Tea Nguyen, DPM (00:00.696)

Hey, hey, welcome back. We are on episode 200 and I wanted to celebrate the 200th episode with a gift. And that gift is the 7 steps to get patients to actually pay you cash. So if you're new here, welcome. If you've been coming back over and over again, I'm sure you're going to learn something new that you can start applying right away. After all these short episodes are intended to give you quick wins so that you can build your direct care practice the way that you want it. If you're somebody who's worried about whether patients will pay you cash for your services, you're not alone. But here's what I've learned in my own transition in coaching other doctors. Getting your first cash paying patient is a lot simpler than you think. Getting your first cash paying patient is a lot simpler than you think. And I'm going to break that down for you as to why this works. 

First, we have to address the fear that patients won't pay or they snarl at your prices. And here's the thing, patients are already paying for things. They're paying for their insurance premiums, their copays, their deductibles, the surprise bills that come months after the service was rendered. They're paying with their time. They're waiting for months to get a specialist. They're dealing with claim denials. They're paying with frustration. They're paying with not getting better. They're also paying for other things, like a nice car, watches, purses, food, electricity, gas, getting their hair done, family trips, cruises, and so on. So the reality is people are paying for things that they prioritize. It's really that simple. Direct care is not about coercing or convincing somebody to pay more, especially when they don't want to. It's really about offering them something that they want that is not being met. 

So in a direct care practice, we offer things like quicker access,more time with the patients and options outside of insurance. So that gives them real outcomes. And the best part is you and I, not speaking in CPT codes anymore. We're talking about what can actually get patients better. We're giving them transparency so that they can understand the value of why they need to invest with out of pocket dollars. So here are seven steps to find those cash pay patients.

Tea Nguyen, DPM (02:24.066)

And it starts very simply. So simple, you're going to say, yes, I can actually think of the next person who might be willing to pay out of pocket to invest in their health, to get the care that they really need because the insurance option just wasn't doing it for them. So number one, you start with people who already know you, who already like you, and who already trust you. In short terms, this is the no like and trust factor.

And that could be your existing patients. That could even be your existing referral sources. It's not uncommon to get other doctors to come into your practice as a patient because it's easy. You make it easy for them. They already have your cell phone number or your email or they're following you on social media and they come in time, we'll need your services. And these are the warmest leads, meaning people already know you. They already know you have the expertise and they trust you enough to ask for your help. So if you're somebody who's planning

for the transition into a direct care practice, just start having conversations now with those people, with your patients, those who already appreciate your care, and just focus on the thing that they will gain. They will get more time with you. They will get better access. They will definitely not be getting a surprise bill, and neither of us need to deal with things like insurance denials. And that's why non-covered services really...

And that's why non-covered services work really well for specialty care practices, because a lot of the preventive care type of work that we offer isn't covered by insurance. I mean, I tell patients all the time, insurance will pay for a limb amputation, but they're not gonna pay for the stuff in between. That is an investment patients need to.

Tea Nguyen, DPM (04:11.192)

decide on whether or not that's what they want to invest in. So the easiest entry point is offering those services that insurance doesn't cover. We're talking about regenerative therapies, maybe even counseling or coaching for extended times. Functional medicine is a big one. Holistic medicine, integrative medicine, lifestyle medicine. Those are things in which the insurance model doesn't offer because it takes too much time.

These are lifestyle changes that patients need in order to prevent chronic conditions or maybe they are dealing with a chronic condition and they need better maintenance over it.

Tea Nguyen, DPM (04:53.902)

So when you're choosing to provide a service that insurance already doesn't cover, that is in our advantage because now you can say, well, the insurance doesn't cover that anyway. And there really is no comparison. So you get to be unique in your selling proposition. When I transitioned my podiatry practice, the existing patients already heard about me and some of them came over and I'll be transparent. Not all of them, but some of them stayed and they've been with me for over seven years now.

and I was very clear with them that they have options, that they can continue to use their insurance or they can continue to receive care from me. And when those stayed with me for as long as they have, I feel so grateful to be in a position to offer this to them. And it feels so validating to see that patients value what I had to offer. And you have that too. You can ask your current patients.

Tea Nguyen, DPM (05:56.217)

what they need, what their needs are. So if they need to find somebody within their insurance options, fine. You can be seen by my great friends here in the community who does take insurance. And if they don't want those options, then that's great. You can come and become a patient with me here in my direct care practice. It's very simple. All right, number two.

Realize that patients pay for outcomes. They don't really care about the tech specs. What I mean by that. We tend to, as doctors, talk about the technical things or the technical benefits of the care that they will receive, right? We're gonna talk about a machine that does a thing. And we go into details about why this machine is better than the next machine. And it's almost as...

Tea Nguyen, DPM (06:46.112)

mundane as when somebody tries to explain to me the differences between laptop computers. Like I honestly as a consumer don't really care. I don't care as much as they think I care. I care enough to know that I need it to be functional. I need it to work fast enough and I need some storage space. That's all it really is. But as doctors we really need to bridge that communication gap to tell the patient upfront what they actually get in the end.

So from the starting point, if they're in a position of pain, the end point is living better without it or less of it, right? Even as pain specialists, we set the expectation of what it looks like to get through the recovery period so that life is tolerable with this condition. Now a lot of doctors find themselves thinking that they have to cure everybody's problems. And I think that's because the system forced us to do things that were out of our wheelhouse out of our scope of interest or even expertise. 

They just made us feel like we had to take care of every little problem that showed up because after all, we have the smarts to figure stuff out. But the reality is we don't have to try to figure it all out. And we don't really have to treat all the things. We can treat a few things, the things that we deeply love and then send out the rest. Is this cherry picking? Perhaps, but that is what makes a direct care practice work. We choose the things that we want to do.

We stay within our scope of practice. We stay within our area of genius. And then we send the rest out. We say we can or we cannot help. But we'll do the best we can with what we have.

So what number two is, it's about, so what number two is about is packaging your high touch, high value services so that you cannot be comparable to the insurance option. What does that mean? Insurance models means that everything you do for the patient, there is a CPT code attached to it. So it's itemized care. It treats our services like a commodity. So if you have a direct care practice,and you offer a line item of services. 

Tea Nguyen, DPM (08:51.246)

That makes you comparable to insurance options and therefore it's not very compelling for somebody to choose you to pay out of pocket for those services. What you would do instead is package all of your stuff. We bundle it up. We make the decision easy for the patient. We make the decision easy for the patient to realize this is easy. If I just buy the package, everything's all included. So you can define what everything is included actually is.

But if you create a service line that has a package, your life will be so much easier. And that's where DPC really thrives. The direct primary care model really thrives because they have a predictable profit model. They have a membership model where patients are paying them monthly for their medical care. Now for me, I don't have a monthly membership option. I have a pay in full discount option. So there's a little bit of psychology in this.

First off, my EMR system right now, I'm unwilling to change it because changing EMR is so painful for me that it has to be so cool for me to change. So for now, I'm going to stick with what I have because it works. It's not the fanciest, but it's budget friendly. And so in that system, there really isn't a monthly payment fee unless I do that manually. And I didn't want to sit there and calculate, this person paid this month or they didn't. So all I really do is pay up in front.

And let's say they pay 12 services in full, then they get the discount. If they want to come per visit, then it's the per visit price. And you'll find that a lot of people just want to take some of the stuff off of their plate. They want it simple. They want the discount. And the package always works out in our favor for both me and the patient, because for the patient, they are committed to getting the care that they need. They are invested with their own dollars. And for me, mentally, it's just freeing. I am fully committed to the patient's outcome at this point, and I'm dedicating time for them to get better.

Tea Nguyen, DPM (11:00.44)

So think about packaging your services so that it becomes a no brainer, meaning what does it take for this patient to get better and kind of put it all together and let them understand that they're purchasing a service that is easy, that has a clear pathway to getting better.

Tea Nguyen, DPM (11:20.556)

Number three is a concept that I hadn't learned till more recently, but it's called the minimal viable practice. Don't overcomplicate this. You don't need to start off perfect. In fact, you will never start off perfect. I'm sorry to say, but what you do need is patience to find you, meaning you need to have a website. You need to tell them what you do, identify your specialty and what you really want to attract. 

And then an EMR, you already know or have experience with some I'm sure and then a way for them to pay you which could be cash, it could be a check, it could be a credit card and with companies like Stripe and Square it's so easy to get paid. There really isn't a second thought around that and then lastly you document what you do so that's the EMR that handles the scheduling and the documentation so that's it that is your minimal viable practice. If you have a telehealth practice you don't need physical space

If you need this, if you need physical space, then you can sub rent an office with another.

Tea Nguyen, DPM (12:30.316)

Aligned healthcare practice, maybe a cash practice even, to help you get you going without a whole bunch of overhead. All right, number four, you're going to leverage what already works and has been worked time and time again, and that is word of mouth. Word of mouth is such a powerful tool, and that's why businesses like the Mary Kay Cosmetics work so well because they're all selling to friends. And it's the best way to really sell honestly to your friends who trust you, they like you and they believe in you, they believe in your business, they know what you're doing is valuable. Now, if you have friends who don't see that in you, then I would say get some new friends, but hey, that's a personal decision at this point. But leverage that word of mouth. When you deliver exceptional care, patients will tell people, right? They're gonna tell their friends, their family, their children, their grandparents, their coworkers, they're gonna say, this place was amazing, did you hear about it? Also, they're gonna be the ones who are your walking billboards.

They will tell others that your practice works a certain way. So they're going to preemptively tell people on your behalf so that by the time that referral gets to your door, they're already pre-sold. They already have an idea of how you run your business and what it's worth going to.

Tea Nguyen, DPM (13:55.567)

Now word of mouth is so powerful that you don't even have to treat the individual in order for them to talk about you. So what do I mean by that? It means when you show up online, you're on social media, for example, which is one of the pillars that I recommend to direct your doctors in their marketing arm is to stay top of mind by providing educational content. This is your professional note.

These are the people who follow you, they consume your stuff, they find it valuable and they stick around. And sometimes they creep around. They may never comment, they may never message you, but they see your stuff. And so you stay top of mind. And when the time comes, they're going to say, follow this account to somebody that they know. Or, hey, did you see that Dr. So-and-so does this very specific thing that you need help with? And so...

Word of mouth, in person and online, takes you very far. And it's the consistency that matters, not the quality. Some quality does matter to some extent. But if you just show up with some good lighting and a mic, and you speak clearly and concisely to tell people what you actually do and how you benefit their life, that goes a long way.

Tea Nguyen, DPM (15:18.498)

Number five, we're going to handle the insurance objection as clearly, as transparently, as least car salesy as possible. We're not doing anything coercive here. Remember, you're going to be offering value to people who want it. So when people say, why would I pay you when my insurance covers it? I like to take the path. I like to take the straight path. And I say, you're right.

then you can choose your insurance option first, right? Give them the freedom to choose. I don't care. Personally, I don't care what they choose to do with their dollars. It's not my business. I just know what my business is, which is I help people with the problems. And so if you're just on their side and you say, understand you should try your insurance option first, then you become less of a salesperson and you become their advocate. They are paying into their insurance premiums and they should benefit from it.

So why not agree with them and say, get it. Go there first. And if that doesn't work out, then I'm here for you. I'm here to help no matter what you choose. It's whatever is best for you. You do that.

Tea Nguyen, DPM (16:32.32)

Now let's say they're bringing it in. Now let's say they're going to bring you into a conversation as to why you don't take insurance. And you can be very clear about this. You can say insurance doesn't let me see. You can say insurance doesn't allow me to spend a lot of time with patients. And that's what is needed to get people better. Right? You can rearrange the words however you like, but make it concise one sentence so that it's oriented to the benefit of the patients. Not so much on you. I mean, of course it goes two ways, but they want to know what's in it for them.

So you want to frame it in a way that benefits them. And the benefit to that is they get faster access. They can have a

Tea Nguyen, DPM (17:15.19)

And the singular benefit they have really to choosing a direct care doctor is access. Access to the doctor who gets them and they get personalized treatment.

Some patients will not be ready to pay out of pocket and that's okay. And others will totally get it and then you make room for them.

Number six, you want to set clear, confident prices, a structure that you can immediately just roll off your tongue without stumbling across the tech specs. So what does that sound like?

When somebody comes to you for a problem, a specific problem that you already selected for, that you love trading, that you have a good protocol in doing and getting people real results, real success, then you put a price tag on it. And here's what you do. You tell the patient the end result. You say, I can get you better in this program. And this is the price. And this is the investment, period. $2,000, $5,000, whatever dollar you want to insert into there. And then you pause and then you scrunch your toes straight down to the ground because it's going to feel weird in your body to say this if this is the first time you're saying it. Practice, practice, practice saying this to many, many people and hold your posture. Be confident in what you deliver and pause. This is the uncomfortable power pause after stating the price. 

Tea Nguyen, DPM (18:48.832)

What a lot of us will do is we'll throw in a bunch of tech specs, meaning we're going to say, well, it's going to come with this, this, and that. And then now you've just confused the person because they haven't even digested the price tag at all. So do yourself a favor, practice saying a very uncomfortable number for your services. You can practice with a friend. You can hop on over to my Facebook group and just ask if somebody wants to practice this with you. You can even ask me. I'll do it with you quickly over the phone.

so that we can get your mind right about it. Because pricing can be such a touchy subject for a lot of us, and it doesn't have to be. It's very simple. You want the thing. This is the price. So now how do you set your prices? I think the easiest way to set your prices is just to find a comparable within your area. So a comparable would be another cash practice that's not billing insurance, for example. And so you kind of take that and you tweak it to make it your own so that you can live with that number.

And I like to encourage doctors to be a little uncomfortable. So raise it 5%. So if you see a number and you're like, okay, that seems doable, just be a little uncomfortable and add another $10, $20 to it to see what happens.

Tea Nguyen, DPM (20:06.86)

And for me personally, every time somebody complains about my prices, I just keep raising them. So it's reverse psychology and it's working for me and I know it's going to work for you too.

Tea Nguyen, DPM (20:17.964)

Other people will suggest, well, what is your time worth? So if you look at your hourly rate, just throw it in there. $500 an hour? Great. Start there. Start anywhere. Just start. You can start there or you can just start anywhere. The point is to start and to take action that is uncomfortable. And I know this is something that not a lot of us get training around. And so we have to do the uncomfortable thing until we get more comfortable.

Now if you're delivering different services that have another overhead expense, like the supplies have a cost to that, sometimes the supply cost is that wholesale price and then you would just tack on two to three X that price. That's pretty typical for things like injectables. And there are practices who are doing way more than that, which is a little bit out of the discussion for this episode. But if you'd like to learn more, just reach out to me and I can share that with you on Facebook.

Tea Nguyen, DPM (21:15.704)

The most important part about this, setting your prices, is that don't price it based on your fears. So don't under price because you're afraid people will say no. People will say no at any price. You can give your stuff away for free and they will still say no. That's not who you're trying to attract. You really want to position your price as a way to reflect your expertise and the value that they get in return. So just be upfront about your prices because it's that transparency that will build trust.

Tea Nguyen, DPM (21:49.111)

And the last step here, number seven, managing expectations. The expectation is not that you are going to cure them. It's that you've got a plan to get them better. So you want to set clear expectations from day one. So when you take the patient, they have an intake with you or initial consultation. You want to understand what their expectations are. Do they want to get over their problem with a pill like overnight? And if that's not realistic, then you know right off the bat, that's not a fit for you.

But if they're willing to learn a little bit more about what you have to offer and you give them a timeline that's realistic and you include all of that in your package and you spend the time to answer all of their fears and their questions, they're gonna find value in that.

And then once they have the buy-in, then you become their best advocate. You are there with them. So if you want to help them maximize their insurance benefits, you can definitely do that. If you don't want to do that, that's okay too. There are practices who say the point of a direct care practice is not to muddle with insurance. And you know, it's really up to you. For me personally, I try not to have insurance conversations because I don't want to look like I am an insurance player. I just don't, I work for patients.

And that works for me. Whereas there are other direct care practices who are happy to help patients maximize their reimbursements and they have a system set up for that. So there's no wrong or right way. It's whatever you feel is an alignment for you and your practice. So the reality is I've just given you the seven steps to get your first cash paying patients. And there is a little bit of a learning curve. What you're learning to do is to communicate your value clearly.

You're learning to market yourself. You're learning to set your prices in a way that's profitable. And your practice should be profitable so that you can reinvest in your team and into your practice to keep things updated.

Tea Nguyen, DPM (23:52.908)

And you are also learning to build systems outside of insurance.

Tea Nguyen, DPM (24:00.919)

Now for some, this path is shorter than others. And that's okay. You start with what you have, which is step number one. Start with the people who already know you, like you, and trust you.

Tell them how you can help them and give them the autonomy to choose. If they want to choose their insurance, that's okay. If they want to choose you, then you have their commitment and you are committed to them as well.

Tea Nguyen, DPM (24:38.286)

So when you choose a direct care practice, you will decrease your overhead by so much. 50 to 70 % is the estimated savings of not dealing with insurance. And in that model, you don't have to say a lot of patients. You just need a few yeses. You don't need everyone to say yes to your services, just a few to make this work.

Tea Nguyen, DPM (25:05.528)

There's always a concern about the risk of direct care, but there's a risk in staying in insurance or staying employed too, because you will be guaranteed burnout. You will be guaranteed shrinking margins. You will be guaranteed that you don't own your time and you will lose your autonomy. And this is far greater than the temporary uncertainty of creating something better for you and your patients. So your action step for this week is to identify five patients who would benefit from direct care and just tell them what you do.

Define that one high value service that gives them a clear outcome. Just don't overcomplicate this. Make it simple. What is the problem that they have? Give them the end result.

Tea Nguyen, DPM (26:01.848)

From here, you want to think about the one service line you want to offer that delivers a clear outcome. And you're going to show them that your treatment has a pathway to get them there. And this is the minimal viable practice. You get the website, you get the scheduling system down, your EMRs, your payment system, charting. And you start having a lot of these conversations. You start telling people about what you're building and why it and why it benefits them. And then you set your prices, you become confident over time. Sometimes you don't.

Tea Nguyen, DPM (26:44.95)

and you build confidence through practice. You don't need to figure everything out. You just need to start getting your first cash paying patients proves that direct care works.

Tea Nguyen, DPM (27:01.24)

The moment you get your first cash paying patient, you're going to feel so good and so validated that direct care does work and it will work for you. It's when you realize patients value your expertise and you can build a practice on your terms that really restores the relationship we as doctors have with the healthcare system, with medicine.

Tea Nguyen, DPM (27:35.894)

And honestly, you will never forget that first transaction because it's going to fortify your path into direct care.

Tea Nguyen, DPM (27:51.883)

If you need support, if you feel like you need more support, join me on the Facebook site. That's where I announce when the next coaching cohort is. And you'll find yourself with like-minded doctors just like you who are willing to support you in your journey.

Tea Nguyen, DPM (28:12.396)

Realize that the physicians who succeed are not the ones who have the biggest practice. They're the ones who stay.

Tea Nguyen, DPM (28:21.699)

Realize that the physicians who succeed are not necessarily the biggest practice. They are the ones who start, they stay consistent, and then they keep showing up. You've got this. I'll catch you next week. Take care.