Episode Transcript
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Speaker 1 (00:00):
I am going to talk about alternatives to health insurance
that are actually about making healthcare both affordable and accessible.
And joining me now is a like I mean, Travis
is like a multiple time guest, he's practically a co host.
Travis Bocens said, is the Chief Experience Officer for Pinnacle
Advanced Primary Care. They do direct primary care. And if
(00:22):
you don't know what this is, hang in. We're going
to help you understand the whole process. And joining her
today is a new Travis bocenstaid guest. Travis books all
the guests now when it comes to healthcare. Lisa Fagan
is the CEO of Smith Medical Direct Specialty Care, and
this piece of the puzzle answers the question what if
(00:44):
I need a kne replacement?
Speaker 2 (00:45):
But we're going to start with Travis first.
Speaker 1 (00:47):
Travis, for my listeners who've never heard you on the
show before, let's do the elevator speech.
Speaker 2 (00:52):
What is direct primary care?
Speaker 3 (00:56):
So Pinnacle Advanced Primary Care in the DPC movement, think
about it like the Netflix of healthcare. You are going
to pay a fixed monthly membership fee for unlimited access
to primary care and family medicine with no.
Speaker 4 (01:07):
Copays, deductibles, or offices at fees.
Speaker 3 (01:10):
So I want you to think about direct primary care
like family medicine used to be forty to fifty years
ago before insurance ruined all of it, and DPC can
take care of ninety percent of a member's everyday health
and wellness needs.
Speaker 4 (01:24):
But for your listeners and Mandy, what we talk about.
Speaker 3 (01:27):
A lot of times is well what happens outside of
the direct primary care space. And it's really exciting in
the marketplace right now that we're not only seeing the
growth of direct primary care, there's a new strong movement
called the direct specialty care movement. And Pinnacle's been very
excited to partner up with our friends at Smith Medical
(01:50):
because they're solving that problem in the market and actually
making big procedures affordable for people.
Speaker 1 (01:57):
So, if you guys have listened to the show at all,
I have been talking since I got a show in
two thousand and five about the Oklahoma City Surgical Center.
The Oklahoma City Surgical Center is a surgical center staff
by fine surgeons and doctors. And if you need any replacement,
you can go right now to their website Oklahoma City
Surgical Center, and you can find out how much ANEE
(02:17):
replacement is going to cost because they publish all of
their prices online and I have held it up as
the gold standard since two thousand and five. And now
we have one in our neighborhood and it is called
Smith Medical Direct Specialty Care. And on their website, I
am right now clicking over to the page that says
(02:38):
surgery pricing. So let's bring in ce Lisa Fagan to
talk about that aspect of it now. Lisa, I asked
you why you called it Smith Medical Direct Specialty Care.
It's actually named in honor of the doctor from the
Oklahoma City Surgical Center. So there's a long introduction, but
I wanted to get all that in to kind of
give the background. You guys are just doing the same thing.
Speaker 2 (03:03):
Absolutely.
Speaker 5 (03:03):
Yes, we named our company after Keith Smith because he's
the pioneer and we were honored that he allowed us
to name our company after him. So we are a
cash pay option for your surgical needs or affordable, transparent
bundled pricing. We're multi specialty, so we can cover anything
from a total joint to a spine to a hernia
(03:26):
and everything. All of our pricing is right online like McDonald's.
You take a look on our website and you can
scroll through and you see a rotator cuff repair, you
see a total joint and there are no hidden fees.
You know the exact price upfront prior to surgery. You'll
never get a bill on the back end. And our
(03:46):
patients are loving it well.
Speaker 1 (03:48):
And you know, it's funny because you look at some
of these prices, and some of them are are high prices.
I mean, you're talking about twenty two thousand dollars for
a total knee replacement. But when you get into the
cost of health insurance for someone over the age of fifty,
they're paying that much in annual premiums for coverage that
doesn't give them a whole bunch more, you.
Speaker 4 (04:08):
Know what I mean.
Speaker 1 (04:09):
It's like you have to break it down into how
you actually use healthcare. Now, I want to ask Travis
a question, because the number one question I get is,
so I sign up for direct primary care, or maybe
even I sign up my business to take care of
my employees with direct primary care. What happens if I
have some kind of catastrophic event. Would you guys recommend
(04:30):
these meta share programs or you work with some of those,
But now you also have you know Smith Medical where
you can say, look, you can go over here at Lisa.
I'm assuming you have some kind of financing options.
Speaker 5 (04:41):
We do have a financing option. But for employers, they
actually love to pay direct too, because they save a
significant amount of money on like their premiums for insurance,
so they save about forty to sixty percent if they
go directly to companies like US. So a total ne
like you said, yeah, it's a big price, but it's
(05:02):
a lot more affordable than if they go to a
hospital or another surgery center and they know exactly what
they're going to pay. A total knee is the same
price every single time they do it. I'm like, when
you go to a hospital, it could be a bunch
of different prices. It can range anywhere from three hundred
percent for the same exact CPT code.
Speaker 1 (05:22):
So there's everything including plastic surgery. By the way, I
was like, wait what, I love that. And I think
that eventually and I'm hoping this kind of model catches
on that this is going to create some downward pressure
on these prices in our metro area. Because years ago,
when I interviewed doctor Keith Smith on about this, he said, look,
(05:43):
we've really seen some price reductions even in the hospitals
because they have.
Speaker 2 (05:47):
To compete with us.
Speaker 1 (05:49):
Now, you guys haven't been around that long, But how
did you decide on this pricing? Like tell me how
you and I don't need like a bullet pointed every
single aspect, but when you're setting pricing, what do.
Speaker 2 (05:59):
You look at.
Speaker 5 (06:01):
Well, we're really going off of Medicare pricing, So we're
doing about one hundred and fifty percent of what Medicare
charges and that's for across the board, so physician Anesesia facility.
And then we don't upprice the implant, which most of
the most places do. They charge like a ten percent
(06:23):
increase from the implant. We give it to them at cost.
So really we're just wanting to be affordable for these patients.
Speaker 1 (06:30):
And that's another thing, Travis about direct primary care is
that you go in, you get your office visits, they
don't cost you anything extra. But say you need a
blood test, say you need a strip test, say you
need something along those lines, you guys will do the test,
but you only charge wholesale pricing, and those price differences
are shocking, Like what you will pay less paying for
(06:54):
the test than a lot of us paying a copay
to go to a doctor's office.
Speaker 3 (06:58):
Right right, what you're finding here we all follow the
same principle. We believe that you can get high quality
care at a very affordable price. And if we start
to lift the veil on the madness that is happening
behind the scenes, we can create stronger healthcare consumers. If
you're someone that owns a business. Right now, and what's
super exciting in the market is that Pinnacle now has
(07:21):
our own health plan overlaid on top of our practice
and we are partnering specifically with Smith to refer surgeries
over to them because we know those who take our
health plan, we will be saving them hundreds and thousands
of dollars by doing a direct pay relationship with Smith Medical.
Speaker 4 (07:41):
So it's like two p's in a pod. Right. We're
keeping them happy and healthy.
Speaker 3 (07:45):
But when we want our members to get really affordable
surgical care with no surprise medical bills, we are perfectly
aligned with Smith and we have the opportunity to save
local employers and their employees hundreds of thousands of dollars.
Speaker 1 (07:58):
I've had a couple text messages earlier Travis from one
of them from a guy who said, look, I run
a business out of Dia and I've got forty employees
and I need to do something just to keep employees.
And I was like, well, you're gonna want to listen
to this interview and give them a call now. At
least people don't have to have a membership with you though,
because you only made I may only need Smith Medical
(08:19):
Direct one time. Maybe if I go to get my
I'm not getting my nose done. I have a good nose.
Speaker 2 (08:24):
But you know what I mean. I mean, so I
don't have to have a membership with you. Guys, No,
no membership.
Speaker 5 (08:30):
And the average person has a surgery every fourteen years, right,
so I mean hopefully you don't see us all that often,
but when you do need us, we're here, and it's
affordable and transparent pricing.
Speaker 1 (08:41):
So there are so many questions, so many questions. What's
the warranty on a knee replacement or any surgery do
you offer? Do do you get like five thousand miles
on that knee replacement?
Speaker 2 (08:51):
How does that does that even work?
Speaker 5 (08:55):
So we don't have warranties on knee replacements. However, we
stand by our work. So if you get an infection
here from our surgery center, we will take care of
it for free.
Speaker 4 (09:06):
We won't make you pay.
Speaker 5 (09:07):
If you need to come in for a washout, or
if you get a hematoma or something like that, a
small complication, we'll take care of you for free. But
if your knee you're rejecting your knee implant, then unfortunately, yes,
you would have to have another surgery. But yeah, so
no warranty. However, we do stand by our infection rates
(09:31):
and quality care, and our quality care is just as
great as everyone everyone else around here. Everyone thinks, oh well,
if it's cash pay, they're not following the same rules.
That's actually not true. We went through the same licensing
and accreditation that everyone else has gone through, and our
quality care is high.
Speaker 2 (09:49):
So yeah, go ahead, Travis.
Speaker 4 (09:51):
I was gonna say, I've been in their operating room.
Speaker 1 (09:54):
Oh wow, love smooth operator, Travis. But I don't want
you operating on me.
Speaker 3 (10:00):
No, you don't, because I had to have a chair
ready just in case I passed out. But I for
sure was in that room witness the most top notch
surgeons and support team do that procedure, and I can
say confidently that we would refer our patients to them.
Lisa runs a tight ship and they do amazing care there.
Speaker 1 (10:20):
A lot of people are asking how to get a
hold of Pinnacle or the Smith Medical Center. I put
them both on the blog, but Pinnacle is PINNACLEAPC dot com.
And I have probably fifteen super specific questions that you
guys need to call and talk to Travis about because
they're so highly specific that I don't want to kind
(10:42):
of get into the weeds on the radio. But just
go to Pinnacle a PC. That's Pinnacle Advanced Primary Care,
PINNACLEAPC dot com. And then Lisa can be found at
Smithdirectcare dot com. And if you're anything like me, you're
gonna go to the websit and look how much every
surgery costs. That's what I did yesterday, Lisa, So now
(11:03):
I know how much every single surgery at Smith's Direct
Care is going to cost. Should I need to use
your services?
Speaker 2 (11:10):
Guys? I love what you're.
Speaker 1 (11:12):
Doing so much, Lisa. I'm so glad you guys brought
this to Colorado.
Speaker 5 (11:17):
Oh absolutely, and it's really fun to be a part
of it.
Speaker 1 (11:21):
Does somebody just ask what about physical therapy services after surgery?
Speaker 5 (11:29):
So we do have physical therapists that we work with
that can be a cash pay price or many times
they'll use their insurance, because it doesn't mean a lot
of times when people are going direct or employers are
going direct, it doesn't mean that they don't carry an insurance.
It just means that they're putting them in a tighter
box and so they can use their insurance afterwards after
(11:52):
the surgery.
Speaker 1 (11:52):
I do have probably ten questions of this nature. Would
I benefit if I have Medicare Travis? How do you
deal with Medicare patients?
Speaker 3 (12:02):
So with Medicare patients, they do have to sign an
opt out waiver. From a DPC standpoint, right, you cannot
bill our services back to those government programs, right, but
we know there are gaps in that care. We know
there are gaps in payment, so we can actually help
bridge that. And then too, as people age, they need
(12:23):
more than a seven and a half visit, So we
actually find those folks are actually contracting with a DPC
and us in direct paid resources, even if they're using
some of those programs.
Speaker 1 (12:34):
So what about the somebody asked, please ask your guests
what the monthly cost would compare to Blue Cross Blue Shield.
We're a family of four and pay out the nose. Travis,
your prices, you can just give those for a family.
Speaker 2 (12:45):
What do they look like?
Speaker 3 (12:47):
So I would highly recommend that if you are a
family that's relatively healthy, low utilizer of healthcare, I would
recommend a combination of Direct Primary Care and Zion Health Share.
Speaker 4 (12:57):
We can cut.
Speaker 3 (12:58):
We can get a family premium to a round six
hundred dollars for the entire household with roughly three thousand
out of pocket, and plus you'll add you know, one
hundred or so on top of that for your DPC membership.
But we know families paying upwards of seventeen hundred a month, yeah,
with fifteen thousand dollars deductibles.
Speaker 1 (13:15):
PINNACLEAPC dot com, Smithdirectcare dot com, Lisa Fagan, Travis Bokinstead,
thank you so much for making time today and just
what a great thing to be happening in Colorado.
Speaker 2 (13:27):
I love it. Thanks Mandy, Thanks Mandy, Thanks Lisa,