By Bob Wachter
Modern Physician just named Adam Singer, the founder of IPC — The Hospitalist Company, its first annual Physician Entrepreneur of the Year. Adam and I don’t always see eye to eye, but I want to congratulate him and highlight some of his contributions.
When the hospitalist field launched in the mid-1990s, Adam was there – I recall seeing him at virtually every hospitalist-related meeting during the early years. He struck me as a bit awkward – maybe a tad insecure – but he was brimming with passion and a near-religious fervor for the hospitalist concept. He had just started his company, whose business was to organize hospitalist programs and place them in hospitals, first in So Cal, and later in other regions. In essence, IPC was really the first “rent” (vs. buy) hospitalist solution, and it quickly found a market niche.
Adam’s vision was unique and deeply held. He frequently scolded me for what he called an overly traditional and “academic” view of what a “real hospitalist” should be. To his way of thinking, hospitalists should be relentless managers of the inpatient stay, less about traditional views of physicianship and more about driving teams and technology to make hospitalizations more efficient and increase adherence to practice standards.
The use of technology was critical to Adam’s ability to bring his vision to fruition. Adam had a fundamental problem to solve: he needed data to run his business, but getting information from all of his client hospitals was nearly impossible. As Adam once told me, “if I need to get clinical and billing data from each hospital, I’d be spending all my time in hospital IT meetings.” So he built IPC’s infrastructure around home-grown handheld devices that allowed his hospitalists to collect detailed patient data; the devices synced up with a central data repository daily. Not only did this give IPC the ability to measure and articulate their value to client hospitals, but it gave Adam – a self-described control freak – a detailed window into the daily practice of dozens, later hundreds, of his hospitalists without having to leave his North Hollywood office. I remember him demonstrating the system to me one day, including the tough, sometimes boorish notes he would tear off to those docs who seemed to be underperforming. It wasn’t my idea of an attractive management style, but one couldn’t doubt his commitment to his vision and his ability to disseminate this vision across an increasingly vast enterprise.
Perhaps most impressively, Adam focused like a laser on post-discharge care, well before it was fashionable. At a time when few saw the business case to do this, Adam developed a sophisticated (and expensive) system of post-discharge follow-up phone calls, aided by his handheld technology system. He found that, by calling every patient soon after discharge, his nurses were often able to troubleshoot and avoid unnecessary re-hospitalizations or harm. “All part of our value equation,” he told me when I asked him how he could afford to do this, and there was no doubt that it was a marketplace differentiator for IPC. Today, everybody is thinking about readmission rates and filling the post-discharge black hole. Adam was all over it a decade ago.
I’ve had my disagreements with Adam over the years, and continue to harbor concerns about some aspects of IPC’s clinical and business model. I also wondered whether he would suffer “Founder’s Syndrome” – he has the kind of high energy, confrontational personality that is perfect for the early, free-wheeling days of a start-up, but sometimes gets shoved aside when the company matures, replaced by a smoother consensus-builder. To Adam’s credit, that hasn’t happened, in part because he is a great judge of talent, bringing in others who have played Robert Gates to Adam’s Rumsfeld.
And you can’t argue with success. IPC’s net revenue now exceeds $200M/year. And last year his company became the first hospitalist enterprise to go public, earning he and his shareholders considerable wealth (which they have retained, despite the market conditions). Others will doubtless follow, but this event was external validation of Adam’s leadership and, more broadly, the hospitalist idea.
So hats off to Dr. Adam Singer, Physician Entrepreneur of the Year. Whatever one thinks of his unusual style, there is little doubt that Adam has been as responsible for the growth of the hospitalist field as anyone.
