Patient Selection & Some Misconceptions

Dr. Tea  0:01  
Owners of a direct care practice are more likely to experience higher job satisfaction than the insurance based practice. And it's no wonder why direct care is independent of insurance. Patients pay the doctor directly for their expertise, the doctor gets full autonomy in how they care for patients and how they get paid. We've chosen this path for the love of medicine. This is the direct care way. 

Dr. Tea  0:26  
By listening to this podcast, you may even start to believe you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey on how I pivoted from an insurance based practice to direct care right in the middle of a pandemic. And the valuable lessons along the way. This podcast may be the very thing you need to revitalize your medical practice on your host owner of a direct care podiatry practice, Dr. Tea Nguyen.

Dr. Tea  0:55  
Hey, welcome to episode number 24. patient selection, this is really important to understand in the dynamics of direct care. And I really want to share the perspective that I have, that is probably going to be inflammatory to some people. But if you're interested in direct care, and want to get a true sense of what there is to expect, that's what I want to share with you. Let's think about patient selection. When you are in an insurance based practice, you are actively selecting for people who choose to pay very little out of pocket. So after all, they are picking you because you are in network. That's the point of insurance. 

Dr. Tea  1:48  
The same goes for direct care, when you are not contracted with insurance, you are selecting for people who are choosing to self pay, because they see the value. Also, these people may have a high deductible. So they're paying out of pocket anyway. Or they're dissatisfied with the in network options. Or they were referred to you by a trusted person that could be their doctor or a friend. And most important, you probably offer something that no one else does. It could be a skill, or it could be more personalized care. This is something I want you to think about when you start diving into your direct care because there is a level of competition in regards to choosing a direct care doctor versus an in contract in network doctor. So you have to figure out what's going to make you stand out. 

Dr. Tea  2:43  
Otherwise, people are going to say exactly this. Why should I see you if my insurance benefits cover what I need. And so you have to work on delivering your message in a way that makes sense for them to pay out of pocket. People with Medicare and Medicaid, they still see me. And if they change insurance or lose their insurance, the benefit for them is that they have the security to know that I will stay as their podiatrist. So there's a continuity of care. And that is such an important part about medicine, and especially if you do preventive foot care or even limb salvage, because the last thing patients need is this continuous care, which is kind of the standard in the insurance based practice. Because if people expect their doctors to be within the network, and then they change their insurance, then they have to change their doctors unless we educate them that we have. But we have rates that are accessible. Now you can be in two camps. You can be in the camp of a an affordable fee, that's lower than what the insurance rates are. Or you can have a concierge type of level where you know that you're the only one who can do this very specific thing. And you can charge much higher for that supply and demand right? So you can decide which direction you go. In direct specialty care, you can have one or the other. 

Dr. Tea  4:25  
You can choose to be a little bit higher volume, but still lower than the insurance based practices in charge a little bit lower, or you can charge a little bit higher, more of a premium level service and see fewer patients. I mean, the world is your oyster, you can really decide what works for you and what works for you. You will only know through practice through understanding your market but you have to look at your market without judgment. You just have to look at the data. You have to create your message that makes it work for you and for the people watching Your door. So these are the types of things that I help my coaching clients understand. When they asked me, How do I get started in direct care, the number one thing that I tell them to start with is managing your expectations. So the people who chose you because you were in network probably won't follow you, at least 100% will not follow you into your direct care. Practice, expect that now the percentage that will totally depends on your community, your offering, and your relationship with your patients. 

Dr. Tea  5:37  
So if you've been in your practice for a long time you've been within the community 1015 years, you're the go to person, you will likely have a higher percentage of people converting into your direct care practice. But you do have to continue to educate them, that it's a better deal, they get more out of it. But you also have to understand that there are just some people who do not value medical care in that way. They just want to get in and get out. And so you really have to sort who you're serving, and understand who that is. So that you can say and know your limits and just know you can't serve everyone. It's kind of like there will always be people who want to shop at Walmart, because it's affordable. And they their motto is low prices guarantee. And then people who shop at Walmart may never shop at Nordstrom, or Nordstrom, people may never shop at Walmart, of course, some people go between the two. 

Dr. Tea  6:38  
But you see there are different clienteles in the way of marketing, you can have really cheap stuff a Walmart, or you can have high quality stuff at Nordstrom, with exchanges, no a no fuss exchange policy. So knowing what clients you serve will help you better define who you don't serve as well. Because after all, this is a physician patient relationship. And it's intended to be long term. So when your insurance base, you already chose to work with people who don't anticipate paying very much, they may already put in a lot of money into their deductible or their monthly premiums. And so they assume that if they're paying that much for medical insurance, then everything should be included. And we have seen on our side, how untrue that is that there are conditional coverage. 

Dr. Tea  7:33  
There are a lot of things that we provide such as preventive care coaching that there's no CPT code for, but we are spending our time in helping people get better and helping people understand what they're doing. Some people require more time in that explanation, but you don't get paid, if there's no CPT code for that. So if you're explaining something to your patient, to one patient that takes you five minutes, and they comprehend, versus another person who may take 15 minutes to comprehend. That rate is exactly the same despite how much time has passed. Now think about the times you've taken care of a patient that wasn't just limited to the office hours, it included contacting family members, coordinating care with other specialists, clarifying orders, with pharmacist, all of the back work that you had to do to take care of that patient. Most of that is not covered. There's no CPT code for that, sure, you can up level your billing code. 

Dr. Tea  8:37  
And then there are conditions with that as well. Because in podiatry if you code a higher level, and it's deemed that that's not a normal code that those of your peer are coding, and then you get flagged and so now you're at risk of an audit, and that level of headache. And so it just it every time I talk about I sweat, I feel a lot of rage and anger that we allow this type of stress on us by accepting insurance. And it does not have to be this way. So the people you are selecting for is not necessarily the rich people. And that is the biggest misconception. Everyone I've ever talked to about direct care has is that they think that I'm only serving rich people. And I've shared previously that I've served everybody from farmworkers, those who are uninsured, those who have lost their jobs, those who are scraping by and they're paying for my services, and it's not my place to judge how they got their money, what their income is of their ability to pay. That is their choice.

Dr. Tea  9:45  
My responsibility is letting them know what I offer and then they can choose how to spend their money. So there will be people who expect medical care to be cheap, just like those who are devoted Walmart shoppers. And that's totally okay. There are people who are just not going to care a whole lot about medical care, not enough to pay cash at least. And they will sort themselves out, you no longer have to serve these people. This is a choice. And it's not a selfish choice, especially when you're running a business. Imagine all the frustrations you've gone through in helping people who don't really appreciate all the work you gave them. But instead, they gave you a one star review, how agitating is that? I know, because I've been there. And I also know that my energy has a limited amount every single day. And as I get older, that energy bucket depletes. So I have less to work with the older I get. And so I have to protect my energy in order for myself to have a better quality of life, so that my family gets the better version of me, not the tired, cranky version, but the version of me that they deserve. So you do want to serve those who are willing to pay out of pocket. 

Dr. Tea  11:03  
Those who see value in these people exist, they come to my office every single day, and they get the benefit of attend to thoughtful care, with appointments lasting up to 60 minutes. And I am more than happy to answer their calls after hours to check my text messages to check my email, often things can be put the next day. But I enjoy what I do now, in a totally different way.

Dr. Tea  11:35  
Another misconception people have about direct care is that they think direct care means concierge care. They're they're pretty different. And people say they don't want to be on their phone 24/7 caring for patients. And let me tell you, no patient has my cell phone number. Maybe there's like two and I have no idea how that happened. But they are texting me they're not calling me. So you are still the business owner, you are still the doctor, you still control your time, and you create your boundaries. So never had I had a patient call me incessantly on my cell phone, my boundaries aren't clear, I answer within certain hours. And if it's emergent, I will deal with it. But thus far, it's not been an issue. So having a direct care or a concierge practice does not mean you have to be on the phone at people's beck and call it is nothing like that at all. So you decide. 

Dr. Tea  12:30  
So this is the time for you to really think about what I've just said, maybe it resonates with you. Maybe you don't like what I had to share. But you can really decide how you want to run your practice. If you have like the high volume practice where you're seeing patient after patient, and that brings you joy, you can continue to do that. But if you find yourself being exhausted, almost wanting to exit medicine, because you can't contain another full day of seeing patients back to back like that. And getting paid very little plus the headache of whatever insurance bureaucracy there is charting, auditing, collecting overpayments learning a new CPT code, this list is very, very long. And then the overhead costs dealing with insurances. Well, that's why there's direct care, because there's over 40,000 of us who's just tired of it. We're not doing this anymore. And for me, I know how joyful medicine is indirect care. And that's why I'm sharing this with you. So I hope you got something from this episode. It's something I care deeply about and helping doctors understand that there is another way. 

Dr. Tea  13:44  
And it doesn't mean that you're selfish or you're greedy, or you're only serving rich people or you have to be on the phone 24/7. It's none of that. So I hope you enjoyed this episode. I look forward to hearing from you tell me all the things, all the concerns you have, and I'll be sure to answer them. My email will be in the show notes. Take care. Wait a minute, I totally forgot. If you're a woman in podiatry, interested in direct care, I have something really special for you. I just put together in many series, a course of stuff, really the kitchen sink of everything that could ever be asked about direct care, I put it all in one place for you, you might be a decision away from a totally different life. And this course is designed to show you everything you can expect in the direct care journey. I want you to be prepared. I want you to learn from my mistakes. I also want to show you what's possible. 

Dr. Tea  14:35  
There are things in this course that is not in this podcast, because they're just a little too private to share publicly. And so I want you to have access to that the link to get access to my mini series will be in the show notes. Or you can go to coaching with t llc.com. To learn more in this course you're gonna get three hours of practical information you can implement right away Be, there are no Fluffs. No pitching. There's no funnels, no Facebook ads to deal with. None of that is really relevant until you understand what direct care is. And until you get the initial stuff together, which is all in this mini series, you're going to find questions from your peers who are just learning about direct care, and are fed up with insurance based practices, you're going to find important questions and considerations before you even start or if you want to uplevel your existing practice. I also included a bunch of worksheets so that you can have a methodical outline of action items that will help you accelerate to your goals because you know, insurance reimbursement is not going up anytime soon. 

Dr. Tea  15:48  
And of course, what's near and dear to my heart is the private Facebook community. The only way to push forward is to do this in community, and I'm there to support you every step of the way, you will not feel alone. Plus, if you complete this course, I will spend time with you, we will get on a strategy call and I will tell you exactly what to do next. So you never feel like you're alone in this journey. Private Practice can be very lonely, but I'll be there with you. And we're gonna dominate this together. 

Dr. Tea  16:19  
Thank you so much for being here with me today. If you enjoyed this episode and want to hear more, please like, share and subscribe. So more people like you can have access to another way of practicing medicine, that direct care way. Let's connect by my info in the show notes and send me your questions. It might be the topic for future episodes. 

Dr. Tea  16:39  
And lastly, if you remember nothing else, remember this. You are in control of your life. See you next time.