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  

If you needed to make $5 Would you rather have a lemonade stand that sells lemonade at $1 Each and you have to sell five of them to make that $5? Or would you rather have really good lemonade that costs $5 for one. That's the difference between an insurance based practice and direct care. Insurance contracts are discounted contracts. That's why it's a contract. So even though you bill out 100 - 200% of Medicare's allowable, which seems to be the benchmark in private practices, you're only getting a percentage of that back. And because we know we only get a percentage back, that's why we bill out a higher percentage. It's a really weird game, I know. And then there are some insurances where you only get maybe 60% of what you bill out. And there are cases where you're actually paying the patient to see you because they pay so poor, or they don't pay at all. And you're not even allowed to charge the patient cash for the difference in my frustration with the insurance model that I didn't know at the time, but essentially, it was just volume driven. In order to make more money, you had to see more people. But everyone has 24 hours in a day and you'll hit a cap. And a lot of us were hitting that cap. And we were taking work home, we had a chart, we had to learn some new codes, we had to finagle the SOAP Notes in order for it to reflect what the insurance wants it to reflect in order to get paid and so on. So not only are we missing out on dollars, we lost time and energy and some of us lost passion for medicine. And it's really disheartening to see that. 

Dr. Tea  2:31  

Now compare that to a cash practice. Cash practices are really low overhead and insurance is expensive. Cash practices are a lot cheaper to run, because we don't need billing software. We don't have to wait for a long time to get paid. And we don't have to deal with high volume practice. And that's what I really want to dive deep into in this episode, insurance based mentality. It's not right, it's not wrong. But the reality is, in order to make money, you have to see a lot of people. The direct care mentality is you can see very few discharge a little bit more. And you have a quality based practice where you give higher quality care in order to get paid more money. So like the lemonade stand analogy, instead of charging $1 for five lemonades to make that $5 We charge $5 For one lemonade. Now let's multiply that let's say we need to make $5,000 a day. That would mean we would have to make 5000 cups of lemonade, versus one 5000 cup lemonade. No, that is just an exaggeration of how you can sort out what you charge per lemonade. Same thing with your services, how you sort out what you charge per services. But the reason for this analogy is to show you a visual, or to tell you a visual of what a direct care practice looks like compared to insurance based practices. So a lot of insurance based practice doctors think that the direct care model is also volume driven, because the question always comes around as how many patients do you see in a day. And, you know, in an insurance based practice, it's very typical to see 30 to 50 people a day versus the direct care practice, I'm only seeing six to eight people a day. Now. My schedule has changed a lot with my daughter going to school. And so my time has become even more valuable because now I have to squeeze out what I need to make in a day in a shorter amount of time, which means I have to learn how to deliver higher quality care or unique care that isn't comparable to an insurance option. 

Dr. Tea  4:34  

But that is the point of having a medical practice isn't it is to have your time freedom back to make money and to be happy. At least that was my goal. I really felt that I was being productive if my appointment slots were packed every single day. I'm celebrating my five years in private practice this August. And I reflect back often to how I used to think when I was opening my practice where I was actually how it might be when each pocket of time was filled with a patient or they were double booked, or whatever it was that I thought was productive, because I thought that productivity equated to dollars. So I'm trading individual pointment slides for money. But now I get to compare and contrast the practice that I have now in a direct care practice. And I don't have every time in my day filled up with appointments. Instead, I have these huge gaps. And some of them were intentional, and some of them, they just don't get filled. But I feel totally okay with that, because I make what I need to make on the day to be profitable, and to be happy. 

Dr. Tea  5:36  

And this mindset shift was kind of a revelation. For me, I didn't realize how much time I was actually getting back when I started to opt out of insurance. And I've talked to my friends, colleagues who are opting out of their insurance contracts. And they also see this shift in their schedule, and they see these empty gaps. And it makes them feel nervous, it made me feel nervous, because they have always equated money with patient productivity, seeing more patients make more money. But what I'm sharing here is a direct care practice, you don't have to see more patients to make more money. What are the different ways that you can make more money by seeing fewer patients? Well, the first one is very easy and obvious is that you charge more, or what I like to say, charge an appropriate amount. When you charge an appropriate amount for the education you have to endure in order to know what you know, at the caliber that you know it at this moment. That's decades and years of time. So your hourly wage is not $20 an hour. It's not somebody's co-pay, it's not even $100 an hour. It's a lot more than that. So when you charge your price appropriately in a cash practice, where you get paid, the moment they walk in, when people walk in, and they're just expected to pay and they are happily paying for your services, that starts to rejuvenate your love for medicine again, because now you can focus on taking care of the patient for the time that they paid you, versus spending time on a billing code, or on charting, or having to see the next patient or making sure that patients are seen on time, or adding on new patients and you're already full schedule, you know, and that becomes an entire mess on its own. And that really weighs you down as a physician, when you have all these extra newest obligations to meet the needs of the insurance contracts, meet the volume based needs and having a lot of staff member high overhead expenses, and seeing everybody on time for a few minutes at a time. That can wear down on you. 

Dr. Tea  7:36  

With direct care, it's totally different. It's a normal life, you see the patient, they pay you, it's done. It's like any other service industry, let's think about all of the service industries that are paid cash, a big one is veterinary doctors. They have some insurance, but it's not to the level of medical care. And so everything that is related to animal care is self pay, and they're making it work. What about chiropractors, they're not seeing 30 to 50 people a day, I mean, maybe the might, the ones I know aren't because they're charging the appropriate amount of time for their hourly time or their level of care and service. And they're making it work. And their overhead is really low. And so that's how you create more money by lowering your overhead. Other ways to increase revenue into your practice, by seeing less patients is just giving more value to the patients, maybe it's in the way of you recommending things already, where they have to go to the store and find the thing that you're talking about, and maybe they grab the right or the wrong thing. So instead you have an in house dispensary, you can increase revenue by selling them stuff you already recommend. That is a nice way to increase the per patient value. In both a cash practice and an insurance based practice. A lot of the insurance based practices and consultants are moving doctors towards these cash enhancing services, selling products, non covered services, and so on. And as a fully cash practice, I'm able to say that you can charge for your time even more, whatever it is that you want, you can charge for that. I currently charge 450 an hour for patient encounters and 500 for consulting. And to me, that seems very average. And now that I do procedures, I offer all these different therapies, you know that number goes up. So I don't want to be the person that offers care that everybody else offers. That doesn't make me stand out from the insurance based options. And that's one of the modules in my course is talking about creating a niche for yourself. And even if you're non surgical, there's a way for you to do that as a medical doctor, and you can look at functional medicine and integrative medicine as a type of model where they offer high value care that people are willing to pay for. 

Dr. Tea  9:50  

People want time with their doctors and they want to get better. But if you find yourself in a position saying my patients won't pay, then perhaps you might be looking to market to new patients, those who are saying my patients who won't pay are likely those who are contracted with insurance. And this is a process called self selection. It's a research term, where when you're creating a research project, and you're selecting for, let's say, healthy individuals, then you're only really evaluating those healthy individuals. That study won't apply to elderly, sick people, and so on. So we are selecting for a certain demographic, when you are contracted with insurance, you are selecting for people who don't want to pay more than they've already paid into their insurance. Therefore, those are the people who maybe struggle a little bit paying their copay, you have selected for that type of person. That's not always the case. It's not black and white. But it's relative. The folks who are saying my patients won't even pay a copay or struggling to offer them cash services is because these individuals see you as a doctor, as somebody who takes insurance, who takes their insurance, they're very good insurance, and have this expectation that everything under the sun should be covered by their very expensive insurance. We wish that was true considering how much money people pay into their premiums, and their deductibles. And on top of that additional co-pays and so on. But we know the reality is patients and physicians are getting shortchanged. Guess who's making the most money in the insurance companies, it's neither us, it's not the physicians, it's not the patients, it's the CEOs, and so on. But this is not a political rant. This is telling you, that's just what insurance based model. 

Dr. Tea  11:34  

So if you're going to continue in that model, that's fine if it's working for you. But when it's not know that direct care is an option for you to start opting out, and looking at ways to enhance the patient's experience in their care. So they actually get better, instead of just being given another prescription or another injection, we're actually taking the time to listen and learn about them, and find ways where they can maintain a healthy lifestyle. And that's worth paying money into. And that's what patients are paying me for. Yes, some of them come for one particular thing, but there are enhancements that I do to make that experience worthwhile to make them refer to other patients. To me, that's the kind of practice that I wish I knew about in residency training. But when we were in residency programs, we were all kind of brainwashed to believe that productivity meant making a lot of money. And so people would brag about how little sleep they had, or how much call they took or how many patients they did surgery on or how many patients they ran it on, like being tired was a badge of honor. And I'm here to tell you that that's actually very dangerous, that leads to burnout, that leads to physician suicide, feeling that they have no other option. And I'm not about that I want to help my friends, my physician colleagues have a life that they love, that they can continue to perpetuate this positivity into the world of medicine to younger generations who might be interested in medicine. That is my goal. Ultimately, I love my practice. And I want my friends to love it too. Because it's really enjoyable when you get to do what you want to do. And then you get paid for that. And it's just a clean transaction. I think medicine in itself is as complicated as it is, but the access to that shouldn't be, and people need us, we trained for a very long time to know what we know, and people need our services. But we also need to get paid for that service. 

Dr. Tea  13:22  

And so that's how you can do that with direct care. Increase your profit margins by decreasing your overhead and charging appropriately. And then maybe adding some ancillary things to your practice as well. And with all of that you have a practice that you truly love that will last for decades, you're not dealing with insurances that can change the rules of the game at a moment's notice. When you have a cash practice, it's you you're the only one making the decision on how much you get paid. When you get paid and what services you offer. When you work with insurance, you're kind of working for them. They tell you when you get paid, they tell you what rates they're going to pay you. And we can be upset about it, we can send them to small claims court, but guess who has the bigger pocket? The house always wins. So that's the insight I have about. You know, sometimes when I'm talking I have no idea where I'm going with this. I'm glad you're still here with me. But that's the difference between an insurance based practice and a cash practice. Think about the lemonade stand. Would you rather make $5,000 Selling $5,001 Lemonade, or sell one really awesome lemonade for $5,000? And yes, that's again, extreme. But maybe you can look at the price point that makes sense for your practice as far as your services go, and attract those types of people who are willing to pay for that, for that level of quality care. You have to think differently when you're in direct care practice. 

Dr. Tea  14:38  

As you find yourself carrying through your insurance base believes that you have to have a lot of patients in order to make a lot of money. Let's chat and sign up for my course. The next call that we have will be this Friday. It's the third of every Friday, typically, but once you sign up, I will give you the actual dates and things like that, but let's talk about it. Let's see how we can move you away from that very busy mentality. Get into a more financially rewarding mentality where you're seeing fewer, and you get to charge more, and you're happy and they're happy and everybody's happy. Well, except for the insurance folks, right? Because they're the ones anyway, you get what I'm saying. So all the information is in the show notes. I'm so glad that you're here with me. I really appreciate all the kind messages that you're sending to me. Keep them coming. If you enjoyed this episode, share it with a friend, give it a review. So more folks can find information like this to help save their own practice and their life. Yeah, I think this is gonna save your life. That's why I'm here. I'll catch you next week. Take care. 

Dr. Tea  15:34  

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  15:54  

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