Welcome to my FFS Journey!

Hi friend,

If you’re reading this, then some invisible force brought us together, and I am grateful for you to share your most valuable resource with me, your time. I want to always respect your time, so these are my following three promises to you. I will do my best to provide value to you, whether it be entertainment, education, or simply just a conversation between a friend after a long week. I will also respect your time, not fluffing up any ideas or stories, keeping everything as concise as possible. And finally, the voice you hear will be mine, and only mine. I toyed with the idea of using AI to help me write, and although it can help me polish up my writing, it will invariably create a gap in the communication between me and you. So every word that you read would have come straight from me. Glad you are here, so let’s jump straight into it!

I’m actually writing this to you at 4:30 am Saturday morning, as I woke up at 3:30 am and was too excited to go back to sleep. I want to share with you all the direction that we are headed with regard to my business. About 2 months ago, when my leadership team and I were having our VTO (Vision/Traction Organizer) meetings (from Gino Wickman’s Traction - more on that in a future post), I realized that to hit our long term goals, there was an incongruence to staying in-network with the insurance plans. The short of the matter is, it’s tough to run a value-based business if you cannot control an important determiner of value - price. The current business model is to do a little more, for a little less. As you keep doing a little more, for a little less, extending that out to its logical conclusion, you end up doing everything for nothing. As a business owner, I’m always dreaming on how I can provide more value to my patients, how can I set myself apart, but by being in network, I’m always pulled back to reality by the big BUT. I want to implement this initiative to improve patient care, to wow the patient, BUT… it will take too much time and resources, and I will end up losing money by doing it. Eventually, this sobering realization puts a complete stop to all thoughts of how we can improve patient care, as all ideas will invariably cost resources in the form of time, or money, and by restricting our pricing, all initiatives will have a negative ROI. When all initiatives have a negative ROI, we eventually coalesce into the same business model, doing the best we can for as little as possible. This was a realization that hit me hard when I was laying out the long-term vision for my business.

What made me appreciate the FFS model

One event from many years ago opened my eyes to the relationship between pricing and value. When I was just out of school less than 5 years, I was still building my skills as a clinician, and working in two different offices, one in-network and one out-of-network. I had the exact same situation happen in both offices, on consecutive days. I was extracting a difficult tooth, and was struggling. On the first day, in the in-network office, as I was struggling, I could see the confidence in the patient starting to wane as I struggled, being replaced by irritation and frustration. By the end of the procedure, sweat pouring down my furrowed brow, the patient was kind enough not to unleash verbal hell on me, but I will never forget the look in their eyes; complete lost of trust, and I can tell that they would never return to me for any treatment. The next day, I found myself at the out-of-network office struggling with the exact same procedure, I did not want to make eye contact with the patient, as I didn’t want to catch a glimpse of their utter disgust at my ineptitude - I had enough on my plate trying to extract this difficult tooth. If I had to deal with the anxiety from the negative thoughts building in my head, the crush to my confidence will definitely sap my ability to complete the procedure. So I buried my head in my procedure, avoiding eye contact, when I heard the patient speak up during a break. “I’m sorry Doc, my tooth must be giving you a hard time.” Shocked, I looked at the patient, thinking “aren’t you upset that I’m taking this long?”. Realizing that the patient wasn’t mocking me, I managed a weak smile and response. “Shouldn’t be much longer, thanks for your patience”. Encouraged by the confidence boost that verbal exchange gave me, I was able to finish out the procedure not long after that. As the patient was leaving, they said once again to me “thank you so much for your effort, I’m sorry you had to deal with my stubborn tooth”.

After those two back to back interactions, I was keen to figure out what was different about those two situations that created such a vast contrast in patient perception. The two patient populations were actually almost identical in both offices. The main difference was the price that the patient paid out of pocket for the service. From the in-network patient’s perspective, paying me $50 to extract a tooth, I became the commodity, and since I was struggling compared to their expectations, I must have been the weakest link. From the out-of-network patient’s perspective, paying me $1500 to extract a tooth, their tooth was the problem, not me, because a provider charging that amount to extract a tooth must be quite experienced, and if they struggle, it must be the tooth that’s the problem. With that change in patient perception, I was able to regain confidence mid-procedure, and better patient care was the result of it.

I’ve since become a much more proficient craftsman of my trade, and hence usually I have the internal confidence to see myself through a procedure. But this experience has shown me a direct relationship between patient care, and pricing. Pricing can affect patient care.

Great, now that we’ve decided to go FFS, what’s the plan? The plan so far is to be FFS by the end of the year. I want to be able to speak one-on-one with all of my patients and explain to them personally why we’re doing what we’re doing, and also to answer any of their questions and concerns. I know we won’t retain every single patient, but my patients deserve at least an indication of what’s coming down the pipeline, so they can make the decision that best suits them. We had a team meeting with the subject of going FFS. During the transition process, I also have an experiment that I want to run, to A/B test verbiage on which approach is best when going out of network. I’ll be able to expand upon these plans on future issues, and I hope you’ll join me for those.

My hope is that if you got value from this, or you felt engaged with the vision, or something I said simply resonated with you, you’ll share my newsletter with friends that you have. This newsletter is to document the journey my career takes me, share some observations I’ve learned along the way, but most importantly, to build a connection with each and every one of you, so none of us will feel alone in this journey of life.

Keep looking out for each other, until next time, take care.