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Advances and Advantages in Direct Primary Care
Episode 400

Rob Lamberts, Owner, Dr. Rob Lamberts, LLC

Advances and Advantages in Direct Primary Care

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Advances and Advantages in Direct Primary Care

Episode 400

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Mentioned Links:

Dr. Rob’s first interview

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more-distractible.org

 

Advances and Advantages in Director Primary Care with Rob Lamberts, Owner, Dr. Rob Lamberts, LLC transcript powered by Sonix—the best audio to text transcription service

Advances and Advantages in Director Primary Care with Rob Lamberts, Owner, Dr. Rob Lamberts, LLC was automatically transcribed by Sonix with the latest audio-to-text algorithms. This transcript may contain errors. Sonix is the best way to convert your audio to text in 2019.

Welcome to the Outcomes Rocket podcast, where we inspire collaborative thinking, improved outcomes, and business success with today’s most successful and inspiring healthcare leaders and influencers. And now your host, Saul Marquez.

Saul Marquez:
Welcome back to the podcast. Today, I have the privilege of hosting Dr. Rob Lamberts, also known as Dr. Rob, for the second time on the podcast. It’s been a little over a year since we had a chat with him. Dr. Rob is a TEDx speaker, Direct Primary Care Physician Leader, Medical Economics and Physician Practice, Contributing Writer, Blog Writer, and overall, a very inspiring leader in our space. And it’s a privilege to connect with him again here on the podcast. Today, we’re gonna dive into some of the things that he’s been up to, as well as some of his thoughts, again, on his topic of focus, direct primary care. So, Rob, just want to welcome you back to the podcast.

Rob Lamberts:
Thanks a lot Saul. I enjoyed talking with you last time and look forward to talking to you again.

Saul Marquez:
Likewise. Likewise. So, you know, folks, if you want to listen to the first interview that we did, we took a real deep dive into direct primary care, its outcomesrocket.health/doctorrob, the link to this interview will be outcomesrocket.health/doctorrob with a number two. So make sure you go there. Check out the show notes, the full transcript. So what’s been on your mind?

Rob Lamberts:
Well, I started the practice, my direct primary care practice about six years ago, over six years ago. And it was much like a startup. And again, just so that people don’t have to go back and if there’s anybody out there listening, doesn’t know, the idea of direct primary care is really two main differences. One is that I am paid only by my patients. I’m not paid by any third party payers. So the direct payment directly from my patient. And the second is that…

Saul Marquez:
Basically, no insurance. Right?

Rob Lamberts:
No insurance. Right. I’d dump any third party payers, be they insurance and or Medicare, Medicaid, whatever. My patients have that I hope they will don’t. But I don’t have any third party payers. The second is that instead of paying per visit, I’m paid on a monthly basis and as opposed to the concierge, the high end practices, the fee is not very high between thirty five and seventy dollars per month, depending on the age of the person. We try and keep it under 100 dollars. That’s kind of one of the defining features of direct primary care. The focuses just on offering good care and keeping people healthy. And if we manage that well, then we can actually build a pretty stable business model. In fact, I’m up to over 800 patients now that I take care of. Yeah, yeah. I’m actually one of the larger direct care practices as far as a single provider goes. And I think a lot of it is just because we’ve really focused on doing things as efficiently as we can. And I’m still able to give extended visits to my patients half an hour to an hour depending on their problem. Yeah, and I’ve still never seen more than 15 patients in any given day. That’s the most I’ve ever seen. And that was a crazy day, which is hilarious because you double or triple that number for my old practice for the typical primary care doctor. So it’s great. My life is good, although the challenges are very different now. Instead of thinking about finances a lot, it’s more thinking about continuing to run the business well, continuing to give excellent care, despite the fact that now my schedule is a little more full than it than it was for the first four years of the practice or so. And again, it’s my income’s actually probably higher than it was when I left my old practice. So it’s actually financially I’m doing really well. So from an overall practice standpoint, I’m gone from typical start ups you’ll have that time where you’re wondering if it’ll succeed. And then you have this vision of growth and then you have to consolidate and you have to say, “okay how do I keep growing? But don’t implode with too much growth.” Which is a good problem to have. But we don’t have any problem. It is still a problem because you could get one of the main cornerstones of direct care is access. And if I get two fold and my patients stop having access, and then why the heck are they paying every month to have access to me if they don’t have access to me? So we’re just kind of figuring out how to do well.

Saul Marquez:
Well, I think it’s fascinating, one of the things that I love and you just I mean, it’s so transparent, you know, and I don’t know if that’s a direct primary care thing or a doctor rob thing. But you go to doctorlamberts.org. And right there on the front page, you see the fee schedule. And it’s clear. And there’s no hidden costs. And this is awesome. So is this a Dr. Rob thing or is this a direct primary care thing?

Rob Lamberts:
It’s a direct primary care thing. The fact is that then that would be to me that some as ridiculous. It’s like saying “Amazon, their costs are right up front on Amazon. It’s amazing.” It’s like they’re that way because people are paying for it directly. But in healthcare, we’re so used to having that third party hide the cost. And that, from my standpoint, is one of the main reasons that there’s so many problems in healthcare. But yes, we put all the cost of all the prices upfront. People know what they’re going to pay. If we do lab tests, then, you know, they had the opportunity to apply their insurance to it. But truth is, the lab tests are probably about 10%. If they get them through here, they’ll pay 10% of what they would pay through insurance. So a lot of folks, even with insurance, especially if they have not met their deductible, they’re willing to pay 10 dollars to get labs done by us versus, you know, one hundred two hundred dollars even if they get it done through their insurance, it’s just it’s night day. So we have better ideas. That’s fine, right? Right. Yes. We’re dispensing medications, too. And it’s interesting, because it’s not only that that we put the prices of those medicines, but our financial motivation is not to make a lot of money off of those are, in fact, our financial motivation. And I tell folks upfront. Said here’s here’s what my business model is. I want to make it so that you can’t afford to stop paying me every month. That is too good of a service. It saves you too much money to see me and say you just can’t afford to not pay me every month because you benefit so greatly from that or from the access that you get from me. So when somebody is like, “well, you know, I’m starting on this blood pressure pill and how much that the cost is there, well?” that’s a dollar a month or two dollars a month or you know, they say antibiotic is a dollar fifty and people get this look on their face like, are you kidding?

Saul Marquez:
What?

Rob Lamberts:
Yeah, well, they experience something that that people aren’t used to in healthcare and that is getting a good deal. They get a bargain. They feel like this is really cool. And then they’ll say,” well, what’s the catch?” And I say, “well, the catch is that you pay me every month. But I already told you that” there is no hit, no trap door that’s going to say. And there’s an extra fee. No, no. All the fees are pretty much upfront and kind of delightful.

Saul Marquez:
I mean, your fees are low. Have you thought about raising them a little bit?

Rob Lamberts:
I have actually raised the fees twice. But it’s interesting. First off, I don’t really need to raise them by five dollars twice. And people are like, I like dollars. But man, as you do the math and say, look, I got eight hundred paid. I know if I raise the fees by five dollars, right. That’s a four thousand dollar per month increase without any change in my overhead. And…

Saul Marquez:
Gosh. You’re offering such a service, Rob. It’s as awesome.

Rob Lamberts:
Right? Right. And so…

Saul Marquez:
My Amazon membership is 99 bucks a month. Oh no, it’s a year actually sorry.

Rob Lamberts:
A year.

Saul Marquez:
Yes.

Rob Lamberts:
That is true.

Saul Marquez:
But still it doesn’t matter, what you’re doing is above and beyond.

Rob Lamberts:
Well, it is. And there is always that debate over at what point in time and raising the price. Will I need to start turning people away and such? And so finding that perfect price is a stretch. But…

Saul Marquez:
If you are in Chicago, I would be one of your patients.

Rob Lamberts:
Well, I appreciate that. I appreciate that. Just good. It’s a good experience for my patients and it’s a good experience for my staff. And certainly I after six years, I don’t have any of that dread going into the office that I already had before. It’s I can’t say “wow it’s a party. It’s great all the time”.

Saul Marquez:
No.

Rob Lamberts:
There’s a lot of laughing, there’s a lot of camaraderie. But it’s work then it’s gotten more and more that way as we got busier. So that’s fine.

Saul Marquez:
Rob so tell me something for the physicians that are currently employed or, you know, just working the traditional way, which is typically just employed by a line of primary care, employed by a large health system, and they’re looking for something different. Can anybody do this? What tips would you offer and what warnings would you give?

Rob Lamberts:
Well, the warnings that I would give her a lot less that I would have given five years ago when I was first starting, because it was hard, because…

Saul Marquez:
Yeah.

Rob Lamberts:
When I first started, there was about 100 that these practices in the country. I was one of the earlier adopters, which means I was kind of stupid. You know, you have to have a little bit of stupidity and just naivete. But I actually kind of knew what I was getting… and I had a very, very strong vision of what I wanted to do, and so I’m willing to take that risk. Oh, my beer. I’m gonna go start a new, different type of practice. You know, that type of thing. But now I will say, wait, one of the big things that’s happened in my life over the past few months, actually since the start of the year, is that we added another physician to… that’s working in our office. He is actually not employee. He is starting his own business. It’s a separate business, but it’s operating in my office.

Saul Marquez:
Dr. Bolen right.

Rob Lamberts:
I don’t hate him at all. Dr. Bolen, and he is basically wanted to start a direct care practice. And I thought, you know, it would lower his overhead if he’s working at my office. He would have our expertise. He would be able to get some of our overflow. And that has allowed him to grow quickly. But plus, he’s paying half of my overhead, which is great for me. I mean, that actually saves me money. It didn’t cost me anything. It actually increases my own personal revenue. So he has started so fast. And it’s not part of it is because he’s there here with me. But part of it is also the atmosphere has really changed the environment. He’s he goes to BMI meetings, this business networking group, and he has all these business folks wanting to make, you know, have all their employees go to him. So he’s growing. I mean, he is well over 100 new patients in the first two months or the first three months, I should say, of this practice. And that’s that. That’s way faster growth than I ever than I ever I ever had. So I would say, as far as advice goes, find doctors in your area and most everywhere has direct primary care doctors. But now it’s especially to the bigger cities. We’ll have that. There are there are plenty of BPC doctors in the Chicago area, and they will vary in terms of what services they offer, what they cost, all that type of stuff. But in general, find somebody and be willing to and see what their practice is like and learn from them. Right now, we’re very much like craft beer industry where willing to sit and give everybody our secret because it’s not we’re not trying to compete with each other at this point in time. We open sharing and there’s lots of secrecy docs who believe in what we’re doing and believe that what we’re doing will really potentially have a big positive outcome in the big picture of things that it actually could have a huge effect on the healthcare system as a whole. If it becomes more and more popular, I think it’s valid. So, yeah.

Saul Marquez:
And some great words of wisdom for the physicians listening that are thinking that they want to try something new. Definitely dive in, learn a little bit more, visit Rob on his site. So now that your six years in, what’s next?

Rob Lamberts:
Well, one of the things we’re doing is we have potentially four direct care practices in the guest area, three of which are just starting up this year. So I was the first…

Saul Marquez:
Wow.

Rob Lamberts:
And I kind of basically blazed the trail and did all the heavy lifting. And these guys are interested the next actually. There’s a couple more people who are potentially interested in doing it. So I think we’re going to see this proliferation of these practices throughout the area and throughout the country. So it’s happening and I guess that’s got to be happening elsewhere. But what we are doing right now is saying, “Okay, let’s form a separate corporation.” And ours is called the Welcome Health Network. If you can’t find it on the Web yet, but it’ll be… it’ll exist within the next month or so officially. And the idea is that we can then approach employers. That’s the primary goal, is that we can approach an employer and say, not just say, here’s my practice. You can have all your employees sign up with me, but say we have four practices in the area and that allows people to choose their doctors depending on their location and availability such. So the employers are able to offer the service that basically says it’s to any of the welcome health network doctors or practices out there. And that allows us to negotiate for even the little bit larger employers to have the concerted effort to be together and even potentially offer some services under that umbrella that we all can benefit from, like radiology or other lab testing or counseling or physical therapy or something. There are things that we could add that would be available to all members of our network and we’re kind of making this up as we go along, truthfully. But we’ve gotten the legal groundwork for that. And to be perfectly honest, on my end of things I’m 56 years old, and so I’m starting to really think, “Okay, what’s my retirement plan?”.

Saul Marquez:
Yeah.

Rob Lamberts:
I did spend a lot of my retirement money building this practice, unfortunately. So I’ve got to think about reading something that has residual value and potentially residual income that I could be earning once after I’m maybe not fully retired, but even partially retired that will supplement my income and not be able to do that. So just trying to think ahead on things and also have an overall growth plan. And with Ed coming in and taking off like he does, and he’s actually been very soon within the year. He’s going to be moving out of my office to his own office, which he has not even started. It’s not even kind of location for yet, but probably next year this time, I’ll be hopefully adding a… my own new physician who will actually be part of my practice or a physician extender IPA or whatever. I know whatever, whatever comes available at that time. That’s my ultimate goal is to actually then grow this practice. And adding Dr. Bolen was just a test run. So that’s what’s occupying me right now and trying to think ahead and trying to make sure that I’m offering as good a service as I possibly can.

Saul Marquez:
Well, I think it’s brilliant and it’s wonderful that you are experiencing the success that you are, Dr. Rob, because the value you’re offering is huge. And I just thought It’d be great to have you back on to remind the listeners whether it be physicians or just leaders in general that are getting cared for by a primary care physician, that there’s more than just the normal way. And I just you know, the thing that keeps coming into my mind is like, you guys are kind of like the southwest of the, you know, the airlines, the southwest of the healthcare. And I think I’m like I walk down the the terminal and I see the big ad that says transparency, you know, and that’s it.

Rob Lamberts:
Yeah. Yeah.

Saul Marquez:
It’s different, you don’t have to charge for bags.

Rob Lamberts:
Yeah. In fact, that’s the thing that when people leave our practice and it’s actually almost like right now I’m at the point where it’s like I’m adding patients, but I’ve really closed down the number of new patients. The fact for people signing up as a new patient. It’s like mid-May right now. The waiting list this into mid-May and it’s pushing out pretty quickly. And yet I keep in that so that I have availability for my established patients so that they can be staying the day out there. You know, we always want to have appointments available so that people can get seen on the day that they need to be seen. But I’m kind of in this when people… they are not leaving, nobody is leaving for my flight growing and growing. Like, that’s fine, although I don’t want it to grow too much and…

Saul Marquez:
That’s funny.

Rob Lamberts:
It just kind of a funny problem they have. But when people do leave for whatever reason, if they get insurance and they say, “well, I’ve got insurance now, so I’m going to leave uninsured folks” and they leave and they’re like, yeah. But they realize that, “Oh. So leaving gives me the opportunity. They have worst primary care that worse primary care than I was having before.” And that’s like, oh, that’s great. I get to wait two hours to get sick and I get to not have questions answered by a text message. I get to have all of these disadvantages and then you have people coming back fairly quickly. And so, yes, we’ve had that happen often that folks just they realize it’s a totally different experience and a better experience. So, you know, is it all roses and such? It’s all pretty good. I do think that there are some real challenges ahead for that direct care needs to direct primary care movement needs to address. I think there some things that that I’ve started to alert the DTC community about because everybody is so excited about this model and it seems like all good. And the answer is, “yeah. So far, we haven’t really had any opposition.” But at what point in time is there going to be a real problem? And actually, in my most recent article in medical economics, I put two big risks that I think is that DTC does actually limit access to some extent that you have as if all the doctors switched over to direct care practices, there would be a question of who would do the primary care for all of these people because the size of the practice shrinks. Now, that being said, Dr. Bolen actually was working in urgent care. He was doing a weight loss thing. He wasn’t doing primary care. And so he is actually adding to it without subtracting. And I think there will be a lot of doctors like especially the urgent care doctors and such. Who are just sick and tired of seeing one hundred patients in a day who want to come out and actually practice medicine. And I will pay… with Dr. Bolen when I asked them, “I said no. After the first month paid. What do you think?” His eyes got huge. “This is so great.” It is very gratifying for that, but…

Saul Marquez:
So I’m curious…

Rob Lamberts:
I think overall there is this question of how are we going to be able to manage? It is 25% of all primary care is… becomes direct primary care. How are we going to manage that? So the real question is, how do we do that? And I don’t know the answer to that. Exactly. I know that adding mid levels will help to some extent, but it has to be managed properly. And finding other innovation only happens when there’s pressure to innovate. Yes. So I think that’s what we’re going to find is we’re gonna have people come up with solutions to that that will be adopted more by the community, that will allow for us to have a larger reach and a larger overall patient population. That’s kind of has to be what what happened. On the flip side, there’s all these doctors. You know, the argument I hear is truth is there’s so many doctors out there that are ready to quit that it’s not a question of shrinking your practice from 2000 or 3000 patients down to five hundred to thousand. It’s going from zero because these doctors are wanting to quit because they hate primary care so much or they hate doing urgent care that those folks, if they quit, we can actually bring them back and we can bring back a lot of doctors who otherwise wouldn’t be practicing at all. That’s to me, the first big challenge. And I think we need to accept that that is a real problem and not dismiss it under the pie, in the sky, feeling just that elation. We have been so great to practice primary care and it is. But we need to be aware that there are some potential problems down the road. And if we don’t work on those solutions, somebody else will will legislate it on our heads. And that would be bad.

Saul Marquez:
This is true.

Rob Lamberts:
To me, the other insidious problem with direct primary care that we say is that we largely have a bunch of vigilantes out there who are kind of doing stuff on our own and saying, “you know what, the system, I’ll do whatever I want.” You know there is that that Wild West kind of I have freedom. And I can I’m unregulated, you know, and. Yeah, not having insurance companies breathing down my neck saying “you have an order to put this person on a statin. Why haven’t you done that?” “Because they’re nursing long. That’s why.” But you get all these pestering and this interference from all of those layers between the patient and the doctor. And any doctor out there can tell you it’s really, really frustrating and we get rid of that. Well, that’s fine. Problem is, is that you’ve got a bunch of vigilantes. How do you regulate the group of vigilante? How do we know that somebody, let’s say a natural path or a chiropractor says, I am direct primary care and they’re not there chiropractic and they’re their natural pet. But, you know, it’s an unknown. Nobody has said this is what it is, clearly defined legally. Then how do you know there has to be some oversight to make sure or there’s a lot of doctors who are selling stuff, who are doing some of this wellness stuff that is on the margins as far as good medical care. How do we make sure that there aren’t going to be a lot of folks who are standing the good name of direct primary care or who are taking advantage of our good graces at this moment? And I guarantee you people will do that. And there has to be some sort of oversight, but oversight in the group that is essentially rebellious in the first place, that’s going to be a problem. And I don’t know what the right answer is. But I think we do have to, you know, approach it from the standpoint of it still benefits us to have some degree of oversight. So that’s kind of a more of a from one hundred thousand feet looking down type of problem. It’s not a problem that we’re experiencing right now, but it will happen.

Saul Marquez:
Yeah

Rob Lamberts:
And…

Saul Marquez:
A good call out.

Rob Lamberts:
I know we…

Saul Marquez:
Yeah. So you’ve obviously given this a thought on a more broad societal level. What are the impacts? Folks if you simply just Google Dr. Rob, you’ll find a lot of his work. If you go to his website at doctorlamberts.org, you can check out his TEDx talk, really good talk there and also continue keeping up with the things that he’s up to. This has been a lot of fun, Rob, I’m glad that we did this again. And what would be your parting thought here for the listeners?

Rob Lamberts:
Well, for the doctors out there, I know the end of my my TED talk. I say there is hope. We need to keep innovating. We need to not let ourselves be pushed around by the system. The essential business transaction within the healthcare community is still doctor and patient. And that if we are able to shrink it back down, the problems with healthcare because of all the layers that are interfering between doctor and patient and direct care is just one way in which this has been you know we just basically tore everything away and we’ve gone right back to a typical business transaction between I’m offering a service, they’re paying for it. That’s fairly simple. I think innovation needs to happen on all levels. In direct care, it is one innovation. It’s not the only one. And we need to be looking at it from that standpoint of how can we tear away all of the interfering layers that are between doctor and patient? I think that’s the one thing. And I think that’s true with with health care consumers as well is trying to find solutions or business owners or whatever is trying to find solutions that tear apart that. All of that bureaucracy that’s between that’s sucking all the dollars out of healthcare and instead is focused on actual care. And you know your Outcomes Rocket, what are the outcomes that people are seeking? Well, my patients are seeking that they’re not sick all the time, that they’re not missing work, that it’s convenient that they’re able to have their lives without it running, being run by the healthcare system. And unfortunately, people are more and more feeling like healthcare is a daily whether it’s the financial burden or whether it’s a I’m sick all the time and I can’t get in with my doctor and my doctor doesn’t listen to me when I’m going in, you know whatever it is, people are fed up with healthcare being such a dominating factor of their lives. And question is, how do we feel that away? How do we fix that problem? And so business owners, everybody needs to be thinking of it in those terms rather than saying, “well, we need a single payer healthcare system or we need this, this and that.” You’re focusing on the means and not the end. And, you know, I always say to those who suggest that single payer system, “how? okay so what’s going to control the cost of care in that type of system?” I’m not totally opposed to that, although I think primary care shouldn’t be covered by insurance. I think that’s crazy. That’s been one of the worst thing that ever happened is that primary care is not expensive. So why are we covering it with insurance? Why not separate that and make that a non insurance thing? And then it takes the hooks of all these other folks out of us, the hospitals or the insurance companies and such. So that’s the key for me is… is thinking about things from those standpoints, whether it be from a legislative standpoint or whether it be simply coming up with a different business model options. And again, is BPC the only one? Probably not. And I care about that, that I’m able to give good care and I’m able to earn enough money doing it and not apologizing, you know, instead of saying, well, you’re doing just that thing, I’m sorry, all the time, I’m able to say, you’re welcome.

Saul Marquez:
I’m sorry. I’m sorry I’m late. I’m sorry this didn’t work out. Yep.

Rob Lamberts:
Well I’m sorry I had to bring you info that’s stupid. You know, to get a worse excuse. I’m sorry. You know, whatever all of this crazy thing go on. And now people are just so grateful when they look at you. I mean, it really is pretty amazing. So…

Saul Marquez:
that is great closing thought there. And Dr. Rob, if folks want to reach out, where did they get in touch with you?

Rob Lamberts:
Well, you’ve given my practice website. You can also go to my blog, which I’ve been a little slim on writing, although I am finding I’m doing a lot more writing musings that were distracted by mine, which is and not just about healthcare. It’s about some silly stuff, too. So more-distractible.org. And I always joke I did .org because they wouldn’t give me disorg… I figured that was anyway. But the idea is they think they can find me there, I’m on Twitter @doc_rob and wherever.

Saul Marquez:
Well…

Rob Lamberts:
Easy to find.

Saul Marquez:
Yup. And we’ll we’ll post links on the podcast episode notes outcomesrocket.health/doctorrob2 and you’ll see all that there. Again, just want to say thanks for inspiring us, keeping it light and doing what you do. Dr. Rob, looking forward to connecting with you again soon.

Rob Lamberts:
It’s my pleasure.

Thanks for listening to the Outcomes Rocket podcast. Be sure to visit us on the web at www.outcomesrocket.com for the show notes, resources, inspiration, and so much more.

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