Dr. T  0:00  
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. They have chosen this path with a love of medicine. This is the direct care way. 

Dr. T  0:24  
By listening to this podcast, you may even start to believe that you too can have a successful direct care practice. Come listen with an open mind as I share my personal journey and how I pivoted from an insurance based practice to direct care right in the middle of the 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. T  0:52  
Hey there, and welcome to another episode, let's talk about how to be less dependent on insurance payments. Now, what doesn't make logical sense is that in spite of inflation, and the rising costs of literally everything, insurance still has the audacity to lower reimbursements to physicians. Now we can choose to sit here and settle and just wait it out, see what happens. Or we can choose to be proactive and not settle, which is most of us. That's why you're here. So that we can plan for a different future in our business, I'll show you how to become less dependent on insurance payments, because, you know, this is a long term game anyway. So why be less dependent on insurance payments. Besides the reason above the declining reimbursement rates, for as long as doctors stay contracted with insurance, the insurance company will decide what you're going to get paid. 

Dr. T  1:48  
So they're going to continue to stretch doctors then by demanding that they see more people, more patients in less time. And nobody has waved the Magic Wand of time to have more than 24 hours in a day. Right? There's only so much that we can give in a given day, this tactic is ends up being a volume driven game. So you see lots of patients for very little. And a lot of us are at a breaking point where this type of work, this type of model is no longer fulfilling is just the transaction. And it leads to unfulfillment and burnout. And a lot of doctors are exiting medicine entirely. Also, there's a lot of great modalities that can help patients stay active. And it can shorten the recovery period or even avoid surgery. And these tend to be the innovative therapies that aren't covered by insurance anyway.

Dr. T  2:45  
So we might as well learn how to offer these innovative services to help patients get better faster. And this is the same with preventive care. Preventive Care is an essential service, it's cheaper than sick care, which is the insurance based model. And a lot of people are looking to pay for preventive care. So why not offer this service at your expert level, ensure people can go to other places that they deem is cheaper. But I always like to say this, you get what you pay for, you can go to an ethical doctor who has the background, the expertise to know what they're doing. Or you can go somewhere cheaper, and maybe not get the best of care. But we want to give the best care rather than discounted care, right? It's the most ethical thing to do. So it just makes sense to learn how to be less dependent on insurance payments, so that we can give better quality care and have a thriving business. 

Dr. T  3:43  
You also need to know how to sell your services to create that financial cushion. So that you can get to a point where you can let go of your lowest payer or the one that gives you the most headache, and have some kind of a hybrid. Or you can go 100% Without insurance like I did and well over 40,000 doctors are doing. You can choose you can be a hybrid or completely all cash. When you rely less on insurance reimbursement, there is less headache, there is less paperwork, there is less overhead, you even need fewer staff to run your practice. And in return, you're going to be able to give higher quality care. Because you're spending more time with patients, you're going to enjoy practicing medicine again, it's going to be a lot more fulfilling, because you're solving problems more fully. So rather than a visit that is 10 minutes or less, you can actually spend an hour giving them their care plan, answering all their questions and concerns. 

Dr. T  4:46  
And it feels really good on both sides. So you can have complete control in your business when you don't rely on a third party payer which means you can decide to make however much you want. So what exactly are the ways to increase care? Cash Flow. A lot of us are already doing non covered services like preventive care, palliative foot care, for example. And I've asked doctors in the past who have reached out to me and telling me they don't want to do podiatry anymore. And I asked them, Do they not want to do podiatry? Because they're doing these routine foot care services for such a low dollar amount? And oftentimes, I'll switch it around and say, what if you did the exact same service? But we're able to charge four times as much? Would that make you feel like you would want to do it more, you would provide the service for the people who want it. 

Dr. T  5:37  
And people change their mind? They're like, Well, yeah, if I'm going to get paid more, if you're actually going to get paid your value, then it changes the dynamics of how you deliver care, then you actually want to do this service, you actually want to give high quality care for this service, because you're actually getting paid your value. Right? So you want to evaluate your circumstances, are you disliking the work because of what it's paying? And oftentimes, the answer is yes. So what if you charge exactly what you wanted to make. So what I found is that oftentimes doctors are more tired, more exhausted, because they're seeing a huge volume of patients, rather than spending that quality time with their patients. So they don't actually hate their job. They just hate the volume that they're seeing it at the dollar amount that they're getting reimbursed for. And that totally makes sense. So look at increasing your cash flow by offering non covered services. 

Dr. T  6:29  
And then deciding what that price point is, the price point that the insurance gives you is discounted, everybody knows that insurance based models is discounted care. That's why they only give you a percentage of what you actually bill out. Therefore, the discounted care translates into a discounted experience. So offer non covered services for your price, you choose the price, if you're happy with the insurance reimbursement amount, then by all means, choose that dollar amount, that's totally your decision. And if you wanted to charge more, you definitely can. A lot of people are doing that even people without medical degrees are offering non covered services for a higher dollar amount than what doctors get for the same service. So people are doing it, we just have to figure how it works out for us. 

Dr. T  7:15  
Next, another way to increase cash flow is to create a package where you're selling an experience, not just the service, if you're selling a service that is in their eyes equal to another in network provider, then yeah, you're you're gonna have to compete a lot harder. But if you create a package, where you sell an experience, like an all inclusive experience, then they're seeing that for its value. So for example, I often offer a surgical package where it is a single price for aftercare of six months, so I do the surgery, but it also includes the appointments, the follow ups, the X rays, the dressings, anything that could come up all of that care is included. Whereas if you go into an insurance based model doctor, each visit is a transaction. So there's a copay involved. There are terminologies that maybe the patients don't always understand, like deductibles, coinsurance, and so on. So the care is not really comparable anymore. So you see, when you create a package, and you sell it at your price point and you give that value, then you can increase your cash flow, and they don't perceive it as just a service by a doctor, that's really important to differentiate, you're not just selling a thing that can be purchased on Amazon, you can't just sell a service that another non doctor can offer.

Dr. T  8:35  
 You see what I'm getting at with that. So maybe you have doubts about like, why would somebody want to pay more when they can use their in network benefits. And I want to give you an analogy. So think about the coffee industry. Why do people who say they're on a budget, continue to buy Starbucks coffee, when we know it can be made for less than 20 cents at home. And I thought of a couple things. Number one go into Starbucks as a time saver. Let's say you're rushing to get out of the door, and you have a Starbucks on the way to your job to your workplace, you're gonna save a lot more time getting that coffee, because now you can purchase on the app and then show up and pick up your coffee then it would be to make your coffee at home. Plus, it's a little bit messier at home if you're using coffee grains and the sort of that and then you would have to go grocery shopping for those things, right? So there is a perception of saving time, therefore, it's worth buying. 

Dr. T  9:23  
The other thing about why people choose to buy Starbucks is that it's convenient. It's convenient to order on the app, it's convenient to just pull up your car and grab your stuff and it's just convenient in general. The experience is convenient. No one is there to hassle you about how are you going to make the payment you know, do you have a third party payer that you want to purchase this through the way there is in healthcare? And then number three I thought about was a lot of us just like that experience of getting out of the house creating our morning routine. Maybe we go to the gym, we take a walk maybe we choose the coffee shop as that routine. And we'd like that experience. Like, it smells nice. When you go into Starbucks, you smell coffee beans, and everyone's really pleasant and they have nice music. So there is an experience associated with Starbucks versus let's say, I don't know, 711 or a gas station. 

Dr. T  10:14  
So with all of those three things, of course, there's more. That is why Starbucks can charge $6 for a coffee, when one can easily make coffee at home for 50 cents, right? So that's kind of how you want to look at your business, how can you create an experience that feels really good for the person coming through, and a lot of people will pay to have a really good experience. So there will always be people who want direct care. There are a lot of people who know how frustrating insurances are. But maybe they don't know that another option exist. I just had a patient tell me, he has this particular HMO insurance, he is a small business owner who runs his own business. So he has to purchase his own insurance. 

Dr. T  10:59  
But he said he would never meet the deductible, he bought the lowest plan. And he's still paying $1,000 out of pocket every single month into the premium. But he also has a deductible of $7,000, that he said he has never met, which means he's effectively uninsured. So no matter what he needs, in his medical health, he's still having to pay out of pocket before any of the benefits kick in. So there are people who know that they have to pay out of pocket anyway. So why don't you just give them that option, where you deliver high value care, and let them know that you can also serve them. So hopefully, you put yourself in a position where they can find you. Because you give amazing care, you are professional, you are accessible, and you are thorough, you're not rushing through that appointment, you're explaining everything to them, so that they can understand it, that they have the time to even digest some of the medical issues that they have going on. And you just can't accomplish that in less than 10 minute appointments. 

Dr. T  11:58  
So that's why I believe so strongly, that director is going to work everywhere for a lot of doctors, and it's beneficial to the patient. As you start adding valuable noncovered services, you are actively learning how to sell and how to deal with objections. This is an exercise that a lot of us don't have, if we are employed, whether it's private practice or hospital setting, or we're just kind of behind the curtains of the money transaction, right, we just get paid. And the patients show up, somebody does the marketing and so on. So we actually never really develop this skill on how to deal with objections. And it's actually a really important skill to have. 

Dr. T  12:39  
Maybe you dealt with objections to some degree, maybe you applied to podiatry school, medical school, and you had to apply to a lot of places because your first choice didn't take you or you had to deal with rejections in a different way, like you applied to a residency program, or a fellowship. You know, unfortunately, they only have a limited number of slots, and maybe you weren't picked. So you had to learn how to deal with some of those rejections, objections come in the same way patients can object to your offer, they can say, No, I don't want to buy what you have. Because it's too expensive. I don't know if I really need it, and so on. So you need to develop this skill of not accepting objections, but really knowing how to handle them objections, rejections, same thing. So as you are adding non covered services, you are learning how to do develop that selling skill in dealing with those objections, which is essential for direct care. 

Dr. T  13:36  
But I don't want you to be discouraged you, you get better at it, trust me, I get rejected all the time. And it's never really easy, but I do get past it faster. So being exposed to the circumstances that I wouldn't otherwise be exposed to actually helped me develop the skill that I needed to have indirect hair, that means you're gonna have a lot of nose before you get to the yeses. And you don't need all of them to say yes to your offer, you just need enough and there is enough in the world for you to have a really good business. Now, there's nothing wrong with making money in business. In fact, it's the lifeline of a private practice. You may know this intellectually, but when you get down to the actual transaction, it might make you feel kind of funny kind of weird to talk to patients about the service that you want to provide. And then this is what you're going to charge them you can ethically sell. If you truly believe that what you offer works, that's the only way that you can sell. 

Dr. T  14:32  
And you have to look at selling as how you're solving problems, not just how to make $1. So you're giving patients a result that they're looking for, that they are wanting to pay you for. And then once you get some of your first wins, you're going to see how amazing it feels to finally be paid your work. And when you have a satisfied patient, then they're going to tell their friends who are likely like them who are willing and able to pay out of pocket and I have found that work. Have Mel for direct care remains the biggest return on investment, it just blossoms because you're creating an environment where you are pre selecting for your ideal clients for people who want to pay for innovative care, preventive care, excellent care, and they just refer onwards. So it's a beautiful thing to get to that tipping point where your practice is just full of people you want to serve. Day in and day out. Isn't that exciting.

Dr. T  15:26  
But if you have a hard time even thinking about that money conversation to have with your patients right now, like it makes you queasy and you're like, I don't think I can ask the patient for money. Then I want to invite you to my coaching program. Currently, my session for this month is closed. So come join the waitlist, I'll put the link below, take a look around, put yourself on the waitlist so that you know when the next session opens. You can also find my private Facebook group. So if you're interested, that's where we have conversations around anything and everything related to relying less on insurance payments. So I hope that this was helpful, and I'm so glad I'm able to be here with you. I look forward to catching you next week. Take care for now. 

Dr. T  16:09  
Thank you so much for being here with me. If you enjoyed this episode, don't 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 find my info in the show notes and send me your questions. That might be the topic for future episodes. 

Dr. T  16:28  
And lastly, if you remember nothing else, remember this be the energy you want to attract. See you next time