Direct Surgical Care in Indiana: The WellBridge Surgical Story with Dr. Eric Inman

In this episode of the My DPC Story podcast, Dr. Eric Inman, a co-founder of WellBridge Surgical, shares about his journey from anesthesiologist to entrepreneur. Dr. Inman shares insights into the Direct Primary Care (DPC) model and how the business of DPC has been adopted to a surgery center.  WellBridge Surgical offers an affordable, high-quality alternative to conventional, insurance-driven healthcare. The discussion explores the benefits of transparent pricing, higher reimbursement rates for surgeons, and the advantages for patients, especially those with high-deductible plans. Dr. Inman also discusses the challenges and successes in partnering with both independent and networked physicians, as well as navigating the complexities of insurance and self-funding employer plans. This episode provides valuable information on the transformative potential of cash-pay surgical centers and offers guidance to DPC physicians on referring patients to such facilities.

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Transcript

Maryal Concepcion, MD: 1:13

Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertips. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle Conception Family, physician, DPC, owner, and former fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care.

Dr. Eric Inman: 2:01

you don't realize how difficult it is for people to access healthcare and it's really hard for people. There are so many people that come to us and say that they don't have the, the money to have the procedure done and to be able to make that happen, when they otherwise wouldn't have been able to, if well, bridge wasn't here. That's just really, really neat. And so there's some that even still can't do it because they can't even afford us. We don't, we don't get everybody, but we get enough people that that's, that's pretty cool. I am Dr. Eric Inman and this is my direct surgical story.

Maryal Concepcion, MD: 2:41

Dr. Eric Inman is an Indianapolis native who graduated from Indiana University Medical School in 2006, and is a practicing anesthesiologist on the north side of Indianapolis. The need for transparency in the healthcare's payment system and his strong drive to affect positive change in surgical care were the impetus behind his co-founding of Wellbridge Surgical. He is passionate about providing a high quality, fair priced option that empowers patients to become active healthcare consumers. Welcome to the podcast Dr. Inman.

Dr. Eric Inman: 3:11

Thank you so much. I appreciate it. It's exciting.

Maryal Concepcion, MD: 3:13

For years I've been wanting to have your story and Dr. Smith's story on the podcast. And so we're check checking that off, already. And we're only mid-season, but this is so fantastic to talk with you because there are so many people who are scared about what's happening to insurance with premiums, employers, self-employed, and people are looking for different options now saying that I wanna go back to the. The, the foundation of Wellbridge Surgical, because you chose to open in, in Zionsville where we just had, doc, the, the physicians from Valiant Primary Care share. And I'm just wondering if you could tell us not only about the, the foundation of Wellbridge Surgical, but also the, choice to put roots in Zionsville.

Dr. Eric Inman: 3:57

I was one of those physicians who saw kinda the writing on the wall, being that, the rates that were getting reimbursed by the insurance companies Medicare all that sort of thing. The, the independent practices, because I was in an independent practice being bought up by the, the hospital systems, there's four big hospital systems in, in the Indianapolis area. And that was something that was pretty disconcerting to, to myself and my anesthesia partners in the large anesthesia group I was with. Four years ago we left the hospital, back when I would, would see these patients and they'd say, is this, is this gonna be, is are you in network? Is how much is this going to cost? Is the surgeon in network, all, all that sort of thing about, they really have genuine concern about not only their physical health, that obviously with having the surgery, but their financial health. I really felt that, that I had been missing something, along the line so that realizing that need that these patients needed, needed an outlet or needed a, an option. And uh, really thinking that where we're at. As far as physician wise within the reimbursement culture that you mentioned is gonna go downhill rather than uphill for us. Just wanted to challenge myself to, to create something that, that would be an option for for folks to be able to, to get to the operating room in a more efficient manner. I, I grew up in Indiana grew up about by 12 minutes away from where, where the surgery center is right now. And so, we kind of fell into, being, saying that, I kind of grew up around here, went to Purdue University, IU School of Medicine, so I, I've been around here, so it wasn't so much a choice to, to do it here. We didn't look, do research or anything. Although if we had the ran, you're probably familiar with the RAND studies and. When we're doing our pricing on, on this, on this stuff. Like before we opened making, making our pricing looking to see what kind of environment we're in in Indiana, we realized that the RAN study, I think at that point it was maybe we're the second highest cost for facilities and third lowest reimbursement for surgeons. And so when you have that, you have that dis disparity and that, that delta, that that, incorrect reimbursement percentage it really made sense for what, what we do and what we do is we try to get the best surgeons around that I know and reimburse them more for the procedure.'cause we can, we control the bundle and reimburse them more and then are able to lower the, the facility costs significantly. And and so it just kind of fell into it being a good environment for that.

Maryal Concepcion, MD: 6:28

And what year is this now that you'll be open?

Dr. Eric Inman: 6:30

So we're just a little over, a little over three years. So December 2nd, 2021 was our first procedure. And it's kind of crazy because our, our first first week we had one surgery. Our second week we had two surgeries, and then now we're doing over a hundred every month. and it's, it's it's kind of surprising. I look back the other day to see how many surgeries we did in January of 2022. And it's just, it's just amazing how many more, more we're doing now. And so hopefully it keeps growing like that.

Maryal Concepcion, MD: 6:55

Absolutely. So, I, I think about, as you shared there, it's one thing to recognize that there are problems with the healthcare system, with reimbursements, with the way that patients are, asking about is it gonna get covered rather than focusing on what's my post-surgical plan for rehab and whatnot. But when you think about Dr. Inman, who, went to Purdue, went to IU med school, was noticing these things, versus Dr. Inman who said, I'm actually going to change the way that healthcare is delivered surgically in my area that I grew up in. How did you go then from, thinking that this is, what, what's going on is not right, but then actively, putting into reality well, bridge surgical.

Dr. Eric Inman: 7:38

Well, I think it's tough because I, I think you know physicians by, by nature and, and one of the reasons I went to med school is kind of a. A, you, you, you kind of had your path wind out for you, right? You were gonna go to med school, you're gonna go to residency, you're gonna make a decent living. And it's, it's, it's kind of, it's, it's kind of the opposite of entrepreneurship, which I kind of fell into later. But I, I guess I had that, had that in me at some, the, the, the desire to do something different like this. But I tell, I tell some people I went to, I went to four years of, of high school, four years of college, four years of med school, four years of residency. After about five or six years maybe of practicing, I was, I was kind of, okay, okay, well what, what's the next step? I'm used to steps and coming every few years and, and, and what is that? And I, I guess I, I think personally I kind of got, got lucky with, the other, one of the other co-founders, my partner Jeff Williams, he's a, he is a serial business owner, so he's done it before, able to kind of help me along with that saying, Hey, this is, this is kind of how it would look. And then we, we wouldn't be here if, if it wasn't for Dr. Smith.'cause it's, it's really funny, the same time that I had seen a, an interview with Dr. Smith back in 2017 literally that same week that Jeff Williams, that one of the other co-founders he had, he had seen it like earlier in that week on something else. Maybe the same one. But we talked about it called Dr. Smith, talked to him on the phone like later that week and then actually went down there and met him. And it's he was just so, so helpful And just, he he'll do anything to, to, to kind of further the free market medical cause as you, as you well know. And so just had a lot of. Kind of lucky connections to, to get there.

Maryal Concepcion, MD: 10:05

It's fantastic. And, thinking about that, your, your comment of you fell into entrepreneurship later on and Yes. Your, your partner Jeff, was definitely, well, versed in, in serial business ownership, the, the ins and outs of running a business. But when it comes to you guys created something where there was nothing, and yes, there was the surgical center of Oklahoma, Dr. Smith opened in 1997, so there's years of that. This model is proven to work. And clearly you've seen that with your own numbers. But I'm wondering when you extrapolated, Hey, not only are we hearing information from Dr. Smith, but also we're in Indiana, this is where you grew up. How could we do things, personal to. Indiana, whether it be similar or different, because it's a different state than Oklahoma. So I'd love if you could talk to us about how you guys, not only took the lessons learned and the guidance and expertise from Dr. Smith, but also how did you go beyond that to make Well Bridge unique.

Dr. Eric Inman: 11:05

The disparity between how much it, how much the facility gets reimbursed here versus the, the, the surgeon that really just fell into what Dr. Smith's model already was. And so, didn't really want, didn't really wanna change that. I've been with two different hospital systems and in Ezra and, and, and in residency. Know most of the surgeons on the north side of Indianapolis, at least I did a few years ago. Usually the ones that I don't know now are the ones that have come out after me. And what was really cool was I could, go, go to these folk, go to these surgeons and talk to them, the independent ones as well. You know, We only have, one or two non-independent ones that, that work with us because the hospital systems don't, don't take too kindly to that. And so, it's, it's, it's been really cool to help the independent surgery groups that I've grown to know around here in the last 15, 17 years to help them. So every place is gonna have a little bit different mix of the independent docs. And so I, I enjoy helping, helping those gain market share. That's, that's one of our, like one, one of our kind of selling points to'em is we, we want you to gain market share. There's going to be people coming from around and we'll, we'll help you out in that manner and wanna keep you independent. One thing that. Is I think a little bit different here is that we have a lot more a lot more high deductible plans. And so, the, the, the crux of what we do is we zero tier. Meaning that if, you're, if you are with, say one of the companies that we, that we work with and we're built into the plan, well, you come here and it's$0 out of pocket for to take, to get your gallbladder out versus, your deductible and co-insurance, it's maybe$3,000 somewhere else. And so that's, that's really how you drive the volume. And, and we, again, we learned that from one of the TPAs that Dr. Smith worked with. So, we've had to come up, come up with, several different kinda avenues up here to get around the high deductible. First dollar amount. And so that me meaning that the IRS says that the first dollar amount has to, has to come from the patient. And so working around that's been a little bit different. We it, it's, it, we, we just kind of started, we, we didn't know any of the TPAs. We didn't know any of the brokers, and we just started talking to people. And one, one thing we've done differently than, than Oklahoma is we actually are in network with the, with one of the big payers, and so we have an agreement with them that they pay the same amount as everybody else does. And so, whenever we talk to somebody new, like a new TPA or a new broker, whatever, it, it, it's kind of blows their mind to say, they'll ask, well, what's the cash price? What's this price? Everybody's the same price. Every single person, whether you're off the street, whether you're United Healthcare, whether you are, with a smaller TPA direct contract, everybody's the same price. That's one of our tenants. We feel very strongly about that. But, but to be a network, I think what's very different about what we do versus everybody else that I know of is we are in network with a couple networks, to try to reach as many self-funded employers as we can.

Maryal Concepcion, MD: 13:46

When we are at the table creating the future of healthcare, opening Wellbridge, surgical opening, independent DPCs I, I think this is where I, I would love to go into this. How did you do it? Question, because so many people hear insurance and they immediately just shut down. What I'm hearing from you though is that you stood at the table to say you're gonna pay the same price as everybody else because this is, this is how we do it at Wellbridge Surgical and that was acceptable to them. And so I'm just wondering, do you worry about being threatened with United Healthcare pulling strings to try to, to try to change that story in the future? And how do you address, those thoughts from other people in our community who are like, oh, we just heard United. Oh heck no.

Dr. Eric Inman: 14:34

Yeah, I think that and, and I was pretty skeptical ear early on. With I, I, I didn't even know what the medical loss ratio was before this started, before we started thinking about this in, in 2017, and realizing that well, hey, maybe, like the, the magical insurance tree that everybody goes get their, gets their medical care at, right? Like, it, it, that insurance is paying for it, quote unquote. Even though 70% of folks that have their insurance through their employer here, it's really not insurance. They're access, like those companies are accessing a, a, a, a discounted rate from a charge master, but it's all their money. They're just an aggregate of self payers and that's all it is. And in reality and and so, so, so I always thought that the insurance companies would want to pay less, right? It would, that would make sense to me. And then I read some stuff that, well, with the medical loss ratio, well, maybe I. They don't want to pay less. Maybe they wanna pay more because 20% of, a million dollars is more than 20% of$500,000. And so I was skeptical. I thought that was probably the case yet. My, we just have a family my wife's family has a connection that, that knew one of the executives of the, kind of the regional area, Indiana area, United Healthcare Network. And so we got an introduction to them and they, they were new to the area and were kind of, sticker shocked by, by the pricing. And, and they came from out west. And and so realizing that, it's crazy. She's, she's like, I could we could ship people out to. Las Vegas and have them come back and it would cost less for a colonoscopy. And that's not even a high dollar procedure. And so, you, you, you do run into people who you know, who, who genuinely care about the cost of care. And, and I, I, I tease that out from what their job description is too, right? Like, like maybe you care about it, but like you're trying to hit these quotas and, and you're, and you need to do this for your, for your boss or for a raise or whatever. But these folks that we talked to in United Healthcare cared about that. They, they, they saw that there was a, a need for it. And within United Healthcare worked for what they were trying to do, at least these folks were trying to do. And so, we believed them at first. And it turns out that, that they, that's, they, they followed through and wanted to do what we wanted to do. And and it's, it's been helpful and, I, I don't think you're gonna go in if, if these people don't have open minds within these network, within these networks of these carriers, these insurers, they don't, you're, you're not gonna change it. And so they, they, we luck. I think we kinda lucked into that, that group and that niche within the company that, that wanted to do that. And and so it, it's been really helpful in that a, you've got the, the fully insured folks that they, they're not, not through their employer, but they just have a fully funded plan where they do pay a premium and then they have to they pay that, and then they, in that case, it is kind of like the insurance tree. You're paying a premium and then insurance pays for it. But then those folks can pay less, less deductible, less co-insurance here at, well Bridge and, and we can kind of increase the access of care to those folks. But with the the self-funded employers, it's been helpful to be in network with the United Healthcare with, in that, there's a fair amount of of market share that UnitedHealthcare has that is, that is self-funded. And so they're basically administrative services only with UnitedHealthcare slash umr. And it just, it makes it easier to be able to work with those companies because, one of the big companies we have in Kokomo, they're with UMR and we've been able to save them hundreds of thousands of dollars for the last couple years. And so, it's, they're, they're a big payer and it's helpful to be able to, work with those folks. So if otherwise, you kind of have to get them away from the BUCAs. And that's not an easy task when you're going and talking to HR and the CFOs and the CEOs, that's a, it is a kind of a comfortable, cozy nest that they're used to. They complain about it, but they're used to it. And it's hard to get somebody to change'cause it's, it is a risk. I mean, any change is a risk and nobody wants to lose their job making a bad decision on, on benefits. And so it increases the amount of folks that we can talk to, the folks that we have access to be able to help. And so it's, it's been super helpful. We're working on other insurers to be able to do that in Indiana as well. Because we want, we wanna make it as easy as possible for everybody to be able to, to access the, well bridge, well bridge prices and the well bridge surgeons. And so, we're, we're gonna continue to, to try to get in network with more folks too.

Maryal Concepcion, MD: 18:54

Even in the beginning of the interview, you mentioned how you are getting higher reimbursement rates for the surgeons who are operating at Wellbridge compared to what they would be getting, in, in their typical fee for service practices. Right here. I wanna ask about your, with, with you and Jeff coming together bringing insurance into the fold. I'm just wondering about what is the percentage of your procedures that are self-insured self-pay versus a, a larger insurance plan like United and have you guys come up with scenarios if, the, the insurance, if, if the, the BUCA type plans start trying to, negotiate your rates down and down and down, do you have an exit strategy if that were to ever happen?

Dr. Eric Inman: 19:37

to answer the first question well, I, I guess it's tough'cause there's a lot of different kind of quote unquote self-pay. You have the Christian healthcare Ministries, you have just different concierge services. You have straight cash pays. I'd say 70, 70% are from the self-funded insurers self-funded employers. So they're funding it outta their own pocket through A TPA, although sometimes the tpa A is UMR, which is with UnitedHealthcare. And so, that, that would, that would count, u those UMR ones that are there are kind of a BUCA payer. They are still within that self-funded employer percentage. Out of the self-funded employers I would say that UnitedHealthcare,'cause that's really the main one that we're, we're with, is. Maybe half. Half of what? Half of what we work with. We work with a lot of smaller TPAs, maybe 40%, something like that. We work with a lot of smaller TPAs, but the biggest TPA that we work with is UMR and then if they try to crash our rates, our exit strategy would be just to, we, we would cancel the contract with them and then, so, so we're not gonna go lower for, for them. We can't really go lower for them because when, when you're in network with one of those bigger payers, there's lots of, you have to de, and this is why Dr. Smith doesn't wanna do this, and I, I, I don't really want to, but to be able to have access, like I said, to be able to increase, cast your net a a bit wider, we, we made the decision to do it, but you have to deviate somewhat from the model of and I'll say this, like Dr. Smith said it at first he's like, no, I don't wanna mess with that. That's, that's, that's, that's insurance and I don't like it. He's like, I want, we do everything cash pay. We want it to be upfront cash pay. And we can make this, taste like, smell like, look like a cash payer and everything's paid up front. We have the patient pay the deductible and the co-insurance upfront'cause that's typically the hardest part to collect anyway. But we still go through the regular process of getting the insurer UHC or UMR to pay usually paid within six weeks or so. So you do have to deviate somewhat. But we, we've found it to be worth it so far, but yeah, but, but it, because of that, you're deviating somewhat. Your AR is long, is coming in a little bit slower than you. You can't give them better rates. If anything, it'd be more, it'd be higher rates, but as far as like, if they said that they didn't want to wanna do that, I mean, the, what we would do is we would go talk to the employer because the employers are very happy with what's happened. Like I said, that one in, Haynes International up in Kokomo, Indiana, about an hour away, 50, 50 minutes or 60 minutes away. They're very happy with what we've, what we've done. Like I said, we've been able to save them hundreds of thousands of dollars and not just savings, it's, it's, it's a concierge service. We've got patient navigators that basically handhold them through this process of, of surgery, which is not fun usually. And so they make it a better experience and it's, and it costs a lot less. And so one of the strategies would be to, we will go to talk to the employers and have them put pressure on on the payer. We haven't had to do that yet, but, just thinking out loud, that's probably the way we'd go because we know that we offer a good service, a good benefit to that employer health plan.

Maryal Concepcion, MD: 22:36

And just because the idea of non-competes is really, upsetting for a lot of people when it comes to they want to open up a DPC in, in a lot of cases that have been talked about on the podcast and they can't because of non-compete issues. Mm-hmm. You mentioned how there are some hospitals, clearly there's in every community where, they don't like their, their staff to be helping other people. Right. When it comes to concerns about talking to employers, when it comes to having physicians come on board, how do you guys get around the non-compete, whether that be like directly in the, the verbiage with a, a United Healthcare type contract so that you can talk to employers separately as well as hire physicians who, you know, are great surgeons. I.

Dr. Eric Inman: 23:19

Yeah, so with the, the surgeon part, we haven't really found a way to get around that other than it looks like, hopefully there's a bill going through this summer that will be, that in Indiana will, will say that you can't physicians can't enter into a non-compete, non-compete agreement with, with an employer. Right now, the way it's written, I think it's written for any phys, any kind of physician with any kind of employer, which that, that's, that's good. Good For me, I'd be happy with that because I think most physicians would think as long as they're not on the administrative side of hospitals, they would think the only proprietary, proprietary, knowledge that I have came from, med school and residency, and that has nothing to do with my current employer. And so there's nothing that I should be restrict, restricted by them to do. And so that, that's, I, I feel pretty strongly about that for our business model, there are. Surgeons that we've wanted to talk, that wanted to have uh, credentialed at, well bridge and do procedures, and the CMO of the hospital has said, no, you can't do that. And it is sometimes, well, really most of it is just they look at us as competition and don't wanna support that. And it just kind of blindly say, say no. So we haven't really found a way around that other than there's a couple that have become physician owned and they kind of grandfathered in. That was part of their agreement.

Maryal Concepcion, MD: 24:30

Is there any verbiage in the, the contracts with these insurance companies like United that does not. Eliminate the option of you speaking to employers, just like similar to the physician not being able to work somewhere because of a non-compete. Is there any concern about United saying like, well, this is our employer, you're not able to talk with them. If we end our United Healthcare well bridge contract?

Dr. Eric Inman: 24:55

Yeah. I don't believe there's anything like that in there. So, so we, and we, we, we, we talk to, talk to the employers very often and we, we will give'em either like monthly, quarterly, yearly savings analysis of you have this many procedures done at, well bridge, this is what you saved on average, versus market market price. So we, there, there's nothing that says that we can't do that.

Maryal Concepcion, MD: 25:14

Now, when it comes to the actual patients, you mentioned how in week one you did one surgery. In week two you did two surgeries, and then that's just blown up from there. But who comes to see you, especially from the DPC community, because this is sort of a loaded question. I've had multiple people say like, oh my gosh, you're talking with Dr. Inman today. Can you give us some examples of how it would work where a DPC physician anywhere in the nation would make contact with Wellbridge and how would that work with getting the patient evaluated scheduled and their, their surgery, bundled for them?

Dr. Eric Inman: 25:45

Yeah, so we surgery bundled, we have, probably, we have hundreds of surgeries that are already bundled and we have prices for them, most of the common ones. Every once in a while. Really still, every, at least every week I've gotta go on my basically we just have a pricing calculator Excel sheet that I look at to, to see what, what, what our bundle for that would be. But uh, yeah, we, we work with a lot of different direct primary care docs around here. And then, you get a fair amount from some of them of of referrals. And so we, we work pretty well with them. Our navigation team works pretty well with them. when we started, when we had only like a couple, couple patients, a, a month or whatever. I, I was the, I was basically the navigator and, and it's still fun to do that sometimes. Like I'll still do it sometimes if you get an email.'cause it's, it's, it's cool to be able to help people. It's, it's, it's nice. And so we've got a, a navigation team right now have a couple of really three, three different navigators that will help out. And they will take in the if a direct primary care doc comes to us, what we really like to do is just show'em around and have'em come in for a tour and say, Hey, this is where if you send your patients here, this is what, this is what it looks like.'cause we, I've been to a lot of different surgery centers and this is a, a newer facility. It's, it's it's just more welcoming. It doesn't feel sterile and hospitaly. And so, we like to, we like to show the, the direct primary care doc who's gonna refer us, show'em around and they will meet Rebecca, who will probably the one who would be taking in the surgery scheduling sheet or the referral sheet. So there's a referral sheet that we'd get from the direct primary care doc. We would reach out to the patient and then let the direct primary care doc say, Hey this patient has a has a, appointment with Dr. Johnson ENT for their kids' ear tubes. They already will have known what it costs.'cause they will, they will tell'em about that, right up front. Most often these are self-pay folks that, that, that, that are, that referred from the direct Primary care doc. They see a little bit higher, higher percentage of those as you, as you probably know. And we just have con communication between the navigator and the direct primary care doc's office that, that says, this is okay, this is what happened at the uh, at the appointment with the surgeon. And they're gonna have surgery this day. And then send the, the op note, to the, to the doctor and, and just kinda keep the, the really, the navigator and the, the offices in pretty good communication. And so just keep'em up to date on anything.

Maryal Concepcion, MD: 28:48

If a doctor who has a patient who's a little bit farther away has an update, if they wanted to send a picture, with like a video otoscope or something, how does, how does that work? If there's like, Hey, they're on the schedule for two weeks from now or something, but does this look more concerning that we need to push them up? Something like that.

Dr. Eric Inman: 29:07

Yeah, I mean, that, that would, that would just go through, that would go, still would go through the. The the navigator and then, e even some, sometimes I'm called in because I've got all the surgeons on my phone and I'll just, I, I just call'em up and, and talk to'em and, and send a picture if, if need be that has not, that, that particular situation hasn't, I dunno if it has happened maybe, maybe a couple times, it's so easy to be able to just get, get that figured out within a couple hours, depending on where the surgeon is in, in their workday.

Maryal Concepcion, MD: 29:35

Fantastic. And can you talk to us about any guidance that you give to direct primary care physicians who do refer their patients to you? Because even with patients who are used to paying cash for their primary care, sometimes they'll think about surgery is just, just not an option to do through cash pay. And I wonder if you have any guidance for the DPC doctor who, wants to, wants to encourage their patient to think out of the box and to think cash-based surgery. What are some, big takeaways or buzzwords that you find are really effective in the DPC doctor talking to their patient about, look, cash pay option is an option in the surgical world as well. Here are some things that can help you understand that patient of mine.

Dr. Eric Inman: 30:14

Yeah. We say it's an average of 40 to 60%, so it's an average of 50% less than the hospital prices. But sometimes, like the other day, we had one of the brokers that I, I've known actually since high school he, he's, he's one of one of the brokers around here who works with some of the employers who work with he had heard about a procedure that was gonna be, I think 13, 13,000,$13,000. And ours was, I think ours is$5,000 or$4,000 of, for the same exact CPT code. And so sometimes I think you have to stress how much less it can be in one of the other hospital systems around, like, it's been, like a finger fracture was 22,000 versus 4,500 for us. And so, sometimes it's, it, it, there's, it's, there's that much of a, of a difference. And I. If you look at what you would pay through that your deductible and co-insurance, a lot of times, and Dr. Keith probably said this too, I know he said it to me. So a lot of times that's like what you would pay at, well, bridge or Surgery Center, Oklahoma, or wherever it is, it's gonna be less than your deductible, less co-insurance. We have, we do tell them, we tell everybody that we have utilized care credit. It's a it's basically, the, one of the programs 0% for six months. So if you pay by six months, then, then it's no interest. Which is helpful to a lot of people. A lot of people have to do that because, say, say it's gonna cost$4,000. Not a ton of people have$4,000 sitting around to be able to e even no matter what their deductible is, they don't have that. And then, and, and same for the, for the self-pay folks. So, the CareCredit, the realizing that it could be less than your, less than most people's deductible. It doesn't have to be that much. Don't be scared of it.

Maryal Concepcion, MD: 31:46

What is your time to surgery typically for for Wellbridge, and if that differs depending on types of surgery? Can you speak to the, the time that a per a patient expects to wait because in fee for service, it's probably way longer.

Dr. Eric Inman: 32:01

Yeah, it, I think it is. And so we're, that's one of the advantages we have is, is to be able to get people in a lot faster. For instance, I think I talked to the, the broker that I talked to about that, that kiddo who had the, the arm arm issue that we're gonna, it's not gonna cost 13,000, gonna cost 4,000. They were scheduled for surgery, I think on, on April 11th. And we were able to get the patient in, we get the patient seen by somebody else and scheduled for surgery like a week before that. So we can almost always beat it. And that's, that's not even I mean like if we have to, if there's a good reason to that's gonna be better medically, we can get it in even faster than that. So for, for. We, we have two operating rooms that we had two operating rooms that were fully functional up until this month we opened a third one. It's not because we're running two rooms from 6:00 AM to 6:00 PM Part of it is what, because of what you said, we don't want to just be, quote unquote cheaper. We want to be a better experience and part of that better experience is getting people in sooner. And so to open the, open up that third operating room now we're, we're able to keep with what we had when we were not busy at all. When we're like, Hey, you wanna have surgery? Oh, you do it later today, we're not doing anything. It's not like that anymore, but we want it to be, we wanna be able to be flexible that we can get people in faster. It's always been an advantage of ours and we wanna keep it that way. So, to, it is different with different procedures, but, in general, we can, we can make it happen. And everybody on our team, especially the, really everybody, we, we take it pretty personally and we all, we've all come from the hospitals of the surgery centers. We believe in what we're doing here. And like I said, it is cool to make a difference and, pull some strings, make things work, and get them, get people in, when they need to be in. And so, it's just smaller in this case is better for, for that.

Maryal Concepcion, MD: 33:50

And it's, it's very local. Like that's, at the end of the day why our patients really love DPCs, accessing care that is driven by the local needs and having somebody who is locally accessible. So I think you guys are definitely achieving that. When it comes to the surgeons who you've, you've had come into the fold at Wellbridge. I'm wondering what does that look like in terms of the discussion for getting really good surgeons who really also. Understand and want to want to operate under the mission of Well, bridge.

Dr. Eric Inman: 34:23

One of our selling points is, Hey, we will pay more than Anthem or United Healthcare will. And, anyway, that, that's helpful. We'll increase market share, but it, it, people like, physicians for the most part, for the most part, you, we all know there's, there's outliers, but for the most part, like, we went into this to, to help people. And at some point along the way, you kind of for forget that so, to, to be able to do something like this. I really believe, maybe I'm being naive, but I really believe that, that a lot of the surgeons, feel, feel good or I, I know that they do because they tell me feel good about, like, the, the, this, this company always has the best people and they, they, we, I I love helping'em. It's, it's really cool to be able to to be able to facilitate those surgeons being able to do that with them. And I, I feel like that's also probably part of the reason why we can get people in earlier. They'll, they'll jump through a couple hoops. The surgeons will, because they're doing, because people do want to, to, to help others. I mean, most people do, to help others and are willing to kind of do the, do the extra thing if, if it's, if it's the right thing. And I think that we have that group here. And yeah, probably some of that is the, the folks that we've selected because I can probably think of some that I've worked in the past that wouldn't really care, but uh, but we don't, we haven't chosen, chosen to work with them. So it's, it's, it's good all around. It's a good group.

Maryal Concepcion, MD: 35:40

Fantastic. And then after a surgery is performed, what is your guys' follow up? Whether it be with the DPC doctor to give them an update and help them, formulate a plan for aftercare or if it's directly with the patient?

Dr. Eric Inman: 35:53

Yeah, so, everybody gets contacted the next day. Or I guess if it's a Friday, I think it'd be a Monday. The, the next working day, business day every patient will from our staff to say, we have'em fill out a survey, we, anything, how was your experience? The nurses will write that stuff down and we'll put'em up on our board in the, in the, in the break room, the good ones at least. But, but really, like we've, we've, they're pretty much all, all good, which is, which is nice. So that's the follow up with the patient and then the patient will follow up As far as postoperative like postoperative visit, like say gallbladder, you'll see. You'll, you'll see, see the patient the, the surgeon will see the patient generally in the in that surgeon's office. And so it's, it's not like the preoperative visits aren't at, well bridge, the postoperative visits aren't at well bridge, they're at the independent surgeon's office. And the, the the communication with the direct primary care doc is that, that's with our navigator. And then there's, they're sent the, the information. Usually it's crazy as it sounds. I think it's usually still facts with with the operative node and or the pathology, pathology, diagnosis on like a on a colonoscopy with, with polypectomy.

Maryal Concepcion, MD: 36:58

I, I, I laugh at that because yes, in 2025, when we're recording this, fax is still a thing. I, I have to tell my, my non-medical family that, and they're like, what? You mean like, like a fax? Fax? And I'm like, yeah, like a fax. Fax,

Dr. Eric Inman: 37:11

yeah. It's, it's just, just medicine, I think. I don't think it's anything else. I, yeah.

Maryal Concepcion, MD: 37:15

For the listener, if you do go to Wellbridge it's Wellbridge surgical.com, their website, you can see at the very bottom of pricing the average market price comparison. But just for the listeners who are like, wow, I'm driving, I'm mowing the lawn, what are some of those prices that you love saying like, no, look at this price that we offer.

Dr. Eric Inman: 37:33

Yeah, I mean, I think a, a very common one that everybody and I need to get, mine, mine done. I'm 45 now, so it's a, a colonoscopy. And so that's, that's just one that everybody knows about. They should know about. And so our price is 2310. So$2,310. And the, the price around here on average, I, I believe is, and, and it's really hard to get averages'cause people don't wanna give that up. But it, it's around$5,000.'cause we've done a lot of digging as far as looking at different savings analysis. That's, that's one. Gallbladders typically cost$10,000 more, so our price is a little bit under 10,000. The, the average cost is, is, is more it is about$10,000 more than that. Any higher dollar procedures, you give the higher dollar dollar savings. But there's an example of just down the street, you can get a, get a carpal tunnel and it costs$11,000. And ours is, I think 41 50 or something like that. Breast reduction. One time I saw a hospital literally about. Three miles, four miles that way. Caught. It was$49,000 that was reimbursed for a breast reduction, bilateral breast reduction. Our price is less than 15. I forget exactly what it is, but it's just absolutely crazy to pay those prices. And we, I, I hope nobody has to going forward. And we're just the start, really, we're, we're really just the start of people being able to make that, make that distinction. The hospitals don't want you to be able to make that. They, they don't want them to know how much things cost, but and I hope we hope, I hope we do like what, what they do in Oklahoma City or what they have done there. Keith started it, Keith and, and Steve and them, and they, they started it. And what we, and, and what we wanna see is what's happened in Oklahoma City is now the hospitals are doing it every, I think the, the cost of care is less there because of them. We're not scared of that. We want that to happen.

Maryal Concepcion, MD: 39:16

Well, thank you again. This has been fantastic. I hope it helps people out there understand even more about the options when it comes to cash pay surgery.

Dr. Eric Inman: 39:25

Yeah. I, I want everybody, everybody around to know that that there's other, there there's other options. I want other places to, to start. I wanna, grow, well bridge so that we can help even more people. So I, I appreciate it. What I want, and I know you do too, is physicians know whether, whether it's, anesthesia, surgery or, or primary care to be able to realize that there, it doesn't have to be the way that it seems like it's going. You can make a, you can, you can be an entrepreneur and uh, just like you have, just like a lot of the folks you've talked to have, it's, it's it's worth it for sure.

Maryal Concepcion, MD: 39:58

Thank you for listening to another episode of my DBC story. If you enjoyed it, please leave a five star review on your favorite podcast platform. It helps others find the show, have a question about direct primary care. Leave me a voicemail. You might hear it answered in a future episode. Follow us on socials at the handle at my D DPC story and join DPC didactics our monthly deep dive into your questions and challenges. Links are@mydpcstory.com for exclusive content you won't hear anywhere else. Join our Patreon. Find the link in the show notes or search for my DPC story on patreon.com for DPC news on the daily. Check out DPC news.com. Until next week, this is Marielle conception.