I Guess We Can All Learn From Geese

I love passing along motivational stories to our team at work and this weeks "Weekly Inspiration" has already circled quite a bit so I thought I would post.  Although I think the purpose of this story was to be directed to organizations I think that the same goes for our family and our lifes.  Living life with purpose, and doing things to come together is what truly matters.  We all got caught up in the hectic day to day grind sometimes, and I love weekly inspirations because it gives me a moment to reflect quietly and make the simple changes that make a difference in all that I do. 

Enjoy!

A Lesson From Geese:

Fact 1: As each goose flaps its wings it creates an "uplift" for the birds that follow. By flying in a "V" formation, the whole flock adds 71% greater flying range than if each bird flew alone.

Lesson 1: People who share a common direction and sense of community can get where they are going quicker and easier because they are traveling on the thrust of one another.

Fact 2: When a goose falls out of formation, it suddenly feels the drag and resistance of flying alone. It quickly moves back into formation to take advantage of the lifting power of the bird in front of it.

Lesson 2: If we have as much common sense as a goose, we stay in formation with those headed where we want to go. We are willing to accept their help and give our help to others.

Fact 3: When the lead goose tires, it rotates back into the formation and another goose flies to the point position.

Lesson 3: It pays to take turns doing the hard tasks and sharing leadership. As with geese, people are interdependent on each others' skills, capabilities, and unique arrangements of gifts, talents, or resources.

Fact 4: Geese flying in formation honk to encourage those up front to keep up their speed.

Lesson 4: We need to make sure our honking is encouraging. In groups where there is encouragement, the production is much greater. The power of encouragement (to stand by one's heart or core values and encourage the heart and core of others) is the quality of honking we seek.

Fact 5: When a goose gets sick, wounded, or shot down, two geese drop out of formation and follow it down to help protect it. They stay with it until it dies or is able to fly again. Then, they launch out with another formation or catch up with the flock.

Lesson 5: If we have as much sense as geese, we will stand by each other in difficult times as well as when we are strong.

Strawberry Truffle ...An Easter Tradition!

I love Easter!  It has always been one of my favorite Holidays for 5 main reasons.  1. I still buy an Easter dress, and love shopping for Easter dresses.  If we have a little girl we are in big trouble as I have already found about a 100 dresses I would love to prance her around in.  2.  I love Easter dinner, we have traditionally had honeybaked ham w/ glaze, mashed potatos, carrots, asapargus, shrimp and grits, and many more 3. I love the feeling of spring and time spent with friends and family 4. I love Cadbury Eggs 5. And last and most important Strawberry Truffle. 

This Easter is different then pasts as it is first we are not actually spending with our family.  John and I are excited to spend a very special Easter with Amber and James, Palin and Lilly in Sarasota!  We can't wait to see them, have some rest and relaxation on the beach, and a delightful dinner on Sunday.  Hopefully a few games (that I will win) in between laughs and drinks (pregnant woman cocktails for me).

Strawberry truffle is really not limited to Easter, as it is a dessert I make for most dinner parties because it is an easy crowd pleaser.  I wanted to share my recipe with all of you to have for Easter and any other time when you want a delightfully delicious dessert!

Nicole's Strawberry Truffle:

2 Pints Organic Strawberries

2 Defrosted packages of frozen strawberries

1 Round Loaf of Angel Food Cake

1 Large Fat Free Cool Whip

Step 1: Pull Apart pieces of angel food cake and lay on the bottom of the truffle bowl

Step 2: Drizzle Frozen Strawberrys and one cup fresh strawberries over angel food cake

Step 3: Layer with cool whip

Step 4: Repeat Step 1-3 one more time

Step 5:  Slice Fresh strawberries and arrange on top

Enjoy!

My Favorite Things April~ Target Spotlight

Since things are starting to get a little tighter I decided to indulge in a little trip to Tar-Ge' to see what I may find to get me through this weird stage where maternity clothes are too big and some of my work dresses are a little too fitted.

So here we go...

1.  Merona One Shouldered Lace Dress:  I bought this in a bigger size to wear  on Easter and hopefully to my brother in laws gradation.  I love dresses and love this style, color, and price!

2. Comfy Robe:  I figured as I get bigger mine won't fit so I picked up one of these babies  perfect for summer, cool, and lightweight

http://www.target.com/Gilligan-OMalley-Slub-Robe-Bright/dp/B0047ZAV8U/ref=sr_1_5?ie=UTF8&searchView=grid5&keywords=robes&fromGsearch=true&sr=1-5&qid=1302133357&rh=&searchRank=target104545&id=Gilligan%20OMalley%20Slub%20Robe%20Bright&node=1038576%7C1287991011&searchSize=90&searchPage=1&searchNodeID=1038576%7C1287991011&searchBinNameList=subjectbin%2Cprice%2Ctarget_com_primary_color-bin%2Ctarget_com_size-bin%2Ctarget_com_brand-bin&frombrowse=0

3.  Sheered Tunic: Very soft and comfy, and perfect with leggings.  Only $21.99, I was looking at a J. Crew one that is very similar for $68 yesterday!

http://www.target.com/Mossimo-Shirred-Collar-Tunic-Top/dp/B0041CN2GC/ref=sr_1_2?ie=UTF8&searchView=grid5&keywords=tunics&fromGsearch=true&sr=1-2&qid=1302133531&rh=&searchRank=target104545&id=Mossimo%20Shirred%20Collar%20Tunic%20Top&node=1041790&searchSize=90&searchPage=1&searchNodeID=1041790&searchBinNameList=subjectbin%2Cprice%2Ctarget_com_primary_color-bin%2Ctarget_com_size-bin%2Ctarget_com_brand-bin&frombrowse=0

4. Ponte Knit Skinny Pants:  I am loving leggings lately and tunics, these are only $29.99 and the fabric is actually fairly thick vs. that thin see through stuff I find most places.  They remind me of BCBG's leggings which are great quality but literally 4x the price.

http://www.target.com/Merona-Collection-Lavendar-Ponte-Pant/dp/B003OR8ABM/ref=sr_1_1?ie=UTF8&searchView=grid5&keywords=black%20ponte%20pant&fromGsearch=true&sr=1-1&qid=1302133782&rh=&searchRank=target104545&id=Merona%20Collection%20Lavendar%20Ponte%20Pant&node=1038576%7C1287991011&searchSize=90&searchPage=1&searchNodeID=1038576%7C1287991011&searchBinNameList=subjectbin%2Cprice%2Ctarget_com_primary_color-bin%2Ctarget_com_size-bin%2Ctarget_com_brand-bin&frombrowse=0

5. Knit Dress:  Nothing like a quick knit dress to throw on to head to the beach, or add a big necklace and a belt for a casual night out.  I bought this because I figured I would be able to grow into the A-Line fit and it would still be flattering.

http://www.target.com/Merona-Maternity-Scoop-Neck-Knit-Dress/dp/B004QJ25C2/ref=sr_1_4?ie=UTF8&searchView=grid5&keywords=knit%20dresses&fromGsearch=true&sr=1-4&qid=1302133945&rh=&searchRank=target104545&id=Merona%20Maternity%20Scoop-Neck%20Knit%20Dress&node=1038576%7C1287991011&searchSize=90&searchPage=1&searchNodeID=1038576%7C1287991011&searchBinNameList=subjectbin%2Cprice%2Ctarget_com_primary_color-bin%2Ctarget_com_size-bin%2Ctarget_com_brand-bin&frombrowse=0

6. Merona Cardigans:  Everyone loves cardigans and these Merona one's come in every color, and are only $17.99.  They are very similar to J. Crew's classic cardigan but I actually like how they fit a bit better as they are somewhat fitted to your body. I think this spring floral print would look great with a black pencil skirt, a skinny belt, and some black patent leather peep toes!

http://www.target.com/Merona-Essentials-Cardigan-Sweater-Purple/dp/B004GNGMHC/ref=sr_1_38?ie=UTF8&id=Merona%20Essentials%20Cardigan%20Sweater%20Purple&node=1041790&searchView=grid5&searchSize=90&keywords=cardigans&searchPage=1&searchNodeID=1041790&sr=1-38&searchRank=target104545&frombrowse=0&qid=1302134032

7.  Rolston Patio Set:  I got most of the pieces of this patio set last year, but today decided to pick up the Chaise Lounge for our Lanai since it was on sale.  I love our patio set! It is affordable, looks, great, and we get tons of compliments on it!

8. Castela Trunk:  I found a seagrass trunk at Pottery Barn for $249 dollars, then I found this very similar trunk at Target on sale for $50.  I love the Seagrass look and wanted something to store extra sheets and blankets for the guest bedrooms.

http://www.target.com/Castela-Trunk/dp/B000UZVLQM/ref=br_1_1?ie=UTF8&id=Castela%20Trunk&node=14183021&searchSize=90&searchView=grid5&searchPage=1&sr=1-1&qid=1302135003&rh=&searchBinNameList=subjectbin%2Cprice%2Ctarget_com_primary_color-bin%2Ctarget_com_size-bin%2Ctarget_com_brand-bin&searchRank=salesrank&frombrowse=1

That's all I have but hope you enjoy, and maybe treat your self to something new and affordable.  I don't know when I became such a bargain shopper but I am proud of my buys!

Guacamole....My Favorite Food In The Entire World

I am obsessed with guacamole, and I always have been! Pregnancy thank the lord is no different, my biggest fear was that I was not going to want my delicious concotion, but the fact is I have wanted it even more.  We probably eat Guac at least five days per week.  One of my favorite gifts I have ever gotten was my guacamole bowl from a dear friend named "Nuda".  In fact JMS commented last week that this is our "Most used wedding gift and food item" The link below will lead you to where you have to go to purchase this baby. 
http://www.crateandbarrel.com/kitchen-and-food/prep-utensils/molcajete/s395196

I figured I would share my secret recipe to all my fellow guac lovers out there.  The thing is I make guac and decide how much of each ingredient I put in based on the dayand how I am feeling.  This is what I use:

Nicole's Guacamole Recipe:

4 Ripe Hass Avocados~ Remove Pits and Mash in Bowl first before adding other ingredients

One Small Jalapeno Pepper Chopped

1/4 Quarter of a Red Onion Chopped

1 Small Ripe Tomato

2 Minced Garlic Cloves

Chopped Cilantro (As much as I feel like on that particular day)

1 Teaspoon Cumin

1 1/2 Teaspoons Salt

1 Lime Squeezed

Mash in your Guac Bowl and you have the most delicious snack ever!!!!!!!

 Enjoy!

My First Professional Article Published!

ASC A Smart Move Toward Future Stability in an Uncertain Future BY NICOLE SEMERARO

It has been a dynamic year for the ASC management and development industry. 2010 marked the busiest year in Physicians Endoscopy’s (PE) history of ASC development and 2011 is gearing up to top it. Some may wonder how this is possible, considering statistics show that ASC growth has leveled off in the past few years. With the uncertain future of healthcare due to reform, the question is what has caused such an increase of physicians interested in developing new centers or to sell equity ownership in their existing centers?

Nicole Semeraro

There is no single answer to this question. For some, the answer is to gain long-term stability and prepare for any future changes. For others, it is survival. With professional fees on the decline, physicians need to identify other revenue sources to tap in order to grow their practice. The answers can be different for every practice. Each situation is unique and equally complex, but there is a possibility for the positive outcome that the physicians are looking for.

With speculation surrounding healthcare reform and what it will mean, many physicians are recognizing that there’s strength in numbers. At PE we are seeing a large number of physicians that have not yet developed an endoscopy center wanting to do so now. We are also introducing the joint venture concept to hospitals and physicians, as potential new opportunities to encourage a long term relationship that creates increased efficiencies and long term stability. Many of our projects under development are made up of coalitions where physicians are joining forces to develop a center which has been their long-time dream.

When you look at how the market has evolved, you’ll see that a majority of large physician groups have already developed a center. You will also see a number of physicians that have thrived independently for their entire careers and want to retain that independence, while benefitting from ownership in an endoscopy

FEBRUARY 2011

EndoEconomics | 13

center as well. For these physicians, the coalition approach is best suited for their needs. They can preserve their independence on the practice side, while coming together as a team to develop an ASC that provides high-quality care for their patients. It is also an opportunity for long-time independent physicians to forge stronger relationships with their physician colleagues.

This is the case for one of our centers currently under development in a historically challenging Certificate of Need (CON) state, a regulatory process that adds an entirely separate level of complexity to the project. The relationship began nine months ago when two of the physicians decided to set up a meeting with PE to discuss the possibility of developing a center. The physicians were presented an overview of the process, financial illustration, and appropriate next steps to move through the process. At the end of the initial meeting, the physicians knew they needed to do something, and agreed to continue through the due-diligence process to determine if it made financial sense. The end result has been five separate solo physician practices have joined together to develop their own endoscopy center. With the professional guidance necessary to align the physicians, Physicians Endoscopy was able to navigate this complex situation by putting together a business plan whereby all the physicians would benefit as a singular group. When asked why the physicians now decided to come together to develop a center, Co-Medical Director Bill Watkins, MD responded, "This is something that we had been thinking about doing for a long time and should have done years ago. The reason we came together to develop a center now involves a variety of factors, such as declining professional reimbursement. Also, we have seen our patients going to surgery centers outside of our county where they can get the same procedure done at a lower cost. We need to recapture this lost revenue. By bringing in Physicians Endoscopy, an unbiased third-party, to manage everything related to the center, we don’t have to worry about anything but our patients." Banding together five different physicians from five solo practices is no small feat. The most important part of the process for PE is to ensure that all physician concerns are addressed and all parties feel comfortable and confident in the decision. The integral role of a professional management company in these relationships is guidance and sharing its expertise in managing a number of different physicians in separate practices to make for a smooth transition that allows the physician to primarily focus on providing great care to his or her patients. At present the CON application is under review.

The second scenario we are seeing is where existing centers are selling a minority interest to management companies and other physicians. This is not just

Our latest acquisition in Augusta, GA is a prime example of acquisition for growth. An existing, successful endoscopy center sought the opportunity to become even more profitable by adding a management partner and recruiting area physicians. Discussions began a year ago when a group of GI physicians approached PE to help put a plan together. How could we position this acquisition opportunity to be a win for them, the new physicians, and PE? We agreed that the next step would be to identify physicians in the area to potentially join practices and buy into the existing center. In the state of Georgia, under a Letter of Non-Reviewability (LNR), all physicians must be in the same practice in order to do their cases at the endoscopy center. This makes the process a bit more complicated, but the physicians agreed to bring in PE to assist with those issues. Over a year’s time PE went through the offer and negotiating process, the practice merger, and the equity sale in the endoscopy center. Deals like this are extremely complex as there are so many moving pieces on both the practice merger side, as well as the center side. There are many decisions to be made and strategic timing of events in order to get to the final signing. The end result of this project was the merger of two of the largest Augusta

any acquisition; this is what we refer to as "Acquisition for Growth." We have been successful in identifying endoscopy centers within a specific geographic area where there are still physicians that could potentially join forces with the existing center to increase volume, utilization, and efficiencies. By coming together through the acquisition, these new physicians provide value to the existing center because increased historical volume of the newly merged group will increase revenue. The physicians gain a business partner with proven expertise to offer guidance and increase operational efficiencies. It is a sound investment that will secure their financial future.

"We believe that coming together will allow our practice to continue to recruit new physicians, maintain our income, negotiate better as a larger group, and continue to grow."

–

Assistant Medical Director,

Augusta Endoscopy Center

Rick Hodges, MD14 | EndoEconomics FEBRUARY 2011

area GI practices into one group and subsequently PE and the new physicians’ equity purchase within the endoscopy center. Why did this group decide to do this now? "It is something that we had wanted to do for the past few years. We did it for long-term stability, security, and planning purposes. We have two physicians that will be retiring in the next five years, and we believe that coming together will allow our practice to continue to recruit new physicians, maintain our income, negotiate better as a larger group, and continue to grow," said Rick Hodges, MD, Assistant Medical Director at Augusta Endoscopy Center.

No one knows what the future holds for healthcare. What we do know is that there will be changes, and there needs to be increased efficiencies in the delivery of healthcare at a reduced cost to the system. Endoscopy centers are the perfect solution for increasing efficiency, reducing healthcare costs, and streamlining care through proven methods of benchmarking. The above examples are ways to increase efficiencies and long term stability for the future. Coming together in an "Acquisition for Growth" or with other solo physicians in your area to develop a new center or enhance an existing center are strategic approaches to solidify your position in the market for years to come. This is an exciting and opportune time for you as a physician to make your dream of owning a center become a reality.

Nicole Semeraro, Vice President, New Business Devlopment.

She can be reached at

Ms. Nicole Semeraro joined Physicians Endoscopy in April of 2009, and has been in the healthcare sales arena for the past four years. Prior to joining PE, Ms. Semeraro served as Vascular Access Manager for one of the top five medical device companies in the world, Covidien. Her responsibilities included managing a team of sales representatives to reach company sales goals, generating new physician relationships, consulting with vascular surgeons on new devices, organizing and implementing clinical evaluations for new accounts, and training new members of the organization on key product lines. Ms. Semeraro started her career in pharmaceutical sales with Sanofi-Aventis, focusing on key product lines within the osteoporosis, insomnia marketplace. Ms. Semeraro earned her bachelor’s in marketing from Bentley University in 2005, where she played Division II volleyball. During her time at Bentley, she was a member of the prestigious NCAA Division II Student Athlete Advisory Committee where she represented student athletes from across the country on a variety of legislative topics that directly affected college athletics. Ms. Semeraro spearheaded the first ever NCAA grassroots fundraising campaign in partnership with the Make-A-Wish Foundation which to this day still continues to grow and has thus far contributed over $730,000 to the children’s benefit foundation. nsemeraro@endocenters.com.FEBRUARY 2011 EndoEconomics | 15
Ownership