The only thing that makes the end of summer tolerable is that football season is upon us.

When you read the email from one of your fellow coaches on the 12 year old football team before you read the one from your largest client, you think you might have issues.  When you find yourself watching the 4th quarter of a preseason game that does not even feature your local team, you're pretty sure professional help is needed.

I am drawn to football for several reasons, most of them good.Other reasons involve nachos.

Part of the annual fall rite is twisted, but interesting in a ‘car wreck’ sort of way – the argument between a player and his team over his financial value.One side of this drama is the player on the rise who feels he is underpaid, producing the lovely ‘holdout,’ where everyone comes off looking like a sleaze bag and fans just want to go wash off.

The other side is melancholy and sometimes sad.The star of the past loses a step to age, and loses his roster spot to some young up and coming turk that we don’t know or love yet. Your kid had his poster hanging in his room and now the player is cut or forced to retire, and a little part of you hates that part of sports.Especially when the player tossed out for being 'too old' is about 15 years younger than you are.

Sometimes, it is not age that causes a player to be dispensable, but rather a change in the team’s approach.A new coach with a new plan needs different skills and that beloved guy does not fit anymore.

Sometimes, assets just lose their value.

Which gets us to a little discussion of book seller market cap and lessons for us in healthcare.  Yes, the random segues continue.Regular readers of this space really wonder about a mind that makes such bizarre connections.

As of August 23 and according to Yahoo! Finance, two of the nation’s largest booksellers compared as follows on some key measures:

Enterprise value (what it would take to buy the company)

• Barnes and Noble: $1.36 billion
• Amazon.com: $57.21 billion

So Amazon is 42 times more valuable that Barnes and Noble.Pretty interesting, but Amazon is bigger, so that make sense, right?Yes, Amazon is bigger, a lot bigger.

Annual revenue

• Barnes and Noble: $5.81 billion
• Amazon.com: $28.66 billion

That is almost 5x bigger.  Wait you say. 5 times bigger, but 42 times more valuable?What is up with that?Is Amazon a lot more profitable?

EBITDA (a measure of operating profit before all of the accounting machinations kick in)

• Barnes and Noble: $297.59 million
• Amazon.com: $1.72 billion

Barnes and Noble makes 5.1% of operating profit and Amazon makes 6.0%.Yes, Amazon is more profitable, but nowhere near enough to justify that massive difference in the value of the two companies.

Of that 42x difference in value, you can explain about 5 of the X’s with size and maybe 8 more due to profitability.That leaves around 29 X’s unexplained.  Why does the market value Amazon so much more highly than it values Barnes and Noble?

I am not an analyst and please do not take this as any sort of stock recommendation, but there is a fundamental difference that my high school daughter got pretty quickly when I ran this little comparison by her (and yes, you should pity her for having to ride to school with me…instead of discussions on the latest indie band featured on her iPod, we discussed company valuations).

‘Dad, the difference is the stores vs. the technology.’

Brilliant.  A proud papa moment.

And now that Amazon sells more Kindle e-reader downloads than hardcover books, the technology advantage is only accelerating.

Like the running back with the big contract who is now a little slow, assets become liabilities very fast.Those 1,375 Barnes and Noble stores were the secret to selling books just a few years ago.Now, not so much.

Technology is an incredibly disruptive force once it gathers steam.

Now it would be easy to appreciate this little parable, but push back on its application to healthcare. You could point out that the entire product in the bookseller world can be digitized, thus setting that industry up for this type of radical transformation.  Music, movies, and financial services are other examples where the product can be automated, so the industry disruption is magnified.  You could point out that the care delivery provided by physicians requires direct physical contact with patients, thus protecting our segment from some similar form of creating new winners out of thin air while decimating the established order of things.  Technology is just a tool to make us more productive, you say, not a complete changer of the rules. 

And I would say you are sort of right.  But it is dangerous to be just right enough to stop thinking hard.

We are still at such an early stage in the technology enabled remake of our industry that the little anecdotes about what is happening are kind of cute.Stories about telemedicine, email consults, and mail order pharmacies break into our consciousness now and then, but generally do not cause us to step back and wonder what could happen to the entire business once our information gets converted to ones and zeroes.

Radiology reads from China and India pose a real threat to that specialty, right?

Every clinical specialty will find unique opportunities and threats that come with the advent of technology, but you should at least admit that ours is an information intensive business.  What could happen when that information gets off the sheet of paper and into the interconnected computer? 

Some practices will be alert and capitalize in big ways.Others will miss the signs until they get the dreaded knock on the door saying coach wants to see you.  And bring your playbook.You know you just got cut from the team.