The Direct Care Way

5 Steps to Direct Care

August 09, 2022 Tea Nguyen, DPM Season 1 Episode 26
The Direct Care Way
5 Steps to Direct Care
Show Notes Transcript

The 5 S's to Direct Care

  1. Seek more info mydpcstory.com, E28 https://www.mydpcstory.com/post/dr-tea-nguyen-she-her-of-pacific-point-podiatry-watsonville-ca 
  2. Self discover https://www.positiveintelligence.com/saboteurs/ 
  3. Stop  being funny about money
  4. Spin the cycle, repeat 1-3
  5. Strategize the opt out process, safely.

Tell me your wins, big or small at teadpm@gmail.com


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. I'm your host owner of a direct care podiatry practice. Dr. Tea Nguyen.

Dr. Tea  0:54  
Hey there! welcome to episode 26. People are always asking, How do I start the direct care path? How do I start opting out? What do I need to know? before transitioning, especially if you come from an insurance based practice either employed or your own private practice, it may seem very daunting, to change the way you think the current model, the insurance based model thought process is that you have to see more patients to make more money. And that makes perfect logical sense. Because each patient has a per patient value. And to predict how much you can make or want to make, you have to see more people. And that is just mathematics. Now, the paradox that I'm sharing with you about direct care, is that you can make more by seeing fewer people. 

Dr. Tea  1:51  
So the first time someone ever said that to me. I was like, Well, that sounds really dreamy. But what does that really look like? And how does that work? I wanted to see like the methodical side of this logic, how can I see more? No? How can I see less and make more? And what can that do for me? So I want to ask you this, what if you can see fewer patients but make more? What could that do for you? For me, by making more money, I reclaim my time, my energy, and really my confidence in the work that I do. Because I put value on medical practice on the surgical skills I've gained. And the way medicine is going right now we're really cheapening our experiences in medicine. By accepting low pay from these third party payers fees, insurance companies are basically saying, our skills that we dedicated our careers to, for the last seven years, eight years, it's going to be dictated by somebody who doesn't even have a medical degree who's not even practicing medicine, they're just looking at numbers. 

Dr. Tea  3:08  
So in health insurance space, we're just numbers, and we are being replaced by lower level providers. People are going to argue we're not being replaced. And yet, that is what I'm actively seeing in the community, locally and nationally, where if there just isn't enough doctors to fulfill a role, they're going to expand mid levels role, because it's unfortunately, it's cheaper, because they didn't have to dedicate seven to eight years. Now, mid levels are an essential part of medical care, we know that it's a partnership. But the expansion to replace doctors replace. It's very, very real. So thinking long term. If insurance companies have so much control in the healthcare space, where does that leave the rest of us who really just want to practice medicine our way, the right way, the way that we feel it fits best for our patients. And there's just really no room left to squeeze out. 

Dr. Tea  4:10  
More time in a day, when we're already seeing a schedule packed full of people. 30 people a day on average, that's average, that gives us seven minutes a patient, the rest is spent on charting. And we even do this after work hours. How frustrating can that be? How annoying is that for your spouse, your family who's waiting on you all day for you to come home and be with them. But instead we're trapped? Charting, we are trapped dealing with stuff that should have been dealt with earlier in their day. But because we're so overwhelmed, we multiply our problems. So the more patients we see we're actually increasing our medical liability, increasing our medical mistakes, increasing our paperwork. 

Dr. Tea  4:57  
So it's not just one more patient to see It's actually one more patient to see times the frustration of them not wanting to pay the copay, the frustration of they don't understand their own insurance coverage. And so we're now challenging the doctor, on why it's not being covered the services that you provide, or they're wanting to debate with you that you're, you're coding inappropriately, because prior doctors were able to get their services covered. So what are you doing wrong, and it's the multiplication of that, that is death by 1000 cuts, I call it death by 1000 clicks, you're sitting there in front of your computer, clicking away at these checklists, these are the metrics that we have to meet for insurance. And then dealing with the social problems that people have in thinking medical care is supposed to be achieved, or practically free. So I'm here to open your vision that your medical practice does not have to be like that. And you can actually reclaim your time, energy and confidence with a way more simplified way to practice medicine through direct care. 

Dr. Tea  6:05  
So in this episode, I want to share with you the five steps that will help you start this transition. Because we're looking long term. Whatever the trajectory is an insurance based practice for private practice is it's, it's very dire. And I saw it myself almost immediately when I opened my practice. So I want to share with you the five things that you can do starting right now, to have a different future, a future that gives you back your time, your energy, your confidence and self value as a doctor ready. So the five steps, or the five S's, I haven't thought about how to make this creative or anything, I'm trying to just simplify this steps, because who wants complicated fancy cute names, right. But I started with the five. So just think about these S's number one, seek or search, seeking search and explore medical information related to direct care. Create your own library of direct care, stuff that other people are already doing. They exist in podcasts. 

Dr. Tea  7:12  
My favorite one is my DPC. story.com. That was where I started when I started learning about doctors who are opting out of insurances. And I really love this podcast, because it's inclusive of all doctors, including primary care doctors and specialists in podiatry is included in there as well. Facebook groups, you know, Facebook is kind of like a hate love relationship, go in there for a specific thing, go there to seek information rather than entertainment. And you'll find it's not a waste of time. Most people are afraid of social media, because they don't want to get consumed in this time, in this black hole that in social media, which is very possible. But if you go in there strategically, and you go there to seek information for a very specific thing, these Facebook groups are really wonderful, because they're doctors just like us just trying to find and gather information for themselves

Dr. Tea  8:04  
in a way that it'll work for them. So Facebook groups was my number two place where I connected with other doctors with the same vision for themselves. And I became really good friends with them. So direct primary care specialist for direct care. And there's so many more Facebook groups that you can participate in and learn from. But I also want to invite you to not just soak up information, but also contribute back because everyone's in a different phase in their practice. And it's all valuable. So whatever you're experiencing that you want to share, and that you want to gain, make sure you leave a penny, you take a penny, give and take. And of course my podcast, if you're already here, the direct care way, you're already you already have the information you need to know to get started. But maybe it's more of a confidence issue, the issue of you're not really sure what it's going to look like or you want that checklist, so that you can predict where you're going to be next. 

Dr. Tea  9:07  
And I hate to tell you, but in business, sometimes you just have to explore. Try out a couple of things, and see how it feels, see what that looks like for you. And then you keep going. So coaching is a wonderful resource as well. There's a lot of practice management coaches, and practice management consultants. Those two things are very different. I'm on the coaching side where I help you deal with your inner voice, the inner struggles that we all have. And then there's the consultants who can also curate a logical step by step plan for you to put all your practice pieces in place. And then next, I really mentioned connecting with doctors who are already doing what you want to do, and create this new social network or community for yourself because if you ask people who don't have a direct care practice their opinions on direct care, you're probably not going to get very far. 

Dr. Tea  10:05  
If anything, you're probably going to get pushed back and say, That's wild, that's insane. Nobody's doing that you can't make a lot of money, that doesn't make sense, you're not going to be able to do surgery, you're not going to be able to give patients full scope of care, which is totally crazy. Because I'm doing all that I'm doing surgery, I'm giving patients full scope of care, I'm spending way more time with patients. And I'm getting way more back in return per patient. So be wary who you get advice from if it's not people who's actually doing what you want to do in your future. Maybe just keep it to yourself until you find your community that you can actually lean on rely on and trust and know that they're going to be with you side by side through this journey.

Dr. Tea  10:49  
 Because this journey is not linear, it's not going to be perfect throughout. I'll share with you the ups and downs, of course. So you have to be realistic of the expectations, it's very similar to when you tell a patient they need surgery. And patients think you just do the surgery, you get some pain medication, and then you're perfect in four to six weeks. But we also have to teach patients there is a downtime, there is going to be some post op pain that's expected. That's normal. That's part of healing. So that's what I want to do here for you is to be your tour guide in your direct care journey, and let you know what to look out for what the highlights are, and what to be wary of. So connect with the right people. Number two of the five steps to your direct care practice, self discover this is such a deep question that goes beyond what I have to share today. But really, what's holding you back? Why aren't you satisfied with the practice that you currently have? What's missing? Are you self sabotaging? So these are questions we have to ask ourselves that nobody else can answer for you. 

Dr. Tea  11:52  
But you have to reflect and look at where your practice is today. And really understand who you are as a person, what bias lens you are wearing in how you view the world, what your challenges are, and what your strengths are. So these are all really important questions you have to ask yourself in order to move forward. Because the way that you've thought about medicine, your practice that has led you up to here is not going to serve you as you move forward in direct care, there's going to be a link in the show notes where you can take an assessment on understanding your Saboteurs. So the book is called Positive Intelligence. There's a website associated with that you can take this assessment and then you can learn what's holding you back. How are you self sabotaging? And then how can you overcome them so you can move to a new future. So that's number two self discover who you are and how you view the world and how to deal with it. Number three of the five S's stop being funny about my stop being funny about money, doctors in general, we are super awkward when it comes to asking patients for money. If you're anything like P you probably thought money was kind of like a really weird topic to have with patients. And maybe you even hide behind your staff. And maybe when when your patients ask you what is this going to cost you let your staff walk in and review their deductibles payment plans and whatever and you skirt on out of the room. 

Dr. Tea  13:16  
Maybe that's you I don't know, that was me though. I was hiding behind my staff because a former consultant says I should not be the one talking money was with the patients, because I needed to divide who I was, which was the doctor to the money component in the fact that there's such a huge veil behind medical care. That's why the prices are the way they are. They are ridiculous. They are astronomical. I just called my hospital to see what an x ray for foot cost. And they were going to charge cash price 120 something dollars for a foot X ray 120 something dollars for a foot X ray. And I charged $50 Maybe and sometimes if they're if the patients are part of my membership program, it's free. It's just all included in it works for me $120 For an x ray that may or may not be taken correctly in the first place with potential of misdiagnosis, the fact that it's at a different facility entirely. That is inefficient care. And that's expensive care. What did I go into that? I don't know, I just thought it was something worth sharing that medical care is, in general, very expensive when you have all these people in between you and the patient and you can certainly make it much more affordable, much more accessible and much more efficient for you and the patient. 

Dr. Tea  14:36  
Therefore you give better care. Therefore you can command more per transaction because it's all inclusive. Do you see what I'm getting at? You're improving the quality of care and retaining more of the money, but it still ends up being much more affordable in the grand scheme of things because you don't have to send patients to all these other facilities. It just gets taken care of in house and people pay for convenience right? So why not pay you, you are the doctor after all. So if you find yourself being very awkward about money, there are a lot of books on dealing with money, the stigma we have behind it, why it's important that we really get over ourselves and how we deal with money and just know that money is just the transaction. It's just the admission ticket to get what they're looking for. And that's it by you, the doctor making more money, you actually reclaim more time.

Dr. Tea  15:24  
 So you have to ask yourself, if your current insurance based practice, is it ever going to give you back your time? Or do you have to keep buying fancy equipments to increase your cash flow? What do you have to keep learning a new billing code to squeeze out another couple of dollars for the patient care that you provided? Or does it just make sense to completely opt out and just not play that game at all? And then you decide what your rates are, and call it a day? There's a simpler way to practice medicine, direct care is the way I'm telling you, there's no insurance verification, there's no coding, there's no pushback from the patients, you know, there's no argument about, you know, why is this not covered, and so on. Like all of that stress gets compounded in your brain space that gets removed, when you go into direct care. So learn about why are funny about money, that's really important, in order to be able to ask for it in the insurance rates that are currently that we are accepting is not your real rate, that is a fraction of your rate. It even says that in your contract that whatever you charge, are only going to pay 60% of it, which is why we have these very inflated numbers of how we charge, you know, it's 150% 200%, whatever, because we know what we're going to get paid, it's going to be a percentage of it anyway. 

Dr. Tea  16:42  
So why not make it clear what your rates are, is what it is, and then you get paid the same day for that number four of the SS, spend the cycle that means rinse and repeat, rinse and repeat numbers one, two, and three. That means this is a practice. So you have to continue to expand your library on things around direct care or cash practices, you have to expand your circle on those doing direct care, learning from people who are already doing it, learning from their mistakes, so you don't repeat history. And then number three is learning about your perception around money, why it's holding you back,

Dr. Tea  17:17  
why does it make you uncomfortable? And then just start practicing getting used to that? And how do you do that? How do you ask a patient for $5,000 for surgery that you already do right now you start by asking them for $100 $1,000 $2,000. And then you move up to $5,000? And that's not an overnight change? That's not an overnight ask. I mean, it might be for some people, but there comes a point where you just have to believe in your own value believe that that's what it's going to be and then just ask for it confidently and sometimes is a stepwise approach as well. Most of the time. It's a stepwise approach. For me it was a stepwise approach. When someone said to me, you should be charging $5,000 for that thing, that service that I already do. I say what on earth who pays for that. And then I thought about all of the other doctors in different specialties who are already cash, orthodontists, plastic surgery, dermatology, even physical therapy, acupuncture chiropractors, they were charging numbers way beyond what we were getting reimbursed for insurance. So I was like, You know what, you're right, I shouldn't be charging more. And I should be doing it with confidence. I spent 10 years doing what I do, knowing what I know, I might as well charge for that for the time that I invested to know that skill set. 

Dr. Tea  18:35  
And it's not $100. It's not $400 In the fifth step in the five S's, that takes you to direct care into starting into moving towards your dream, direct care practice future. Number five, strategize the opt out process. Now I looked at stuff online, from people who have their checklist of how to have a direct care practice, they missed a huge component, it's not that you should just opt out suddenly, there's a stepwise approach for that, to do it safely so that you don't sink financially. There have been doctors who thought that this was kind of a solution to all of their problems, and so opted out immediately out of everything, and found themselves in a financial crash having to close their practice. And that's something if we can prevent that we should. This is not the best approach. The only time that I could imagine anyone opting out immediately is if you have another financial resource, or you want to close down your practice, and maybe reinvent your business entirely, and you have the financial reserves to do that. But for most of us where we rely on our clinical practice as our primary income or even secondary income, there's a strategy. So how do you do that? First, you look at your payer list, you look at all of your insurance and you're going to be surprised maybe you'll be surprised like I did. I suddenly found myself having 20 different contracts to opt out of because I had left it up to my biller at the time to deal with anything related to insurance contract. 

Dr. Tea  20:04  
So they were applying for all these different insurances. And then underneath that umbrella was like different parts of that insurance. So you know, there's like the HMO, the PPO, the EPO, and then there's like the contracted version of the local health system, it was crazy, I saw this listen, I was my jaw dropped, I was like, my, I was not close enough on the pulse of my practice. And that's a big fault that I have on my own, because I relied heavily on professionals, because I wanted to do the doctor thing. And so I let go of a lot of control in my practice. And so I had to undo a lot of that as well. So learn from me, don't let go the parts of your practice, know what's going on as far as contract goes. So take a look at your insurance contracts, know what they generate for you, in proportion to your financial revenue, which one gives you the most headache and the least amount of pay for it. That's, that's one approach. 

Dr. Tea  21:02  
The other approach is look at the payers that you don't even see and you don't even need to be contracted with and start opting out. And so you can go from big to small or small to big as far as letting go of these contracts. But do it in a stepwise approach, some people who choose to get rid of the the insurance panels that don't serve them at all, I find that that was very empowering, found that, you know, it just takes that first step to opt out to realize that it's actually pretty easy to do. So you'll want to review your insurance contract, and strategize how you're going to do this, what are your financial reserves to do that, because once you start opting out, you're basically starting all over, you're going to mark it to a new type of person, when you are in insurance, you were opting for people who didn't want to pay a lot of money already for medical care, which is why they chose an in network provider. 

Dr. Tea  21:56  
But when you start opting out, you are now going to be an out of network provider. So you're going to be selecting for people who know that you're going to be out of network and are choosing you because you have value, and so they're going to pay you. So think about that your insurance, maybe it'll be a snowball effect, where you start with the lowest pay or the least financial impact on you start opting out. And then you start realizing that the process is easy. And then the last one left is your biggest payer. And then you decide whether you want to be a hybrid, or you want to opt out completely. But look at your finances before you make that decision. For me, I did the opposite. Well, I did a combination I started with like the one or two that I didn't even know I was contracted with. And then I just wrote my letter, sent it out, got the confirmation, and then everything was great. And I was like, This is really easy. And I was like, I'm fresh enough in my practice, where I'm not tethered into patients that I've seen for decades. 

Dr. Tea  22:52  
And that's going to be a really hard thing for a lot of people who have been in the insurance practice for a long time, you are tethered in so many different ways. There's like different it's like a cobweb of systems in the internet space practice where you know, you start opting out, but you then you realize you're going to lose, quote, unquote, lose patients. But in reality, you have to let go certain things in order to gain something else. So I knew that I was early enough in my practice, where I wasn't tethered down that deeply, the roots were not set deep. And I knew I had to make this change quickly. And did it hurt? Yeah, it really did. But now I've completely opted out of my biggest insurance payer two years out. And I have no regrets about that I could have done it better, I could have been more strategic about it had I had a course like this, I would have saved myself a lot of headache. But you know, you live and you learn, hopefully, you're going to learn from me to not just opt out immediately. 

Dr. Tea  23:46  
That was a terrible decision that I did. And I was warned. But I also had a backup plan. So anyway, that's, that's the deal with what I did, I opted out of my biggest pair because I knew that I had to do it now rather than later, it was going to get harder later. So that was my process. And now two years out, I'm looking back like, you know what, I think in the end of it all, I did what I did, and it's worth it for me. I've learned some lessons. My business has not shut down yet knock on wood. I'm incredibly happy with the time freedom I have the control they have in my schedule, with what I get to do for patients, I get to provide medical care that I feel is in their best interest. I'm focused on the patient, I'm no longer focused on what the insurance wants. So that for me was the biggest trade was I traded that feeling of loss for gaining freedom in my time. So look, I never said that this was going to be easy. I was telling you it's simple, but it's like, it's like working out. You want to build muscle. You got to do the reps. You got to do the tiny little reps that look really boring. It's not sexy. It's not anything to write home about. You know, you don't need to show off your reps every time on social media. To prove that you're doing the work, right, you don't need to show off these seemingly boring steps that we have to do every day. And that's what this process is. Some of it is harder than others, some of it is super boring, opting out of the lowest payer insurance that had the least financial impact. That is super boring. I did not post about that. 

Dr. Tea  25:19  
But when I finally called it quits, like that was a huge milestone for me. And I celebrated every step of the way. So I hope that these five steps give you a clearer idea of what you need to do in order to move to the next part in your journey towards your direct care practice, whether it'd be 100%, direct care, or some kind of a hybrid, which is what most people choose, that's totally reasonable. Either way, you're going to find that you're making more money more easily. You're seeing fewer patients, you're having a lot more fun in your practice. And maybe you want to stick around your medical practice a little bit longer. I don't know we'll see. Right? You won't know until you get there. And so I hope that you get to share your story with me. I would love to know what your processes are, what you're learning along the way, what your little wins are, and even your big wins, because I want to be part of your community too. 

Dr. Tea  26:08  
This is a fascinating time in medicine. I think the pandemic really pushed a lot of myths over. We either moved into the cash practice, or we completely left medicine, but I'm hoping to keep more doctors more podiatrists within medicine because we have so much to give with committed so much of our time to help people and people still need the help. So hope you stick around for it. I'd love to hear more from you. My contact information is below. I'll catch you in the next episode. Take care. 

Dr. Tea  26:35  
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 could 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  26:56  
And lastly, if you remember nothing else, remember this. You are in control of your life. See you next time.