Thomas Zenty

So you ask the question, well, then why am I receiving it?

Well, rather than talk about the Medicare requirements, why we have to do that, we send a follow-up.

And then that says, this is not a bill.

So the point is, you need a Rosetta Stone to figure out a patient bill.

But we have to move in that territory of consumer facing in ways we've never done before.

Now we're getting a fair amount of consternation about, is this an issue of margin over mission?

So that culture is what we really have to manage.

We need to be more psychologists than business people because this is about leadership.

It's about buy-in.

It's about ownership.

It's about participation.

And it's about changing the culture

Yeah, the only thing I would add to that is sometimes in adversity, meaning when there's a competition for funds, creativity becomes paramount.

I think one of the things that we don't do enough of in our industry is effective philanthropic support.

I've been in the organization where I work now for 17 years.

And 16 years ago, we started a big program in philanthropic support for our research and our teaching mission.

Faculty said, well, this is not a rich community.

I work in Northeast Ohio in the Cleveland environment.

Well, interestingly, if you fast forward now to 2019, we went from having virtually zero academic chairs to now having 140.

And it's a million and a half dollars to fund a chair.