Episode 68: Dr. Tea Nguyen (She/Her) of Pacific Point Podiatry - Watsonville, CA

Direct Care Doctor

Dr. Tea Nguyen of Pacific Point Podiatry

Dr. Tea Nguyen is a board certified podiatrist with a subspecialty in minimally invasive surgery and diabetic wound care. Her extensive fellowship training at UT Southwestern in Dallas was the foundation for her passion in helping at-risk people prevent major amputations. She offers office-based surgery to prevent recurrence of diabetic foot ulcers, which reduces common postop complications associated with traditional open surgery. She opened her private practice, Pacific Point Podiatry, in Watsonville CA in 2018 and she is married to Dr. Paul Nguyen and has a daughter named Vylet.

CONTACT:

Website: Pacific Point Podiatry

IG: @drtea_podiatry

FB: Pacific Point Podiatry, Inc.

TRANSCRIPT*

So in your bio, you mentioned that you have the ability to have creative outlet time.

And so I want to start with that, especially because in this time where we're in the holidays and everything is so busy and we might have patients, trying to get ahold of us in mass right now because they're prepping for vacations and whatnot. I would love to hear more about how you spend your creative time.

The creative things that I think I've always craved doing something with my hands or with my mind. And so I'll a lot of my free time now has to do with crafting. And I feel like. My husband teases me.

And he's that's the old lady thing. Yes. I'm an old lady. It's fine. And I embrace it. Like I love crafting. I love working with my cricket. I love creating things, designing things, making gifts for friends. I designed t-shirts, I make the vinyl like cut it with the Cricut machine, iron it on, and then make it, sell it, whatever.

So I have the freedom to do those types of things that I never had time for before. And I think that creative outlet allows me to just unwind and relax and be in a different space. But I think ties in a lot to how I am as a physician, as a surgeon, because then I'm able to create things that perhaps I never was taught before or learned in the books.

A lot of times in surgery, I have to MacGyver my way around and how to troubleshoot a particular problem. So I think having that creative freedom really enables me to be a better surgeon.

I really love that though, because it makes me think about how on, football players will be required to sometimes do things like ballet as part of their training. And it just this idea that you are able to exercise all parts of your brain.

And then I love how you're able to also bring the skills that you have from doing things like crafting into the surgery room. I think that really makes you so flexible. And like you said, you're, MacGyvering it. Anybody who's seen MacGyver can understand exactly what that means, but everybody's body is different.

And so you have the ability to, pivot where you need to. That's fantastic.

So now I want to ask, because you have been opened since 2018, and as a specialist, where now we're seeing the creation of the drug specialty care Alliance, where we're seeing more action with regards to specialty groups on Facebook. I want to ask when you were starting out in 2018, the year that your daughter was born also your, the quote that you have on your website was I built this practice with the same attention to detail that I give to my daughter with my whole heart and soul and including that pun, which is awesome.

The statement really gets at the heart of the movement to go insurance free. So how in 2018, did you even come up with the idea of developing and creating an opening, your practice?

To be completely transparent. I opened my practice because I didn't have a choice in 2016, my husband and I came from Michigan to California to accept a job that was available for me and for him in the same community.

So I took that job as an associate and about a year and a half in, I became pregnant and I shared this with my employers. At first glance, they were excited for this new change. They were supportive. They said, it's great that you're pregnant. Just know that we support that pregnancy. And not even a month after that, my surgeries that were meant to be scheduled for patients, they were just getting canceled.

So I was really frustrated in the lack of ability to control my schedule. And I had asked why my surgeries were canceled. I just barely two months pregnant at the time two or three months. And the only thing they said was you're a little bit of a liability now, and we don't want to take care of your surgical patients in case you're not available.

So I was just flabbergasted. I felt like I got caught blindsided into this type of control. And at that point in January of 2018, I made the active decision to just create my own practice. I knew being employed just wasn't for me anymore. At the time, even though after fellowship, I had dreamed of having an academic position.

I had dreamed of being in a corporate setting. It was just something that was instilled in my education for so long. And now I have to pivot greatly because I'm introducing a child to the world that I want to be a part of. And now I have to build a practice that works for me. So I created this. Aaron honestly, thinking that I could do better.

And when I opened in 2018 in July, I did the exact same thing. My previously, my previous employer did, I got onto every insurance panel possible within the community, thinking that was the way to go. Not even a year in, I was thinking financially faster than I knew how to get myself out of, because I was waiting for pagans.

That was 90 days, late, six months late. And even today, this past week, I got a payment from an insurance company for a surgery that performed 11 months ago. And I just couldn't wrap my head around how I'm supposed to keep afloat with this mentality, with the traditional mentality of relying on insurance-based payments on top of paying for my lease, my business loan and all the equipment I needed to do my job.

So it was January, 2020, where I got really serious about finding an alternative way to practice medicine. And as a surgeon, I didn't know that was possible that a cash practice as possible, because I didn't think people would pay out of pocket for surgery. They were already struggling paying for their copays.

So it was a fight like this is the negotiation you pay your part and the insurance pays the rest. So I had it in my mind, in my limiting beliefs that patients were just not going to pay. But I think I was in a point where I really had no choice. I was not employable. I had a newborn, so I had to make it work.

I was really persistent in trying to find a way that was going to make it work just for. So I started scouting around. I spoke to other colleagues who had cash practices. One was from my podiatry school. And he had told me he was cashing the get-go right after graduation. He made it work and he shared all of the benefits that he had.

He has a hundred percent cash practice podiatrists. And I thought that is incredible. If there's one of him, there's got to be more. So I kept digging. I kept networking and more and more people came to light. And then I just, in January, 2020, I made a decision that by the end of the year, I would have at least 50% or more patients as cash payers and the remaining insurance-based.

So right now, in the end of 2021, I've met my goal more than half of my patients are cash paying for surgeries and for conservative care, And I'm starting to dwindle the remaining insurance that have just been pissing me off. So that's where I am today. I'm a hybrid with the intention of growing at least 90% cash.

And then the remainder insurance-based,

It broke my heart. When you said the phrase, limiting beliefs. I, that is absolutely it in terms of, we go to training and I'm sure podiatrist is, school is the same as medical school.

And that you're taught, like you said, like your expectation was to work in an academic corporate setting and, to do codes and to do insurances, what was, what you knew. But that is it's limiting because we are not exposed to, even though it that's changing, but we're not exposed to the possibilities of independent practice as a way to do medicine passed our training.

So that is great that you. Are you are where you are at today, but it is heartbreaking to hear that, that, that phrase limiting beliefs, because that's something that I feel most people who have been on this podcast have been through. And, on that note, when we talk about our training, I want to ask, because you said that your friend had opened a direct practice, a direct cash pay practice, right out of residency.

In your curriculum, did you have business training in terms of if you wanted to open a bar, open up a business, this is, these are the skills you would need to do or did you also, figure that out on the fly?

Everything has been on the fly. The way I do surgery today has been on the fly.

None of this was changing residency or fellowship. So a lot of what I do is my brain. My whole business is just on the fly. The friend I'm talking about, he's a non-surgical podiatrist, more sports, medicine oriented. And I was curious too. I was like, how on earth did you have the imagination to believe that you can do this as a cash practice, as a podiatrist in the Midwest and for him?

He was just driven to make it work as well. Like he had a mentor I believe was a plastic surgeon who showed him the way to a cash practice. And it got me thinking it's really unfortunate that podiatry the profession itself is very small, that we don't have mentorship for this pathway. And so I'm determined to show people that if I can do it as a new mom in California, where everything is expensive as balls, but my community that I serve, the median income is $34,000 a year.

If I can make it work, there's got to be way more opportunities out there. That's being. In our education in a podiatry school, I hadn't asked this question. I said, why don't we learn about billing or what insurance is even what it's like to be contracted with them. And the answers were always the same.

It's insurance insurances change so fast. We can't keep up with education. So you're just going to have to learn on the job. I think that's so unfortunate because what is on the job? Does the job mean only insurance based or is there a non-insurance based way that was never even revealed? I've not thought of one podiatrist in my entire training that has a cash practice.

So to me that's wild and I'm so grateful for where I am today and for the people I've met because there is another path and I'm living it.

Especially for, that data where the median income is below $40,000. If you aren't aware Dr. Wynn is located around Watsonville around the Santa Cruz area.

So that's geographically where she's at, but it's just it's incredible because I hear people ask frequently, oh, that's like concierge medicine, paying cash out of pocket is only for people with means. I literally had this conversation with a patient during a home visit the other day.

And so that is definitely something that, you're proving is not, this is not medicine for bougie people for the rich people only. And I want to ask when you opened, how did you get to your community that you were open and how was that experience shifting from fully insurance-based to doing a cash practice?

Was it people were jumping on right away because you're the only the only surgeon of your type in the Monterey Santa Cruz area, or how did that go for you?

I think this was a combination of things that I just got really lucky with. The first thing was I was already established in the community for a few years.

And so people knew of me. The second is my husband's a general surgeon in the same community. So collectively, I think we had a power, couple status where if you knew, when you had to know the other I'm involved in the hospital I'm the only podiatrist that ever shows up on these hospital committees to speak on behalf of podiatry to speak on which board certification is appropriate for credentialing to talk about what our needs are as podiatrists in the community.

So I'm active in a lot of different ways so that I can connect with people in the community. So in 2018, I was insurance-based and a lot of people just found me because of the insurance networking. And then in 2020 I started opting out of the worst payer because I was losing more money than I could catch my breath.

And by doing that, someone told me, once you start getting rid of the lowest payer, you make room for people who will actually pay. And I could not believe him. I was. That doesn't make any mathematical sense. People are physically in my office right here right now. And you're telling me if I get rid of them, get rid of their insurance, not the people, but their insurance, I would get paid more.

So it couldn't, I couldn't just, I couldn't get my head around it. But I knew I had to do something different because it was that or filing for bankruptcy. That was where I was at. At the time I was completely desperate. I was depressed. I was like, I can't believe this is the business I'm running. So I made that decision to cut ties with that insurance.

Sure. Enough people who were willing to pay more, showed up. They started filling my schedule. Whereas my schedule was packed for an average day. I think I was seeing 20 people and I couldn't catch my breath. And I couldn't remember the people I saw. I couldn't remember their names. I felt like I was disappointing myself.

Cause I couldn't get to know my patients. On a deeper level because I was hurting to see the next person. So with all of that, I think it was a breath of fresh air to drop that one major insurance. I was taking to really come to a realization that all the fears that I had was completely false.

And so I started taking risks, one small risk after another, basically to prove myself wrong, like whatever it is that I was feeling, I'm probably wrong. Best case scenario, I make money. So I started doing things. I'd have a gut feeling against my gut feeling sometimes. And that's what happened there.

It was all on the fly I have, I had, there was no playbook. There was no one person that said to do it this way. Everybody was like, ah, you're on your own. You'll just learn as you go. And I think that really is the best lesson in business to be.

That is so awesome though. Again, just reflecting on what you've shared this idea that you're proving yourself wrong.

You've gone from a place of limited limiting beliefs to a place of unlimited belief in yourself. So that is amazing. And I love that you've shared, that, that gem about cut off the lowest paying insurer and then having that space filled with people who are willing to pay out of pocket.

That's amazing. I know for sure that it's, especially if my patients who, because I'm geographically close to you are able to do cash pay. I will absolutely be sharing your details with them. Do you have people because of your services, do you have people coming in from out of town or out of state?

I have initially had people at a state call for an initial consultation. With the desire to come here. So I think the furthest person was Washington and that was through Netflix networking with another podiatrist. So they kindly referred to me and the person happened to live in town part of the time, or grew up here, but lived out of state so that Arizona Washington, where some of the states where they came from, most people are local in Watsonville.

It's a small town. So I do draw people from Monterey Salinas, which is maybe 40, 50 minutes south. And as far as San Francisco driving a weekly to see me for surgery or aftercare,

that's incredible. Now I want to ask just with regards to the business side of your practice, because you are a hybrid, how are you balancing billing?

Like how do you manage getting the codes taken care of getting the insurers to pay you eventually and how do you manage the cash pay?

Oh, I'm somebody who maybe like most of the listeners is not a numbers girl. And I had learned to become a numbers girl in order to make this work out. So I had a wonderful biller, but she saw me transitioning out of insurances.

And so she has less work to do, and eventually she resigned, but I keep her close to me and pay her an hourly rate for questions regarding their remaining bills that I have. And I've had to basically learn everything on my own. With the remaining insurances I have, but it has been much more tolerable because I don't have 20 different insurance contracts to deal with.

Now, I think I have just three and that's more digestible. I'm able to understand each insurance a little bit better in detail as far as what the appropriate code is and what their reimbursement is. And the more I dug into what their reimbursement was because I was just billing blindly. I was like I charge my rate at the traditional 150% or 200% above Medicare only to realize insurance did not care what your rates were because they have what's called an allowable.

So you can say you want to charge 500% of a Medicare rate. They're just going to charge what they think is appropriate for your skill level. And since everyone else is accepting that rate you are to, or opt out. Saying that the numbers were never going to work for me at the rate that was being reimbursed.

I just started opting out really fast. And I think in the last month I opted out in another three or five insurances. And by January I should only have two panels left and I think just dumping everybody else out, made it easy for me to bill. And I have a really wonderful EMR system that has the billing side built in where I just put in a code, maybe a modifier and click submit.

And that's it

wonderful. And Dr. Shane Purcell had talked about this a little bit in his podcast interview and in your situation's very different because you are. Actively cutting out those insurance payers, but how do you go about, okay, this today, I'm going to be done with this insurance. How, what steps do you take to get out of these contracts?

Number one, I had to get it out of my head that it had to go because I was scared. I was like, I keep dropping insurances. That means I'm going to keep losing patients. But to think that way you're never going to prosper. So I had to reframe it. Once I dropped this insurance, I'm going to make more room for more people, more types of my people that I can actually care for.

That was number one, number two, I just started looking at their reimbursement rate and said, okay, who's giving me the worst time. Who do I have to keep asking prior authorizations for an x-ray they're going to go, who is not paying me within 30 days. They're going to go who Is threatening my business in any financial sense or telling patients the wrong information that the doctor didn't get the proper prior authorizations or didn't code correctly and putting the blame on the doctor.

They've got to go. So I've been able to do that sequentially. I think I did it in a way that, it's going to hurt just rip the bandaid off and get going.

And in terms of the logistics, when you're canceling these contracts, do you does it work the same with each one to get out of the insurance contract?

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