Intro
Hey, I'm Dr. Ariana De Mers. I'm an orthopedic sports medicine surgeon, and I have successfully integrated orthobiologics into my busy practice so that I can provide a continuum of care and treat patients who are in the gap. The gap is this gray area in orthopedics where standard conservative treatments have not been effective, but surgery may not be warranted. And we usually tell our patients, come back when it's worse. What? These are your patients coming to you for help. Orthobiologics is that solution that can fill the gap and help you treat your patients who are in your office looking to you for help. Orthobiologics can also be an excellent treatment for frustrating problems without good surgical outcomes. This podcast will help you create the orthobiologics business that will make you love your job again. We will focus on value of orthobiologics, patient selection, how to talk to your patients about money, office setup, and other logistics. If this is something you've always wanted but don't know where to start, join me in "The Business of Orthobiogics" podcast.
Dr. Ariana
Here's what we'll cover today. Taking a payment. We're going to talk about Square, Stripe, Point of Service, and we will also talk about collecting before a service is rendered, flexible spending accounts, CareCredit, Medi-Share, and as well as Health Savings accounts, talk about your profit first, as well as your bank account. Okay. So, let's talk about how to take money. We can take money with credit cards, checks, cash, and check-ins. Let's talk a little bit about the electronic options for you. The most common ones are Square, Stripe, and Point of Sale. You can do PayPal here, Vend, Lightspeed. Additionally, you can have integrations with your electronic medical record with Square or Point of Service directly into the EMR process. Regarding the payment processing fees, whenever you take a credit card, there are fees involved with processing [inaudible] so you can get paid. So both Stripe and Square charge a fee for each transaction processed. But the fee structure is a bit different, so let's go over that. Stripe charges a flat 2.9% plus 30 cents per transaction. Square, charges 2.6% plus 10 cents per transaction, for in-person transactions and then 2.9% plus 30 cents per transaction for online transactions. So, both Stripe and Square accept credit cards, debit card payments, but Square also offers the ability to accept payments via mobile wallet, Apple Pay, Google Pay. As far as payment features, Stripe offers a little bit more advanced payment features such as the ability to set up recurring payments, split payments between multiple recipients. But Square offers a wider range of payment options, including the ability to accept payments via its own Square card reader or virtual terminal and accepting payments over the phone. With integration and customization, Stripe and Square integrate with a variety of e-commerce platforms, accounting software, and other third-party tools. However, the specific integrations each service offers might differ, so it's important to check with the types of accounting platforms or software as well as your electronic medical record to make sure that it is supported. Stripe offers a more customized option for businesses to design their own checkout experience. But Square is a more standardized checkout that is easier, in my opinion, to use for in-person collecting of fees. Let's talk a little bit about collecting upfront. This is an experience that most physicians do not have experience with, and so we do need to highly recommend that we collect at the time of decision. And so when you are signing somebody up for a cash service like platelet-rich plasma, make sure that we're getting at least 50% upfront and make it super easy to pay. Additionally, I recommend having a written agreement or price quote, and we just don't want to collect money after their procedure. It'd be like collecting a fee after their surgery when they're groggy or sore, and it just makes it super unpleasant. Other options are flexible spending accounts, health savings accounts, care credit, and management plans. And so we'll go over this. So flexible spending accounts and health savings accounts are used for medical and dental expenses. This includes copays, deductibles, prescriptions, and other medical and dental expenses that are not covered by insurance. This is super important if we're using this for orthobiologics because most people's health insurance plans don't cover orthobiologics. Therefore, they can pay with a flexible spending account or health savings account. These also include vision expenses, over-the-counter medications that are including medications purchased without a prescription, such as pain relievers, CBD cream, allergy medications, cold and flu medications, and then medical equipment. This includes items like blood glucose monitors, crutches, which you may want to use after your procedures, unloader bracing that may not be covered by their insurance, as well as, you know, other things like hearing aids and such. It's also used for mental health expenses, additional costs that may not be covered by insurance, and then certain medical procedures such as laser eye surgery or cosmetic surgery, or any uncovered benefit as long as it's deemed medically necessary, such as orthobiologic procedures. Now, a little bit about CareCredit. CareCredit is really, for my business, has been a really nice option for my patients. A lot of patients already have CareCredit for their dental procedures or for their veterinary bills. And you can apply as a business owner to participate in CareCredit. And then the way that works for the patient is the patient applies for a CareCredit, credit card online, by phone, or at the participating healthcare provider's office. Now, I would not recommend that you start filling out paperwork for your patients. Make sure that this is an opportunity or option that you offer that you accept it, but that I would not get into helping them apply for this. They will need to provide some personal information and some financial information. It's highly recommended that they apply online and do not leave the financial go-between for your patients. Once approved, CareCredit will review the application and line credit history to determine if they qualify for a line of credit. If they're approved, they'll be notified of the credit limit. And that's why we need to make sure that they understand how much the procedure is going to cost so they know what the credit limit is going to entail. And then for repayment, they receive a monthly statement and as long as they make their payments, they can either make minimum payments or pay it off in full and the interest rates vary. It can be up to 18 months of repayment. So this has been super helpful in my practice. Let's talk a little bit about pricing. So determine the pricing for your services. I'm going to recommend you take into account your physician's hourly rate using $3 to $500 an hour as a guide, and then take the cost of goods and cost of staffing as well as hard costs plus your hourly rate. When you look at your hard cost, you want to add 2-3 times that as your pricing to take into account staffing and your pay. So additionally, I'd recommend pricing to look around and make sure that you're within reason for your market and then definitely adjust prices as needed. I would also recommend policies for accepting payments. Are you going to take partial payments? Are you going to expect all payments upfront before service is rendered? Which is what I would recommend for sure. Definitely make it the exception that they pay after the procedure has already been done. Make sure that your office knows if you take cash or checks, or credit cards, or online payments before you start charging. That way it's very clear when you can and how you can take money. Of note, a lot of my patients, when I tell them it's a cash practice that we don't take insurance, they take that very literally and provide us with cash, which is totally fine as well. So make sure that you have a small amount of change in order to be able to provide change for your patients if you need to. I would also recommend you consider a profit-first principle that you're not familiar with in the book. It's "Profit First", and you can just Google that and look it up. And basically, it's pay yourself first. And really it's super important. In traditional accounting, businesses prioritize paying their expenses first and then use whatever's left for profit. Profit first changes this and prioritizes profit and then allocates money for expenses later. You use some multiple bank accounts. The system includes setting up separate bank accounts for different purposes such as profit, taxes, and operating expenses. And this helps your small business track your cash flow and ensure that you have enough money set aside first for each profit. It's [inaudible] for each purpose. And then you establish target allocation percentages. And then we recommend setting target percentages for each bank account based on your business's revenue. Now, if you don't know what your business's revenue is, just start thinking about the percent of profit that you'd like to set aside and have it be a goal. It doesn't have to be a hard and fast, but if you don't pay yourself first, you will take a back seat to all the other expenses that are at the outset. And then the final recommendation is that you implement a rhythm of regular allocation. Usually, we encourage your business to set up regular allocation days to transfer funds between bank accounts. And basically, this removes temptation, so you don't overspend on nonessential expenses. So, let's talk about getting paid. How do you get paid? You determine your prices, you charge the patient, and collect the money. Please don't be afraid to talk about money and charge patients for services rendered. This is how the rest of the world works. When you go to the grocery store, you can't leave the store without paying for the food. When you go to a restaurant, you can't leave the restaurant without paying for your food. When you want to purchase something, you purchase it first and they send you, just like Amazon, you send them the money, they send you the stuff. So if you don't take hold of your profit and your money, no one else will pay you on a whim if you don't ask for money. So, the next lesson is talking about getting equipment and centrifuges. So please stay tuned for our next lesson on equipment and centrifuges. Thanks so much.
Outro
This has been "The Business of Orthobiologics" podcast. Thank you so much for joining us today. If you want to know more, please join us on the website, "PRP-Now.com" and click on the FREE Masterclass. Also, don't forget to "Subscribe" to this podcast to get more guidance on integrating PRP in your busy practice. Bye for now.