Practitioner Spotlight Interview featuring Aaron Berger, MD

Dr. Berger discusses his practice's transition to private equity

Chief Medical Officer, Director of Clinical Research
Associated Urological Specialists (AUS)
Chicago Ridge, IL


	Dr. Aaron Berger

Topic Area: Private Equity, the elephant in the room.

Clinical interests:
Advanced Prostate Cancer
Robotic Prostate Surgery (Da Vinci Platform)
Robotic Renal Surgery
Benign Prostatic Hyperplasia (BPH)
Erectile Dysfunction
Kidney Stones

Bio:

Aaron D. Berger, M.D. earned his Bachelor of Science degree from the University of Wisconsin with a major in biochemistry and molecular biology. Dr. Berger attended medical school at the David Geffen School of Medicine at University of California Los Angeles to earn his M.D. He completed his residency in Urology at the NYU Langone Medical Center in New York. Dr. Berger completed a fellowship at the University of California San Francisco in Laparoscopy, Endourology and Robotic Surgery. Dr. Berger is a member of the American Urological Association and LUGPA (Large Urology Group Practice Association).

LUGPA: When was Associated Urological Specialists, LLC., acquired by Solaris Health?

DR. BERGER: We closed our deal on March 1, 2021, so we are about two and half years in now.

LUGPA: How did the acquisition start to involve your position as CMO? Were you a part of the research process?

DR. BERGER: I actually was given the title of CMO after closing, although I was part of the AUS leadership team before Solaris. We looked at a few other PE platforms before ultimately deciding to pursue a deal with Solaris.

LUGPA: Did Solaris Health first express interest, and AUS give them permission or grant interest to start the research process?

DR. BERGER: We had some very early discussions with one of the Solaris leaders when Solaris was still getting started and thought what they were trying to achieve made a lot of sense. Once the initial two practices joined and Solaris became a real entity, we then circled back with them, and they still had interest in our practice so the process of vetting the deal began in earnest in the latter half of 2020.

LUGPA: What is one word you would use to describe the acquisition process in the beginning? Middle? End/ closing of the acquisition process?

DR. BERGER: The beginning of the process I would probably say cautious. There are a lot of misconceptions and misinformation about private equity deals in medicine so definitely many in our group, myself included, were cautious. The middle I would describe as tedious. Our “deal team” was mainly me and our practice president so we were tasked with handling the bulk of the calls with the attorneys, tracking down all the documents and information that were requested, etc. It is a lot of work, and we certainly had a great deal of help from our COO, treasurer, and finance people. At the end, I would say it would be a tie between excitement and relief. The day we closed, I was actually skiing in Jackson Hole, so I called in to the closing Zoom call from the top of the mountain on a clear, blue sky day with some fresh powder from the night before so I took that as an omen of good things to come.

LUGPA: Did the acquisition process ever feel aggressive or rushed?

DR. BERGER: I do not think we really felt it was aggressive or rushed at least in the beginning. As it got closer to closing day, however, definitely got very busy trying to get all our ducks in a row so to speak, so it was a lot of work for many people in our group.

LUGPA: How has AUS become more valuable or more valued since the acquisition?

DR. BERGER: I think Solaris has really helped us to find some efficiencies in several areas of our practice to cut expenses. Also, just with the economies of scale we now have, the costs of equipment, medications, supplies, etc., have all gotten better overall. We also were allowed to continue, and encouraged to continue, some initiatives that were already getting started pre-Solaris that were helping AUS improve as a practice overall. Through collaboration with the other Solaris affiliates, we have also implemented some new initiatives that were successful at other practices. Improving our men’s health clinical pathways for treatment of ED and Peyronie’s is just one small example of how we have learned from others in the Solaris network.

LUGPA: How have day-to-day operations changed since the acquisition?

DR. BERGER: The day to day has not changed appreciably since the acquisition, which was one of the primary reasons we chose Solaris in the first place. Their message always was that they were interested in our practice because we were already successful and they just wanted us to continue doing what we were doing, and they would help where they can to improve efficiency. None of our doctors were interested in being micromanaged by a PE firm.

LUGPA: In the past I’ve heard independent practitioners talk about P.E. as if it’s this formidable foe or that’s it’s not ideal for independent practice. However, there are certainly positive aspects of being operated by a Private Equity firm, can you talk about a few?

DR. BERGER: As I mentioned earlier, there are a lot of misconceptions about PE overall. Solaris is a physician led medical services organization or MSO. The PE firm is not “operating” any of the Solaris practices, they just provide capital and business expertise at the MSO level. Having said that, every PE platform is different, so the details are what is really important. All our doctors had and have the goal of remaining independent, and I think that is true of all the urologists who are now under the Solaris umbrella. We want to remain independent, but I think we realized that the healthcare marketplace is becoming increasingly complex and competitive. Many healthcare policies in the United States favor large hospital systems, which in many cases allows the hospitals to just keep buying independent practices. Having the financial backing of a large PE firm levels the playing field a bit and collaboration with other amazing urology practices around the country allows us to focus on best practices and provide real value for our patients.

LUGPA: Are your patients aware that AUS was acquired by Solaris Health?
DR. BERGER: Yes, we made no secret about the acquisition and put it out on our website and social media platforms when we closed.

LUGPA: Was a seamless transition or seamless adoption a goal with this acquisition? How do the administrators and physicians ensure this?
DR. BERGER: No change of this magnitude can be completely seamless and there certainly was a lot of concern from our employees as after we closed, the non-clinical staff became employees of Solaris. Having said that, I think the Solaris leadership and administrative team made the transition as seamless as possible and there were no major issues.

LUGPA: What happens when the company is sold again? Is that a concern?
DR. BERGER: The way that Solaris is structured, a new owner cannot unilaterally change any of our operating agreements. This was another very important reason why we chose Solaris. We all hope that the company will eventually be sold again because that means that we have been successful in creating a model organization that has value to another PE firm. It also means that our equity has increased in value which is one of the reasons that practices explore PE transactions in the first place.

LUGPA: Do staff/ employees get any equity as part of the acquisition?
DR. BERGER: There are some very senior members of Solaris leadership that have some equity in Solaris, but it is mainly the physicians.

LUGPA: Who do you think, or what kind of company do you think a private equity acquisition is ideal for?
DR. BERGER: I think that any independent urology practice potentially could benefit from private equity. However, as I mentioned previously, no two private equity platforms are the same, so it really depends on the details and what each practice is looking to achieve.

LUGPA: Ten years from now, where do you see AUS as a result of the acquisition by Solaris Health?
DR. BERGER: I hope that in the next ten years, we will go through at least one if not two sales to larger PE firms. Regardless of what happens with additional transactions, I am confident that AUS in 10 years will still be thriving and as part of Solaris, leading the nation in providing high quality and high value urologic care to our patients.

LUGPA: What would you say is the major success of the acquisition of AUS by a private equity firm?
DR. BERGER: I think we have had many successes since our closing two and half years ago, but the implementation of clinical care pathways ratified by our affiliates, developed by the thought leaders in multiple different disease states throughout Solaris, will have the biggest impact for our patients as they can be confident, they will be getting state of the art care, regardless of which Solaris provider they see.