Dr. Tea  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. Tea  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. Tea  0:52  
Welcome to another episode, I'm going to help you start to opt out. I have a little flub going on here. So don't mind me, if I sound a little bit raspy. I'm going to try not to choke in between recordings. I'm going to take a deep breath every now and then. So this episode, I'm going to talk about my process to opting out of Medicare. And it's going to be a lot easier if you've never had a contract with insurance, then you don't need to opt out. But for those of us who are already bound to contracts, we are in private practice, we own our business, we are an associate and our name is still tied to those contracts, this is going to be relevant to you. And you may not decide to opt out today, make sure you go through this podcast in this particular episode, so that you are well prepared to know what to anticipate as you're making the decision to opt out how to prepare your staff how to prepare your patients, and then moving on from there, so that you can enjoy the practice of medicine without dealing with insurance. 

Dr. Tea  1:51  
So I've got 10 key items that I want to share with you today. So let's get started. Number one, I decided that I was going to have a successful practice without billing insurance. So I started my practice in 2018. It wasn't working out through 2019. And into 2020, I started to make some key decisions to have a better life for the next several decades. In 2021, I finally decided to opt out of Medicare, which was my biggest payer, and it was a really hard decision. Because I had to have a lot of conversations with patients. This was about 50 to 60% of my revenue. So I knew how to plan for a Plan B, once I opted out. And it was forewarned that my income or my revenue would drop once I opted out, especially because I didn't have like a marketing plan in place to fill in those losses. And plus, I'm a little bit impatient, I really just wanted to let go of this contract, because it was just hurting me so much, it was very expensive. And on top of all of that, even if we did get paid on time, some reasonable amount, the money that's paid out to us by the government is not truly ours, they can always reclaim it back in the form of audits. And so I just knew that this was the path for me to just remove myself from contracts and just be able to focus on the patient rather than paperwork. So I made a decision that I was going to be successful no matter what. So number one is mindset. 

Dr. Tea  3:15  
Number two, I asked other people what they did and what they wish that they knew. And I've asked seasoned doctors who have been opted out for a long, long time. And just speaking to them gave me gave me hope that it was possible for me to have a practice without insurance that was profitable. And that was fun. That's what I wanted out of my life was to enjoy the work that I was doing and get paid for that. What I found was nobody had said they regretted the decision to opt out. And in fact, the older ones were saying they should have done it sooner. And so I said, Well, then I think it's time for me right now, I was fresh in my practice just a couple of years and, and I wanted my practice to last a long time. And in order for that to happen, I needed to opt out. But I needed to know how to do it the right way. And seeing that nobody else regretted it meant that I had to do the hard thing in order to get the easy thing later on, which is a practice that people paid for. Also, I was worried about losing patients or abandoning patients. And I want to put this in your mind. It's not that you're abandoning patients so much as the patients are choosing to spend somewhere else. They're going to choose to spend where they're going to buy their food, what restaurants they're going to go to where to go shopping, what car to buy, you know, all those things are financial decisions and health decisions. It's just another decisions they have to make. So they're going to choose to pay you or not pay you and that's totally up to them. It really doesn't have a lot to do with you. So don't take it personal, everyone's gonna look out for themselves. And that includes you too. As the CEO of your business. You have to make key decisions in order to keep your doors open, and to have a business that works for you, not you working for your business, right. Ultimately we want freedom and all the work that we've put in so those were the conversations I had, they were micro conversations in the sense that I wasn't actually making a decision, I was just learning, I was just trying to collect more data, and then formulate my own plan until I was finally ready to take the plunge. 

Dr. Tea  5:14  
Number three, there was a thing about opting out where if you opted out, then it would apply to the next quarter. And I found some information online, which could be a little bit confusing. And that's also why I put together this podcast and my course and my coaching program. So what I found is that it's going to be region specific. I'm in California. And so what I did was reached out to the person that was listed in my contract that emailed them, I sent in my letter that I'm interested that I want to opt out. And they sent back a formal form, and told me exactly how to do that. And so you'll want to review your contract as well, to see who your contact person is, and to make sure that it's relevant to your region, because I've had a little hiccup where I sent it out, but I said it at a future date. And then it was invalid, because they said, You can't do that it has to be either today's date or prior. So just make sure you know what your process is neuro region. 

Dr. Tea  6:06  
And then number four, I had conversations with patients a few months prior, so that they were aware, and they can plan for their next appointment. I hate that meant I also had to prepare a pitch or a statement of why I'm no longer contracted with insurance. And so instead of giving, like long winded answers of oh, they're just not paying really well, I can't pay my staff and all those things, I just found that just being straightforward with it. Matter of fact, it was the easiest for me. So what I said to patients was, it's really difficult to run a practice with insurance. And I left it at that. And so sometimes I would engage in a longer conversation, because a lot of my appointments are usually nailcare or something where you know, it's a 30 minute visit anyway, and we're just having small talk, a lot of people understood, a lot of people said that they'll stick around, but many of them didn't. And that's okay. They know that I'm here for them, if they wanted to spend the money. And they also have options, and that's okay, that's just how it goes. So I would tell my patients starting this date, I will not be billing insurance anymore, would you be interested in being self pay at that point? Or do you want a referral, and then we would just take it from there. So just being aware that a lot of patients will not come back. And that's okay, because you don't need a lot of patience, when you have a direct care practice, you just need a few that will pay you a normal regular price for you to sustain your business and be profitable and continue to help other people. That's it, you just need very few to pay you high quality dollars compared to seeing a bunch of people for smaller dollars or even $0. And then you have to chase all the claims after that. So you have to weigh which one sounds better to you. For me, I would much rather serve a smaller population of people who paid me a lot compared to sing a lot of people who paid very little. And that's the business decision I had to make. I always do this, I forget what number I'm on. So I think I'm on number five. 

Dr. Tea  8:02  
Number five, they wanted to know where they can go. If they no longer wanted to be with me, I gave him one or two friends locally. And then I said ultimately, you should check with your insurance. And there's a phone number on the back of their card where they can call and see who their local doctors are in their area, they would then have to call that doctor's office to see if they provide the services they're looking for. And then they would have to wait months to be seen. So that's something for them to figure out. 

Dr. Tea  8:27  
Number six, I didn't mail out letters, I did the first round when I was opting out of Medicaid. And that was a huge insurance for me. And that was a lot of money on stamps, printing paper time. We all we did this all manually. And then a lot of patients called upset and I was like I don't really know if this is really worth it. And I don't even know if this is my obligation. I was told that it was the insurance obligation on knowing who was in contract or not. Right. And the fact that I'm a one person show, having to send all these letters out, I've done it the first batch, I was like, Do I really need to do a second batch. And so what I decided to do was for the people who were already on the schedule who had a future appointment, we would my staff would call them and let them know, by the way, the endpoint for this insurance is this date. And then the front desk would handle that. And then through the conversations I've had in previous appointments, so I had to train the staff to call these patients with upcoming appointments of the change. 

Dr. Tea  9:31  
Number seven, I started to create a short price list on what I would charge as a cash practice. And this was a little bit challenging because I didn't know what others were charging. I didn't know what was what did they call it? fair market price. And I had asked somebody about what this meant fair market price on medical services, and they put it bluntly that there's no such thing as fair market price for medical care. There just isn't you know why good. Why is there a plastic surgeon who can do a procedure for $5,000. But then you go down the street, they're charging $30,000 As long as people are willing to pay it, then that's the price. And as long as you're transparent about it, you don't sneak in a bill or, or what insurance is doing right now is that if a doctor is at a network that a network doctor can charge whatever they want, without regulation, and that can bankrupt people, and that's highly unethical, right? We're not doing that as a direct care practice. We tell people our prices upfront, and then the patients have the time to think about it and be financially prepared to pay for it. So what is fair market value? I don't even think it exists. To be honest, I've had people try to call me out on this on LinkedIn and say, Well, how do you patients know that they're getting a fair market price, they don't. And they're free to shop around. I think my prices are fair, they're not low, and they're not super high, I would pay for my prices is what it came to. So I created a price list. And this was very uncomfortable in the beginning. So I asked around what other prices were at what prices were at other practices. And it was a variety of practices like acupuncture, it went to like a specialty nail salon, who had their own prices, which is way higher than what podiatrist we're being reimbursed, which I find mind boggling. But besides the point, so price is subjective, as long as people are willing to pay, then it's fair, it's good enough, right. So in the beginning, the this will be uncomfortable, but it's necessary. And then I started to also realize my own money bias, which was the biggest thing holding a lot of us back, I bet. At that point, I decided that I wasn't going to judge people how much money they have, or how much money they're willing to spend, or even where they placed their value on what's worth it to them. And what's not. All I did was set the price, made sure that it made sense for the business, considering all of my overhead and things like that. And then I sat with that discomfort not really knowing if I was really worth it, I just made it into like a research project and experiment, I set the price and just kind of listen to the feedback on what people were saying. And there were people who were saying, that's way too expensive, I can't afford that. And I said, okay, but I remembered other doctors were charging a lot more. And I just sat with that. So creating your price list, just do it, and then see what happens. 

Dr. Tea  12:15  
Number eight, I started to market a lot more to other cash practices I saw that we had in alignment, we just wanted to practice medicine. That worked for us. And we you know, we want it to give quality care for our patients. So I started to understand how they were running their businesses, I started to add more services to my practice more inclusive, comprehensive things into my practice. And I really tried to make it a standout experience. So when patients came in, they knew what they were getting, they knew that they were going to get the same doctor, the doctor who knew their medical history, and I just made it really easy for them to come in. It's like meeting with a friend, it just becomes very familiar. And that's what a lot of people like about seeing their doctor. So making your practice easy access, making it personal and giving high quality care was my priority, I decided that I was no longer going to function like a factory, the way that I was trained where you're seeing a bunch of people all the time for every minute, I didn't want that anymore, I really wanted a high end boutique type of practice that was affordable. Number nine, the hiccup I had with the paperwork and opting out with Medicare was that I used a future date. And that wasn't really relevant to them. So instead, they responded back, they gave me the form to fill out, fill that out, send it out certified, I fax it, and I followed up with the person who sent me the information to ensure and confirm that was my opt out date so that I wouldn't bill insurance anymore. And also gave patients consistent date, so that they also knew in advance on whether or not they can continue to see me or they're going to pay out of pocket or choose somebody else. 

Dr. Tea  13:50  
And then finally, number 10. When I finally sent out my letter, I celebrated, and then I got scared all at the same time. So for the next three to four months, I was mortified with my decision. But I also knew long term, it was the right decision to make. And as I was sharing this with people close to me, I said, you know, I opted out of insurance. They had all of the same questions that you're having. And they have the same concerns. And these were people who loved me very much. They wanted the best for me. But they had their own doubts. Because they weren't in the same mindset. They weren't in the same industry or they weren't in the same type of practice. And they place their doubts on to me, and they made up myself, which is very frustrating. So it's important to have a strong mindset going into this because you might be influenced by other people's biases. So don't let that happen. Somebody said to me, why don't you just opt back into insurance? And I was like, this was ego to ego at this point. It was an absolute no. I had to prove to myself that I could make it work because I've seen other people make it work. I just had to give it time and a level of maturity in order to see all of the hard work I've put in to To be to become fruitful, I really wanted to live this one out. So that was the mindset, I went into the process. So when you're finally ready to go from curious to serious, grab the roadmap that I offer in my course. It'll show you everything that you need to know in order to transition out either an employment situation or an insurance contract. Or even if you're coming out of residency or fellowship training, and you want to start your own practice, I want to be here to support you as a solo practitioner of a micro practice or a small practice, and make it easier for you to have the life that you've been craving for that work life balance, that ability to just escape insurance and their shenanigans, so that you can love practicing medicine again, through direct care. That's all I've got for today. Thank you so much for being here with me. I hope you take advantage of the resources down below. And I will catch you next week. Take care. 

Dr. Tea  15:57  
Thank you so much for being here with me. 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 find my info in the show notes and send me your questions. That might be the topic for future episodes. 

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