Marketing A Direct Care Practice

You're listening to podiatry marketing, conversations on building a successful podiatry practice with Tyson Franklin and Jim McDannald.

Hi. I'm Tyson Franklin, and welcome back to this week's episode of Podiatry Marketing. With me is my cohost, big Jim McDannald. So, Jim, how are doing today?

Feeling bigger than ever. I've been working out, getting huge. Nothing's been good here in

How do you been working out? Do you do weights?

I do three times a week now. Hit hit the gym and and try to, you know, get those middle forties. You gotta realize that the muscle mass is gonna get less and less over time, so you gotta be proactive. I got two small kids I gotta try to keep up with, so, yeah, I'm hit I'm hitting the weights.

That's a good idea. I got a friend who oh, I don't know how old he is. Probably late forties, I'd say. He might be 15, I think he is. I've insulted him if I said he is.

And he just told me recently that the last six months of last year, he hit the weights, and he's put on six kilos extra of of muscle Nice. Just by hitting the gym three or four times a week.

Yeah. I think the running the running that I do kinda keeps it off. I'm not a I'm not a bulky guy, but definitely definitely feel a little stronger than I did before I started.

So I went for a run yesterday. It reminded me why I don't run.

There you go.

Yeah. Yeah. I'll just stick to stick to kickboxing. So much easier. So what are we talking about today?

Yeah. So today we're gonna jump in a little bit about direct direct care and ways to market a direct care practice. I think that's I've been spending more time on LinkedIn this year and met some great folks there. And a lot of them are kind of chatting a bit about direct direct care or kind of fee for service practices. Yeah.

I think that there's definitely a lot of people out there that whether they're totally committed in The US to just fee for service versus there's kind of a hybrid of some practices that have these kind of fee for service modalities or treatments and, you know, how do you work that into your marketing or, you know, how do you get started in, you know, highlighting or kinda showcasing some of those those treatments. But just, you know, feeling comfortable with that and and ways to communicate that to prospective patients and also patients that are in the in the clinic.

So to explain this to people, say, who are probably in The UK and Australia listening to this, the North American system is a little bit different. And that and that's sort of what you're talking about, isn't it? Because a lot of podiatrists in America will they have to deal with insurance companies. Everything is really revolved around insurance companies. So they're now looking for services and products and things that they can do where it's just a cash payment directly from the patient instead of having to go through insurance companies.

And I don't mean cash under the table, like illegal stuff.

Yeah. You're gonna hear a lot of different names for it, like concierge, podiatry, or

Oh, okay.

Pay or fee for service. And like like you're talking about, there's you know, if you're opted in into into a certain insurance plans or you take Medicare in The United States, kind of the government payer

Yeah.

You're kind of limited to as far as the amount of the the kind of fees you can charge for certain types of procedures. But there are procedures that aren't not necessarily coded. Or if you're if you're opted out of Medicare, which is a whole process, which I don't I don't know personally a lot about, but there's some folks I could probably recommend people chat with about that. But if you're opted out of the Medicare or Medicaid system in The US, there's you know, you're able to basically kind of, you know, provide kind of transparency as far as cost transparency. Obviously, the having insurances in The US, these kinda HMO, these health management organizations or these PPOs in The US kinda cause a lot of paperwork or additional bureaucratic, you know, work for practices.

So there's some people that these days have, you know, whether it's fully direct pay or concierge podiatry or, you know, some are you know, if there's not certain services like, you know, someone that is in practice taking some insurances can do some of these cash pay procedure. They in common ones would be in The US, like, these the swift warts removal, sometimes, different types of laser or other types of treatment as far as the kind of hybrid, but then you have these people that are completely cash pay practices, which is kind of I don't know how common it is if that even even happens in Australia or The UK. So

Yeah. But you said that you're you're chatting with people on LinkedIn. Are you chatting with them about how they're using this service, or or is it bit have you thought about using this as what sort of conversations you're having with people?

Yeah. I would say, like, you know, there's kind of a like, talking about the the amount of kind of bureaucracy and paperwork that is required to do a certain either in surgeries or certain procedures in The US, you know, makes it very onerous from a time perspective for not only the doctor but for their staff. So, you know, there's there's kind of a it feels like there's kind of some momentum in The United States of people kind of banding together to, you know, like I said, have price transparency. Right? Just because someone has insurance doesn't necessarily mean that, you know, it's nice to have that kind of, say, like safety nut.

And and me living in Canada, like, I'm very aware that, you know, they don't pay for a lot of elective procedures to be done here. But if I were to get hit by a bus or, you know, fall out a window or something, I'll be taken care of.

You live you live a wildlife, Jim.

You get hit by a bus or

fall fall out a window. I'm thinking,

my break your leg on the ice when you're you're skiing or skating or something. You know? It's a good Canadian stuff.

I'm just pitching you falling out of a window on a bus.

There you go. But it is one of those things. Right? If if it is something where, you know, an ingrown toenail or, you know, like, there's there's certain, you know, helpful treatments that are not covered by insurances. You know, sometimes a fee for service model can be a benefit to the patient and knowing that that's available.

So when I, you know, talk with folks on LinkedIn, they're kinda talking about how they did it. You know, they're they're kind of a a group of people that I would say that are really open to sharing information about, you know, how they've done that. But there's also you know, it can be an adjunct to, you know, to insurance, you know, procedures or providers that, you know, haven't opted out of insurances or Medicare necessarily, but there's certain procedures, like I said, Zwift or other Zwift or other things that sometimes people would incorporate into the practice for to kinda boost the bottom line of the practice.

So can it actually work out cheaper for patients to not go through their insurance company?

Well, I mean, I think in some cases, right, I think, you know, when we're bulletproof maybe from the ages of, you know, 22 to 35 before we start falling apart, maybe there are some benefits of having that or even getting a plan that has a relatively high deductible and just paying cash pay for a period of time for more smaller elective things. They don't have to, you know the the coverage doesn't get bumped up in The US, you know, sometimes if you, you know, your your your coverage can get more expensive and more expensive over time.

So So you're saying if somebody had somebody is in it with an insurance company and they have an ingrown toenail, if they go and see the podiatrist and the insurance company pays for it, but their premiums could go up the next year because they actually made a claim.

Well, I mean, just they could just go up in general. Right? But if you're, you know, getting a higher deductible pre you know, a premium or a higher deductible plan with a certain provider, you know, maybe it's you have you know, the first thousand dollars is on you or the first two thousand dollars is gonna be much cheaper to pay for that plan as opposed to someone that's trying to have everything covered. Right? So, you know, if it's if your deductible is only $50, you know, you know, you for sure, per month or, you know, every quarter, that's gonna be a much more expensive plan for somebody.

But if you're relatively young, healthy, maybe in in your younger days, you can get away with a higher deductible. You know, have that kind of safety net of, you know, because it's private insurance primarily. But you're not going to the well or, you know, doing that every single time. So there's different ways, you know, and this is not really about the insurance, the reimbursement, but there's definitely reasons why people will consider, you know, cash pay versus, you know, more insurance covered providers.

Okay. And I wanna point out to anyone who is not in North America. Who doesn't have to go isn't faced with this sort of problem as much, still take on board some of the advice that Jim shares because you might think instead of saying, oh, no. That doesn't that doesn't apply to me. Just think about how can I make that apply to me?

Because they're they're sure to give me ideas because how how does someone get started changing their business or moving in that direction?

Yeah. So I think the first really kind of step people should make is to, number one, you know, talk to somebody that's kind of done that before. Know, you don't you don't have to kinda reinvent the wheel. I think sometimes, you know, me personally, not that I've ever done it before, but, you know, sometimes you just think, oh, I'll just kinda do that. But I think there can be a real benefit to understand that, you know, if you're gonna kinda walk down that road, you know, talk with someone that's kinda been down there before to see kinda what the the trials and tribulations were.

If you're considering either, you know you know, bringing something like a certain modality into your practice, what were the you know, have you done that before? Have you brought in a laser and never used it? Yeah. You know, do you have kind of systems in place that if you do something that's more cash pay where that's just a modality before you just, you know, dive dive off the deep end into more of a direct pay practice. I think it can be right for the right person, the right location, but it's probably not something that's gonna work for every personality or for every you have to kinda be relatively, I'd say, business savvy and wanting to really explore it.

So, you know, if you're in a small little rural area that's not very, you know, wealthy or doesn't have that type of patient in your in the local area, maybe not a good fit. So by talking to somebody, I think is is step number one. I think also you have to learn how to kinda communicate the differences between, you know you know, what is someone getting by going to a cash pay doctor or direct pay versus, you know, going to an insurance provider. Maybe it's, you know, they're they're able to see you that day. There can be definitely some different benefits, but, you know, how are you gonna highlight and differentiate yourself from other competitors?

Because now you're not accepting a lot of payers that other people are, and it may be a little bit of a change for some people to understand, you know, why don't you accept my insurance? So you have to kinda communicate on your marketing material, on your website, probably on the you know, when they call your clinic to make sure that they don't feel duped. If, you know, if, you know, if they come into your practice, like, hey, you don't accept that insurance. Everybody does. You don't wanna set up those situations.

So it's it's a lot of communication I talked about as well. Price transparency can be also a a huge marketing factor as well by just saying this is what we charge. I've seen the different, you know, I'd say, like surgery centers in The US that are only cash pay. They have that price transparency, which can be beneficial. But it is one of those things where, you know, whether it's, you know, getting into direct care, if we're if we're going to turn to practice in a different way, I think there are beneficial it's very beneficial to talk to people that have been down a similar road, I'd say, especially in the direct pay concierge podiatry area.

People are very open Yeah. To discussing what these things are and there's no, like, you know, special secrets or, you know, I'm not gonna tell you. You know, I mean, someone's practicing in Maine and then someone else is in California, somebody's in Florida. It's there's not like a concierge practice on in every locality, so you're gonna find a lot of camaraderie amongst people to practice in this manner.

So when you say when you say no to a particular insurance company, does that mean you're saying no to the insurance company across the board on all services, or is it just, I'm not gonna take that insurance company for nail surgery, I won't take it for doing routine foot care?

So it it I think it really depends, but I think for the most part, once you kind of opt out of an insurance provider, like you're opting out of like all of those things they would cover for patients.

Oh, shit. Did it? Does the insurance company go, what are you doing? Why won't you accept these patients? Do they contact you and say, hey.

What what are you doing, Jim? You're killing us.

I've not done that personally. So like I said, I'm kinda speaking from, you know, some of the conversations I've had with folks on LinkedIn. You know, definitely, if people are curious about this way, they can they can send me a DM, you know, send an email to the to our podcast here, and we can kinda get you set up with some folks that have kind of gone through it. But I I've not experienced that, so I really I I I don't know what those conversations are like.

Alright. Okay. Yeah. I wasn't sure because I'm think I could just because I love our insurance companies over here work completely different. It's it's mind boggling what what happens in North America in comparison.

So if somebody say somebody wants to head down this path, okay, the first thing is they start talking to other people that have done it, try and learn from them. Is there a way that you start small, like you only pick one insurance company first just to see how that feels, and then you you slowly expand from there, or is it always it's always gonna be a hybrid. There's always gonna be some insurance companies you will work with because they're great, and there's other ones that you're just gonna can pretty quickly because they're not.

From my understanding, it's a real spectrum, to be honest. You know, like, from from region to region in The US, there's gonna be different insurance providers. And, you know, some maybe pay okay and others pay horribly. So you can from my understanding, you can kinda pick and choose which ones you want to. I'd say my real focus here today is to kinda like probably work more on the marketing of how you're gonna communicate those different things as opposed to really the the dirty details, nitty gritty as far as, you know, which of those insurances to drop and how do they happen.

But I think it's it is one of those things where it's probably I I mean, like I talked about, there's a few folks that that I that I'm aware of that could probably talk about their path about when they dropped what insurance plan and, you know, how they kind of either gradually transition from accepting everything to, like, to nothing and opting out completely. I know that there's, you know, like I said, there's some of these procedures or modalities that are not kind of covered by insurance. So they are up to to kinda have that conversation with the patient about, you know, we do have this other form of treatment that's highly effective that insurance doesn't cover yet. So Yeah. That's a skill set and something people have to work on.

So

And that becomes part of your marketing. That's like you said, so you you have a service. So it's like when Shockwave first came out or laser or thumbnails. It would have taken a period of time for the insurance companies to catch up to that.

And sometimes they haven't. Like, sometimes it's, you know, there's off there's off uses for some modalities. Right? It's not just the modality itself. Maybe it's like, you can't use this laser for a wart, but you can use it for some type of the other ablation or something like that.

Right? And it's not the code isn't there, so it's kind of an off use that they're not gonna cover. Yeah. But it's it's how do you communicate that, like I said, not only through you talking directly to the patient, but what are the ways that you when when they come onto your website, you utilizing your digital marketing channels to make sure they feel informed and it's very upfront to them about that you are providing this type of service because you don't want that surprise coming to to your practice. So that includes, you know, the way the copy on your website.

It's how you're highlighting the different you know, making different pages on your website, whether it's transparent pricing. I've seen some real there's, you know, some really good websites out there that some of the concierge podiatrists and the direct pay podiatrists are utilizing that, you know, you don't have to copy paste what they do, but get a general sense of how they're educating Mhmm. The patient before they come into the practice to make sure they have they understand what the the pros and, you know, the pros and cons or what the benefits versus the differences that they may experience kind of in a, you know, normal patient account if someone's used to, like, going through that kind of insurance dance that they're used to, you know, when seeing podiatrist. But I think, like I said, utilizing those digital marketing channels, whether that's through SEO, your website, you know, kind of improving the kind of overall visibility to make sure that it's when they land on your website that they're aware that either nothing is covered or there might be certain procedures that require cash pay.

So when people are first starting this, normally, they will if they're setting up their own business or they're when somebody's setting up their business for the first time, normally, they will just take all the insurance companies on board. And then it's not until they've done that that that they then start making the changes. It's rare for someone to try doing this right from the start, or do you think it's a good idea for people that the sooner you can do this, the better?

I think that's gonna really, you know, vary between individual. Right? I think that, like you said, the kind of most common places that you just kinda like, you put up your shingle and you're you're wanting to get revenue in the door. Yeah. So you're kind of willing to kinda bring on every payer.

And I I think it would, you know, unless someone maybe has a parent who has a direct pay practice or, you know, a direct care practice, they they may not have, you know, we were busy in school, you're busy in residency. Even me, like, I didn't really think that this was something that was a possibility when I was going through residency or school. I don't know how other people, how their listeners if this is something that's more prevalent nowadays. I mean, I I graduated, I guess. I hate to age myself, but I think it was Yeah.

Yeah. How long ago how

long ago did you graduate?

Twenty twenty years ago from school

Yeah.

And, you know, seventeen years ago from residency. So maybe things have changed and it's more of an option, but I think it is one of those things where, like, you know, it's not it's it's communicating it once you kind of figure out what that path is for you to go towards that direct care path. But I think there there are ways, you know, besides just kinda digital marketing stuff. Right? I think there are you know, it's it's pretty common.

You're not depending on what province you're in or what state you're in, you know, some people are used to paying more for health care or allied health care services, like getting, you know you know, networking with some of these other providers like massage therapists. Maybe there's some physios. Maybe there's other people that are kind of in a similar, you kind of referral network. And we talked about these kind of both medical or non medical referral networks.

Yeah.

They're kind of used to, you know the shoe store is not used to, like, you know, having to reimburse an insurance plan for someone's orthopedic shoes or something. I mean, sometimes you'll get custom shoes for diabetics, but I think it is important to kind of, like, solidify these this network of local businesses so that they understand the benefits. Like I talked about communicating these benefits of your direct care practice versus, you know, oh, this person is you know, they have a three month wait. They only accept these insurances. There there are definitely ways to differentiate yourself from some of the other clinics in town that can be beneficial for these other local businesses to know about.

Yeah. Because like you said, the the whole online world that you can actually market and tell people what you're doing. But offline, like you said, communicating this to other businesses, but I assume going to health fairs, expos, anything where you can actually connect with the community would probably be a good idea as well.

No. I think that's a perfect example. Right? The the more chance you have to kind of communicate because it's sometimes it can be hard enough to communicate, like, all the all the foot and ankle care we provide or what our air area of expertise is. But this is, like, kind of one more layer of explanation to people.

And like I said, you don't have to necessarily reinvent the wheel, but if you're maybe you're venting you're you're putting on, you know, biannually like open houses at your practice to help kinda educate your community about why you're, you know, a direct care practice, you know, what are the benefits kind of in person so they can you know, it's not just something they land on a website or have to read, but they've actually been inside of your practice. I I've seen some different podiatrists kinda utilize an open house model in a way that's can be very beneficial. So that that's one thing that I think people can utilize. But like you said, community events, community speaking opportunities are a real way to kind of communicate your message about, you know, how you're trying to practice medicine in a different way that is more, you know, patient focused. I think one of the kind of the big selling points as well is that, you know you know, if you're taking insurances and they're not paying at a reasonable rate, either you can, you know, see more patients and spend less time with patients to try to generate the same amount of revenue.

Or, you know, some of these alternative ways of practicing, you know, would allow you to say, if if you wanna spend thirty minutes or forty five minutes with a new patient, have conversations, really get to know them, and really try to, like, you know, treat their problems in a way that you feel comfortable with. It it provides a different way of practicing that maybe the current model with insurance plans and HMOs and PPOs, it's it's not impossible, but maybe it's it's a it's an a different way of practice than maybe some people will find attractive.

But wouldn't it be what percentage of patients wouldn't have insurance? Is there a like, over here, for example, for podiatry covered, it'd be yeah. At least 50% don't have podiatry covered all with with insurers. And we have, like, insurance for, like, hospitals and and surgery and all that, but then allied health is a separate thing that you pay for. And probably 50% of our patients didn't have any coverage for podiatry.

So would that be the same case in The States?

Yeah. Like like in The US, The US is so big, it's gonna really vary. I think there are of some different ways in The United States that people try to save up money for health care expenses. So sometimes people will utilize like, you have a a health savings account called an HSA in The US where you can put away money, I think, either tax deductible or tax free into this account. So it's one way that sometimes you can pay for some of these services that either your insurance does pay or doesn't pay.

There's definitely certain criteria you have to match in order to get like, if you're being treated through Medicare. You know, Medicare is kind of the plan in The United States for people that are more of retire you know, in retirement age. So you're not gonna be, you know, in another if you're younger than retirement age, you're kind of on these Medicaid plans. And they're kind of usually bare bones, of very emergent safety net type type of care plan. So but it is one of those things where, you know, if you are like, for me, for example, I am a business owner in Canada.

I come from The US. If I were to be in The US and try to have to pay for my own health insurance, it would be prohibitively expensive. Yeah. And very expensive to buy your own plan depending on what state you're in and and what's available. And that's kind of that's a that's a whole another discussion.

But, you know, when I'm here in Canada, I have, you know, this kind of baseline of safety net. And there there are some safety nets in The US, but it's not quite as comprehensive comprehensive as it is here. But I think to me, the the direct care or the concierge medicine is it's gonna be right in the right location. Right? Someone that wants a high low you know, it usually happens in affluent areas.

Yeah. Or people that are willing to they wanna be seen today or tomorrow. They wanna have, you know, a high level of care, but, know, are are willing to pay out of pocket for it because they just they just don't wanna wait for that patient at their you know, maybe they're on a maybe their husband has a plan or they have a plan from work, but the the three providers that that are allowed that are allowed to see are booked out for three months or or or four months. And it's not emergency room worthy. So what are you gonna do in the meantime if you have the means instead of, like, limping around on that that heal that's

bothersome? Sense.

You know, maybe and maybe it makes sense to go see the podiatrist in the meantime.

And that's

all part of

the marketing, though. That's it's all the part of getting that message out to the patients that, hey, you don't have to wait three or four months to see this person. I could do this for you now or a lot quicker and get you out of pain.

Yeah. Exactly. And I think there's also been kind of a proliferation in The United States where, like, everything used to be pretty much, you know, hospital based. Oh, you're hurt, go to the ER. Oh, you're sick, go to the ER.

Yeah. But in The US, they've kind of transitioned now into and there's been, you know, mixed reports whether this has been working well or not. These kind of urgent care centers, you know, in the local strip mall, go to the urgent care, you know, urgent care center and have this taken care of. And sometimes those are, you know, paid by, you know, insurances will reimburse those. But, you know, more and more, it makes sense to have some availability.

I think some podiatrists maybe even do this in their own practice whether accepting insurance or not accepting insurance is having some add on room where that person with an ingrown toenail, that person that might have a fracture or something like that can be worked into the schedule and having that availability to kind of offload some of the ERs, especially, you know, during times of COVID when no one wants to go to the ER for any reason Yeah. You know, promoting that you are available and have add ons or day of or, you know, within twenty four hours receive care, whether you're direct care practice or, you know, someone who does accept, you know, Medicare or insurances. Like I said, it's a real spectrum of what's available out there, but I think there are ways to make that more visible and communicate that to patients in your local area.

Okay. Well, like I said, this is probably one of those areas that being in Australia, we I I can get my head around it because I've been over the state so many times and spoken to so many podiatrists. So I understand what they've gone through and why they're trying to make the change, but I'm so glad our health system is different. Because you're always here. You just hear you watch TV shows and they everyone, when they get a job, they they wanna know, oh, does this come with full, you know, full medical and dental?

Seems to be a like, that's the job that people want. Whereas over here, no one thinks about it.

Well, even in Canada, right, like, talked about, we do have a great safety net. But if you have something that's, you know, not an emergent procedure, you're gonna be waiting a while. And I think part of this this kind of change too is that I don't know if it's Amazon or Uber Eats or Uber. We just expect to like, you know, push an app or do something Yeah. And be seen within twenty four hours.

We want immediate care, immediate results. And at least up here, that that's not really possible. So I've I've actually gone to some a fee for service providers in Canada because I didn't wanna wait, you know, six to eight months for a health checkup. Right? I I wanted to I wanna be proactive about my health and the system wasn't actually giving you know, they would give it to me eventually, but, you know, if you do have questions that need to be answered just for that peace of mind, you know, you kinda balance it out.

I do have that safety net, but if I wanna be seen within a year for something, you know, maybe Australia could teach the Canadian system here a little something and maybe, you know, it's yeah. It's no system is perfect, but it it is interesting these kind of different ways of practicing and these different ways that patients can receive care kind of a pop up as good alternatives.

Yeah. And like you said earlier on, someone from a a different country may be listening to say, well, we don't have that problem. We're not faced with that problem, but you can still take on board everything about how you actually market your services to the general community is you need to do it anyway, regardless of whether it's cash through insurance company or whatever. You should be out there letting everybody know what you do.

And I think it's important just to have some general awareness. This is a thing. Right? Even if you're in The UK or in Australia because, like like I said headed your way. Well, when I was twenty years ago twenty years ago.

Right? This is not something I even No. Had a passing thought about. So, yeah, like, it definitely is probably more of a North American US based episode today, but I hopefully that The UK and Australian Westerners can maybe they they're more thankful to be where they are today as opposed to in North America.

So Yeah. And things are always changing, so I think it's always fine. It's always good to be aware of what's happening in other countries because every now and then, your government or organizations and insurers will see what other people are doing. That would work here. So they just start doing it.

So so, Jim, I think that you've covered that pretty well.

Yeah. Thanks, Tyson. It was a good chat, and look forward to the next one.

Yes. I'll talk to you next week. See you later. Okay. Bye.

Thanks for listening to Podiatry Marketing with Tyson Franklin and Jim McDaniel. Subscribe and learn more at Podiatry Marketing. That's the website address, podiatry.marketing.