Episode Transcript
[00:00:04] Speaker A: Welcome to Skinbreep. I'm Dr. Ana Chacon and today we have a very special guest joining us. Get ready for some expert insights you won't want to miss.
[00:00:15] Speaker B: Thanks for having me, Dr. Chacon. So my background is primarily in compliance and operations, working with a lot of different clinicians, digital health startups, and just kind of different ventures. And that's kind of how you and I, you know, got connected. I, I was following you on Instagram and just any doctor who has lots of licenses is always very appealing to me, especially with all the different kinds of organizations that I work with, because it kind of makes you a little bit of like a unicorn physician. And so, you know, really my background and experience is all in helping companies build compliant operational structures, ultimately to protect physicians and the clinicians that are working there.
[00:01:00] Speaker A: And then tell me a little bit about your background and compliance, because I know we've talked about this before, but I don't really understand what it is that you used to do with the state of California and physicians where you used to work, what your day to day was, what you learned from that.
[00:01:18] Speaker B: I kind of started my career in, in the public sector, so I went to school for government.
I didn't quite know exactly what I wanted to do in the government and the public sector sphere. And so the interesting thing is when you're a government employee, you can actually go from different agency to different agency and kind of see what you like and what you don't like. So I had like a stint on like unemployment compliance, and I didn't really like that. And then I did construction compliance and I was like, I didn't like that. And then I went into healthcare, and healthcare really was like, really attractive to me just because the immediate impact you have on people's lives. And so I was a California state regulator for the Department of Health in California for about 12 years. And I basically oversaw a lot of the Medicaid programs in the state of California. So we would issue policy. So, you know, this new program is going to, you know, come out. We want to, you know, let's say, expand access to Native American tribes and tribal communities. So we would like issue policy.
We would then monitor those programs and just make sure that they're actually getting done. So as we're doling out money to all these providers and doctors and, you know, different clinics, we would then kind of enforce and oversee that they're actually doing what they're supposed to be doing per their contracts with us.
So it was a little bit of a hodgepodge where I would actually, like, launch the programs and lead the programs, but also, like, do investigations into, you know, fraud.
Really kind of like your catch. All of just making sure that providers are acting properly. In the state of California, was that.
[00:02:55] Speaker A: Through the Medical Board of California or what department?
[00:02:59] Speaker B: It was through the Department of Health, so we were over just the Medicaid program. So in California, we call it Medi Cal, but it's basically your Medicaid program. Here we would partner with the medical board. So we partnered with the medical board. We also partnered with the Department of Managed Health Care, which is overall commercial health plans. So the other subset. But that's where we would all kind of work hand in hand. Because if we did identify, let's say, a physician doing something potentially illegal, we'd have to work kind of in lockstep to make sure that we could effectively do our investigation and potentially bar the, you know, physician from practicing.
[00:03:41] Speaker A: Wow, that's crazy. And then tell me, what kinds of illegal things did you see? I'm always, like, kind of interested in the stuff that basically could get you in trouble. Because as we've talked about before, we both know horror stories of great doctors that have just gotten in trouble.
[00:04:00] Speaker B: Yeah, I mean, I think a lot of. A lot of what I would see would be that a doctor wasn't actually doing anything intentionally wrong. They just didn't quite understand the rules. So the biggest thing that would kind of identify a potential fraud to me is if a provider was doing balance billing, which is basically, you're treating Medicaid individuals, but you're also asking for a copay or some sort of, like, money from them, which is illegal in. Under, like, federal Medicaid rules. So if we would catch on to, like, a doctor that would say, like, okay, well, in order for me to see you, you have to pay $25. That's like a big no no in Medicaid. And so that would be kind of like one big thing where I think providers just don't quite understand that you're not allowed to do that. There was, like, the blatant fraud where, you know, you could see that a service was not necessarily medically necessary and was overly being prescribed.
There was a lot of fraud when it came to, like, dental in our world, but it was primarily like, the two subsets would be, like, doctors just not quite understanding that they're breaking the rules. And then the other group of, like, blatant fraud of we have all these, like, fake patients that we're billing for that never got a service or, you know, don't even exist.
[00:05:10] Speaker A: Okay, and how would you identify that? And for, let's say these balance billing, because I've heard of that a lot. Do you do anything if it's like one person or it kind of has to be like, like a lot of people.
[00:05:22] Speaker B: I think it heavily depends on who your investigator is. So I would basically every single month, every provider, health plan, they're required to report certain data elements to regulators. And it kind of goes like up, like completely upstream. And so through these reports, that's how we would kind of identify different things. So if, let's say I would look at grievance and appeal data. So if a person is complaining month over month saying this provider, you know, did X, Y and Z, and it's kind of raising the alarm on my side. It doesn't matter if it's one provider or 100 providers, like, we would investigate that based on the claims. So it could be something that's actually pretty minor. If it's a priority for the state or the department, they will want to make an example out of a single provider if it's, if it's worthwhile.
[00:06:17] Speaker A: I see. Even if it's one case or would it be something where, like, what would they do?
[00:06:23] Speaker B: It kind of depends. I mean, sometimes, like, if it's one case, they could in theory, you know, contact that provider, talk to them, give technical assistance and try to get them into working, you know, operating correctly. Most of the time, that's what's going to happen. They're going to want to work with you. The providers that actually get barred from the program, that get put on, like, this is the suspended and ineligible list. Those are the ones where like, regulators have said, you, you're making mistakes, and then the providers have said okay and not corrected them and then continued to make the same mistakes over and over. And those are the ones that are a little bit more. They get in a lot more trouble.
[00:07:01] Speaker A: And what kind of trouble can you get into? Just wondering.
[00:07:04] Speaker B: Oh, man. I mean, in my experience, like, I have not necessarily taken physicians licenses away, but I have barred them from Medicaid and Medicare billing, which ultimately took their license away because they weren't able to be reimbursed for any services that they were providing any longer.
And that was mainly due to significant fraud though. So they either overly billing, weren't necessarily following protocols, did something pretty bad. Pretty bad in order for us to kind of like warrant getting them kicked off the program.
[00:07:39] Speaker A: And then were you. So you were just with Medi Cal when You did that. Which medical is enough? Like, it's like a huge program and it's, you know, has a lot of compliance things. And what about your transition to telehealth? Because I know, you know, we've crossed paths through different telehealth platforms. How did that come about?
[00:08:00] Speaker B: So after I left the. The state, it was during COVID and so I went and worked for a public health startup.
[00:08:05] Speaker A: Mm.
[00:08:05] Speaker B: And it was an interesting transition. I was so used to on, like, the Medicaid side, everything is so rigorous. You. Every single thing requires, like, a review and an approval before anything can actually happen.
So, like, when I was, you know, at the Department of Health, I mean, we would review marketing materials, we would review member notices. Like, every little thing had to be approved. Whereas on the digital health side, none of that exists. There is no approval. There's no, like, final check mark that says, like, this platform has been, like, approved. You're good to go. So, to me, the biggest shift was actually making sure that things were running in a compliant way when there was really no guardrails preventing anybody from starting when they probably shouldn't have started, if that makes sense.
[00:08:56] Speaker A: And how long have you been doing telehealth? Because you and I are about the same age, I do think of you as being like. I feel like you're. You're kind of have this mom mindset because you have four kids, right. Which is amazing. And you have this business, this consulting business, and then you have a podcast and then you work on all these startups like I do. How long have you been in telehealth and how did that transition sort of happen?
[00:09:19] Speaker B: So I've been in telehealth for about five years now, and I think the transition just happened kind of like, organically, I think. I think telemedicine is like the future care. And I think ultimately, even though, like, digital health companies aren't being super regulated today, I do foresee that being something in the very near future that they're going to have to come to grips with or they're going to put a lot more providers at risk. And I think that's kind of like, that was the one thing I think that really incentivized me and was really interesting about the digital health side was how many of these companies don't actually understand the. That they're doing things wrong or completely out of compliance. And just even in my conversations with so many doctors, how many doctors are trusting these companies that they're working with and the companies are doing things that are really putting the doctor's licenses at risk. And so for me it was, yeah, maybe it is like my mom mindset or like the mom that give me, but like I do feel like some sense of, like I feel like I have to protect the doctors that are working in these industries because it is so easy for them to kind of get put down the wrong path. And I, I just, I would, I've heard horror stories of doctors working for platforms that were, you know, the platform did this and the platform did that and later down the line they, you know, had a big Medicare fraud case against them or you know, a really big act of non compliance where they, you know, were getting investigated by a medical board.
[00:10:47] Speaker A: Do you hear about those cases a lot or how do they kind of come up on your desk?
[00:10:53] Speaker B: It's few and far between. I mean typically a lot of the doctors who will, you know, kind of come to me and want to consult with me are one just trying to understand like, is this, you know, they have a medical board investigation that, you know, kind of came to them and now they're like, well, I didn't even realize this wasn't a correct thing to do. I didn't realize that. I'm. So a lot of them is really just talking to them and explaining like their roles and then coming up with a game plan on how they're going to kind of get through the investigation and what documents they're going to need to kind of like demonstrate that this wasn't a.
And there was no malicious intent behind it. Sometimes like it works, sometimes it doesn't. Like there's been, you know, some doctors who have actually had their licenses revoked, IMLC status completely revoked, and it's really impacted their ability to continue practicing.
[00:11:43] Speaker A: And the imlc. Talk about that a little bit because I am not a part of that.
It wasn't like part of the state of Florida and people suggested it to me just because it's so much cheaper to help get licensed in. If you just have IMLC status, would you recommend it and what are the kinds of things? Because yeah, the investigations and malpractices are more common than we'd like them to be. What actually happens when to your status when that happens?
[00:12:14] Speaker B: Oh yeah. So I mean, IMLC basically, it's just a way that you can expedite getting licenses in states that participate in it. I'd like to say there's like 30ish states that participate in it, probably more now. And it just, it really speeds up the process. The only problem is, let's say you get in trouble.
Part of the qualification for MLC is that you can't have any board actions. And so if you get one board action against you that's upheld, you will actually lose your IMLC eligibility.
And then from there they will slowly take away all the licenses that you've obtained through IMLC. So if you have 30 licenses through IMLC and you lose your IMLC status, you're gonna have to go and individually apply for each of those. So it's just, it's one of those things where it's like, as long as you're practicing well and you're protecting your licenses and you're kind of doing everything the right way and asking the right questions, you should be okay. But you do just have to understand, like, that's one of the things that could potentially happen as you're expanding.
[00:13:15] Speaker A: Are most of the doctors that you work with, they are under IMLC or they kind of applied independently like I did.
[00:13:22] Speaker B: I think it's a mix. I think it's a mixture. There's some that went the traditional route, like you. There's a lot of them, I think, that are going the IMLC route just to like save money and, and time.
But I still think it's, it's pretty. There's still a lot of doctors that go the traditional route of getting the individual licenses.
[00:13:41] Speaker A: How did you do this and have four kids at the same time?
Like, how do you manage everything?
[00:13:49] Speaker B: It just kind of happened. I mean, I think, you know, I think anything when it comes to entrepreneurship, it just kind of like falls in your lap and happens. And so part of it is I really enjoy this work. So I don't actually look at it like work. To me, it is just the normal part of my, like, day to day, and I really, really enjoy it. My kids, I don't know, I mean, they, I'm probably a workaholic and they probably talk a little bit of mess about how busy I am all the time. But you kind of just, you know, you, you get into your groove, you figure out your, you know, how to juggle it. You set some clear boundaries around when I'm working and when I'm off. But ultimately, like, I've just. It's been years and years and years of me getting to the point where I'm at now of just hard work, late nights after the kids go to bed, opening the laptop back up and getting it done.
[00:14:38] Speaker A: What's the most exciting startup that you're a part of?
You have a consulting business and then single Aim as well.
How do you divide your time between both of them? What do you like better? What are the differences between them?
[00:14:52] Speaker B: Part of what I do, which is kind of like interesting in my niche, is I actually work with a lot of like early stage companies that are in the phase of trying to figure out like strategically how to position themselves and scale up. So a lot of like the companies that I work with, I do very short term contracts, like six months where I'm actually helping them come up with their strategies, launch, and then I kind of take a step back. So Single Lane was one of those companies where I, you know, I got to partner, you know, work really closely on, you know, kind of figuring out how to actually, you know, bring it to life. And that was like, really fun because I got to work with tons and tons of doctors who were interested in medical directorships, you know, different kinds of things in like the digital health, like virtual supervision space. Some of the other startups, you know, I think I got to work with like a really great startup that was doing at home Botox and at home aesthetic services, which I thought was really interesting.
I'm really, really, really focused on the Medicaid space. So I have one client where I'm working on some Medicaid with them, which to me just kind of pulls my heartstrings. But they're also different. And I think that's the thing that makes it really fun is getting to work on so many different cool ideas that I think are all going to be like, ultimately like very successful because they're, you know, they're all so different. They're all focused on like a very specific niche, you know, target audience.
[00:16:17] Speaker A: What resources or networks do you recommend healthcare professionals or doctors like me look to strengthen compliance knowledge?
[00:16:24] Speaker B: There's one big network that I think is like a really cool one. It's called Health Tech Nerds. It's a Slack channel, like a newsletter. And it's all experts in digital health. So you have like, you have entrepreneurs, you have founders, you have clinicians, you have people like me that are very focused on the compliance and the regulatory aspect. And it's really interesting because it's just people sharing a bunch of information, asking questions.
It's like a really great place to learn. And so that's one place where I've been a member for a couple years. I just, you know, you go on there, you kind of read and you see what's interesting and what's not. I'm really big on just trying to stay up to speed with Everything. So I read lots and lots and lots of articles. Kaiser Family foundation has some really great stuff, Modern Healthcare. But it's compliance is really tough because there's not like one single repository that just has all the answers. You kind of have to like dig. And so to me, like that's the fun part of like just kind of trying to do my best to stay up to speed. Even though I'm sure I'm missing, you know, a thousand things because it's just so complicated.
[00:17:30] Speaker A: No, I know it's. Or it's just like experience based.
[00:17:34] Speaker B: Yeah. And then everything is varies by state. So it's like for someone like you who's licensed in so many different states, having to understand what is changing state by state by deadline, it just layers in more complexity.
[00:17:49] Speaker A: And then most of the doctors you work with, are they purely telehealth or do some. Are some of them like me, where they're kind of like hybrid and this is kind of like a side thing that they do. But I have my own clinic, for example.
[00:18:03] Speaker B: I think it's a combination. I think that there's. The majority of the ones that I work with are primarily telehealth, whether it's being PC owner, medical director, doing telemes, Edison consults. And then there's like a good, I don't know, maybe 20% that have either their own private practice or they're in the process of like wanting to build their private practice. And that's kind of what I partner with them on is like, well, you know, what's the best way for them to do it? That's actually going to work.
[00:18:32] Speaker A: And do you work with in person clinics too or is this just primarily telehealth?
[00:18:38] Speaker B: I do, I do work with brick and mortar and in person clinics.
They're fewer and they're not as common anymore, primarily just because of the overhead cost of like actually having to have a brick and mortar facility. I think nowadays people are like, if I don't have to have a facility and I could just do telemedicine and.
[00:18:54] Speaker A: Yeah, I know. It's also like, it's harder to move through patients for sure. You know, having a brick and mortar is actually the least profitable part of my business. I enjoy it, but it's definitely harder to move through patients. And then. Are you from. Talk a little bit about your upbringing. Are you from California? I know we met there near Sacramento. I'm going back again in October. But where, where did you grow up? Kind of talk about your upbringing a little bit.
[00:19:21] Speaker B: Yeah. So I Grew up in Sacramento, born and raised here, California. I've never lived anywhere else besides California. Went and did undergrad out in the Bay Area and then ended up just like wanting to come back and be with my family. I think, like, the one thing like you and I have, like, really, really, really in common is like, we're both extremely family oriented. So for me, I can't. Like, I need to be around my parents, I need to be around my grandparents, you know, at least while they're like, still here. Like, I, I need to have them around.
And so, yeah, I mean, I've been here basically my whole life and don't, you know, I couldn't, I couldn't leave my. I come from both sides of my family, are entrepreneurs. So on my dad's side, my grandma owned a bunch of residential care facilities.
So she, she did that all over kind of like Northern California. And then on the other side, my family owned the oldest Italian restaurant in Sacramento up until the point of when it closed during COVID just, you know, due to all of that stuff. But yeah, both sides are kind of like entrepreneurial minded and I think that's kind of how it got transferred down to me.
[00:20:32] Speaker A: Single Aim and the Camino Consulting that you run, are those pretty much run by you only? How big is your team, just out of curiosity? And how long have you been doing that?
[00:20:44] Speaker B: Single Game was just a project that I was working on, so that's actually ran by a completely separate team now that it's like the infrastructure has been fully set, they're growing, so they're like a very small startup. But I'm anticipating that they're going to be scaling up relatively soon, which is super exciting for them on my side. So Camino is a boutique consulting firm. We partner, like I said, kind of like with, with digital health startups. A lot of physicians that are looking for, you know, kind of just like some sort of like partners in bringing something to life, an idea strategy. And my team is, we have three consultants, all kind of in different areas of focus. So we have MBAs, we have clinicians, we have strategists, we have operational folks. So it is really kind of like your end to end on like whatever you would need in this space. Like, we have, we have the people there to kind of support that.
[00:21:38] Speaker A: And then how long have you been involved with both of them?
[00:21:41] Speaker B: So Single Aim I was involved with for about seven or eight months.
And that's kind of what it took to, you know, kind of get everything up to speed from like zero to ready, you know, from having a minimum viable product, as they call it in the digital health world.
And Sync Camino strategy I launched last March.
So it's been about a year and a half that I've been kind of building up my own firm. And now I can say like with a year and a half in, it's really starting to get to the point where I'm at capacity. I don't really have, you know, I don't really have a lot of space. A lot of people are really wanting to partner with me personally and I'm like one, one person, you know, I can't, I can't take everything on. But it's, you know, it's been about a year and a half to where I feel like, you know, I feel like it's the momentum and the movement is there and.
[00:22:32] Speaker A: Oh, so that, that's interesting. I didn't know that single aim was not. I thought it was 100% yours.
[00:22:38] Speaker B: Yeah, no, no, I was a consultant on it.
[00:22:41] Speaker A: Yeah, I thought it was your business.
[00:22:43] Speaker B: No, it's, it was owned or it is owned by somebody who I had met in kind of like the digital health space, who we just contracted to kind of like build it up together.
[00:22:55] Speaker A: So about collaborating with, you know, other practices you mentioned to me there was and we talked about a couple horror stories. Where can you get in a lot of trouble with this? And also through telehealth in general compared to in person practice, like if you were to advise a physician or some of our listeners on this subject. The subject matter, I think for the.
[00:23:20] Speaker B: Most part brick and mortar and telemedicine is kind of viewed the same.
I think there are certain states that are just a little bit harder in terms of they either have tougher rules or they're just, they enforce more. And so I think the, the big states that I've seen issues in are Alabama, Georgia, Mississippi, Maryland has some interesting rules, but then they also all vary by scope. So there's going to be some states that are going to be a lot tougher in like the aesthetics and like the derm space than you know, let's say like mental health or vice versa. And so it's really interesting because there are some states that are just like really strict, but it might just be about like one type of specialty versus others.
And so, you know, the big ones, the states where I've seen people get into trouble are, you know, the states that I mentioned. Mississippi requires you to be within like a certain distance of the clinic and they actually go out and check the location and make sure that you have, like, you are complying with that. And so there's a, there's a handful of states that do that. And that's where I've seen, you know, some of the trouble. There's inadvertent things that just happen naturally or very standard practice in brick and mortar that doesn't necessarily, necessarily happen when you're doing some of the virtual medical director stuff. So I think I was telling you, like, in every state, you're supposed to have a plaque that says who the medical director is of those, those locations. And in digital health, sometimes people forget to do that. And if you're getting audited and you have somebody go out and there's not that sign that says, you know, Dr. Anna Chacon is our medical director, that could in theory spark an audit. So little things like that that could just be in most practices, like just very standard practice.
When you're working in a space with like, new clinics, new people who don't actually understand the rules, those are the things that get, get people in trouble.
[00:25:18] Speaker A: What about Maryland?
[00:25:20] Speaker B: Maryland has a lot of requirements around, like, not being able to delegate certain services. So a lot of times in digital health, you'll have companies want to use nurse practitioners, RNs, physician assistants, and that's kind of where they go, okay, well, we're going to get a collaborating physician. The physician's going to delegate certain things. We'll be able to, you know, prescribe and do all of our stuff.
Maryland has a lot of rules around that just not being allowed. So, like, you can delegate certain things, but the physician actually has to conduct the initial telehealth visit.
The physician has to write the care plan.
And I don't know how many physicians are actively doing that in Maryland when they are, you know, so used to just like the traditional delegation structure. So it's little things like that, those weird nuances that just get, they catch people off guard.
[00:26:09] Speaker A: So you're saying that the physician has to see every patient if they collaborate.
[00:26:14] Speaker B: With a nurse practitioner for specific services in Maryland. So this is like, I think specific to like Botox. Let's say they can't actually delegate that down to a nurse practitioner. Whereas like in other states, you can go and go, okay, I want Botox or oh, I want micro needling or oh, I want prescription skin care. Let's talk about it. The only way to do those prescriptions compliantly would be to have the physician actually conduct the initial visit.
[00:26:40] Speaker A: But they are allowed to do those procedures.
It's Just initially it has to be seen by another provider, basically an MD or do, I'm guessing correct.
How did you find that out?
[00:26:53] Speaker B: Research. You just, you know, you, you research, you work with clients who want to, you know, I think everybody wants to use the lowest level of staff needed. And so it's kind of this like reverse, you know, reverse thing. Like can an RN do it? Can an NP do it? Can a PA do it? Does it need a doctor? So it really is like diving into all the rules and really having to understand it in and out.
[00:27:15] Speaker A: Do you have certain law firms that you recommend that are specialized in this area? Because that's another, I guess, niche area is finding accountants and legal people that are not just affordable because you're dealing with a lot of states and all of this could add up. But knowledgeable in this area.
Do are there people that you recommend or that you've worked with that you know, would be able to know the answers to these questions and that are coming up?
[00:27:43] Speaker B: My biggest recommendation is you want to find a lawyer who specializes in healthcare, but also specializes in the scope of practice that you are launching in.
So I have one law firm in Texas that I work with that primarily does aesthetics. And so it's like aesthetics Med Spa, you know, rules and regulations. You of course have like your very large firms. You know, the one that I always say is like the North Stars. You know, Foley. Foley is a really great healthcare law firm. They're just really pricey, you know, if you want something done completely correctly, like Foley has just been. I've worked with them at many digital health companies and they've been great. But you know, ultimately the biggest thing is you're going to want to find somebody who is very, very, very up to speed on, on the scope of service that you want to provide. And those law firms exist, you just kind of have to like figure out where to find them. But that would be kind of like my 2 cents. I work with a handful of different ones because they all kind of focus on different areas.
And I think that's the most important part is that it's not something that's generic, but it's really specific to what you're doing.
[00:28:50] Speaker A: And then do you find, you know, telehealth? I love it, but I feel like there's so many people in this space. Space. Do you find that to kind of stand out or make a difference? They often need like outside investor money and things like that, like marketing, whatever it is, just because there's a lot of people in it now.
[00:29:08] Speaker B: I think it depends. I think like, marketing dollars is something that a lot of clients that I've worked with are like, well, we don't want to spend money on marketing. I'm like, well, like, you're probably not going to get a lot of patience, you know what I mean? Like, it's just the normal way of doing business.
I do think that telehealth is getting a little saturated in the sense of there's going to be a lot of platforms that are kind of doing the same thing. They're all kind of solving for the same problem.
And I, I mean, if you just keep throwing more money at, you know, marketing, I don't, I don't, yeah, I don't know how successful they will all be if they're all kind of doing the same thing.
So, you know, to me, I think the, the, the interesting thing, the thing that I think is actually going to happen is you're going to have a lot more digital health companies come out and then you're going to start to get more feedback from consumers that they want brick and mortar again. And I think you're going to see this like, nice hodgepodge. The digital health companies that are going to win are going to be the ones that have a combination of telehealth but also brick and mortar options where people can see people in person if they want.
[00:30:12] Speaker A: I was going to say that's kind of like my practice, right? Because I kind of got, you know, like a little bit tired, but also like, you know, I don't want to say get tired and just like, hey, I need to see more people in person.
So I have this combination. And I think when we last met, I told you I had kind of given up on insurances. Like, I was just paid so poorly and it was just so much effort. I couldn't believe the amount of effort required to just credential or get paid something out of an insurance company.
So we partnered with a bigger company. It's like a group of doctors of like 800 doctors. And it's crazy to see how backward they were. They wanted me to work on a desktop with a ton, ton of cables just coming out.
And it turns out that none of the doctors like ever see people at home. They're so used to like getting in a car, being in their office at 8, leaving at 4:30, that that's like not my lifestyle at all. Like if I need to go to the office on a weekend, I'll be there. If I need to call patient from home and write a Note, I just do it. You know, if there's a hurricane coming, I could turn my, my Starlink on in the backyard and I'm like still working, you know, and they were like, we've never met anybody like that. Like, we don't know how to, if we can even trust you with like a laptop. And I was like, okay, I'm not even sure if I'll be able to work here, period.
Yeah, it's kind of like just how some people's different workflow is if they've never done telehealth. Yeah, yeah, so, but I agree, I think, I think it's kind of the best part is like having a hybrid of pretty much everything where patients can feel you see, you know that you exist and you're not just a body behind a computer and where you can bring them to the office if you need some. If they need something, basically.
[00:32:11] Speaker B: Yeah, yeah, well, but I think there's like certain, like, I don't know, for me, every single time, you know, you get an appointment, do you want to be seen in person? Do you want to be seen virtual? Is it a phone call? And I don't know, sometimes I'm like, yeah, I do want to be seen in person. And like, luckily, like, I have that option. I think more people are just going to want to have sometimes that personalized touch. And I think that was a good thing of like the traditional health care and like insurance and I think telemedicine just because like weeded out like the 80% of people who don't need to be seen in person.
[00:32:40] Speaker A: Right, yeah. And how did you meet Leo? I was just wondering because he seems like such a, you know, well rounded doctor. I'm very jealous of his lifestyle in Hawaii, but he's, you know, living in one of the most beautiful states that we have. But how did you guys meet?
[00:33:00] Speaker B: Yeah, so we actually met through like a learning collaborative. So I was doing some compliance work for this like, large organization and Leah was part of. He was like my counterpart at that company.
And so he was kind of the, I was the compliance side and he was the physician side working with a bunch of other doctors who were learning about digital health and telemedicine and how to kind of like get different jobs in telemedicine. And me and Leo just clicked because we're both, you know, both kind of like super operational. He's ex military, I'm ex government, so we kind of just spoke the same language.
And yeah, we decided to like launch our podcast together and we've Been doing it now, gosh, eight months. Eight months. We started in January.
[00:33:47] Speaker A: And you guys are weekly with our.
[00:33:50] Speaker B: Weekly. Yeah.
[00:33:51] Speaker A: Who are your guests typically?
[00:33:53] Speaker B: Oh, we have like a good, a good kind of variety. We've had, you know, people in kind of like my world, so operations, so startup CEOs, C suite executives. We just had, you know, like the Charta CEO which is like a huge digital health company that just like is like the one that everyone says is going to be like the unicorn they came on. And we've lots of doctors that are working in telemedicine, so either you know, juggling between different platforms, medical directors, and then we have like different, different kinds of providers too. So. So we have people who work in digital health but maybe don't do clinical care, people who work in government.
So it's. Yeah, it's kind of like a little hodgepodge of different people. We'd love to get some consumers on there. Like I would love to have like, like a patient like some patients or you know, people who have either struggled with telemedicine or love telemedicine from like the patient perspective to come on and have a conversation because I think that would just be like a really interesting, you know, perspective.
[00:34:55] Speaker A: What regulatory changes should we be aware of? Like I know, I think the one I was freaking out about was that telehealth was not going to be covered for Medicare and then it got pushed back. Any that you can think of, like any regulatory changes that have come up that you think people in telehealth should be aware of, doctors and everybody else, and then the most rewarding aspect of your career.
[00:35:19] Speaker B: I personally don't think that they are going to take away telehealth from, for Medicare. My best guess is like to do any of these regulatory changes, it takes a really long time. And so I'm assuming that they're going to keep extending it until they can pass like a resolution that's written in regulation, extending it in perpetuity. But I'm watching those like very closely. I think the one that I'm more interested in is the prescribing rules and how that is going to change. So I believe it's at the end of this year that they're saying, you know, they're going to go back to like the traditional kind of like Ryan height where you have to have an in person visit before you can prescribe via telemedicine. And that will really rock the telemedicine industry today if it is something that is not allowable. So like for mental health. For a lot of, you know, a lot of these industries that really rely on Schedule 2 prescribing, it's going to be something that I think would be a significant, like a significant, significant issue for some of these companies.
They've already extended it for those in the addiction medicine space.
So I, you know, we'll have to kind of see where those land. But that's the one that I'm the most like, paying attention to because there's other implications that it has for digital Health where like early on I said other companies or clinics or organizations have to go through all these checks and balances and like digital health doesn't have to do that. And this is actually recommending that they go through some sort of like licensing requirements, which I think would be very helpful.
[00:36:54] Speaker A: Wasn't it this company, I forget what it's called, but it's like there was, I don't know if you recall this, but there was like a while, maybe a couple years ago when all these ADHD companies were popping up online.
And then there was like, of course, Wall Street Journal articles, investigative reporters.
Then somebody got arrested. I forget which company it was. You've probably heard of it, but they got arrested. And then when you look at the statutes of the dea, it's very unclear. Like it's still very unclear. After Covid, they didn't really, it was one of those things. They hadn't solidified their recommendations yet. They were acting on it and even arresting people after years of kind of being wishy washy since COVID on what they decided was going to be basically the norm. Do you want to elaborate a little more on that? And we'll end with your most rewarding experience and then wrap up.
[00:37:50] Speaker B: Yeah, no, sure, sure, yeah. I mean, I think the FTC regulations, I think are one. In medicine, nothing is supposed to be on a subscription basis. Right? Everything's supposed to be medically necessary. And if you're saying, and I think this is like where I had issues with some of the GLP1 prescribing rules was you're basically saying that if a person keeps paying a subscription, you're going to keep giving them these drugs regardless of what the labs say, regardless of what. If a physician says that it's no longer needed. And by not requiring, you know, additional visits and additional authorizations, there's like, you're kind of blurring that line between like business and medicine. And then like, you know, the ftc, like they are regulating basically like marketing and how you're selling to these consumers.
And so there's a lot in terms on like FTC regulations as it relates to some of these, like, larger companies. So like hims, for example, is.
I think they're under a lot of scrutiny right now just with, you know, they're compounding how they're guaranteeing things to your point, how they're not allowing people to opt out of memberships, which is. Is problematic.
And then I believe like everything is like asynchronous. So I don't believe they do any sort of like synchronous type visits.
So, I mean, yeah, I think HIMSS is a really good example of you could see probably a lot of more regulatory bodies coming after them for some of these other kinds of things that they are doing.
[00:39:16] Speaker A: I look forward to catching up with you in Sacramento next time I'm there and. Or hopefully sooner. Anything else you want to mention?
[00:39:25] Speaker B: No, I mean, just. Yeah, like, you know, thank you for having me on. I mean, it's. It's been great to get to kind of get to know you and work with you and it's.
Yeah, it's been fun. We're going to have some fun when you come back.
