In the 24 plus years I’ve been in this business, I’ve been blessed to see a lot of changes happen in our business.   From the adoption of computers in most offices to an improvement in medical care to the recognition of how important it is for the office managers to stay on top of changes.    There is no doubt in my mind that we in the USA are still blessed with the very best health care in the world – regardless of what the liberals and socialistic minded pundits try to make us believe.

There is no one in this country that cannot get health careif they need it.  Now – whether they have to pay for it out of their own pocket is a different story.  It’s one thing to know that if you have an emergency, that you cannot be refused health care and you will get the best inthe world, which is different if you live in most other places.   You don’t have to walk for a day to see someone who may or may not have the skill, medicine or technology to help you.  You just have to be able to dial911 on your phone and you know that in a matter of minutes, someone will be there to assist you.   Thank God for the USA and all of the blessings we have.

The reason for this email is to talk about the Faitful Five.   In 24 years of doing the work I  do, I’ve only had 5 practices follow ALL of our recommendations.  Just 5.   The other physicians were either too hesitant to follow the recommendations of the different associations (ADA, AHA, ASCA, APA) or they have office managers who could not see that it’s better to work smarter instead of harder – and this email will give you some things to think about.   There was almost a sixth and that one in a south west state told others that I had helped him increase his income by more   than $300,000 per year – but he hired a new office manager who did not help him continue following my    recommendations.  I’ve since done a preliminary analysis of that practice – based on their patient flow,insurance mix, diagnosis patterns, etc… and sent them a report – that I honestly do not know if they ever read.  The sad thing is that not only could that practice increase their income by another$400,000 a year (very easily) – but more importantly – it would help them capture some illnesses that they’re missing now.

Ok – let’s discuss what is happening with those Faitful Five.   First – they have faith – but not necessarily in Keith and I.  They have faith in themselves.  They have faith in the studies that have shown how to truly improve patient care.  They have faith in their staff to be able to follow our teaching and training.  They have faith in God that God is using us to help them.     

We have Dr. Mike (D.O.)  in Dallas who has gone from around $30K a month to around $100K a month – without working harder.  He’s working smarter now and he’s getting better results with his patients, but he’s not working harder.    I stress this, because a doctor’s wife real close to where I live recently told me when I said I could help her husband make his life so much easier was absolutely convinced that I want him to see more patients or work more hours – when the truth is EXACTLY the opposite.  I didn’t bother trying to explain it to her as she’s been doing this for 35 years at least and she’s absolutely convinced she’s right and no talking on my part will change anything – so they’ll continue to make about half as much as they can, while continuing to practice the way they always have – missing a lot of diagnosis on their patients……   He'll continue to work harder - and that saddens me as I really do like this doctor.    So, Mike has not only tripled his income and he’s home every night with Cindy and the kids on time – but he’s getting better results from his patients too.  He’s about to increase that net income (net is after EVERY expense) another 30% by adding on the lab to his practice that we’ve recommended.

We also have Dr. Wallace (also a D.O.) in south Florida who I had the pleasure of seeing her and her lovely family this past week while I was speaking at a Florida convention (this was before my vocal cord surgery – so I had a voice then).   She continues to tell others about us and we slowly make improvements in her practice – going just as fast as she wants us to and she too is a blessing to work with.

Another physician (he too is a D.O.) we’re blessed to workwith is Ted Hill and his lovely family in Ohio.    Ted has followed all of our suggestions sofar – and he’s constantly improving his bottom line and reporting greatsuccesses with his patients just about every time I talk to him.  

The reason that 3 of the 5 we’re talking about are D.O.s is because I do not speak at any M.D. conventions. I’ve found that most D.O.s (not all) are not so set in their way that they want to continue practicing the way the have for 200 years and their main interest is to discover the cause of the problem instead of treating symptoms.   I honestly have found most D.O.s are more fun to work with than M.D.s – but there are exceptions.   I immediately think of Wiley Roosth MD (whois turning 87 today) and still practicing in Tyler, TX.  I think of Diego in northern Florida.   I think of

Two of the nicest M.D.s that I’ve known in 24 years are Absalom Tilley MD in Arkansas and Joe Goin MD in Cleveland, Texas.  Both of these practices have 7 providers and multiple locations and both are not only very good businessmen – they are genuinely good people who put patients first.  Now – the fact that both have increased their income by $ Hundreds of thousands by giving better medical care than other practices is no small matter either.   Both of these practices have done everything we’ve recommended – and as such – have benefitted in their business and their medical outcomes.  By the way – when I say “everything”, that includes setting up protocols in the practice, installing lab equipment to get point of care information to be better doctors – while increasing NET income by tens of thousands per month.  That includes retraining their staff and the result is that they are getting better clinical outcomes on their patients than the physicians who “know better” or are waiting for who-knows-what before they act.

My question is to the rest of the doctors that we’ve worked with.    When Keith and I show you the medical necessity guidelines as published by people a lot smarter than I (and maybe with a few more clinical resources than you have), you may or may not act on it.    When I show you that 21% of your patients are suffering from pulmonary dysfunction and that by doing PFTs in your office, you’ll be able to not only detect COPD and pulmonary problems earlier – thereby allowing you to better treat YOUR patients – why do you not act?  It can’t be the money because we show you – in such a way that It’s easy to see – that your NET (after every  expense) income will increase by $6,000 to $14,000 per month – thereby allowing you to pay off other debts – so why do you not act?  It can’t be that you still believe that the spirometer is giving you what you truly need to help your patient as hopefully, you’re smarter than that.

When we show you that you can be doing ABIs (Ankle Brachial Indexes) on your own diabetic and hypertensive patients to detect Peripheral Arterial Disease – why do you not act? You admit that 1 out of every 3 of your diabetic patients over 50 have P.A.D..   You admit that 1 out of every 3of your hypertensive patients over 50 have it. You admit that 1 out of every 4 of your black patients over 50 have it because you agreed with the National institute of Health.   You tell me you want to give the best medical care and that you want your office to be the kind of office where you want your own loved ones and relatives to go to- yet, you don’t act on what we show you.   Especially considering that only 2 patients a month makes the device to do the test and detect P.A.D. early enough that you can save a toe, a foot or a life profitable – I’m confused.     It can’t be because you’re worried about Obama or if it is, then I didn’t do a very good job of explaining that the entire device would be paid off in 2 months with your patient volume that you gave me and you know it will take at least 18 months before anything Obama passes is instituted.   The Federal Government requires a comment period in the Federal Register prior to changes in healthcare law.  How many of YOUR patients will you keep from having an amputation in that amount of time?   How many will you not prevent?

I could go on and on with how many of your Orthostatic patients are suffering from syncope NEEDLESSLY because you have not acted on the Heart Rate Variability testing that would put another $9,000 a month NET into your practice.  We could talk about the number of your CHF patients that have no quality of life right now because you refuse to do the ANSARS to detect which ones are being over beta-blocked by their cardiologists who are giving them too much Coreg or Toprol.    How many of your ASYMPTOMATIC diabetic patients are suffering from silent ischemia that you’re not capturing?    Maybe your number is higher or lower than the national average of 22% that the ADA and American College of Cardiology reports.      When you do realize that thousands of physicians have been helping patients with these problems for years that you've been missing - and some of those are your own family members - will you regret not listening to these other doctors earlier?

Yes – I’m talking about changing how YOU practice.   No – I’m not a physician – but I don’t have to have graduated from a medical school to know right from wrong any more than you have to be a mechanic to know that it’s dangerous to put your hand into a moving fan belt.    How many patients died from being "bled to death" before others woke up and realized that they may need to change how they practice?

Yes, I am being arrogant – but sometimes that may be what it takes to wake someone up to realize that they may be wrong.  If you want to continue practicing how you’ve always practiced – you’ll continue to get the kind of results you’ve always gotten.   We know what those results are –if you’re in the national averages:

1.      31% of referrals from primary care to cardiologists turn out to be non cardiology problems

2.      22% of asymptomatic diabetics suffer from silent ischemia

3.      65% of those patients will die from complications of heart disease

4.      33% of diabetics over 50 have Peripheral Arterial Disease

5.      33% of heart disease patients over 50 have P.A.D.

6.      25% of black patients over 50 have P.A.D.

7.      25% of diabetic hospitalizations are to have an amputation as a result of P.A.D.

8.      1 out of every 3 geriatric patients will fall this year, at least once

9.      25% of geriatric patients falling will be hospitalized for a complication

10.  The number one cause of syncope is Orthostatic Hypotension

11.  14% of Americans suffer from Orthostatic Hypotension

12.  21% of Americans have some kind of pulmonary dysfunction

13.  Spirometry only gives you the mechanics of the lungs

14.  If diffusion or gas exchange is the problem –the mechanics can still be fine

What can you do to improve the care you’re givingyour patients?   Do you want your wife,husband, son, daughter or parents going to a practice that captures theseproblems early enough to make changes and improve the patient or do you wantthem coming to a practice like yours?  It’sa tough question and one you need to honestly answer.

Keith and I are going to continue to help the physicians and their practices that allow us to.  Many of our clients will pick and choose which recommendations they follow and they’ll limit the improvement to their medical care.  They’ll limit how much ofan increase they can see in their monthly bottom line.   A few will follow the more than 50 years combined experience we bring them with substantial data from the research and studies done and they’ll do all that we recommend. Those are the ones that a year from now will have increased their bottom line by several hundred thousand.   Which one will you be?

Please do not be like the practice last year that recognized the technology would help their patients and help them increase their own income - but the foolishness of pride kept them from doing it because "I don't want to go into debt" - even though they admitted that doing the short term debt on the device would allow them to pay off the loan on their $26,000 truck in 1/4th the time they are taking now - thereby getting out of debt faster.       What kind of care do you want YOUR patients to have?