A View From the Top: Dr. John Prunskis of Illinois Pain & Spine Institute and DxTx Pain & Spine

April 29, 2021

The interview below is part of a series from McGuireWoods that features interviews with C-suite leadership of private equity-backed portfolio companies. To recommend a leader for a future interview, email Holly Buckley at [email protected].

Dr. John Prunskis

Q: What do you believe is the most significant current challenge to growing your business and what will be necessary to overcome it?

Dr. John Prunskis: There are a few significant challenges. One is the increasing consolidation in hospital systems. Physician groups and surgery centers, especially in my space of pain and spine, are also now consolidating. They can also benefit from scale advantages, so this represents at least one path to overcoming consolidation of hospital systems.

The other and equally significant challenge is educating physician colleagues on the depth and breadth of services we offer as a leading interventional pain and spine practice. What I mean by this is communicating to them that our focus is on diagnosing the source of someone’s painful condition, using opioids very judiciously and, in the overwhelming majority of cases, preventing overutilization of surgery. Many physicians were not exposed in their residency trainings to high-quality interventional pain practices, so we must help educate them on our focus of diagnosis and treatment of the source of the pain.

Q: What was the most significant business challenge you have faced?

JP: The most significant business challenge is also a medical challenge. At the Illinois Pain & Spine Institute, where I am medical director, we always focus on diagnosing the source of someone’s pain, fixing it and using opioid medications judiciously.

Right now, that is how most physicians view the use of opioids. However, in the not-so-distant past, I was in the absolute minority of my colleagues in taking this approach.

It was quite difficult for me to continue to speak at national meetings for a period. Many on the speaker’s platform were advocating the use of opioids. I was disagreeing and encouraging my colleagues to diagnose the source of the pain first and then, if necessary, prescribe opioids when we could not fix the problem with non-opioid techniques and methods.

Although it sounds like a nice story now that we are largely successful in moving on from this mindset, it was not very pleasant back then. I feel blessed in the sense that many physicians and scientists hold what is viewed as a contrarian position and only after they die are they vindicated. At least in my lifetime, I have seen the movement away from hospital administrators and physicians encouraging the use of opioids, to focus on diagnosing the source of a painful condition and tailoring the treatment.

It was ultimately our commitment to diagnosis and treatment that made my perspective valuable, leading to a presidential appointment to the U.S. Department of Health and Human Services (HHS) Best Practices Pain Task Force.

Q: What advice would you give to a CEO evaluating potential physician partners?

JP: The physician must have a solid resume. Even more than that, they need strong recommendations from their program directors, their supervising physicians during training and maybe one or two peer recommendations. We mainly focus on prospective partners’ program directors, both in their residency and fellowship. We want to ensure that recommendations for potential physician partners speak to their ability to work well with others. We are also looking for partners with good technical skills and solid clinical judgment who are reliable and work well as part of a team.

I am generally interested in and excited about seeing what physicians can do for patients, what they have done for patients and how they view their interactions with patients. We have on-site interviews with prospects where they meet with their potential physician partners and also with members of our team from the patient accounts department and the administrators to our medical assistant leads. After these processes are complete, we get together and evaluate each candidate.

Q: What advice would you give to a CEO evaluating potential investment partners?

JP: To answer this question, it is important to first share some background. Illinois Pain & Spine Institute is the longest-established and largest interventional pain practice in the Chicago area. My peers have voted our practice as a top pain practice in the Chicago area 12 times. We have received multiple other peer recognitions.

As a result of these accolades and our size and history, we have been visited by most private equity companies in the pain space and some private equity companies that wanted to be in the pain space. We decided we wanted to partner with someone, but we also wanted our partners to recognize the work it took to get to where we are currently while making us better in some ways. We were not looking for a cookie-cutter approach, and we struggled to find that ideal partner. Oftentimes, a top-down management style comes with the investment that does not allow for the degrees of autonomy that carried our practice to where it is today.

For that reason, we decided to help establish an alternative organization called DxTx Pain & Spine that has a different approach than the traditional top-down private equity model. The DxTx core philosophy aligns with mine: that we should affiliate only with high-quality practices, then value and preserve each affiliated group’s autonomy. DxTx is backed by a flexible group of investment partners with a multigenerational time horizon.

I held a common vision with the initial partners in the venture who are Harvard graduates. Practices that partner with DxTx are not called acquisitions, but rather become practices in a “consortium.” It is a different mindset.

DxTx has affiliated with organizations and individuals with high ethical and moral character. It seems to have worked out well. We are now in multiple states.

Concerning affiliation with practices in the consortium, DxTx continues to look for high-quality pain and spine groups to work with, seeking out those that are already leaders in their area that want to affiliate with a high-level consortium such as ours. The groups must have high ethical and moral standards. They must have sound patient care practices and also be financially viable. DxTx’s aim is to partner with them and provide resources and support that takes them from good to great.

Q: What characteristics do you look for in leaders within your organization?

JP: In our organization, leaders need several traits to succeed. They need the ability to earn the respect of those who report to them and those they report to. They need to bring ideas to the table. These leaders need to be willing and not afraid to make suggestions, even if those ideas are sometimes not accepted. They also need to be reliable and demonstrate they can execute once decisions are made.

Q: What do you think are the keys to recruiting and retaining talent?

JP: There are a few keys. The relationships must be based on mutual respect, shared vision and creating opportunities together. It starts with trusting my colleagues and treating everyone with respect and then recognizing accomplishments more than their errors. Everyone is going to make mistakes. It is important not to dwell on those. When an error occurs, do a root cause analysis to try to determine how it occurred. If it was a process problem, change the process.

Supporting all of this requires establishing clear goals for performance and compensation. It also involves finding opportunities for talented individuals to grow in their career and continue to learn while we support them in their process within our organization. Smaller organizations might not have that capability, but now as we are getting larger, people can grow within our organization as we see where their talents and interests are best applied.

But what is most important — and must always be treated with the highest priority — is the delivery of patient care and using the diagnostic and therapeutic techniques that we feel are the best for the patient.

Q: What was the best advice you ever received about running a business successfully and who did it come from?

JP: The best advice I received was to join one of several organizations of CEOs who meet monthly and go over problems or opportunities that each of us had in our businesses. What I learned from this experience is that although our types of businesses may be quite different, there is tremendous similarity between the opportunities and problems we face, which meant we could learn about successes and struggles from one another.

One of the benefits of DxTx Pain & Spine is the approach the consortium uses to share best practices among the different practices and problem solve with leaders who may face similar day-to-day and strategic challenges.

Q: If you had the power to change our healthcare system, what would be your top priorities?

JP: One significant problem I see in our system is the site-of-service payment differential for identical procedures performed in an ambulatory surgery center (ASC) and a hospital. There is currently a large disparity between what a hospital and an ASC gets paid for an identical procedure. This is not only one of the biggest challenges in our healthcare system right now, but also one of the reasons why Medicare is having such financial difficulty.

The federal government has taken some steps forward through price transparency laws for hospitals that came into effect on Jan. 1 of this year. But the hospitals have generally been less than forthcoming with that data. If you try to look up what a hospital gets paid for a certain procedure from private insurers, it is currently extremely difficult to impossible to get that information. That was not the intent of the laws.

The other issue is the electronic health record (EHR). The first time I was invited to the White House was to participate in a discussion about opioids because our practice had built a national reputation around the topic we already discussed, which is the diagnosis of the source of pain and using opioids judiciously and only when needed.

At the same time, the White House was interested in hearing about the EHR issue. EHRs are reported to be the No. 1 cause of physician burnout and one of the leading causes of physician suicide. Unfortunately, our younger doctors have not experienced practicing medicine without EHRs, so they do not know any difference.

In this initial visit to the White House, I met with President Obama’s senior adviser and a senior architect of Obamacare. It became clear during a meeting that this senior architect withheld the detrimental impact of EHRs on the healthcare delivery system. It is my opinion that Obama and his senior advisers left office not knowing this EHR mandate that was part of Obamacare was having such a negative impact on our healthcare delivery system. During that meeting, I found out that the mandate was added on due to lobbying groups on behalf of the EHR industry. It was not one of the initial cores of Obamacare. Instead of mandating that EHRs be used by hospital systems and other provider types, I believe it should be a recommendation.

About Dr. John Prunskis

John V. Prunskis, MD, FIPP, is one of Illinois’ most esteemed interventional pain specialists. He is the co-founder of Illinois Pain & Spine Institute and The Regenerative Stem Cell Institute. He serves as a clinical professor at Chicago Medical School and medical director and principal of DxTx Pain & Spine, a network of affiliate interventional pain and spine practices across the United States. Dr. Prunskis is also a past presidential appointee to the HHS’ Best Practices Pain Task Force in Washington, D.C., where he co-authored diagnosis and national standards for the treatment of painful conditions.

He completed three four-year terms representing Lithuanian Americans in Lithuanian Parliament. For his professional achievements and philanthropy, the president of Lithuania honored him as a “Knight of the Order of Merit.”

Dr. Prunskis is board-certified in anesthesiology and pain management and has achieved the highest distinction for an interventional pain physician as a Fellow in Interventional Pain Practice (FIPP). He is a 12-time winner of the Castle Connolly Top Pain Doctor Award, as voted by his peers, and has been honored as a U.S. News & World Report top physician.

Dr. Prunskis earned his medical degree at Rush Medical College of Chicago and completed his anesthesiology residency and fellowship training at the University of Chicago. He is a former examiner for the interventional pain certification examination and a clinical professor at Chicago Medical School.

Dr. Prunskis is married to Dr. Terri Dallas-Prunskis, who served as chair of the University of Chicago Pain Program for seven years.