0:00:02 - Mark Henderson Leary

Welcome to Practice Freedom. What if you could hang out with owners and founders from all sorts of healthcare private practices, having rich conversations about their successes and their failures, and then take an insight or two to inspire your own growth? Each week on Practice Freedom, we take an in-depth look at how to get the most out of both the clinical side and the business side of the practice, get the most out of your people and, most of all, how to live the healthy life that you deserve. I'm Mark Henderson Leary. I'm a business coach and an entrepreneurial operating system implementer. I have a passion that everyone should feel in control of their life, and so what I do is I help you get control of your business. Part of how I do that is by letting you listen in on these conversations in order to make the biggest impact in your practice and, ultimately, live your best life. Let's get started. Welcome back, practice leaders. Welcome back to another interview episode of Practice Freedom. Got an interview coming up with Autumn Piccolo, who is co-founder of the American Ivy Association, and David Light, who is COO of the same, and so hearing their perspectives on the emerging market. Now, both of them have different backgrounds. Autumn has been in healthcare law for a long time, has that legal background, understanding broadly the industry and David comes from a PT background and also, obviously, entrepreneurship, and so what we talk about I think if you're interested in the IV space, I think you'll find it interesting, because they're an association, they don't directly provide IV services. 

Their customer are the IV providers, which range from just the small independents to the larger groups, and I think there's a lot to be learned in a couple of different areas. One is the leadership space of what it is to be the craft person, the provider, the healer, and that's not enough. You have to have resources outside that and so they're really providing that space for the peership and the advice and some of that information that is needed, not just at the basic level, that's needed at the more sophisticated level for advocacy and things like that. And I think the interview really tells a lot of the story about how important it is to have that community and it also talks about sort of the dynamics and the pivot and how that works. And I think really this one subspecialty I was really intrigued by the attributes of IV hydration and its relative risk and its relative newness and how it's being incorporated and who incorporates it, and is it a leader in the value chain or is it a follow on in the value chain? Is it independent? Is it incorporated with other things? We had a lot of conversation around that. So if you're interested in adding things to your practice, if you're interested in IV, if you want to understand how the market dynamics of an association are working right now in that space, I think you'll enjoy this interview. 

Community of Practice Freedom is to give you access to creating that high value, amazing practice that you love, that your employees love, or the culture is strong and everyone feels like they're privileged to help heal people in some way, even if they're just scheduling people in a convenient way, and it's running great and it's profitable and it gives you the life you deserve to make the biggest impact possible in whatever way you are meant to make. But if you're stuck, please don't stay stuck. Please reach out. We'd love to help you get you on your way to a free practice. Reach out and schedule some time at practicefreedomcom. Slash schedule With that and no further ado. Autumn Piccolo and David Knight All right, well, good morning guys. How have you guys been since we last talked? What's going on in your world? 

0:04:10 - Autumn Piccolo

End of the year crunch, gearing up for the holidays, winding down for clients, chasing goals for clients, hitting that end of the year rush. 

0:04:22 - David Light

Yeah, and at the same time, trying to build up strategic plans for and, and, and. At the same time trying to build up, you know, strategic plans for next year, and, and budgets and forward thinking. So this, this, this time of year is is very, very busy. 

0:04:33 - Mark Henderson Leary

What? What do you feel good about this year? 

0:04:36 - Autumn Piccolo

Oh, wow, that's a long list. 

0:04:39 - Mark Henderson Leary

Yeah, I mean you overall feel feel good about like a lot, of, a lot of great things have happened this year. Do you overall feel good about a? 

0:04:45 - Autumn Piccolo

lot of great things that happened this year, absolutely, I mean, it's a good moment to pause now that we're live and recording, because I usually don't take that moment to celebrate and reflect. We planned on doing that in about two weeks. 

0:04:56 - David Light

Yeah. 

0:04:57 - Autumn Piccolo

So, yeah, we feel great about it a lot, We've accomplished a lot, and I tend to be one of those people who's foot on the gas to a fault and I don't take that moment to sort of reflect and realize what I've accomplished. But we've done a lot this year. 

0:05:11 - Mark Henderson Leary

Well, I guess that's the entrepreneurial life and that's one of the things that I think is so fun and exciting. But you know it's very overwhelming and part of you know going so fast, everything is so urgent, we forget to pause and assess and sort of check in. 

And this is the time of year to do it. This is annual planning season for my clients and this is the time to sort of reflect and I think what for me? I get to the end of the year, I get frustrated because I'm trying to really end strong and the year is starting to cool off. People are starting to slow down in many ways and I'm like I'm not done. I don't this vacation time, this time off, you know it sounds great but it's very inconvenient to me, and so I start to get this friction of like you know, come on, let's just hurry up and get everything done and the rest of the world's going like no we're not doing that. 

0:06:00 - Autumn Piccolo

You know what. I start to reframe it as I start to tell myself I'm just getting ahead of them all. I'm going to be a week or two ahead in January when everyone's just clicking back online and I've been doing what I've got to do and what I'm inspired to do and I think of it like a head start. 

0:06:15 - Mark Henderson Leary

Yeah, well, that works when you can do things, that that, that have your, that you can your work product like if you're a new process, a new presentation for me, new content, but I'm trying to get people to finish their stuff, so that's where I start getting frustrated. Yeah, I get that. So when you're looking back, thinking about well, I don't know If you had to summarize for you what was 2024 about, for what you guys were doing, what were we trying to do and what ended up happening, yes, I'll take that one. 

0:06:47 - David Light

So we started off, we kind of wrapped up 2023 in a little bit of a different space. We were not really. It was up and down and kind of left and right and we put together a strategic plan for 2024. So we implemented that. You know, january, february, out of the gate. So I mean to summarize, 2024 was basically like we built the rocket ship in 2023 and 2024, it lifted off and we were sitting outside of it and be trying to hold on. So I mean, it was just a trajectory that we didn't expect to happen so fast and be full of so many highlights. So it's been a rush. I mean it was really a busy year. 

I think now one of my reflections on it is how did it happen so fast? There was a lot of travel involved. We did a lot of different things through the different organizations that Autumn and I are a part of, and that really kind of leads us to reflect of what do we want to because of that rush and the inability to really pause as an entrepreneur, what do we want to strategically avoid next year that we felt like maybe took too much of our time, effort and our energy, and what do we want to? You know, what do we want to put in its place going into 2025? But it was a combination of, you know, growth in multiple different factors, from relationships to size of the businesses that we're a part of, to changes in some of the businesses that we're a part of, and it just went all out. 

And I guess my kind of summary on that, Mark in a short version, is I feel like 2024 was kind of where 2019 was a little bit like pre-COVID I mean. I think the M&A market was taken off. There was a lot of stuff moving in the right direction, the economy was really really strong&A market was taken off. There was a lot of stuff moving in the right direction, the economy was really really strong, and that was kind of a rush as well. And then things went sideways, obviously, for a few years. 2023 was normalized, I guess, as a whole, but for me 2024 was really like okay. Finally, now we're back on track to explosive growth in multiple different areas from a business perspective. So that's kind of the way I'd sum it up. 

0:08:48 - Autumn Piccolo

Yeah, that makes sense. 

0:08:50 - Mark Henderson Leary

Well, so let's get specific. Tell me what worked. What did you try that was like man, this is landing. 

0:08:58 - David Light

I think the biggest thing that I saw that worked for the organization that Adam and I were very intimately involved in is the fact that we were able to leverage connections with other professionals that have relationships, products, slash, services in our space and sort of crowdsource. In a way, we developed an inner circle, if you will, with our company that brought in service providers and suppliers, slash key vendors and we brought them all in. We brought them all in. They volunteered, obviously, to come in and be a part of this organization, not only to lend advice and guidance and wisdom and resources, but also to help the intricacies, to kind of run it. And that wasn't like a big delegation factor, that was just, hey, let's put our heads together for this project, let's put our heads together for this project, and we were able to utilize a bandwidth of professionals across the country that you know back in 2023, we didn't have. 

So I think you know when I look at that, I've never really done that with a company before. It's always been the grind of you know you're going to. What's your ROI on this? What's your ROI on that? Is it going to be digital, is it going to be print, and how much can and combat can you do over the course of time to try and get an outcome? This exponentially grew because we were able to leverage the resources of all these other professionals that wanted to work with us and in the end result, we really developed the product a little bit better and were able to tap markets that we didn't think were even reachable in the beginning of the year. So that's probably my key takeaway. I think that I learned this year. 

0:10:39 - Autumn Piccolo

It's an interesting lesson. I mean, I think both David and I have been a part of organizations that were really B2C in the past and doing that B2B switch. Whereas in 2024, we were focused on that over 2023, where we were just trying to build that customer base, moving to a B2B sort of networking focus brought us the B2C you know, growth and we had both seen that linear approach of focus on your customer and deliver what they want and go after them, and we were really. We were there in 2023, but looking at the way that things really grew in that geometric way in 2024, that was how we went a little bit different side of the funnel and got where we wanted to go through that. 

0:11:24 - Mark Henderson Leary

And so what was the customer base? What were we growing? 

0:11:27 - Autumn Piccolo

So the organization that we've been working together on is the American IV Association, which is a membership organization for IV hydration providers, wellness providers, people in the wellness industry who are seeking that business guidance getting into business, staying in business, compliance, what's going on with the industry, news regulation, things like that. So it's a nationwide membership organization for those providers and the reason we created it was because those providers have been in the past very disaggregated, one off here, one off there, across the country and they don't really have that beacon that's responsible for bringing them all together and creating a voice for them, both with regulators and the media and on the business issues that they're going to face. So they're all over the country and finding, like that, one person in Minnesota who needs, you know, an organization like that, versus going to some of the larger business connections like the franchisors and looking at their organizations with 80 or 150 or 200, you know locations or folks under the umbrella. That was able to. That helped us grow quite a bit. 

0:12:38 - Mark Henderson Leary

Yeah, so you're saying those larger communities were the source of faster growth? Yeah, okay. 

0:12:45 - David Light

Yeah, and the inherent difficulty that Autumn just spoke of is the fact that we have an organization that represents a service and that service is performed by multiple different individuals across the country. So you have licensed professionals but not one licensed professional. You may have an MD, a DO, a DC, a physician assistant, an APRN or an RN, and then you also can have an entrepreneur that's unlicensed, that heads up, say, a franchisee, and employs those type of people. So it made for a very, very, very difficult aggregation process to get in front of that crowd. And to Autumn's point, and what you just mentioned is by relying on vendors that are already servicing those organizations, we were able to get in front of them at a much faster pace and identify our B2C audience better. 

0:13:37 - Mark Henderson Leary

Yeah, so that's one of the things that I observe in healthcare is that there's not always enough attention placed on in healthcare is that there's not always enough attention placed on location in the value chain that you have to know. Somewhere in this ecosystem, your customer, your patient, your ideal person to help, is already having a conversation with somebody that's going to need a next step. That is you, and if you don't have the relationship with that person, then you're not going to get that, or they're going to get, and how often they just go to nowhere. So it's really important to figure out how do I connect with the right people so you know? So who was or who is who? Are you finding those best sort of influencer, guidance, referral? You know who are those folks and organizations. 

0:14:27 - David Light

Yeah. So for us it really boiled down to you know that inner circle is defined by two groups of people. We call them founding members and key vendors. The founding members are are the individuals that are responsible for organizations that actually provide the service of IV hydration. You know they're. They're they're franchisors or owners of large swaths of clinics or have large amounts of people that answer them from a provider side and then from a vendor side. It's incredibly diverse. I mean we've got people from you know, like DreamSeat, that builds chairs and customizes those for lots of sports teams across the country, to pharmacies, to labs, to individual products, to insurance providers. I mean that's when we look at what is that value chain and what are people asking for? That's where the key vendors come in and we're trying to hit all those because we want to make sure that we have those available for the soon-to-be member as well, from a reference point or a warm handoff. 

0:15:29 - Mark Henderson Leary

Well, how did you get into the Ivy space? You dig that one. 

0:15:32 - Autumn Piccolo

Great question. Well, I've been running a healthcare law firm for the last 15 years and my partner, who is a 40-year health lawyer board certified in health law, and I you know, we have coffee all the time and it was one of those coffee conversations we were talking about one of our dear friends asking you know, he's a guy who likes tech and build surgery centers and really complicated technology in health care. And he's saying you know what's next, what's going on, what are you guys looking at? And this was, you know, a couple of years ago, a handful of years ago, and Jeff, my partner in the law firm, said you're going to hate this answer because the no, we don't want to provide that service. Do we want to be the Uber for that business and connect the patients to that service? I don't know about that. 

Well, what are the people that are providing that service going to need? Oh, they're going to need an association, a membership organization that provides X, Y and Z, and, having been in this space for many years, I had seen it done in a couple of other subsets of health care, such as med spa. We actually had tried to build one in the addiction treatment space, but did not have a lot of success because we didn't have the industry buy-in, there wasn't a feeling of everyone wanting to collaborate in that space. So I said, why don't we just build it? And again, because we have been operating, you know, as a healthcare law firm advising clients in this space for many years, we said, okay, well, we have that client base, we know where to find a lot of those folks, and let's just build it. 

0:17:14 - Mark Henderson Leary

So we did, and it was an immediate success. 

0:17:18 - David Light

Oh yeah, I mean every. You know the minus touch. We've got the G5, you know, on hold after this call because we're going to have a lot of game ends. 

0:17:27 - Mark Henderson Leary

No, yeah, so that hypothesis. So how close to that initial hypothesis did I mean? I guess there's three questions in here. It's like you know that hypothesis was tested how did that test go? And then, how have you evolved since then? So go back to the first question. You had a hypothesis after coffee. You're going to archetype this thing and you're going to run it out there. You know what did you encounter in terms of, like man, we're in, we're all in, or was there crickets? And you had to keep tweaking. What was that first attempt like? 

0:17:55 - Autumn Piccolo

The first attempt consisted of essentially an industry meetup. We put together a couple of events and I did so with the help of someone who was skilled in event planning and knew how to do that. So you know, we had I believe we had our first event in Los Angeles and 50 people showed up and were raving and so excited and I'm so glad you guys are doing it. It was kind of like a little mini focus group, a little test group, and from there we scheduled our next event, which was based here in South Florida, and I think we had 150 people come and we thought, ok, we've got something, we've got some buy-in, we like this, but we can't quite crack membership, you know, in the thousands. You know we were thinking these are great focus groups, great indicators of interest, but we're not seeing that and meet that big buy-in. 

So you know, we kind of struggled along after that to kind of add the members in a very linear fashion, again thinking the events are the key to doing that. Well, the events are certainly an arm of a profitable organization like this, but not the key to that end user buying into what you're selling. You know, we looked at our benefits, we tried to really build out the benefits so that the membership delivered a lot of value. And again, that was how 2023 looked, I think was to sort of take that approach and think we're going to do some events, we're going to do more membership. Anyway, we decided we're not event people, we don't want to do events and it's not moving fast enough for us. 

And that's when we brought David into the project and got aligned on what is it going to take to move it quickly and what are the things that we're seeing here that we just don't have eight years to build this and we don't see the runway being that long. We need to reach way more people way quicker and that's what we put together Our plan in late 2023, got aligned with some other industry leaders and certainly people who are very visible in that space, and when we launched, you know, full on, in January of 24, we saw that growth 10x, which is what we wanted. So that was the process, but that first couple of years, certainly not an overnight success. 

0:20:01 - Mark Henderson Leary

Yeah for sure. So just so I can tangibly understand the shift, the initial value proposition was just the community. You were getting people in a room and that was the initial sort of. This tastes great. I get to hang out with people who are like me, yeah, or was there? That was essentially it, and so now we're like that's not our thing, we're not a meetup. How would you summarize? Like the reason people join right now is because of why? 

0:20:27 - Autumn Piccolo

So the initial thought was education. Okay. So we wanted to make sure that everyone had great education. The way that we did that was through those events, through those meetups, I think. Beyond that, we sort of understood that there would need to be some tangible benefit as well, like, for instance, if you can't attend the event, how else are you going to make use of your membership throughout the year? So we looked at bringing in the insurance vendors that David spoke of and other vendors that provided business resources that these folks would need in the course of being a business. 

Once we had those benefits dialed in and we decided we're not going to exclusively focus on benefits or exclusively focus on events, then we really started to focus on the or exclusively focus on events. 

Then we really started to focus on the community. 

And it's interesting because we did a very strong push, probably the second half of this year, the prior six months, to really focus on the identity of the type of provider that would benefit from associating with other like-minded individuals, the type of person who has that entrepreneurial spirit and is not necessarily looking to get a tangible benefit but looking to associate truly associate with others, connect with people through the committees or through the other face-to-face value that we're trying to create for people and when we started focusing on identity and the identity of the provider, that really helped, I think, solidify that this is an organization not just where you pay your quarter and you get your gumball out, but you get access to other people who have been through the issues you're going to be through and have faced those endeavors, overcome those challenges, have those resources that connect you with additional value. 

So the value I think now in the membership although we have a great list of benefits, amazing vendors, we do have events the value seems to be the energy that people are bringing to the organization. They're flying across the country to show up for events and getting on these community calls with David and our monthly check-ins with everybody, our new member meetings. I mean we do a lot to create the value face-to-face with the people that are, you know, choosing to invest their time, not just their dollars. 

0:22:32 - Mark Henderson Leary

So it seems like there's a little bit of a I mean it's not events, but there is some event, though I mean you're saying, if you get the right avatar, the person who's sort of self-identified, this is my tribe. Then you got to say, well, we're going to get you together with them, and maybe it's not events, but it's like opportunities to get on a plane or whatever. And so did it kind of come full circle to like, I mean, explain that like the events now are supporting the community and is that's the difference. 

0:23:03 - David Light

Yep, that's exactly it. So now you know we went from. We went from thinking that was the driver to using the event, if you will, or events maybe smaller, as as a supplement or an additional benefit to the people that are already associated with it. I mean, I'll pull up, you know, a parallel off this, but you know, in my past life I still am, but I was a practicing physical therapist in private practice. In my past life I still am, but I was a practicing physical therapist in private practice and a lot of what we see with people moving into the IV hydration space is licensed clinicians moving into an entrepreneurial role that they're not really qualified for. They're certainly qualified to do this service, but they have no business training. 

I can say that because I was a licensed clinician that went into business and it's a struggle. The way I've described it and the way I described that time was you're really on an island. So the real voice of this organization speaks to those people more specifically of hey, you don't need to be on an island, or you can be on an island, but you can also be very well connected to the mainland, which are all these other people that are going through the same things, or have gone through the same things as you from not only an entrepreneurial perspective, but an entrepreneurial perspective specifically in the IV hydration space, and that that's really where the true benefit is. So to your point that the events kind of support that, but they're not now as we thought in the beginning, they're not the driver for it. 

0:24:33 - Mark Henderson Leary

Yeah Well, it seems like that's a very common healthcare formula Isolation, tons of education in how to do the craft, no education and no mentorship and no peership on how to run the business and I've talked in any kind of specialty you know, I talked to, you know, people running small optometry practices, and I've talked to somebody running a hundred plus physician orthopedic practice, and you know, and, and their story is the same. 

It is, we didn't know how to do the hard part of growing the business. We knew how to do the hard. The easy part ends up being healing people. It's not easy, it's really hard, but I got that figured out. But, like, how do I find people to heal? How do I get other people on the path to do this? And so I think that I guess this is a combination for you guys of the age-old healthcare problem. It's treated like an art and you're going to figure it out how to commercialize it in a capitalist free market economy, and that is. It's like picking the. It's like listening to the lock tumblers on the safe, trying to get that to open up, and there's no training on how to open the safe. And so that meeting with a ton of demand like so you see, iv, like everybody's going to IV hydration, great. Well, what we know is that everybody's going to be stuck, and so we got to create a place for them to share and collaborate. That's essentially the oversimplification of where you guys have landed. Yeah, absolutely. 

So who is getting into IV hydration now? Who are these folks? You kind of touched on it. These are people who are fresh out of school. They're frustrated with their past life, they're not licensed, looking for a hot new world to get into. Maybe all that. 

0:26:15 - Autumn Piccolo

Yeah, a couple kinds of people I mean. 

I'll name one of the first that comes to mind is that person who has the entrepreneurial inclination and who was originally getting into Ivy was more so as a result of COVID. We had a lot of nurses and a lot of people who were working in facilities, who didn't want to be there, saw a lot of terrible things and, you know, were frustrated. The environment was really challenging at that time and they said you know what? I have all these patients, I want to help them and you know really kind of true entrepreneurial story. You know what I have all these patients, I want to help them and you know really kind of true entrepreneurial story. 

You know driving around in their cars. You know hooking patients up and helping them out and just trying to do what they could to support the people that they knew around them and, you know, turned into a business. You know the patients calling them. You know eight and 10 visits a day and it's a beautiful thing but, as you pointed out, you know it creates challenges that you have no idea what they're going to be when you're just focused on helping people. So there's a lot of folks like that that got into it. For that reason, I think there are still, you know a fair amount that that look at the freedom of you, know that sort of model and think I'm going to get to you know, practice health care and wellness in my own way and help people in my own way and that really they're drawn to that. 

0:27:25 - David Light

Anyone else yeah, the smaller sub, that's definitely the majority. The smaller subset is the entrepreneur that has a wellness focus or mindset that thinks, hey, I want to go into something and I want to help people, and Autumn had mentioned much earlier that the barriers to entry are very, very low. This is a desirable market and space to get into. The difficulty, though, comes in the sustainability of the service from a long-term perspective. What's the landscape look like from a competitive standpoint? How do you differentiate yourself? What's your USP? It can't just be a website that has a competitive price list on it and you go out and conquer territory. There needs to be more than that, and also where we really licensed practitioner or the business owner within that state to really understand what they can and can't do and how to deliver that service within that state under their guidelines, position statements or opinions or regulations formally to say this is what you can and can't do. These are the rules you need to play by, and that's a learning curve as well. 

0:28:44 - Mark Henderson Leary

So yeah, you've touched on this a couple of times the low barrier to entry, high margin, ostensibly, and at least the promise of it. I don't know what that maybe you can speak to like what the reality ends up being, but that historically means lots of low quality, opportunistic providers and real estate agents, wealth advisors We've seen it when they're flooded mortgage brokers it's anytime low barrier to entry and a promise of a big paycheck. You're flooded with low quality. What are you guys seeing and what are you guys doing to kind of hopefully prevent just terrible stuff out there? And is it going to self-correct? I mean, is this regulation is going to be coming down? Where is this going? 

0:29:34 - David Light

Yeah, so typically, fortunately I guess not typically fortunately what we've seen is not a. There has not been a, and I'm talking very, very broad spectrum. Right, there hasn't been a tremendous amount of adverse effects over the course of the last couple of years. Right, I mean when you look at even if you can't really measure the quality from a quantitative perspective, but if you can make that assumption, hey, there's all sorts of people coming into this space the outcome of that has been still very, very positive. The infection rates are incredibly low and the adverse effects are incredibly low. 

When you look at that across the board and some of our inner circle people have done millions of IVs at this point. So I mean, we've got data sets that we can look at it and judge that. So that's much more objective. What Ava's trying to do and part of our mission is we've got an attestation before you can join, you've got to agree with these types of things. And then we do have a scientific advisory board that has some of the biggest names in IV hydration in the country. As a part of that, dr standard operating procedure not a clinical pathway and a clinical guideline of like what to do with the patient based on these types of symptoms, but more or less standardizing the intake and the data that's coming in and the output and the outcome of the data that's going out, so that can then be aggregated and then compiled for some different types of studies. But you know, fortunately it's it's. 

It's not a IV hydration is not a service that the large, large, large majority of people performing are not licensed to do. 

It's not like you have that entrepreneur like you or me that says, hey, I'm going to go open an IV hydration station and I'm the one that's going to do this. For the most part, I think what we've seen is people have the enough wherewithal to understand somebody needs a license to do this, that has been trained to do this, so it's a service under that medical professional, which is good, and that's why, even if the quality varies a little bit, it still funnels through the large majority, if not all the time. A licensed healthcare practitioner and their good faith exams and there's medical oversight and stuff like that. That's why we talk about the barrier to get in is not that hard, but to sustain it and perform at a gold standard, it definitely is and it definitely takes some work. However, the consistent theme through, that is, there are licensed healthcare providers that are providing this service, and that's one of the reasons why the adverse effects are so low. 

0:32:13 - Mark Henderson Leary

Yeah, a lot in there. My mind's kind of going several different directions and I'm thinking that and you can kind of go either way with this I'm thinking what's the reason to scale this and what is the threat to the scaled entities through the independence which hold on a sec, because I'm getting ready to get to make this complicated it sounds like it's relatively low risk, relatively consistent outcomes, which is basically synonymous with commodity, right? Because commoditization is when an orange is an orange as opposed to like. This orange tastes amazing, mind-blowing, is worth $11. This orange doesn't taste great, it's worth 12 cents, and so that's, that's the diversification. 

The breadth of quality is what creates the opportunity in a marketplace to have wild margins and differentiation. But you know you're saying that we there's a lot of marketing burden to kind of get those unique selling propositions out there and you know who are we targeting. But it sounds like the product is pretty consistent. It's a lot of oranges, but am I wrong? So in that whole mess of sort of questions of why to scale and how to differentiate, what kind of comes up for you in terms of what's interesting and what are you seeing and what am I saying? That's crazy. 

0:33:25 - David Light

Yeah, I think there are two factors on that that I see from a macroeconomic perspective. Number one is, you know, somebody is going to pay more because they're going to perceive the value as higher from a physical location standpoint. You know, if this IB hydration station is like a Ritz-Carlton, obviously you're going to think, well, I'm going to pay a little bit more for that because the surroundings and the atmosphere is much more spa-like and it's relaxing and I'm looking at the ocean compared to the one that's, maybe, you know, sort of tucked in the back of a doctor's office. So I'd say that's one right, of course. I mean you've got a physical differentiation. The second is, when you really get into the part that's not going to be included in the standard operating procedure, there are providers that are out there that really have spent a lot of time, effort, energy and money over the course of the last few years with their data and with their advice from their chief medical officers on what you know, as opposed to like a patient walking in and saying I want one, two and three. Them doing a much more detailed history from a clinical perspective and saying, hey, based on the following objective and subjective data, we feel like you need four, five and seven to go on your IV. That'll help your outcome a significant amount more. So. That's really, you know. 

Is the bag the same? Yeah. Are some of the products the same? Sure, but when you look at what the clinical decision making is and the clinical differentiating factors between a patient presenting and needing or wanting something, and someone with more oversight and or technology steps in and says, hey, based on these presentations that you've had, we feel like these components of the IV would be more indicated for your wellbeing. That's another one that sort of separates the oranges. If you will, I look at those two Now. Without those two withstanding, there's a lot of oranges and when there's that type of supply and demand curve, the competition is going to drive the market price down. But if you can differentiate with one of those two and there are a couple other small ones, but one of those two I think we'll be able to keep your market share up. 

0:35:39 - Autumn Piccolo

you know, over the course of time, yeah, we're seeing a lot of people differentiating with ancillary services as well. 

0:35:44 - Mark Henderson Leary

You know to. 

0:35:44 - Autumn Piccolo

David's point, whether you're looking at the ocean or maybe you want to try some cryotherapy or something other than IV hydration, you know there's a lot under the wellness umbrella that has really started to take shape and you're seeing functional medicine clinics integrating IV as part of a treatment protocol that includes six other modalities. 

So we're seeing a differentiation with the way that it interacts or the way that you know some of the vitamins or you know some of the supplements and things that people are adding will interact, defecting from traditional healthcare, and we're seeing wellness now kind of turning that corner to be almost back incorporated into a lot of the traditional healthcare approach, which is, we call it functional medicine. And wellness is healthcare and it's well care and everybody wants to feel good. So you're even seeing some of the more traditional providers adding IV hydration as an ancillary service to their primary care physicians, to their primary medicine practice. So it's kind of interesting to see it get, you know, integrated. And to David's point, you know it's essential, of course, that anytime you're dealing with a patient, you're touching somebody, you're treating it, you know, with the right respect that it needs and the right protocol that it needs. So you're getting a lot of the traditional health care benchmarks, integrated with that, that need to be there. 

0:37:18 - Mark Henderson Leary

Yeah, that's an interesting topic in and of itself and I love where that goes. I love the wellness, the well-care, fitness as primary drivers, more and more so. But it also opens up this sort of can of worms of the value chain, which I think can flow both ways and meaning if you have an urgent care, then people go to you for urgent care. The value chain can be. You know, we also run a primary care next door. It's run by the same people and you had a good experience here with this sprained ankle. Why don't you set up your next appointment for a well check for your kids next door? Absolutely, we can do that and that's an expansion of value chain. But it goes the other way as well. It's like you know. You've been coming here for years. Do you now know that we have a relationship with the urgent care that you don't have to go to like the ER? You could come to us, and so I heard that in your thing as well. 

I'm assuming that there's somebody who's working too hard, drinks too much and is like you know. You should get IV hydration. It'll be back to work on Monday at a higher level. You have somebody come out to your house. It's a concierge thing, or you go to them and that's the first they've ever heard of it, and then there's sort of this expansion of like we've got all kinds of other supplements we can sell you. And then the flip side. It's either somebody who's like hey, we're functional medicine. You know you've got this relationship and you know we're adding more and more things. Iv hydration can be helpful for you in your elite athlete pursuits and if you're doing training for this sort of stuff, you should come in before or after your aggressive training regimen. Are you seeing that both of these ends of the spectrum sort of rise equally, or is there? 

0:38:54 - Autumn Piccolo

something that's leading the charge, that's a good question. 

I do feel like that whole tide is raising all boats together. I do think that a lot of people are having the business awareness. Going back to the point, you can provide the service and put your head down and do what you got to do, but you've got to have some business awareness, you know. Going back to the point, you can provide the service and put your head down and do what you got to do, but you've got to have some business awareness that this patient may want this other thing. And now we're getting back into some business principles, which is how are you going to cross sell? How are you going to make your patients aware of what else you offer? What's your marketing plan? You know, what have you put together to ensure that your business? You know if, for instance, regulation changes and you cannot provide that particular service, that you've built your entire patient base on. What else do you have you know as an offering so that you can survive if something happens. So that kind of gets back to some more in the business principles. But I do think that overall you're seeing the wellness industry sort of rise together and everyone who's providing this service you know IV hydration in particular is at least aware of, if not providing a number of other services I mean they're at least aware of. 

You know, the biohacking thing is huge. There are biohacking conferences and they're talking about a long list of things that you know. There are becoming buzzwords that nobody heard about five years ago. So it's interesting now. I mean it kind of it goes back to that entrepreneurial spirit of the folks that got into this industry that I think part of the entrepreneurial spirit that any entrepreneur has is curiosity, and so you're seeing a lot of people who were just curious like how else can I help someone, how else can I help a patient? Will this work? Would someone like to try this? And that's a really cool thing to see because we're becoming aware of things that you know. Although we started an IV hydration association, we're even bringing in providers, vendors, to talk about other opportunities you know, to add services, and maybe this would be a good you know thing to consider, and maybe there's some clinical training to offer on this other thing. 

So it seems to me and you know you might share a different view, but it seems to me that that entire industry is rising together and focusing on wellness as a whole, be it through functional medicine or biohacking or whatever you want to call it. Everyone just wants to feel good as best they can. 

0:41:07 - Mark Henderson Leary

Yeah, right, yeah, yeah. That's one of the things about healthcare that I recently heard is that you never, you never, heal the world. Like that problem doesn't get solved, like people always want to feel better, people will get sick, they will, their health will decline and they will die, and so that it's a totally inelastic demand that never goes up and never goes down. It just shifts in terms of its flavors and the timing and the life cycle of people where there's going to be some need for relief of suffering and increase of health in some capacity. So it's that's an interesting sort of macro reality that doesn't always feel true in the short term. In the micro reality, you know, people stop buying expensive glasses when there's a recession. People stop buying plastic surgery. People stop, I'm sure stop buying IV when it feels very discretionary but macro, it just moves around. 

0:42:03 - Autumn Piccolo

Absolutely. I feel like healthcare. You know I've been in healthcare for 15 years now you for longer than that. The best industry to me, you know it's really you know, everybody wants to feel good, everyone is chasing feeling better and quality of life and it is kind of that forever industry. It's more of a forever reality, yeah industry. 

0:42:27 - Mark Henderson Leary

It's more of a forever reality, yeah, and so we're probably covering most of this. But a question I have that came up is again kind of just the bad outcomes. What can we watch for there? The one thing that is so consistent in I guess I guess it really is across all specialties is the distraction of something that will add profit. It is, you know, I'm doing this, this thing, and there's this. 

I've been, I was trained in it. I mean, I've been doing it for a while. It's been a. It's a mature specialty that people know how to buy and do. But there's somebody who's got a new laser, a new treatment, a new wound care, a new aesthetic thing that I could find a way to get into my practice and make some money with. 

And inevitably it's like I just bought the laser, it's 120 grand, it's going to be amazing, and then it takes two years to get off the ground and then that that laser is outdated and it's like, ah, what do I do? How do I try to sell the old laser? No one wants it and I got to buy a new laser. And it's like and I was, and I was never in laser business in the first place, so this is one of those things that feels like it could add margin and it's in the ecosystem of health. It seems like it fits in pretty well in terms of not being so random, but is is there? Is there the potential here for abuse that people just add it in Cause, like, ah, you're just going to add that, we're going to do that, we're going to make more money on it, and are you seeing people you know innocently just dive in and kind of be humbled by trying to do it without the right commitment? 

0:43:55 - David Light

I don't think I've really seen that. I think you know, across the board, when you look at you know, speaking as a healthcare provider, that was in business right I mean when you look at that relationship that they have with patients, and I mean this includes the doctor with the laser of course, but across the board, when you look at that relationship of you know I want to do everything I can to help my patient, most typically from a differential diagnosis standpoint. If a patient comes in and they sort of qualify, you know and you think this would be a good opportunity for them to enhance their health or well wellbeing, they're probably going to suggest it and if you don't, then you won't. And then the second step to that is you know the patient's response to it. I mean, if the practitioner suggests it and they take advantage of it and they feel fantastic, then they're probably going to go back and do it again. But it's a completely voluntary decision tree there. It's much unlike you know, mr Smith, you can't walk anymore. We're very aware of that. You know you're going to be, you're real child bound. You're going to need a total hip replacement. There's really not a whole lot of voluntary. You know discretion and clinical decision making on the patient standpoint. In that regard, it's like I need to follow my doctor's orders With with IV hydration. 

I think we find it's much more consumer driven and it and it and it and it's much more consumer driven from a repetition standpoint. The other thing is there's not that the the 500 to a million dollar laser that's getting there, that they've got to pay off, like we talked. You know we've mentioned this a few times, but it's true. You know it's really hey, can you define some space in your office and provide this service and buy maybe some supplies? So it's not, you know, it's not this astronomical, you know line of credit that they've got, that they've got to tap to run this service line out, you know, and it couldn't even be outsourced. It's just, hey, we're going to offer this. So I've not really seen a lot of that from the practitioner side or the consumer side, and I think you know for those reasons. But the main one is it's really a consumer driven process, as the whole well care space movement is. 

I mean, I look at it from a very simple, simplified standpoint. Right when I first got into this, which was a couple of years ago, before that, it didn't really have anything to do with IVs at all, you know. So when I was asked well, what is it? What's the difference? It's as like, well, it's really the same. For the most part. This is very high level. It's the same thing that's been going on for many, many years from a supplement standpoint. It's just a different method of delivery, which is obviously much more effective. So it's a much more effective method of delivering some of these different supplements than people had really access to in the past. It's an evolution of that. So you know, the supplement industry is a multi, multi, multi-billion dollar a year industry and has been for a very long time. So it's really just the evolution of that. You know, not only from a from a delivery standpoint, but also an expansion standpoint, because you can do more stuff with it as well. 

0:46:47 - Mark Henderson Leary

Well, it sounds like you're in a pretty good sweet spot because of the. It seems like it's relatively low risk. It's it's not so new that everything is unproven, and I think in advance and you can tell me if I'm wrong on here it seems like the upside is it's it's high margin, but it's not like so high that it incents people to be crazy, you know, tripping over themselves to get into it. It's good margin and if you like it and it fits into what you do, it's a good add-on, and if you don't have a way to fit it into your value stream, it's going to be a waste. I don't even know where I'm going to put these people, and so it seems like it's almost like a really good balanced opportunity. 

0:47:27 - Autumn Piccolo

Yeah, we see it as a good opportunity, and I was smiling earlier because you used a word in the context of the oranges that I was laughing about, which is distraction. 

And I think, kind of getting back to some of the business principles and things that we aim to share with our members through Ava and that we've experienced ourselves is, you know, in the law firm. I can't tell you the amount of providers and practitioners that come in with opportunities and the opportunities are to sell apples when the provider hasn't even really gotten that at selling oranges, and I think that it's the age old. You know, everyone's like looking at doctors, like well, they can do this and here's an opportunity and here's an opportunity for that. And you know, one of the things that we'll tell our clients and that we, you know, share with AVA members as well, is get really, really good at selling oranges. You know, if you're really good at selling oranges, selling apples may be a good opportunity for you, but if you think that selling apples is the way to go because you can't sell oranges, Right yeah. 

I would caution you on that. 

0:48:30 - Mark Henderson Leary

Right, right, right, yeah yeah. Look at the margin on oranges. You know this is so much better than apples. Well, how are you selling it? It's like people don't come here for fruit. You know it's not. Let's think this through. 

0:48:40 - Autumn Piccolo

Exactly. I think that you have to have all of your business plan, your marketing plan, your USPs, everything dialed in before you look at adding on anything. So dialed in before you look at adding on anything. So you know. Again, I agree with David, we have not seen abuse, because it does kind of hit that sweet spot. But from a business perspective, it's certainly something to only consider if and when you have the resources and the awareness of how to really dial in what you're doing, before you start adding in this $200,000 laser. 

0:49:13 - Mark Henderson Leary

I see that, yeah, because I think that's the promise. I mean, if you're a physician and you don't know how to market in a B2C capacity and you think credentialing is your path to a line of patients out the door and you see the laser is another bill, that they will come. But that's not how that works at all. And because that's not the it, the it is a destination where there's a laser, not a laser in and of itself. People have to be coming here and you can add value to them, and so you know. I think this is what you're saying. But in that space, the entrepreneurial mindset these people show up already primed that they know they have to go to market, they're going to have to go out and tell a story, they're going to have to go find some people. They've maybe already found these people and they want to continue telling the story, and that's already well aware. Now, I'm guessing it's first of all. Is that true? 

0:50:10 - Autumn Piccolo

Yeah, I would say that that's true. I do think that they are a little bit more savvy than some other types of providers. For sure, I've seen that, yeah. 

0:50:19 - Mark Henderson Leary

And then, once they show up with that awareness, all right, I have a vision. I can imagine a world where we've got trucks in every city, or they're coming to us, or this spa Right now we're working out of my house, but next year we're going to be on the beach. There's a vision component to that and they're doing that. And then how hard is it for them? Is it like, oh, you just got to work? Or it's like some of these people really hit the wall and, you know, is there like a bounce rate and people fail because they don't realize how hard it is? 

0:50:47 - Autumn Piccolo

Oh man, I feel like we got to get back into like some business 101 statistics. What is it Like? Nine out of 10 don't make it past the first year. 

0:50:53 - Mark Henderson Leary

You can make up whatever it is. It's half, it's 100%, I don't know. It's like 120% of all businesses that start fail in the first five years and everybody else has failed in the next five. But yeah, we know it's hard, so I'm assuming it's a similar sort of thing in that space. Oh yeah, absolutely. 

0:51:11 - David Light

There are a few. From what we know and have seen, there are a few really large providers across the country and one that we work with. That's more global right, and then I think there's a pretty significant gap. There's a few in the middle it's maybe an inverse bell curve, but there's a few in the middle mid-market kind of space and in the large majority are definitely on the smaller side and that's a. You know, that's a result of of a lot of factors, but I think the first one is back to the business 101, the large majority of those people in practice haven't had that business 101. So they don't. You know, you go from one location or one mobile provider to two, that's a big step. When you try and go from like three plus, that's a huge step. 

So, in order for them to scale, a lot of them just miss that critical foundational infrastructure from a business operation standpoint because they've probably never been exposed to it. They don't know what type of financial platform to have. They don't know what centralization of EMR is. They don't know how to brand and market and scale a territory or a location or how to involve outside investors or do a series, a round of fundraisings. They just have no idea of any of that. So they're kind of stuck to their own plan of simplistic growth, mom and pop type style, which is totally fine, but that's usually about as far as they'll go, and every once in a while we'll see somebody kind of rise up and get out of that, but that's definitely not the norm. There's a few really, really big ones. There's a handful of mid-size that are pretty big. 

It's like 10 to 20 locations yeah, but not a lot. And then I'd probably say, and this is a total made up number, but 85 to 90% are in the small category. 

0:53:00 - Mark Henderson Leary

Yeah, and that's a normal evolution. We know that's the case in any emerging market like that where there's an opportunity like that. So it's just normal and you're going to see those people sort of aggregate and a lot of people shake out and yeah, that's that's what we're here, who were to help. So that that's that's great, that it's it's a. I love to hear the story. I mean this is I'm glad to have heard all the stuff you shared that it seems like it's a thriving market. That I'm sure will. 

Just by history it's going to start stubbing its toe. There's going to be issues, there's going to be be news. That's inevitable. That's how this always unfolds and there will be some winners that will start setting the standard of excellence. But it sounds like, when compared to some of the other past things like even things like an emerging market in psychedelics, that is high risk relatively speaking and I think the opportunity there is huge, but it's got a lot more variables, lots of regulation, lots of potentially terrible PR that you guys don't seem to have. So that's optimistic and exciting to see that unfold. 

I think that just starts to tell just create more marketplace is create more marketplace, because my assessment of healthcare is it's been 100 years of being a business space with no free market pressure and therefore no appetite and understanding of how to really market to consumers, how to understand pricing, how to understand delivering value. And it's only now that, after everybody thinks we've figured it out, that they're having to do it for the very first time, and no one has the chops for us. So it's it's. It's exciting because there's so much opportunity, but it's frustrating because there's so many false starts and so much market making and so much differentiation in the marketplace. That just is going so clunky. 

And so I love to see that because, if nothing else, it's great to have specialties and sub segments that can kind of pioneer and show what it is to sell the health care product to a consumer or to another provider or to anywhere in the space and say you know what, if you do good work, you create a great brand, you help people feel better, you charge a fair price, you can make it, and that's the message. I love just to be visible, because everybody else in the healthcare value chain can learn from that. Even to radiology, even these like behind the scenes anesthesiology there's things you can do to add value and be better, and so I love where that's going. So we've covered a lot. I appreciate everything you guys have shared. Is there anything you feel like we missed? No, I think we got it. Is there anything you feel like we missed. 

0:55:32 - David Light

No, I think we got it. 

0:55:34 - Autumn Piccolo

Yeah, we're excited about it. We're excited about it going into 2025. I'm definitely excited about the industry and where it's going and what everybody's doing, and we might be down for a week or a week or so. 

0:55:47 - David Light

Yeah. 

0:55:48 - Autumn Piccolo

Just to celebrate our year. But we're hitting the new year hard and we'll stay bullish on that. Iv hydration. 

0:55:54 - Mark Henderson Leary

Absolutely Well, so great to connect. So how does somebody find you keep up with what you guys are doing with with the association and give us that, that their socials or your website or whatever? 

0:56:05 - David Light

Yeah, the easiest way is is our website, you know, wwwamericanivcom. That's got, you know, automized contact information. We're also very, very visible on LinkedIn so we're easy to track down. David Light, you know, and Otto Biccolo on LinkedIn. So one of those three ways, or any one of those three ways, it's just super easy to find us. But the neat thing is, if you go on the American IV website and download the position statement, you just have to put your email in there. You'll be added to the what's it called the group list for email updates and stuff like that. So that's the best, easiest way to get in touch and stay in touch with us, outside of obviously joining if it's up your alley. 

0:56:48 - Mark Henderson Leary

Awesome. Well, thank you so much. I've enjoyed the conversation, everything you shared. Thank you, David, and thank you, Autumn. 

0:56:53 - Autumn Piccolo

Thanks, Mark you shared. 

0:56:55 - Mark Henderson Leary

Thank you, david, and thank you Autumn, thanks Mark, thanks no-transcript, of course. Also never forget that if you're stuck, if you're trying to grow your practice and you feel like you can imagine an amazing, high-value practice that helps your patients, help your customers feel better, be better with employees who love what they do and feel like they're adding value, and you're imagining this practice giving you this amazing life and allowing you to lead and make the biggest impact possible, but for some reason you're stuck. For some reason, it doesn't feel like it's moving forward. Don't stay stuck. Please reach out, hit us on the web, get us at practicefreedomcom, slash schedule and get a time to talk and figure out what a first or next step looks like to get you on your way. That's our time and we will see you next time on Practice Freedom with me, mark Henderson Leary.

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