Episode Transcript
[00:00:00] Speaker A: So with the one star reviews, and I've got a couple as well. Right. I think those are perfect because you want some bad reviews, right? This is going to sound crazy. The reason why is because if you have, like, all right, I've got a co resident, he's got about 600 reviews and they're all five stars. I mean, when you see something like that, you know they're fake. But you throw In a couple 1 star reviews, it makes all the other reviews seem legitimate. And if it's about insurance bs, it's not related to you and your health care, then it's perfect.
[00:00:24] Speaker B: Welcome to skin deep. I'm Dr. Anna Chacon, and today we have a very special guest joining us. Get ready for some expert insights you won't want to miss.
So thank you. I've been following you a lot on LinkedIn, everybody. This is Dr. Daniel Paul. You have a lot of followers. You have. I think LinkedIn had a term for you even that when I logged in the other day, it was voice or something, right?
Yeah, it's someone that has like a unique voice and following.
And you're an orthopedic surgeon. I was very intrigued by your story of how, how and why you became an orthopedic surgeon with. We have a few things in common. I noticed you have something in common with Miami. Either you did med school or residency there.
[00:01:09] Speaker A: Yeah, I did med school in Miami.
[00:01:11] Speaker B: And then I want you to start with little Daniel, little Dr. Daniel, and where you're from, how you were inspired to pursue this career and how he became the surgeon that you are today.
[00:01:22] Speaker A: Going back, I mean, there was nobody in my family who was a doctor. I'm the first one, really. And they're all sort of engineers. And that's probably what I would have done had I not had a bad skiing accident when I was 14.
So I'm lucky, really to be alive. But I skied into a tree and I broke my right radius, ulna, both my femurs and my left tib fib, like, all at the same time. And it was pretty bad. I mean, thankfully I didn't hurt anything else. So, I mean, you know, I missed a few years, a few months of eighth grade, and I was basically recovering and I had all these orthopedic surgeries. And I went from, you know, being just really essentially crippled to like, oh, I'm running track the next year in high school. And I'm like, this is pretty amazing. Like, I think this is what I want to do. So that was sort of the Moment that I, I decided I wanted to do ortho and like most typical ortho people, I just didn't really think about much else and I guess just sort of went for it. I mean, there's a caveat to making decisions like that. No, a lot of docs make decisions through a story or something similar when they're of some, you know, an age, you know, like that. And it seems like an advantage at the time because you're like, well, I know what I want to do. No one else really knows what they want to do. I know what I want to do. But you know, your 14 year old self is making decisions for your, you know, 30 year old self, your 35 year old self, you know, so it sometimes, you know, when you get around to the other side, it's not maybe what your 14 year old self envisioned. And then the needs and wants that you have as like a grown person are different than you had as like a young teen. So I will say there's that caveat to that.
[00:02:51] Speaker B: You have your own practice, Easy Orthopedics. Tell everybody a little bit about what makes your practice different, how you aim to change the system a little bit. Because I do have a little bit of a hybrid practice myself. I'm trying to get away from insurances and it's actually very easy because you can't get on any insurance panels in South Florida. They're all saturated or closed to new physicians. So most of my patients are self pay anyway.
Not necessarily by choice, but forcibly self pay.
[00:03:23] Speaker A: Sometimes those things work out for the best. So fast forward a little bit and I kind of tell you why I started it is so yeah, get into medical school, University of Miami. Had a little taste of Jackson, that was enough for me down there.
Place is rough, man. And do my orthopedic surgery residency, everything goes fine. And then I started a fellowship in hand surgery. I was going to be a hand surgeon and just do hand surgery. And a couple things happened. One, it was not a very positive educational experience.
I didn't have to be there. I won't go into the details, but you know what I mean. So that's going on. I'm also looking for a job. My wife's from Colorado and at this point I dragged her all over the country, you know, and then we're trying to go back to Colorado where her family is. And the jobs out here are just real trash, you know, like they want you to take all their call for their entire practice or hitting you with a four month guarantee or you Know, these things are just not great, you know, because of the desire for orthopods to be out here. So then I interviewed for a job out in Connecticut and man, it was just some old bitter senior partner telling me how much money he made in the 90s. And like I was like, man, this seems this, it was like an existential crisis moment where I'm like, well you know, you're grinding away for so long. Am I just going to keep grinding? I mean, or is it there like an end to it? You know, and it just seemed like you get taken advantage of. I mean look, you're getting an education and training, but just seems like someone's always taking advantage of you. So it was that combined with the fact that the fellowship was not really good in my opinion. And so I quit. Yeah, I quit my fellowship, I broke my lease, I moved out to Colorado with no job into my in laws basement. And I always say I had a friend who started a house call practice in Miami actually doing sort of internal medicine type stuff. And I'm like, you know what? This guy's doing better than anybody I know. He's happier than anybody I know. And I'm like, I'm just going to go for it with orthopedics. I don't really know what it looks like but like that's really sort of my only option. And like I knew I couldn't take any insurances because like I can't afford it would just be incompatible, you know, with like my small size and everything. Like I would go out of business so fast. So it was became insurance free and I started almost six years ago now and just kind of roamed around mobily and sort of figured things out. So yeah, I don't have an office. My staff is just me and my wife. There's no mas, there's no anybody else, we don't take any insurances. I've opted out of Medicare. I'm still mobile to this day. I go see patients at other people's offices and we don't interact with any insurance companies, at least not regularly. Very rarely if like we're sort of forced to. But like a prior authorization for someone who wants to use their insurance for an mri. But yeah, it's basically insurance free and I think it's just so much more sustainable. It's so much more enjoyable to practice. Patients like it so much better. And you know, people, some criticisms are like, oh, you're just seeing healthy and wealthy people and like as you know, that's just not true at All. I mean, there's plenty of people who I am the most economic option because they don't have health insurance or their premiums or their deductibles too high. So it fits a nice niche. And you know, over the past six years I've sort of been working to kind of, you know, flesh that out.
[00:06:14] Speaker B: I had a patient myself that NF1 and I'm the one that take all the neurofibromas off. Not people on his insurance plan has over a thousand choosing me to come every month to remove them, you know. And I also like you. I don't see. I see a mixture of people. I wouldn't necessarily say my practice is concierge. It's more like a. A dermatology, urgent care, to be honest.
And yeah, that's kind of what it's working at. What is the name of the physician in Miami with this practice? Just curious.
[00:06:47] Speaker A: His name is Jared Mate. Dr. Mate. His practice is called Pulse and Remedy.
[00:06:52] Speaker B: Yeah, I heard of it.
[00:06:53] Speaker A: You heard of it?
Yeah, I know him from med school and like, you know, he's just. I don't know, he. He sort of figured it out real early. And you know, everyone has their own flavor of how they do their sort of own practice. When you get into these like small practices like yours and mine and his and you know, they kind of work out to, you know, you have a desire what you think they want to look like, and then they'll look like what they actually look like.
[00:07:13] Speaker B: Yeah, correct. And it's important to evolve. You're a mobile practice or do you have a location?
[00:07:20] Speaker A: So we're still mobile. I mean, so. But most of my patients, I'd say probably 90% are in offices these days because it's other practitioners offices and they want me there to see their patients. So I kind of bounce around at different offices and they'll let me bring some of my own patients there. I still do house calls. I mean, it doesn't really make a difference. I'm always bringing my stuff around anyways. So, you know, whether I go to someone's house or I go to an office, it's pretty similar experience, you know, except there's one office that has an X ray machine that I'll use. So like that, you know, there is a difference. Or I'll do prp. Obviously I'm not doing that at someone's house. But yeah, for the most part I'm still mobile.
[00:07:54] Speaker B: I do house calls too as well. Not, not as common, but for elderly patients who won't Come to see me. Otherwise, I do that. What about these EMRs? Because I know you mentioned you use Google a lot and actually I use the same where we're having this podcast right now, Google Meet. It'll actually transcribe everything. It'll include a summary and it'll. It's just very easy and you can have a baa and it's, it's very, very affordable. But you could really get trapped in private practice choosing one of these expensive EMRs. You were talking about the Epic campus. I almost, after watching your video, I almost drove there to actually look at it because I was just so outraged. And I was like, I can't believe this. And their contracts are really, you know, modernizing medicine is also another one that's super expensive. Tangles you in for years. In fact, I had a contract with them and I had to break it because I couldn't see a patient. I was, I had a patient scheduled that day. Couldn't reach anybody. I couldn't even log in. I was like, you know, this is really, is not going to work. I need to be up and running, ready to go. And then I actually broke the contract with them. It was actually pretty easy. What do you have to say in terms of EMRs and independence from EMRs and a practice like yours?
[00:09:13] Speaker A: So, yeah, I just want to focus on that Epic medical campus for a bit. So for your listeners. So if you've never. If you don't know what I'm talking about. Epic is an electronic medical system, record system that's in like most hospitals, it's considered sort of the better, one of the better ones. You know, when you compare it to something like Cerner or something like that, which if anybody has experience with Cerner, they'll know what I'm talking about. It's like The DMV of EMRs, anyways.
[00:09:37] Speaker B: Yeah.
[00:09:37] Speaker A: So they're in all these hospitals. And, you know, it's rare in healthcare that you get to see the level of wealth that exists in, in the system. You know, it's about 20% of the GDP of the richest country, you know, in the history of the world. We're considered the United States right now. And if you look at the Epic medical campus, I believe it's in Verona, Wisconsin. It's still privately owned by this lady who started it, I think in the 70s. I mean, she's a billionaire, obviously. And it's just crazy, man. They've got all these different buildings. They're all themed like Alice in Wonderland building. And it's like all this sort of like one looks like Harry Potter, you know, and you get to like, a sense of, like, all this decadence of, like a company that's making money off, like, our dysfunctional healthcare system. If someone's not in the medical field, they're usually like, whoa, that's cool. If you are in the medical field and you have used something like epic, usually it's pretty sickening. The level of like, you know, I mean, looks super cool, don't get me wrong. But. So I was, I was talking about that. But anyways, to answer your question, for EMRs, so if you're not taking insurance and, like, you don't need all that crap, like, you really don't need one of those EMRs, they're essentially billing machines. So if you're not billing, then you don't need them. So what I've done, and it sounds like what you've done too, is through Google Workspace, you can sign a baa. And HIPAA haters will always tell you, you gotta make sure you complain it is compliant. You sign a baa, it makes all Google's products and you're paying for this, by the way. It's not like free. It makes them all HIPAA compliant. So I just have, on the, on the Google Drive, I have a folder for each patient and it's all HIPAA compliant. And, and I have a templated Word document. So when I need to make a new note, order, record, review request, whatever, Super Bill, I just template a Word document, save it as a PDF and then pop it back in. They all sign in my consent forms. It allows me to email them, and the email is all encrypted and everything. And, you know, I pay $18 per user per month, and I have two users, so that's $36 a month for something which is super functional for me. It's very efficient. I mean, I can even look it up on my phone, you know, like if I missed a note or something, I'm in the office of the patient and they just load up the Google Drive and there it is, and everything's all contained under one thing. There's absolutely. There are EMRs built for direct primary care docs like Atlas, I think is pretty good. Hint might be all right. And they're sort of built for that and much more affordable. But if you're a specialist, like you or me, I don't. We don't really need all those, like, reordering medications, or at least I don't. So I'm having very episodic Care. So that EMR works good. And, you know, I do a lot of medical legal work and the lawyers really like all my notes because, like.
[00:12:02] Speaker B: You can read them and then what do you use for your prescription portal.
[00:12:07] Speaker A: In the state of Colorado is probably different than Florida. I don't need to electronically prescribe stuff, so I'm pretty old school that where, you know, I'm just writing out scripts when I see them or calling them in. So I. I think. I think where you are, you probably have to be able to do that. So I don't really have a solution with electronic prescriptions because I just sort of write them at the time I'm there.
[00:12:28] Speaker B: Okay. And who are the two users you and your wife you talked about? You work with your wife as well, right?
[00:12:34] Speaker A: Yeah, she's the other part of the practice.
[00:12:36] Speaker B: Excellent. What is her role and do you find it challenging to work? Because one of the.
I'll just say, personally, I do have a family member that works with me. I do. He actually is from Cuba. He crossed over through Arizona in the middle of the night a couple years ago and ended up in my dining room. And he used to be a surgeon there. And he's very good surgically when he's assisting me.
But looking back, it just. When there's a disagreement, it's sometimes very difficult with friends or family. Looking back, I probably would have not started with friends or family, just personally. However, I do have friends in private practice that have been burned by people who just didn't care. You know, they were. They even feel set up, reported the board by just unhappy patients or people that knew too much. Maybe they knew how much revenue they were making and just, you know, you know, handed them to the board. And I kind of know that that won't happen to me with friends or family, but. Or have that assurance that they care. Have you noticed it's. If it's difficult or not. What do you like about it? What do you not like about it?
[00:13:45] Speaker A: It depends who the family member is. You know, I mean, obviously it's a big step to start working with one of your family members if you haven't before. It's just work for us. We try to communicate a lot, and it's not like we're working right next to each other, you know, because she's basically working from home. And then whenever I'm seeing someone, I'm out. And, you know, I established a lot of these systems before I had her start working with me. So she was sort of able to ease her way in. She's good at that stuff. So I kind of try not to micromanage and we just make sure we have good communication. Yeah, it just sort of works. I mean it's hard, I guess it's hard to really explain why. But as long as we respect each other and you can communicate well and you both have the same goals, I think that's important.
And like we're in different domains, I think that helps as well. So I'm doing all the medical stuff. I take care of the finances and some, you know, contracts with whatever and she'll do some other things. Like she does like a lot of the medical legal follow ups and you know, obviously answers the phones and schedules patients and that sort of thing. So we have like different set of things that we do and I think that helps as well. We're not like both trying to do the same thing.
[00:14:47] Speaker B: What do you do for the business aspect? How do you kind of manage that? And did you have a business plan? Do you have like bookkeepers, CFOs or things like that that help?
[00:14:57] Speaker A: You know, this model does not. Is not a high volume model. Right. It's a low overhead model. So you know, it's not like I'm, you know, some days I'm running around, but some days I'm not. So I, I have the time to invest to just figure the business stuff out. And yeah, like you, I didn't have any business skills when I started. I sort of had to learn by trial and error. For me, what's helped a lot is reading a lot of books, not necessarily even on business, but on behavioral psychology.
It sounds sort of strange, but if you can predict why someone's going to do what they do and you know, small business is all about relationships. You can kind of figure stuff out like, you know, like why is this person doing this? Like why are they like, you know, what are someone's true motivations? And that sort of helped me plan. I mean as far as all the other stuff, it's just fairly simple. I mean just like spreadsheets and you know, accounts receivable and making sure and then yeah, I mean experts. I have an accountant of course, so I did consult with some in the beginning, like for make sure I was compliant and that sort of thing. And I don't think I have in quite a while. I mean since it's been running, you know, sometimes you need a lawyer for, for whatnot or to make a contract for you. So I use them when, when I really need to. So I guess yeah, but I don't think I've ever used just like a general business. I mean, at this point I understand my business better than I think most other people would. So I don't think it would be super useful.
I mean, for the most part, I mean, I don't know, probably, you know, I'm not big on marketing. I just, I used to network a lot. So I mean there's always that aspect of the practice, but it's been growing organically so pretty much do it myself these days, me and my wife.
[00:16:24] Speaker B: You connected with this community of physicians on LinkedIn. People who embrace this, you know, non insurance model and you really became a leader in that model. I would say that you're a leader. I read your post. When you post, I repost some of them. I very much believe in it. An example, I think it resonates with people because. And it, it's important to get out there because there's a lot patients don't know. For example, at least in my practice, when people get upset with us, it's usually it has to do with insurance. Oh, I'm not a network. Okay, well why is Dr. Chacon not a network? It's because they won't accept me to be a network because a lot of panels in Florida are actually closed. So if you're not part of a big system or a big private equity group, you actually cannot even get on.
In fact, I tell patients, I show them rejection letters. I try to be transparent. I post online.
For example, Oscar, you could apply right now to Oscar as a dermatologist and by this afternoon you will be rejected by Oscar because they're full. It's not merit based. It should be illegal for you to go to school, be qualified, be board certified and never be able to treat the thousands of patients on United States or Oscar or any of these plans because they just choose not to have you. Because it's easier for them for their panels to stay really small so they don't ever have to pay doctors to see patients. You know, it's better for them to make a patient struggle to get care than it is for them to give you a contract and say, okay, well yeah, you can actually see a lot of patients.
So most of our reviews if we about 4.8, 4.9 stars. But if you look at the ones they usually have something to do with money or insurance, you know, not being a network, nothing to do with quality of care or the care itself. Did you know that a lot of these panels were closed? Because I did not until I started my Own practice. I had no idea.
[00:18:25] Speaker A: So with the one star reviews and I've got a couple as well, right. I think those are perfect because you want some bad reviews, right? This is going to sound crazy. The reason why is because if you have like, all right, I've got a co resident, he's got about 600 reviews and they're all five stars. I mean, when you see something like that, you know they're fake. You know that they're, they're fake. But you throw In a couple 1 star reviews, it makes all the other reviews seem legitimate. And, and if it's about insurance, bs, you know, it's not related to you and your health care, then it's perfect. You don't want negative reviews that are like, oh, Dr. Paul did a terrible job, like you don't want that. But you know, if you get some for some weird administrative thing, like those are perfect, those are good. So you know, as long as you don't have a crazy amount of them, you know, and you can offload them by the five star reviews, it makes your other reviews seem more legitimate as opposed to the office with 3005 star reviews and like 104 star reviews and one 1 star review that got in there somehow that tells you that they have terrible care. So anyways, my 2 cents on that. When I think someone gives me a one star review, when it's like something weird like that and I haven't actually seen them, I see it as kind of like, you know, I'm happy they did that. I know it sounds bizarre, but that's my take on it. As far as the insurance paneling. I did not know that. I've never applied for insurance paneling. Another thing, I think it's probably a blessing that you're not part of those systems, to be honest with you, because they'll sink you eventually because they, they launch your overhead up to do all this insurance billing and then, you know, they pay you less year after year. So I mean, I think that if you were like all in insurance, I mean, you'd be, you know, probably would be struggling. But if you can make it work without them, I mean, you're so much more sustainable, you know, and the quality is so much better for you and also for your patients, I think. So it sounds certainly frustrating that they have wield all that power and they essentially, in medicine, whether it's insurance or it's not, whoever sort of controls all the, where all the patients are sort of controls like, you know, everything, which is true of hospital systems as well, right. You know, when they buy a primary care practice, they're buying, they're essentially buying the patients that, that's why they do it. So they can then, then refer all these patients into their system and get them, you know, God knows what happens to them. But yeah, I think it's probably a blessing. I've never personally applied. I mean, I've also opted out of Medicare, so, I mean, I've really been, you know, I really don't interact with them at all. I had to do a prior off once because some guy with insurance, like, was really, really pressuring me about it. I'm like, all right, this guy's gonna go crazy if I don't do this, so let me at least attempt it. But it's terrible. I mean, I gotta, I'd write a whole page, you know why? This guy needs some order. I think he does. And then I have to do a peer to peer and she has no idea what the heck I'm talking about. You know what I mean? She's not an orthodox. And then they approved it, thankfully. But it was just such, it's just such crap, you know, compared to me ordering something for cash. And they just get it done.
So Those are my $0.02 there about those topics.
[00:21:09] Speaker B: Were you surprised by the whole incident with United Healthcare that happened a few months ago in New York?
[00:21:16] Speaker A: I mean, it was assassin. It was a true assassination. Right? I mean, I felt like that it was. He didn't know the guy. It was like essentially like politically motivated, more or less. I mean, surprise. I mean, yeah, I guess it's pretty extreme to have someone, you know, kill somebody. So it was surprising. It's not like it happened. So, yeah, I was surprised. I mean, but then I also wasn't. You know, they do a lot of harm to a lot of people over a long period of time, so the probability of something crazy happening is not zero. So, I mean, I guess I wasn't super surprised that something like that did happen. And like, you think that would be a wake up call, but I'm sure it wasn't. You know, those back to probably doing whatever they were doing before that happened. But yeah, these companies really screwed, you know, not just doctors, but patients over. I mean, if they see you as a patient and they determine something's not medically necessary and you come to harm, like real harm or even die or anything, they have no medical liability. They'll say, well, we didn't say you couldn't do it. We said we're not going to pay for it. Even though in reality that usually means someone can't get it, so they're directing medical care and essentially without any liability. I mean, you know, if we do something like that and we make an error and it's against the standards of care and someone gets hurt, we have liability, we can get sued for that. They can't get sued at all. You can only sue them saying they had a breach of their insurance contract, which is not the same thing, or like a bad faith insurance claim. But you know, who's going to do that? You need a bunch of lawyers and everything. So they basically can deny things with impunity and that's what they've been doing. And I think that led to that sentiment of why that person got murdered.
[00:22:44] Speaker B: Yeah, I was going to say with insurances, at least with Medicare you can get on even though their rates go down every year, that that's probably the one positive. You know, it's that if you have, you know, board certification, as long as you're not on the exclusion list, you can actually get on. But with the insurances, you, I mean, they just have free rein to not accept new doctors and they're doing that. The epitome of that is South Florida, but it's actually radiating throughout other states, even Alaska, where there's hardly even doctors. I've heard it. This is happening. Another thing that you brought up on your blog or Your profile on LinkedIn one year post is this really, really scary thing that can happen to physicians knowingly or unknowingly is going to prison. I subscribe to the OIG List just because I'm curious what their task forces are.
And I'm always surprised at the things they pick on and all these things going on, like wound care and dermatology happens to be a big one. I get approached by wound care all the time and I just choose not to do that. I don't want to be known as a wound care lady, I guess want to go into that, like how you can protect yourself from these sorts of investigations and even going to prison.
[00:24:00] Speaker A: So obviously I'm no expert on this and so I'll just tell a quick story here. I think I was before I quit my fellowship. I remember I was in the hospital. I get a call from some lady, she's like, oh, I see you have a Medicare number. We can set you up with this telehealth thing where you can order DME durable medical equipment for, you know, seniors. And I was just like. So I was like, no, I don't like, have my Own Medicare number. Like I'm still in training. Like, it's not something that, yeah, I can do or want to do or whatever. I didn't think too much about it. And she calls me back and she goes, oh, I see you have a Medicare number in Ohio. I'm like, well, that's where I did my residency. Like, that's again, I don't have, like, I haven't like officially applied for one. And she's like, oh, okay. And then I didn't think about it again. And it turns out it was a big scam where they basically would have docs do telehealth and inappropriately prescribe seniors, you know, durable medical equipment. And then one doc went to jail for like 10 years and he got paid 400 something thousand dollars by the company, and the company made like $22 million and then he was forced to pay restitution of like $22 million. So you do not want to defraud Medicare in any sort of way. And like, if somebody seems like they're just using you because they want your medical license, that usually is a red flag. So, you know, don't listen to them. They'll tell you whatever they need to tell you in order to get, you know, so that you'll do what you need to do. But Medicare is one of those things that you really got to make sure that you're, you're following the rules and, and even if you make a mistake, you can still get tagged in it. I mean, for me, I've opted out of Medicare. I don't take any insurances, so my risk is extremely low, if not zero, because, you know, if I'm not billing them in, if I'm not billing Medicare, then like, what do they care? I guess they could care in my instance, if I'm seeing Medicare patients for cash, which I am. But you can do that legally if you opt out and you have them sign a consent form. So I do that and you know, they know I'm opted out and everybody's okay. And. But I guess it could be a problem if you didn't do that officially opt out and then somebody like submits a bill to Medicare, which I think can happen with like pts, like, or kairos. People who can opt out, they're better off not seeing Medicare because it's not necessarily the patient themselves, but sometimes their kid comes in and submits something and then they can get in a lot of trouble. So yeah, you just gotta be careful. I mean, you know, all the coding and billing, you can get knocked for upcoding, for down coding. Again, I'm not an expert in this because I don't really do this stuff anymore. But. Yeah, I mean, it could be certainly scary, but just certainly don't do anything where someone seems too good to be true and they're basically just having you bill Medicare for a bunch of things that you're not really connected to.
[00:26:24] Speaker B: Yeah. Or are just seen as unnecessary.
I've heard of that because as you know, or you may not know, but I have 53 licenses and so I think I did.
[00:26:33] Speaker A: That's great. That's a lot. See, 53. So I mean, that's all the states. And where else do you have licenses? What are the extra three?
[00:26:39] Speaker B: The territories? The only one I don't have is Puerto Rico, which I really want to get. But Puerto Rico is a really bureaucratic state. You need for each license, you need different things, different hoops, different fees.
[00:26:51] Speaker A: Yeah.
[00:26:52] Speaker B: You need to have a background check in Puerto Rico. You need to pay in a bank in Puerto Rico. You have to have two Puerto Rican licensed doctors sign off on your license.
[00:27:02] Speaker A: Maybe it's not worth it.
[00:27:03] Speaker B: And they never pick up, you know.
[00:27:05] Speaker A: Yeah, forget it.
[00:27:06] Speaker B: Or respond and just put next to.
[00:27:09] Speaker A: It on the map.
[00:27:10] Speaker B: Yeah, exactly. But I actually have a big interest in being licensed in Puerto Rico. I, I have a huge interest. There's a lot of. It's a healthcare desert, at least for dermatology. The dermatologists are doing really well there. I wish my practice was there sometimes, as opposed to Miami. But yeah, I mean, I. There are all these. You kind of become a target on your back. I mean, I've been called like just yesterday somebody emailed me about wound care. I'm aware that some graphs pay $20,000. I've been shown checks and I just won't even look at them, you know, because if it's too. If it sounds too good to be true, it. It probably is. You know what I mean? And yeah, no one's going to pay you that much for one patient.
And these investigations I've read about, they're very. It's the whole government coming after you, basically unlimited resources.
And you will lose pretty much everything. You know, you'll end up in prison.
You'll lose your board certification, all your licenses, your ability to practice. You won't even be able to pay to defend yourself. And they freeze your accounts. I heard. You know, when. Once that happens, I mean, I wish that they went over this stuff in medical school a little bit more. The scary side about practicing the very.
[00:28:23] Speaker A: You can see getting caught in that. Maybe you're in a tight spot and someone's like, hey, we'll pay you all this money to do wound care and put these fancy biologic dressings on these people. And you're like, okay, you know, and you see the patient, you put it on, and you find out they build Medicare, like, $100,000, like, under your name for, like, this wound dressing or something. I don't know. I mean, yeah, I was approached by that, too. I mean, yeah, it came all the way down from Denver to Colorado Springs, which is an hour, and they're like, oh, we can do this thing. And I'm like, look, I've opted out of Medicare. Like, well, we can make a. Create a company that hasn't. And, you know, then you can provide all these seniors with their wound dressing. We just want them to get their wound care. And it's these two business people. I'm like, give me a break, man. Like, you know, I know you don't care about that. This is where all the behavioral psychology stuff comes in. I'm like, I know you don't care about that. I know you only care about the money, and I'm not working for you, you know, and so I never gave it any thought more. So because I'm stubborn, I don't want to work for anybody ever again. But, yeah, I mean, they come at obtuse angles and they're pleasant and they promise you all these things. And, like, you gotta be real careful. And in the beginning, when you're starting or you're. You're, you know, if you're in dire straits, like, you know, you could see yourself, it's like a scam, right? Like, you could fall for. Anybody can fall for a scam if you're in the wrong state of mind. And, yeah, you got to be careful. So, I mean, good on you for not. I mean, I think there are some legitimate wound care jobs where you go into nursing homes and, you know, you bill and you do stuff. But, you know, there are. I think you're right. There's some, like, biologic dressings or whatever they're doing where they're just trying to just bill as much as possible to Medicare. And then. And then I guarantee you when things hit the fan, you can. You're not going to find any of those people will be gone, and you're going to get hit with the majority of the brunt, even though they sort of scammed you because you're the one who has the medical license Right.
[00:29:57] Speaker B: No, they'll, they'll go to prison too. And in fact, you know, I took my dad to a dinner at Morton's with one of these people and even my biller called me because he knows I'm struggling. I, I, I wouldn't say I'm struggling. I'm actually doing quite well.
But the hours I put in, it's unreal. You know, the hours I put in are ungodly. And some of the work I do and administration, I like it, but it's not the administrative part, but it's, I work way too much, I think, for a dermatologist. I'm the hardest working dermatologist I know.
[00:30:29] Speaker A: But licenses.
[00:30:32] Speaker B: But my biller was even like, anna, I know a way you can make so much more money. And he was like, call me, call me about it. He's like, you could do this and I'll even find you a buyer. And took my dad, and my dad at the end was like, I, I don't ever, ever want you in that. You have no reason to do that. And you know, he just knows right from wrong. He's a doctor that was able to succeed without, you know, he did critical care, you know, thrive and succeed on his own in private practice without the need for doing anything shady ever. You know, just, and you know, I know I can, I can do that. And it just, you know, I don't want to be known for, for selling, you know, dmes. I, I definitely have heard of that in Telehealth. That's a very big scam in Telehealth. And the wound care, you know, just putting these expensive dressings on and people, I don't, you know, I, I do what people need and that's it. Where do you see the easy orthopedic practice going in the future?
[00:31:32] Speaker A: Growing but staying the same, you know what I mean? Like, I, my, my whole, like I've got a few principles that like, I run my business by. And like one is I can't interact with any insurance company. So that's number one. So I can do anything sort of I want as long as I don't have to do that. And then number two is I don't let anybody bill on my behalf. So nobody gets to send a bill, say Dr. Paul did x amount of work, I'm going to collect and then pay him. So I don't let anybody do that either. And I just kind of live by those two guiding principles. And yeah, you know, obviously avoid the scams. I mean, real quick, another one I had Was like this whole out of network billing nonsense. And, like, you want me to do all these surgeries or injections? And they're like, that's like a scam as well. And, I mean, I think the insurance has cracked down, and a lot of those guys have since essentially failed. But, you know, you know, it's not good when you go to a dinner and they're like, well, we'll take 87%. You know, we'll give you 13. You're like, oh, my God. You know, you got to watch out for that stuff. These people are greedy. But, yeah, it is scary with that kind of thing. You just, you know, you kind of, you know, thank your lucky stars that you. You didn't say yes for whatever reason, and then you realize later how bad it was. Right. I told someone the other day I wasn't going to do injections for him because he wanted to bill on my behalf. And I'm like, yeah, I'd rather sit home and do nothing.
[00:32:37] Speaker B: Tell you about a temptation. And they can get pretty big. Guess what? I was invited to the Super Bowl.
[00:32:43] Speaker A: Really?
[00:32:44] Speaker B: And I decided not to go.
[00:32:46] Speaker A: For you.
[00:32:47] Speaker B: Yeah. Because it was another. It was actually not. It was someone that had talked to me about wound care. They're not even doctors, like you said, look them up. They had a couple lawsuits already. That's already a red flag to me. And, you know, I actually chose to work. I. I know, but I got to see, you know, and really help people that I enjoy helping. Like the. It was actually the day I met that patient with neurofibromatosis. That is a project for us that we're going to be working on monthly. So I decided not to go because, you know, I just. I. I really don't like the sound of it. Usually when they offer you things like that, they're expecting something in return.
[00:33:25] Speaker A: Oh, yeah. I mean, gosh, yeah.
[00:33:28] Speaker B: Yeah.
[00:33:29] Speaker A: This is again, where the behavioral psychology comes in. Like, there's no one's gonna just take somebody they don't know to the super bowl for no reason. Right. There's something. They want something from you. And if it's not, you know, and if it's in a business sense, they want your blood, it's going to be something not good. It's going to be something, you know, they're going to abuse you, and you could end up, you know, a criminal. So, like, you can't. You know, it's almost like the more they offer sometimes, like, it's scarier. It is. So, yeah. I mean, nobody takes Someone they don't know to the Super Bowl. I mean, I could see if you're trying to close a business deal and you're taking a bunch of business people or taking some other business people and they know it's on the table, but just to take them. I mean.
Yeah, it's also creepy, man. I don't know obviously who the person was, but as a female, I think that that could be fairly creepy as well.
[00:34:11] Speaker B: Yeah. Yeah. And then there was also this thing in the Wall Street Journal. Have you heard about this sort of abuse going on with Medicare Advantage and basically this long list of diagnosis that they're getting paid thousands for? Have you heard about that?
[00:34:25] Speaker A: Yeah, I kind, I think I've read a little bit about it. Correct me if I'm wrong. They essentially add diagnosis onto their Medicare patients so they can up the level of complications so they can get more money.
Yeah, I mean, I'm not surprised, but you know, if the.
Yeah, these are large health systems with a lot of resources and like, you know, I'm sure they have lawyers looking at it and it's hard to find. I mean, it's hard for the government to go after. It's easier for them to go after you or me, but it's harder for them to go after these large institutions, institutions like that.
Yeah, I mean, it's just another instance of gaming the system. I mean, eventually though, with insurance you can game as much as you want, but at the end of the day they write the check. So you're never going to win because you're dependent on them writing checks. So my whole feeling about that is like, you know, you can do these things that are mildly unethical to sort of get ahead versus insurance and you know, they're, they're eventually going to win in the long run.
[00:35:13] Speaker B: And where can people find you? For our, the viewers of our audience, our audience is mostly physicians, some patients and anyone in healthcare. Where can they find you? Your practice? You also have courses. I know that you've created some pretty cool courses.
[00:35:29] Speaker A: Yeah, so my website's EasyOrthopedics. Com. And yeah, I have an insurance free medical practice course which gives I think about 34 CME credits and kind of shows you how to replicate what I've done. And yeah, you can find me at that. My website on LinkedIn is DanielPaul MD. That's where most of my stuff is. I've got a YouTube channel, but it's mostly informational. It's called beyond the Scalpel. And then, yeah, that's pretty much it once. I was on one of these one time where someone's like, do you want to give your phone number? I'm like, no.
Yeah, absolutely not.
[00:35:58] Speaker B: Yeah, that's funny. All right, well, thanks. Thanks, Dr. Paul, and thank you for being on. I really always wanted to get to meet you. Put a face to the name on LinkedIn, and I will continue following you and reposting some of your thoughts.
[00:36:13] Speaker A: Awesome. Thanks so much for having me on.
