Podcast

Ep 14: How Collaborative Medicine Improves Patient Outcomes and Grows Practices with Dr. Cheng Ruan of Texas Center for Lifestyle Medicine

Listen to the podcast on any of the platforms below, watch the full video interview, or continue reading this blog to see the transcript.

Click on your preferred podcast platform below to listen or watch the interview on YouTube.

 

About Cheng Ruan, MD

A native Houstonian, Dr. Cheng-huai Ruan graduated from Texas A&M University in College Station and received his medical degree from Ross University School of Medicine in Dominica, West Indies. He completed his residency in internal medicine at New York-Presbyterian/Queens Hospital, serving as chief resident. He was named physician mentor of the year by his peers.

Board-certified in internal medicine, Dr. Ruan specializes in the diagnosis and treatment of a broad spectrum of chronic illnesses to emergent medical care for patients 13 years and older. His clinical interests include internal medicine and diabetes. He has created a diabetes reversal program that uses food as medicine.

Fluent in Mandarin, Dr. Ruan stresses the importance of knowledge and education. He is passionate about empowering his patients to optimize their health and lower their risk of disease. A strong advocate of open patient-physician communication, Dr. Ruan is accessible through many avenues, including social media.

Follow Dr. Ruan through his channels:

www.txlifemed.org

LinkedIn

Facebook

Twitter

Instagram 

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Transcript

Hey podcast listeners is Omar M Khateeb your hosts for journey, a private practice. And we’re joined by a very special guests as Dr. Chang, Ron, who is the founder, CEO, and clinician over at Texas center for lifestyle medicine. And I’m very proud to say he’s also a gentle customer, somebody that, uh, before it was Gentium customer.

 

I really hope he can, you know, he joins on board, but he’s a man who has a true vision for what medicine can look like at scale with a very entrepreneurial mindset, which I love because in my opinion, my humble opinion, the best quality medicine for patient care and for healthcare are ones that are run by physicians.

 

So Dr. Rawan, thank you so much for joining us. How are you doing. I’m doing very well. Appreciate, uh, appreciate your time. Absolutely. Absolutely. We know today’s topic is very interesting, which is what does medicine look like at scale? And you, you, uh, have a very quotable quote, which is, you know, medicine, healthcare was not designed scales, design fail, right?

 

Absolutely. Yeah. Before we do that, just, you know, at a very high level, what is your origin story for some of our listeners who are just getting introduced to you? I, I I’m surprised that some people may, may be hearing about you for the first time, because you have a huge Facebook following, I think like five or 600,000 people, do you have a very big presence online, but what is your orange origin story?

 

How’d you get into medicine? Where are you from? Yeah, so I’m from China, uh, immigrate to the U S in 1990 when I was seven years old. So, you know, my mom does acupuncture and herbs, and my father worked for Baylor college of medicine here in Houston at the time as MD-PhD researchers. I kind of grew up in the integrative health mindset and we literally took herbs.

 

My mom had and looked at what it does under the microscope of stem cells and, and, uh, cardio cardiomyocytes and all this stuff like that. And actually got some papers published in the Texas medical center. So, uh, I kinda grew up curious about stuff like that. Right. So, um, so integrative health has always been the normal for me.

 

And if I got sick, you know, I get my mom to do acupuncture and give me some herbs and stuff like that. So that’s really the origin of how I grew up now, growing up in Houston and in the biggest medical center in the world, and having access to some really famous people who I didn’t know, a famous at the time, uh, I was able to have a perspective very earlier on of what residency looked like and fellowship look like.

 

Even when I was six, seven years old, sorry, seven, eight years old, six years old, six years old, still in China, seven, eight years old running around Baylor college of men. In seeing the interaction between the attendings and the fellows and the residents and medical students. And it was, it was, uh, it was very cool for me to, to have that experience.

 

Um, you know, what, what really sparked my interest, uh, was adopting that sort of integrated mindset within a Western medicine field. And part of the reason is because my grandpa. Uh, established a Western medicine mindset into Eastern medicine fields. So he brought in like aspirin and steroids and stuff like that to the Chinese rural population.

 

So he was integrating health on the other side and on other side of the world. And so, uh, and I’m the sixth generation of physicians in the family. So it just kinda turned out that way. And it was something I was passionate about. That’s amazing. And you know, you, you may have been too young to, to realize that at the time, but I mean, when you were running around at Baylor college of medicine, You’re there during like some of the glory years.

 

Cause I think at the time still the, the DeBakey Cooley ran a war on, on cardiac surgery was still waging on. Yeah. So that was probably the heat of it. And, um, being in the, or with a

 

hilarious, yeah, that could be a podcast literally just in itself. Yeah. Or another time I have a lot of stories growing up. Dr. Cooley was fabulous. He actually put me under his wings in and, uh, what eventually was built out to be the Texas heart Institute, thi and I got to be part of the grand opening for that and the research into that.

 

So I have pretty cool. It was really, really lucky to be exposed to all that earlier. That’s amazing because it’s, for some of those businesses that don’t have a cardiac back, I need the baking. This is like Michael Jordan and I don’t know LeBron or Kobe. I they’re, they’re essentially two Michael Jordans in my eyes, you know?

 

Yeah. Literally you’re looking at while in Berlin or something, you know, like old school, literally within less than a mile of each other with the most fierce rivalry in medicine. I mean, I, I kinda miss that style of like medicine like that kind of pioneering. Cause that was, that was amazing that when I was a kid that kind of influenced me in my path to go to medical school just because I was like, man, that’s awesome.

 

Yeah, yeah, yeah. Me too. Let me do that. That really solidify my decision. Yeah. Proceed onto medical training and stuff like that. So it was fabulous. I can guarantee you that the cardiac surgeons and the cardiologists who listened to the show are going to message me and be like, can you please invite them back, uh, for an episode just about the DeBakey years.

 

And so you just signed yourself up also. So let’s talk, let’s talk about your practice because it’s, it’s not your, your usual run of the mill private practice. There’s something very special going on. Just not, not just with the name, but if you go even go to your website, it says a lot. Tell us about, yeah.

 

So, um, so the practice name is Texas center for lifestyle medicine. Um, and this is a prototype practice, uh, as an experiment to see if medicine could be scalable without doing the traditional practice of medicine. What does that mean? So I think that. 

 

Medicine in the US, especially in primary care, has several flaws.

 

And probably the biggest one is also the reason why a lot of practices don’t make it: Communication. Between the physicians, leaders, and the staff. Between the staff and the patients. Between the physician and the patient. Between the patient and the insurance companies. Between us and the insurance companies.

 

There’s so many riffs and I call it the four riffs of medicine. Are those conflicts, um, And before, before starting the practice, I was very fortunate, uh, to be, uh, a partner in another practice where I got to see the intricacies and the business, uh, behind it, uh, for, for few years. And, uh, so Texas center for lifestyle medicine was founded upon the principle that we can incorporate, uh, communication lifestyle and something, uh, really sexy at the time called , uh, basically the social determinants of health.

 

Uh, which is something that the CDC was really wanting to get into the American public, uh, overseen by the, um, by the WHL. Um, so, so talking about social determinants of health, talking about who do they have access to? What do they have access to? Are they living alone? Are they living, you know, are they homeless and stuff like that?

 

So those are really hardly addressed in the primary care setting. And even if they are, there’s not much physicists can do about it. So from the practice of lifestyle medicine, we take all that into consideration. And, uh, we start to build our, uh, relationship with patients, not necessarily as where they’re heroes, but whether they’re coaches or where their guides, if you will.

 

And, uh, and we’re medicine has gone wrong in the us is that physicians are seen as heroes. And I actually don’t think that should be the case. It just seems to really be seen as. And honestly, because heroes suffered tragedies, we call that physician burnout. Right. Uh, but guides are seen in a very different light.

 

It’s like, you know, you watch, you watch star wars. Do you, uh, Luke Skywalker is a hero. He’s suffered many tragedies. Right. Uh, but look at Yaddo yo, this kind of chilling in the corner right there, uh, advising on certain things. And I think that we should really be guides for our patients because they actually speaks to a much higher level of communication.

 

Uh, rather than the hero. And so, and so, you know, if you look at our website, you know, uh, Texas center for lifestyle medicine.org or T X or PCLM, uh, so if you, if you look at what our, our website looks like, and the first thing that you’ll see is the word collaboration, right? Uh, as w we’re we really promote a collaborative type of medicine.

 

It’s not about how good the doctor is about how good your physician team is and what communication is. There is. I can’t tell you how many times my team reached out and gather all the specialists here to have a conglomeration of ideas. And then, and then present that to the patients of how much that impacted patient lives in what people don’t understand.

 

Is that these things are actually reimbursable. There’s actually procedure codes, CPT codes for communication that came out first in 2019. Now it’s even more robust in 2021. There’s a there’s communication codes. If you’re sending patients emails and vice versa or text messages or, or short phone calls, five to 10 minutes, short phone calls, these are all sort of billable events.

 

And they’ve been there for a while. In medicine, but because the practice of medicine is so backwards thinking in that one-to-one doctor patient relationship within, within the, uh, within an office, it kind of imploded into our fixed costs are getting higher. We have to do way more crap with the EMR and documentation and administrative stuff.

 

So that continued to increase our fixed costs. Increasing burnout would that one-on-one reimbursement structure. Hasn’t really worked. And so what we really wanted to do is, uh, to capitalize on not just the one-on-one, but one to many. So we started doing group sessions, which people love the group session.

 

We’ve got so much good data out of it and great outcomes out of it. And we started talking to people in virtual groups and stuff like that. So I think we kind of took, took a medicine into the classrooms. Uh, and adopted a business plan out of it. And now I’m not going to tell you it was easy. It was not failed many times, but we started speaking with insurance companies and then speaking to CMS at the federal level.

 

And all of a sudden, there’s this giant movement after 2020 and the pandemic to do this type of medicine. And that’s where medicine is headed to in the very near. And you said something very important that I want to go back and highlight, which is this idea of doing it as a group, because if you take your usual, let’s just say the stereotypical patient who’s dealing with diabetes, it’s the same talk, track, same kind of questions.

 

Every single time, you know, what can I eat? What can’t I eat? How do I do this? How do I, how do I make sure that, you know, I’m not, I’m not. And so it makes no sense to have to do if, if, if medicine has to get more streamlined, why do that every single time with each patient and not in a, in a group setting.

 

Right. And that’s essentially what you’re saying, which is looking for the inefficiencies in medicine and say, well, in any other industry, they would have done this as a group. Why not in medicine? Is that correct? Uh, yes, but there’s something way higher level than that is that when you’re, when you’re a teacher and a group, You’re you’re officially a guide.

 

You’re not the hero anymore. You’re a God. Right. And you’re actually providing value and it’s not taught to as a medical school, but more importantly, within a group. And this is what we see every time each of the group dynamics of the people within the group are so solid. That’s um, uh, bonds can be formed within a group setting, not between the physician or the nurse practitioner and the patient or the dietician or the patient, but within the group itself.

 

And we see this in psychiatry. We see this in dietetics. Right? We see this AA is an example of that. Yeah. Yeah. So this has already been done. If you look at the definition of a dilemma, dig a drop in group medical visit that was defined back in the early nineties, by the American academy of family practice.

 

Right. And so at that, if you actually Google it and I’ve been digging, it was defining, I think in 1993, And it says, oh, the, the future of medicine with the next 10 years, most people will be seen in groups while it still hasn’t happened. But I think we’re transitioning to that finally after about 20 years.

 

Right. And so I think it’s a very powerful, powerful tool. Fantastic. And, and, you know, it makes, it makes so much sense too, because you know, a lot of times when you’re like a perfect example of someone in my family, who’s a physician at age 40, 45 or 40. They’re diagnosed with diabetes and that, that was extremely upsetting and scary for them.

 

And so for patients to be within a group where they’re not only being taught and being guidance by the physician, but they have peers to do work through this together. It’s a lot less scary. And I’m sure that the outcomes, the compliance everything’s just better because the patient isn’t just by themselves, dealing with this.

 

Yeah, that and we get to celebrate together. You know, tell me about that. Oh man. So many stories, but the first one that really came to mind is as you know, I have, uh, one of our fabulous health coaches, her name’s Jenny, and she’s our mind-body medicine coach. And I remember, uh, going into a group session and we were doing, uh, I presented this data on how breathing exercises can drop your blood sugar, drops to 20 points.

 

I’m like, you know what? Let’s try to prove it. Let’s try to prove this. So it’s called box breathing. So you inhale for, you know, uh, inhale for four, two seconds, exhale two seconds. And it’s like a box. Uh, and then we did it for longer periods. So we did it in. So the, it was, it was published in, in the very, uh, fabulous national journal.

 

And it’s this one guy who has type one diabetes and with the continuous glucose monitor, you can actually see the actual drop here. And then, um, And then it’s hilarious because I was like, I was like, this is crazy. And then like all six people started like applauding and stuff like that. I’m like, we just found a way to lower your blood sugar for free by breathing this doesn’t involve eating a kale chips.

 

Right. So, and so it’s fun when you practice medicine like this, because you get to celebrate together. You get to discover things together. Yeah. And I’m always inquisitive. And we always look at this data of how to help our patients. And it’s sort of this light bulb moment. And then we have other, you know, we have cooking sessions and stuff like that.

 

And, and I introduce people to the idea of a purple yam, uh, which is a resistant starch, uh, which does not elevate bless your very much, but it’s very sweet. And you put in the freezer contents like ice cream. And so we did a thing where, where I gave people this and told them it was ice cream. They really believed me.

 

I was like, no, that’s appropriate. So I think that’s stuff like that, that you get to kind of have fun with. Um, but that, those are just two really cool stories that, that we have, um, that we’ve seen a lot of patients, which, you know, garnered a lot of success. And I do think that’s why we’re so, uh, we’re so passionate about just the process of communicating with the patients, but also also knowing that this is a viable business in the prototype that we.

 

Is not only viable, but it can be scalable as well. I love that. And what I love about this, I mean, I have a bias about positions staying independent and saying I practice, but the other two. Yeah, seriously, you know, I’m I grew up in wa in west Texas in El Paso. My father was a surgeon, had his own practice.

 

And so the kind of medicine I grew up seeing was that a physician, and this is what I, why I looked up to my father and I wanted to be a physician at one point before I went into tech, was that. You don’t, it was, it’s not enough just to be a physician, you have to be a community, a leader in the community.

 

So you, you read these novels with a physician, was somebody who was guiding like local politics and, and, and, you know, helping, you know, being, being a, a key part of the community. And what I love about this is it’s, it’s beyond just practicing medicine, right? It’s giving people guidance in, in their entire life because there’s so many things like what we read in Robbins, pathology, or Harrison, Patients don’t fit in a dropdown menu or box there’s so many, so many things that complicate things, right?

 

Including stress. How often do you think a physician knows how to educate their, their patient on like, Hey, here’s a, here are a couple of breathing exercises or ways you can just easily meditate at a lower your stress. Yeah, absolutely. Right. And we actually, uh, for people coming in and they have high blood.

 

Like, we’re not going to take their blood pressure when you first come in, I was like, you’re here, here’s the 62nd meditation exercise. I want to do it. And then we’ll take your blood pressure again. Cause I don’t believe that this is a real blood pressure. Sure. See, you know, that’s see, I love that because that’s, that’s true medicine, which is this inquisition questioning things and saying, you know, Is this really the real blood pressure or is it just because they, they literally walked into, this is the first time they’re meeting me.

 

They’re feeling vulnerable, you know? So a patient who’s overweight, they’re getting ready to step on the scale and people are gonna see their weight. Right? So these things like it’s common sense when you think about it, but nobody’s stopping to actually question the process and it seems like your practice is leading the way in saying.

 

Hey, these things they’re very easy to implement. They’re not expensive and they make these better and you can scale a business. Everybody wins. So my question is why isn’t, why aren’t more clinics doing. Oh man, simple answers. It’s because of your mastermind is going to roll out maybe in a few months.

 

That’s what we’re doing. Yeah, exactly. It’s my masterminds coming out in 2022, but one of the reasons is, man, that’s not how medicine is taught. You know, that know, um, you go by national blood pressure guidelines and half the patients sit there and take your blood pressure in this way or that. Um, but come on.

 

I mean, we’re the, the, the practice of medicine. Is driven by very specific things we do with outcomes that may or may not fit within a box called a guideline. Right. You have guidelines from American heart association, American cancer society, you know, USP, STF, and all these different things. And a lot of times they, they class, they class with each other, like right now, like as a realtime to get colonoscopy is a 45 or is it 50?

 

Well, depending on which guideline you read. Right, exactly. And I think that physicians are taught, especially in residency. That you want to practice within a guidelines. Otherwise you may get sued, right? And you always see why medicine, right. CYA medicine. And I trained in New York, which means that we didn’t have the great protection we have in Texas here for, for lawsuits, but training in New York.

 

It’s like, everything is a CYA type of medicine. So, so like it’s ingrained within you. Like don’t, don’t, don’t think outside the box. W what happens is that you just guarding him getting more, more and more burnt out. 

 

When I was reading, uh, the, the, uh, the implementation of AI and how it replaces physicians, what’s a selling, replacing physicians because the AI knows the updated guidelines.

 

Right. Um, but as the physician, it’s an artistry. Like we have to communicate with our patients. There’s a human element to it. That AI can’t do. So who cares whether there’s AI or not, maybe I can guide the AI to help me understand things. From a, from the knowledge side, but me as a physician, I still have the human element and the human elements not taught very well.

 

Uh, in medical training. Absolutely. It’s not taught well, and more importantly, you cannot replace it. You know, the AI, you know, AI and technology is really there to alleviate things that a human being should not be wasting time doing. So we can focus on things that we are good at, which is, you know, the human touch.

 

Right. And I think that on the, on a good side, it’s, it’s good. Medicine over the last few, you know, 50 years has evolved to be very rigorous on the science side, on the technology, on the business side. But these things have overwhelmed and literally pushed out the art of it completely out. Like they’re, you know, in my, you know, for the viewers, they can’t see it.

 

I’m in my library, their books. And my father gave me they’re 40, 50 years old on the practice, men and talking about how you’re supposed to touch a patient. Right. How do you, how do you engage with them? How do you look at them? Right. The tone of voice, these things happen. Yeah. Not hot, you know, you’re right.

 

When I was chief resident, uh, and your presence hearing in Queens, um, uh, I held a workshop, uh, for some residents and actually we had a mix of internal medicine residents and ER, residents come in and we actually had some fun cause included some wine, but one of it is like, how do you, how do you approach a patient?

 

And my workshop is actually on. The language of, uh, of, of, of being compassionate. Um, and you know, I’ll give you a really cool example. So, uh, does a patient that came in and he’s like, oh, my chest hurts. And I’m short of breath. Uh, and, uh, I’m terrified and I don’t know what to do. And so the ER docs like, well, don’t worry about it.

 

I got you. Let’s get an EKG. You know, if it’s something serious, we’ll take care of it. Um, well, there’s a, there’s a problem with that. Uh, there’s a problem with that in that you establish yourself to be the hero first, before exploring a little more. Right. And so, uh, one of the things that I encourage people to do for that week is if a patient comes in like that, you know, instead of saying, Hey, this is what we can do, what we can do, what we can do.

 

Uh, ask them, what do you think is going on? What is, what is the worst case scenario and the best case incident of what you think is actually going on the minute you ask that you now empower them to think, so they have a perceived control over their medical journey, right? Which may they may or may not, may not have real control, but what happens is that you just flip yourself into the guidance.

 

And guess what the review scores of those residents were asked from a, can we hire for that week with a challenging questions? Like what do you really think is going on? And then after they asked, what do you think is going on is like, how do you think that I can help you to, to the worst case scenario at this time?

 

And then now what happens is they give the resident the permission to, to be the hero, but it’s on their time. That makes sense. So, yeah. And so that’s permission, permission-based medicine permission-based. And when we got the scores back, I was sitting there with the chief of medicine and, and he, and he was just kind of blown away.

 

I’m like, man, we should do this like all the time, uh, which didn’t end up happening because I left shortly after, as the chief residents come back. Uh, and, uh, and that like stimulated me to think, okay, wow. How am I going to approach patients? So a lot of times patients come in and, um, I stop assuming why they’re in the office.

 

It doesn’t matter what my medical system is putting on their, you know, refills for blood pressure, whatever. Right. And so I’m sitting down, I was like, you know what? I see my medical assistant wrote that you refill blood pressure, but just out of curiosity, what are your health goals for 2020? And that always takes people guys like, oh man, I haven’t thought about that.

 

You know? Um, and so, but, uh, it opens up such a beautiful conversation and then all of a sudden they’re letting things out there. Then the member told anyone because no one really asked them what they really wanted and that, you know, 10 minutes, 15 minutes in the doctor’s office, maybe the only time that year, this patient.

 

Is being asked what they really want, because a lot of times they live in the state of demand, their caregivers for the family, you know, their work, uh, they work all the time or in school time and stuff. And by doing that, you established this beautiful connection within just one or two phrases. And I think, I think just by adopting that behavior, it changes the doctor from the hero to more of a guide.

 

And immediately a lot of the burnout, the doctor’s experience can, can reduce because now the perceived value of a physician is much higher in the marketing world. I used to own a digital marketing company in the marketing world. We’re all about perceived value, you know, um, know I, um, I, we did this thing where, um, we, we sent out questionnaires to ask patients.

 

How long did you think your doctor spent time with you? So for the residents who spoke, uh, in the way that we directed it, um, their, the time they spent with the patient, the perceived time is twice as long as the people who didn’t go through this method. And so it’s the same amount of time, right? It’s the, so the proceed time is, is very it’s it’s, it’s like double and that’s, what’s crazy about it.

 

They may not tell you, you may not remember what you told them, but they’ll always remember how you made it. Absolutely. And it, it what’s, what’s amazing is how so much of this is connected not to get like super meta on you, but there’s, you know, uh, you know, not just within marketing, but even with itself within like a tragedy.

 

And self-development, I tell people that you have the power within your own mind to decide how you’re going to perceive this in author your own life. And there’s a quote that I love, I don’t know where it came. Maybe I came up with it. I’ll take, I’ll take credit for it, but, but the, the quote is, is that, you know, um, that, uh, all, all his mind, the universe is mental.

 

And I think, you know, what you just pointed out makes so much sense because within a certain, you know, everything’s so much perception based. And a lot of times I think, because as a position. The physician might go through how they’re trained. Cause like I need to get this information out, but they don’t realize like a simple question.

 

Like why, why are you here to see us? Right. Simple question. But if it’s asked the wrong way and the wrong tone to a patient, who’s upset, maybe they had a big fight with their spouse. Maybe they’re worried about all these things. They come in and now they’re like, who’s this asshole and why are they talking to me like this?

 

And then they leave and they eat bet. And it becomes a cycle. When in fact it just takes a second to stop and ask, like, you know, Maybe I should just put it on that and get a little extra information and that’ll help me in the long run versus coming in with my own assumptions and telling them what to do is that the right way to think about it?

 

Dr. Wan, we’re not trained to do that. Right. And the other thing to think about it, that piggybacks on what this is, that the most powerful phrase that you can tell a patient is, I don’t know. Okay. And doctors are terrified. And I use that all the time. We truly don’t know something. I was like, Hey, listen, I want to help you.

 

But I don’t know. And I just pause and then they’re like, oh, well, thank you. You know? I was not taught to say, I don’t know, first of all, you know, I’m Asian and we were immigrant family. So there’s nothing that we don’t know, you know, Chinese. Right.

 

Okay. And so, you know, uh, through residency I learned better, but I, uh, and I, and I teach my, my nurse practitioners and my physician partner. Is that, um, the word, I don’t know, it was just so powerful because it’s humility. Right. And so, um, another good example. So we see a lot of, uh, fourth or fifth consult, which means that by the time they see four or five physicians, I mean, where there’s six opinion, if you will.

 

Right. Um, and they, and a lot of these people have gone all over the country or the world or whatever. But they ended up sticking with us. Not because we know more because we don’t know more and they know that we don’t know. No, but guess what? We’ll always have their back. That’s the, that’s the point of collaborative medicine.

 

Right. And so, um, I have a lot of patients that come in and within a new patient visit, they’re like, oh, this doctor did this. And this doctor did this. And this doctor just wants to put me on medications. And every time I’m like, you know what? I want to think this doctor for being part of your journey, because this doctor has.

 

That allow them to care for you, but they only know what they know, but they don’t know what they don’t know. No, and I’m the same way. So let’s forgive everything and let them know that whatever your path you’ve been on utilization in my office, and I’m going to see what we can do to help guide you in your journey.

 

Right. And so, and that’s the language that I like to use with the patients. But like I said, do, are we smarter than other doctors? No. Um, we’re not. Um, but what we are. Is showing that we’re able to have compassion and in collaboration. And we also know that the value of coming to our office is not a prescription.

 

It’s a conversation. And then it’s collaboration. And most people think that takes more time. It actually doesn’t, uh, it’s the way that, uh, it’s the perceived time is more. Um, but you know, so I started using, um, Uh, an AI scribing service. And, uh, and by the time I’m finished and I, and I hit whatever, I’m like, oh, thanks.

 

You know, the last 11 minutes has been really powerful. Like, oh, it’s only been 11 minutes. I was like, you’ve covered more than that. I thought, you know, you can cover in an hour. I’m like, yeah, well, that’s, that’s all we do. Right. And so, um, by the way, I’m a data miner. I keep track of everything every minute.

 

Every second that I speak, I keep track of to see how much I can accomplish to see if things are better. Right. And so, um, so the perceived value, the perceived time saying, I don’t know, is just exceptionally important and letting the patients know that, okay. I don’t know, but I still want to help, you know, but in, and I see a lot of doctors do do the following.

 

They’re like, okay, well, patient, you know, I don’t know what to prescribe you. So there’s not really a reason for you to come back anymore. And the patient takes offense to it. Because the patient perceived the doctor’s the one that doesn’t want to help anymore, which is false. The doctor does want to help them.

 

But the only tool that doctors has is like crest store or, you know, or something like that. Right. And so, um, but instead the doctor could be like, okay, well, you know, there’s nothing prescriptive I can offer you. Um, but if you want to go on the journey of, you know, lifestyle on wellness, I think that’s a totally cool plan.

 

Was this follow up in 90 days? And you go on that journey and I can check your labs again. No one says that, you know, and, and I, and I feel like it’s really crazy that no one, no one says that because once again, the perceived values and the power of. Uh, which, which will mean we’re in 2020, and it’s definitely not the case, you know, cancel culture is out there.

 

People were very, um, you know, people are very critical about professional disease days. And so we really have to adapt to change no, a hundred percent, a hundred percent. And you know, I want to talk about some other areas of scale on medicine, but one thing that kind of stood out to me in your story and everything you just shared.

 

What would we often see? And again, I’m a guy in tech. I built my career in medical technology, et cetera, but these things are invented to supplement and augment and amplify things. When in reality medicine, unfortunately physicians. Yeah. And who, you know, I don’t know, there’s not like a bad, a bad person.

 

Use these things to replace the art versus what you have done is you’ve taken the technology to do the art at scale. Am I right in saying that? Yeah. I mean, you know, I, you know, I’m in, uh, I’m in several Facebook groups, very large Facebook groups with physicians, private practice physicians. And there’s just so much resentment in technology because, oh my God, I have to keep up with it.

 

Or what. And, uh, there’s a lot of resentment in other professionals. Who’s like, oh, you know, we’re being replaced by there’s practitioners and PA’s and stuff like that. Um, I just think it’s not necessary if you understand the business side to things and if you can create solid security structures for yourself.

 

So the point of technology is consistency, right? And so if you’re thinking. Okay, well, what are my five areas in my practice? That’s inconsistent. Okay. And by the way, for most practices, and I’ve done surveys on, this is billing. All right. Front desk, back office, medical assistance, right. And then management is the top five.

 

Right. And billing is always number one. There’s no consistency. I’m like, well, if that’s the case, then you need to adopt technology to cover each one of this, develop the consistency, because guess what a robot’s going to work 24 7 for you. Right. And if you think that, you know, you’re, you’re, you don’t have enough money to build a process and stuff like that.

 

Well, the alternative is worse, which is extinction alternatives. Yeah. Yeah. So I think that by looking at technology as consistency. And working with companies and vendors that are consistent, that speak your same language that can guide you become a better physician or a practice or whoever you are.

 

That’s the people that you want to work with. Right. And that’s, that’s the technology you want to adopt on and, and will also 

 

Take billing for example. Right? So in and no medical practice I talked to, is there any predictable in reimbursement of this issue? Plan would this CPT code over a period of time?

 

It’s just like, okay, let’s look at historical data. Right? Well, you’re a human has to go and look at historical data and maybe put it into the spreadsheet was take a bazillion hours. Right. We want, I mean, this technology that overcomes that, where that’s what Jensen is, right. Exactly. Let’s look at scribe, like on my phone, like scribing, like why can’t a robot, listen to my conversation with the patient and then put it for me into my, into my EMR.

 

You know, we have that. Um, and so that helps me have eye contact with a patient when talking to them, which is exceptionally important. And then you look at staff. Okay. Um, most medical practices, I have a tremendous amount of staff turnover, and most of the time it’s happens when the doctors ask you away on vacation.

 

Um, cause to lack it to, to avoid confrontation, I was like, well, why don’t you have SLPs and systems put together on some sort of digital platform? So that every person that can be trained the same way, you know, that’s literally why I worked at McDonald’s when I was in high school. So I want to know how they’re training.

 

And I went through McDonald’s university and there was so sequential, you know, if you look at Starbucks is the same thing. Like every step is accounted for. It’s crazy. And so we’ll put that into a systems. We have online training program through another company called channel, uh, that has all our training programs.

 

We have videos for everything like that. And if someone screws up, it’s not because we first think it’s not because you’re incompetent. Maybe wouldn’t include the training program. And then if I see that you did in the training program and you pass this section and a little test right here, then we can say, okay, maybe there’s some competencies skills that we have to to do.

 

Right. And then, so that’s quality control of your, of, uh, of your business of your employees because they are, they are your right hand. Right. And then there’s, you know, front office, back office, all of these things can be streamlined with technology. Why technology? Because the cost of healthcare can be significantly cheaper if you have the right technology.

 

And, and when I say cheaper, I don’t necessarily mean just cheaper for your current practice. I’m saying cheaper as you scale your practice because a lot of these are completely necessary to scale. You know, private practice is designed not to scale. That’s how medicine works. Yeah. A hundred percent. And I think that, you know, a lot of this, again, like going back to the other theme, which is the idea of reframing and perception, right?

 

I think that the culture of medicine is very much based on, you know, even though the art is not as practiced, it’s not practiced as much. The culture of it is rooted in art. And so the idea that you go and put in your 10,000 hours to medical school training, et cetera, et cetera, you get out and you find out that there is a robot or a technology that does part of what you do.

 

It can be upsetting, but the technology is not, it’s not good or bad. It’s, it’s, it’s, it’s an eminent inanimate object. What you make of it is what’s important. And so either you could fight it and say, I don’t get it. I don’t like it, et cetera. Or you look at it and say, I have no, I have no choice. This thing is here in my environment.

 

So how do I incorporate this and adapt it? And if I’m not doing this, so this part of my time is not being used for it. How do I scale something else that technology can’t help you with? Right. And I think, I mean, this is by no means should anyone ever compare marketing medicine? But just as an example, I remember many years.

 

When the algorithms on Facebook and different things got better. A lot of marketers performance marketers got pissed because they were really good at doing that manually. Right? Yeah. So I didn’t fight that. And I said, okay, that’s great. I just like, I can’t, this is not going away. So while that’s happening and other marketers spend time, Trying to fight against saying, no, I’m better than algorithm that you’re not going to be better than algorithm.

 

You’re an idiot. This is, and this is back in the early, early days when Facebook released the app half, I said, okay, well, now that I’m freed up there, I can’t do it. I can’t beat the AI there. What am I better at? I’m going to be better at copywriting. I’ll be better at design. I may be better at other things.

 

And lo and behold, that’s how I was able to move up in my, in my career. Right. And then these things, they all, they all, they’re all very cyclical now. Facebook’s uh, Facebook had to change on their algorithm. And so you can’t just throw things on the algorithm anymore. So now the marketers who spend all this time, just like throwing things on that algorithm, they didn’t spend the time scaling on the creativity side, the design, the stuff that actually makes sense.

 

And now they’re having to start over for me. It’s just like, well, it’s another change. Like anything else you just changed with the time scale? Yeah. Um, I’m going to use exactly what you use, but I’m going to direct to that medicine now. Right? You read my mind. Thank you. That’s why you’re great. So check this out.

 

Um, and uh, I actually do think that that medicine should be compared to marketing because I’m going to do it right now. So you talk about Facebook with this gigantic entity. All right. So instead of Facebook, let’s call that CMS center for Medicare and Medicaid services. I already love where this is going.

 

All right. So the problem is, um, with digital marketers, they’re looking at algorithm cause they have metrics. Doctors don’t have metrics, man. You know, even the large institutions don’t have these metrics. When they look at what CMS is putting out what United healthcare blue cross blue shield, because it seems too complex.

 

Right? Um, Um, but your livelihood depends on it, but then you’re busy being a doctor and serving the patients and being that hero. Right. You got to be a hero to yourself. First, your self and your staff. I mean, they come first for yourself, your, your family, your staff, that they all come first, um, before, before the actual patients do, because that’s what drives the system.

 

And that’s what decreases medical, uh, liability also decreasing medical errors, you know? And so if. The algorithm of CMS has completely changed starting in 20 19, 20 20 blew up 2021 complete massive overhaul. How many of my physicians friends know the new E and M and CPD guidelines? Very, very little, unless I’m the one who told them about a first, I actually knew November.

 

So two months before it came out, November 15th is when AMA had their meeting, which I attend. To figure out why these guidelines will put out in the first place. Lo and behold, they put it out back in 2016, but it didn’t take action until coronavirus made them take action on it. Right. So now look at 2021, the 2021 AMA CPG panel came out with all these different, uh, rules and new codes and took away old codes and stuff like that from audiology to physician visits, to neurology and all this stuff.

 

And so the algorithms has completely changed, man. It’s got, it’s completely changed. And unless you have a system to monitor that change, you don’t know what’s going on. If you don’t look at your revenue cycle or if you don’t know what our revenue cycle is, that’s a big problem of your private practice.

 

You’ve got to know what a revenue cycle is. And if you look at your revenue cycle and you’re like, I don’t know how I made this. Like, you’re going to be screwed when the algorithm changes even more, because you’re gonna be so behind, you know, that’s why, you know, Jensen is so it’s such a valuable thing

 

But if you take that to every aspect of what you do, um, look at, you know, SEO search engine optimization within your, uh, your clinic, a website, or you look at these algorithms.

 

Those are really important to see because, because these are algorithms that dictate your livelihood and your longevity now, CMS, because we have so many medical. And private insurance patients. Uh, we’re actually, they’re all pretty much all of them are, um, that we have to look at that to understand how to scale and how to adapt to risk and view risk things that are too high of a risk for us to do, and sort of narrow our focus on different things and be absolutely essential to the process.

 

Right. And so, Your digital marketers. They know the algorithm of YouTube. I mean, YouTube is a huge change in November, 2020. Look at Facebook, uh, Instagram. Uh, TechTalk whichever it is, but man, like why, why aren’t physicians really looking at the CMS changes because it’s it’s complex and they don’t have the tools to know what the revenue cycles are.

 

And so everyone’s kind of falling behind, right? So you got to adopt a technology to do this. I’m sold you’re out. You know what? I changed my mind. You’re absolutely right. That is the analogies. Aren’t good at persuasion, but they are damn good at explaining things. You are absolutely Craig and that makes complete sense.

 

And at least from the marketing steps, We have to keep up with these algorithm changes because what was working organically or even paid even a few weeks ago or a month ago may not be working now. And if you don’t know about those changes, you don’t monitor it. You end up spending a lot of time, which you don’t get back or a lot of money, which you, you know, at least a budget wise, you definitely don’t give back.

 

And this is the thing that, that is shocking to me. This is kind of what brought me to Genta, which is. And every other business, you open your shop. Hey, you do a service. You get paid. Look, when I was talking to, I talked to a physician earlier today on a private call and he said, the thing that pisses me off the most as a surgeon is that I’ll go do a procedure.

 

Okay. And depending on the type, the patient and insurance type, I’m going to get paid differently for the exact same thing. And I’m going to pay, you know, at some point in the future, the rep. Who comes and brings the hardware for that case is going to get paid at the end of the week, the same amount, regardless.

 

Why is that? And so, because of those things, positions more than anybody need data-driven strategies and technologies. If you don’t have that, you’re, you’re going to get farther and farther and farther behind. Why some of these physicians and practices of, and helps they have like, you know, a million or 2 million in AR or they have, you know, 300,000, like for example, 300,000 in hidden revenue, that’s purely preventable.

 

And there’s like, oh, we had no idea, you know, cause it’s in a spreadsheet somewhere because you’re relying on a human being to do it. Yeah. Um, 300,000 is a small number for most practices that we actually look at, you know, Um, that, you know, the no, one’s, you know, here’s the thing. And I was talking to my, my good friend.

 

Who’s actually starting a pediatric practice in Houston. And, um, and you know, the startup, doctor’s always like, yeah, I’m going to start doing billing myself and get a website out there. I want to use a Wix account or whatever it is. Right. And so, which is, which is fine because that’s literally how I started in the very.

 

Um, but the problem is, is that you got to learn from the mistakes of other people who’ve been in your shoes. Right? And my mistake was, I did not know my numbers. I knew, uh, down to the thousands of dollars, I didn’t know, down to the penny. I want to know down to the penny. Now there’s anything my CFO has taught me is that you’ve got to know things down to the penny where they come from.

 

When are you going to get your money? And there’s gotta be a percentage predictability that’s on it. And that’s how you drive business. 

 

We are right. That rep that sells the device or the meds, whatever it is, it’s the same, there’s a predictability for it, but that’s actually not a bad thing is because if you have variability and variety and reimbursements, and if you have the right data, then you know how to, what to do with the data.

 

So if you know, I was talking to an orthopedic surgeon for example, and he’s like, dude, you know, I get, you know, two times more for, for doing this. Um, uh, from United healthcare than I do from, you know, Anthem and, uh, and I’m like, well, do you have data on, on, on, you know, metrics and improvements is like, yeah, I have data on, you know, patient metrics and outcomes and stuff like that.

 

And then also while you have that, and then if you have a revenue that’s generated by other insurance companies, is that you had that, this is not fair. Why are you down here? And I did this with signal last year. Like, why are you down here? And everyone else is down here. Look how much value provide most doctors don’t know.

 

They can go to the insurance companies. Talk about the contrast and the change. And like everyone can change it actually. And so that, and that part, people were afraid. I was like, oh my God, I need a lawyer and stuff like that. No, just had a conversation. I was like, listen, signal. Like you have you ensure the city of Houston public services department.

 

And we have X number of patients and we have reduced their hemoglobin A1C of diabetics. And prediabetics to this within the three month period. This is us compared to the benchmark. Why are you giving us like 40%, less than blue cross blue shield right now? Or, or 17% less than Medicare fees? Like it, it doesn’t make sense to us.

 

Right. Um, and so once you start the conversation by value, they will actually list insurance companies a little bit. Listen, but you got to have the data. You got to have the graphs, you gotta have all that stuff there. And using as ammunition. That’s what drives. I mean that one conversation with insurance company and Kim B multiple millions of dollars over the next five to 10 years for your practice.

 

And it’s that huge, that’s, that’s amazing. And, you know, again, you know, being so busy, I’m, I’m very grateful that you’re spending some time with us and I want to be respectful of your time, but just to kind of wrap up on a couple of a couple of topics. So, you know, and I’ll leave, I’ll leave links for the show notes, personal, you know, I wanted to ask you.

 

You know, some of the key pieces of advice you give to some of the, uh, practices that you’re coaching. But before we get to that point, I know you have a very special summit coming up for private practice. Can you tell us just a little bit about that? Yeah. The physician practice, AI upgrade summit kind of a long name, but, um, it’s designed for private practice docs who.

 

Uh, maybe a little burnt out and one to, uh, have consistency in different parts of their practice. And I call it AI, um, partially because we have companies that feature the AI products, uh, to improve healthcare. And a lot of them are asking a physician, ran a physician owned companies. Um, so it’s, it’s a nice peer to peer discussion, right.

 

But more importantly, um, that really is a lead into discussing things that are. Truly more emotional on the private practice side is how do you stay within private practice? How do you avoid burnout? How do you have better personal relationships, not just with your patients, but with your spouse and with your family and stuff like that.

 

Once I really want to have a very raw discussion, uh, with physicians, with companies about how to tackle the pain points. So that’s what the physician practice AI summits is about. It’s coming out October 18th is the first day. It goes for seven. Uh, at least until unless we get more interviewees, it seems like a lot of people want to be on the summit.

 

Um, but it’s a virtual summit. And if you go to a new practice, coding.com, um, actually is a sign up for the summit, but you also get a free gift. Um, you get the 20, 21, uh, CPT communication guidelines is actually a flow chart of how do you bill for emails, text messages, and phone calls with the patient.

 

And whether you’re a provider or a medical staff or mid-level and whatnot. And so it’s something that I put a lot of work into, but it’s a nice one. She did that kind of tells you that’s fantastic. That’s fantastic. And I will leave the link for that in the show notes. Now, something that I want to leave the audience with, and I know that we’re going to definitely have you back, but you know, with the practices, you know, uh, that you, that are able to get ahold of you, that you do coach you, it, you know, for the private practice owner, who’s listening to this right.

 

You know, you mentioned knowing your numbers down to the penny, you mentioned leveraging technology, but if you had to say they were going to, let’s say, listen to this podcast and tomorrow they’re going to wake up. What are three things that you would tell them, Hey, this week, these three things, you make sure that you do these three things is week or know them.

 

What are those three actions that, that can kind of get them started towards building that scalable practice? First thing is ask the people around you. What are the strengths and weaknesses of the business, uh, and also ask your spouse or the family around you. Like, what do they wish they see more out of you?

 

Is it more time? Is it, you know, being more present and not being on the cell phone, taking call and stuff like that. And it’s basically, it’s like a check-in for yourself where you are. And when you know where you are, you define where you want to go and be uncompromising about it. Right. And so, um, I find that no one, no one truly understands where they are until they ask for it, for the people around them.

 

And then another thing is, um, you gotta be open to conversation. Uh, of the, the people who, who you perceive the most uncomfortable to talk to, those are the people that you need to talk to, um, because you want to be able to have knowledge from every angle. And, uh, part of my coaching is that I get everyone to fill out a disc, uh, assessment, DIC personality profile, uh, and, uh, and people who have different this assessment speak very differently.

 

And a lot of times I can even predict the conflict between team members. Even before it happens, I write down on a piece of paper. And then when it happens at plum, a piece of paper is here. I wrote it back two weeks ago. I knew this was going to happen. You know? Uh, so, and so I, I wouldn’t know that I not understand the characteristics of people’s personalities.

 

There’s always ways around that. And then the last thing is you gotta be truthful to yourself, you know, uh, optimism kills. Uh, and I know that because it’s killing me multiple times. Well, I survived that. Um, you know, just my disc profile is a high I, which means it’s very influential, which means optimism is always, always there, no matter what.

 

Um, but, um, there’s cautious optimism that you really have to take and you can’t just assume things are going to be good once you develop the, the procedure for O once you set it there, there’s no such thing as set it and forget it in life or in business ever. And you have to keep on top of exactly what’s going on and be that.

 

Uh, and be that leader for yourself as well. So and so on compromising road of where you want to go, that’s fantastic. And even for somebody who’s not a physician, you know, that those are, those are very valuable things that I’m going to take to heart. And I can actually impart that on some of my team members even.

 

So thank you for sharing that. Now, the last part of the show, you know, to kind of wrap up, we do a, sort of a fun, rapid fire questions. So you can answer these as quickly as you can. Or take as long as you want. Okay. You ready? All right. So my first question to you, it’s an easy one. Um, medicine’s about continuing education, right?

 

So there’s no stopping and learning. What’s a book that you felt that you’ve gifted or recommended more often than not people and why the book is a essential ism. Uh, basically it’s the art of doing less. Uh, and if you know, this one, one phrase may really describe your life. If you’re listening to it, it’s the phrase that, you know, complexity is the enemy of progress.

 

And I think that as physicians, we adopt things that are very complex and may not really need to. So I think essential ism is a fabulous place to start. And it’s not just about business. It’s about your life and, and labeling what’s essential. Absolutely. It’s a great book, by the way, it helps put things into perspective, very binary.

 

I all right. So my next, my next question to you, um, obviously you’ve had some fantastic mentors. I mean, you, you know, your mother and father, you’re very grateful to have those kinds of people in your life, but, you know, as you grew up and went to medical school and then residency and fellowship and, and what that you had some mentors along the way that helped you, what was the most memorable.

 

But painful thing, a mentor ever told you that changed who you are for better. You are not who you hire. You are, who you don’t fire. That is Tony Robbins. He’s a great mentor of mine, uh, that, and I’m a disc profile. I’m a high I, which means that I fear lack loss of connection that still hits me. And as I say it, I just get shivers down my spine.

 

Um, But that’s the absolute truth. And then I’m going to put two on here, actually. Yeah, no, please. That was a hell of a answer. And the second one is you get what you tolerate. They go very well together. Right. And I’m not going to expand on it because if you’re listening to me know exactly what I mean. I L I love you.

 

So you made it into my quote book and in my garage gym, I have a quote board. I put things up that I want to remind us that those two are going up on there. Those are fantastic. Well, all right. So my last question to you, I want you to imagine that for the next year, gen 10 is a startup. We don’t have this budget just, you know, within the next year, let’s pretend.

 

I come in and say, Hey, we, we, we took out an advertisement and now we have every single billboard in every major city, every small town, everywhere, and every private practice physician or private practice owners going to see this billboard as they go to work everyday for a year. What message do you put on that billboard?

 

So many things come to mind. Take a moment. Yeah. It’s it’s, it’s a, it’s a doozy. Um,

 

don’t forget yourself. Why do you put that on? Why would you put that? Uh, we all forget ourselves. You know, once you get into this heroes mentality, you want to do X, Y, and Z. We all, we all forget ourselves. And once we do that, that’s where burnout really happens. And it affects every part of a physician’s life, you know, personal professional and everything like that.

 

You know, uh, and as you’re asking me this, I’m just thinking of driving on I 10 here in Houston and I’m like, man, that’d be really cool. It’s like, don’t forget yourself. Like, okay. And the other thing is that I think that one phrase means so many things to so many different people, but always brings them back to the core of who they truly are.

 

The altruistic person that they have inside a hundred percent. And I think, I mean, I’ll send it to you, but there is a post I made on LinkedIn that, uh, generated a little. Uh, passionate responses from physicians about an article that came out about physician burnout and mental health issues. And I think what you said strikes right to the heart of that.

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