Northpoint Surgery & Aesthetics with Dr. Jillian Ciocchetti

General Surgeon Dr. Jillian Ciocchetti left her very comfortable hospital-employed job of 15 years to venture into Direct Care Surgery. She gives us insight about how she connects with self-funded plans that funnel patients to her and she performs the surgeries at a Direct Care friendly facility. 

This is affordable surgery, not cheap surgery. 

Find her at:

• Northpoint Aesthetics
• Northpoint Surgery & Aesthetics

Transcript

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Dr. Tea  0:01  

Practicing medicine without insurance is possible. Imagine a private practice where you get to see your best patients every day, providing medical services you truly enjoy, all without the hassle of insurance. My name is Dr. Tea Nguyen, and I'm a recovering specialist who was completely burned out from insurance based medicine. I pivoted into direct care, where patients pay me directly for my medical services, and have never looked back. If you're a private practice owner or planning to become one who's looking to be free of the grind of insurance and you're craving it, simplicity, efficiency and connection with patients, you are in the right place. This podcast will help you map out your exit plan and uncover the mindset needed to thrive in today's economy. Welcome to the Direct Care Podcast For Specialists. 

Dr. Tea  0:54  

I have a wonderful general surgeon, by the way, did you guys know I'm married to a general surgeon? But it's not who's on podcast today, not yet. Anyway, I have Dr.Jillian Ciocchetti, who is a general surgeon in Denver, Colorado. After 15 years of caring for her patients through traditional models, she changed course, and we're going to talk all about that today. In 2023 she quit her corporate job, hospital based job, and is now pursuing entrepreneurship and direct care surgery. Welcome to the podcast. 

Dr. Jillian Ciocchetti  1:25  

Thank you so much. I'm just I'm so excited to finally be chatting with you. I feel like we kind of message back and forth a little bit. We probably could have done this a little sooner, but it's a perfect time to be doing it, because I feel like what I set out to do is now coming into more focus. You know, you sort of think you know your plan, but life throws things at you, and then you actually get on your actual path. So yeah, 

Dr. Tea  1:48  

The older I get, the older I get, the more I believe in magic. I just feel like things just happen for a reason, but you have to open that door for possibilities to happen, because if you're stuck in a situation, those opportunities never show itself. And we were just talking before the recording, exactly how that worked out for you, but you took a step, and then things start to come in. So why don't you take the listeners into your journey as to why you left your very comfortable situation and now you're into direct care surgery, yeah. 

Dr. Jillian Ciocchetti  2:18  

And you put it really well, I had a very comfortable situation. I worked at an academic community hospital in Denver, Colorado. I was teaching residents. I had no RVU production targets or quotas, nothing like I didn't have to do any certain amount of work, and I was paid well and all the things. But I realized after being at that job, I was there for seven years, and I had this moment where I thought, you know, what I came here for was great, and it was actually really good for a few the first few years, but what I came here for is not what I have now, and I am frustrated, And I spend my days at work, you know, angry or frustrated or not finishing on time, and definitely, like, trading way too much of my life for this job. And I don't exactly know what I'm going to do, but I'm not going to do this anymore. And it actually took me three months after I quit to figure out what I quit right? I wasn't done being a doctor. I wasn't done being a surgeon. And I think what I quit was insurance based practice. That is what I actually quit, even though I couldn't have described that to you at the time. For the first three months after I left my job, I was convinced I'd made a mistake. I was convinced I needed to call and ask for my job back, and I had to get out of that head space. I had to sit there and really, you know, work on me and get out of that head space. Because I think our training really prepares us for, like, if you don't do it the way they want you to do it, you're not doing it right. And you have to, you have to have some pioneering spirit to say, I don't know what it looks like. I don't even know if it will work, but I'm going to go try it. So I gave myself, I made the decision to leave in, I think, like mid February, like the second or third week of February. And my birthday is February 27 and on my birthday, I called to quit my job. I decided it was going to be my birthday present for myself. Um, myself. I was 45 last or 44 when I quit. And I called and I gave my notice. I had to give a 90 day notice, which is kind of painful in medicine, you have to give such a long notice, and then you have to sit there and watch how they dismantle your practice while you're waiting to be done. But I gave my notice, and I walked into my surgery center a few weeks later to tell them that I was leaving, that I, you know, my block time was going to be opened up. And I talked with the business manager of the surgery center, and I said, Hey, Lisa, I'm going to be leaving in a couple months. My. Block time will open up. And she says, really, well, I'm leaving too. Would you like to hear what I'm going to do? Because it's very exciting. And you know, up until this point, my plan had basically been I'm going to go do locum surgery for a year. I'm going to continue to grow a side business that I had started quite a few years before as a small Med Spa. I'm going to continue to grow that. I'm going to do locums for a year to pay the bills, and I'm just going to see what else falls out of the sky. And this conversation with Lisa led me to find out that there is such a thing as direct care surgery. You know, prior to that, I had known about direct primary care, and it sounded like a dream. Wait, what? You have a practice where the bills are all paid by the fifth of the month because all your membership fees hit on the first and you have enough money in your account to pay all the bills. And wait, what's that like? An employee job where people actually pay you to do your work, right? I didn't know that was available in medicine, but there was no place for specialists or surgeons in that you know, at least as far as I could see. So Lisa asked me if I've heard of the Oklahoma surgery center. Many of you may have heard of it. It's out of Oklahoma City, and it was started about 20 to 25 years ago by Dr Keith Smith, who's an anesthesiologist, and I had heard of it, and she said, Well, our idea was to take his model and scale it nationally, and he doesn't really want to do that, but he'll be on our board. So it's called Smith medical, and that's what we're going to do, and we're starting in Denver, just down the road. Do you want to hear about it? And so, um, it was about a year before we actually opened. So when we first started, when I first started learning about it, but it's been a really fun journey. So that's kind of how I decided to leave 

Dr. Tea  6:50  

That's such a cool story, because it's not common that we get a surgeon who's like, this model sucks, and I'm gonna leave it like we all know it sucks, but to pave our way and just figure it out as we go. That's really scary, and I can't even imagine what it is, because for podiatry, at least, we do a lot of elective things that people are willing to pay out of pocket for. But for general surgery, we're talking about Colin resection, gall bladders, weight loss surgery, things that my husband do, for example, it's like, if we get rid of that safety net? Will they actually pay out of pocket? And I always argue that the patients in my community, at least in Santa Cruz, they go to Mexico for these procedures, because the price is clear. So how can we retain that care home? And I think by having direct care surgery available, where people know what they're going to write on their checkbook, what it's going to cost. It's going to keep people here, and it's going to keep them safer, too, and then they have all their networking team, their physician teams, here for them, should there be a complication after surgery. So I find this to be so incredibly valuable. Now, can you tell us how you are working with the surgery centers? What does that look like in your current phase of practice right now? 

Dr. Jillian Ciocchetti  8:05  

Yeah, so there's a lot of different ways that patients get to me, and they're not it's not all the same. So you might think in your mind, you mean, I'm going to have a cash pay practice where everybody comes and pays cash for what they're doing. And there is a component to that. I mean, as a general surgeon, my ability to perform lipoma procedures in my office is vastly superior, both for me and the patient, than going through insurance in my office, I can do a 45 minute procedure from start to finish, and it only costs me, I don't know, a couple 100 bucks, you know, I have to have an autoclave and stuff, but it doesn't cost me very much money to do all of that in my office, and I can easily charge 750 to $900 that's a pretty great hourly rate, and you're making as much to take out lipoma as you'd make to take out a gallbladder with insurance right way less liability the patients can afford that. I mean, some people come to me, and if they can't afford it, I won't give them a payment plan, like you can't have your surgery now and pay for it later, but I'll happily let you put it on layaway, you know, give me 300 today, 300 next month, and in the third month, give me the last 300 we'll do your surgery, no problem. It makes it you know, if they went through their insurance, they're going to pay quite a bit more out of pocket, especially for the Senate Surgery Center, and I'm going to make $100 for taking out a lipoma in the office. So by cutting out all those people in the middle, it works a lot better. But that is not the majority of the patients that I'm getting. It's not cash pay patients. Okay? What it is is working with employers who work with self funded insurance plans. Now I'm guessing most of the people who are listening to this have no idea what I'm talking about. Do you know what I'm talking about when I say a self funded insurance plan? 

Dr. Tea  9:53  

It's a long word, yes, but go ahead and explain it to the person who may not know what it is.

Dr. Jillian Ciocchetti  9:58  

Yeah. Okay, so let's. Talk about a traditional insurance plan. So let's pretend you're the employer and I'm the employee. It will cost you about $1,500 a month to insure me and my family. Okay, now in that sort of a relationship, there's an $8,000 deductible, which I am responsible for. So the first $8,000 in care I pay for, you're paying the 1500 a month, and then after we hit the $8,000 deductible, then the insurance kicks in to cover the rest of the bills. That's simplifying it, but that's basically how a traditional insurance plan would work. In a self funded plan, the employer is choosing to take a little bit of a risky gamble to save money. Okay, so you're choosing, as the employer, to only pay $300 a month to cover me and my family. In exchange for that, I get an $8,000 deductible. So from my perspective, it's not much different, but you have a $25,000 deductible on me. So the first $8,000 of care is paid for by me, anything between 8000-25000 is paid for by you, and then insurance kicks in. So insurance tends to be a little bit more of a catastrophic medical plan at that point. That's why it costs so much less money as the employer. That makes you highly invested in my health and my well being and in finding places who will do simple screening tests like colonoscopies or small outpatient surgeries at reasonable prices, because if you're stuck paying for the first 25,000 you're going to be a savvy consumer. So if you can find a marketplace of doctors who will work for less than the hospital employee doctors, you're going to preferentially use them. This leads to companies like coral health and zero card. Now, people in the direct care space might know those companies. Those of you who aren't in the direct care space might not ever have heard of them. There are actual marketplaces for people in the direct care space, basically saying, I'll do colonoscopies for $1,200 a piece, and you put yourself on the market, and the employers are using these marketplaces to send their clients, their employees. So for instance, we work with one of the school systems here at the Boulder Valley School System, and every employee at Boulder Valley gets an app on their phone. It's called the Zero card app. And if they look in the zero card app and they find any procedure or anything that they need, and it's in the zero card app and they choose to use the doctors listed in the zero card app, it becomes a zero out of pocket expense for them so they don't have to pay the deductible part. If you get your hernia repaired by Dr. Ciocchetti at Smith medical it will cost you nothing. So the employee is highly motivated to use the zero card program. The employer is highly motivated to use me, because my price for an inguinal hernia repair is $5,200 as opposed to the $12,000 bill they're going to get from a regular surgery center with a general surgeon, or the $27,000 bill they're going to get for bilateral robotic inguinal hernias from a hospital. So everyone's incentivized properly. The surgeon makes more, the anesthesiologist makes more. The employee pays less, and the employer pays less. That's where we're getting about 85% of our business. So there is still a decent amount of cash pay, but it is not the majority of what we're doing in this direct care model. Yet,

Dr. Tea  13:27  

That's really amazing. This is brand new to me, so I'm excited to hear that it's not just you looking for those people, but there's a network that funnels it to you, kind of like when we were with insurance, if you were in network, those patients just kind of gradually come by gravity, but now we're directing to people who are looking to save money, employers just like you and I. We are business owners, and we will eventually have to pay for healthcare benefits to our employees. I know I did that back in the day when I was with insurance, because that was the expectation of a full time practice. I don't do that anymore, but now that there is this option, I think it's a really viable way to not just save money, but to also protect your employees, make sure that they do get the best for what you're paying for. And I think that builds a sense of community, where not only do I employ the local people who live here, I'm also protecting them, not just financially, but in their health as well. So there's so many different prongs to the value of direct care as an employer, as a surgeon, as a surgery center, and I want to know more about how Smith medical you said that they were going to make this nationwide. What exactly are they doing to copy and paste this to other areas?

Dr. Jillian Ciocchetti  14:42  

Yeah. So we are. We opened in April of last year, so we're not even a year in business yet. We will probably becoming profitable within this next quarter. So in other words, making enough money from our surgery revenue that we're paying all the bills and able to pay investors who came. In and I am a surgeon at Smith Medical, and I'm invested in Smith medical, but is not my company. You know, I am a very enthusiastic supporter of the place, um, we what they're doing. They're working with a lot of other companies. So there's a couple companies out there right now, and I would say, within the year, you'll probably hear about them, one of the things they want to do, and Dan Barnett, who is the CEO of Smith medical, told me, when I first met him, I said, Tell me what your 10 year goal is with this. Is it just to have a bunch of surgery centers? He said, No, no, we want to change all of healthcare. We want to do for healthcare what Travelocity did for travel. We want there to be a website that you can go to whether you have insurance or not, and say, I need an abdominal ultrasound performed, and you type in all of your information, what's your pair you know whether your insurance or not, and up on the screen pops 14 appointments available to you In the next two weeks at centers all around your house with Google reviews of the facility, transparent prices, whether you have insurance or the cash, pay price and you can book your appointment. He said, That's what health care should be. We should be able to compare across the spectrum, just like you can when you're shopping for a dentist, right, or a med spa or somewhere to go. Why can't we do that with healthcare right now? There's nothing like that, and they're working very hard to bring that to the forefront. So while they're working hard for surgery, they're connected with other companies, like spoke health, NextEra, and a lot of larger direct care groups that are starting to come together, and the goal is to make healthcare transparent. I mean transparent, high quality, patient centered, customer service focused. Those are all of their goals.

Dr. Tea  16:52  

We need to talk to Mark Cuban like this just makes so much sense. You know, he wants to disrupt the pharmaceutical industry and make medicine accessible, and you and I here want to make surgery accessible because it's the right thing to do, and it doesn't make sense when we put up all these red tapes after patients are spending into their premiums, into their deductibles, and then finally, they get a Doctor Who's overworked

Dr. Jillian Ciocchetti  17:19  

Our system. I mean, it's not poor quality, it's not cheap surgery, it's affordable surgery, right? I'll give you an example. We took a breast cancer patient through this system last year. She had a combination of a health cost sharing program like federal health, Zion health, Medicare. I don't know if you're familiar with those, but she had that as her employer's plan, and then her employer dumped a bunch of money in her FSA account, sort of like her deductible money. And so we had to negotiate doing an entire breast cancer case treatment, radiation, all of it in this direct care system. It was hard. We had to do a lot of negotiation for her, but prior to her surgery, we needed to do an injection for her sentinel lymph node. This is normally done at a hospital space, and because our surgery center was only a couple months open, we didn't have our license to handle the radio isotope yet, so we couldn't order the medication like it's it's right there on Cardinals website. It costs $400 for the drug like all we had to do was order it and inject it. But because we didn't have our handling license yet, we needed to find a hospital who would do the injection for us, and then the patient could drive over to the surgery center for her surgery. First hospital, we called their price quote, $4,500 for literally, a subcutaneous injection of a $400 medication. The second hospital we called $3,200 and we haggled them down to a $500 price, where they made 50 bucks, right? 100 or $50 to do a sub q injection. And then she came over. But that's the point. There is so much. There's so many people sucking off the system of your work and my work and the patient's premiums and deductibles, like, if we can just take those people out, there's still room for profit. There's still room for everybody to make money, but it's not at the expense of the health of our country. 

Dr. Tea  19:16  

Yeah, I totally agree with that, and I think it really comes down to having relationships within your community where you pick up the phone and you happen to have done surgery on the person who answered the phone's family member, and you're like, Hey, can you do me a favor and just cut the price so that we can make this work for the person who's on the table who happens to be our neighbor? You know, this is like a community effort. We can't do this on our own, and we can't rely on corporate to help us. Clearly, they have not.

Dr. Jillian Ciocchetti  19:44  

No, they have not. And to be clear, right now, we're really only set up to do pretty much outpatient procedures like we we are trying to get ready to do inpatient procedures, but, man, the resistance is real. You know? Um, last year I asked my hospital that I was leaving. I said, Here's my model, if we come to you with a patient that we need to take care of, can we arrange a price that makes sense to everybody? I mean, you'll get paid the day of surgery like you'll get a check for your facility fees and your anesthesiologist from Smith medical, but we need you to agree to reasonable fees. And they said, No, we're not interested. We don't want to work with people who are, you know, competing for our business. However, one year later, we have all kinds of crazy insurance stuff happening in that hospital that is now getting a whole bunch of their business pulled out. Next time we have an inpatient one, I'm going to go to them and ask again. I tried. Recently, I had a patient who had a complex abdominal hernia and a diastasis recti at the same time, and I was a little worried she would need more than one overnight stay. So like, can we really do at the surgery center, or should we have to admit her? So I asked one of the hospitals for a price. Now, our price at Smith with pre op care, post op care, mesh anesthesia, surgeon, all of it. The facility fee was $12,000. That was going to be our price for her surgery, and that was a complex abdominal hernia repair and a diastasis rectus repair. When I asked the hospital to give me a price, they sent it to me over email, and then I called her, and she's like, What do you think of the price? And I said, well, our price was 12,000 and that includes everything. Your price, and you didn't even pay the doctors, was $42,000 like, how, how? You know, like, I don't want just like, this fake number you're pulling out of the hat. I want you to go find out how much it actually cost you to do the operation. Add 20% for profit and bring me that number. That's the number that I want to know. She didn't call me back. So they're not willing to play right now. They are still too enamored by these huge billable charges that they can probably sometimes collect on. You know, they get away with it. Yeah, they do get away with it. They will eventually want to play in the sandbox with us. Though,

Dr. Tea  22:06  

I believe it. You know, the first time they hear about it, it's, you know, you're crazy. The second time, stop coming. It's not until something really falls apart for them to realize, you know, we are the safety net when there's a gap in the current situation, we're here to help. So you've described a global problem that we really need to fix, and we know it's not going to happen overnight. And I'm curious to know what your practice looks like from day to day. What is your LLC composed of? What are you doing? I know we don't have traditional workloads from Monday through Friday, nine to five. Or for a surgeon, it's like 80 hour work weeks or whatever, right? So, what is your life? 

Dr. Jillian Ciocchetti  22:46  

Not in this life anymore. I did that for too many years. So this will sound like a lot, because I started entrepreneurial work. You know, probably about seven years ago is when I really started doing it, and I've slowly grown in, and now you just realize that once you put that thing down that occupies all of your time and all of your thoughts, you're such a smart, capable, educated, brilliant person that there are a lot of people who want to work with you, but you don't have the space to see it or hear it or like an OP you met. You mentioned earlier in our conversation that the opportunities won't come until you have space, but they're there. You just literally cannot see them. You cannot see them as an opportunity for yourself, because you're so you're just so overwrought with the state of your life just getting through your day, like I was talking to another physician last night, and I said, right now, I have an entire day set aside, which is like my entrepreneur day. I mean, I might be busy with something like this, doing a podcast or meeting with a potential new referral source, or doing a phone call while I walk my dog around the lake, like it could be full, but it's a space for thinking. The only space I ever had when I was an employee general surgeon was like three hours on Friday afternoon to finish my charts up from the whole week. And that is not space for thinking, right? That's not my week. Generally, I have tried to really limit myself to only three days a week of patient contact. I've learned that, whether my nature or my nurture, I am a workaholic. You know, I don't know that I was that in my 20s, but becoming a surgeon has made me into that. I love doing the work. I love the patient stuff, but I can easily let it overwhelm me. So three days a week of patient contact is all I allow myself, whether I'm teaching, whether I'm operating, whether I'm doing Med, spa stuff, three days a week, then I have one day a week that I am off, and I have one day a week that's my entrepreneur a day. And I don't work weekends anymore. I just gave up call about three months ago, and I really don't work weekends anymore. So. So that's what my life looks like. I was on vacation all week last week, and I didn't have to take PTO for it, and I didn't have to ask for the time off, and revenue continued to flow into my business while I was gone. And I just, you know, I've I sit on the task and the goal of creating a life I wouldn't need a vacation from. I think I'm almost there like I really. It feels great, and I feel not owned by the system anymore. You know, I feel free. I think that's the overall feeling. I feel free 

Dr. Tea  25:34  

That is the most beautiful thing you've put together to create a life that you don't need a vacation from. And I think we forget that, that if we can truly create something that we love, showing up to every single day, not being resentful, not being inconvenienced. You love the people you take care of because you're doing the thing that you most enjoy, getting rid of everything else that just gets in the way of that. And I think that's where doctors shine. The best we can do our best work when we have the space to do so

Dr. Jillian Ciocchetti  26:07  

Yeah, and I won't work more than about 35 hours a week anymore. I don't have to, you know when you're doing work that's meaningful to people, and you have a real market economy where I know what I'm worth, and I'll do it for this much, and I won't do it for less. You don't have to work 70 or 80 hours a week. You literally don't have to do that. So I have a life again, and I like to rehumanize myself over the last year and a half, and that feels really good.

Dr. Tea  26:37  

That is so healing. Thank you so much for sharing your story. I'm curious to know what your projection is for doctors who are in the system. They want to proceed with surgery, they want to provide that care, they want to get paid for that care. What's the trajectory for the doctor who is interested in leaving corporate medicine, insurance based medicine, 

Dr. Jillian Ciocchetti  27:00  

Um, you know, I think that there are ways to do this, even if you don't have a Smith medical down the road, look at the model of plastic surgeons. I mean, for many years, they have offered face lifts or breast lifts or plastic surgery, and there's a set price, right? Let's say that their price for a breast lift is $9,000 and people walk in knowing that they're going to pay $9,000. Those surgeries are done sometimes inpatient. They have agreements with the hospital. How much do I have to pay you for the or for two hours of anesthesia, and the patient pays the 9000 to the plastic surgeon, and the plastic surgeon pays the hospital and the anesthesiologist. Okay, there is a model for you to be able to do this. There are patients out there who will come to you. I can give you several examples. I had one patient last month. He's actually a neighbor in my neighborhood, and he only knew about what I was doing because he knew me, but he's a guy with plenty of money in the bank. He's retired, he has VA benefits, and he had a painful hernia, an inguinal hernia, and he's very active, and it started to bother him. And he called the VA and it was going to be three months before they could see him, and six months before he could get his surgery done. And he called me, and he came in for a consult, and we gave him a quote to do both sides. I think it was $7,500 to do both sides. And it was a no brainer for him. I saw him, and he was in surgery less than a week later, and he's recovered before he even would have got his appointment. The VA, I have a website. You can look it up. It's surgerydenver.com, which literally has transparent prices for basic, general surgery procedures. And people call me every week. Some people have a lot of money in the bank. Some people have a big FSA account that they've had or an HSA account that they've been building for three years. There's $14,000 in it, and they'd rather just pay to get their umbilical hernia fixed, because it's way cheaper that way. There are people, even undocumented patients, who have plenty of cash in the bank and no insurance benefits and their gallbladder is bothering them and they'll pay to get it out. So my advice to someone who wants to get into this would be to consider dropping out of your employed job and trying locums for a little while. It is a safety net. It's a little different. I mean, the first thing you can do is go part time, ask to go point eight. That gives you one day off a week. First of all, re-humanize yourself, and then, you know, you got to plant seeds. You're not going to build a business in two months that replaces your many hundreds of 1000s of dollars of income at your employee job. But consider, you know, starting small in a small way. You know, if you start talking with your surgery center or your hospital, you'll find out that to rent the or another case on Thursday this week where I got the patient, he's got 12 lipo. Is that he once removed, and we didn't want to do it in the office, because it was going to take a couple visits. And so we're going to the surgery center. The patient and I agreed on a price of $4,800 to do all of his lipomas, and the surgery center is charging me $2,100 so I'm going to pay the surgery center for anesthesia time and or time. And I'm, you know, gonna make a decent amount of money for a two hour case of taking lipomas out, and the patient's super happy. It's less than it would cost him if he went through insurance. You know, it's working well for everybody. So you have to be enough of a business person to know what you're worth. And then you would, you know, you would approach one of your surgery centers and ask them, if I want to do a one hour case, what's it going to cost me? And figure out there's an hourly cost for anesthesia and an hourly cost for the or and then you can start pricing things the way you want to. And it might take a while. A year ago, when I started doing this, I might have done one to three cases a month. It was very slow. At this point, I'm probably doing between eight and 10 cases a month, and my goal is to cap out at 20. I want to work one full day a week in the or and do you know, four to six cases each of those days. And I don't want to be any busier than that, so I I think I'm halfway there, and it's been less than a year, so

Dr. Tea  31:22  

That's awesome. I'm so glad you brought out the point that you're renting out the time. And I wanted to share real quick that I have a surgery center here that I used to be credentialed at, and I'm not anymore, but I did ask them for cash prices. But the struggle with them, as you have mentioned or alluded to, is the separation of taking insurance and those who don't take insurance, you know, and it is going to take time. And I strongly believe that if I persist enough, I can get a better rate for my patients at this time. It's not, though,

Dr. Jillian Ciocchetti   31:55  

because you could say to your patient, your surgery can be run through insurance, but my surgeon fee is not you could say that to them, I don't take insurance, so you'll still need to pay my $800 surgeon fee or my $1,000 surgeon fee, but you can run your facility costs through the regular channels. There's nothing wrong with that. So you know, when I do it that way, I ask for half the price as a down payment to secure a scheduling date, and then they pay the other half the day before surgery, so I'm paid in full when I do their surgery. But that's another option for you. Let the surgery center haggle through it. The problem you might run into with that is the patient's having to pay their deductible plus your surgeon's fee, which might feel like a lot to them, but there's no reason why you can't let the surgery center run everything through insurance and you just charge a surgeon fee.

Dr. Tea  32:48  

That's what I used to do, and I'm encountering people who don't have insurance. So if they don't have insurance, they're either going to Mexico, getting a bot surgery, or coming back for the aftercare. Here, it's a whole thing, yeah, but at least we have the conversation. At least we have the idea put out there that, yes, somewhere down our timeline, we're going to be able to give better access for patients through the surgery centers that we partner with. We're not competing at all. The more we can partner with, the more surgeries we can do, and the more we can provide care for people who need it without the ringmark of insurance. So thank you so much for bringing into light as to the options that not just what doctors have, but how patients can choose to pay for their medical care. Is there anything else you'd like to share with the listeners while you're here? I

Dr. Jillian Ciocchetti  33:38  

I think I would just like to say that we all sit inside of such a broken system as employed physicians and as insurance based providers. We didn't choose the system, we didn't build it. We wouldn't have built it this way, and it seems really hopeless when you're sitting inside of it like there's no job for me out there, right? But I think I just want to encourage you that I think we're on a I think 2025, is sort of going to be a year for transparency in health care and direct care. I think it's going to come into the forefront more. I think more patients are going to find out about it, and more of them are getting frustrated. You know the barriers to them getting their surgery sent in their health care are becoming so big that they're getting frustrated and Google searching affordable surgery to see what they can do. So I think as a practitioner, you may be sitting inside of a very frustrating box and feeling like there's no way out. And I think I would just encourage you there, but you have to be willing to think differently, and you might have to be willing to make a little less money for a period of time. I think in the end, you'll make more money and you'll be way more satisfied. I mean, I don't really care if I ever get back to my full salary. I. Um, I think I will in maybe two years, but I really don't care, because my life is so much richer now, and I have more time with my kids and more time with my friends. And, um, I did a surgical consultation last week while on vacation, and didn't feel mad about it at all. I was my choice. I didn't have to do it, but I truly was like, Yeah, I can work an hour. No problem. You know, no big deal at all. And I think what you're what you're sitting in, it's a little bit of a jail cell, and there is freedom on the other side, but it takes some out of the box thinking to get you there. And if you start even with just one small, small thing that gets you moving in that right direction, so encouragement that it doesn't have to be the way that it is. 

Dr. Tea  35:50  

I love that. Thank you so much for your time, your expertise, and I look forward to catching up with you soon, because I have so much more to ask you. 

Dr. Jillian Ciocchetti  35:58  

It would be great. I would love it. Thank you so much for your time today too. 

Dr. Tea  36:02  

I will catch you all next week. I hope you enjoyed this one as much as I did. Take care. If you enjoyed this episode, please give it a review and share it with a friend so more doctors can learn about direct care. Let's keep the conversation going on LinkedIn so we can help more doctors escape insurance and thrive in private practice. Thanks for listening. I'll talk with you next time take care.