Peer, thank you for having me here and I really appreciate speaking here.
I want to tell you about patient first models of healthcare.
This is what I've done.
I have a direct primary care practice and I've been practicing for 21 years.
I started this in January of 2003.
I was, I'm going to move here.
This is my objectives today.
I'm going to give you my perspective of the flawed medical system from a primary care
perspective as a family doctor who's done this for a long time.
I'm going to show you my journey and I'm also going to talk about DPC practices as being
a blue ocean.
You'll see what that is.
I'm going to talk about the DPC history and also about my good friend Mark Brown specifically
that had to do with my little attempt to change healthcare.
I found out about this 20 years ago that you can't use a health savings account to
pay for my services.
It was a long journey.
This is my background.
I'm a family doctor and went to Tulane University, undergrad, med school, and my pediatric internship.
I went to Montego Bay to take care of some poor people.
I had actually, I was a district medical officer for the government of Jamaica and I had medical
students coming down from Tulane being out there.
It's a different perspective than our regular system.
I did a family practice residency and I was in private practice from 1990 to 2000 at which
time I had trouble getting paid.
The HMOs were in town for all during that time and I didn't want to work that hard and
see that many patients so I ended up not making much money and had to change jobs.
I ended up changing to a pharmacy software company called PDX.
They took care of about 60 chain pharmacies, small chain pharmacies like Winn Dixie, Target,
Kmart, and I was chief medical officer.
We were trying to combine pharmacy with medicine and basically Teladoc right in age in the
2000 and trying to even actually buy one of the first firms.
We could have it on the website if you're a pharmacy and it would say ask a pharmacist
but also say ask a doctor.
We were thinking way, way, way ahead of the time.
After that I realized I wasn't going to be that good sitting behind a desk.
I'm a family doctor.
I love seeing patients.
This is just what I do where my heart is.
I started hearing about direct primary care.
I saw it in the Wall Street Journal, a guy named Garrison Bliss who was one of the first
guys to do it in the country, a real legend.
Words of wisdom, the hardest conviction to get into the mind of a beginner is that the
education upon which he is engaged is not a college course.
It's not a medical course but it's a life course for which the work of a few years under
teachers is but a preparation.
You'll find now with young medical students, it's unfortunate they don't have any mentors.
Back in the old days we had people that would really give us good ideas and it was tough
then because they would really, really give us trouble.
We'd stay up all night but they taught us little things like if you had someone with
blood in their urine, hematurgy, you'd remember sit cube, stones, infection, trauma.
You learn things like that.
William Osler is just great.
You've heard of listen to the patient.
They are telling you the diagnosis.
Well the system is broken and the doctors don't have time at all to even listen to your story
and we'll talk about that in a second.
I always loved Mark Twain.
Mark Twain said be careful about reading health books.
You may die of a misprint and it's amazing.
People really worry that our doctors are really wary of all this stuff.
It's just, it's new to me and I'm still learning.
I just have so much.
My mentor is my father, Dabney Ewan.
He died at age 94.
He's from New Orleans.
Very learned man, a scholar taught for 40 years at Tulane University teaching hypnosis.
Now he's a general surgeon and he got into it because of Burns, his big burn clinic.
He would find people who were in trance and when they were in trance, you know, you're
sitting there looking at your full burn, you don't know what's going to happen and
he learned how to look at people and say hey and take over their trance basically and
give them suggestions like you're cool, you're comfortable and what happens?
The healing process was so much better, so much more quick to respond.
Inflammation went down.
He ended up getting into more also psychosomatic stuff and anxieties and long term pain problems
and he ended up teaching around the world and I'd be with him the little kid, medical
student in the back with a slideshow and I'm in Perth, Australia or a band for Budapest
or Paris or wherever and he was just full of wisdom.
That was my mentor.
He wrote a book called 101 Things I Wish I'd Known When I Started Using Hypnosis and
it's 101 of his best finest pearls.
I recommend you get it because there are things like 16 is quit.
I hear people say quit smoking here, Paul and oh I'm laughing.
The American Cancer Society says quit smoking.
No one's a quitter in America, I mean coaches tell you not to quit.
You sit there and are you going to be a quitter in anything that you do, it's un-American
so I tell my heroin addicts or my smokers or alcoholics, I say stop smoking.
For your health and the health of those around you.
This is really good.
This is written in 2009 for Paul.
The best doctors are Dr. Diet, Dr. Quiet and Dr. Maryman and you'll see that he found people
that would take the recommended daily dose of vitamin C. It was only 60 milligrams and
it's your stress vitamin.
I thought it was great and this only guinea pigs, anthropoids, apes and humans have an
inborn era of metabolism and they don't make their own.
Isn't that funny?
So vitamin C was stressing that people get a thousand milligrams a day back then.
These books, I want to tell you what the regular doctors out there read and what I read.
I read the war on ivermectin but outlive.
Peter T., I don't know if any of you all follow him, he's got the four horsemen of disease
and what that is is metabolic syndrome, insulin resistance, it's heart disease, it's cancer
and it's neurodegenerative diseases and it's a great podcast and I've been watching him
for four years and he interviews the brightest but he hasn't been here.
Something else and he really should be here or at least watch us.
He's that smart though.
You see the end of Alzheimer's and Dr. Breslin, that Suzanne Gondon was telling us about,
keep the heart attack gene, that's Brad Bale and Amy Dainine.
They trained me over 10 years ago and they have 100% guarantee that you will never have
a stroke or heart attack if you follow what they say.
So that's important and no, that's what regular doctors do that are not in this kind of group
and seeing it.
I'm a statistic, I'm a doctor but also I'm vaccine injured and it's not fun.
Here 40 hours ago at 5 in the afternoon when we closed down, I ended up starting to get
some decreased, a foot drop in my left, I'm going to show it to you right now but basically
this is a nerve, I can't even bring my foot up now here.
I can bring this one back and forth, this is all I can bring it to and that's from shedding.
One of y'all shed on me but the, no maybe all of y'all did, who knows but it's really
amazing to be able to show you what this is all about but I started getting constipation,
you'll see up the right corner, that's me and I didn't go to the bathroom for 7 days.
I took an ivermectin one time, the next day I lost a third of my bowel, I emptied it.
I had erytocyclicitis, I got psoriasis and I've got coronary artery disease and carotid
artery disease but that acted up.
My blood pressure was 65 over 45 and that was just a month ago.
Now here's my blood work and I've got disease and I'll go through this quickly but I have
47% lesion on my widow maker.
This is me a year ago and I took the guys out for dinner, I realized how skinny I was
at the end of the table and I lost 15 pounds in 6 weeks just by chance and the week before
that I was on vacation in the islands, I played tennis and what happened?
I started getting short of breath, I was breathing 100 times a minute.
That fast and I couldn't stop, I thought I was having a PE.
It was great because I had all these experts, a week or two later I was going on a fishing
trip but not me, it was an expedition and it was 3 weeks in the middle of the Pacific
Ocean, it took 3 days to get there, 80 hours by boat between Samoa and Hawaii and I'm
bringing the AAD and everything, I'm really scared.
So here's the flawed medical system, the US has a primary care third party payment system.
It's a systems problem but it's the third party payers but it's a fee for service problem.
The doctors don't get paid unless they see the patient, it's horrible.
And we've changed that.
So you have the patients, they're paying the insurers, the doctors over here, you've got
these bean counters, these bean counters, so I don't work for the patient.
Now the doctors, you've got to give them a break, they're overwhelmed, they're burning
out, I see friends that are quitting, I remember when I was stopped practicing in 2000 after
10 years, I went 3 or 4 months without a paycheck.
The girl answering the phone made more money than I did but my cost of living I had 4 daughters
and I had to support more but I ended up going to work for a pharmacy software company and
what's happening to doctors now is that we've become data collectors and that happened to
pharmacists back in 1968 when they had the first PBM, pharmacy benefit manager.
And what I'm telling you is that that's just held up everything over the last 10 years.
The pharmacists used to get paid by filling about 300 prescriptions and when they'd fill
that they would charge about 5% more and make a little profit.
Well now they're back, they're collecting data.
Well doctors are doing that, they're so disengaged and now they're working 17 to 18 hours a week
on paperwork and admin.
My medical assistant told me when I was leaving her doctor is now taking off Tuesdays and
Thursdays just to do paperwork.
He's working Monday, Wednesdays and Fridays, it's unbelievable and you'll see that on the
right, on the left you'll see fee for service, that's going away and concierge medicine will
never be able to do that and really fulfill all the need.
But here's the DPC history, Howard Marin had the first practice and he was a doctor for
the Seattle Supersonics and the owner who's a zillionaire said, you know, gosh, I can't
get in to see you, how much money does it take for me to get your phone number?
And he changed his practice, he formed MD squared and MD squared, what do they do?
They, I see one minute, okay I'm good, you know MD squared decided to do a model whereby
they take about 50 families but they charge a big price for those families but then they
could give concierge care, that's where it came from, concierge medicine.
Concierge medicine is probably the most polarizing word you can say between a patient and a physician.
And it's really sad, the doctors have gotten to a point where they're saying, I can't
do this anymore.
And so, you know, I used to have four or five thousand patients and when I walked away there
was zero, well if people go to direct primary care and they have 400 to 600 patients, everyone
gets all mad and they say, well, you know, you're leaving all those patients.
Well it's either I do that or I quit.
It's that bad and it hurts them so bad because when you're leaving these patients, but think
of the reality, I hired nurse practitioners and for me as always doing it myself, I had
more and more patients, they weren't mine, they're the nurse practitioners and the PAs
who are just absolutely stunning all of y'all, I really mean that, but I lost control of
my practice.
Now think about it, doctors don't start getting paid until they leave the room, what?
You go inside and you see the patient, but when you walk out the door, you're going to
the EMR and you're checking the boxes and you're collecting data.
You see the difference?
It's a huge difference and we're hearing all this bad mouthing of physicians and it really
hurts and it hurts them and it's not their fault, they're just trying to make a living
like you and it's that bad.
In 2004, we started an association called the American Society of Concierge Physicians
and it was started by John Blanchard, my friend up in Michigan and they called it because
that was a term and we didn't really like that term but it ended up being pretty good
because it was polarizing and Garrison Bliss who was Howard Marin's partner, he started
a different model where he had about 800 patients but he charged a price for age groups and
I tell you that because it's a different model and everyone has all these different models.
I'm going to go quickly.
I became president and I joined them for one reason, well I'm going to go here, one reason,
Mark Brown, the Mark Brown amendment.
Mark is a friend he died a year ago of glioblastoma.
We diagnosed him two years ago.
One of my closest friends, he gave me this book in 2000 called the New American Family
Physician.
It was built, excuse me, it was written in 1901, the chapter on vaccinations is great
talking about Jenner and smallpox and cowpox and all that.
But it was everything you needed to know about medicine that was known in that one book.
Fascinating.
And what he asked me, he's my insurance guy, he asked me, Chris, why can't I use my health
savings account to pay for your services, why?
And they had just come out, here's a little bit about health savings accounts.
In 2003, the Medicare prescription drug improvement and modernization act came out and it was
created to form the Medicare Part D prescription drug benefit.
But at the same time, it created health savings accounts and most of you all probably know
what that is, but they are the most powerful retirement savings vehicle there is, even
more than 401Ks.
And why is it?
This is for the middle class.
Funds can be invested in stocks and bonds and funds, but they also can be withdrawn without
any penalty as long as they are qualified medical expenses.
And the thing about it is that I didn't realize I'm not a qualified medical expense.
If you look at an HSA and that HSA on the Internet, it'll say it'll cover glasses, dental,
long-term care, copays, but it doesn't say prepaying for a doctor to get unlimited access
to care.
I tried for two years to do this, mostly by myself knocking on doors at Congress, talking
to people, and you talk to someone who's 25 and they say, yeah, I'll talk to the senator.
This is too hard.
Well, Roy Rantum was in the East Wing with President Bush.
He was a senior health care policy advisor, and I met him on the last day as president
of Society for Innovative Medical Practice Design.
That's when we changed the name from Concierge, and he was the last speaker, and it's like
a conference, and I asked him at the end, I said, listen, I'm president, but I'm quitting.
Stopping, I said that on purpose.
I said, how do you do this?
You're Mr. HSA, because he is the one that helped the U.S. Department of Treasury implement
HSAs in 2003, and then went with Bush.
He looked at me and said, Chris, that's simple.
That's subsection 213, part D, subsection of the Internal Revenue Code of 1986.
All you have to do is to change this, amend this law, and we have to include it.
So he went and in three months we worked out this deal, and we worked with actually Senator
Warren Hatch, and I worked with their people, and here's the amendment.
It prepaid physician fees.
So in order for me to be a qualified medical expense, I've got to become medical care.
So it said the term medical care shall include amounts paid by patients to their primary
physician in advance for the right to receive medical services on an as needed basis.
That's how simple it is to change health care, and it was my one little trial.
They're trying to do it now.
It's been in multiple bills.
That was 2008.
The present one is the HSA Modernization Act.
It's in there, and it's going to try and expand the eligibility for people to join and get
an HSA, and also double your contributions.
This is the end of Peacekeepers versus Peacemakers.
I'm a family doctor.
I'm out there in the real world, but I'm also vaccine injured, and I go to my doctors,
and they look at me as if I'm a leper.
I even show them a validated, I have stage 3.5 out of 4 on my clots.
And what I'll tell you about that is it's very hard and difficult.
I just had a colonoscopy and wanted to talk about my constipation and nothing to do with
COVID.
It's amazing, and you all hear all that.
For all you patients, this isn't a figment of my imagination.
I didn't die.
You're going to get better.
I was hoping to tell you everything that I didn't die and that I'm feeling fine, and
all of a sudden, what happens?
I sit here and get this, a foot drop.
But this is a great example for y'all about shedding.
You're going to get better and better every day.
That's my prayer for you, and many of y'all probably don't know that Helen Keller is my
great aunt.
She's not.
It's through marriage.
It's my dad's brother's wife.
Her dad was the brother of Helen Keller, and you may not have seen how well she writes,
but she wrote to my dad in 1945 on the inside of the cover book for Dabney Ewen, who will
find that obstacles are things to be overcome if we are to live strong and unafraid.
So get out there, blessed are the peacemakers.
If you talk to a physician and your doctor, B. Level Joel did a great job on this in Peter
yesterday about being even keel because this is real conflict, but we need to spread this
message and all you patients, every day and in every way, you're going to get better and
better.
Thank you.
All right, Chris, so I'm an old man now.
Well, now you got a foot drop because you got shed on, huh?
Yeah, I know.
I got shed on.
I mean, these are the kind of things that happens with the vaccine injured.
And I just mentioned that yesterday, I mean, every visit I have with patients, it's some
new symptom.
That's strange.
They'll ask me, you know, why is this happening?
Like yesterday, someone, patient of mine, talked about new boils that were popping up
on their body.
What do you think, Dr. Corey?
I don't know.
Anyway, let's talk about models of healthcare.
Let's do it.
How does one choose afford an EMR when starting a private practice?
Oh, you have to pick your own.
I use amazing charts, but that's, you can, you just have to look.
Yeah, I actually can talk about that because I went through that process recently.
They all have warts and strengths and minuses.
All I can tell you is I look carefully, talk to folks.
I started with practice fusion.
We didn't like it.
A friend of mine who actually helped, he was the former executive director of the FLCCC
Schoenberg.
He kept telling me that his physician uses this EMR called Serbo.
As the patient, he said, I love it.
It helps me to communicate.
It's just got such a great patient interface.
Our practice moved over to that because of that testimony was that on the patient side
it was so good.
We're even finding on the provider side, it's really good.
I'm not plugging.
I don't get money from Serbo, but there's a bunch out there.
I really don't know how to pick them.
Just my experience, I went through one, picked two, and I would say Tisha, we're pretty happy
with Serbo.
Correct?
Right?
Yeah.
Look, nurses giving a thumbs up.
Here's the deal about Serbo.
His father, the guy that started it, I was up in Cambridge when I was president.
His father's a family doctor and he ended up, we all had different models that were talking
to the Robert Wood Johnson Foundation.
His father had a model where it was, you turn on like a lawyer, you turn on the second hand
and if you're here for 15 minutes, I'm going to charge you this amount, but I ended up
knowing that guy.
Oh, wow.
Let me talk to you about models of care though.
When I have someone that I want to teach about doing this kind of practice, I put a bet on
them.
They need to be a businessmen.
They need to be an entrepreneur and they need to be teachable.
I think what Dr. Salibi is doing is just fabulous.
I congratulate you so much because you're going to be able to teach people the roots
of this.
Anyway.
Sounds good.
Now, where do we stand now with HSA bill for prepaid access to care?
Right now, there's a thing called the, I think it's the Modernization Act, but it's gone
through about three different iterations and it's changed.
When it originally started with mine, I was looking at this as a physician problem.
Now we have so many wonderful healthcare providers, nurse practitioners, naturopaths, love pharmacists.
It's more inclusive, but anyway, it's going to be helpful when that gets passed because
just think about it.
You can pay one bill once a year for unlimited access to care.
My model, I do monthly fee for unlimited access to care or you can do a quarterly by
credit card, but it's different.
What new niches and roles are possible in this new healthcare system and economy?
What do you think?
Yeah, that's a big question.
New niches and roles, I mean, for me, what's new, I would just define what's new to me.
I mean, for me, if you've heard the speakers in this session, for me, it's just the autonomy,
the freedom of being able to spend as much time as I can with my patients to practice
any discipline and use any sort of therapeutic that I can.
I get no oversight.
To me, it's just the full autonomy of the physician-patient relationship.
It really is.
It's just wonderful because the first time I see you, I'll spend two, three hours with
you if I need to.
I know the names of your dogs when you were a kid, but it's really, these are your best
friends and you know what to do over the phone.
I have patients from Sweden, North Carolina or Santa Fe, Oklahoma, anywhere, and that's
just what they want is access to you.
That's great.
Can you discuss hybrid practices with both insurance and paid membership?
Yes.
When we first started the how-to conference when I became president, and it's a two-day
conference to learn this, do not do this alone, I would say, but we had three models
that we found.
We found a fee-for-service model, a fee-for-care model, which is my membership, and a fee-for-non-covered
services model.
That is the MDVIP model where you'll pay a monthly, a yearly fee, but also when you
see the patient, they will charge for that.
That's how that works.
There's a question here, maybe I'll try to answer it, unless it says why not paper charts
question mark?
I'll answer that.
I love paper charts, and I still use my page, my one-page sheet from my training, use it
when I first take an intake, because it's just got the medical history, the surgical
history, and their names, and I've got it written on one page where I can just look
at it and walk in.
It's too hard for me to go back and forth and remember everything.
I think paper charts are wonderful.
I'm just going to say I do paper charting.
We have an EMR, but I don't type, I don't look at a computer screen, I talk to my patients,
I just take notes, and it's laborious, it's not very efficient, but I think it's much
more personal.
I get to engage with my patients, I just take notes.
I paper chart, and then afterwards I dictate in the EMR.
The EMR though, Chris, the efficiency of the EMR, the ability to review and go over a timeline,
a history, and access all the information, you just can't really do that as well with
paper charts.
No, you can't.
That's why I like the one I'm using now, is that I'll have on my PMH, I really structure
it the way I think with the soap note, and that's what's wonderful.
So this person writes in, I use freed AI in our clinic for charting, and it is HIPAA compliant.
Initially I had to edit what was built into the plan regarding vaccines, but not anymore.
Interesting.
There's more of a statement than a question.
I'll just say that I used freed AI for a time, and I think I'm just too stuck in my
ways.
I could never be totally happy with the note that came out, although it's an amazing program.
It literally listens to your conversation with the patient, and it formulates like a
soap note.
Have you ever used that?
No, I haven't used that.
Oh, excuse me.
I do.
I just got it.
I used it, and then after a while, the notes weren't me because they're written by a software
program, and I just didn't like the way the notes came out, so I went back to paper charting.
If I could, all healthcare is local, and it's really between you and your patient.
When I sit here and try and teach someone how to start their own practice, you really
have to, you can't market yourself.
You look at someone and say, look, I love you.
I'm a family doctor.
I'm going to take care of you, and that's how you build your practice, but I don't know
how we're going to fix this.
DPC is the way to go, but there won't be enough of us to go around.
The system's broken, so we'll see.
Yeah.
I think I'm just going to share it.
We have a minute left here, or not really, because JP mentioned it, it might be helpful
to you.
I'm someone who just built a practice.
I just fled the system.
I went through this process, and just to give you a ballpark, it cost about $50,000 to get
up and running and flying, and a lot of that was hiring a practice manager who was an absolute
beast at getting my practice started.
She just did everything.
That's Christina Morrow.
She's in the room.
She works for the FLCCC full-time now, but she was amazing.
I mean, I literally was just like, okay, yes, we should do that, and we just got everything
done, but it's a telehealth practice.
It was selecting an EMR, paying for that, finding staff, we had to hire some MPs, but
we're fully remote.
It didn't take us long to get up and running, and luckily, the patients came a little bit
because I'm somewhat known in this field, and vaccine injury is such an underserved
population.
I thought we would have the floodgates open.
I thought we would have thousands of patients immediately.
That's not what happened, but we were pretty quickly ...
If I may, I'll tell you a little bit about when I started.
I opened up.
I thought I'd do great.
I had two patients.
I had $200 a month in revenue.
I quit practicing medicine in 2000 because I went four months without a paycheck.
I see my friends are burned out like crazy.
When you think about it, when you walk in the room with a doctor, they're going to see
you, but they're not making money.
When they walk out the door, that's when they start making money.
They're going to get this whole note together, and then they're checking the boxes.
The burnout rate is so bad.
I'm interviewing people for a job, and they're young, and then the mid-30s, and they've got
over $300,000 in debt.
When I'm $350,000 in debt, and they're driving little cars and living in apartments, and
people don't know how bad it is.
It's so sad.
Some people can do it.
When I left practice, I left 4,000 to 5,000 patients.
When I restarted again, I'd worked for the pharmacy software business, and that's a whole
different story where I learned that business.
I had nothing, and when I opened up, $200 a month in revenue, I told my wife, hey, get
it to work.
I did not make $1 profit for eight years.
That's how hard it was in the beginning.
No one understood.
They interviewed me for good housekeeping.
It went over everywhere.
I'm all in the article.
This is the way you should be done.
When that came out, I got two phone calls, one from a pharmacist in Tennessee, and one
from someone in Frisco, and said, maybe I'll be your doctor.
That's it.
Wow.
I mean, I got more stories like that, which I wish I had, but my brain's not thinking
good, so.
Sounds like my on-ramp was a little bit faster and a little bit better, because that's pretty
remarkable.
No, yeah, but it's amazing what's going on.
You helped me and Scott structure our practice, and we have a very similar model to Chris's.
It works, and our patients seem happy, so thank you.
Okay, buddy.
Thanks.
Thanks.
Bye.
Bye.
Bye.
Bye.
Bye.
Bye.
Bye.
Bye.
Bye.
Bye.
Bye.
Bye.
