The #1 Way to Boost Your Practice’s Bottom Line

If your business isn't working the way you expected, it's not because you're bad at business. It's because no one ever taught you how it actually works. We were trained to master algorithms in medicine, but when it comes to revenue teams and growth, we were never taught anything. We weren't even told to figure it out. We just assumed somehow we'd know. Like it would magically make sense. But it doesn't. The era of the seven Figure Physician CEO is here. And it's not about working harder. It's about learning entrepreneurship as a system. The same way you mastered ACLs and pals, you can master the algorithm of building a profitable scalable business. That's why I recorded the seven Figure Physician CEO audiobook. Whether you're building a medical or non medical business, and whether your goal is your first million, first 2 million, first 5 million, first 10 million, this is where the journey starts. There is no calvary coming to save us. We are the calvary.

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So go get your audiobook now. Www.entremd.com 7Figurebook. And let's rewrite the narrative for physicians. Starting today, you need to be looking.

At your pricing and you say no. But I use the standard pricing. Yes, but you may be giving 30 hours of work for $59 a month compared to what I'm putting in taking care of these patients. How does that compare to the amount I'm charging? Because especially in the beginning, you're like, oh, yeah, but this is what I want to do. That's because you have five patients. When you have 100, it would drive you nuts. You've got to look at the numbers.

Hi, docs. Welcome to the Entre MD podcast where it's all about helping amazing physicians just like you. Embrace entrepreneurship so you can have the freedom to live life and practice medicine on your terms. I'm your host, Dr. Unna.

Today we are going to talk about getting paid for the work you already do. Okay. In private practice, it is not unusual to see multiple six figure and seven figure ars. It's not accounts receivable. It's not unusual at all. And this is something that we're going to make a historical fact. Okay? This is something that is going to become a thing of the past. We're going to look at this right where we are going to start getting paid for the work that we do. Where the more work you do, the more you're bringing in right there. There are times where private practice can feel like a treadmill you're working, but the faster you run faster. And it's not creating more stuff, it's creating more stress. It's creating more patience. It's creating a need for you to hire more people. And then the margins are getting smaller and you're like, wait, this is. It's not supposed to play out this way, okay? And we're going to stop that. That's the whole point of tonight, is we're going to understand what is going on and we're going to understand how to stop it. Okay? The first big thoughts before we get into the nitty gritty is this. First of all, seeing patients is not equal to getting paid. Like, seeing the patient getting paid. These are two different things. And so, oh, yeah, you know, I had 25 patients on my schedule. I'm so glad our volumes are up. But your volumes being up does not mean that the volume in the bank account will be up. It doesn't even mean that you meet payroll. Like, seeing that many patient may require that you hire more people, and you hire more people, and now you can't pay them. Okay? Again, we're going to make that historical fact. But I want you to, like, when you see that you're busy, don't let that translate into your mind that we're making more money, because there's something else that needs to happen before that, and we're going to talk about that. Okay? The second thing is, having enough money in the bank account to pay for your expenses does not mean you have a healthy profit margin. Okay? It might just mean that work done equal to zero, like, I'm bringing in enough to send enough out. That's it. Okay? So seeing and seeing money in the bank account go, like, we're able to meet payroll, we paid our bills, all that stuff. Nah, this is not translating to a healthy profit margin. Okay? There are things that we need to do. There's a different way we need to look at things. Now, I know when they talk about, you know, like, oh, this business, you know, physicians are not really great entrepreneurs. I want you to unsubscribe from that lie. It's not true. We have learned some of the most ridiculous things. We have learned things so hard that in a country of over 330 million people, only one. Right. One in 330 people would decide to learn what we learned. Okay? You're super smart. You can learn things, you can learn skills. And this is just one extra skill, and we're going to learn it. End of story. Okay, so let's talk about the very first thing I'm Going to give you three things. They're going to be so simple. You're going to be like, Dr. Una Really? And really, they're simple, but they're profound. My job is to take complex business principles and make them simple. This is my job. And I know what my job is. So don't be confused by the simplicity of it. Okay? The first thing is you have to know your numbers. You have to know your numbers. Okay, so true life confession. I was the person who ran away from looking at my numbers. I would not look at a profit and loss statement. I was not going to look at my accounts receivable report. I was not going to. I just would like. I don't know these things, right? And there's money in the bank account to pay the bills. And we are seeing patients. So we're good. Everything is good. I don't have to go know all those things. When I think about them, I break out in hives. Almost like in my mind, at least I'll break out in hives. But we have to know the numbers. We have to normalize these things. Okay, I'm going to talk to you about some numbers that we do want to know. And for those of you in direct primary care, direct specialty car, I have a number for you that's number set for you as well. But these are numbers we need to embrace. We need to know. Having a private practice, and I'm a private practice owner. So what I'm about to say, I'm not saying that to insult anybody or to be rude, but I want you to hear me because it's the truth. Having a private practice and running away from your numbers is like being ICU doc and running away from the monitor. Like, I don't want to know what their heart rate is. I don't want. I don't want to know what that. Like, what would you say about that, Doc? Right? Either ICU or emergency department. Like, I don't want to. I don't want to know what the vitals are. Like, oh, my goodness, you can't do that. Is like irresponsibilities, malpractice is like, quit, go sit on the beach somewhere, stop working. Right? And it's the same thing with private practice. We cannot not know our numbers. Like, that's like our own little dashboard. Like, our vitals. Like, we have to know what the numbers are. Okay, all right, so let's talk about some numbers here. Your AR days, okay? And if. If you're like, But I don't know what that is, don't worry about it. There was a time you didn't know what a Krebs cycle was. There was a time you didn't know how to put in IVs. There was a time you couldn't make any diagnosis. You were too scared to take an hpi. Now you're a rock star. All those things. So it's okay. Sit in the discomfort of it, okay? AR days is a number we need to know, okay? Insurance based private practice. This is a time between when you send out a claim and when you get paid. I don't know what that number is. Okay? Are we doing good? Is it like two weeks? Is it two months? Okay, because one is like, okay, our patient is doing okay. The other one is like, oh, my goodness, we need to run a code. We need to start chest compressions right now. Right? Like, what is that number? What is the trend? Right? What is the number? We have to know what that number is. It tells us something. It tells you when you see these patients, if they get billed on time, then this is where you can expect to be paid. Like is just something you need to understand, okay? You have to know that number. You have to know your accounts receivable, Your. Your agent report. Like, how much money do I have in the 0 to 30 buckets, right? 0 to 30 days. How many. How much money do I have in the 31 to 60 bucket all the way to more than 120 days. You. You have to know what those numbers are, right? You're going to need a report. You can have your bill or send your report. I look at mine every week, every week, every month, whatever. But you got to know what that is. And in the beginning, you may look at it and you're like, I don't even know what this is. But you can learn. You can learn. And the same way, remember, it's like the ICU doc who says, I don't know anything about the vitals. You don't have the luxury. You're a private practice owner now. You're a big boss. Okay? And, and, and I want you to think about this. You spend time away from your family to build this practice. You spend time. You could be taking a nap to build this practice. You took on the risk to take this practice to build this practice. The least we can do is put our practices in positions where they can be profitable. If you're not looking at the numbers, you don't know. There's no way to know. There's just no way to know. Okay? So your accounts agent report you want to look at that, right? And you can just start looking at it then you'll figure it out. And we're going to talk a little bit about that in a second. Your gross collection ratio, this is a number I like. Of all the monies that your front desk team was supposed to collect on the day of, how much did they collect? Did they collect the CO pays? Did they collect the coinsurance? Did they collect the deductibles? What percentage did they collect? You just want to know. I'll tell you something funny because this is the thing you can't say, oh, I know, my people are doing a good job. No, the same way an MA doesn't tell you, oh, the vitals are good. And you say, okay, you still look at it. You still gotta look at it. So they can't say, oh yeah, oh yeah, we're collecting the cope. No, you gotta look at the numbers. Okay. Okay. So this thought process, I had this in my practice many, many years ago. And I was like, okay, nobody goes by our doors if they have not paid their co pays and all of this stuff. We had put that in place. We had trained the team, we had coached them up as far as, you know, money mindsets. Because of course, nobody wants to be yelled at because they did collect money and all of those things. And we had put it in place and it had been running for months. And I came on a workshop just like this. I was talking about your gross collection ratio and all this stuff. And I was like, you know what? Let me go look at my numbers. Because I was like, nobody. This was me. Nobody goes past my door. You passed the waiting room into, into the, the exam room without their co pays being paid and all of that stuff. I go to pull up a report, it was like 80 something percent. I was like, I was just running my mouth the other day. You guys make me look so bad. The numbers don't lie. People do. The numbers don't lie. People do. So Dr. Emmett says, I know I'm bleeding from the front. That's not collecting up front. This changes tomorrow. Yes. First of all, I'm happy you observed that. Second of all, I'm happy with the decision you made because that, that goes straight to your bottom line because that's for work you already did. This is not for new patients you're going to find. This is for work you already did. So how much of it was collected? You got to know what the number is. Somebody telling you, oh, we're collected doesn't mean anything. You walking By. And hearing them like, oh, your copay will be $20. Like, you hearing that doesn't mean it's being collected. You gotta look at the number. You gotta know what the heart rate is. You gotta know what the respiratory rate is. Okay? Okay. The last number I want to give you here, and this is for my DPC folks, is you want to know, like, your subscription status. Because people are like, well, that doesn't apply to me. I'm like, mm. And then they go look, and you find out that there are patients you've seen for five months and their car declined five months ago, and nobody caught it. How many of those do you need to create a big negative dent in your business? Right? Those are things that can be missed. Okay? Your dpc, part of your. Your dashboard is you need to be looking at your pricing, and you say, no, but I use the standard pricing. Yes, but you may be giving 30 hours of work for $59 a month. So something has to give. So you have to look like, compared to what I'm putting in taking care of these patients, how does that compare to the amount I'm charging? Because especially in the beginning, you're like, oh, yeah, but this is what I want to do. That's because you have five patients. When you have a hundred, it would drive you nuts. So you got to look at it like, this pricing model that I've put here. How does this math math? You got to look at the numbers. Okay? So I have had people who are like, oh, my God. Oh, my patient also deserve this. Oh, my patient will also be nice if they have a health coach they could talk to every month, and, oh, you'll be nice. And, oh, oh, oh. And by the time they're done, they're running at a loss. Patients are doing great, but they're running out of loss. So you've got to look at your privacy. So you have to know your numbers. So the first thing is we got to know our numbers. The second thing is we need to be able to translate the numbers. What does that mean? Okay, so if somebody's in the hospital and grandma's sitting by him and his heart rate is 120, grandma's not bothered because Grandma could read numbers. Grandma can look at the screen, but Grandma has no idea what a heart rate of 120 means. You walk in and you're like, huh? What's going on? Like, immediately, you know, like, there's something here. Why? Because you can interpret the numbers. You can translate the numbers, right? And so when you see your Data from your practice, these numbers that we talked about, you need to be able to translate it. What does this mean? For instance, you have your AR days. Maybe used to be 16, 16 days, and now it's 24 days, then it's 32 days. What does that mean? Right? Like, it could mean that your doctors that work with you, it's taking them forever to even send in their claims. Maybe that's part of what is happening. Or, or it could just mean that your billers who used to send claims same day have changed their mind, and now they send it a week later. When you look at the numbers and translate it, you can find what the problems are so you can fix where you're bleeding, right where your practice is bleeding, hemorrhaging. So when you look at the AR days, what does that mean? When you look at the accounts receivable, the aging, what does that mean? So, for instance, maybe you look at your, your, your insurance piece. Like, the numbers look good, but the personal balance, you're like, wait a minute, why do we have $2,000 here, $4,000 here? Like, what, what's happening? It may be that you're a very good front desk. The person that used to collect is no longer collecting. It could also mean that your biller decided, I want your AR to look good and I don't want you to blame me. So they turned everything over to personal responsibility. And you're like, my billers are amazing, but are they. You need to be able to translate, like, what does this mean? You see a specific insurance and by, the numbers are just ballooning. For all you know, you just went out of network and you didn't know and you spent months seeing patients that you're not going to be paid for the visits. Do you see what I'm saying? Like, when you look at the numbers, they start translating the numbers. Like, what does this actually mean? Okay, you look at your gross collection ratio. It used to be really good because you had this person who was really good. They'll collect the CO pay, they'll collect the deductible, they'll collect the outstanding balances and all of that. And you hired three more doctors and you hired more front desk people. So the one person is doing a good job. And these other people, they're afraid of asking people for money. So you translate. You're like, wait a minute. Then, you know, okay, I have to have a session with them. And we talk about collecting money up front, right? And talk about how, you know, people will always act like they, they don't have money, but they pay at Walmart. They have never said Walmart. Can you bill to. At Walmart? Can you bill me? Can you send me a bill? It's in the doctor's office. They say that they're trained to. They don't say it anywhere else, right? And so the numbers tell you. The numbers tell you a story you gotta be able to translate and understand. What does this mean? What does this mean? Your subscription status. You see those failed cards? Okay. It means, oh, well, we need to build in a, you know, like we probably need to build in a policy, you know, like to have this looked at in a certain way. It's not a problem. Just means it needs to be fixed. If you're noticing for DPC and you're noticing people love you and love you, high utilization and month three, they're counseling. It's a trend. You notice it. You're like, huh? So what that means is they come in, they're getting great care. And so in that honeymoon period, they're super excited. They're. And they get to the wilderness that always shows up after the honeymoon period, and they're like, is this even worth it? Paying for all of this? And they cancel, right? What do you want to do to that about that? And I can give you guys a hint, right? But some of the things you can do is you can help people in their decision to be healthy by offering them annual plans, right? With a better rate for the annual plan. Or you can do some people, what they do is they do a deposit that is higher than their monthly payment. So the person has always paid more than they've used. So then they just like, well, you know, I've already invested in this. I'll just do it. It's not manipulation. It's not hiding people in, is just that you're helping people make the decision they want to make anyway. Right? Now if you translate the numbers, you're like, oh, this is what is happening. Like, I'm seeing that the people who do cancel, 80% of them are canceling between month three and month six. I got it now. So I got to know my numbers, I got to be able to translate. I got to know, what does this mean? What does this mean? The third thing, or even, even when you translate for my DPC folks again, you got to be able to say, this is the cost of delivery of the services that I'm offering. You have to translate that. This is how many hours, this is how much money I'm spending getting them resources and all of this stuff, this is how much I'm charging. You got it? You got to be able to translate that. So am I at a profit position? Am I, am I breaking even? Am I making a loss? Like which one is it? You got to know what that is. You have to translate it. So the third one, okay, so know the numbers, translate the numbers, then make decisions and take action based on the data. This is what the best run companies do. They make data driven decisions. So as a CEO of this company that you own, you make data driven decisions. It's not based off of a whim, it's not based off of how I'm feeling. We make data driven decisions. As a physician, what do we do with our patients? We look at the patients, we do all of that, but we make data driven decision. Whether that's data from a monitor or data we got as we got at HBI or data as we examine the patient, we make data driven decisions. This is what we need to do if our practices are going to thrive. Okay. I have heard people tell me things like, oh, you know, I'm going to do this thing for my patient. The insurance company doesn't pay anything for it, but they really deserve it and I'm not going to charge them for it. That is not a data driven decision. There's no universe where that works. There is a cost to doing business. So does that mean we ignore the patient? No, no, no. Right. The reason why we don't talk a lot about patients in the entrepreneur world and all of that is because I know physicians, we love our patients, we care for people, we put people before profits. That's not the issue. It's just that we put people in a lot of things and then the afterthought is the profits. So I'm just trying to help you bring it closer because it needs to be closer if we're going to survive. That's all. But I know I'm not going to take them out people out, number one. That's who we are. Okay, so it's not about not doing that, but at the same time, we also need to make data driven decisions. So what that means is if your AR days start getting longer, the data driven decision is okay, this is getting longer, which means we're going to start running into cash flow problems, which means I need to talk with the biller. We need to find out what the issue is and we need to get it resolved. And we are going to meet weekly until this is resolved. I have had so many clients, they try to meet with the biller, they, the biller is like, no doctor has ever tried to meet with me. I'm telling you I got it. I'm telling you everything is good. And I'm like, that's not the way this works. And if you have a biller who insists on that, you need a new biller. Ultimately, you need a new biller, right? You need to have these conversations. You need to have difficult conversations. If they're required, you need to have them explain to you what exactly is going on and what the plan to fix it is. Okay? That is a data driven decision. People have left this to linger long enough that they had to go out of business. And you're on here because you love your patients, you built a practice, you want to have impact to their lives. You want to have financial freedom and you want to buy your time back. I have time freedom. That's why you're here, okay? And because of that, data driven decisions are required, right? So if your air days have the great auto whack, that's a meeting. If you're looking at your AR aging reports, right? So this is you, you build out to the insurance companies and it just tracks like how long it's been unpaid for, right? 0 to 30 days, 31 to 60, 61 to 90. All of that, if you, if you look at it and you've translated the data right, Again, you're going to hold the biller accountable. Like, okay, help me understand, right? What is happening with this insurance company? How come this insurance company's AR is just ballooning out and they're like, oh, you know, don't accept. Oh, you know, you need like a concrete answer, like, what exactly is going on? I'm going to go look at it. Okay, great. So look into it and then we'll meet at 8 o' clock tomorrow so we can, we can work through this. You make a data driven decision, like, we have to have this result. You look at your aging report and you see your personal balance is out of whack. Is that the bill are handing it over too early? Is that your front desk people no longer collecting the money? And if they're no longer collecting the money, then now you're like, okay, we need to resolve this. Because I don't get, I don't pay you from my 401k. I pay you from the money we get from taking care of the patients. So we kind of need to resolve this. And it doesn't mean you become a tyrant, right? So think about it, okay? How many of you don't want the front desk person's job of collecting money from patients. Be honest. You're like, man, I'll pay them every day because I don't want to do that. So I want you to think about it. You are the owner of the practice. You are bearing all of the financial risk for this practice. You are the one who is figuring all this stuff out. And you don't want to collect the money. You best believe your front desk person doesn't want to collect the money either. They don't want to have that conversation. And so what that means is there may be some coaching. When I say coaching, what I mean is explaining to them the way this works. This is how we get paid. It also means you let them know.

I have your back.

So if somebody comes to you and says, oh, you're front desk people, they're awful. They made me pay my copay and all that. It means you don't throw them under the bus. It means that you stand for them. No, that's their job. And that's how I keep the lights on. So their lights on when you come into the office, like, they need to know you have their back, right? And you encourage them and you give them the gift of accountability, right? The gift of accountability. So, okay, so, so you talk with them and all that stuff, you're like, okay, but this, we need to fix this. So we're going to come look at it tomorrow, we're going to come look at it the day after that. And if you hold them accountable long enough, it becomes second nature, right? When they collect, you praise them for it. What gets praised gets repeated. Just understand, you're the owner. You don't want to do it. I promise you, they don't want to do it either, right? So give them the support that they need. Give them the training that they need. Give them the empowerment that they need, right? Encourage them when they do a good job so they can continue to do it. Do you see that? But it's a data driven decision. You got, you got to make the decision, you got to take the action you may not want to do because you also don't want to hold them accountable for something you don't want to do. Right? But you got to give them the gift. Because when we don't do these things again, it's like the ICU doctor who doesn't want to look at the vitals of the patient. This is a very, this is risky behavior. And so when we don't look at the data, we don't translate the data. And we don't take action based on the data. That is risky behavior for our practices and we don't do that anymore. Okay. Okay. These things will probably all make you nauseous. Meeting with a biller to hold him accountable will probably make you nauseous. Talk to your front desk person will probably make you nauseous. But that's okay, right? If you do it long enough, you'll no longer be nauseous. It'll be great. Okay? Dr. Bedford is a rock star on stage. Like, she kills it on stage. You ask her, the first time she had to go speak on stage, she was nauseous. Right? Now she's so good, we call her ebs Oprah. So go figure. All right, so do it. Nauseous. Your subscription status, if you're, you know, you're. You're dpc, Your membership status, right? You look and you see there's so many failed things that you're like, okay, I need to change something. So maybe you start introducing annual payments. I've had many clients who have done that. Or maybe you do this, deposit that. So they have a smaller monthly payment, but they paid more upfront and they kind of think about it a different way and they're less likely to just cancel again. That's a decision made. But I want you to think about it. If you have people typically staying six months and you implement this and they stay six months longer, you double your revenue. You double your revenue. Like you, you go back to your practice and you implement this. You just, you just go cut Dr. Luna checks. I know you said that was free, but I just created so much revenue from that one strategy there, I decided just. I'll just send you a check, doctor, but data driven decisions. Okay, so question for you. If you become the CEO who knows the data, translates the data and makes data driven decisions like this is your default setting, what do you think happens to your practice if you change and you start doing this? You do it for 90 days, you do it for six months, you do it for a year, what will happen? You become the person. You know your numbers, you know your numbers, you translate your numbers. You make data driven decisions on a regular basis. If you are private practice and you have two or more physicians, this is hundreds of thousands of dollars added to your bottom line. Hundreds. Hundreds added. Right. And that's what you gangs. I'm glad that you're going to do this. And as you know, on trendy, it is our mission, we consider it our mission to help you do this. Okay, so When I see doctors who are committed, like, I'm committed, you're committed is like a match made in heaven.

Right?

And I want to take a moment to show you guys, like, on our side, what we are committed to doing to help you pull this off. Okay? And not just pull it off once. Not just pull it off for a week, but for this to become what you do, how you function. Like filling up a patient schedule is something you've. You've mastered. Like, you know how to fill up your schedule. Getting paid for what you do is something you've mastered. Someone might say, yeah, but the insurance companies. This is the deal. The more empowered private practice owners we have, the sooner we can go after the insurance companies. If our practices are not profitable, if we're putting out fires, if we're the ones doing everything and we've not figured out how to unlock our team, we have no leverage with insurance companies. None. But the more empowered doctors is we have, the sooner we do that, the sooner we could go after them. Right? And I cannot wait for that day. So let's do that. Okay?