
07:03 MK: Wow. And why is that?
07:04 TP: Is something called post-hospital syndrome. The hospital is a horrible place for older people to be. It’s exhausting, the lights and the beeps, and how it is can really make people delirious. People get infections and medical errors and bedsores and things of that nature.
07:20 MK: Wow, 40%. That’s crazy.
07:23 TP: It is.
07:23 MK: It’s crazy high.
07:24 TP: Yeah. New York Times just did an expose around it. So pretty big issue here, and a bad patient experience to try that to get to. The second thing in these nursing homes that I saw that led to these transfers is the diagnostics here are very sparse. So lab tests, EKGs, these things take 24-48 hours to come back. That works for chronic care but not for acute emergency care. And then thirdly, physicians are not present in nursing homes. When I was in that nursing home living there walking around nights, holidays, weekends, I never once saw another doctor.
07:55 MK: Wow, and they don’t even have somebody on call that could come in a case of emergency?
08:00 TP: Yeah, they could but they’re usually docs who also work in the hospital or at home. There are nursing homes that have staffed physicians there or NPs, but those are… There’s fewer of those in the US and usually higher in nursing homes. So most patients, long-term care patients are required to be seen once a month and then short-term patients who are… A mom who fell and broke her hip and she needs three weeks to get better before she goes home, that’s called a short-term patient. They’re seen about twice a week. So that’s the system.
08:34 MK: So the system is pretty bad. So there’s almost no real physician on site, nobody there to help in the case of emergency, 911 has to be called. Then the experience itself is pretty bad having to go through emergency services when 40% are coming back in a worse state. So how does it then differ with Call9? So you have a paramedic on site and how do they use Call9? How does the process look then?
08:55 TP: Yeah, so we’re there immediately with the patient for one, and normally these patients are waiting hours to see a physician. Even when 911 is called, the average time for a patient to see a physician after calling 911… If you pick up the phone right now and call 911, it takes about 64 minutes with the waiting times for you to see a physician. You’re pulseless, it’s about 36 minutes on average. Your heart has stopped, it’s 36 minutes. The numbers aren’t great when you start to really look at it.
09:23 TP: So, for one we’re there immediately and able to treat them immediately, be with these patients. Secondly, we have our paramedics there who know emergencies, unlike most of the nurses at the nursing home who have been in chronic care. And they have a suite of diagnostics with them, that is a EKG that they take and integrates into the technology and goes to the screen of the physician. Telemetry and vital signs that beep and go on to the screen of the physician in real time. We have bedside labs that results within two minutes, basic labs, which is a cool technology by Abbott that we integrate with. We have real time ultrasound that we perform, put in IVs, IV fluids, IV antibiotics, breathing treatments. And in this way we’re able to do pretty high level care and able to treat those patients…
10:10 MK: Just to provide some context for our audience here, what sort of emergency cases do you most typically see in a nursing home?
10:17 TP: Yeah, so for those that we avoid going to the hospital, there’s kind of two groups here. About 20% of the patients we see go to the hospital and those are heart attacks and strokes that need to get there, and then 80% we maintain in the comfort of their home, in the nursing home, and that is… The top diagnoses are pneumonia, chronic heart failure, COPD which is emphysema, urinary tract infections, skin infections, and then dehydration. Those are the… Which can happen in the elderly pretty easily. So those are the top six diagnoses, those are the things that we’re treating.
10:49 MK: And then which of these can you treat on site with your lab and the equipment that you have?
10:53 TP: All of those we can treat.
10:55 MK: Wow.
10:55 TP: So those are the diagnoses that we are most frequently treating and keeping in place.
11:00 MK: So, what’s been the result? Obviously, I’m sure you guys have been keeping track of it and comparing how the traditional experience would have been like, on average, compared to the Call9 experience. How does that go?
11:09 TP: Yeah, so that is exactly what we do. We have integrations, technology company has integrations into the electronic medical record systems of the nursing home, and that allows us to do a tremendous amount of data tracking and analysis and put some machine learning algorithms onto that data. So what we see is that we treated, over the last 20,000 visits that we’ve had, we show that we’ve been able to save about $8 million per 200-bed nursing home per year. So, on the finance side, that’s how this works. We save the government, who pays for most of these patients, and the insurance companies a ton of money while also tracking the health outcomes and showing that we’re having better quality measures. So not only avoiding the hospitals, but having low levels of infection and good follow-up care, things of that nature.
12:05 TP: And so the way that Call9 works around business models, because we have those numbers and have that data, and because we share that with the insurance companies, we enter into arrangements where we save them money and then we get a share of those dollars. That’s called shared savings. And this is called value-based care, meaning trying to do things for the patient that are better for them and then being rewarded for it, unlike what a lot of medicine is, especially emergency medicine, which is just do as many tests as possible and get charged for them, and get paid. And that’s the old way of medicine and now we’re doing the new way, which is bring value and get paid for it.
12:40 MK: That’s great. It’s a win-win situation, and how does it look like on the patient side? Have you been keeping track of… Obviously some cases end up being fatal. And how does it look like when you have on-site treatment and you don’t have to go through this traumatic experience of having to go through emergency services?
12:56 TP: Some cases are fatal. People have strokes, people have heart attacks, there are things that lead to the end of life. One of the most beautiful things that we do and situations that we can create, are by helping people at the end of life have a dignified life and be there in the comfort of their own bed and a place that they know with their families there, and we do a lot of end-of-life care because of that. Otherwise there’s palliative care, help with people’s symptoms there. That generates a lot of emotions, a lot of mission for our employees to come work here at Call9 and be part of that experience, and it’s something we talk about every Monday team meeting. We’ll talk about a patient who’s passed and honor them. Things of that nature. It’s the population that we’re working with and the people that we’re working with. It’s just an inevitability of life but we try to make that as peaceful as possible.
13:48 MK: Yeah. So I wanna take a bit of a step back and want you to go back and think about the moment when you guys started with Call9. How did that end up happening? I see you have actually specialised doing your Doctor of Medicine at NYU and Emergency Medicine? Did that influence you into getting into what you have been building today?
14:08 TP: Yeah. So I went to med school at NYU, went up to Harvard for residency and that experience up there in Boston, there’s a few experiences that really led me to take the plunge and leave my job there. I think one that I’d like to talk about is a patient who was end-of-life care. She was a palliative care patient and EMTs who are in a nursing home, who were called by 911 to go pick up this patient said, “Hey, I have a patient… ” They called me at the emergency department said, “Hey, I have a patient here who is what’s called Do Not Hospitalise,” meaning please don’t send to the hospital because they’re not going to do anything good for the patient. You need to keep this patient comfortable. “But the nursing home wants to send them to the hospital anyway.”
14:50 TP: I said, “Please don’t do this. Please don’t do this. It’s not right for the patient. We’re not gonna be able to do anything for them here. They’re just going to cause harm to this patient.” They did send the patient and bring the patient to the emergency department. That patient wound up sitting around for 12 hours until she finally went back to the nursing home but we didn’t do anything for her and she wound up getting a big bedsore on her leg from just lying around there.
15:15 MK: Why do you think they insisted on it?
15:16 TP: So that’s what I didn’t understand. I just didn’t understand what was going on in nursing homes and why this was happening. And that’s what led me to, again, go live in a nursing home and try to figure this out. And it really came down to, this patient was having some difficulty with breathing because she had bad symptoms of emphysema and they felt like they didn’t have the time to take care of her. They had 35 other patients to take care of and that nurse didn’t have the time to give the care that they needed and that was a very sad reality of the nursing home couldn’t give the care, we in the emergency department couldn’t give the care. There needs to be a different system, there needs to be a different way to kind of bridge the gap between the emergency department and the nursing homes. That’s led to this idea of, what if we could bring the emergency department to the patient, instead of having them come to us and flip that on its head.
16:09 MK: How did you even go about that? I can imagine you’ve been getting probably several dozens, maybe hundreds of cases like that, and it must have been extremely frustrating to you. How did you even… Did you first actually end up going to a nursing home and staying there for three months before you even had the idea of what you could do or how did you get to that moment?
16:28 TP: Yeah, it really started with… So that was one… So it started with trying to figure out how can I be with patients at the moment of emergency, where they are, whether they were in a nursing home or not. And looking at that problem and telemedicine seemed to be a logical approach. The video, seeing if we can use video to get to patients. And the name Call9 where it comes from, is first, we were thinking what if we can go direct to consumer kind of thing where someone would call 9… Call us instead of call 911 and it’s such a ubiquitous term to say, “Call 911.” So we’re thinking, what if we could be Call9? It’s a bit shorter than 911 and then they’ll yell that.
17:07 MK: Oh, okay. I don’t know why didn’t see that, they’re already it.
17:10 TP: Yeah. So that’s kind of where that came from, but it wasn’t logical to go direct to consumer.
17:18 MK: Did you ever try in implementing that or how did you notice it wasn’t the right approach?
17:22 TP: That’s a good question. It’s simply going through the exercise of making… Just using FaceTime and putting it into people’s hands in the field and saying, “What would you do if you had an emergency?” Doing the most light product development process as possible, and realised very quickly that that wouldn’t work out for us. So we pivoted to looking at, “Okay, what businesses might be able to use something like this?” Nursing homes being at the top of the list, just made so much sense for this population and emergency in the nursing home who were being transferred and again, it’s 20% of the transfers are coming from this one place.
17:57 MK: And that was in 2015 or when was that?
18:00 TP: Yeah, that was 2015 when we started this.
18:02 MK: And at that point in time did you already know like, “Okay, this is what I want to do.” At that moment, were you still in Harvard Medical School or how did that look?
18:10 TP: No. I was already a practising physician at that time…
18:13 MK: Okay.
18:14 TP: And out of medical school, out of residency. But it really… It took hold and when knew that this was gonna work, this was something that needed to happen and came to this realisation after treating our first patient and I’ll tell you about Mr. D, our first patient but…
18:30 MK: I would love to hear that.
18:31 TP: If I’m not here and if Call9 doesn’t exist, this patient population, these patients are gonna go through this horrible experience and a lot of them are gonna die. A lot of them are going to not get the care that they need, but my job in the hospital, when I left that, someone else took it, right? Someone else took my job…
18:47 MK: Yeah.
18:49 TP: And took that job and did the work. But these patients are going to have nothing. It’s a zero to one. Mr. D was our first patient. We were supposed to get started on July 16th, 2015 but instead, the medical director of this nursing home that we were in called us in and said, “Hey, can you come a day early and start, and I just wanna make sure the Internet works and all the I’s are dotted and T’s are crossed.” I said, “Sure, we’ll come in and see a patient the day before we go live,” and we had to see Mr. D. And Mr. D’s complaint, his chief complaint, what was wrong was that he was constipated. So he was backed up and we’re like, “Okay, we’ll see him.” It’s not a patient that we would typically see, maybe.
19:33 TP: We’re seeing patients who have high fevers and belly pain, and whatever. So that was a good patient to practise on. When we got there and he did have abdominal pain, belly pain, and I could see him on the screen and he looked a bit short of breath. He was pretty gruff guy. “Mr. D, are you short of breath?” “No, no, I’m fine. Don’t worry about it.” “Okay,” and so we put him on the telemetry machine, which is the vital sign monitor and we’re able to see that his respiratory rate was a bit high, actually. And I could see, ’cause I’m integrated with his records, that the data that is right there in front of me, that is a brutal diabetic. And so diabetes, shortness of breath, and big abdominal discomfort to an emergency physician means heart attack until proven otherwise. That’s actually how a diabetic presents with a heart attack, unlike the movies when you’re grabbing your chest. So, we did an EKG and because we have his past medical records, I can see his old EKG and in fact, he was having a heart attack in comparison to his old EKG.
20:31 MK: Oh my God.
20:32 TP: We ordered aspirin, administered aspirin, but can see that his oxygen was falling, so we put oxygen on his nose and then I got that back up, put in an IV, and in the meanwhile called our ambulance company that we have a third-party contract with, that comes and gets the patient outside the 911 system. That works a lot faster, kind of a backbone straight to them, and then they sent the ambulance. I called the family because we call the family on every single patient that we see, and told them what was going on, Mr. D was going to the hospital. His son Charlie, which turns out it was Charlie’s birthday actually, was…
21:08 MK: Oh, my God. It keeps getting worse.
21:10 TP: Yeah, met Mr. D at the hospital, and by the time we got to the hospital, his lungs were starting to fill up with fluid and they put him on a breathing mask that helped there and he actually turned around him and put heparin, a blood thinning medicine. Through the IV that we had placed. And by the time he got upstairs, he was admitted to the hospital and he actually left three days later with only 5% less of his heart function, which is you lose 5% when you run a marathon. It’s not much at all.
21:40 MK: That’s crazy, and that was literally your first patient?
21:43 TP: First patient. What they were gonna do is give him an enema, a treatment for his constipation, and have him go back to bed. Mr. D would not have woken up that morning.
21:53 MK: And you wouldn’t have even showed up normally on that day. You were scheduled to show up the next day, right?
21:57 TP: That’s right. So it was kind of lightning in a bottle.
22:00 MK: That’s crazy.
22:00 TP: We knew that this was… We were onto something here, knew that we could save lives. We proved that we could save lives on the very first day and again, it is this realisation that if I’m not here doing this, if we as a team aren’t gonna make this thing, there are people out there that are gonna die.
22:17 MK: How did actually your family and friends react to all of this? It seems like you made this change in your life, for better or worse, at the time it was, I guess there was a lot of uncertainty, right?
22:28 TP: I was, I guess at the time about 33, 32 year old doctor. I had a career and a salary and a life and a position at Harvard, a faculty position.
22:44 MK: Yes, and I’m sure it took quite some time to get there, right?
22:47 TP: It took a lot of time. Doctors, we give our 20s over to medicine. A lot of studying, a lot of work, a lot of 36-hour shifts. I put a lot of effort into it. So my family thought I was pretty crazy…
23:01 TP: To give that up and when I told them, “Oh… ” And in Y Combinator you have to give up your job. Usually they gotta require you to not be working on anything else.
23:11 MK: Yeah, so that came on top of it. You left your job and then you told your family and friends, “Hey, I’m moving to Silicon Valley for that thing called Y Combinator.”
23:20 TP: Yeah and they’re like, “What’s Y Combinator?” [chuckle] Yeah, they didn’t quite get it and then after that first patient, it just became completely clear. You had something tangible that they can understand. The vision became reality with the snap of the finger.
23:37 MK: So that was in 2015 and obviously a lot must have happened since then. Can you just walk us a little bit through where you are today and how does that compare and what have you learned from that time actually?
23:48 TP: So where we are today just on the numbers, we cover about 4000 beds everyday, in terms of patients that we monitor. A typical hospital is about 200 beds, to give you the scale of what we’re doing right now. This is all in New York, in lower New York. We actually just opened our second city, which is Syracuse, New York, which is a completely different market starting the scaling process of going from city to city. We have about 180 employees right now, a physician group and a paramedic group both of about 100 people, which is pretty exciting. We have contracts with 10 major insurance companies. We’ve raised tens of millions of dollars to make this happen from great VCs and I think most importantly is we’ve treated tens of thousands of patients, and soon I can probably say hundreds of thousand patients. We’re almost there.
24:40 MK: Wow, that’s incredible.
24:42 TP: It’s pretty exciting moment and we’re getting ready to really scale at this point and show the world what we can do now that we’ve taken time to make the product sound, and our safety and quality is as high as it possibly can be. But the other big thing here is that we have been working and lending assistance that helps us treat the poor, helps us treat Medicaid and Medicare patients. Right now we have to exist mostly on contracts with private insurance companies because Medicare doesn’t recognise, it doesn’t recognise the service. There’s just no payment model for it, not that they don’t want to. It saves them a bunch of money, it’s good for their patients. It’s just when they came up with the rules of Medicare, they weren’t thinking of Call9 and what we can do.
25:23 MK: Right, right. And how does that compare right now with most of your demographic?
25:27 TP: Yeah, so 60% of patients and nursing homes are covered by Medicare.
25:32 MK: Oh yeah, that’s stil… But 40%…
25:34 TP: Yeah, still 40% by what’s called Medicare Advantage, which is private insurance. So about 60% of the patients are there, who are in need and that’s more in rural areas, poorer cities or cities with a large population. So there’s a lot of patients to still serve. So in order to do that, gotta get the law changed. We brought our data, this impressive dataset over to Congress and the House of Representatives has introduced the bill HR6502, called the RUSH Act, which is Reducing Unnecessary Senior Hospitalizations Act. It was just introduced in July of 2018 and it looks like it’ll be voted on very soon, maybe even this year, if not early next year. And it’s really… It’s been introduced by Republicans and Democrats working together to…
26:23 MK: It’s bipartisan?
26:24 TP: Exactly, it’s a bipartisan support of a non-partisan issue.
26:27 MK: So can you tell the layman in me what’s currently really blocking it then in terms of the regulation?
26:32 TP: Yeah, so you have to create… So what we’re trying to do is create a value-based arrangement. We have talked about this…
26:38 MK: Yeah, we have talked about it.
26:40 TP: So basically at the end of the day, when there’s money left over because you’re spending so much less, Medicare keeps 50% and then the nursing home and the physician group, I.e. Call9 and other physician groups that’ll do this, will split the other 50%. So that’s how it puts that payment programme in place that authorizes the programme to get that payment and makes it a full government programme. So that’ll be super exciting and once that happens, the whole 15,600 nursing homes in the US will be exposed to the Call9’s model, whether Call9 itself is doing it in our physician group or other physician groups and hospitals that we’re working with will do it, and we’ll just help them with our technology.
27:21 MK: That’s amazing. So between then, when you had your first patient and now, what was one of the major challenges that you guys have faced, where you were gasping like, “What the hell is going on?” ‘Cause I’m sure you must have had a moment like that in time.
27:34 TP: Yeah.
27:34 MK: Or many moments.
27:35 TP: Many moments. I think trying to make the transition from start-up to company, where the transition of Tim, the product owner, the person who’s also doing the physician visits, who’s sometimes doing even the paramedic role because we didn’t have someone to do it one day, and the operations etcetera, to Tim the CEO. The big transition there was, I had to convince other physicians to leave their jobs and join me…
28:07 TP: And join me in this idea.
28:09 MK: Well, you set the best example, right?
28:11 TP: Yeah, [chuckle] yeah. So there was a time when we were trying to scale and we were adding on new nursing homes, and we hadn’t really gotten any… Much traction yet. And so the schedule was thin, meaning there were not a lot of physicians covering it, and so I was working a lot of physician hours while…
28:32 MK: Oh my God.
28:33 TP: And seeing patients while also trying to fundraise and things of that nature. So I think that was probably the hardest time, I was kinda working 24 hours a day. But we got through that because the traction kept coming through. So that was about summer of 2016 when that transition started to change.
28:49 MK: That’s great. So where do you see Call9 going over the next two or three years?
28:53 TP: Yeah, so we’ll expand our own service, meaning Call9 continuing to see patients in more nursing homes and more cities. We’ll next year be in our next state after New York, maybe by the end of year, the third state as well. And then, like I said, we’re about 4000 beds right now. I’d like to get to… My image is that we’ll be in a million beds and there are a million beds up there.
29:17 TP: But what really it is, is this that, once this RUSH Act passes, Call9 will be able to help a lot of other people see patients and help patients and save lives where their lives wouldn’t be saved. So we’ll be able to help sell our technology, and we’ll consult for people, and then show them how to do it. We’re already working with certain medical centers to be able to figure out what that looks like. So that’s the next stage of Call9.
29:42 MK: Still a lot ahead of you.
29:44 TP: Yeah, there’s a lot to build still. It’s amazing. You would think at this point when you’re starting you’re like, “Well, four years later, you’ll build them. You’ll build everything.” [chuckle] But that is not the case. There’s always everyday you’re like, “Oh man, we gotta build that now?” So, yeah, every day you’re building.
30:00 MK: I’m kinda curious like, where do you think… What is the future of the nursing home in 20 years down the road? There’s a lot of technological change, obviously, in healthcare in general, but how do you think that’s actually affecting nursing homes but also aging in general?
30:15 TP: Yeah, it’s a great question. I think it’s more of what’s the future of the hospital, which you have to think of, and that the hospital… The idea of walls around an emergency department and walls around the hospital is very artificial. There’s stuff going on in a hospital. There are services being provided, services being rendered, things happening to patients but the idea that it has to happen in this one centralised building, will start to melt more and more as we have more telecommunications technologies like telemedicine, as we have more remote monitoring, as the essentially internet of things become stronger. And as we start using data to be able to predict who is having emergencies before they do, having illnesses before they actually have them and start doing more preventative approach.
30:57 MK: Do you actually think we’re gonna have less hospital?
31:00 TP: So that’s what I’m saying. Yeah, I think there’s less hospitals and the hospital becomes much smaller or much less of them, and they’ll be reserved for just the very certain things that can’t happen even in the home. Yeah, you can see a day when we are treating 80% of the things that we do in the hospital today in the home and that’s already started. There’s a lot of telemedicine being used in home care sensors. And let’s say it’s essentially what we’re doing too, we’re just doing it at a nursing home.
31:27 MK: Do you think we can also scale emergency care to average people? I could have a heart attack any moment right now but for me, there would be no alternative than 911 at this point.
31:37 TP: Yeah, that’s tough. I think it gets back to… In the future, you’ll be wearing a lot more sensors than you are. You already have your phone in your pocket, which works as a sensor. You might be wearing your watch, which works as a sensor but I think, you’ll have a lot more biometrics being fed into monitoring programs. And so some things happen acutely and it’s on a dime, and things change. But most things have warning signs and most things are, like we talked about before, energy behind a dam until it breaks. So you just gotta get to people before the dam breaks.
32:13 MK: On that note, what do you actually think about Apple’s new integration with becoming in EKG that is FDA approved. Is that something that you guys imagine also integrating in your service or how do you see that?
32:25 TP: Yeah, I think that service, what’s cool about that is it’s for the consumer, it’s for people walking out there. It’s exactly what we’re talking about, step one of that. That technology already exists, it’s not special to Apple. What’s special about Apple is that they’ve been able to, as always, give it to the consumer and be able to get mass scale out of it almost immediately, which is amazing, and that’s where… From that comes huge data sets that you can then make predictive predictions on what will happen to any one individual, because you have large data sets to look at. I love that first step, it’s a small step but it’s a big breakthrough toward a much better future.
33:05 MK: Alright, so I just wanna conclude our interview with quick fire rounds. So basically I’m gonna ask you a few small questions and I don’t really want you to spend much time thinking about them, just give me a short answer between 30 seconds and a minute, or so. And yeah, why don’t we shoot ahead with the most easy one, what did you have for breakfast?
33:24 TP: [laughter] What did I… I’m trying to think. I think I just had a Starbucks coffee and didn’t get to breakfast until lunch today. I had some sushi.
33:32 MK: Okay. Do you have any health and fitness apps currently installed on your phone?
33:37 TP: I do have Strava. I love Strava, which is social media for running and biking.
33:42 MK: So one habit that has dramatically improved your life for the better?
33:45 TP: I learned this from seeing my girlfriend. She’s an incredibly happy person. She looks at life so happily and you take it for granted and I wonder why, but she works at being happy. She’s very purposeful at it. She does the right things for her and it’s just a mindset kind of thing to say, “Okay, today I’m gonna be happy. I’m gonna make the right choices.” I have tried to emulate her and I’m half as good as she is, but it has changed my life to just wake up everyday and say, “I’m gonna make the right choices today.” And just having that consciousness around that, has been an extremely great habit to have in the morning when waking up.
34:20 MK: Yeah, it’s incredible. There have been actually studies that have confirmed that, that if you just smile in the mirror and re-affirm, positive thinking has tremendous positive impact on your life. What about diets? Do you think diets are useless?
34:35 TP: [laughter] I think diets are great for losing weight, only to gain it back.
34:43 TP: I’ve done that many times with diets. Yeah, there’s a permanent change and it’s just an awareness kind of thing. So I don’t think diets really… I can’t even recommend a single one. You look at the ketogenic diets, you look at protein-based diets. I’m not gonna put my money and my…
35:00 TP: My word behind any of it as a doctor.
35:03 MK: Can you put your money, though, behind a book? Any favorite book, anything that any listener should definitely listen to that is into health or fitness?
35:11 TP: Yeah, I think talking about mindsets, it’s on top of mine right now. We’re talking about, I think, Growth Mindset by Carol Dweck is something I go back to every year, at least.
35:20 MK: And why’s that?
35:21 TP: The idea that our minds don’t need to be fixed, that we can accept criticism as an opportunity to learn, makes for a happier life and that it makes a more successful life and one…
35:36 MK: And for personal growth.
35:37 TP: And one that… Yeah, and that people around you start to feed off of that growth too, and it becomes contagious and you eventually get a group of people around you who are all trying to just be better in such a way, in a supportive way.
35:49 MK: Do you know something that you would say most people get wrong about health or fitness in general?
35:55 TP: I think it’s the mind-body connection, talking about that and kind of staying on that theme is that you can feel a whole lot better physically if you tend to your mental health. I think mental health is actually more important than physical health, because physical health follows mental health and not the other way around.
36:14 MK: Super true, yeah. That was my last question. I really appreciate that you took the time and yeah, is there anything that you wanna still share with our listeners?
36:22 TP: Yeah, sure. I would encourage people to go to rushact.org right now, which is where there’s a petition to sign to be able to support the RUSH Act and put your support in it.
36:33 MK: Yeah, we’re gonna put the link in our show notes.
36:35 TP: Oh, awesome. That’d be great. Yeah, I think it’s a really important thing. The more signatures and the more support there is, the better it is for… And the quicker it’ll get passed for sure. If anyone is representative of their organisation, their startup, whatever their organisation is and is the CEO or a founder, or can speak for their organisation, there’s also a support letter from organisations and getting those signatures would be amazing as well.
37:04 MK: That’s great. Well, I don’t want to take up more of your precious time. I really appreciate it, and thank you for coming on the show.
37:10 TP: Alright, thanks so much.
37:11 MK: Yeah, thanks a lot, Tim.
37:12 TP: Yeah, thanks so much.
37:13 MK: And that’s a wrap. I think it was really awesome to have Tim here at the show. Personally, I think it’s great to hear another founding story of someone going down that risky road of entrepreneurship to try to really make an impact. And again, if you want to learn more about Call9 and the great work that they’re doing, and also the books that Tim has mentioned on this podcast, make sure to head to our show notes on 20minute.fitness. Feel free to reach out to us also on Twitter. You can find us on @shape_scale to share your feedback with us or suggest whom we should talk to next, whom we should interview on the show. And yeah, if you really enjoy our podcast, I would suggest that you leave us a review on iTunes or your favourite podcast app. Doing so really helps other listeners to discover this podcast and really share the joy and the knowledge. Thanks again for listening, and hope to meet you here next time. Bye.