Renovo Health offers affordable health care through traditional options

Rachel Sankey

Staff

August 12, 2024

MANITOWOC – The opening of Renovo Health, Co-owner Steve Borene said, stemmed from a need he and his business partner, Josh Johnston, saw throughout their combined 40 years as anesthesiologists. 

The need, Borene said, being affordable health care.

“We both worked together at a hospital… up until about five years ago when we found that it wasn’t meeting all of our personal goals and some of the autonomy and flexibility we were looking for,” he said. 

Since then, Borene said he and Johnston have been doing traveling work as locum tenens.

After working as a traveling anesthesiologist for some time, Borene said they “realized there was still something missing.”

“Some of the same complaints in the health system existed even under that work environment,” he said. “We had patients come in frequently, and they don’t always know why they’re having a procedure done. They have questions that haven’t been fully vetted.”

And, Borene said, a lot of people would ask, “how much is this going to cost?”

“We couldn’t give them answers to a lot of those questions – especially the cost question – because the hospitals don’t tell us,” he said. “We don’t know how much it’s going to cost them – even for our own services.”

If the procedure the patient has requires a different approach, Borene said the hospital, in many cases, will increase the charge of the process.

“We never knew how much of that (charge) was going to get pushed to the patient,” he said. “And it depends on their health plan… Sometimes it depends on whether they say they’re going to pay cash, through an insurance company or directly through their employer.”

Patients became so disconnected from the payment process, he said, “that we were confused, (too), even after working in health care for decades.”

Finally, Borene said he and Johnston had enough. 

“We thought this was something we could improve for patients,” he said. “Help them understand the system and help them have more autonomy and better decision-making options based on knowing the whole story.”

From there, the two started Renovo Health – an affordable surgery and medical infusion center that opened last month at 1720 Memorial Drive in Manitowoc.

About direct pay

Borene and Johnston said it was important to make sure their practice was transparent, priced fairly and available to them and their employer – “the people who will commonly pay for these procedures.”

That ethos, Borene said, led them to the direct-pay market.

“There’s a fair number of direct-pay primary care doctors across Wisconsin,” he said. “(The state) is doing a great job of (attracting) independent family practice doctors primarily (to direct-pay), but (have also begun attracting) more internal medicine and cardiology doctors to the more traditional relationship.” 

By traditional, Borene said he means how “things would have been 50 years ago” when someone had more immediate access to their physician, could see how much care would cost and be a part of the decision-making process. 

“We wanted to be part of that market,” he said. “We’ve seen a whole lot of opportunities for direct pay, as far as procedural care goes – by that, I mean surgery and endoscopy procedures. We’ve also put ourselves into the medical infusion market.” 

Borene said it’s crucial to reiterate that transparency and accessibility are key to Renovo Health and its relationship with patients.

“You don’t leave Walmart without an idea of how much you paid and what you got,” he said. “You wouldn’t expect them to send you a bill a month later – or six months later – to say you owe an additional amount for this part of the equipment you bought… but in health care, you get that all the time.”

A common example of that, Borene said, can be seen when someone has a colonoscopy.

“‘Hey, actually, on this colonoscopy, they removed a polyp, so you owe us another $8,000,’” he said. “That’s not fair to anyone to do things that way.”

Borene said he and Johnston wanted to “do something different” and have been following a model from a group in Oklahoma City that emulates Renovo’s ethos and philosophy. 

“People are craving that free market, principal healthcare option,” he said. 

To put it simply, Borene said direct pay means a patient will “get one bill off the bat with no surprises later.”

That bill, he said, is typically also far less expensive than what the patient is used to seeing. 

Tieing in the colonoscopy example, Borene said Renovo’s cost for the procedure is a flat-rate price of $2,995 – regardless if polyps are found or not.

“We will still remove that polyp and send it to the pathologist and provide a full report to the patient, but we will not have any additional charge…,” he said. “It costs us more to remove polyps, but it’s in the few hundred dollars (range), instead of the thousands of dollars other systems will make it appear (to cost).”

If for some reason the team needs to use additional equipment to provide a procedure, “that’s something we’re willing to share the risk of as well.”

“Our prices don’t change because the procedure is somewhat different from what the intention was at the start of the process,” he said. 

The price of procedures are listed on Renovo’s website (renovohealth.care).

That way, Borene said, people know immediately that charge and can plan for their procedure accordingly.

Being able to offer health care at a lower cost is due to several different reasons, Borene said. 

“Part of the way we can have our prices so low is we don’t have a collections department, and we don’t have a finance arrangement,” he said. “We’re putting all of our work into taking care of patients… so we don’t have people who sit in the office and do work.”

In fact, Borene said there is no office staff at Renovo at all.

“The people who are in the office are all physicians or nurses and are involved in taking care of patients, so we don’t have built-in payment systems and everything else,” he said. “That’s intentional because we want to be delivering care and saving people as much as possible.”

Having a staff entirely made up of healthcare professionals, Borene said, means payment plans and insurance aren’t part of the equation when it comes to direct pay.

“All of that being said, that’s often no different than when people have procedures done otherwise,” he said. 

For example, Borene said if somebody had a health plan with a high deductible, and they came in for a procedure, they’d be responsible for writing a check.

“While working with us, many of the procedures – the cost of the entire procedure – are less than people’s deductible,” he said. “So if they went to a hospital and had a $30,000 procedure, and they had to write out an $8,000 check to meet their deductible – for example – maybe they could get that entire procedure done through us at only $6,000.”

Implementing direct pay, Borene said, helps patients in three ways:

• Decreased cost
• Less time spent dealing with insurance and/or getting a bill reduced
• It allows people to understand what the procedure is worth and what they’re worth

“Whenever we buy something, we shop around,” he said. “When we buy a new TV, we look and compare it to other TVs… and if we know how much it costs, we say, ‘maybe it’s not worth the purchase this month, but maybe in three months, it will be worth it.’”

Non-urgent medical needs, Borene said, can – and should – be the same way.

“This can be a step toward all aspects of medicine, being under this new type of system – which in many ways, is an old type of system,” he said. “But, it gives people the knowledge and information needed to go ahead and make informed consent when they’re (managing healthcare solutions).”

How to go about direct pay

At Renovo, Borene said there are three main ways in which patients do business with the organization:

• The patient comes to Renovo Health directly.
• The patient is referred to Renovo Health through their employer. Borene said Renovo has agreements in place with many employers where it deals directly with the company, reducing the cost of the procedures.
• The patient is referred to Renovo Health through a direct-pay healthcare system or primary care doctor.

As far as payment goes, Borene said there are a variety of options there as well. 

Most of the time, he said, Renovo has an agreement in place with the patient’s employer, and the employer takes care of the bill. 

“Many times, (employers) give incentives to the employee – pay for their gas, pay for a hotel stay if they have to drive in and don’t want to make a two-hour drive in the morning to come see us,” he said. 

In those cases, Borene said it is still cheaper for an employer to send their employee to Renovo for a procedure or infusion than closer healthcare options.

He said he experienced that instance recently with a group in Utah.

“That’s their plan,” he said. “The gentleman I spoke with said it’s less expensive for them to send an employee and spouse on an airplane, provide them with a rental car and hotel room, have them have surgery and their immediate recovery near us and then return.”

Borene said some patients have a cost-sharing plan with their healthcare plan or direct-pay arrangement, which he said means they would submit their costs to one of the nationwide cost-sharing plans.

“What those people will do is they will pay out of pocket the full amount at the time of the procedure,” he said, “and then we make sure they have all the paperwork they need to submit that back to their cost-sharing plan so they can get reimbursed.”

And, some patients pay the full cost upfront, Borene said. 

Services

At Renovo Health, Borene said he, Johnston and the rest of the team offer what he describes as the “bread and butter, typical surgery services.”

And, he said, the health center has an “experienced orthopedic surgery staff” that takes care of the procedures and infusions. 

“It’s the same surgeons who cared for (patients) in the legacy systems in the area,” he said. “That’s also true with the anesthesiologists – every case has an anesthesiologist who also happens to be an owner – either myself or Dr. Johnston are the ones doing all the anesthetic. We have no plans to change that, either.”

Surgery services, Borene said, include shoulder scopes, arthroscopies, rotator cuff repair and ACL repairs.

“We’re not currently doing total joint replacements, but we expect to offer that service in the next six months as we continue to build up our practice,” he said. 

For gynecologic surgery, Borene said procedures, such as hysteroscopies, endometrial cysts and endometrial cystectomies and hysterectomies, are offered.

Borene said Renovo also has three endoscopists who handle colonoscopies and EGD (esophagogastroduodenoscopy) services.

“That’s been the service that has gotten the most attention for us because of our competitive costs,” he said. 

Medical infusions are also available for those who are on medications, such as antibiotics, biologics or monoclonal antibodies.

“One unique thing about us is we do not add a markup to the cost of the medications we use,” he said. “If patients have a health system where they can get a preferred purchasing rate, and we would be willing to have their health system send over medications, we put it in the refrigerator and save it for them. All we charge is a processing fee, which covers the cost of our nurses, equipment, monitoring and expertise.”

Not marking up the cost of medication and only covering the cost of the infusion team, Borene said, can save a patient up to thousands of dollars per infusion.

Renovo’s full list of services is available on its website.

Why Manitowoc?

The choice to make Manitowoc the home of Renovo Health, Borene said, was a strategic one.

“Knowing the restricted covenants a lot of legacy health systems and hospitals place on their positions, it was important for us to not be in an area of high population, where the hospitals were so dense we’d be unable to get our surgeons and gastroenterologists to come work with us,” he said. “We needed to have an area that was physically removed from those systems.”

Additionally, Borene said he and Johnston were familiar with the primary care doctors and more advanced, modern health systems that promote the free market principles they support in the Northeast Wisconsin area.

The price point of the building, he said, was another factor.

“The building was already a functional, though underused, surgery center,” he said. “We got in at a lower price point because of that… (which means) we can pass that savings directly on to patients and employers.”

‘Outstanding’ response

The reception Renovo Health has received since opening, Borene said, has been “outstanding.”

“We’ve been able to meet patients at a place they didn’t know could exist in health care,” he said. “Our first colonoscopy patient saved about $10,000 compared to when he had the same procedure done a few years ago.”

Borene said patients and community members are pleased with how easy it is to access the site – which he said also comes with a nice view.

“We are right on Lake Michigan, so it’s a beautiful view,” he said. “People have commented on having a comfortable atmosphere.”

Overall, Borene said they couldn’t be happier with the space.

“We feel like it’s the way of the future – because it has to be – the current system is broken,” he said.