Direct Care Doctor
Dr. Grace Torres-Hodges is a board certified podiatric physician and surgeon who started Torres Hodges Podiatry in 2001. She transitioned to a direct care specialty practice in 2017. She completed her undergraduate studies at Vanderbilt University and was pursuing graduate studies in sports medicine at the US Sports Academy prior to medical school. Dr. Torres-Hodges received her medical degree from the New York College of Podiatric Medicine and completed her post-graduate training in podiatric medicine and surgery at St. Vincent's Medical Center in Jacksonville, Florida. She maintains surgical staff privileges at her local hospitals as well as the Andrews Institute for Orthopedics & Sports Medicine.
She has shared her knowledge with the next generation of physicians teaching the medical students and residents at Florida State University College of Medicine and the USUHS programs at Eglin Air Force Base and Navy Hospital Pensacola as well as within the Doctor of Podiatric Medicine Mentors Network (DPM Mentor Network). Dr. Torres-Hodges has been named a Top Doc by HealthTap Online and was named the 2020 recipient of the FPMA's Podiatric Physician of the Year.
Dr. Torres-Hodges holds an executive MBA from the Quantic School of Business & Technology and promotes physician entrepreneurship. She is co-founder of D2P Medicus Consulting and remains a staunch advocate of preserving the doctor-patient relationship and the independent private practice of medicine. She has been featured on podcasts for Lean Frontiers, Healthcare Americana and the Benjamin Rush Institute and has been an invited panel member to Women in Leadership conferences.
Locally, Dr. Grace is still remembered in her hometown as a musician and cellist with the Pensacola Symphony and remains active with volunteer organizations in her community. She is proud of her family heritage, especially the traditions and values her physician parents taught her. She was honored to share their immigrant story as part of the compilation book Filipinos in New York City. Above all, her most treasured time is spent with her husband, son and daughter.
@drgracedpm on Social Media
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Welcome to the podcast Dr.
Torres Hodges. Hey, how
Thank you so much for being here. And it is wonderful to start with such an impassioned opening statement. I just, I absolutely love that and I hope that the listeners are just ready, ready to hear your story. So you are a podiatrist, you are a specialist who has been opted out of Medicare since 2017, but I want to take a step back. And if you can give a little bit more about your history as to after you graduated podiatry school, what, what did your, what did your world look like at the.
So after podiatry school, I did my residency in podiatric medicine and surgery in Jacksonville, Florida at St.
Vincent's medical center. I had a great opportunity there to learn about all aspects of pediatric medicine and surgery, because number one, we ran our own clinic. So there was something there to be said about actually considering private practice. So I was exposed to that. And then also we were the only surgical residents at the hospital.
So we scrubbed every case. I mean, I was scrubbing gallbladders and heart and everything. Never again will I did do that. But it was nice because, you know, you got to meet all different types of specialists. You've got to learn different techniques from other people. You just interacted with the whole system at at the hospital.
When it came time after, after graduation, trying to figure out where to live. My husband and I actually were separated our first two years of marriage because he was still working in Washington DC. And I was in Florida. Um, We racked up a lot of frequent flyer, mileage back and forth, and a lot of calling card calls all the time.
But it was going to be either around the DC area or in Florida. I had an inkling of wanting to come back home to practice in Pensacola, both my parents practice there also. So I kind of had a little bit of a leg up to, to come back home. it wasn't that difficult to convince my husband to move to Florida.
So, I'm very grateful that he obliged and, and we did. So I started practicing in Pensacola. I actually joined a group first and was employed and. You know, I remember my parents saying, well, why don't you just open up by yourself? And then both of them, they have a general surgery and internal medicine, clinical cardiology background.
And they wanted me to join them. Like, no, no way. I'm not going to do that. I grew up being a doctor, Torres kid all the time, and it was bad enough that I come home. And even as a doctor already, they were always knew me as, oh, are you Dr. Adelaide or Dr. Dewey's kid. So you always had to be kind of building up your own reputation on that, which again, that's another thing altogether, but it was, I think it empowers me, it empowered me at the time and made me, I have to prove I have to do this right.
And do well, but I joined a group practice and I learned the intricacies of insurance. Capitation and contracting didn't realize that at the time when I signed away everything that I was in that practice, actually, I didn't realize I was the one being assigned all the capitation stuff. So here I am working my butt off and was not getting a return because I had a an associate to partnership agreement that was going to be based on the revenue that I was making.
But when you're cafeteria, you're not going to make the revenue on that. And I didn't know that long story short, the relationship there ended after a year. And then I opened up my own, my own practice and that's it did not have one HMO or competition plan in that, but one of the benefits of opening my own practice, I learned.
From my previous employer, how to run a podiatry practice. But I also had a little bit of a leg up because my parents both had had private practices already. They were actually in a joint private practice together. And so I got, I was free labor all growing up. I worked in that office. I answered phones.
I filed I cleaned, I even transcribed. So I learned how to, you know, I was doing a lot of the transcription over there. But one of the things that. It was a family business, not only where my mom and dad, the two principal physicians there, but my aunts actually where the office manager and the reimbursement and claims specialist and early on, I don't even recall them being too much into insurance things.
I remember when my aunt told me about the copay and how that was a different thing that they were doing. And, you know, I was probably in middle school when all that happened, but you know, so I got to see the practice from both ends from my mom and dad's side and also from my aunt's side to see all of that.
And so I had a little bit more business knowledge that I was able to take with me into my own practice. I successfully practiced from to 20. About 2013 when I was feeling, you know, the, the pinch of all the new regulations with, after having completed PQRS with Medicare, after completing a change up to, I mean, I started out with paper charts and then I had to switch over to EHR, I did the incentives with the. Electronic prescription because you know, none of us know that at the time that what you end up doing is you're given a, a directive and said you know, you can get an incentive on your Medicare reimbursement, if you Do this, this upgrade to e-prescribe without the knowledge, knowing later on that they're going to penalize you once you didn't reach or attain that by a certain date.
Um, But we were like conditioned to just do this over and over again. And one day my husband was asking me, what are you doing? Come on. Let's go.
And I'm like, no, I've got to do my charts. I've got to fit. I've got these audits to finish up. Cause there were probably some chart or audit and he goes and says, you know, what, what are you doing? You do this every night. And, and I said, but I had got to. And he goes, but is it helping your patient? And then that little question right there was the one that kind of got me thinking.
And then, you know, is it really helping my patient? No, not really was it was going to help me get paid for helping the patients that I already helped. And then, you know, it started the wheels turning a little bit on like, what am I doing? Why am I working so hard? And then each year up until 2013, I started you know, each of you had to see more people because your reimbursement rates kept them going lower and lower and lower.
I had all the insurance plans. Like I said, I had no HMO's, so these are all private pays and Medicare all PPS. And you could feel that that just overworked and it's like, why am I doing this? You were just tired. I mean, you, you love what you're doing, but you just hated all the minutia that was, was around it.
And then from that point, what happened was I got this email. How about this meeting called how to thrive, not just to survive from a group called the American association of physicians and surgeons. And it was a one day, a all day event and you can get CMS and it was over in Dallas. And I really didn't know what to expect.
I didn't know much about what the group was. And so my husband and I decided to fly out there to see it. And I get into this room. And the first thing that they talked about was opting out of Medicare and I'm like, wait a minute. Why, why would you do that?
You know, who can do that? Especially me as a podiatrist. Why would I want to do that? That's like 50 to no more than 50. It's about, it was almost 75% of my practice. You know, why would I want to do that? But then I got to thinking as they was listening to the lecture about all of the rules and regulations about the caps of how much you can charge about the reimbursements, the punitive, the punitive damages, or the punitive penalties that are there.
If you don't do something right. And I got to thinking, oh my gosh, this is. That. Yeah, they are right there. That's exactly what I'm thinking. Why can't. Yeah. And then, then they had a couple of other people come on and give basically a case studies on their practices themselves. Josh umber was one of them.
And you know, he, they to hear about Atlas MD early on in 2013 um, it was pretty, still new and it was amazing because these guys were young, they just got out of residency and they just opened straight up. And then ironically, I actually met three specialists at that meeting also Dr. Kathleen Brown dermatologist.
She talked about her practice, Dr. Gerard Ginoli an autoloader ecologist. And he talked about that and to hear it from a surgeon that was really interesting. And then Dr. Chris held who's an ophthalmologist To hear her. And then another doctor who's an emergency medicine doctor Dr. Beth Hanes went up and talked and she was very very passionate about explaining the importance of continuing on the noble profession of medicine.
Um, At the time she was very much involved in the Benjamin Rush Institute. And that was my first encounter with the Benjamin Rush Institute which for those who don't know, it is a nonprofit organization that is geared towards educating our medical students and residents about free market principles and honoring the doctor patient relationship.
And that was probably the biggest thing that you get out of that conference was that everything was geared towards the doctor patient relationship. And it was. Kind of what, like my husband, when he asked me that question is what are you doing? Is it helping your pay, everything kind of jelled together at that point?
You know, and then I made a, I made a commitment at that point to start really paying attention to my numbers. And we looked at the books, I looked at my payers, I knew who was paying well and who wasn't paying well. And and then unfortunately every year they got worse and worse and worse, but I decided to look at who was paying the worst and start weaning off.
A lot of it also was educating. There was a group there called docs for patient care. That was really good about. Giving material to their patients, because it's not just doctors that have to do this. We are the first ones on board, but you have to also educate your patients about it. And I think that was the biggest thing in my transition from 2013 to 2017, I took that time to really educate my patients about what insurance and third-party payers were actually doing.
Not only to me, but to them that they weren't being good stewards of their money. And by the time I dropped Medicare and opted out of Medicare in 2017, I had there's a method of doing it, but it was about 55% of my practice. I took a huge financial drop that first year, year and a half. But when you drop those people in there, a lot of them stayed on because they'd been with me for, for a long time.
And when I had already educated them about how the whole practice was going to run at that point a lot of them stayed on, but you know, when you did, you, you did lose a lot of those first timers that, that one, you know, you have to be ready for that.
If, if you're going to go this route. I think in retrospect, if I was coming out of residency, I would have tried to do it directly. It it's, it is difficult when you're already in, not, I wouldn't say difficult. I say that it, it's more, you have to plan it properly when you're traveling. Does that make sense?
does. And Dr. T wen had mentioned this in her podcast, but that you are so passionate about mentoring. And so when you mentioned, you know, just being ready, it's definitely something that, to be business savvy, you have to prepare for the future.
So I think it's very intelligent to, to mention that because people who are new to this world of what is direct care or could direct care work for me as a primary care doctor, as a specialist, that is something that they have to
consider. Absolutely. You know, and the thing is, is that we want to do it.
Well, those of us that are in direct care, you want. For personal reasons, selfishly, we all want to do well. One of the things, I think that's difficult for doctors, we're, we're naturally altruistic and we want to serve, people. But I heard a, um, I heard a great phrase.
I, I took the Hippocratic oath. I didn't take a vow of poverty. And that was awesome when I, when I heard that, because, you know, that's so true. We, we were running a business when you were running a private practice, it is a business and you have to start running it like, and thinking of it like a business, your patients or your consumers, but there's just an added bonus to it.
The fact that you develop a relationship with those patients. And that's the essence of medicine is because there's that personal relationship that you get with them over there. But Yeah, it, it, we want, we want this to do well. We also want to attract good people into medicine. That's the thing.
And the way that third-party payers and administrators have hijacked medicine by adding all these extra rules and regulations it's burning out everybody and you hate to say burn out because that makes