Covenant vs Contract

Welcome back to the Cash Practice Solution podcast where we help
healthcare professionals leave the limitations of insurance and third
party meddling and build thriving, joyful cash practices. I’m your host,
Doctor J, and today’s episode goes deeper than systems, pricing,
marketing. It’s about the heart of a successful practice. In this
episode, we’ll explore five key ideas that make the doctor patient
relationship look more like a covenant than a contract, and how
embracing this mindset can transform your ethics, your patient
relationships, and your bottom line.When we think contract,
we think of transactions, right? I provide a service. You pay me, we’re
even. But in health care that doesn’t even scratch the surface. In
a covenant., on the other hand, is relational. It’s about commitment. A
pledge that’s rooted in trust and goodwill. In a covenant, the
relationship matters more than the transaction. The transaction matters.
But it’s eclipsed by the covenant. And that’s where the magic happens in
a cash practice. Because, let’s be honest, patients don’t choose cash
practices because they’re just cheaper or they’re faster, they come
and they spend their money because they want a relationship based
situation with someone who actually listens, explains, and genuinely
really cares. The patient perceives that you care. A contract says, I’ll
treat you because you paid me. That’s a fair trade. Nothing wrong
with that, but it’s nowhere near as powerful as a covenant. A covenant
says, I’m committed to your well-being because that’s who I am as a
healer. It’s not just the money. It’s because that’s my mission. The
shift changes everything about your culture. You stop competing on price
and start thriving on trust, authenticity, and outcomes. I came in
today, and today is not my day to see patients, but, one of our patients
who I’ve known for years needed blood work done, and I’m handy.
She’s here. I don’t want her to have to waste another day coming back
for blood work at another time. It’s easy for me to engage her. We can
have a nice, brief conversation. She can get her blood work done, and
she knows she can trust me to care for her, not just to get her blood
work done properly. But I care that she doesn’t have to waste another
hour or two running around trying to get a visit, set up and doing all
that. I’m here. She’s here. We’ll get it done.
Let’s talk about motivation. A contract is motivated by obligation. I do this because she
paid me, and I have to. That’s the rule, right? I have to, I don’t have a
whole lot of choice at that point. I’ve made an agreement. It’s a
contract A covenant on the other hand, is motivated by faithfulness
and purpose. I do this, because I’m that guy. That’s who I am.
I drew that blood. I took the time to do that with her because I
care about her. I don’t want her to have to waste her time. In a cash
based settingtrust becomes the coin of the realm. So it’s not just
about the money. It’s about building that trust. When patients aren’t
relying on insurance networks to tell them where to go, they’ll rely on
trust to guide their choice. That’s why communication, follow up and
education are such a deep part of it because it builds
trust. When you recommend care plans, they shouldn’t sound like a sales
pitch. You might have seen that there’s people advertising all over the
place for all sorts of procedures:, stem cells and PRP and,diet
plans and all these other things. And it’s a sales pitch and people feel
it. Instead, it should sound like a promise. I’m here to guide you at
every step of the way. My goal isn’t just to treat your pain, but to
restore your health and keep you thriving. And, part of that, and I
think this is really important, is that a patient needs to know that
it’s a process. Not only are you engaging that patient and becoming more
and more trusted partners in your covenant. But patients feel that they
can feel that trust drives your motivation. You’re creating loyalty,
for sure, but you’re also creating on a more medical side, compliance.
Patients if they trust you, they’re going to do what you
say. And, my patients really, I would say almost to a person say if you
say it I’m doing it. i And then
you get referrals because they trust you and they love their friends and
they care about their friends, they’re not going to send them to
somebody who’s just in a contract relationship. They’re going to send them
to somebody they trust. And then you have those long term relationships
that sustains your practice. So it’s really important to understand that
trust is really that that’s the ultimate currency. That’s what builds
this practice and what makes a covenant a very different thing.
Contracts end when the service ends. You treat the problem. You get
paid. You move on. Now there’s some specialties that are like that. I
mean, the surgical practice, dermatology. Those things that you’re
doing, things that you have a procedure to do, and you move on, that
makes perfect sense. But in our world, in primary care and in really
longitudinal care, you treat the problem. You do get paid, and then you
engage. That’s a covenantal practice. The relationship continues. Your
patients aren’t case numbers. They’re part of your family. Think
about it. Your best patients don’t come in for just emergencies anymore.
They’re coming in for the long term maintenance of their health. Looking
For advice, So I heard this about vitamin D3, Is that really true? I, I didn’t
know it had an immune effect. I thought it was basically for your bones.
I didn’t know that. Yes. For prevention, for wellness. And that’s not
coincidence. That’s continuity. And in cash practice, continuity is
sustainability and that’s recurring revenue. You can do all sorts of
things to create recurring revenue outside of covenant. Basically, come
in for a shot every week. They’ll come in for a shot every week for a
while, and then they won’t. They’ll go somewhere where it’s cheaper or
more convenient. But when they trust you, they’ll drive and come
to do whatever you ask them to do within reason, because they have a
trusted relationship. When patients stay with you year after year, it’s
not because their insurance permits it, but because they trust you.
You’ve built something that’s going to last. You’re not chasing new
patients every month and running through marketing, marketing plans and
all sorts of different people who are providing you with a
new website, a new interface. You’re nurturing long term relationship.
And that’s how covenant based care turns consistency into stability and
stability into success. And I know that because we’ve had a practice for
30 years, and we see patients that have been with us for 20, 30 years,
and they are referring patients constantly.

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So let’s zoom out to 30,000ft. Every one of us, whether you’re, a DO, we take  the
Osteopathic oath, an MD Hippocratic oath. Nurse practitioners, there’s a
nursing oath. They all circle around the same idea.
We promise to act in the patient’s best interest. We’re not going to do
stuff just for our own good. And that is the the ethical center of
medicine. In the insurance driven system that’s pretty hard to do
because there’s a lot of stuff that insurance doesn’t cover. And even
though we know it would help the patient, we’ve got to figure out does
the insurance cover it? Is it going to be okay?For me that’s not acceptable. You  have to see more practices patients in less time
because they’re cutting your fee. You have to  document for all sorts of
billing issues instead of documenting, How is the patient making
progress? Are they doing the things that they need to do? Are we missing
anything? In our practice and with Espre Health software we are able to prioritize compassion over coding. That builds a covenant. So many practitioners
are turning to the cash model to reclaim their ethical freedom. There’s
not that moral burnout where you have to decide not to give a patient
something they want or need, because the insurance won’t cover it. And
you spend a lot of time if you’re in an insurance based practice chasing
that. When you’re running a covenant based cash practice, you realign
all of that so your business aligns with your values. You decide how
long you need to spend with each patient, and you decide really what’s
best for them, not what’s covered. And you can say with complete
integrity. I’m here to serve you, not your insurance company. If my mom
was in this situation, I do this for my sister, my brother, my wife, my
friends. That’s not just good ethics. It’s really good business. In a
world of completely impersonal care where health care has become a
commodity that kind of ethical clarity and lack of moral burnout, it
stands out. Contracts don’t enforce a covenant. Your own integrity,
reputation, and consistency do so. You know, what does this have to do
with the way that you relate to people? If it’s a contract, you’re
paying me. And then I respond by doing that thing. What’s the
motivation? Contracts. Focus on your rights. You’ve made a contract.
What am I going to get? I made the promise. I’m going to give you what
you pay for. Covenant focuses on responsibility. Basically, what can I
give? What do I have in the wealth of my experience and,
really my heart, my love for patients. What can I give them? That’s the
heartbeat of a covenantal practice. Serving people. Now, when patients
sense that your first concern is their well-being, not their wallet.
Instead of seeing you as a PEZ machine where you see them, they pop the head, the little PEZ comes out. You’re not providing
some kind of commodity. You’re providing them with you, and you’re
you’re really a true partner in their health journey. And practically,
this is something you can do that makes it real easy. You
educate people. You tell them why you think it’s a good idea before you
try to sell them anything. You recommend care that serves their best
outcome, even if it’s not your most profitable move? You’ve got to make
money with your work. You have to, and if your income takes a little bit of a hit because you’re making a recommendation that is going to serve
their best outcome, you do it and people feel it. They know it. You
don’t have to convince people that you’re doing that. They feel it.
People talk about our practice and the way we serve people in the
community in that way. They say he really does care. He’s really
committed. You make sure there’s boundaries. It’s not unlimited. You go
anywhere you want with this. You know, there’s certain things. If a
patient just chooses not to follow advice or do the things you want them
to do or need them to do to be well, there’s a point at which you just
can’t serve them. And really, the generosity of offering them all that
you have creates trust and trust builds that long term recurring
revenue. It seems like at some point it would wear out. But the
more you give, the more patients value your care. The more they value
it, the more that they’re going to invest emotionally, compliance wise
and financially. So when something costs them a little more than they
might normally pay because they trust you, they’ll pay. And that’s not
transactional medicine. That’s the covenant of care. And it’s what turns
an ordinary practice into an outstanding one. Let’s recap five
covenantal principles that define a thriving cash practice. So
1 relationship over transaction builds trust, not billing.

2. Purpose over obligation. Let your values drive you, not what’s covered. I think
   about, medical magazines and there’s pages there that there’s a, a new,
   pulmonary function study. It’s now it’s covered, by some insurance
   company. So you should buy this machine because now it’s covered. You
   can do this, and you’ll make more money. Well, does the patient really
   need that? Is that the that the idea is let your values drive your
   motivation, not the latest ad for the latest thing that’s going to get
   you a little bit more money, continuity or closure. Right. So you’re
   looking for the long term relationship, not signing somebody up for a
   plan being done. You’re looking at having a long term relationship with
   this patient. How do you create that? How do you maintain that and how
   is that going to impact your practice?
3. Integrity over compliance. Basically, you know, the thing to do and you’re going to do it because insurance doesn’t prohibit you wih compliance with a list of rules from an insurance company, basically that’s not going to ever work. You’re never going to have joy in your practice. You’re just going to resent it.
   4. generosity over gain-  give more than you get,
      expectation wise, and you’ll be surprised how much you do get when you
      leave these principles. You stop being just a provider, a commodity, and
      you start being an individual’s trusted guide, their partner. And yeah,
      really, and this is not, pie in the sky, a healer. Your relationship by
      itself is medicine. That relationship that you have when somebody really
      trusts you and they know that you have their best interest at heart and
      there’s data to support this. Their immune system functions
      better, their blood pressure goes down, all sorts of really good things
      happen. And that’s what patients crave in today’s health care climate.
      They want authenticity and commitment. And here’s the best part. It’s
      not just ethically right. It’s a financial juggernaut. I mean, you will
      l be shocked at what this will create for you from a business
      perspective. Because trust compounds like interest. Every good
      experience leads to another referral. I have a man I saw yesterday and,
      he had a problem that took a little time to unravel the
      chords of what was going on. And, it’s funny what he said because
      it’s kind of goofy, but he stood up in his business mastermind group.
      There are a whole bunch of CEOs and big shots, and he said, “I got to go
      because I got to go see my doctor. He saved my life.” Like, I don’t
      think I really saved his life. I made his life a lot better, that’s for
      sure. But, he referred a whole room full of people, 60 to 100 people
      there in that mastermind group because his experience is so good
      every fulfilled promise creates another advocate like that. So that’s
      the real secret behind every successful cash practice. 
      If today’s
      episode inspired you to rethink your doctor patient relationship, ask
      yourself one question. Am I building contracts or am I building
      covenants? Because the most profitable and fulfilling practices are
      always built on trust. It’s covenant. Thanks for tuning in to the cash
      practice Solution podcast. If you found today’s episode helpful, share
      it with a colleague. Leave a review. Subscribe for more insights on
      building a thriving, ethical and financially powerful cash practice.
      Until next time, listen to your patients, learn their stories and love
      them with all your heart. You will be unstoppable. Thanks for joining
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      to help your cash based practice thrive. And don’t forget to check out
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      They’re free to you and we’re always adding more. Keep raising the bar
      in patient care. We’ll reconnect in the next episode with more ways to
      help you succeed.