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« Medical Spa MD {3} Dr. Setu Mazumdar & Physician Wealth Management | Main | Medical Spa MD {1} Gregory Bledsoe MD & The Medical Fusion Conference »
Saturday
Sep182010

Medical Spa MD {2} Dr. Elliot Justin & Telemedicine

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In this episode of the Medical Spa MD Podcast we discuss social networks (Facebook, Twitter, LinkedIn) for physicians and interview Dr. Elliot Justin about Swift MD and telemedicine.

Trust an authenticity? In this episode we discuss how cosmetic medical clinics are using (or not using) social networks to market to potential and existing patients and how physicians are loosing patients because of this.

We also have an interview with Dr. Elliot Justin of Swift MD, a telemedicine service that connects physicians with patients. Dr. Justin discusses the state of telemedicine, how and why he started Swift MD, and why the current environment in healthcare is forcing a change in primary care.

Some of what we talked about in this episode.

PODCAST 2: DR. ELLIOT JUSTIN & TELEMEDICINE

This is Medical Spa MD

Andy: Hello everyone and welcome to the show. Well, we help cosmetic physicians reclaim control of their medical practices and lifestyle, even you’re clueless about running a business and you’re already working 60-hour weeks. Medical Spa MD is brought to you by MedicalSpaMD.com, a worldwide community of physicians practicing cosmetic medicine. Hello Jeff!

Jeff: Hello Andy! How are you doing?

Andy:  I’m very, very well, Jeff. What’s new Jeff? Is the Medical Fusion Conference… what’s the latest news there?

Jeff: I talked to Greg a little while ago and it looks like we got additional people signing up including a couple of Medical Spa MD members. I’m pretty excited about that and look forward in seeing everybody down in Las Vegas on November 5-7. I think it’s going to be an excellent time and certainly a lot of fun as well as whatever benefits and education-wise that we’re going to all have.

Andy: Well cutting you up… A little bit later, we have Dr. Elliot Justin, don’t we? Coming up… We’ll talk about it in a little while. You got a question for me. Haven’t you Jeff?

Jeff: You know, I did because we were having a conversation just before the show and I realized that you’re helping already some physicians with social media getting their word out and stuff. I just wanted you to kind of mention that Andy and drop kind of a note of what it is you’re both doing and how the physicians are kind of both reacting and what results we might be seeing.

Andy: Yeah, I am working with a cosmetic physician actually over here in the UK. He said some quite interesting things actually. I think he started off with video. He was in lot of videos and he had a very straightforward strategy. He was putting a lot of informational videos on YouTube.

Jeff: Is he doing this to kind of actually provide content to his own site and become a kind of a friendly face? Or was he doing this for SEO purposes originally?

Andy: No, he was doing it generally as a friendly face. He just want to put more information out to clients. But the interesting thing in doing this is actually aiming at a different audience. His some videos are for potential clients, but he’s doing some audio podcasts for, we can potentially be argued, his competition, for other cosmetic physicians or aesthetic physicians.

Jeff: Does he do training and stuff as well?

Andy: He does. He does his main plastic surgery stuff, but he also does cosmetic courses and things like that. So he’s got a different audience there as well. But, his videos are going quite famous. They’re very, very well looked at. And when I say videos, he’s got videos like a friendly talking face about how Botox works or what you might expect if you’re having this or if you’re having that one, all the way through to actual surgery, which is a very interesting approach.
I remember the first time I saw one of those and I had to… I’ve already [jumped? – inaudible -  03:16] sandwiches for about a week, I remember. But nevertheless, it was very interesting. That’s rich coming from someone who wants to be a doctor actually, isn’t it?

Jeff: Well, it is.

Andy: But, it’s fascinating video. I remember one story he told me that he’s, I think it was before he put the actual surgical videos out, already got a very good following on his channel of YouTube videos. He was visited by, I think, a couple from Middle East. The lady was so enthralled that she actually met him [inaudible – 00:03:46]. And that’s the effect that you can get by sort of putting some informational videos on YouTube.

But yes, he’s also got a number of audio podcast that he’s pushing out. I’ve actually lost count on to how many audio podcast he’s got. I’m not talking episodes here. I’m talking actually podcast series. So he does focus on various, different audiences. And I’m not sure what feedback he’s getting. I presume it’s quite good. I think maybe you’d need to speak to him.

Jeff: How long is he been doing that?

Andy: He’s been doing it, the audio podcast, for over a year now. I think the video was he was doing before he hooked up with me. I think he’s been doing the video probably for at least six months before me and him started working together.

Jeff: Well, we have to get him on the show and he can talk exactly what he was doing and why he’s done It and why he’s continued to do it. He must be getting results from it.

Andy: I think he is. I actually think that social media… Is social media the right term? Yeah, probably it’s the right term. It’s potentially a very good thing for physicians to get in to. I don’t know what it’s like in the US, Jeff.

Jeff: Well to be honest, I see a lot of attempts at it. You know, I give anybody a credit for making an attempt because actually taking action is the first step. But often, a clinic will have a Facebook page or they might have a Twitter feed or some other kind of thing, but they’re not really providing any value. What they basically do is they go out there and paste ‘We’re having a special’ or ‘Come in and see us on Tuesdays’ or some other kinds of things. There’s really kind of no sophistication, what I would call sophistication, around what it is they’re attempting to do. And you’ll often see that they have maybe 20 followers on Facebook likes or a hundred or a little bit more.

To be honest, I’m not a huge Facebook user. I do have two young women in my household and they tend to be on Facebook a lot more than me.

Andy: Same here.

Jeff: Yeah. But, we do use it. We have a Facebook page and we do have some resources that kind of pushing that or looking to develop that. I mean Facebook now has what, 500 million users?

Andy: I’ve lost count. It’s huge. It’s bigger in some countries, isn’t it?

Jeff: I think if it’s a country, it’s the 4th largest in the world now or something.

Andy: Yeah, probably the 3rd largest now.

Jeff: And certainly it’s only a matter of time until they hit… you know, they’ve got 500 million now… It is growing in Europe. Do they have Facebook UK?    Or is it all the same Facebook?

Andy: Do you know, I don’t know. I think it’s just Facebook.com. I think it’s the same one because I’ve linked up with people across the [pond? – spelling – 06:47] on Facebook. I’m sure I have unless I’ve got mixed up with Linked In.

Jeff: Yeah, Linked In is another one. It’s not nearly as big, but it’s focused more on businesses.

Andy: I don’t know across the [pond? – spelling – 07:00], but Linked In seems a bit of resurging its popularity over here in the UK recently.

Jeff: Yeah. I would say it’s the same here. It is a very good way to kind of network through individuals and get an introduction or to see how connections are kind of working. It’s much more business-oriented than Facebook is by stretching your imagination. I’m Linked In much more than I am Facebook.

But, Facebook for consumers is becoming almost a ‘go to destination’ now where potential patients will go on and mention a treatment or physician to their friends to kind of get feedback. I’ve seen that myself and I [inaudible – 00:07:44] a number of times. The physicians have been looking… I’ve been a little bit challenged on how to kind of adopt to this new for marketing, you know. 7:59 the Yellow pages and kind of old school marketing. If it’s not on its way out the door, it has certainly been shown its hat.

Andy: Probably. Just getting back to the whole sort of the potential for using social media as a way of gaining trust and showing people what you can do. I really do think that showing people or giving patients reassurance, which is something that my guy over here has been doing a lot, telling patients what will happen and what results they can expect and also testimonials. I mean there must be so many people searching. The whole cosmetic field must be so well searched.

Jeff: It is. Now there is a tremendous amount of competition around that. My own feeling is that it’s not necessarily showing somebody what their treatment is going to be like. What you’re really doing if you’re successful at this, is attaching a face and a personality and giving some warmth to somebody who is searching for this. There are tremendous physicians that are successful in the consultation room and in effect, although physicians very rarely like to admit it selling treatments, we are talking about retail cosmetic medicine, are those who can generate a level of trust in their patients. Then the patients say: “This is the person who I can trust when they say ‘This is how it should be done’ and ‘Why it should be done’ and ‘This is the best treatment for me’ and I’m going to believe them.”

Trust is really, kind of, where that gets to. And I do this because one of the services that our select-partner Frontdesk SEO provides is Facebook. You know, modification, upkeep and special offers and that kind of stuffs. So I’m very kind of well aware of how this is going on through that. But physicians often will, if they’re just doing promotions, not really generate any leads from that and they might have 50 or 60 people that just kind of attached themselves to this page or kind of liked it. If it is done really well, it could be both a powerful motivator as well as very effective for the physicians, both in their reputation and in their business at getting the word out. And because there is no payment, I mean if you actually do this very well, the return of investment, from a business sense, is very, very high.

[10:40]
I mean is not like the Yellow Page, where you’re paying $1500 or $3000 a month. It is really just a little bit of time or expertise or the hiring of a more sophisticated outside service, which is not [inaudible – 10:56]. The Yellow Page is super expensive for what it is that you get and educating yourself a little about how to go about these types of things will go a long way to kind of grow your practice, not only that but, give your patients some sense of community. This is something that is just terrible as a business practice for cosmetic practices is complete lack of follow-up and patient care. Meaning, how many times you touch a patient, and I mean touch, contact them or provide them additional value after they’ve had a treatment.

If you are lucky, clinics that are thought of as being sophisticated will send out a newsletter. But, that’s one point of contact. It’s generic to everybody. I have seen some clinics that are really generating tremendous ROI, because it’s very easy to do, that just provide this kind of value to their existing clientele and they allow their existing clientele, in effect arm them, to go kind of spread the word about their reputation, benefits, as well as their business lump bottom line.

Andy: Definitely. You hit name on the head there actually when you said trust and another one is authenticity.

Jeff: I think almost everything can be lead back to trust. If you come across is fake, people will oftentimes see through that immediately or you’re trying to hype up something or sell something, Medical Fusion Conference. I just put it in there, it’s just subliminal.

Andy: This is a perfect segue. I am looking at the website of Dr. Elliot Justin who we are going to be interviewing or you are going to be interviewing, aren’t you? Tell us a little bit about him.

Jeff: Well, Dr. Justin is very interesting. He is actually going to be one of the speakers of the Medical Fusion Conference. He has a number of outside businesses. He is a Emergency Room Physician. He has graduated from both Harvard and then he went to Boston University School of Medicine. And he is a very well respected physician.

He has started a couple of businesses, one of which is Swift MD. You can see that if you want to at SwiftMD.com. And that is a teleservice for physicians to provide healthcare advice and medical advice to individuals and groups, so businesses and those types of things. It’s an interesting service. In effect, you can call up and either talk to the physician or the physician will call you back and give you an honest opinion.

I’m going to be talking all that to Dr. Justin to kind of denote more about that, but it’s a really interesting interview. I was actually very interested because this is something a little bit of a noble service. And I was interested in both how Dr. Justin got started and where they are right now and where they’re planning on going and how they see this market place developing. So, it’s a really interesting interview.

Andy: Well, let’s have a listen.


INTERVIEW

[14:39]
Jeff: So Elliot, let me ask you to start of. You have a couple of businesses here. You got Swift MD. You got Pegasus Emergency Group. You consider yourself an entrepreneurial physician. But, what do you consider an entrepreneurial physician to be?

Dr. Justin: Well in my specialty, emergency medicine, an entrepreneurial physician is a physician who doesn’t want to be in shift work. One of the unfortunate conditions for emergency physicians is the way in which they get compensated being shift workers. And they don’t like it, at least some don’t like it. And the ones who don’t like it they want to break out of it. Well some seek entrepreneur models and they want to escape from the shift working world.

Other physicians in general work for a large contract company [inaudible – 15:30] or they work for a hospital and they’re paid hourly. Some are paid as little as possible in order to make as much money as possible. Some are going to take them away or sniffing them out of what they generate and keeping it for themselves. People who want to get out of that world, I was saying about the entrepreneurial inclined, may look for other opportunities both within their special field and how far their specialty and like to escape from the shift working world.

Jeff: That’s interesting because I have heard emergency physicians described as the gunslingers of the medical world. That one of the attractions in going to emergency medicine is, in effect shift workers, you’re going in there, spending 8 hours or 12 hours…

Dr. Justin: I’m laughing because they’re not gunslingers, they’re migratory workers. They migrate across town or across state in order to make another $5 an hour or $10 an hour. That’s no the behavior of gunslingers [inaudible – 16:38]. I think that in emergency medicine basically there are 15 problems that occur again and again and again.

The good physicians develop an algorithmic approach to those problems and quickly realize the challenges [inaudible – 16:56] the patient’s holistic needs as well as making a diagnosis while performing procedures. So many emergency physicians enjoy the variety and pace of working in shift. After residency in the field of practice, it becomes daily routine. It becomes shift work.

When I went to residency, there were no attending physicians in the E.R. We really were on our own and feeling things were unexpected in ways that we did not know yet how to often to deal in a consistent way with problems that the specialty has emerged as it evolves into [inaudible – 17:55]. I think a lot of physicians find it to be a routine, relatively well-tamed routine, but routine. And they looked to get out by thinking about [inaudible – 18:12] cosmetic practice, should I be [inaudible – 18:14] Botox, should I be learning… You know… What can I do to get control over my life? Because the problem with emergency medicine is that, a lot of physicians don’t make enough money. That’s the general problem with healthcare right now. In the outside, people look at physicians: “Oh God, they make a lot of money.” From the inside if your guy’s making [$20,000/$30,000? – inaudible – 18:42] a year, and you had two homes, two wives, two kids and you want to take two vacations a year and especially if you’re living in a high tax state, and your kid is kind of going to a private school, there’s nothing left over. I think there are lot of physicians that are looking aggressively, not majority, for other opportunities.

Jeff: it sounds as though you had gone through exactly this, this kind of curve that you started out. Were you always this way? I mean when you sneak into the business school of Harvard, did you consider yourself to be an entrepreneurial student then?

Dr. Justin: That’s an interesting question. Philosophically, I got a major in [inaudible – 19:35] language and literature in Harvard. As result to taking classes by Marx’s, I became an anti-communist and that eventually led to my becoming a catholic. But it wasn’t until I was relatively old in my mid-40 that I have the money that I was making, working for a hospital and running an E.R. would not be enough to provide the type of lifestyle I wanted for a family of five.

[20:04]
So my first business was [inaudible – 20:07] emergency medicine company at one hospital and that became three hospitals and now it’s 16 hospitals. And that model was an attempt to address two problems I think we’re getting at in emergency medicine why I want to transform shift workers in to owners. And that’s [inaudible – 20:29] emergency company. I want the benefits… to give a profit to physicians who were thinking and acting like owners. That they’re going to be more responsible and more accountable on the consequences of owning a business.

I also didn’t want to be a vendor of services to hospitals. I want to write a business plan to hospitals that object at the parameters that are necessary for quality and profitability in the E.R, measure those goals and deliver high-quality emergency medicine operation and financial success, both the E.R. group and the hospital. That led turn to my interest in telemedicine.

Jeff: So, how do you kind of balance… there’s kind of a push-pull… You’re trying to provide ownership to the physicians who are working inside the system at the same time they’re providing a service to probably for profit hospitals that are attempting to make as much profit as they can.

Dr. Justin: Even in non-profit who want to make profit.

Jeff: Sure. So how do you manage that on both sides? Meaning, how do you align the individual physician so that they both feel the ownership and manage the expectations of the hospital that you’re delivering the service for and their need to create a profit?

Dr. Justin: We want the physicians to be invested in the contract from the beginning and then we want to incentivize parameters that address quality and financial success for the physician. So basically taking them up as a [inaudible – 22:15] shiftwork model, what we really were doing is building the partnering of the management companies, partnering with the physician to build a private practice.

So for example, this is the model that was used outside the emergency medicine, if an EMD or an Ortho or an OB or a surgeon is going to town and joining a practice, they don’t care about their hourly, they want to know what’s the practice’s worth, what’s the [inaudible – 22:42], how long is the partnership and what’s the growth potential of the practice.  We model all those things for our physicians so they understand what they invest, what they can make because in our experience we can project what the growth is going to be. And because we’re concerned with both operation and financial success, we also, in the contract in general, have incentivized the things that will be to operation and financial success.

On the hospital side, I’ve discovered that hospitals don’t care that much about quality. It’s not their primary mission. It’s not their major concern. They care about profitability. In New Jersey  where I started Pegasus, we had [inaudible – 23:33] of 99% though. I though that I will be able to market that to hospitals. I was able to take up a couple of contracts. When I rebranded Pegasus 2 or 3 years ago, I focused on hospital profitability. [inaudible – 23:50] to become profitable E.R.

Elimination of walk-outs - every patient that walks-out, even they’re not paying, is your reputation walking out the door.

Improving documentation – We will take on a contract that uses paper. We [inaudible – 24:07] electronic mail records and want to have operation financial success as does the hospital. For every dollar we make, the hospital makes 2 or 3 dollars. And the hospitals are leaving that money behind the table. They are leaving behind, the oxygen, the money, the oxygen that they need to run successful programs.

We also want to be certain that patients who meet the initial criteria are admitted, those with appropriate admission. And we want to write a marketing plan with the hospital in order to increase the census in the E.R. And that’s the type of this model.

Jeff: So you’ve been successful tracking the emergency physicians they find it noble. Are there other people that are using the same approach? Or do you feel that this is something that you’re leading the charge on?

Dr. Justin: I don’t know anyone who uses this approach, but there are people who talk about it. What we’re trying to do is bridge the gap between what the consultants recommend and what is actually delivered. So there are consultants to the group that tell people what they should be doing [inaudible – 25:18]. But, I don’t know anyone who’s doing it as comprehensively, as aggressive as we are.

Jeff: You brought up yet another interesting point. Who in the [scrum? – inaudible – 25:30] is actually the biggest proponent for patient care?

Dr. Justin: We are because the hospitals are looking for someone to manage their problems in the E.R. They don’t so we [mark? – inaudible – 25:49] in ourselves, not as a vendor. We’re not plugging which doctor into a schedule like our large competitors. We are partnering with the hospital to achieve certain objectives and we are agreeing in advance. I want what those objectives are and what’s necessary to achieve those objectives.

Jeff: So let’s talk about telemedicine now.

Dr. Justin: Sure.

Jeff: How did you get involve in that and how did that germinate?

Dr. Justin: You can argue the contradiction between telemedicine and the emergency medicine business. And there is. The telemedicine is really transformational. The telemedicine is a reaction to the crisis in healthcare. For really to change healthcare, we have to replace 19th century healthcare model of extensive brick-and-mortar and [inaudible – 26:48] physicians with technology and technicians wherever possible and achieve the path of cost savings and efficiency that have been realized by the computers in the rest of economy but not healthcare.

Healthcare is extensive, it’s inconvenient, quality is indifferent and you actually ask yourself why. The reason is, in my opinion, the physicians in hospitals are driven by reimbursement menu in this which physicians practice defensive medicine and we know we have traditional practices like the ritual otoscope, stethoscope, and reflex hammer that basically just waste time and don’t lead any additional information. Do you know how the price is in healthcare?

Jeff: Well, I prefer this is a coding dance, but go ahead.

Dr. Justin: It is. Basically, manage care moving Medicare to such prices for what… 7,800 [inaudible – 27:45] manage care pays in multiple. And this is a dumb model. If Medicare is going to pay $3 for a physician that would buy you 2 minutes a time 2 weeks from now in this level. And if you pay $448 from the [inaudible – 28:07].

The hospitals and physician groups at offices, staffs, [inaudible – 28:20], so what do they do? They bring patients in. They then level up. They order tests in we see that are truly not necessary. They rationalize that they’re in expectation that it has to be extensive… but they really don’t have a healthcare crisis. They have reimbursement crisis driven by bad regulations. What do patients really want most of the time? I know in the internal studies that half the patients in E.R. and 25% patients of the primary care offices just want advice and or a prescription, but they can’t get it because of this [inaudible – 28:59] and Medicare and their ‘don’t care’ stupidity only pay for visual contact. They pay nothing for advice. Well physicians are [inaudible - 29:08]. They don’t give it. If you call to the E.R., they’d tell you: “We can’t diagnose over the phone. We have to evaluate you.” But, the truth is they’ve being paid nothing for. If Medicare can pay $100 for an advice over the phone, E.R.s and physicians and offices would be empty.

Jeff: You’d have phone banks.

Dr. Justin: One of the two most common problems in healthcare… one in general healthcare… One of the most common reasons that people seek out doctors for trauma is not from a traumatic gunshot wound, it’s an ankle sprain. For an [inaudible – 29:47] process, it’s a sore throat or URI. Well in fact, those are problems that can be answered by a computer. You don’t need a doctor for those things. We were really mismatched in the resource. The problem is the consequence is we end up with healthcare that is extensive and inefficient.

I became interested in telemedicine to address these inefficiencies.  I was thinking about around 2000 I would found the Swift MD. It really start working out at ’06-’07 and the company started on November 2008. That was    year of consumer-addressed healthcare. We’ve now moved to problem controlled healthcare, [inaudible – 30:31] and unfortunately the development of new approach healthcare that could be really transformational. And it’s not transformational to get people medicate because, or medicate equivalently which [inaudible – 30:46] does, 40% physicians don’t even accept medicate. So if you’re going to increase the man without increasing supply… you don’t have to be a genius to figure out what’s going to happen to quality and cost.

Jeff: Let me ask you this, What was your original thought when you started Swift MD? Was it more around telemedicine? Or, was it more around harnessing technology?

Dr. Justin: Both, it was on both. Ultimately, what I wanted to do is demonstrate a transformational model.     Swift MD is healthcare by physicians primarily using telephone. Later I can tell you what we’ve learned what consumers really want. What I really do was to do demonstrate the transformational model. Ultimately, in which consumers using their [inaudible – 31:50], their pre-abduction dollars, will basically have an option. That was less expensive financially and less expensive in time than going to going to E.R. where they [inaudible – 32:08] doctor. It’s for the common problems that represent most people’s healthcare needs.

If you’re a 40-yr old man, the average guy in the country, you don’t have cancer or diabetes, you have 2 healthcare problems a year. You have an infectious process. I mean, you have other work traumatic injury. If you’re a woman, you can have a third visit for some reproductive healthcare needs. For those people, in a place like New York, who have to go out and purchase themselves or have an employee purchase for them a $14,000 policy, is absurd.

Swift MD is an attempt to get those people their healthcare needs in real-time to give significant savings In healthcare. I want to demonstrate as well not only the quality of healthcare be equivalent, but actually be better if people are taking care of out of doctor’s offices and out of ERs for the common problems that represents the bulk of the reasons why people seek healthcare.

Jeff: Sure. And so you decided to launch Swift MD. And how did you do that? Did you fund this entirely yourself? Did you start out very small? Did you look around for people that you knew, you know, angels that might kind of kick in some money?

Dr. Justin: The Swift MD… I went to my physician network the Pegasus and we raised some money to ask physicians networks [inaudible – 33:45] investors. There was no outside angel. There’s no venture capital, just physicians to whom this idea appeal because they knew from their own experience in the emergency department that if they treat these people the way they treat their friends and family, they can take care of them on the phone.

Jeff: So tell me how Swift MD actually operates? I mean, going to the website… If I am subscribed to the service, I make a request and then a physician calls me back, how does that actually operate? How does that get channeled or funneled? How do you manage that time-wise with your physicians? Since you’re offering 24-hour service, how do you group all of that together?

Dr. Justin: The physicians are working 12-hour shift. Unlike our competitors, our physicians are working dedicated shifts so our response times are good. And they’re being paid by the contact. They make $35 per contact. On the customer side, we have… although 9,000 customers [inaudible – 34:58] in the city area, majority are coming from one union and self insurance. These people can then access through call center or through going online. The physician gets a text on their cellphone of the patient’s number. The physician can either respond to the patient just by their phone number, or by their computer and going to our application, go to the patient’s portal and pull up the patient’s healthcare record.

And most of the problems that we deal with are the type that you can see in the emergency care center, you know, back pains, urinary tract infection, poison ivy, insect bites… Our response times of call is about 18 minutes.

Jeff: What’s your average time that physicians spend on a call?

Dr. Justin: Less than 7 minutes. It’s 5-7 minutes. And for the physician, we have computer [inaudible – 36:06] diagnosis. We basically push our doctors to ask the right questions that would rule out more serious conditions that would warrant the patient going to an E.R.

Jeff: And what kind of potential liabilities challenges have you faced doing this? Because obviously if utilizing a technology, but you know… Are you attempting to practice defensive medicine or CYA medicine?

Dr. Justin: Well, what I’m fascinated about is initially a lot of physicians would say: “Gee, I just don’t feel comfortable doing this. I don’t know if I’ll feel comfortable doing this.” Because there’s no ability with Swift MD to take to order a lab test or order an X-ray.  If the company grew and grew and grew, we would add that type of functionality. But [inaudible – 37:00], physicians find that if suddenly they’re in a virtual environment they’re able to manage [inaudible – 37:08]. if you observe the [auto ankle rule? inaudible – 37:20], most ankle sprains don’t even need X-rays. So if you have someone online who tells you: “I had twisted my ankle while playing squash, it hurts, but I can bear weight on it and I can walk…” that patient doesn’t need an X-ray. The temptation actually to order a necessary test is gone with it. We’ve restored a certain honesty and transparency to healthcare system with this type of approach to healthcare.

We carry the same malpractice insurance that people carry in the E.R. We have [23 million? – inaudible – 37:48]. We have not had any losses. We’ve been in the business since November ’08. We have no problem.

Jeff: How many patients does a physician call during an average shift?

Dr. Justin: Let’s talk about the [inaudible – 38:00] piece of it. We have [inaudible – 38:02] video capability. We find patients don’t want it. People want the convenience of using their phone. In fact some people want the privacy, which someone may tell us: “I haven’t done my hair today.”

Jeff: Sure.

Dr. Justin: People simply [inaudible – 38:20]. I think people get more and more comfortable with telemedicine and have cellphones incorporated with more and more 3G technology. We will move in that direction. Although there is an issue of [inaudible – 38:35] with the type of… with Skype for example.

Jeff: Do you have any number wrapped around how much money you potentially have saved in healthcare cost by doing this as opposed to E.R. visits or even General Practice visits or office visits?

Dr. Justin: It’s difficult to calculate to be honest. Because if you’re an employer and you get people Swift MD, people are going to utilize that service because it’s convenient. And they wouldn’t have gone to the doctor because it’s inconvenient.

Jeff: Sure. They just have access to it so they use it when they… it’s a lower barrier.

Dr. Justin: Exactly. On the other hand, if you’re a self ensured entity… I’ll give you an example. I had a patient who would see a doctor that day to rule out appendicitis and it turns out it was a total appendicitis. And he called me five hours later and I told him he did have appendicitis. Basically, the guy had a little bit [inaudible – 39:54] temperature, described pain migrating from the bellybutton down to his right little quadrant. I told him he had appendicitis. The guy is in a shift at work. How do you quantify the benefits of that? The guy’s delayed 2 days and ends up with a [inaudible – 40:16]. He works for a self-insured entity. [inaudible – 40:20] self-insured entity $50,000-$80,000. On other hand, how would he actually be hid? How would’ve he actually acted? Would there be a delay that long? Would there be an access? So it’s hard to quantify.

[40:37]
Jeff: Sure. Let’s change subject for just a little bit. You’re managing technology. Have you been a technologist? You got an online portal. You’ve got other things that kind of managing these. How do you go about developing those?

Dr. Justin: We hire a technology team to build the application for us. Components of application we life [inaudible – 41:00] and there are assets that are proprietary. One piece of proprietary and fortunate to utilize because it’s potentially so powerful in terms of cost savings… the 30 most common problems, emergency care problems, patients actually have the ability to go into to the patient’s portal and self-diagnose and whether they need to get an X-ray, what [antibiotics? – inaudible – 41:21] the right cost-effective [antibiotics? – inaudible – 41:23] for urinary tract infection. That information, which we develop, which is proprietary low…

Jeff: So that’s underutilized because patients don’t trust themselves to make that diagnosis.

Dr. Justin: It’s hard to say because our survey indicates that what patients really want is to talk to a provider who can write a prescription. And our cost are actually low and someone else is paying. If you’re a Union member and uses Swift MD while the Union’s paying, why self-diagnose when you can call the 877 number and get a doctor. If you’re a wealthy individual who uses, because we have wealthy individuals not very high… Let’s say we have approximate 35-50 high network individuals who use Swift MD… They want to talk to a doctor.

If you really want to change healthcare, we had to come up with an incentive that drive people to self-diagnose because if want to transform healthcare and save money we need people to self-diagnose for common problems.

Jeff: So what challenges has Swift MD faced a number of times?

Dr. Justin: When we launched, we quickly got over 9,000 customers. It was all part of our business plan that we go for a second round of funding as common with business. And as result of the implosion of the stock market and the advent of the government-controlled healthcare, there’s no money in healthcare. We [inaudible – 43:14] right now. The venture capitalists are deterred by the [democrats? – inaudible –  43:23] have become really uncertain. People don’t know what the government’s going to do for regulation, specification, and pricing. So without that certainty it’s difficult to sell this. The insurance companies have become close to zombie industries. As much as the government wants to beat up on them for their revenue, the issues for them are profits.

If the [inaudible – 43:53] as I recall last year made 2.2%, well that’s it. That’s the [inaudible – 44:03] industry. So investing money is wait and see what’s the government’s going to do. Basically,, Swift MD is at this point is going [inaudible – 44:19]. We have enough revenue to stay in business, but we don’t have enough money to aggressively develop sales program. And those sales are difficult to make in this market. To sell in this market is to large self-insured entities or third-party payers and to put them to deliver health care efficiently, less expensively… but that’s a difficult sale in the market where there’s so much uncertainty in the regulation.

Jeff: Is this something that patients that use this? Did they love this? Do you have a [inaudible – 45:04]? Or, is it very low?

Dr. Justin: That’s a great question. The user’s rate is low, but people use it, like it and use it again. In the audio world, this should be driven by [mashcare? – inaudible – 45:21] Medicare. They basically would impose higher cost on people for utilizing expensive brick-and-mortar healthcare, which would drive people to the cellphone and the Internet in order to access their routine healthcare. That hasn’t happened yet.

Jeff: The forces are going to push for efficiency eventually. I mean there’s has been a kind of a brick wall built around inefficient delivery methods. One of the things I often kind of talk about is physicians in the future will be much more adapt and they will be managing technologies as oppose to…

Dr. Justin: Let’s stop right there, Jeff. Why should the physician be managing technology? Why not have technicians managing the technology? Why not computers managing technology?

Jeff: That’s exactly why cosmetic medicine… why there’s this overlap and why there are lots of physicians moving to cosmetic medicine is because of a couple of things. One is there’s no third-party reimbursement. It’s demand-driven. The other thing is that it is scalable. If I have six treatment rooms and they’re full, I would just add another piece of technology, get another technician and I’m scaling because the physician is managing what is going on as oppose to delivering all the services themselves.

In effect, what Swift MD is doing in some respects too is the physician is now not relying upon people driving over and seeing him. He’s actually able to kind of deliver services at a distance. I would argue that there are real similarities there. Would you agree with that?

Dr. Justin: I would agree with that. The people in the cosmetic market get to set the prices in a way… They get to set the prices basically.

Jeff: Well that’s true except the competition demands…

Dr. Justin: You’re right. I would say cosmetic medicine is more market-driven with its price instruction. With Swift MD, the sale is really the third-party payers. Consumers in general are not there. The sale is in the third-party payers. We’ve had several RPs (Request Proposal) from Manage Medicare. But if Manage Medicare is paying $25 per office visit, it’s kind of hard for us to compete with that.

Jeff: Let me ask you this. It seems that there’s some overlap with concierge practices. Have you seen that before where you’re providing telemedical services for concierge clinics or private practice?

Dr. Justin: We would love to deal with that. We have over 9,000 members. I’m aware that 12 of our members that have MD VIP, which is the leading premier, premier healthcare and concierge service. I ask myself and I ask the people: “Why do you have us?” Well, I have asked because they see us as a compliment. The MD VIP are doctors and the tele-doctors are interns. They don’t see the person necessarily [a dude? – inaudible – 48:43] in emergency. Look if I have an emergency they want an emergency physician. If a child falls of a bicycle and has a [medical term – inaudible – 48:50], the MD VIP doctor is not worth that much to them. What they really want to know is would they see a plastic surgeon, what should be done in the E.R. If we were successful in the scale of MD VIP, we would compete with that service. Actually, what we think we’re doing would be superior. I mean MD VIP is kind of the last stand in my mind of brick-and-mortar practice. They still live in brick-and-mortar medicine as oppose to virtual medicine. Whereas, we’re doing is delivering virtual medicine.

Jeff: Well it is. It does seem to me kind of complimentary where you… or have this coverage where kind of first line of defense might be telemedicine and then if you actually are going to see a physician and you don’t want to wait in the waiting room, it might be a concierge practice.

Dr. Justin: The concierge doctors are still delivering a lot of care, which is people who are rational, they wouldn’t need. I have no problem with it. Let’s say the general problem is you want to put meat in someone’s belly. The concierge medicine is equivalent to [inaudible – 50:07]. The telemedicine is equivalent to Burger King or McDonald’s.

Jeff: Sure.

Dr. Justin: If your problem is urinary tract infection or an ankle sprain, I’d say, if you have the money, you should be able to go to the concierge doctor or the god of urology and spend it whenever you want it to. But, what I’m trying to address here is actually a different problem. You don’t really need to be examined for that problem. Someone needs to ask the right questions. And you don’t really need to make an appointment because of the expense of having a concierge doctor, [inaudible – 50:52], when telemedicine breaks down the barriers and can deliver cost-effective healthcare at a very low cost. Concierge medicine is expensive.

[51:06]
Jeff: Elliot, you are going to be speaking at the Medical Fusion Conference on November 5 in Las Vegas, Nevada at the [Win? – inaudible – 51:13], I think it is. What are you going to talk about there?

Dr. Justin: I’m going to be talking about the promise and potential of telemedicine and the current challenges to developing a career in telemedicine.

END OF INTERVIEW

Andy: Well that’s it for the show. Thank you very, very much for listening. I hope you enjoy it. Now, we would love to have feedback. So of course, questions and comments please send them along to the email, which is podcast@medicalspamd.com or you can leave a comment at the physicians’ forum on the MedicalSpaMD.com website.

If you’re a subscriber, that’s great, but if you haven’t please do come along and subscribe. You can get the show downloaded automatically whenever there is a new episode, so just find Medical Spa MD on iTunes by searching for it. Or, visit the MedicalSpaMD.com website and click on ‘Podcast’. There are some ways to subscribe there as well.

Now as always, please consider we say to be complete conjecture and random speculation, not medical or legal advice. And laws & regulation vary everywhere so do consult a medical or legal professional before taking any action.
So, it’s goodbye for me, Andy White.

Jeff: And goodbye for me, Jeff Barson.

Andy: Wishing you all the best until we see you next time on Medical Spa MD.

END OF PODCAST

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