Transcript
josh MacDonald: Hi, I'm Josh McDonald.
Miranda Materi: And I'm Miranda Maciere and we are Hand Therapy Academy.
josh MacDonald: Let's talk a little bit about the things that we maybe give away or comp to patients in our clinics, whether it's little things or big things, some of the things that we don't recoup funds for as we're giving things out to clinics or to patients. Miranda, do you have something that maybe you should be charging for but don't?
Miranda Materi: Yeah, I feel like there's a few things that, um, And I think, you know, this has changed over time a little bit.
josh MacDonald: Yeah.
Miranda Materi: So we used to give away a lot more, but now with, I think, reimbursement being cut so much and our profit margins kind of shrinking down, we're, as a clinic, we try to operate a little bit more efficiently, but there are few things.
Miranda Materi: I think one is the edema gloves. Those usually don't cost us a lot. And um I also don't want to nickel and dime our patients for a $7 edema glove.
josh MacDonald: yeah
Miranda Materi: So there's that. We give away a lot of kinesio tape. um silicone gel sheets. I usually give away a couple of those to start. um Tuba grip is a big one, you know, like the tuba and that's kind of expensive. And then some of the adapted grips we give away as well.
Miranda Materi: How about you?
josh MacDonald: We're kind of in the same same world. I feel like a lot of those things, I'll give away the first and then tell the patient, you can go get most of these things on Amazon or we can sell them to you. But the first one we give to make sure you like it and make sure it works. And um I do feel like there's some patients that become a little dependent on those. Well, I have a patient right now who every time she comes in, she wants a new compressive sleeve and it's like, oh, it's so dirty. Like, listen, you walked to the car and it was dirty.
josh MacDonald: Like they get gray almost immediately, but I can't keep giving you a new one every week when you're coming for a long-term diagnosis. So I'll show them here's the link where you can buy a box on Amazon if you really want them that recently. But and I i think people expect that insurance is just magically covering all this stuff like, oh, insurance. code It doesn't. So I try to do like if it's a low cost item, the first for free and then talk about payment after that.
Miranda Materi: And I think what is hard too, as being a private practice owner is also as we grow our teams and our teams get bigger is knowing, making sure we have clear expectations to the therapist of what they're allowed to give away too, right?
Miranda Materi: And making sure we're not giving one patient more stuff than the other patient, just because we may get along better with that patient, right? So it's about being fair to our patients and then also being fair to our therapists and what we expect them to charge for and what we expect them to give away.
josh MacDonald: Yeah, yeah. We have a general rule that wound supplies, you do what you need to do. That's kind of cost of doing business. Zero form, adaptic gauze, four by fours. You do what you need to do. That's just kind of like, I buy toilet paper and paper towels from the clinic.
josh MacDonald: I got to buy those things too. Those are bought in bulk. Most of our stuff is the the little like incidental things are give one away, but not after that if you can avoid it.
josh MacDonald: um I think an exception for us is LMBs. I had that with LMBs until I started paying more attention to how much they were costing. um and And then I found a cheaper place to buy them for like 30 bucks a piece, but still at 30 bucks a piece, if I'm giving the first one of those away, a lot of patients never need a second one. I'm never recouping the cost on those. So we charge patients for LMBs kind of right off the bat.
Miranda Materi: Right. Well, and if you're insuring, you know, some of our insurance contracts, we may only be getting $50 per visit for that patient, right? So are we supposed to pay our therapist and give away, you know, a $20 item?
josh MacDonald: Yeah. Yeah.
Miranda Materi: We're essentially operating in the negative and that doesn't cover our rent or, you know, all those other expenses that we may have.
josh MacDonald: yeah Yeah, yeah.
Miranda Materi: Well, I think it's tricky. And I think, you know, you don't want to come across as nickel and diming people are being cheap. But I also think it's like, Well, this is you know, i I can almost guarantee all the other clinics are probably charging for a lot of their supplies.
josh MacDonald: Yeah. Every doctor's office out there is charging for supplies. it's It's either cooked into the visit or they're charging for it. And i think I always had this hesitation. I didn't want to sell cookies for my kids' soccer club because i didn't want every time I walked around, they said, you got to spend more money and support this. and So i I have that kind of ick feeling about like, oh yeah, you totally need this device and you need to pay me 30 bucks for it.
josh MacDonald: It felt like used car salesman, but it's a product that costs money. And um' I'm charging like 5 to 10% more than Amazon for the product.
josh MacDonald: I pay attention to the prices I'm paying and we update our cash pay sheet.
Miranda Materi: Mm-hmm.
josh MacDonald: So it's just, there's a really small convenience fee of 5 to 10% on most of our products. I round up basically. So i'm not making money on this. I'm basically just covering my costs for all these supplies. I shouldn't hesitate to charge what I know everyone else is also charging for.
Miranda Materi: Right, and sometimes, you know, like we might get something cheaper if we buy it in bulk, like the wrist widgets or something like that. So I'll just tell the patient, this is what I get it for, so this is what it's gonna cost you.
josh MacDonald: yeah
Miranda Materi: And I think most people are like, oh, that's reasonable. i don't expect you to buy me these extra things, right? And of of course, I'm like, this is something your insurance doesn't cover, otherwise I'd be happy to bill your insurance for you.
Miranda Materi: And then I think another thing is keeping track, too, of like if I don't know in your clinic and our clinic, a lot of times we'll have one therapist, you know, they the patient may go between therapists. They may not always consistently be seeing that person.
Miranda Materi: So if one therapist gives them something and then the next one, then they might know like that therapist better or um we don't really know what they've been given and what they haven't been given.
josh MacDonald: Yeah. Yeah. And, and I feel like patients will sometimes play us against each other. You know, mom tells you no, dad tells you yes, you go ask dad. And so they'll, yeah, they, they learn who's the one that's more likely to be guilted into giving something out versus the other. That's like, no, no, no. I gave you one last time. That one should last a little bit.
Miranda Materi: Right. And it's like keeping track of all those things.
josh MacDonald: Yeah.
Miranda Materi: So I think for us, so there's like one or two things we may give away for free. But I think that's those days are becoming less and less. And it's i it's kind of sad to say that.
josh MacDonald: Yeah.
Miranda Materi: But when it was just me working in the clinic by myself, it was easy for me to keep track of all those things. But as we grow, I feel like those things are a little bit harder to dial in and keep track of.
josh MacDonald: Yeah. We did have an experience recently where we got burned a little bit. We had a patient who was not comfortable using Amazon um and had RA, needed a whole bunch of adaptive equipment. So my therapist worked with her to order some stuff for her to come into the clinic and try. And she gave a yay or nay to it and she said, okay, just give keep kind of a running tab. And they went through this process.
josh MacDonald: And then we were stuck with five or six. There's an IMAC glove and a rocker knife and a button aid and things that we don't need in the clinic. And that patient is not coming back for term visit. It's outside the window of returns for Amazon. So I've got, you know, 50 or 60 bucks for the stuff that's now sitting in the clinic.
josh MacDonald: Maybe some other patient wants to purchase it from us in the future. But we also have to kind of protect ourselves from that. That patient probably didn't think twice about like, oh, I just can't make it back in for therapy. But ultimately, we're the ones that paid for that.
josh MacDonald: And it's now out of our pocket.
Miranda Materi: Right. Yeah, no, that's very true. And I think there's other like exceptions with certain plans like work comp, right? Like all work comp stuff usually goes through an adjuster. So like some of those adaptive equipment and supplies are covered by work comp.
Miranda Materi: And so I think, you know, knowing your patient's payer source, if it is work comp, know that a lot of times you can get that stuff covered. You just have to get it approved first.
josh MacDonald: Yeah. Yeah. So in addition to materials that we might um comp patients and give them, are there situations where you might not charge full or the copay or coinsurance to a patient or situation?
josh MacDonald: How does that work? Do you do that much in your clinic?
Miranda Materi: um Yeah, there's definitely circumstances where we may work on, and it all depends. You know, there's some legal obligations we have with insurance companies, so we need to make sure we're honoring those first and foremost. But then there's other things where um maybe that specific insurance plan doesn't cover splints, or maybe the patient can't afford the splint. So we'll definitely work with them, either giving it to them, you know, even sometimes for free or at a reduced rate.
Miranda Materi: a reduced rate. But it's really a case by case basis. And I, I don't like micromanaging my team, but I always like them to run those things by me first, since it's ultimately, you know, up to me to keep the clinic up and running.
Miranda Materi: So how about you?
josh MacDonald: Yeah. um we had a We've had a couple where in the neighborhood we're in, we have it's a little bit lower income area with one of our clinics. And we've had situations where you know a single mom comes in and she's got 10-year-old son who broke his hand and now needs an ulnar gutter.
josh MacDonald: And they have a coinsurance that they just can't cover. And you can tell that this is just a different dynamic. And so we contacted our, our lawyer who who gives us some legal advice on these things. And he says that insurance companies do allow for a small number of these hardship case accommodations throughout the course of a year.
josh MacDonald: And so on rare circumstances, we will say like, Hey, you know, if this is, I have a general rule for my therapist. If it's a kid who needs something or a veteran who needs something, and they just absolutely cannot afford it rather than send this flexor tendon or fracture or something like that out the door in harm's way.
josh MacDonald: I'd rather you just make it. And even if we write off the $30 worth splinting supplies or whatever the case is, let's just make sure someone who is maybe underprivileged or can't handle it. But we try to, we as a group, we keep that to a minimum. we We keep that for special situations only, not just throwing that around for our favorite patient or the one who whines the most or that kind of thing.
Miranda Materi: Yeah, and I think making that call is hard too, righti Because you want to make sure you're fair. and And it's not like we're doing this in-depth look into their financials either, right? We're kind of doing it based on what they tell us too.
Miranda Materi: So you don't ever really know.
josh MacDonald: Yeah. Yeah.
Miranda Materi: And so sometimes I'm like, oh yeah, just get like give it to them. It's fine. I see these are like hard times for this family. But also we don't we don't know people's lives. They could have a lot of money at home or maybe they have none and they're still trying and they still want to do everything they can to pay.
josh MacDonald: yeah
Miranda Materi: And we don't know that, right? So-
josh MacDonald: Yeah. yeah And so I do tell my staff start from a base point of telling the patient, this is how much your insurance applies to you. I don't want to ever surprise people. So we always verify benefits up front and say, you know, here's what the cost for this splint is going to be.
josh MacDonald: And you may perceive them as a hardship case, but it may not be. And they say, okay, sounds good. And so start with, this is the base cost. And then only in rare circumstances do we do we um hedge off of that in any significant way.
Miranda Materi: Yeah, it is interesting. Like we had a case for a patient that was coming up from Mexico. They had a radial nerve palsy and they were a kid. I think they were eight or eight or nine years old and they had a radial nerve palsy for over a year that was diagnosed by a chiropractor.
josh MacDonald: wow
Miranda Materi: So in that case, it we ended up making them a splint. You know, they had no insurance, which was fine, but we ended up making this one for free. And then we ended up finding a, um there was like a pro bono clinic at the county hospital locally where we could to connect them with a hand surgeon. So sometimes it's also about finding resources that are available because obviously that patient probably never had any well child visits or anything like that. So not only looking at just maybe what's going on with their hand and maybe their finances, but also like their overall health care. And if there's any resources that we can help to tie them into, I think can be just as valuable as giving them something for free.
josh MacDonald: yeah Yeah, definitely. These are all tough choices to make, especially when you're in a smaller clinic. Hospitals have different rules and you got to abide by whatever your employer gives you. But um it's nice to have the the leeway like we maybe do in a private clinic more so where we can make those decisions in the moment.
josh MacDonald: And you have to make sure you're keeping the lights on. But at the same point, you know, we're we're all in this job because we like helping people. And we sometimes have a little bit more freedom to do that than than maybe if you're stuck in a bigger system.
Miranda Materi: Very true. All For more info, you can reach out to us, info at hamtherapyacademy.com or on our Instagram info, or excuse me, at hamtherapyacademy.
josh MacDonald: Thank you.
