Find Your Motivation - PRP Now AMA

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Website: businessoforthobiologics.com
Apple Podcast: apple.co/3Azvt3R
Spotify: spoti.fi/3oICYmh
Youtube: bit.ly/drariana

Transcript

Intro

Hey, I'm Dr. Ariana DeMers. I'm an orthopedic sports medicine surgeon, and I have successfully integrated orthobiologics into my busy practice so that I can provide a continuum of care and treat patients who are in the gap. The gap is this gray area in orthopedics where standard conservative treatments have not been effective, but surgery may not be warranted. And we usually tell our patients, come back when it's worse. What? These are your patients coming to you for help. Orthobiologics is that solution that can fill the gap and help you treat your patients who are in your office looking to you for help. Orthobiologics can also be an excellent treatment for frustrating problems without good surgical outcomes. This podcast will help you create the orthobiologics business that will make you love your job again. We will focus on value of orthobiologics, patient selection, how to talk to your patients about money, office setup, and other logistics. If this is something you've always wanted but don't know where to start, join me in "The Business of Orthobiologics" podcast.

Dr. Ariana

How are you doing?

Dr. Dianne

I am doing good. How about yourself?

Dr. Ariana

I'm pretty good. I think this time of year is always hard. It's the mad dash to the end and trying to get everything sorted out before the new year. I have not learned a good lesson. I've heard amazing things. I have a friend whose company racks everything up for the year by December 1st. And so then they just [inaudible] in December.

Dr. Dianne

Wow.

Dr. Ariana

Which why shouldn't I do that? That seems like a brilliant plan, you know.

Dr. Dianne

Is the company a healthcare company too or no?

Dr. Ariana

No. But I don't know. I own my own business. I can run my business any way I desire. So I've been trying with that idea. Maybe a way to stop this craziness that exists. Every stink in December is like this, right?

Dr. Dianne

Time of the year, yeah.

Dr. Ariana

Yeah. It's not sustainable, I don't think. And it just leaves me exhausted, like going into New Year like Holy cow. Instead of starting a new year refreshed and ready and doing other things, I don't know. I'm totally open to suggestions because I have no idea. It's not working currently.

Dr. Dianne

What I have done in the past is I would always take off between Christmas Day and New Year's Day. At a certain point, I was stretching it out to ten days, and I was wanting to stretch it out to two weeks, where you're just gone. Then because in my practice, I do have physical therapy, they keep working even when I'm not there.

Dr. Ariana

Sure. That's brilliant.

Dr. Dianne

Yeah.

Dr. Ariana

I mean, I do, truly, we usually have at least one week off, either over Christmas or New Year's. I'm actually going to be gone-- I'm going to see my family for Christmas, but my husband is on call, so he's going to be gone. Which is a bummer. So he's going to be by himself for five, six days, and then I'll come back and then we'll go to Cabo. We always do Cabo every year. I want to do two weeks in Cabo, but that does not exist in his world right now. So I keep bugging him to do more in his cash practice and less in his employed practice, but it's coming along. He's like it's all about mindset, right?

Dr. Dianne

It's a mindset.

Dr. Ariana

It's so interesting. So that was part of what I wanted to talk about today was that mindset of what's holding you back and where you're stuck. So if you're interested, I do think that it's so much. This is what I was thinking about today with my husband. It's so much mindset. We're getting in our own way. And like, Well, I can't do that because of blah, blah, blah, or whatever. Then you have to say, Is that true? In reality, usually, it's not. It's just a reason that we've put out there to keep doing what we're doing, right?

Dr. Dianne

Absolutely. I've been in practice for over 20 years. I left residency in 1996. That's like 27 years ago. You just get used to doing things a certain way and then you do it that way year after year after year. Then you form a habit you know, and then to pick yourself up from there and go to this completely different way of doing things. There's some anxiety involved with that to say what if and what if and what if. On the other side, you're being cheated out of your, you know [inaudible]. But that's sure. You have these humongous insurance companies who take all this money, they stiff you as the provider, and they stiff the patient, too.

Dr. Ariana

Right.

Dr. Dianne

No, that's just not right. That's not the way I want to continue things, but then you have to build this other practice. But now I know I can do it. I know I can do it. It's just a matter of getting started.

Dr. Ariana

Yeah. How did you come around to that shift in mindset?

Dr. Dianne

It's just that one, you really, really have to value yourself, and you have to value your services and what you do. Because once you come to that realization to say, you know what? If you value what I provide to you, then you'll be able to take care of these services. Now my patient, my clientele is going to shift. I know that already. Because I'm hearing resistance from some people. No, I'll only do it if insurance pays for it. I know my relationship with folks like that is probably short-term, you know.

Dr. Ariana

It's interesting talking about value. I have a virtual assistant, and he's in Kenya. And I was talking to him this morning. And he was saying-- I was telling him-- we were talking, I think, some social media posts on this program. I was saying, Do you want to help your patients and provide better care? And he's like, well, it is better. This is a better way. And I was like, I love you. I was like, I'm so glad you're drinking the Kool-Aid. He's not a physician. He went through this course. He did all of the coursework and to be familiarized with the product. And he's just like, this makes so much sense. He's fully bought into the fact that orthobiologics is better for the patient and better for the doctor. And we have to figure out a better way. And like I think we were talking about last week when you have that confidence that you know your package is going to get them the best results, it's easy to sell.

Dr. Dianne

Yup.

Dr. Ariana

It's like, this is the best way. How can I help you get the best results? Right? Well, we could do this other thing. It's pretty inferior, so I'm not going to recommend it. And they know it.

Dr. Dianne

I know. It's still going to be a step for me from--

Dr. Ariana

What do you think is the hardest part?

Dr. Dianne

I've thought for a couple of years the price for PRP is $1,000 or $1,200. Now to package it, to add other things to it, and then it's three times that, sometimes I still get--

Dr. Ariana

Yeah. Well, maybe I can share my experience and maybe it'll help you. Because this trajectory of price changing has been an interesting experience. I started out at a thousand.

Dr. Dianne

Okay.

Dr. Ariana

Not that long ago.

Dr. Dianne

I see.

Dr. Ariana

Not that long ago at all. Maybe last year, let's just say.

Dr. Dianne

Okay.

Dr. Ariana

Okay. Yeah, last year, 2022, I think my price was just about maybe 1,000 or 1,200 for a PRP injection. And then I met Matt, and he said, no. Double it. And I was like I can't do that. I can't do it. I don't know why that scares the crap out of me. He's like, okay, just make a 1,500.

Dr. Dianne

Okay.

Dr. Ariana

Okay. That doesn't sound too scary.

Dr. Dianne

Not too much. Yeah.

Dr. Ariana

Yeah. That's not too far off. Because maybe I started at 1,200 or something. I went to 1,500. And zero people bought. The people that are going to buy it are going to buy it not because of the price. They're going to buy it because it's valuable. Right? And so it actually doesn't matter what price you put at it.

Dr. Dianne

Wow. So you're saying nobody bought when you went from--

Dr. Ariana

No, nobody even was-

Dr. Dianne

Oh, they ought. They didn't-- yeah, got it.

Dr. Ariana

In bulk. They were like, okay. I was like, I just changed my prices a lot in my mind. And nobody said boo. Nobody said anything except for okay. And then I said, I was like, okay, well. And then so I went to 1,800 and nobody said anything. And then I went to 2,100. And that was probably 2,100 was probably four months ago, five months ago. But I was then instituting these packages. And so the A la carte price was 2,100, but then the package price was 3,500 or 4,500 or something like that. And I was having a really tough time selling the packages because I was getting lost in the weeds. I was doing the nitty gritty like, well, if then-- and then they were like, well if I don't want that, can I have this? Can I do subs to this? And that I'm like, all right, this is ridiculous. And I didn't have as much confidence in my package. And so it came across. And so I didn't sell packages. So then I was stuck selling just the a la carte, 2,100. And then I was like, sick of it. I was like, God, I'm sick of sucking at selling packages. So I just made that decision. I was like, All right, that's it. They're all packages, and my PRP across the board is $3,500.

Dr. Dianne

Take it or leave.

Dr. Ariana

It's with the package.

Dr. Dianne

Okay.

Dr. Ariana

If you want the package, you don't have to have the package. But I'm not even going to tell you what's in it because my PRP is 3,500 and it includes CBD, a repairal sleeve, 12 sessions of Laser, and the whole 30 book-- that's just what it includes. Because I know by adding on all those parts--hi, Phyllis. I know by adding on all those parts, they're actually going to do better. And so ultimately, I made that shift a couple of months ago, and it's changed my revenue stream. It has not changed how many people say yes. I also upped my BMC or my cellular therapy, and I also upped my spine prices significantly. Just today, I had a two-level spine that came, and my spine prices because number one, because I don't like them because they're longer for me because I'm not as facile. I don't have 10,000 injections under my belt. I only have five years of experience, right? And so they're harder for me. I have to focus more. It's just not second nature. You know how you were like, Oh, we just get comfortable doing this, right? I'm not to that comfortable of spot yet. And so I made the price point a little higher because it was harder for me. So my single-level spine is 5,100 and that includes the package too. And then if it's another level, it's 2,000 for a second level.

Dr. Dianne

What do you target when you do your spine?

Dr. Ariana

It's a comprehensive spine. And so I know you've heard everybody talk about this comprehensive spine situation. I think it comes from the Regenex, but there are also other people that are using the comprehensive spine. Annu Navani just published maybe two years ago on comprehensive spine, and that is all of the things. So the sets, ligaments-- so ligamentum flavum, interspinous transverse process, as well as multifidus and epidural. So all of those together is the comprehensive spine package. I know that Ashu Goyle, any spine is comprehensive, no matter the number of levels. And he charges, I think, six grand. And he blocks out two hours. And so he can get anything done that needs to be done in two hours. And it's six grand across the board. So there are lots of ways to kind of skin the cat, right? But I think my experience with raising prices is you can go incrementally, and then you're going to have small successes where you go, huh, no one said anything. The people who are going to say no are not going to say no because of the pricing, it's very unlikely, right? If you are making a compelling discussion that it is the best choice for them, they're going to sort it out. Now, I've had a couple that they got early on, maybe I quoted them a package and then they came back and they said no initially. And I'm like, oh, well, it's just 2,100. They're like, oh, well, I can do that. But I think they just maybe needed more information or more hand-holding rather than, was it the price itself? I think that's an excuse just because something else is not resonating with them. Does that make sense? That may be an interim solution and maybe just looking at the calendar and saying, okay, my pricing in 2024 is going to be 1,700 or 1,500 or 1,250. My husband, oh, my gosh. So he does the O-shot, right? And he started out at $1,100. No, 1,200, because 1,200 is the price basement. So Charles Runels, who trademarked the O-Shot, will not let you sell it for less than $1,200. So that might give you an idea that that is the price basement for PRP. Across the board, that should be the bargain basement price, okay? So it's not a grand. And also there was a study that was done that talked about the pricing. It was done by Brian Cole, and he calculated what is the appropriate price for PRP across the nation, all things and all the reimbursement and all the things. And I think it came out to something like, I want to say, like 1,278 or maybe it was even higher than that. Maybe it was 1,478 or something like that. So if you're charging less than 1,200, you're below market value, like the bottom of the barrel. If you're charging 1,500, you're probably on par with insurance-based care. Okay? So at least give yourself that and say there are studies that have been done for pricing that show that probably 1,500 for PRP is appropriate to start. So then if you just say, okay, in 2024, my price is 1,500, the cost of goods is going up for every single other business. You paid more for all of the things that you bought this last quarter than a year ago. So prices go up. The price of gas went up, the price of butter went up, the price of eggs went up, price of PRP goes up. And you don't have to tell anybody, right? You don't have to make an announcement. Oh, we're raising our prices. Don't need to. That's just the price. Your gas station didn't call you and tell you that they're raising their prices. That's just the price, right? And so you don't need to justify what your pricing is. And then maybe every quarter inch it up 200. And then by the next quarter-- by next year-- at the end of next year, you'll be at 1,900 and you'll have given yourself a 100% raise.

Dr. Dianne

Now, that sounds good.

Dr. Ariana

And your extra work, right?

Dr. Dianne

Yeah.

Dr. Ariana

You need to do that. So 1,500, I think is what you should probably at least start at, for sure.

Dr. Ariana

Okay.

Dr. Phyllis

Is that the same procedure that Matt was saying you should charge $3,500 for?

Dr. Dianne

Well, with a package. So with a package and all other things.

Dr. Ariana

By the way, the $3,500 I made it up, right? I just made it up.

Dr. Phyllis

No, Matt said it last week. He was very-- yeah.

Dr. Ariana

It's probably right. But honestly, I made that up and I made up what's going into my package. And I was like, well, this is what I have in my bag of tricks. So this is what I'm going to put in. And I stopped offering a la carte and I offer PRP. And what PRP includes is all these things, take it or leave it. If you don't want it, you don't have to have it. But this is PRP. And the price of my PRP is 3,500. And I don't go any lower than that. And that has taken so much stress off of me, so I don't have to sell any packages. This is just the price of doing business. But if you're going to go a la carte, like Diane, because in her brain, she thinks PRP is a $1,000. And we just talked about the fact that's not true. So when we're like a mindset, you're like, Is that true?

Dr. Phyllis

No.

Dr. Ariana

We have scientific data that says that's not true. What if you just said it's $1,500? What do you think would happen?

Dr. Dianne

Probably nothing. But I think what I have to do is I have to stand in front of the mirror and just say it.

Dr. Ariana

Ten times at least.

Dr. Dianne

Over and over. Yeah.

Dr. Ariana

How much is PRP?

Dr. Dianne

$1,500.

Dr. Phyllis

Video yourself saying it.

Dr. Ariana

Of course, it is. How much is it? It's 1,500.

Dr. Dianne

1,500.

Dr. Ariana

And then stop talking. No justifications, right? Because then if you justify people, they're like, Well, why are you justifying? Is there a catch? Is there something weird? What's going on? Whereas if you just tell them the price, like how much is the price of bread? $6. Okay, great. And then in your mind, you're like, is this worth it? Is it not? And hopefully, you've given them a compelling discussion on the fact that it is worth it because they want their life back. They want-- and they've told you, I'm here because I can't do this. I can't do this. I can't do this. I can't sleep. I can't do this. And you say, Well, here's the price for getting your life back. When would you like to schedule?

Dr. Dianne

Okay, yeah.

Dr. Ariana

Another little thing that I've been using that's been resonating with my patients a lot is you deserve it. You deserve to get your life back. I know I can help you. You deserve it. Right? Because they do. Why are they suffering? Nobody gets a gold star for suffering. They deserve to have their life back, and they're worth it. I also have been sharing, my parents just asked for Christmas for PRP.

Dr. Dianne

Oh, wow. Well, that tells you.

Dr. Ariana

Right? I mean, I've treated them a number of times different from joints, and that's all they asked me. I said, What do you want for Christmas? Well, actually, we'd like PRP for each of us and the airfare to get out there. I was like, Okay, we can do that. But I've been sharing that with my patients that my family thinks it's valuable enough that that's what they want for Christmas, right? And I usually give it to them for free. All right. Was that helpful, Diane?

Dr. Dianne

Very, very much. So, thank you.

Dr. Ariana

It's just things you get stuck on and you can't figure a way out of a paper bag sometimes, you know. You're just like, I don't know why I'm stuck in here. And then you turn around, you're like, Oh, that was easy. Shoot.

Dr. Dianne

Absolutely. Thanks.

Dr. Ariana

Awesome. Yeah, absolutely. Okay, we were talking about what you guys are stuck on. What is the reason that it's not humming along, that you're not getting 25, 35, $45,000 in cash every month? Who wants to go next? Phyllis, do you want to go?

Dr. Phyllis

Sure. Well, I'm not doing orthobiologics. I'm doing weight loss. And so, you and I talked at the conference about I need to stop stuttering. And I did. And I just laid out there. And so what we're doing because we didn't do very well with our email 5130, we're going to be doing a text 5130 to see if we get a better response. I think part of the problem was when it launched last time, kind of like somebody said last week, they didn't know where to go to find the responses. And so a bunch of responses sat there for a week. And so by the time we reached out, we don't know how much of it was that contributing to it. But even the people that came after that weren't responding to our calls. If we got somebody on the phone, they didn't want to come in, it's kind of like-- so one of the things that we did was develop what's called a wellness assessment, which is just a brief history form that they could fill out, come in, sample some of our technology, and have a brief consult with me to talk about what their goals were and what their health challenges were that were creating these goals. And we did get a few people sign up for that. I didn't get anybody to sign up for the program even after doing that. And so--

Dr. Ariana

Now, remind me what the program does.

Dr. Phyllis

It's a lifestyle medicine course. It's a 10-week training talking about all the things that affect people's inability to lose weight, like whether--

Dr. Ariana

Is it in-person or online?

Dr. Phyllis

It's all online. So it's all virtual. It incorporates homeopathic drops that really take care of the appetite and the cravings. It's real food. And we added to packages that include red light. So we have a red light bed. And we're seeing people who are doing the program, 20 to 35 pounds is typical. So women typically lose between 20 and 30, and the guys usually lose between 30 and 40. And that's really just taking the drops and eating the food and managing all the things that we teach them they need to manage. Like, you know, they're stressed and their sleep and their mindfulness and all of that. It's getting people to sign up and buy. And so a lot of what we're doing now, we have a Red Light promo. And so people come in, they do the Red Light. And then we offer an opportunity for them to have a free discovery call with me, especially if they say that one of their main concerns is to weight. Even that is we're struggling with getting people to show up for their calls because it's free. And it's like, oh, well, yeah, it's free.

Dr. Ariana

Right.

Dr. Phyllis

So it's-- yeah, I don't need to show up. And if they show up, then getting them to sign up. And so we thought we would try this texting campaign with the 5130. But the program we were going to promote is even more expensive than the more expensive Red Light program. So we have a la carte, you could call it without Red Light. So it includes a number of supplements, a detox supplement, a liver supplement if they're on the Red Light, and then the homeopathic drops. And then the platform, they have access to us every day to direct message us. We are reviewing what their progress is. And I do a weekly call, group call, just talking about some of the lifestyle--

Dr. Ariana

Yeah. How come your program-- your call is free?

Dr. Phyllis

The Discovery Call? Because we offer free Discovery Call on our website. Okay. Now, typically, that should be done by a staff. Okay, typically. But I'm doing it now because I don't really have the staff trained to do that yet. And I feel like I'm more likely to get them adequately informed to really be interested in mine, to be honest. Okay.

Dr. Ariana

So what are you selling? So for me, you just told me I could lose 35 pounds in 10 weeks. That sounds amazing. And I don't have to eat any weird food. All I have to do is go lay under the light and take some drops. Why do you think they're not saying yes?

Dr. Phyllis

I don't know. Maybe I'm not convincing them.

Dr. Deb

Can I ask you something about your weight loss? I've learned some stuff this weekend. So are you using Ozempic or any of those types of medications?

Dr. Phyllis

I'm not. I'm not yet.

Dr. Deb

Okay. So this is what I heard this weekend at a pellet course, that is going away. Apparently, once the drug companies catch up with the dosages, they're not going to be able to compound a lot of that stuff. So it's very possible that's going away. So this is my opinion, I'm no expert, but I think you need to create a bleeding neck by letting them know that Ozempic is probably not going to be available. And so your way of weight management is absolutely necessary because they're not going to get to do the easy stuff anymore. It's just a thought.

Dr. Phyllis

Yeah. No, I like that because honestly, I had thought about adding that to the upgraded program as kind of-- if we don't get to where we want to the first 6-8 weeks, then adding-- I was going to use the tirzepatide to enhance it the next go around. But I'm struggling selling the 26.99 program, which is the top tier right now. It's like 12 sessions of Red Light, which is twice a week, and six weeks' worth of drops. And again, people do it the way they're supposed to very predictable results. And so I don't know. Do you have any--

Dr. Ariana

Yeah. I think that what I know about selling, and it's not selling, it's education and guidance, right?

Dr. Phyllis

I'm trying.

Dr. Ariana

But what I don't know is they want the transformation. They don't care how they get there. So don't tell them about the how. Don't tell them about the Red light and like all these things. What it is helpful to do is address the objections, right? Like, I don't want to eat any weird-- no, that's your whole food. I don't want to do any shots. Oh, no, no shots. Just drops. I don't want to do any tummy touch.

Dr. Phyllis

Strenuous exercise.

Dr. Ariana

Yeah, strenuous exercise. Oh, no, this is just lay there on a red light table, right?

Dr. Phyllis

Right.

Dr. Ariana

What you've done with those three things is you address their objections. But what you haven't really told me, and I'm not sure, is you're not painting that picture of--

Dr. Phyllis

What are they missing out on?

Dr. Ariana

Not only what you're missing out on. So you have to be scratching the wound a little bit and being like, do you look at the hill and think, oh, my gosh, I can't ever climb up that hill? Do you ever just get a block and you're winded? Are you sad that you can't quite fit in your pants? And even though you had to go up one size? Are you this, that, and the other, right? And then you say, what if I told you that we could solve this problem in 10 weeks without this, that, or the other? And not selling the how, not selling the bridge, but selling what's on the other side. Imagine this time where you get to play with your kids, you don't get winded, you show up to your 30-year reunion and everyone's like--

Dr. Phyllis

You get off with some of those meds. That's the big one.

Dr. Ariana

Yeah, you get off all of your medications that-- you don't have to take the high blood pressure medication anymore. You know that Metformin? You don't have to take that anymore because you're now your ideal weight. And you know that promotion they passed you over for? You're going to get that promotion because they're going to think, wow, this person has stick to it. Let's give her a shot. So I think it's not selling the how, but the what. The what's on the other side. What's that transformation? What does that look like? And what I've heard-- and this really resonates, and I think it's been effective, is and what emotion does it cause? So you have to tie that transformation then to the emotion that it causes. I'm going to be so relieved when I can finally fit in my high school jeans again. I'm going to be like-- any of those emotions, right? And it has to be tied to the person and their issues. But I think that selling the transformation, you can use the how to address the objections, but then tie that to the emotion.

Dr. Phyllis

But it's really hard to get people to come in to have that conversation. So do you agree that it's okay to just schedule the call and just go through exactly what we talked about over the phone? Well, yeah, because that's not the way the 5130 was structured, at least the last time we were told that, no, you have to get them in the office. No, you have to get them in front of you, and you have to-- no, they need to pay to come into the office. That is really a struggle. It's virtually impossible.

Dr. Ariana

I structured my 5130 differently, and we used it in part. We also had ridiculous, overwhelming responses and so much so that we couldn't actually accommodate that.

Dr. Phyllis

That'd be a good problem now.

Dr. Ariana

Everybody's different, right? And so we couldn't actually accommodate. I couldn't get them into the clinic. And so what I did is I invited them to an informational seminar. And then at the end of the seminar, they could schedule their candidacy evaluation for $97. That made it a little bit-- right, because that's like screening out, looking loose.

Dr. Phyllis

Right.

Dr. Ariana

I'm saving my time so I can address a bunch of people at once to say this is the amazing opportunity, but we have to know if it's right for you. And then having then put down a little bit of skin in the game, come in and get an evaluation. And I tell them right upfront, this evaluation is worth $397. I charge $400 an hour for an evaluation. Normally. But today, today only at the end of the session, you can schedule your consultation, and your candidacy evaluation for $97. Saves you that spot.

Dr. Phyllis

And that's kind of what we did with the wellness assessment. So I like that. The other thing, I think the webinar is actually a good idea because one of the things that I had created already is what's called a Master Class. So it's a webinar where I talk about the program, how it works, why it works, and why they should do it if they are struggling.

Dr. Ariana

Yeah. Maybe invite all of your 5130s to the webinar.

Dr. Phyllis

Right.

Dr. Ariana

And honestly, I would do it live. I would do a live webinar or in person. We did it in person so they could get to know our staff and get to know me in person and know where our office was and get into it. Because our office is really great. It's a spot, right? You come in, waterfall, and you're like, Oh.

Dr. Phyllis

Ours too. Yeah.

Dr. Ariana

And so we wanted them to come in person. But you could do an online webinar and then invite them if you want to know if you're a good candidate or whatever. And today only, schedule your call. But it works better in person because then they can just go to the front desk on the way out and be like, yes, I want to.

Dr. Phyllis

And schedule. Right. I agree with that. Okay. Well, that's a good plan.

Dr. Ariana

We kind of fiddled around with it because so many of my patients were like, hey, I think you got hacked. We got this weird email. I was like, oh, no, that was me. Would you like to come to our informational session?

Dr. Phyllis

Right. Okay. Well, that's helpful.

Dr. Ariana

So that's what we did.

Dr. Phyllis

Great. Thank you.

Dr. Ariana

Yes, absolutely. All right. Yes, Diane, you're muted. Here, I'm going to unmute you. I don't know if I can.

Dr. Dianne

Okay, I just did.

Dr. Ariana

Here you go.

Dr. Dianne

Quick question is, the informational seminar, do you do that at your clinic so you have them come to the clinic? And how many people are you bringing in at a time?

Dr. Ariana

Okay, well, so my clinic can accommodate probably 25.

Dr. Dianne

Okay.

Dr. Ariana

I have a big presentation place with a screen and everything and tables and chairs and stuff. So we can accommodate 25 at a time. So then that made more sense because we had a very aggressive showing. And so then we could invite every single one of those patients to the seminar. And if they couldn't make that one, we did a second one. They're like, Oh, we can't make it, but we'd love to. Like, Oh, great news. Well, we're having one next month, too. And so then we signed the ones who couldn't come for the next seminar. Makes sense? Good?

Dr. Dianne

Thank you. Yeah.

Dr. Ariana

Deb, how are you doing?

Dr. Deb

I'm good. My dogs were barking, so I had to unmute.

Dr. Ariana

That's alright.

Dr. Deb

I'm doing great.

Dr. Ariana

How are things going?

Dr. Deb

Well, same thing. I've got 11 appointments to convert this week. I really don't have my packages all together.

Dr. Ariana

You can borrow mine.

Dr. Deb

We have the prices in mind. I'm really not ready to convert, but I have to because it's now or never.

Dr. Ariana

Yes. And are you ready? Yeah, you're totally ready. Do you believe that this is going to help patients?

Dr. Deb

Absolutely. I just don't have the price down.

Dr. Ariana

3,500.

Dr. Deb

Okay. Because I don't necessarily try to get more patients, but I have a guy who has been a patient for 10 years. He's in my target population. And today we were going over his-- I had him bring his discs today, and we just went over his cervical spine, MRI, his shoulder, his elbow. And he was just full of places for me to inject PRP, just full of them. But, you know, I didn't ask him. I just said this is what we can do. We can do a cervical epidural for that problem here. We can inject your lateral epicondyle. But it would be better to put PRP in these torn tendons over here and blah, blah, blah. But he just-- he wasn't really like-- I think he was thinking, hmm, you just want to sell me stuff, you know. And so he didn't say yes or no, but I think we're starting off with our insurance and doing those procedures first and kind of going to introduce [inaudible]. 

Dr. Ariana

Yeah.

Dr. Deb

I don't know how to get them to jump on the bus. I guess I'll just start out with my toxic steroids and then kind of see where we go.

Dr. Ariana

Well, I've done it both ways. And it does matter, like feeling the patient out and you're like, that's like that quick read the room, like rapid fire. And then when their eyes light up, you're like, aha, I've got you. But again, you have to figure out why they're there. And I had this argument with a patient. She was naysaying everything. She's like, Yeah, but I don't want to do that. I'm like, I mean if you are fine with all of the problems that you have and you are not having any pain, you are not having any dysfunction, you are 100% satisfied with your life, then you don't have to do anything. And we'll just shake hands and out the door you go, and I'll be happy that you're 100% satisfied. But if you are not 100% satisfied with the state of your life, as you have told me before, I think I can help you. But we have to be equal partners in this. And so it's your choice. I said you're a grown adult. You can make the decision to do this or not. My opinion and my recommendations-- and you can go get other recommendations from a bunch of other doctors. But for the problems that you have, the C-spine, the lateral epicondylitis, and the shoulder, after my exam of your MRI and of all of your physical exams, I think that the majority of your problems is coming from your C-spine. And while we could do an epidural, I think that you may be better served with platelet-rich plasma. Have you ever heard of platelet-rich plasma? Right? Or you could even say, we could probably go for a standard epidural to see for your cervical spine. But here's the problem is for your elbow, steroids are not appropriate. And we really should do platelet-rich plasma to actually cause healing of those tendons. And if we're going to do platelet-rich plasma of the elbow, it would be really quite straightforward to do the platelet-rich plasma epidural at the same time and blah, blah, blah, blah, blah. And so you don't have to go all in and be like PRP or nothing, but at the same time, you lay crepe on the fact that corticosteroids. And I say this every single time. I'm like, I could do corticosteroids. I could do a steroid injection. But it does accelerate arthritis. It does cause weakening of the tendons. It causes osteoporosis, and it elevates your blood sugar. So for all of those reasons, I really am hesitant unless it's an emergency to do corticosteroid injections. They're like, oh, I didn't know I did all that. What else is there? I'm like, Oh, I might have something for you that's much safer. And then you go through it and you're like, Unfortunately, your insurance company has decided that they don't want to cover that. But I do think this is the best option for you. And then shut your mouth or be like, How does that sound? Are you ready to get your life back?

Dr. Deb

Let's talk packages.

Dr. Ariana

Yeah.

Dr. Deb

I don't know what people are charging for certain sources. For instance-- and I think they talked about this earlier on the other Zoom this evening. But I get what you would charge for a basic joint, but for spine, to me, spine should be a lot more. And that said, that's the area I love. I want to do lots of that. Do you charge per level? I heard someone was doing whatever they can do in two hours.

Dr. Ariana

Yeah. So, Ashu Goyle. He does whatever the patient needs. He calls it the full comprehensive spine package, whether it's one level, three levels, facets only, [inaudible], or whatever. And it's six grand, two hours, is what he books. And it's this lovely spa experience. So he only books two or three in an afternoon or I think two or whatever. And he loves it and he loves what he does. I think it probably should be more if--

Dr. Deb

Two hours? I can't even imagine--

Dr. Ariana

Five levels or whatever.

Dr. Deb

Taking two hours.

Dr. Ariana

Yeah. I think it's very leisurely and really lovely. And if you're making six grand in two hours, that's probably pretty fun, right? You're like, oh, okay, fun. But ultimately, that's not how I do my package. So for a joint, I charge 3,500 and I don't do a la carte. If I want to do a second joint, like I did two knees today, it's an extra thousand dollars. Now, Don Buford doesn't charge a smaller amount for the second joint. It would be 3,500 and 3,500. Boom. Okay.

Dr. Deb

So how many levels is too many? And the reason I asked this is because I'm not due. I haven't done orthobiologics in the spine. So I know that with some of the other treatments I've personally had, sometimes it hurts like hell afterwards. And I'm just wondering how many levels on the spine would be too many to do at the same time?

Dr. Ariana

So spine is different. The majority of people doing spine use a combination of spinal, like platelet lysate and PRP. PRP is sometimes a little irritating, but the flare reaction for spine patients is much less than the extremity flare reaction after PRP or cellular therapy, in my experience. They actually feel pretty good the next day. They feel a little sore, a little achy like they got poked in the back a bunch of times. But that lysate works pretty quick. And so it's really nice anti-inflammatory effect, actually. Now, intradiscal is a whole different ball game. But I'm not currently doing intradiscal at this point because it's a little bit more advanced and it's a little bit more risk. And I'm just not that risk for that specific thing right now. Plus 80% [inaudible]. Yeah. So maybe what some people need, but it's not what the majority needs, right? And so I do 5,100 for a single level, and I add $2,000 a level. You can use that if you'd like. I was charging way, way, way, way, way less for my a la carte. So I was charging $2,700 for a spine single level and then $1,000 for an extra level. But I was feeling grumpy about it because I was doing too much work for not enough money. And I was not selling packages. So what's in my spine package? It's the same crap that's in my extremity package. Laser, it's a body sleeve. It's an incrediwear body sleeve. It's CBD. It is a full 30 diet. I think there's one more thing. So that is what I've settled on because I feel really good. I don't have to remember. There's no like pixie choosie. Oh, if you choose the silver level, you get this. If you choose the gold level, I'm like, no, I can't remember all of the things. So I'm going to just go package, PRP, spine PRP, cellular therapy, end of story. And my cellular therapy is 6,500 for a single joint and then two grand for an additional joint.

Dr. Deb

Okay. I like those prices.

Dr. Ariana

You can use this.

Dr. Deb

I can use the exam. Your price lists.

Dr. Ariana

I'll put it in the chat. It's fine. But what I'll actually do is I'll write it down on the mighty networks.

Dr. Deb

Okay. That's great. Yeah. Your patients won't ever see that. That's a good thing.

Dr. Ariana

Right. Well, hopefully, they won't see it in my chat either.

Dr. Deb

Okay. All right. Semi-clinical questions, if you don't want to talk about it, I'll just let you know. But I've got like a 66-year-old, healthy lean pathologist who's been a patient for a while. Nothing worked. Nothing helped him. Nothing, really. He has some degenerative disease. But what he ended up having was that they finally-- the spine surgeons they have settled on was kissing spine disease or baastrup disease. So the spine surgeon wanted to go in there and cut out some of his finest processes. And I'm like, I don't know. That just doesn't sound like a good idea to me, cutting stuff out because you're disrupting the ligaments. Why don't you let me inject the ligaments with some PRP and let's see if that calms everything down? No, he went for the surgery. And of course, he's just as miserable as he was. It's been six months. I was going to do PRP for free at the time.

Dr. Ariana

I'm telling you, doctors are hard patients because they have been brainwashed. Standard doctor teaching is that PRP is bullshit. And surgeons are even worse. Right? So I have two surgeons, but I have two spine surgeons that work in my town. One of the spine surgeons, I did his rotator cuff with PRP, and he's singing my praises. He's like, Oh, my God, this is the best thing. But yet when I tell his patients that they need PRP behind the spine, he's like, That shit doesn't work. I'm like, Dude, really?

Dr. Deb

What?

Dr. Ariana

Well, I think it's implicit bias. He doesn't realize that he's biased because he's thinking that there is only so many pieces of the pie and that if he says that PRP is going to work for his patient, then he's going to lose a piece of the pie. Turns out it's not the same pie, okay? Right?

Dr. Deb

Right.

Dr. Ariana

These are not the same pies. But I don't think he's on purpose, really. I think it's this implicit bias that he just hasn't seen at work, doesn't see at work because he's not looking for it. Right? I have colleagues all the time when they're reading the literature, Oh, PRP is bullshit. And I'm like, Put their journals. I'm like, Did you see it in your journal? He's like, What? Where was that? I didn't see that. I'm like, Well, it saw you. You just either can't write, or read or don't have eyeballs or something. But it's this conformational bias that what you don't know you continue to ignore. You're like, No, that's crap. I'm going to focus on what I like, and what I know, and I'm going to continue to ignore. Instead of being open-minded and curious like It's interesting. There are these PRP articles in my Arthroplasty journal? Weird. Or my spine journal? That's strange. I wonder what could be done. So I think honestly, you could probably do PRP in the ligaments and along that interface and see what you can get done.

Dr. Deb

Yeah, I'll talk to him about it some more. I mean, he's just desperate. He's just desperate. He asked me about a pump. I'm like, No, you're not on enough narcotics to consider a pump. He's like, What about [inaudible],  I said, no, no, no, let's not do anything like that until we try something less invasive that might heal you.

Dr. Ariana

Right. So low risk. Even a PRP epidural with a PRP of the ligaments, PRP, and the multifidus muscles, what does multifidus look like?

Dr. Deb

I need to get his MRI. I haven't looked at his MRI in about six months. I wasn't looking at multifidus muscles back then.

Dr. Ariana

Radiologists don't talk about it at all.

Dr. Deb

I know. I just started looking the last couple of months.

Dr. Ariana

Isn't it mind-blowing? You're like, Oh, my gosh, there's so much atrophy. And you could just put PPP in the muscles for all of the multifidus atrophy. I mean, it helps. So if you can address the ligaments, address the facet joints, address the area between the spinous process, and then do some ligaments, and maybe even consider, I don't know if you are familiar with prolotherapy, but you can add a little bit of prolotherapy to your PRP for the ligamentous application and give you some more stability.

Dr. Deb

We could do that before the PRP, you know.

Dr. Ariana

What?

Dr. Deb

We could even do that before the PRP.

Dr. Ariana

Totally. And it's super cheap. Just mix up some--

Dr. Deb

Then how would you price that? The Prolo.

Dr. Ariana

For one of those naysayers, one million dollars. No, just kidding. So a little trick, if you're going to use insurance, they won't pay for Prolo. But what they will pay for is cortisone injections. And you can use a nanogram dose of dexamethasone in your Prolotherapy because they didn't ask how much.

Dr. Dianne

They did not.

Dr. Ariana

Yeah. One unit is what you are using, and the unit is very small. So that nanogram dose dexamethasone is like physiologic cortisone, like cortisol, like a stress dose, like someone scared you and you're like, ah. So I think that that's what I've been doing for those cases with these big naysayers where you're like, it's a test dose to see if you can get any kind of relief, any response, bill it to their insurance. We're either ligament injection under ultrasound guidance or you can do small joint injections like facet injections, or you could do even like trigger point injections with corticosteroid and get paid for it. If you wanted to go that route for the super duper naysayer.

Dr. Deb

I like that.

Dr. Ariana

All right, we're a little bit over. But is anyone else having burning, questions, issues, problems, or anything they want answered today? Colin, you good? He's in black. I don't know. Can't see it. She's like, Ah! I'm not calling you out, bro. It's fine. All right, well, I am here. We'll see you next week. Oh, you have something, Diane? Yes, yes, yes.

Dr. Dianne

I just wanted to send Deb words of encouragement to say she's going to nail those-- convert those patients and then come back to tell us about it.

Dr. Ariana

Yes.

Dr. Deb

Pressure.

Dr. Dianne

Is it, wooh, I've talk to the patient here.

Dr. Ariana

Well, but just remember. Yeah, you're going to do great because remember, you are offering them an amazing treatment. Remember how excited you were about the CGM? Because it was a game-changer, right? Prp, once you get into this, because it still sometimes feels like a pixie dust you're like, is this really magic? But ultimately, it is an amazing opportunity. Oh, Colin, he's having computer issues. He does have some questions. So we'll get that taken care of. But yeah, you're going to do amazing. It's just really going in there knowing that you can help them. You have an amazing solution for them. And I think the thing is Colin will be right there. I am doing BMAC, yeah, so we'll get to that. What Matt Gillogly had to say that was so important that has really changed the way that I attack things. When things are really important to me, I take a little step back and I put myself in that winning mindset like, I am going to get this. This is going to happen. I am going to be able to help this patient. And then tie that emotion to it and say, just like when you're selling to your patients, right? Sell it to yourself. Say, I'm going to be so ecstatic for my patients when they sign up for this course. I'm going to be so excited to give them the treatment that they deserve and then go in as like, I have an amazing opportunity for you. And this is what we're going to do. I have the secret sauce, right? This is how I feel about and why I'm so passionate about teaching at this because this is the secret sauce that saved doctors' lives. Right? This is what reinvigorates doctors to love their jobs again. Isn't this so exciting? Right? It's a new thing. You're like, what do I do? I know it's scary, but also it's so exciting. It's mind-blowing. So, Deb, you're going to do amazing. All right, Colin, you have some questions. Am I doing BMAC? Yes. Phyllis, you're going to go? Okay, thanks. I really like that. What other questions do you have? I know you're having some computer issues. Hopefully, you can just type. I don't know. Let me see. Yeah, I'm so sorry, Colin. Oh, your video and your mic are not working, but you can hear me. So just type in the chat what you're wondering about, and I can maybe talk to you about that. Oh, good. I can't see you. You're all black and your video is on your mic. That's okay. What can I help you with with the BMAC? Or maybe we can just chat offline. Here, what I'll do? Yeah, everyone, I'm just going to put my cell in the chat. And then, Colin, if you want to just give me a ring, that'll be good. Otherwise, I will see you guys. Please feel free to take this. My cell number. It's free to give me a ring or whatever you want to do. 5035. Okay. So that is my cell. Colin, if you give me a ring, we'll get this done. Okay. Otherwise, I will see you guys next week. Deb, you're going to kill it. Diane, how much is PRP?

Dr. Deb

It's 3,500.

Dr. Ariana

Deb will answer it for you.

Dr. Deb

I'm sorry.

Dr. Ariana

All right. Bye, guys. I'll talk to you later. Have a good night.

Outro

This has been "The Business of Orthobiologics" Podcast. Thank you so much for joining us today. If you want to know more, please join us on the website, "PRP-Now.com" and click on the FREE masterclass. Also, don't forget to SUBSCRIBE to this podcast to get more guidance on integrating PRP in your busy practice. Bye for now.