Medical Procedures that Boost the Bottom Line

Welcome back to the Cash Practice Solution podcast, where we help healthcare professionals leave the limitations of insurance in the dust. Third party meddling is over, and we build thriving, joyful cash practices.

That’s attractive. How do you do that?
I’m your host, Doctor J. And today’s episode, we’re going to go into the nuts and bolts of the services that our colleagues offer to keep their practices just humming along, some of them to the tune of more than a half million dollars a month with just a few practitioners.

First, everybody knows about this. Concierge practices, DPC practices, our practice. We do fee for service, but for cash. The extended annual visit. Everybody complains their doctor doesn’t spend enough time. If you want to create buzz, spend time in that first visit. Charge what it’s worth. The insurance company is not dictating that. Charge what you think your time is worth. Spend an hour. Spend 90 minutes instead of that very brief, insurance driven visit where you’re just identifying disease, disease, here’s the diseases I need to treat. We’re not hunting for disease! We’re seeking health!

It takes a few minutes. And when you do that, you have a vast array of things that you can actually address. Part of that is to do advanced biomarker testing instead of the approved panels, which is, you know, basic comprehensive metabolic panel and maybe, maybe you get to do a hemoglobin A1c. Instead, we’re doing a large panel of tests, inflammatory markers, micronutrients. We use a Spectracell test, food sensitivity testing, stool analysis for the gut microbiome. And then you can do comprehensive genetic testing now very inexpensively, less than a thousand bucks, and you can get the entire gamut of their genome.

And a lot of this stuff is not covered by insurance. In fact, almost none of it is. So looking at it from that milieu where you say, I’m going to look at this patient completely, I’m going to spend the time, I’m going to get to know them. Then I’m going to get to know them biologically, metabolically, and really identify what they need. None of that’s covered by insurance. You develop a reputation very quickly for being a thorough and really effective doctor. If you do that, a really great provider.

Next, something that we do really well, I’ve been doing for I wrote my residency paper in 1987 on progesterone and PMS. So I know a little bit about hormones, or at least I have a lot of experience with it.

Hormones and anti-aging therapies are huge. It’s a gigantic field. We’re really very experienced. So we see a lot of the, more involved cases, but we see a lot of simple stuff too. And we use a lot of bioidentical hormone replacement with pellet therapy. I like pellet therapy. Tons of reasons to use it. There’s some risk reduction, that’s part of it. The compliance is 100% because they’ve got the pellet and they’re going to do well with it. There’s recurring revenue for you in that. And patients feel amazing is really good. I have nothing against compounded creams. We use a lot of injectable therapy and patients are demanding it. They absolutely require it to feel well.

And the benefits are just starting to mount up and their literature start to show all of that.

I did a men’s meeting the other day, and we had something we were meeting on, which is unrelated, but everybody wanted to know about. Hey, doc, what peptides do you recommend? And I very diplomatically said, it’s not really the good setting. I need to know you better than that to tell you what peptides to take. But CJC, Ipamorelin, BPC, used to be hCG was everybody kind of knew about that HCG diet. But that was kind of one of the first ones on the scene. But man, the peptide craze is just sweeping over the integrative medicine field and the Cash Practice field none of it is covered by insurance. Virtually none. Now. The GLP-1s, Yeah, but we’ll get to that. Then, and I love this is a huge part of our practice, when our patients need to get well right away. They come in for IV’s. IV vitamin C, appropriately prescribed rocephin, clindamycin, whatever it is that they need.

Patients don’t want to necessarily call somebody in a service to come to their house to do an IV with an unknown cocktail. They want somebody who’s a trusted professional to provide that, and hey love it. So we do a ton of IV therapy. It’s a tremendous way to get patients what they need and get rapid results that they can really tell they know that they get better if they need to have their it’s Thursday and they need to go on a trip on Saturday. They come to us for their IV and we get them well. 

Back to the GLP-1s. We do a lot of compounded, GLP-1s because of the compliance issues. A lot of patients don’t feel well when they do semaglutide or Trizepitide they just feel sick to their stomach. They have reflux. They just feel icky. And in that context, we’ll formulate for them a micro dose schedule where they’ll do it two times a week, three times a week, and then we’ll add whatever additional compounds they need, like B12 for energy if they’re fatigued, or any other compound that we think is important as part of it. And cost wise, it’s a win for them.

Some of these things are off label. So we have to make sure that we have proper disclosures and consents. But beyond that, it’s a gigantic win because they’ll be able to get a really comprehensive weight loss protocol that is effective, relatively inexpensive. And they’re going to tell their friends.

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All of this results in healthier, happier patients. They can work out. They can do things and ultimately they get injured. So as part of the spectrum of care, we provide regenerative therapy. And it’s kind of a sports medicine approach to it. And I really enjoy that. The orthopedic sports medicine part. Platelet rich plasma is a big part of what we do. When somebody strains sprains and has something that’s current or recurrent or chronic, we’ll give them PRP in their affected joint or affected ligament or whatever it is that they need, and we get great results.

We also use it for some more aesthetic applications. With great results. The next step up, if somebody is over 50 years old or they have a really complicated or really messy problem. We’ll use adipose- derived stem cell therapy with great results. All of these things are not necessarily covered by insurance. I’ve never seen them covered by insurance except for a few health sharing programs occasionally will do it, but they’re massively effective. Change people’s lives. And once you get 1 or 2 patients well with these protocols and these platelet rich plasma, especially in the adipose derived stem cell, they tell everybody they know. We have an entire cadre of patients in the horse community, and these are people who are very committed to their art and to their horse riding, and they’ll do anything to be well. And these treatments work and they get well so they can compete. There’s a bunch of other things that are in that category: prolotherapy, shockwave, all the things that are in that category. And if you’re going to provide a really good cash practice service that’s wellness oriented, you need to come up with some way that you can address the sports injury you’re going to see.

Medical weight loss programs that are designed to give the patient an opportunity to come in and be checked regularly are really good. Where the patient comes in once a week, they get weighed. The compliance is way better. The results are better. And then you do have recurring revenue in that way. And then there’s the more functional medicine side of things, which is a little bit more sophisticated, and it may take a little bit more work to get there, but detox programs for heavy metals, for, petrochemical exposure.

Chelation, heavy metal detox, gut repair, all those things, they’re a huge part of getting that patient who’s you put them in a wellness program and they get stalled, or you find this early on, that’s an element of it that you’re going to want to have as part of what you’re considering. If you’re not great at it, find somebody who is, because it’s definitely going to be necessary.

And finally, and I think this is, not just in the alternative and integrative field, but any cash practice should have the ability to provide the basic esthetic procedures. Botox, fillers, microneedling things that are low cost on the front end where you basically invest in the product and the training and then you provide the service and then as you get better at it and you have enough patient care flow, then you can invest in some devices.

But I advise against buying expensive machines, buying lasers and contouring devices. At first you probably want to hold off on that, unless you have a lot of business experience with marketing, because there’s a ton of competition. So as we get into this, you’re going to eventually get to the anti-aging patient who’s getting older. They’re really fit. You’re treating their sports injuries, and they’re going to have some sexual health issues. So P shots, O shots, those kinds of things. You’re going to want to learn that as well, because that’s a huge part of our comprehensive getting patients as well. They’ve got to be sexually effective. If you want to be athletic. They want to feel good. All these things come together.

The thing is these are all cash based because the insurance doesn’t cover them. So only really cash based practices can do them. And, payers are only paying for medically necessary disease management, right? Standard of care stuff. If you try to find a CPT code for a bunch of this stuff, you can’t even find it. It doesn’t exist.

Patients who want this. Patients are asking for this kind of care. If you get good at providing it, you’re going to be very, very busy. And if you handle it right, you’ll be very, very successful. So if this is something that you think is interesting and you’d like to see more of it, we have a whole series of podcasts that handle details on this, not just the basics.

You can check them out and check out, subscribe to our podcast. And, all of this ultimately brings about this huge development of relationship with patients that is just rewarding. And so the practice being a drag and a burnout, it’s fun and you can really enjoy it. And you can have a practice that really is rewarding and fulfilling.

If this works for you and you like it, I’d love for you to subscribe. Tell your friends. And, until next time, I’m going to ask you to do the most important three things that we ask people to do to make this work. Listen to your patients. They’re going to tell you what they need. Learn their stories and love them with all your heart and you will be unstoppable.

Thanks for joining us. And if you have enjoyed today’s conversation, be sure to hit subscribe so you don’t miss out on future episodes packed with insights to help your cash based practice thrive. And don’t forget to check out all the tools and resources available at CashPracticeSolution.com. They’re free to you and we’re always adding more. Keep raising the bar on patient care.

We’ll reconnect in the next episode with more ways to help you succeed.