The $2 Million Dollar Practice Part 2- Ethics (S1E11)

Welcome back to the Cash Practice Solution Podcast. In today’s episode, we’ll answer the question I think everyone really needs to have answered.  Can you be wildly successful at cash practice and still be a good person? Can you be ethically sound?  The simple answer is yes. The way to succeed and never surrender the high ground is simple.

Balancing Patient Outcomes and Your Income

You want to balance patient outcomes, what’s best for the patient, and your income. And never let them get out of balance.  30 years ago, I went to a really great seminar. There were lots of good things about it, but the best part was the keynote speaker. He mentioned  a lot of things, but the practice management strategy that he came up with was so good, was powerful. And he said, if your service improves the patient’s outcome, something that you’re looking at, a new procedure, or hiring somebody who’s maybe a mental health professional or whatever, if it improves the patient’s outcome and doesn’t negatively impact the patient, or the practice income.  It should be adopted. It should be a no brainer. If it boosts income and actually makes that better, well, of course, you’re going to want to adopt that even sooner. But this formula has been the guiding principle for lots of successful practices. There are a lot of practices that we’ve really helped with this idea. You don’t have to have a management degree. You don’t have to be some kind of MBA genius to know that if the patient’s outcomes are improved. And your income isn’t damaged by it or better yet improved, it’s a really good idea. By incrementally improving patient care, people start to talk about your practice because you get good outcomes. Then in the community where you’re operating you’re going to find that you get better and better referrals. So, as you update your business practices and your engagement strategies and your treatment modalities all come together and  your outcomes continue to get better and better and better, so will your income because outcomes will drive patients into your practice. You’re going to have more patients who are satisfied and happy. And if your income is not negatively impacted, they’ll just rise together. Some real life examples about how the formula works. Our practice is pretty active. We move fast. One time a patient said that when we did an IV setup, we did something that seemed kind of sloppy. The situation was disorganized. This patient, as many of our patients, are really good friends. So they were being very frank with me and said, you know, this is really a problem. Somebody might think this is kind of not sterile or not the best.. And it turns out that our tech, who was absolutely brilliant, unflappable, amazing at getting an IV stick, had been an army medic.So all the things that he’d learned, he learned to apply in the battlefield. He was used to battlefield environment not a regular practice setting, but it was really easy to correct. The patient told us,[and had a good enough relationship with our practice] that’s not so good. By listening to the patient, modifying our approach we responded by creating a standardized treatment tray, which is simple a little plastic tray  The set up cost a buck, maybe, and put all of our materials for the treatment  into that tray and then everything was packaged and put together and the outcome was that the patient thought ooh, they’re really sharp. [Which our staff is, they just weren’t showing it at that moment.] That patient of course later received my profuse thanks and every time he gets an IV he receives great service. Another example is, one of our patients is a doctor and he commented that his stress level at work was just driving him crazy. And mostly it’s the paperwork caused by inefficiencies with his electronic medical record. And he said, it’s not an electronic medical record, it’s a billing system. The problem that he saw was, it didn’t maximize health outcomes. It maximized financial outcomes, which is income. So,  he basically said, I’ve known this principle for years, decades, outcome = income, the outcome for the patient wasn’t the focus of this thing that had happened in his big medical, he’s a neurosurgeon, in his big medical group. The group  was focused on income. And it was creating a huge problem. Not only because the patient’s care was affected by it, but the doctor himself was not having a good time because he was forced to focused on that instead of the patient’s care. He said the patient could come in on fire and leave on fire. As long as the codes and checkboxes were done right, he passed right on through as long as the billing was right. It was great. Didn’t even have to put the blaze out. So the idea is the (patient) outcome has got to be primary and the income secondary including how your technology works with you, not against you.  The most significant stress for this doctor was the disconnect between the outcome and the income. How do you think that relates to the patient’s experience of the practice?  When you have a baked in problem with your system, whether it’s your technology or your income [you can’t get the job done.] I think most of the providers that I work with, in fact, very few don’t, care about their patient first. They care about the patient’s progress. He wanted to see evidence of the outcome in the documentation and he wanted to spend his time on that.  In our practice, we use a system that’s focused on the patient’s story and we want to look at their health and quality of life, not just thier billing. Billing’s important, but it’s secondary. In a cash practice, this is the greatest thing. This is the beauty of the whole thing. We call this the cashpracticesolution.com. It’s really the “you solution”. You’re the solution to the problem and all you have to do is do what you know is best for the patient. [In a cash practice] Billing is simple. It doesn’t have to be time consuming and you can afford to focus on the patient’s outcome. On the flip side, lots of practices fall into the trap of focusing on income generation rather than patient outcomes. Billing software generally falls to private equity buyouts which are notorious for focusing on income.  If you sell your practice to a private equity group the costs to acquire the system is about 20 to 30 percent of your income. Unfortunately, the care doesn’t get any better. In fact, it generally gets worse and doctors hate it. Hospital employment can feel like that, too. Everybody complains about the high paid CEO and their high flying salaries and the doctor’s getting a quarter of that or less.  The doctors who look into practice are looking for security, which makes sense, and it’s more predictable. But it’s predictably going to be something that makes you unhappy.  Independent practices that rely on third party payment are going to fall in the same category. They’re going to be more complicated. You’re going to have to be focused on the income because that’s the struggle every year or every month, the complicated regulations keep piling up and they’re more and more. The only people who can keep track of regulations are corporations because of the mountain of regulation and they’re the only ones who can succeed in the insurance industry because it has to be an income machine.  Independent practices are dying and it’s not going to get better. The cash practice solution is a solution to that problem.

Let Patient Outcomes Guide Your Growth

You’re the one who’s in charge and the key to the independent practice growing is letting the patient outcomes guide your growth and go third party FREE. Cash is the only sustainable way.  So, how do you measure outcomes? There’s lots of quality measures and silly check boxes in all sorts of federal programs but they don’t do any good. They don’t help. They, don’t show any improvement in the patient’s health, you just have more checked boxes. Outcomes should be measured in partnership with the patient, not by the arbitrary metrics of the insurance company or the government, because those sands are shifting constantly. One year is one thing, it’s accountable care, next year, it’s always something different. Okay. Thank you. Superior outcomes are going to drive  your referrals and the practice growth. That doc with the patient on fire, the reason I got to talk to him is because his wife brought him in as a patient, she’s been a patient for several years. Her outcome was so good that the doctor said, “All right,I’ll fold, I’m going to go in and see your doctor.”  When your outcomes are good.  It’s going to drive your income and they’ll be balanced if you follow this formula from the get go. So at the very beginning as you’re strategizing to switch into cash practice or you’re trying to upgrade your cash practice to something that really works well, manage this balance first. Make sure your outcome and income are consistent. Don’t have a lot of loss leaders in your practice. That does not work. When you do have patient outcome results, it locks in continual revenue growth. You continue to do better and better and become more and more profitable. Then the thing that you can be most concerned about as a good practitioner ethically is your patient is getting the best care. That’s absolutely possible and you’re capable of doing this in the future. It’s pretty much written in stone at this point. If you stay in a third party practice and you’re an independent clinician, you’re going to struggle and it’s just going to get worse and the pay cuts will keep on coming. The government is not going to solve the problem, but you can and the way that you can is by switching over to a third party FREE practice. Call it DPC, call it what you like, but get the third party out of your life and you will be a happy camper. So that wraps up today’s discussion on outcomes and incomes. In our next episode we’re going to explore the importance of hospitality and customer service in creating a five star patient experience.  If you’ve ever felt stuck in a practice model that’s holding you back, remember there is a better way. Join us next time, we’ll reveal some more simple steps to drive outstanding patient results and financial success. So, if you want to maximize your current practice or start out on the right foot, check us out at cashpracticesolution.com.  Thanks for tuning in to the cash practice solution. I’m Dr. J and I’m here to remind you that a fulfilling cash practice is within reach, we can help you get there. Until next time, listen to your patients, learn their stories and love them with all your heart and you will be unstoppable.