Joel Swider: Hello, and welcome to the Healthcare Real Estate Advisor podcast. I’m Joel Swider, and I’m an attorney with Hall Render, the nation’s largest healthcare focused law firm. I’m joined today by Vikas Sunkari, Senior Managing Council at SSM Health. Vikas, thanks for joining me today.

Vikas Sunkari: Thanks for having me.

Joel Swider: SSSM, as we’ll hear in a moment, is a large health system with sophisticated legal and strategy departments. So, today I’m excited to learn more and to share with our audience about how SSM handles its real estate as part of its larger M and A transaction and alignment strategy. To start, Vikas, could you give me a bit more background on SSM as a health system?

Vikas Sunkari: Sure. So, SSM Health is a Catholic nonprofit health system. It was initially founded in 1877 by the Franciscan Sisters of Mary. They came from Germany to St. Louis in 1872. Their initial work was, I think, there was a smallpox epidemic going on in St. Louis. So, they were really focused, then, on serving a very vulnerable community. And that mission persists through today. It’s a large part of our identity, and our mission to serve the communities that we’re in, to be present for our communities and our patients. It’s exemplified in our mission statement, which is, “Through our exceptional healthcare services, we reveal the healing presence of God.” Today, SSM has 40,000 employees, about 11,000 providers, and that’s across 23 hospitals and several medical groups that are regionalized in nature in Missouri, Southern Illinois, Oklahoma, and Wisconsin. So, that’s our health system in a nutshell. There’s probably a lot more to say, but I think that encompasses a high level overview of what we do.

Joel Swider: Yeah. So, Vikas, how long have you been at SSM Health? And what was your path to your current position there?

Vikas Sunkari: Sure. So, I’ve been at SSM for about seven and a half years. When I came to SSM, just immediately prior to that, I was working in the telecommunications industry in an alternative legal role, if you will. There I was doing leasing and land use work for some of the telecommunications carriers, like AT&T, Verizon, companies like that, putting up cell towers and rooftop installations. So, it was real estate work in a sense. That was in Chicago. I was actually, for personal reasons, trying to relocate to St. Louis. I was trying to be close to my now wife. So, when I was looking for other opportunities, I think I wanted a shift back more into a traditional legal role, and I saw that SSM was seeking an attorney specifically to assist with their commercial real estate matters, commercial real estate contracts, leases, and whatnot.

So, to me, that seemed very well aligned with what I was doing and a natural progression to what I was doing in the telecom industry. It was similar nature, but also moving forward into the path of commercial real estate matters, which is something that I was pretty interested in towards the end of law school and through some other job opportunities I had in law school. So, I really was interested in that opportunity and I came on to SSM and jumped right in and have really flourished in that practice area and some others since I’ve been with SSM.

Joel Swider: That’s neat because I could have used your help the other day. I was helping a client review a cell tower access agreement for a hospital building. So, I wish I would’ve had your expertise for that. When you made that move, obviously, you mentioned some geographic reasons, but was there any fork in the road moment? I mean, obviously, there are some parallels for sure on the real estate side, but was there any fork in the road that made you realize that, “I want to move this direction with my career?”

Vikas Sunkari: Yeah, I think there was. So, in my old career, which I really did enjoy it, I really appreciated the organization I worked with, the people I worked with. It was a small business environment, which was nice, but I was getting more into the business side and less into the legal side of things, and I felt like maybe I wasn’t using the skills that I wanted to use. So, seeing this opportunity showed to me, I could maybe use more of the legal side of things. Not to say today, I do work extensively with our business people and still wear some of those hats, but I wanted to shift back more to the traditional legal type role. So, that was a big motivating factor for it.

Joel Swider: Sure. So, Vikas, your title is Senior Managing Council. What are your areas of oversight and expertise within the organization?

Vikas Sunkari: So, I have two counterparts that have the same role as me. We oversee a team of six attorneys who manage transactional work for the entire SSM health system. So, across regions. And our work, among other things, that primarily involves the development, drafting, negotiating of a variety of contracts, mostly physician contracts, whether those are with individual employed physicians or independent contractors or larger medical groups that are hospital based. Also, other clinical service agreements, and then of course real estate arrangements, whether those are leases or timeshares, development matters, construction, purchase and sale of property, among many other types of agreements.

But that really encompasses the bulk of what we do, and obviously a large focus of our work is to ensure compliance with federal healthcare regulations. So, stark and anti-kickback. Throughout that, as well, in addition to actually working on maybe new contracts or changes to contracts, we’re also giving guidance on various either transactional general matters or matters that are specific to a certain contract. If a dispute arises or there’s a question about interpretation, we work with our business people to give them advice and guide them to resolve any particular question or concern they might have.

Joel Swider: Well, thanks for that introduction, Vikas. And just to set out the goals for this particular episode, SSM Health has been involved in a number of large transactions, at least the ones that have made the news in the recent years. I’m sure there have been many other smaller transactions, as well. Things like acquisitions of hospitals, acquisitions of physician groups, and a variety of other partnership and alignment transactions, plus all the day-to-day real estate management activities that are involved with running a health system. And obviously, each of these transactions and scenarios is unique. But our goal today, my goal, is that we can try to uncover some common threads that our audience could apply more broadly when they’re dealing with healthcare transactions in the future. So, to that end, Vikas, could you give me an idea of what are some of the types of acquisitions and transactions that you’ve been involved with in recent years?

Vikas Sunkari: So, I’ve been involved with pretty much all the varieties of acquisitions that SSM will undertake. Those can be as small in scale as those that involve, I’ll give a couple examples. On one end of the spectrum, you have just a simple acquisition of maybe some pieces of equipment from a physician practice, or maybe we’re acquiring medical records, or we’re acquiring both and that practice might be closing. That’s one flavor of acquisition. No real estate considerations in a situation like that. Maybe the next level up is when you’re, similarly, acquiring assets, records, but maybe we’re taking over a lease because the practice is closing. That could be a lease that we’re taking from a third party, or we may be leasing space from a physician who owned a building. I know I’ve done at least one of those where we had to enter into a new lease with that physician.

Then similarly, we have situations where we acquire an entire business or the practice itself, like the going concern of that practice, and we fold them in to one of our medical groups. We employ all their physicians. You might have a situation there where you’re assuming a lease again, or you could be assuming multiple leases, depending on the size of the group. And then, just rising in scale from there. They look the same, but at least in concept, but then you could have larger acquisitions where you’re acquiring a practice or perhaps even another hospital or a large medical group, and then you’re assuming multiple leases and/or acquiring real property that that practice or that other hospital might own, and then the complexity rises from there.

Joel Swider: So, Vikas, in that variety of transactions, I’d like to think through what are some of the biggest challenges that you’ve faced, and how you got through them, how we can learn from that. Maybe starting with the due diligence phase, what are some of the challenges that you face? To the extent there are common threads there, what are some of the challenges that you face in the due diligence phase of a transaction like that?

Vikas Sunkari: So, I think for one, no matter the size, I guess even in a small transaction, we’ve got to figure out what property or what lease could be involved in this acquisition. If we’re acquiring the practice, we’re acquiring the assets of a small practice, do they need us to take over a lease? Or are we trying to take over space that they operate in, is one question. And then, if that is the case, that’s the first questions. Do we have a need to occupy the space that they were in? Do they own that space? Do we have to enter into a lease with the person we’re requiring it from? If not, who is the party that might own the space that we have to enter into a new lease with, or assume the lease that the prior owner of the practice, I should say, held.

And then, along with that, if there’s a third party landlord out there, we’ve got to figure out what is their status. Are they implicated by our stark and anti-kickback? Are they a referral source in themselves? Or they could be a lot of different possibilities. We could be entering into or assuming a lease from a referral source, or it could be a commercial landlord, or it could be one of our large institutional rate type landlords. And the same becomes true even in a large transaction. You’re just doing that at a greater magnitude. Instead of looking at one, you’re looking at possibly 10 or 20, which obviously increases the amount of work you have to do up front to both figure out what’s out there. I think once you figure out what’s out there, the next question is what do our business people who are managing this transaction or managing this acquisition, what do they want to take over?

So, let’s use the example of a larger transaction. If there’s, let’s say, 10 locations, we’ve got to figure out what leases are involved, and then what are the terms of those leases. And by a term, I actually mean the duration. How much time is left? Do we want to assume those leases or not? What compliance obligations do we have? What federal healthcare regulation compliance obligations do we have? Depending on those leases that we do intend to stay with, we have to figure out what our termination rights are in case there’s a different strategy about those spaces. Or maybe when you’re acquiring so many, there may be concerns of, over time, maybe we want to reduce our space or consolidate that space that this group or this other hospital was using with the existing space that we had. So, there’s a lot to wrap your arms around in the situation like that.

And a lot of thinking to be done on the business side of things, which really is a combination of maybe the individuals who are leading the acquisition who could be people looking at it from a strategic standpoint. If they’re not, you’ll want to have your strategic people involved to advise if this fits maybe in their vision. We need to get our facilities, our real estate team involved to figure out how do these properties fit with their goals. And usually, they’re already aligned. I mean, in our case, there’s usually already a cohesive vision about what they want. So, it’s not so much getting the people to talk so much. It’s more about everyone being able to understand what that vision is so we can accomplish it together.

Joel Swider: So, Vikas, you mentioned at the outset dealing with compliance concerns. One question I have on that front is suppose you go through your due diligence and you find, okay, there’s one or more concerns. Let’s say there’re leases. How do you, then, work with the business team to determine is this a risk we’re willing to take? How do we isolate the risk? Maybe it’s something so big that we wouldn’t close if that issue is still open. How do you go through that analysis and the interplay between the legal function and the strategy function?

Vikas Sunkari: So, I think it’s helpful to think about what the downside could be or what risk we’re really talking about assuming, and that’s that we could be acquiring a non-compliant lease. And I’ve seen it happen at least in cases where maybe the prior landlord-tenant relationship didn’t have the same stark or anti-kick back implications. So, I think upfront, let’s say, we were acquiring a practice or acquiring another hospital and then they had a lease, either as a landlord or tenant, with a referral source. And the first thing we’d want to see is is this lease in itself compliant? Or is the rent fair market value? That’s going to be probably the biggest thing to be paying attention for.

And if it’s not, or we aren’t able to obtain that confirmation, we have to let our business people know, before we make this assignment effective, ideally if that implication came up or that there was a concern about being compliant, we’d want to make sure we get our new fair market value opinion, for example, initiated to either support the rate or to give us, I guess, a negotiation point to say, “Look, we’re going to acquire this practice, we’re going to assume this lease with X landlord, and we need to make sure that the terms are compliant with stark and anti-kickback because of the nature of our organization and what our risk tolerance is,” and making sure that we can do that timely before the acquisition closes or before we would actually assume that lease.

And also, we got pushback, I’m sure at times. I don’t have a particular instance to think of, but people are usually used to thinking, “We’ve always done it this way.” And when you bring a new party in, we have to communicate we have a different tolerance for risk or have a different set of obligations. The prior parties may not have had to comply with stark or anti-kickback, for example. So, we have to really communicate that and get the timing right, especially, I know we’re going to probably talk more about that shortly, but the timing is an interesting factor of it because, let’s say, if it’s a small transaction, if you run into some real estate issues or some real estate FMV issues for example, since it’s such a big part of the transaction and it might be a smaller transaction, you have more leverage to, I guess, get that issue resolved before the acquisition closes, for example.

In a very large acquisition, the real estate’s only part of it. So, you’re really under pressure to get this piece resolved so it doesn’t delay the larger acquisition, which could have a lot of other moving parts. Real estate’s just one part of it, and you don’t want to jeopardize other aspects of it or hold up the rest of the deal to resolve this one component of it. But it’s still crucial, obviously, to get these in hand because you don’t want to end up with a bunch of compliance issues after you close either.

Joel Swider: Well, yeah, that’s a great point, Vikas. And let’s dive into that a little bit more because you mentioned the timing. Let’s say that we’ve gotten through our due diligence phase, everybody’s good to go, we’ve got the green light, and there’s a lot to be done between that time and the lead up to closing. What lessons learned or challenges are you facing during that period?

Vikas Sunkari: So, I think it’s a lot to essentially be done, and you can break it out into a couple different areas. So, one, you’ve got your due diligence of what leases are out there, what are our requirements in order to assume those leases if we choose to. And if, let’s say for example, there’s 10 leases, three of them are with referral sources. Then, we’ve got to make sure that we get all of our compliance matters in hand before the closed date. For the other ones, we just want to make sure they get signed by the closed date. And then, on top of that, you may have other real estate matters, like acquiring property, and then that adds another level of timing concerns. So, if there is an acquisition of property involved, then we’ll have to be doing our title work and our survey work and trying to make sure that aligns with the larger acquisitions close date.

So, we’ve got to really pay attention to the timelines and make sure that people are communicating not only from our business people and our real estate people talking to the other parties or, I guess, the other parties on the real estate side, as well as the larger transaction side, to make sure we can get all of our documentation in hand and complete all of our steps in advance. So, like I mentioned earlier, let’s take the example of if there’s an acquisition of land. I mean, in a pure purchase or just purchase or sale of land, if there’s some title issues that come up, the parties might say, “We’re not able to cure those.”

And then, the purchaser has the ability to walk away, and they can make a informed choice if they want to do that, weigh out the risks, and either decide to proceed or not. You lose that leverage in a larger transaction. You don’t have as much flexibility to say, “Should we walk away from this deal?” Of course, if there’s a major issue, it’s got to be dealt with, but you have less of that leverage to say, “Well, I’m walking away from it,” whether you’re using that as a negotiation tactic or if it’s the actual intention.

Joel Swider: Yeah, that’s a great point. The distinction that you raise between the pure real estate transaction versus real estate as a small part of a larger transaction, I can see how that would change some of your remedies or the leverage that you might have to get them to cure things. What other aspects, Vikas, should we be thinking about in terms of whether it’s a large or small M and A transaction? What other themes or challenges do you see cropping up time and again?

Vikas Sunkari: So, this hasn’t quite come up, but I could see how it would come up, for example. So, let’s say there’s an acquisition, and there’s a lease that the acquiring party would be assuming. It could be with a landlord that they already have a relationship with, especially if it’s a large breed type landlord. There’d be a question there of does the lease that is being assigned, or that we’re assuming, does it sync up with the deal terms we have with that landlord? If you’ve got a negotiated lease or template that you work with with a larger landlord, then you wouldn’t maybe want to assume another party’s lease. You might want to rewrite that lease on your template, for example. So, that’s a consideration. And also in a situation like that, come to think of it, if the rents inconsistent, that would pose an issue.

Maybe it’s paying rent at a nearby location that’s been negotiated. It’s been vetted either by fair market value or broker’s value opinion, for example. We want to make sure those are consistent for a number of reasons. Another consideration is that you could be acquiring a lease that is essentially with another one of your system’s entities. So, if you’ve got now intercompany leases, there’s a question of are they needed? In our case, we like to maintain intercompany leases because it’s a good way of for the parties to understand what’s out there. Just a good best practice. But we’ll want to make sure that those are captured, especially if you’ve got, let’s say, one entity is nonprofit, the other’s for profit. You definitely want to make sure that you have the lease in hand there. So, that’s another consideration. I mean, in other cases, though, maybe there’s an intercompany relationship that’s now being formed, and a lease is no longer necessary. So, that’s a step to validate. Let’s see.

Joel Swider: What about employment agreements, Vikas? Because I feel like, in the last couple transactions I’ve worked on, we’ve had some issues there in terms of timing. And, well, we need a go-live date of January 1st, but the parties aren’t ready to move on the asset acquisition side yet. Have you come upon any issues like that?

Vikas Sunkari: Yeah, yeah. And I think, luckily, we’ve gotten the timing lined up, but that often can be actually in a smaller transaction, for example, determinative of the deadline, if you will. X physician needs to start, or the practice we’re acquiring, that physician needs to become our employee on a certain date both because, well, I guess the initial step is that there’s certain paperwork. I think IRS paperwork that needs to be filed and other state paperwork that needs to be pretty precisely filed to change the employment status of that person. We’ve got onboarding concerns. There’s certain requirements, I guess, when someone would have to file their paperwork to show that they’re an employee, I think you can push that out. I don’t think you can pull it in. You can’t backdate an I-9, I believe. So, that can have a pretty strong effect on what is our timeline. And it’s also a matter for that practice’s patients, for example.

If they’re going to come over and join one of our medical groups, they’ve got to let their patients know, they’ve got to send a communication out, and you don’t want to change that date a whole bunch because some of the steps that are needed to complete the deal are lagging or haven’t been addressed. So, I guess another thing that comes up with employment arrangements, too, that was recently was brought to my attention was wanting to make sure that the terms of the employment agreement, if there are some, if there’s one or multiple, we want to make sure that those terms are compliant with fair market value on their own, and that goodwill from the acquisition isn’t being transferred through the employment agreement. Let’s say you acquired some assets, that all syncs up with your fair market value opinion, but if you give them an extra couple of thousand dollars and their employment agreement, that would feel a little problematic. It would be transferring the value that should have been captured in the asset acquisition that maybe wasn’t warranted and putting it in different buckets. So, that’s something to be mindful of, too.

Joel Swider: So, Vikas, these transactions, I know you may not be able to speak specifics on a given transaction, but a lot of these I could see being issues that arise on a large transaction, say. Are there meaningful distinctions between a large transaction and a small transaction? Or are they really equally complex, just different purchase price? How do you compare those to the extent that you’re staffing. For example, on your team, you say, “Well here are the expertise that the various attorneys and business leads that we need to be involved.” Is it largely the same? Or would it differ?

Vikas Sunkari: I think it’s pretty similar in concept. There’s a lot of the same moving parts depending on the size of the transaction. I mean, I think in a small one, you’ve got to account for the real estate, the employment matters, the equipment that might be involved. You’ve got to get a lot of the same type of paperwork or contract or bill of sale. You’ve got to get all these same types of documents involved. But just the scale of it. How many of those are you having to do? If you acquire a small practitioner, you’re doing one or two employment agreements. If you’re acquiring another system, you might be doing hundreds of employment agreements, and that’s a heavy lift.

So, I guess there could be other concerns depending on the size of the transaction that are just necessarily going to be more complex. With a larger health system, like there may be third party agreements, for example. If you’re acquiring another large practice or another hospital, they might have other arrangements with other medical groups or other healthcare entities or other businesses that are, maybe, not necessarily healthcare. I guess whether they’re providing or receiving the services. You’ll see that more in a larger transaction, certainly, than you will in a smaller one just because a larger entity’s going to have a lot more third party arrangements that they’re offering to various parties.

Joel Swider: So, Vikas, last question at a macro level, and then I’d like to get into some quick lightning round. But taking a step back and just broadly speaking, how would you say SSM Health is able to leverage its real estate as part of its growth strategy?

Vikas Sunkari: So, I guess it depends. I mean, we’re always trying to get access for our patients. That lines up with that mission and what we’re all about. So, the real estate, if we can acquire a practice, whether that’s because that person wants to close up or they want to become part of us, that allows us to maybe take over space that they’re in or assume the space that they’re in and provide greater access in certain areas. We’ve been able to do that. Again, we operate in multiple areas. Some of our regions are more metropolitan areas. For example, I mean, I’m here in St. Louis and a lot of our reach in St. Louis is in the metropolitan area. But in other regions we’re in more rural areas, so that can have a pretty significant impact. I would say it’s maybe less about growth and more about that access. I think that’s the crucial part of it, and that’s what you hear people within the organization talking about and really valuing, being able to provide services to more people.

Joel Swider: Well, Vikas, lightning round. A few questions about you personally. What’s a fun fact from your childhood?

Vikas Sunkari: I thought about this, and I thought about what would be interesting. And I just looked around the room that I’m in, and I came up with something good, which is that I used to actually be a pretty diligent comic book collector. Not so much these days, but I still have a bunch of them from when I was young and trying to get my son into it a little bit. But we might have to wait a couple of years for that.

Joel Swider: Nice. Any great values that you don’t want anyone touching because they’re worth so much money?

Vikas Sunkari: No, nothing like that. I used to have stuff like that, and I didn’t have the good sense to keep any of it. So, nothing too valuable.

Joel Swider: What’s your biggest struggle right now, whether personally or professionally? What is it that you’re working on?

Vikas Sunkari: So, I guess one struggle is probably just there’s a lot that I’ve got to manage for the breadth of what my role is, both as a manager and as counsel to my organization. So, keeping everything prioritized, getting what needs to get done the most efficiently. But I think my biggest struggle personally, I think, is I have a pretty good work-life balance and that’s very fortunate for that. I’m very grateful for that. So, with that, it’s not necessarily a bad thing, but my struggle, I think, is trying to be a really thoughtful parent. I think it’s something that I’m always trying to learn, and my kids are getting older and I’ve got to grow with them and learn what they need and just try to give them what they need from a both mental and emotional standpoint. Just be there for them and learn with them and spend time with them. So, not necessarily a struggle, but something that I put forth a lot of effort into to try and be on top of.

Joel Swider: Yeah. Well, when you figure it out let me know because I agree. It is very, challenging.

Vikas Sunkari: I’m guessing it’s going to take about 50 more years.

Joel Swider: Right. So, Vikas, what’s your favorite way to self-educate?

Vikas Sunkari: So, when it comes to just maybe non-legal or just general topics, I mean, I guess lately, because I think so much of my job involves reading over things, I tend to listen to stuff more. So, I’ll learn more about history and whatnot or other things that interest me through podcasts, or listening to something is probably the best medium for that. When it comes, though, to learning more about what I need to do for work, what I need to do professionally, obviously attending CLEs or other programs. Maybe not so much CLEs, I guess more seminars that come up my way are a really good way to learn, a really good way to hear what’s going on out there. But also, on a more specific level, I think learning from more experienced attorneys has been the best way for me to learn.

When I first started off at SSM, I didn’t know a whole lot, and I have a good example of maybe the best way for me to learn in that. I think the first time I had to really deal with a real estate purchase, I didn’t quite know all the steps, and I bought a book. And I don’t think I even read through it. My father-in-law is a real estate attorney incidentally, and I ended up talking to him about it, and that was a lot more insightful to me than the book was. And then, since then, on the same note, I’ve worked with outside counsel a lot to have them walk me through things, whether it was, maybe, a general matter or giving me the framework to walk through something, or if it was actually a specific transaction. Maybe, at first, rely more on them.

And then, over time, I’ve been able to take the driver’s seat more on those. And also learning from peers, like yourself. I mean, I’ve brought up a lot of interesting and unique fact patterns your way to get your advice on, and that’s been really helpful for me to learn and also to share some knowledge with the rest of my team. And then, lastly, I think learning by doing. Sometimes, there’s really no other way just to put yourself out there, and sometimes you’ll make mistakes. But then, I mean, there’s plenty of times I think I’ve done things improperly, and I’ve had to fix them, or teach myself how to do them correctly. And it’s not always pleasant in the moment, but after the fact, you can look back and see that something that seemed completely foreign a couple of years ago is now very familiar.

Joel Swider: Vikas, since you started at SSM Health seven and a half years ago or so, what has been the biggest shift that you’ve seen during that time?

Vikas Sunkari: I guess the shift is maybe investigating, maybe, different types of arrangements. You see, maybe, more telemedicine, for example, more creative ways of partnering with healthcare providers or medical groups. I think that’s really stood out a bit. Maybe moving away from less traditional models, and then the whole emphasis on it is to have, again, a bigger reach to provide better healthcare to more people the best way possible. So, I think that’s one shift I think I’ve noticed. It’s still ever evolving, I think

Joel Swider: I noticed, by the way, I think it was just last week, SSM Health was honored as one of the top places to work in healthcare by Becker’s. So, congrats. One thing that I learned recently about SSM is that there is, I guess, I don’t know if it’s a policy or an approach to non-violent and inclusive language. I was wondering if you could give me any more insight on that.

Vikas Sunkari: Yeah. So, I think that was a policy that’s been in place for quite a while, and it was initiated by one of the former CEOs who was part of the Franciscan Sisters of Mary. It’s always been really important, I think. People really take it seriously, and I think, in everyday practice, it’s as simple as maybe not using certain words that could have a violent connotation. Even if they’re not something we typically think of as violent, certain expressions, “Kill two birds of one stone.” I mean, we try not to use examples like that even though they might feel innocuous. If you maybe don’t say that, you don’t say other things that could come off inappropriate, or maybe sends a certain message. So, I think, on one end, you have that from a simple everyday mindset, but it really flows into how people treat each other.

There’s a lot of respect within the organization for people at all levels of the organization. So, people in my experience, seem to treat each other with a lot of respect, very courteous. Even if maybe you’re dealing with difficult situation, I think there’s a culture of understanding. I’m sure we’ve all worked at places where people maybe thrive or are put in an environment where there’s yelling and you’re under pressure a lot, and I think our organization, really one of our big benefits is that doesn’t fit within our mission and it’s not how people treat each other. And I’ve seen that people get the same outcomes because we’re united in our overall mission. So, for me, I think I’ve noticed a pretty big benefit of it because I think the language aspect just builds it. It’s a way to build into just a general more overarching culture of respect.

Joel Swider: Vikas, last question. What’s your favorite strategy or work tool that helps you be the most productive?

Vikas Sunkari: So, I always make lists, and I do them a lot of different ways. But sometimes if I’m feeling really overwhelmed, I just make a list of here’s what needs to happen today, or here’s what needs to happen this week. And the practice of even doing that is a big stress reliever and a guiding tool to say these are the things that need to be focused on first. And then, I can just continually do that. So, I’ve got a couple, well, not a couple, but I’ve got an ever-evolving to-do list that really helps me stay on top of all the different things I’ve got to be mindful of.

Joel Swider: Well, Vikas, if people want to connect with you, what’s the best way to do that?

Vikas Sunkari: So, you can find me on LinkedIn at Vikas Sunkari. I’m at SSM Health, and then my email is just Vikas.Sunkari@SSMHealth. So, people can reach out to me there.

Joel Swider: Perfect. Well, thanks Vikas, for joining me. And thanks to our audience for tuning in. If you’re interested in signing up for Hall Render’s weekly healthcare real estate news briefing, and our other articles and content on healthcare real estate, please send me an email at jswider@hallrender.com.