Dr. Tea Nguyen (00:00.0)

Practicing medicine without insurance is possible. Imagine a private practice where you get to see your best patients every day providing medical services you truly enjoy, all without the hassle of insurance. My name is Dr. Tea Nguyen, and I'm a recovering specialist who was completely burned out from insurance-based medicine. I pivoted into direct care, where patients pay me directly for my medical services and have never looked back. If you're a private practice owner or planning to become one, 

Dr. Tea Nguyen (00:30.648)

who's looking to be free of the grind of insurance and your craving simplicity, efficiency, and connection with patients, you are in the right place. This podcast will help you map out your exit plan and uncover the mindset needed to thrive in today's economy. Welcome to the Direct Care Podcast for Specialists. 

Dr. Tea Nguyen (00:53.73)

the real reason why I opted out of Medicare as a podiatrist. I found this recording on my phone that answers this question. And so you're gonna hear me paste that recording from my phone onto this episode. And I wasn't using my mic at the time. Sometimes what I do when I see a question online is I'll answer it on a voice memo on my phone, just so that I remember what I was thinking about and the types of answers I wanted to provide you. 

Dr. Tea Nguyen (01:23.372)

And so that's kind of why you're going to hear a different recording. If you have questions that you want to submit, I'm going to also put a link where you can do a voice recording down in the show notes. I think it's easier to be able to articulate the questions that you have. So feel free to use that. And I look forward to hearing from you and helping you on your direct care journey. Without further ado, I'm going to give you a somewhat brief answer as to why I, as a podiatrist, decided to opt out of Medicare, one of my biggest payers. 

Dr. Tea Nguyen (01:52.894)

And I hope it gives you some insight as to why I do what I do. Here you go. The real reason I don't contract with Medicare anymore. When I opened my practice, that was the insurance to take because people who were 65 and older oftentimes need podiatry care. So in my profession and my specialty, we see a lot of Medicare patients. And so it wasn't uncommon to see 

Dr. Tea Nguyen (02:20.588)

the population or the revenue come from Medicare patients around 40 % upwards to 75%, something like that. I don't have the actual data, but that's what I see to be true. Now, Medicare used to offer a lot of great benefits, but as you know, with time, their restrictions got worse and then the reimbursement got even more worse or worse, I don't know. 

Dr. Tea Nguyen (02:49.538)

the correct way to say that. But I think the real reason I let go of Medicare is because I was afraid. I've heard colleagues, friends talk about clawbacks, like the doctor would get paid and then the government would say, just kidding, we changed our mind or we had a retroactive something that required them to take the money back. Or really, it's the audits and... 

Dr. Tea Nguyen (03:18.826)

I haven't been audited, knock on wood. This doesn't mean I won't in the future for the Medicare patients I did already serve, but I think that always loomed over me and I was fearful of losing my time and my peace because what happens is with clawbacks, it can happen with anything that we do and I've seen it done with injectables where they say it was covered and then... 

Dr. Tea Nguyen (03:47.916)

down the road, some changes happened, and then they stopped covering it, and then they requested money back. I've also seen this happen with diabetic shoes. And a lot of the places that originally did Medicare diabetic shoes dispensing, like the specialty pharmacies around my area, slowly started to opt out or no longer provided that service because of the burden they had to go through. 

Dr. Tea Nguyen (04:15.906)

The process is not easy. You first have to apply for a DME license and there is a criteria to be a person or business to dispense these durable medical equipment, the DMEs. It could be DMEs like a cane or a wheelchair, a walker. For us, it's diabetic shoes and braces, things like that, which are covered and those are durable medical equipment as it's named. 

Dr. Tea Nguyen (04:45.354)

If I wanted to be a DME holder, a certified holder, I'd have to apply. There's a process where somebody has to audit and look at my facility to make sure that the posted times were accurate and based on my application. Also that I had space to store it in a certain way. And once I cleared that, then I could dispense or write for. 

Dr. Tea Nguyen (05:12.238)

these prescriptions and then the benefit to that is if I were to dispense them, I would gain the profits on that. If there was a profit, you know, if the boot that I purchased was at cost, let's say $20 and Medicare was willing to reimburse me for $120, that's all positive margin. But that continues to decline with time. And for the work that I had to do to make 

Dr. Tea Nguyen (05:41.034)

like $100 of profit, it just never seemed worth it for me because $100, I could be giving my consulting time with no clawback, with no risk, with no overhead, with no additional expenses or even administrative work to get paid that amount. So I think fear for me was a big one. 

Dr. Tea Nguyen (06:07.456)

I was afraid of losing my time. I was afraid of losing my peace. And I just knew even if I was right at the end of the day, even if I did all of my paperwork, which by the way, a lot of us sometimes paperwork is just so intense that there could be mistakes, right? That's just human error. And I knew I was not infallible. So I just knew that within this system, I would be much more liable.

Dr. Tea Nguyen (06:37.044)

 And so I simply didn't  want to subject myself to that any further. Was the decision to opt out of Medicare hard? It was because I didn't know how else to build my practice. I served a lot of people who had Medicare, including people who were younger, but they were disabled and qualified for it. So I knew that there were going to be some things I had to let go of in order to get this new thing. You can't have it all. And I think it's 

Dr. Tea Nguyen (07:06.414)

the misunderstanding to think that you can have it all. So sometimes I joke about practices who want to have a hybrid where they still want to have it all, right? They still want to work with some insurance and they want to have cash. But I think in reality, if you look at it, it's if you're a hybrid and it works awesome, you know, it's it's the risk that you're willing to take. And I just was not willing to, number one, take on the financial risk with the potential for callbacks and audits and just waste my time. 

Dr. Tea Nguyen (07:35.694)

in the paperwork to take care of all those things. And the second part of that is I didn't want to be confused as the person who took insurance because it's really time consuming to tell the patient, yes, I can build this for your insurance, but for this other thing, it's not covered. And then, you know, they go off and do their own thing and they try to bill for it. And like, I don't have the time. I don't have the mental capacity. 

Dr. Tea Nguyen (08:03.296)

I really wanted to make it very clear that any service I provide is all self-pay. I will do my best to give them the most financially responsible option. If I know something is covered by insurance, I will make the offer. So if I know they need to have a diabetic shoe, I will write the prescription and they can take that prescription to a DME provider. 

Dr. Tea Nguyen (08:32.012)

and if they can't find a DME provider, I tell them I can get some cash prizes. Just let me know what price they offer so that I can give them that option too. So in a nutshell, that was my personal reason for no longer taking Medicare. There were also some other areas of confusion with Medicare. So Medicare is the government insurance that people pay into. So even now, if you're working, you're paying into... 

Dr. Tea Nguyen (09:00.79)

your own Medicare social security benefits. There's Medicaid or in California Medi-Cal, which is state funded for low income as well. So if a person had Medicare and their secondary insurance is Medicaid, what I found problematic for that in a private practice is you cannot bill the patient for that 20 % if they have Medicaid. So traditionally if they have Medicare, 

Dr. Tea Nguyen (09:30.69)

by itself, the patient would be responsible for 20 % of the accrued charges. Medicare takes the 80 % and the patient or private insurance would pick up the 20%. But if the patient had both Medicare and Medicaid, if they can't pay, if the 20 % is not paid by Medicaid, you can't ask the patient to make up the difference because it's considered low income. And so in that situation, we would lose 20%. So, 

Dr. Tea Nguyen (10:00.064)

It was costing us to see patients. Now, sometimes if patients can't afford certain things, it's no big deal, right? But when the practice is predominantly Medicaid, Medicare, that is a huge financial burden, making it really hard for private practice to thrive, to pay their bills, to increase wages on staff. Now we have to see more patients in order to accommodate the loss. 

Dr. Tea Nguyen (10:29.472)

revenue because of the decline of reimbursements and so on. So that's the nutshell why I chose to opt out of Medicare completely. And I will be completely honest, doctors who want to know how to do a hybrid, I step out of that conversation. I am not at all interested in talking about how to be a hybrid, how to stay with insurance, what codes to bill, how to have conversations with patients when they get mad that one thing is covered and the other thing isn't. 

Dr. Tea Nguyen (10:58.978)

The only thing I can advise is to reach out to the doctor who has the model that you're looking for and pick their brain. Certainly be thankful, be grateful that they're even providing you with their time because, you know, we're all very busy and it feels almost thankless work from time to time when we give free information that we had to learn the hard way and people just want to take it from us. 

Dr. Tea Nguyen (11:28.728)

there was this impression that we had as residents. I think one of the attendings said to us that residents are just information vultures. And sometimes that could be exhausting. And I didn't understand it until I became an attending myself. And all of these people wanted information from me. And, you know, it can be really draining. Like we do want to help. And sometimes we don't know when to say no. So we keep providing the help. So I think the best thing you can do in that scenario is just write them a thank you card. 

Dr. Tea Nguyen (11:58.614)

At the end of the day, even if they don't ask for any money, just write them a thank you card or write something nice on their social media profile. You know, something to show that you are grateful for their time. I think that goes such a long way. Like I never asked for money, but when I get like a gift certificate of any dollar amount, I am so grateful that the person acknowledges the time and the value of what I 

Dr. Tea Nguyen (12:28.27)

had to share. So do keep that in mind. Don't just be an information vulture. We want to help, but we also want the next generation to continue to also help others, but show a little bit of gratitude because it really does go a long way. All right, so I'll be back next week answering some more basic questions about direct care. And if you have a nuanced question, please do ask it as well. 

Dr. Tea Nguyen (12:56.344)

There is a button down in the show notes. I think it's still there that says send us a text. You can do that. I'll also include a voice message if you feel like you're more of a person who likes to record the question or the question's more complex, then you can type out. I really like that function because then I can hear you and I can understand where your concerns are. And I can dive a little bit deeper if you choose to record your question and I'll get that immediately. And I make all of these anonymous unless you tell me. 

Dr. Tea Nguyen (13:26.262)

otherwise because I do want to protect your privacy. I know a lot of doctors who reach out are usually in a predicament where they're still employed or they're just kind of looking around. They don't want to raise suspicion. So I totally respect that. So I would love to hear from you, whether you choose to text, email, social media, connect, or use that voice message so that I can produce more content that's valuable to you and for your growth. Thanks so much for being here. I'll catch you next week. Take care. 

Dr. Tea Nguyen (13:57.388)

One last thing, if you took anything from this episode, whether it's a small dose of inspiration or even an aha moment, could you please share it with a friend or post it on LinkedIn? The direct care community depends on doctors like you because no one is coming to save us. So it's up to each and every one of us to keep the conversation going to a point where direct care becomes a normalized path for private practice and not some secret that we have to mine for. 

Dr. Tea Nguyen (14:26.552)

Thank you if you've already done so or if you've given this podcast a review, really does mean a lot to me. Sending you peace and possibilities. I'll catch you next week. Take care.