Transforming Practice with Mindset, Mastery, Cash Pay With Dr. Ashu Goyle & Nikki Goyle

All right, everybody.

I am here with Dr. Ash Goyal and his lovely wife, Nikki. She is the brains of the organization, without a doubt. So, Ash, why don't you tell everybody the name of your practice and where you're located?

The name of our practice is Integrated Spine Pain and Wellness, and we're located in Scottsdale, Arizona. I'm a DO. I went to medical school at Ohio University and then I trained in anesthesiology. So I did my anesthesia residency at Cleveland Clinic and then I elected to do a 1-year advanced fellowship in interventional spine and pain management also at Cleveland Clinic. So my practice focuses heavily on treating people with any kind of spine pain. So back pain, neck pain, mid-back pain, as well as musculoskeletal and joint pain. So knee pain, hip pain, shoulder pain, And so, I come at this from more of a holistic approach. We focus on helping people benefit through diet, exercise, mindset, movement, and then we have a heavy emphasis on orthobiologics and PRP.

And so, the practice until we met was 100% insurance, correct?

Well, for the— I would say it was 98% insurance, 2%— 98%.

Okay.

Yeah.

Right.

So, that was a good setup, right? That was working out really well for you guys? The 98% insurance and—

I'm kidding. It's not so much. Yeah.

What was life like when it was just a straight insurance practice?

Incredibly busy, incredibly frustrating. I mean, I'm still seeing a lot of patients now, but then, I mean, I was seeing a lot of patients every day in the clinic, doing a lot more procedures when I was, well, primarily insurance-based than I am now. But not making any money. All the money that was coming in was going out. We were having to take out additional loans to make payroll, to cover our overhead. Despite the 80 hours a week I was putting into this place, the return was very little.

Nikki, I want to ask you, because from a spouse standpoint, what was Ash's work schedule like?

Typical day is waking up early in the morning, out the door by 6:30, at the office by 7:00. Working until probably 7, getting home 7:30, and then doing notes from 7:30 until like 10, and then going to bed and doing it all over again. And that was every single week, 5 days a week.

Have you ever gone to a medical event, medical conference, learn a great new medical skill, and you get all excited about how to go home and you're gonna sell this to your existing client base? And you go back and guess what? Nothing happens. Maybe you sell one or two of the procedures, but all those dollars that you had bouncing in your head of how much money you were going to make, well, they don't seem to materialize. Well, the reason why is there's a gap. And the gap is, is that no one has ever taught you how to marry the science of business with the science of medicine. That changes with what we call the Business of Orthobiologics. And this is an event that is hosted by Dr. Ariana Demers and myself. We host it a number of times throughout the year. And it's a 2-day event. And what it is, is that half of the event is about the medicine of orthobiologics, and the other half is about the science and medicine of business, if you will. So what we do is we show you how to marry all of that. And what we find is that our average attendee adds $50,000 of cash-based procedures to the practice within 60 days. Wanna find out more? Click the button that is here below or click the link and it'll take you to the page where you can read more about The BOB, the Business of Orthobiologics. It's a one of a kind event. No one else is hosting an event like this throughout the entire country, and we want to help you grow your cash-based practice. Join us at the BOB. Find out more details by clicking the link below.

So then weekends, anything that he didn't get caught up on during the week, it was Saturday at the office for probably majority of the day after he would try and get at least one workout in for the week. And then on Sundays, same thing, getting ready for the week, calling patients back. No dinners at night together. No vacations. Everything just is focused or was focused around our practice.

So, and Ash, you had tried, you, you had started doing orthobiologics how long ago? When did you start getting trained in orthobiologics?

2017 for A few years. And then, but that was, I was at a different practice then. And I knew my organization, the PRP kits they were buying were suboptimal. And so I was really very reluctant to do PRP and orthobiologics in that practice. So I did a few cases that I knew were going to be slam dunks. And then I avoided more of the complicated cases until I started my own practice. And I had the ability to invest in, you know, top-of-the-line equipment and really focus on equipment that was gonna bring patient outcomes.

What were you charging for a cash, for an orthobiologics procedure?

$1,000 to $1,200 per procedure. That was for a single joint. Yeah. Sometimes I would throw in a second joint, no additional charge.

Oh my God. I just got heartburn. Like, I swear to God, I think I just had arrhythmia. So, um, what are you charging? What are you charging now?

For a single joint, anywhere from $3,000 to $4,000, depending on how complicated the pathology is and if I'm going to be injecting all the ligaments and tendons associated with that joint. And that's for one joint.

Nikki, what was Asha's response when we would start saying you need to charge more? What was that process like?

It took a while. I think there was a little bit of a hesitation and there was definitely some mindset components that were there. And, you know, it wasn't like, okay, tomorrow I'm gonna start charging more. It, you know, you guys really had to like work with us and really teach us how to do it.

What would you say has been the biggest transformation Since joining our program and joining Business Mastery Fellowship?

Confidence and mindset. Being in this community that you've created and connecting with like-minded physicians, some of who are incredibly successful, hearing their stories and seeing how they were doing things really was eye-opening for me. It's like, well, okay, these guys are doing this and they're stellar physicians and people are paying for this and they're getting great outcomes. So why can't I do that? And that was a mindset part of it, right? Because I mean, we are our own worst enemy. We create mental roadblocks. And I think the initial biggest transformation when, you know, we became part of your team was overcoming those roadblocks. And a lot of that was through the camaraderie and connection that we had with the other physicians in the practice. That was the biggest part, was just really realizing, okay, I am worth it, right? And I'm doing this like no one else is doing this. I really care about my patients and I'm invested in their outcome just as much as I want them to be invested in their own outcome. And so at the end of the day, it's money, right? And it's money that they're gonna blow other places. Why not invest it in themselves? And that was one thing that you really helped us, you know, hone in on was the fact that people are gonna spend money. You want them to spend it on themselves. Or they should want to as well so they can improve their health and overall quality of life.

And you just finished a really great month. Tell everybody, let's walk through like a 3 to 4 month, you know, when you really started grasping the concept of the pricing and the packages. Walk us through just kind of how that worked, because really what we started— you did what we talked about, just start talking to your existing patients, right? That's all you did.

Exactly.

And so walk us through, like, how did that go along, like, from the standpoint, from a revenue standpoint? Where did you begin and where are you today?

So when we first met you in February and going into March, Nikki was on all the calls. I mean, my schedule was nutty, so she was on all the calls and she was like, hey, listen, you really need to jump on these calls. What these guys are doing is tremendous and this is what you need. This will get you out of the situation you're in. And I think I came on one call sometime in March and that was my first call with you guys because I had an ultimatum. If I wasn't on the call, something bad was going to happen to me. So I jumped on the call.

This is why I love Nikki. She's a great wife for you.

I think she is for sure. But that one—

No, that was your ultimatum.

Oh, that was my ultimatum. All right. I thought maybe, you know, you were using leverage, but that's all right. Whatever it takes.

No, I think that was you and Shaktar threatening me. So, but it was that one call I jumped on. Like, it just, it was so eye-opening that I was like, okay, I'm going to double my prices. And that's the first thing I did. And so we went from collecting anywhere from like $5,000 to $12,000 a month in cash-based services to doubling that the first month. I think we did $25,000 the next month. And then for the next several months, we kind of held steady between $25,000 to $45,000 with an average of about $30,000 in cash-based services per month. Fast forward to last month, we did $84,000.

Wow.

In cash pay. Wow. Yeah.

Wow.

Tremendous. Tremendous.

You fired some of your insurance providers, right? Didn't you send— didn't you— aren't you jettisoning them now?

Yes. So we dropped Cigna last year. I mean, my private rate insurance contracts are terrible. So we dropped Cigna last year and we just gave notice to Blue Cross Blue Shield. So we'll be dropping them June 1st. We have a list of other insurance companies we're going to be dropping along the way. Yeah. And so what that will ideally do is thin out the schedule and allow patients who really want to be seen by our practice and what we do here, it'll give them the time and availability to come in at a, in a more convenient fashion than having to wait a week or 2 for an appointment because insurance patients are taking up all our time.

What has made our program, Business Mastery Fellowship, what has made it different From other coaches or consultants or programs that you have been through?

We have consultants that we work with, have worked with. We've done— I've done some masterminds. I would say your mastermind is completely different because you continue to go above and beyond what you're offering. You are really focused on teaching us the operational side of the business as well. Creating a good culture, showing us how to get our mindset different. I mean, you go into all areas focusing on our team and you just— and we're meeting twice a week, which most masterminds, you're lucky if you get one call a month.

So how do you feel about your investment in the program?

Priceless.

You guys are just all there on a regular basis to help. Give us all the tools that we need, answer all of our questions, support us in any way that we can to show us that this is possible. And that's what is so nice. And just there, you can't put a value on that. Yeah.

And your team exudes authenticity and integrity, Matt. That's really what's attractive to us. And I think you and your team have done a very good job of making the whole process come from a place of compassion, also from, you know, an entrepreneur perspective, you know, building something financially sound.

Well, great. Well, thank you for that. I appreciate you all taking the time. I, for the folks in the audience, hopefully they were able to get something from this as well. So keep up the great work, Ash. I'm proud of you.

Thanks.

I know it's been a big transformation, and I, I know Nikki and I have been, and Shakta as well, have been over there kicking in your butt. But It's kind of fun. So, um, to move you along. So I can't wait to see what the next 12 months hold for you. I can't wait for you to, uh, send that last letter out to the insurance company and be insurance-free. So thanks for joining us today. I appreciate it.

Great. Thanks, Matt.

Thank you.