Why Your Hospital Bill Is 10x What It Should Be (And What This Doctor Is Doing About It)

You cut your hand in the garden. It needs stitches. Where do you go? Urgent care can't really handle it. The ER is going to cost you $5,000 and six hours of your life. And up until now, those have been your only two options.

In this conversation, I sit down with an ER physician who spent 23 years inside the system before he decided to build something better… a place that costs a fraction of the ER, sees you faster than urgent care, and tells you the price before you walk in the door. We talk about why hospitals charge ten times what care should cost, why insurance has become the most expensive way to pay for routine medicine, why the best doctors in America are quietly walking out of the system, and what it actually takes to build the kind of healthcare experience patients deserve.

If you've ever stared at a hospital bill in disbelief… or wondered why your doctor seems exhausted and rushed every time you see them. This episode will change how you think about both.

In this episode, you'll learn:

• The hidden reason healthcare costs ten times more than it should — and the simple shift that's quietly fixing it
• Why some of the best doctors in the country are leaving big systems to build their own clinics, and what that means for you as a patient
• The mindset every frustrated physician needs to hear right now if they want to take their career back

Connect with Dr. Noah Kaufman & more Resources:

• X: @noahkaufmanmd
• LinkedIn: https://www.linkedin.com/in/noahkaufmanmd/
• CrowdHealth: https://www.joincrowdhealth.com/
• https://kaufcare.com/

Chapters:

01:22 – The Garden, The Cut, And The Question Nobody Can Answer 

02:50 – Meet The Guest 

03:14 – The Financial Harm Doctors Don't Mean To Cause 

05:38 – Why You Don't Insure Dinner But You Insure A Doctor's Visit 

07:16 – Direct Primary Care On Steroids 

10:34 – The Space Between Urgent Care And The ER 12:15 – What Doctors Lose When They Lose Time 

14:12 – Pairing Cash Care With A Cost Sharing Plan 

17:36 – Once You See It, You Can't Unsee It 

19:35 – Building The Clinic From Scratch 

27:11 – Your Boss Should Be Your Patient 

29:58 – Doubling Doctor Pay While Cutting Patient Costs 

31:06 – Walking Through The Memberships 

33:17 – What Modern Medicine Should Actually Look Like 

40:33 – When To Send A Patient To The Hospital 

42:30 – The Bitcoin Treasury Strategy 

48:06 – The Most Surprising Part Of The Journey 

55:42 – The Ninja Warrior Story 

58:15 – Stop Complaining. Do Something About It.

Transcript

SPEAKER_02 0:00

Imagine it's a beautiful summer day and you're out working in your garden. You cut your hand, it starts to bleed and you say, I kind of need stitches. Then you start to think, where do I go? Do I go to the urgent care? The good part is it's pretty cheap. You should have to wait that long, but who's going to be working there? I want to see a doctor. You're like, it's probably not going to be the urgent care. So then I say, well, maybe I'll go to the emergency room. Then you think, I'm going to wait for hours. It's going to be very expensive. And I'm not going to know what the prices are when I walk in. And I have a big deductible. I'm going to be paying most of this in cash. What do I do? And up to now, there's been no good answer. But on our show today, we have a guest who's going to give us a great answer. It's called KoughCare. And this is a great idea. It's going to revolutionize care in America. His name is Dr. Noah Kaufman. He's an emergency room physician, board certified, with over 20 years of experience. But he's much more than that. He has a colorful history and he always thinks outside the box. And he was on the American Ninja Warriors show for seven seasons, which is pretty wild. He's an avid Bitcoiner. He's got medical consulting business, and he has his hands in many different areas. So very excited about that. And this podcast is for educational purposes only, not medical advice. Always seek the advice of a physician for any problem you have. Noah, I'm so happy to have you on there. Very exciting with all the things you're doing.

SPEAKER_01 1:28

Jim, thank you for having me. I mean, it's exciting being on your incredible podcast and your platform. Thank you.

SPEAKER_02 1:34

What an introduction. Well, I appreciate that. Thank you so much. And you know what? I always think back, every successful startup identifies a problem, a pain point, and then comes up with a great solution. Could you frame for me what the problem is that you're addressing?

SPEAKER_01 1:51

Yeah, absolutely. And I guess first let me start by saying, you know, as doctors, we give an oath to first do no harm. Okay. So foundationally, like the problem is we are doing, we are part of a system. And whether we're witting or unwitting accomplices, we're doing massive financial harm to people. And, you know, we're not doing it on purpose. We're not doing it as physicians. We we don't want to do that, of course. We don't even know what stuff costs. No, we have no idea. I'm discovering it now, uh, ordering the stuff. And I'm like, wow, needles are really cheap, uh, you know, and they're all made in China. But uh, so the problem that we're fundamentally trying to address is the fact that as everyone knows and is sick of uh healthcare insurance, the self-pay prices are massively lower, and nobody can explain why hospitals are charging like you know, 7x or 10x on what things should cost. And what um is starting to happen is there's starting to be an independent market forming, which ironically is the way it used to be. So it's kind of like we're reinventing the wheel a little bit. And the real the real problem is, you know, all you really need in the relationship is the doctor and the staff, the nurse and the medical assistant and the medications, the needles and stuff, and then the patient. And that's really all you need in in medicine. It's like having a lawyer and and uh a client. You know, you just need those two things. And when you start adding on bureaucracy and layers of administration, and then layers of administration to administer the administration, and then everybody puts their hands in the pot to get some honey on their hands. Uh, all of a sudden, you're just robbing the patient blind, and you're robbing the physician blind, uh, and the rest of the and nurses and PAs and everybody. Um, and really you're funneling, you're you're you're sucking all of that money out of medicine and you're putting it into the hands of uh stakeholders who are more sophisticated from a business sense. So you you know, we're trying to take it back uh uh, you know, like let's throw throw this away, let's start over, and uh uh we can do a better job. And I think all physicians uh need to start thinking this way.

SPEAKER_02 4:15

I love this. And you're absolutely right. I mean, going back to the 60s in America, we paid for 50% of our health care out of pocket, and people were used to that. And there's there's nothing simpler than paying a doctor in cash at the at the point of service. It's cheap. Yeah. And you know, we're insuring things. I've I love reading stuff on X. People are saying, you know what, you spend more when you go out to dinner with your significant other than you do to see a doctor, but you're getting insurance on that. You're not getting insurance for the restaurant. Why are you getting insurance to your doctor? And and people will say, well, I want to get insurance that'll cover physician visits, and they pay, you know, $5,000 more, and then they consume $300 worth of physician visits. You're like, that's a terrible idea. You know, and it's so I love that. The simple thing is perfect. The other thing I know, you know, the ER docs are struggling throughout the country. A lot of them are being replaced by nurse practitioners in the ER. And, you know, there was just that situation in Oregon where they fired a long-standing group of ER docs. And I mean, it's just crazy. And that never would have happened 20 years ago. And they're gonna, you know, bring them in another group, and obviously they're trying to undercut them. They don't want to pay them what they're worth. And I love the fact that this is kind of sending a message to the ER docs out there, like, hey, you know, there's other options for us. We're not stuck in this terrible situation. And so I love that. I mean, to me, this is like direct primary care on steroids because now that's a great option for family docs, internists, pediatricians. And now you're saying, hey, here's another thing we can do, which I love that.

SPEAKER_01 5:55

You know, so I mean, like we have completely transparent prices. We have, and and I think physicians getting into the nitty-gritty and starting to understand the business of medicine is absolutely essential at this point because um we've we gave up control of the house of medicine and we did it because we were focused on our patients. Uh, and then all of a sudden, healthcare is a third of GDP and it's a trillion dollars down, you know, and most of it is just down the drain for useless, uh useless kind of stuff. So I I am providing an alternative path. Um, we are trying to create an alternative path for emergency physicians. You know, as much as I would like to fix medicine completely, uh, I think that we would each best be served by focusing in on our specialty and starting there and then maybe organizing and growing together. Obviously, we're all standing on the shoulders of giants. And I've looked to leaders who were long before me who've been doing this. You know, I mean, um, so Surgery Center of Oklahoma, for instance, obviously there's a lot of physicians who know what the fundamental underlying problems are. So, you know, now imagine being an ER doc, you've been practicing for 20 years, it's a cortisol factory. Um, you uh you hate working nights, you could barely work nights.

SPEAKER_00 7:19

Yeah.

SPEAKER_01 7:19

Uh, you know, it's you're you're not, you've got all the experience in the world, you know how to deal with anything. Uh, but now you get woken up in the middle of the night by you know, a snock no known kid playing on his iPad, and the parents are freaking out about a fever at 3 a.m. and and you're questioning your whole raison d'être. You know, like you're like, why am I doing this? Uh uh, you know, I'm I'm an ER doc. Um, so it, you know, there there is a space between urgent care, which is a race to the bottom, with private equity has moved in, and it's about volume, volume, volume. Very good at treating a strep throat, very good at very basic things. Go to the urgent care. Don't don't come to the emergency department or even cough care if you have something ultra basic, uh like a cold. But then there's the emergency department where you wait for six hours. You do get seen by a board-certified ER doc, who's, you know, many of which have 10, 15, 20 years of attending experience, but you're gonna wait and then you're gonna get like a $5,000 bill for a simple, you know, laceration repair. And, you know, the urgent cares are sending a lot of these to the ER. I know that because I've been working in the ER for 23 years, and I get a lot of cases from urgent care who are like, ah, we can't deal with that. And I look at it and I'm like, okay, this is you know something we can do. Um, and and so cough care lies right in the middle of that. It provides a path for physicians who don't have to work night shifts. It's not a full ER. Um, we do have limitations, we will refer to the ER or um even directly uh with our specialist uh colleagues. Uh, but it's also a a higher experience level and a higher ability level to deal with uh all sorts of procedures than the urgent care and the mid-levels who have a lot less training, who might be very good. There are mid-levels who are definitely operating at a doctor level, you know, working at a very high level. I know some of them, they're incredible. Um but that being said, we think that there's a pathway here with transparent pricing. So you can go on our website right now, you can compare prices to the ER. Uh, you can see what it's like if you're a member of Kough Care. And then in conjunction with with uh uh with other organizations such as Crowd Health, which is providing an alternative to insurance, you can you can create something that is very high value. Um and also, by the way, has a completely different vibe. You know, we're not gonna have a hospital, sterile environment, but we're gonna have plants and just a very nice, comfortable area, a compassionate vibe. We've got uh a lot of educational materials, and we're gonna spend time with our patients in a really compassionate way. Um, and so that's what we're creating at Kough Care. And I think there's a lot of problems to address, and there's still a lot of problems, you know. Like I'll be the first to admit that we need to pay for our rent, we need to pay for all the needles, salaries, and all these things. So we can't deliver um care to everybody right away. But you know, if you come to Kough Care, I'm gonna take care of you, whether or not you can pay. Don't let the word out. But we need to find a way to deal with that still, and recidivism and other problems that we see uh classically in the emergency department.

SPEAKER_02 10:53

Well, there's a couple added value ads I would say that you're doing that are really powerful. And a lot of them are, like you said, kind of a retro. The first one, which I love, is you have the time. One of the problems I see in the ERs, and everybody says, well, ERDocs order CAT scans reflexively on everybody. I'm like, okay, well, the ER doc goes in there, there's a zillion people, they don't have time to sit there and think. I mean, it's so chaotic. They don't have time to look at this one person, talk to them. The other thing is they don't know this person. It's like one time, you know, where if it's a long-term patient of mine, I kind of know all their nuances. There's some patients, if they say, I'm hurting, they never complain. You're like, okay, call the OR, something's going on. Other people you're like, you always say that. You know, there's nuances, and you guys don't have that, where it's great to start having the time to think. And I think that's what's been taken away in healthcare. And that's one of the frustrations for physicians. Everyone thinks it's about money. It comes down to our work environment, is number one. And we need time to take a breath, breathe, look at people, and interact with them, watch them. All of that is so important for diagnostics. And that's what I think this is going to be a huge value add. The crowd health, I I love crowd. I'm a huge fan. Uh, fortunately, I can't be on there. I've kind of timed out on my age, but I I love a phenomenal plan. And, you know, somebody's the right person, young, healthy, doesn't have a lot of chronic medical conditions. That combination of you and crowd health, especially with their shopper that they use, you know, they have the negotiator person for you, the navigator, that's really powerful. And I would think hopefully there's some businesses in the Denver area, you know, if you're a small business and you're struggling with health care, and especially if you have under 50 employees, I think that combination of cough care plus crowd health would be very powerful.

SPEAKER_01 12:49

Exactly. Yeah, no, I you're you're absolutely right. And I'm I mean, look, the the thing about insurance in general, and you talk about this all the time, and we're all kind of focused on this, yeah, is that when you have car insurance, you don't use the car insurance to do the oil change. You don't use the car insurance to go off the gas, you don't use the car insurance, even for uh you know, basic mechanical work, you don't do it. Um, you do it for like if your car gets totaled or something horrible happens. And that makes sense. And that's the whole basis of insurance from like the beginning, why human beings thought up insurance. So it's it's a it's insurance, it's a backup plan if something goes catastrophically wrong. But the problem is, as you alluded to earlier in medicine, you know, in insurance is used for everything. Yeah, and um 80% of people don't hit their deductible, and the you know, the the cost is like $27,000 for an insurance plan for average person in America. I'm on crowd health, and you know, I pay a couple hundred bucks a month for me and my family. Uh, and if something bad happens, I pay the first $500 in the year, and then everything else is covered by the community. And I've already had to do that, you know. Unfortunately, I've had uh some back issues um and uh from like from you know just uh overuse and and uh working the back, and and I have a spondylolithesis with like a grade two shift on my vertebrae. So that's and and the disc is gone, so I'm gonna have to have that fused. And I've seen a couple of neurosurgeons and uh an orthopedic physician, and everybody agrees I need surgery at some point in the next year or two or whatever it is. Uh, and it's a little limiting. Um uh, but you know, crowd health is gonna take care of all of that. And when I'm doing this cash pay, uh I I get to get much lower prices because every time I go in to see a neurosurgeon or something, like the price would be a thousand dollars, and then they're like, Oh, your cash pay? Well, okay, it's $150.

SPEAKER_02 15:04

Yeah. Yeah, it's amazing.

SPEAKER_01 15:06

Well, how does this work? Yeah, like it, but but Crowd Health pays it and they they help uh negotiate and they help find the prices and they say you should pay this. You know, and uh it's very helpful. And so, you know, I think that there's a big everybody's sick of insurance, so there's a big push towards it. And I, you know, I became very frustrated in the ER because I kind of woke up uh to the fact that, you know, one once you, it's like the kind of thing is once you see it, you can't unsee it. And I think as a new doc, you are so busy learning medicine, getting your you know, 10,000 patients, your thousands and thousands of hours to become an expert in your field that you're not really thinking about anything, and you never see the prices. This is by design.

SPEAKER_02 15:54

Exactly.

SPEAKER_01 15:55

I never had any idea how much it costs to, you know, what what somebody would get as a as a bill. Okay. And you go to the ER, you get like 10 bills, you get the radiologists, you get the hospital fee, you get this doctor, and it's months later, and some stuff is refused, and then you get collections. It's horrible.

SPEAKER_02 16:13

It is.

SPEAKER_01 16:14

And so, you know, just seeing that and then opening my eyes to it, and now seeing what the things actually cost, um, and how the hospital um, you know, how the hospitals kind of function and how they work. And they're not all, you know, evil, of course, hospitals are good. Um, but you know, you see the the real problem, and it's much easier uh now being a patient and a physician and understanding healthcare costs a little bit and learning from people like you and everybody else on on you know who's speaking on on both X and elsewhere. Um it's time for a change. And uh, you know, we can complain, but then people are are right to say, uh, hey, you can complain, but do something about it. What are you gonna do? No, that's great. So it's it's time to do something about it. And it's um it's exciting, it's stressful, it's uh I'm all in, you know, like it's a little bit existential. Uh uh, you know, I'm self-funding. I've turned down uh numerous investors who have approached us. Um and you know, what we want to do is ultimately uh we're never gonna sell out. We're going to try and work with other board-side of board-certified ER docs and other experienced physicians who are interested, and perhaps even franchise and grow KoughCare into a national brand uh based on transparency, compassion, and competency.

SPEAKER_02 17:45

No, though those are all good things. You know, I always think of health insurance should be like term life. You know, term life, you pay it, it's inexpensive, and you hope to God you never need it. You know, and that should be what health insurance is, you know. And we we I love that you're making it simpler and just allowing patients, we have to really change the mindset because, like you said, 80% of the people don't meet their deductibles. That means they're really paying cash for medical services, but they don't think about it. So if you're paying cash, then you're saying, okay, if I'm paying cash, I need to be a good shopper. I can pay $350 for a CAT scan or 10 grand. So I don't want to pay 10 grand. And but so I I love that you know, this will help get people educated with that. And to all the docs out there, because there's a lot of us, you know, people are like, I'm getting frustrated. What do I do? I feel trapped, I don't have any options. How did you start the process in terms of you know a design? Because to me, I'm like, okay, I don't want to make design errors because you know, you're building out this box and you're kind of stuck with that physical design. If you screw it up, you have to, if you put in too few exam rooms or you don't have a treatment room where you can do certain procedures, or they're not big enough, or you know, so how did you address all that? You know, did you do it yourself? Did you get some a designer in there with you, or how did you get started?

SPEAKER_01 19:02

That's a really good question. Um, and I guess I would answer that uh, you know, much like um much like I approached medicine, uh, and and like many of us approach medicine, we all look different on the outside, we all look different on the inside. And people respond differently to different medications, to different treatments. Um, and so, you know, people don't understand frequently that it's not like a one-size-fits-all um kind of scenario in medicine. You have to create a treatment plan with, uh, as you said, you know, you know your patients, and we're limited by that in the emergency department. Uh, to some degree, there is some people who are always in and out. That's true. Um, but when when we practice medicine, we have to really think about the person individually. And I do think that moving forward, there will be a whole frontier of genetic medicine coming our way with individualized uh treatment um drugs and all sorts of incredible innovations uh will be coming our way in the near future. But that being said, when I'm developing uh a system or a business like Koughcare, and I've done businesses in the past, I've always been fairly entrepreneurial, so I've learned a lot from my failures, let's put it that way, and from successes. And I've worked with private equity and I've I've I've done some um uh successful businesses, and I've learned quite a lot from leadership and designing those systems. But one thing that I've that I've always noticed, whether it's with a patient or with designing a business, is you have to stay flexible, you have to um stay away from confirmation bias, especially from anchoring bias. And you have to realize that pivoting, you know, there's an old saying, champions pivot. And if if and and so the best thing to do is get an idea down on paper, get a get a thought, get um a creative vision for solving a problem that's gonna help people. And once you do that, um you can consult with a hundred different consultants and they might come up with a hundred different answers, or maybe 50 different answers, let's say. I mean, I mean you you're gonna get a broad range of ideas. I already know what works in the emergency departments that I've worked in, what works with patients and seeing patients, and how to deliver the best care possible. That's what I've been doing for 23 years in the in the emergency department. And because of that, um my focus is 100% on the patient, and how can we provide the best care with the best outcomes for the patient? Everything else is derivative to that, and and everything else is is focused on that one goal. And and of course, part of providing the best care for the patient is keeping our lights on and staying open. So although it's derivative, To it, we need to worry about the finances and we need to make sure we're successful. And if it's a good model, we want to grow it and propagate it so that we have an alternative path for patients and for physicians. So when I think about you know what we're going to do, a lot of it is logical and common sense. We've got an x-ray room. We have a room that's more orthopedic and all of our orthopedic stuff is in there. It's just like the ER. The best ERs I've worked at, there's a room where we always put the OBGYN. There's a room that's my life ENT, Opto. Yeah.

SPEAKER_02 22:32

Yeah.

SPEAKER_01 22:32

You got all the stuff in the right place.

SPEAKER_02 22:34

Absolutely.

SPEAKER_01 22:35

There's a triage room, like a real easy room. There's a major procedures room. It's the same thing. And so, you know, when I'm designing it, the nice thing now is I don't have 10 different people coming up with 10 different ideas in the hospital, and then this guy gets fired, and then this guy, you know, and it's like a game where it's too many cooks to spoil the meal. And so the best ERs are where one person, one smart, experienced person had a vision, they made their vision, and everything works. Okay. And so, you know, right now, that's what I'm getting to do. And as we expand, we'll probably franchise out. We'll only work with board-certified physicians and different primary care specialties, uh, who are, and you know, it'll be a very a very uh very interesting application process, let's say, to to um you know be approved to get a cough care center. But then once we do, we'll work with our partners. We have the playbook, um, and they will enact their vision based on what works best for them in their practice, um with what we've done as kind of like a template to start from. And it's just like a template that when you're when you're uh um charting or documenting, you know, all of us have slightly different templates and a slightly different way of uh documenting. And and it's the same sort of thing here. So it's a good question. Uh, and the answer is uh complex and variable. Um, but I think I think we're at a very exciting place. And you know, hit me back in three months, and I'm sure every room will be different and reopening.

SPEAKER_02 24:21

Absolutely. Oh, yeah, it's it's a moving target. The other thing that's exciting to me is we're starting to see a movement, which is much needed, of getting patients out of the hospital. And there's they call them hospital at home, but it's really to be acute care at home. And I think that's another area with the remote monitoring that I would love physicians to take that over. And I think you're kind of on this spectrum. So of people taking stuff away from the hospital. You know, there's a lot more inexpense of great monitoring now that we, you know, that we didn't used to have, a lot of tools that you can use. And I so I see you as kind of part of that whole process with that, because I think that's going to be huge. All of a sudden, you know, you can have people with CHF, TOPD, sepsis. These were all the ones that they were treating at home, and they actually did better in their own home. Now, here's the crazy part: the hospitals were paid the same as if they were inpatients. Like only CMS would think this is a great idea. And CMS for non-medical people is the Center for Medicare and Medicaid Services. And they really run a lot of our health care. Now, here's another thing that I love what you're doing is you rightly told like many physicians, senior physicians have been in the system, you get frustrated with it. And what you're doing is you're just saying, I'm opting out of a bad system and getting a better alternative. Because now you don't really care what CMS is saying. They're not your boss. So I love that. You know, that's the beauty of getting away from the insurance thing. All of a sudden, your boss is your patients, as it should be.

SPEAKER_01 25:54

Yeah, that's right. And and and think about this also. Um, you know, if so, as a patient, I want my physician to be happy, excited to work on me, absolutely, excited to help me. Absolutely. And I don't want them thinking about money or stress or debt or any other problems. And I I like like even from a non-selfish standpoint, I want my physician to be like in a in a frame of mind where they are able to devote all of their mental faculties, well-rested, their passion, their care, their skill, their art, their craft to helping me because I need it. Yes, I need the best surgeon possible to use my back, you know, and uh uh um so so the reason why I say this is because not only are is the system sick, but patients are sick and get, you know, and doctors are sick also, as we talked about. And so, you know, imagine if we can create a system where um we remove the administrative bloat, we remove insurance from the equation, um, we figure out the the drug piece, which it's incredible how cheap drugs are. We can dispense them from uh from cough care. I'm I've like ordered you know hundreds of drugs. It's it's crazy. It's like it's like Christmas. You just go shopping. I'm like, I just got I got the propofol in yesterday, la beta, la low press, or some big bottle bottle of cephalexin augmented. And so like the pills cost pennies. Everybody knows this.

SPEAKER_02 27:32

I saw your rosefin the other day uh this morning. I saw the rosefin, which we use that a lot in GYN. So I was getting excited. I'm like, all right, we got Rocephan. We're in good shape, man. Those gram negatives are in trouble.

SPEAKER_01 27:42

So yeah, we we got those covered. We got those covered. What if we can remove that 70% of the cost of health care that goes into non-value adding uh black hole?

unknown 27:59

Yeah.

SPEAKER_01 27:59

Um, and what happens if we double physician's income and we reduce patient costs by 60% or 70% still? We can accomplish that. So, you know, what I hope to do is uh personally, in my very small neck of the world, um, you know, I certainly don't think I'm gonna change medicine dramatically, but I want to start and create one of those ripples that adds with a ripple from Surgery Center of Oklahoma and all the other docs and Atlas and all these, right? All these wonderful, um, you know, innovative entrepreneurial docs. But what happens if I can create a better path for ER docs, especially seasoned ER docs, so that you get all your training, you work, and and let's say after 15 years and you haven't had lawsuits really, or too many lawsuits, or they were frivolous, or whatever, and you know, you meet all the criteria to get yourself a cough care as a physician. Maybe the incentive, the financial incentive, pay off your loans, get out of debt, make your, you know, make your own paths. You don't have to work nights, all these things. Maybe we can create something really incredible for doctors at the same time as we create an experience for patients that is top tier without the weight, without the expense, and boom, you pay that day, you're done, no more bills, no more, uh, you know, there's no copay deductible, this, that, or the other thing. And yeah, you know, and and that's where we want to start. And then we want to grow into um mechanisms to provide care for people who can't afford it. And for because as a doctor, um, I'm gonna take care of anybody who walks in.

SPEAKER_02 29:40

No, that makes sense. The other thing that's interesting, too, you have two ways people can access you. They can access you, people can come in one off. You know, I'm traveling in Denver and I cut my hand, I can pop in there. And then the second one is memberships. So I like that. There's a lot of flexibility there. And then you have three. Can you talk to us about the three? I know you have three levels of memberships. If you could talk to us about what those are, the pricing, you know, kind of give us a little taste of that.

SPEAKER_01 30:09

Yeah, so memberships are really um, really interesting. Um, our base prices are already pretty low compared to going to the emergency department. And uh the the visit prices are actually even low compared to urgent cares, but then that visit price um gets counted towards a procedure price. And the procedure you're going to get top-level um procedural medicine uh that you would get at a university level hospital. Um, and so so that's part of the value proposition. The memberships uh do a couple things, they take the visit fee down from $120 as a base visit for every anything across the board, takes it down to $50. And um, so you can come in anytime for $50 and whatever you whatever you need, and that counts counts towards whatever you need. So um, you know, if you have a UTI and uh and then of course we have met medications we can uh dispense to you right there, and then you can go get uh you don't have to wait at the pharmacy.

SPEAKER_02 31:14

That's huge. Yeah, I mean you have a two-year-old with an earache, that's great. Not to have to go in the rain, you know, go. I mean, all these things are so huge for patients. They love it.

SPEAKER_01 31:24

And I mean, there's you know here, I let let's take a tangent for a second and we'll put memberships right here because I do want to thank you for asking. Oh, yeah. Um one thing that's interesting as a doc. Imagine this. I have zero clicks and zero typing in a day. Yeah, I have a scriber AI in my back pocket. Uh you know, the the phone is listening and writes a note for me, and then the staff copies the note in into the chart. I I read through the note at the end of the day.

SPEAKER_00 31:57

Yeah.

SPEAKER_01 31:57

Um, but all the orders, everything is done technologically in an advanced way to where all I'm doing is seeing patience. It is so optimized. Yeah, the EKG machine is a is a brand new EKG machine. It's not the stickers anymore. It's a it's a band, it's smart heart. The x-ray we have is called novel cam. It's all tied in so that images immediately go into the chart. We have the little b-bird device. You look in your ear, and it's it shows a you know, the patient can see live time on a phone. We have iPads, and and so we educate show patients and we can look in any orifice and show them what we're seeing and what we're gonna do. Um, and so the you know, we have an opportunity to technologically advance care to where it should be. Whereas in the ER, the ERs are like everything is like most ERs are not, you know, you got the machine, the ultrasound machine is 15 years old. You've got lame band-aids that are like the vinyl plastic that come off in 10 seconds. Like, I get to choose the highest quality stuff for my patients, period. And it's not, it's not more expensive, it's like already what is out there. That's crazy, and we're just not using it, we're not using those tools. So, for so, so, anyways, that for doctors and patients is going to be huge. Um for uh for the memberships, though, for our members, they're going to have access to all sorts of things. Not only do they get 15% off of everything across the board, but they get um, you know, and we have a huge retail shop in the uh in our you know, in our space. Um, but they also get a whole long list of bonuses. So they get they get preventative care medicine, they get um, you know, these yearly check-ins, they get uh free labs, they get a free IV once a quarter, they get um some longevity medicine counseling, they get like you have to go on our website and see all the things, and we're gonna continue to build that out. But all the things that are kind of easy for us and and don't cost anything, that's gonna go to our members. And then um, you know, we and obviously we have to um uh we we are focused on on uh evidence-based medicine, and you know, we have to stay away from um certain things where we're uh there's not really good data. Sure. Uh and you know, we we have to practice good medicine the way we understand it, but we will speak with patients about the stuff that's more bordering on the line. And you know, we're considering um adding stuff that that people find uh really useful that is data supported. So there is, for example, obviously a rush towards peptides and whatnot, but there's a gray market, a black market, and then and there's a lot of poorer use of peptides. There's a lot of just willy-nilly using it, not monitoring labs, not understanding the science. So we need to take those things, and those that type of program, like peptides, for example, will be for members only. And it will be an ongoing consultation and um figuring out what the best science is, and then discussing how everything is probabilistic in medicine and how we don't always have perfect answers. Um, so those are the memberships, and there's an individual uh membership, there's family membership, there's signature uh membership, and you can get executive, you know, full-body MRIs and everything. And then, of course, there's uh for business. Uh, and then those are tailor-made um uh plans for local businesses uh to see and and help them. And yeah, I mean, and and the other thing is, you know, hospice care. Uh urgent care is mostly won't see hospice care and give patients diluted and monitor them and um you know, or or even help them if they're dying. People come into the ER and it's the it's a horrible place to die. Yeah, that is true. You know, and and hospice care is a big thing. So that's another area where we can provide extremely compassionate care for a family. Um and and and and so there's just so much we can do with this uh as you know, emergency medicine physicians or just experienced primary care physicians and family docs. Um so you know it's it's very exciting, and and we will grow and and and be flexible with the memberships to see what our patients want and what works the most, but focused on health, longevity, um, health span, you know, healthy living, um, and preventing disease because you know we want to prevent disease with our patients. Uh I I don't want to see 60 patients a day who are sick. I want to keep 20 patients a day healthy for as long as possible and be their best friend and caregiver and and uh really care about them and their family uh the way it should be.

SPEAKER_02 37:12

I when I was looking through the memberships, I really like the basic lab panel, it's great. You know, put that in there for free, IV services, and then under the family membership, you also had sports physicals, which is great as well. So you're really addressing pain points. You're sitting there like, okay, what what's what would help patients that I know you know, you're gonna be constantly changing this. You'll get that feedback, there'll be a moving target, you'll find out what people really value, and you know, you'll and you'll add other services to that. So I really like, and I also like in your app is phenomenal. I have to say, you've got a lot of good stuff on there. And I love the pricing on the app because you can put it in there and you can see compared to ER pricing, you can toggle that on and off, and then you can start adding discounts. The first one's membership, second one is veterans. That's veteran, I thank you for that. And the third one is Bitcoin, and they kind of add up the up to 35% discount on every service if you click all three of those. So I I love that it's so easy to see. And the other thing you have here is a really cool kind of a self-triaging tool. You say, you know, you know, what is your complaint? And then you have, you know, review systems in there and you give people some guidance based on that. And then you also have a chronic condition. You can learn about your anemia or whatever. So there's a lot on there. So I want everybody listening to go to coughcare.com. I want everybody to download the app because it's a really cool app. I want you to spend 10 minutes, you know, get a cup of coffee and just go through all of it. There's a lot of great material on there. So I mean, you you've obviously put a lot of thought in it, but I think all that's gonna help people out too, because people don't know. And like I said, I think over time, more and more people are gonna be able to go to an advanced urgent care model, and you're gonna be really good at knowing when they need to be transferred. And then are you close to a hospital? Do you have any relationships with any neighbor uh near hospitals, neighbor hospitals?

SPEAKER_01 39:07

Or so and we're developing all of those right now. Um, a lot of it is with long-term care centers, um, local uh direct, independent physicians like primary care who don't have good acute care uh options for their cash pay patients. And you know, there's a we're in Denver, uh there's a huge gig economy, and there's a lot of 1099 business owners, business workers. So there's a lot of people who don't have classical insurance or pay pay through the nose for it. So those those relations are all being are all coming right now. Um, the big hospitals are kind of like lower on the food chain, they're doing their own thing. They have uh, you know, I mean, they're and look, we're not against hospitals. I think there are some problems uh obviously that need to be addressed, but a hospital is absolutely necessary and it's it's where we will be sending patients when we're worried if they have a heart attack or a stroke or something.

SPEAKER_02 40:08

Um and I'm and I support that as well. Like you said, if somebody comes in with crushing chest pain, you're like, all right, we got to get you and their O2 is low, you're like, all right, we're getting you out of here. And no, I I agree with that. And I have patients, you know, through the years as an OB, people come in with something like that. And I'm like, all right, we're getting you out of here like immediately. They're like, don't you want to? I'm like, no, I don't need to know anymore. I'm like, whoop, we're getting you. And we were attached to a hospital. I people would laugh. I would like put them in a wheelchair and run them down to the ER, you know, myself, because it's it's so much faster. It's like a minute I'd get people over there. And I'm like, okay, you know, we we got a code stem, you know, we we have to make sure as person's not have a heart attack. And I would just wheel them past the front desk and back into the base. Because I'm like, I don't care what the rules are. I'm just like, boom, I'm just doing this. So, you know, it's but and I know you're gonna be really good about doing that. And obviously, people you're worried about a stroke, heart attack, aneurysm. And we all realize the importance of hospitals, we support them, but what we're really calling for is hospitals to really act in the best interest of the patients, is which we're talking about price transparency, you know, reasonable prices. And I think all that is good. Now, I I have to also ask, and I love all the ideas you have. And the other thing is what are your thoughts on Bitcoin? Because you have Bitcoin as one of the options to check on there. And I know you've been interested in Bitcoin for a while. And what are your thoughts about where the current value of it is, future values, those sorts of things?

SPEAKER_01 41:37

Well, first let me say that I am very sensitive to the fact that there's a big stigma against digital assets in general. And I think that 99.9% of the space is scams and frauds, and it's a real problem. So I think that the obvious uh you know, forthcoming eye rolls and scoffs about Bitcoin because it gets lumped in with everything else, is totally understandable. So it's not something we're going to be widely advertising or marketing because it's just going to generate eye rolls. And it's not easy to explain to people the benefits. But I will tell you up front, when I accept stripe payments with a credit card, um, I'm paying on a million dollars of revenue, if we should be so lucky, type of thing, uh, I'm paying $30,000 in fees. Wow. And uh that's actually it's more than that. Um, let's say it's about $40,000 in fees. With Bitcoin, I'm I'm paying like $1,000 at the most in fees. So it saves a lot of money to take Bitcoin. And the Bitcoin is the its final settlement. It's like instant final settlement. So we don't have to wait for three days or five days um for the banks to talk and this, that, and the other thing. Um, and then the other thing is Bitcoin is being adopted as a as a network, um, and it is decentralized, it's not controlled by the government, so they can't print more of it. Um, and and so just the, you know, I've I've I've always owned some real estate and some stocks, and I have had some gold and silver. Uh, and it's important to be diversified. So, you know, a long time ago, I bought some Bitcoin and I studied it. And it makes sense to me. You know, it's code, it's very simple code, it's the only human network that's never been hacked. Um, there's a lot of interesting parts to it. There's only 21 million Bitcoin ever. Um, ever since I bought it, it's just been going up in value. And and so it, you know, it's part of our treasury uh uh strategy uh at Kaufcare. We hold some of our Uh we will we hold some of our investment capital in Bitcoin. We will hold revenue, uh a portion of it in Bitcoin. Um and you know, so I I'll just kind of leave it there. But uh I think when we're thinking about our physical our patients' health, when we're thinking about um the health of uh our business and individual health, um, you know, I think that uh without without starting to sound too crazy, I think that Bitcoin is like an important part of a well-rounded uh financial approach to your health. Instead of keeping all your eggs in one basket or dollar-denominated assets, I mean, we all know that inflation is eroding the value of our dollars over time. Um, and so Bitcoin was designed to be deflationary, so it was designed to go up in value over time, and it has done that ever since I've owned it, you know, over 10 years ago. Uh, and I I've just kept buying it, and it's it's done very well for um for my family and and myself. So, you know, I think that teaching people about this decentralized fair money uh that's an alternative that you know would that you can use to spend at Kauf Care and other places could help their financial health. Uh, and while this isn't financial advice, and I have no idea what's going to happen, um you know, that's kind of our general approach to it. So we won't be marketing or talking about it a lot, but there are there's a um a lot of people in the Denver area who are active, avid Bitcoiners who want to use our clinic. And so we're also catering to them. Um, and it's a growing sort of thing. And to everybody who you know rolls their eyes at that, I would challenge them to actually like keep an open mind and and read up and learn a little bit more um about digital assets. Because while there is a lot of fraud and scam and problems, there's also a lot of hope for the future and a lot of potential. Um, everything has been digitalized from photographs to maps to audio, uh, everything. So why not money? Why not digitize money? I mean, it's the future, whether it's dollars or Bitcoin or whatever it is. And so if you're going to digitize money, why digitize something that has an unlimited supply that benefits the people who actually print it and make it and seems to benefit the billionaires and the banks and this sort of thing? So I'll stop there, but uh it's it's it's a small part of our puzzle.

SPEAKER_02 46:42

Sure. No, it's a great answer. And it was interesting to see that. And I think that's wonderful. What would you say has been the most surprising part of this whole journey, the cough care journey? The one thing you're like, well, I didn't see that coming.

SPEAKER_01 46:56

Well, first, um, there's a lot of help. Uh so I use McKesson, and my uh account manager is like amazing. Oh, that's great. And and we are total bros now. Oh, that's fine. There's a lot of people who want to help and uh want to uh you know make this easier. And so, you know, they're trying to get me the cheapest options and help me solve problems. And you know, the and and then using ChatGPT as a resource uh helps. Getting the X-ray machine, like I hadn't, I thought you just buy an X-ray machine. No, you have to go through all kinds of state regulations, you need a physicist to come in and do calculations of how many x-rays you can do a week uh without getting lead-lined walls. You need a policy, you need dosometers, you need, you need, you need, you need. So the physicist has been extremely helpful, and now he's a friend. Oh, that's right. And um, everybody has been coming together to help us make this happen. And so, you know, when I have a question like, how do I keep my drugs and like how like what are best practices for the drugs? I ask ChatGPT and it's that it'll give me a list of things and who to contact, and then I'll double check, of course, because I don't trust you don't want to trust AI with and and lo and behold, yes, you need a refrigerator for some meds, and then you need a separate DEA-approved refrigerator with a lock on it for other meds. The whole room needs like uh an approved lock, and you need a video camera, and you need background checks on your employees, and so it's like a million little things that you need to do to make the and and it's like the that old saying, How do you eat an elephant? The answer is one bite at a time, right? How do you climb Everest one step at a time? And so being in the ER, constantly juggling a list of a hundred things and prioritizing and triaging and having 10 patients who have a heart attack, and this guy, you know,'s got a nail through his hand and blah, blah, blah. I'm used to uh list navigating at a very high level. So this is like that. And as we do it, we're memorializing what we're doing, creating a policy, a cough care policy startup book, so that we can repeat this without me, and so that any other provider who wanted to do this would not have to reinvent the wheel, and they would just have a book full of like very easy to read chapters and bullet points, information dense of where to go, what to do, who to talk to, and how to make this happen as quickly as possible. And then we're also partnering um with these great technologically uh current uh systems, um, and those will become part of our DNA, and those will become partners with which when we expand and uh either franchise or grow um beyond our our our Denver, our first Denver location, um, it'll be much easier, the second, third, and and time moving on with partners who want to help us. So the most surprising thing has been, you know, for such a challenging, overwhelming thing, like if you just think about opening your own clinic, you'd be like, oh my, how do I get the least? What do I don't want to do that, you know? But it's become it's it's like there's always an answer, and it's easier than I thought it would be. It's just never-ending work. Yeah, there's really fun and exciting, yeah, but it's all coming together, and it's like I I never hit a real roadblock. There's always something to figure out, and then of course, I told you before, the other massively shocking thing is like, okay, I'm gonna buy you know Pivacaine, uh, you know, that so that I can do a procedure or inject a joint or something, and yeah, this is gonna cost a thousand dollars. No, a box of like 25 multi-use biles is it's it's not expensive. It's like less than a hundred dollars.

SPEAKER_02 51:06

It's gonna last for like a year. That's amazing. And how long did this whole process take you, Noah, from start uh when you open?

SPEAKER_01 51:15

Well, you know, I've been stumbling over my own feet a little bit. So I'd say I could do this now in two or three months. Well, um uh, but it's been six or seven months, it's been a year in ideation. It it's uh well, it's been since uh since about August, last August. Okay. That's when I stopped doing shifts in the emergency department. Okay. Um and uh really started focusing on what else I could do with my medical career. Um and and you know, uh my back was limiting what I could do in the emergency department, and I can't stand on tables and reduce you know, hips anymore. Uh I like I actually can't do it. So um I needed to find something else, and I didn't want to go to work for somebody in an urgent care. So it started, and I've been dreaming about something like this my whole career because I've always seen the problems. Um but but yeah, so I I'd say that now starting the next one, you it was it's hard to get the right location. It's hard to get the lease and negotiate the lease and get the rent abatement, you know, like you shouldn't have to pay rent for six months. Uh, you know, you to get the tenant improvement because we had to repaint everything and redo the floors, you should get a tenant improvement allowment. So all of those things, you know, um uh take take the the majority of time, setting up the team, legal, this, that, and the other, setting up the entities, uh, understanding the structure. You know, you you as a physician, you need a PLLC, you need a professional organization, but then you have an MSO, a management service organization, and there's a management service agreement between the two, and you might have a rental business as well that buys the equipment and leases it. Um, and then there's different silos for where the money and where the risk go. So the PLLC holds the malpractice insurance, and and you know, I have malpractice insurance personally, and and uh the PLLC is only owned by a doctor, or I think a PA can can own 49% in Colorado. But so there's all this stuff, and learning about it, you know, took a long time from the beginning, but now it's like incredible. But you know, now it's like I could open one of these anywhere. I feel like I could literally open a whole hospital now. Um that's great. And and and actually, you know, I think that would be the natural evolution if I were if we were allowed to, and that section of the ACA was reconsidered.

SPEAKER_02 53:59

Right, section 6001. I hope the American Hospital Association is listening or coming for you. That's what you want to say. So no, that I love that. That's great stuff. And how did you totally off topic? Last question How did you get on the America Ninja Warrior? Tell us about that whole episode.

SPEAKER_01 54:18

Well, you know, um so you know, the how I got on it was a little bit uh mundane. My buddy did it, it was season two, and he did it, and he was like, This is easy if you're a rock climber. I'm always open to new experiences. I'm an ER doc. ER docs are already like a little crazy in motorcycles, and and we already are you know high uh um high adrenaline people, uh ADHD kind of people to begin with. So I, you know, I got on the show because uh I wanted to run what looked like the most fun obstacle course, like a giant playground. And I'm a big kid anyway. So I I I applied and I got on it. And actually, the very first season, um uh a chiropractor was doing an obstacle and he dislocated his shoulder on the obstacle. And we were in LA, we are uh at muscle at Venice Beach. Oh my gosh, and so he's sitting there and he's he's like in 10 out of 10 excruciating pain. And uh I jumped the, you know, and they called the ambulance, but it's it's LA, it's gonna take forever. Yeah, and he's like and he's pale as a ghost, and he's sitting there and he's he's moaning. And so I jumped over the they kept all the competitors in like a little fenced-off area, and I jumped over and they're like, No, you can't go over there. I'm like, I'm a doctor. They're like, You can't go over there. And so I I they're like, you're not gonna be able to run the course. And I'm like, this guy's in pain. Right. So I ran over. I talked to him, he's like, he's like, and I'm like, look, I'm an ER doc. You know, do you want me to take a look? And and I was working in Tahoe uh on the ski slopes. We staffed the ski, uh, all the ski mountains, Kirkwood and Heavenly and stuff. And so I put shoulders in like four a day.

SPEAKER_02 56:01

Oh, that's funny.

SPEAKER_01 56:02

And uh I'm very good at it. And so, you know, uh his name is Alan, and and uh, you know, I'm like, Do you want me to try and put it back?

SPEAKER_02 56:09

Otherwise, you're just waiting here for the Yeah, that's incredible pain.

SPEAKER_01 56:13

And and he was like, Oh god, please, please put it back. And so I, you know, I did a modified Stimson, I put it back in, thunk, it went back in, you know, and and he was like, Oh, he's like, Thank you so much. And he was like, and I you know, I was like, let's leave you up. And um turned around and the cameras were on and everything was being filmed, and we I was in my own little world when I was doing it. So that actually made it on air, reducing his uh uh his his shoulder. And then and then, you know, there were a ton of funny stories out of the ER uh from doing it, but it it was a really good uh experience.

SPEAKER_02 56:48

That I I love that. And this is a great place to end. You know what? Thank you so much for being here. I really appreciate you sharing your vision. And this is an inspiration to me. I think all the docs who are frustrated, we have answers. We have options. So don't sit there, be employed, be bitter, come home, drive your family nuts because you're always venting. And like they say, you got to do something. So, you know, look to NOAA, look to the you know, the guys like Atlas MD, the Steelman Medical Group. There's so many good examples, 30% of Oklahoma. We've got a lot of good, what I'll call healthcare heroes out there. So thank you so much for being here. Thank you for all the listeners. And I want everybody, you know, go to coughcare.com and then look at that app. It is a phenomenal app. You can get it on either Apple or you can get it, you know, on the um Android. So definitely get that app and go through that and let us know what you think. Let us know in the comments if you have any questions for for uh Noah or myself. And please like and follow for more. And you can follow me on X and LinkedIn, and please follow Noah as well. So he's on X and he's got a great account on there. I think you have like 30,000 followers, and you always have great stuff on there. So I recommend strongly, and I'll put all this in the show notes. Everything for Noah, I'm just gonna put it in the show notes. You don't have to write anything down. So we'll see you guys next episode. Thank you so much.