Episode Transcript
Daniel Wrenne: Hey guys, hope you're having a great day. In case you hadn't picked up on this, I'm a huge fan of the direct care model for physicians. I think it's a great way to sidestep the problems that exist. A lot of the problems, not all of 'em, but a lot of the problems that exist in the system of healthcare. By eliminating this relationship with insurances and the big healthcare systems, that in itself cuts out a lot of this waste and this bureaucracy that exists.
and more importantly, I think it shifts the control back into the hands of the physician and the patient and more directly connects them in working with direct care physicians and having them as guests on the podcast, I don't. I can think of a single, physician that is burning out and in fact, they're really excited about their work and, just love to talk about it.
you can check out, I had my friends, Ryan and Katie Brown on a while back to talk about breaking away from primary care to start a concierge practice. and they're a great example of doing a more direct care model. and in the coming weeks we're gonna be talking with more direct care physicians, so that you can hear their stories.
So make sure to check those out. So I would love it if more physicians just completely jumped ship and went all in on this direct care model overnight, but I also recognized. it is kind of a big jump and a lot of you are probably like, you know, is there, a little bit, less of an, intense, switchover.
and maybe, some of you're interested in some sort of a middle ground. So the good news is that there's a fantastic middle ground that I've recently discovered. and so many of you get. could get into this platform that exists relatively easily, and today I'm excited to have a conversation with the founder of this platform, that is designed to help match physicians with direct paying patients.
My guest today is a practicing vascular surgeon. She's an entrepreneur and is the founder of Uber Doc, which if you haven't heard of it, make sure to go check it out. It's a really cool platform that helps physicians. to have kind of a side hustle, while still carrying on their normal practice, but have that side hustle that, still utilizes their expertise and also gives them the opportunity to test out this direct to patient care model.
So I think a lot of you're gonna be interested in just at least checking out this platform. I'm super interested. And so my guest today is Dr. Paula Muto. In our conversation, we talk about some of the problems within healthcare. She shares a lot more info about Uber Doc, and we discuss how it's helping solve some of these big problems in healthcare.
So we also talk a little bit about this idea of physician entrepreneurship, her being a physician entrepreneur. She has a lot of insight in that, and so make sure to check out the end too, where we talk about, her predictions for the future of healthcare and the direct care model. So I'm excited to share the conversation with you and I'd love to jump into it now.
I hope you enjoyed as much as I did.
Paula, thanks for joining me today on the podcast.
Dr. Paula Muto: Thanks for having me, Dan.
Daniel Wrenne: I'm looking forward to our conversation. We've kind of been catching up on some of the cool things you're doing. You're doing a lot of really cool things as far as solutions in healthcare, and you know, you've got this Uber Doc thing that's really, really cool.
I'm kind of obsessed with, I was checking out the website. I'm like, how did this thing. Exists for so long and I didn't know about it. And so I'm excited to talk about that stuff. A lot of cool, different, things you're doing. But before we get into that, I was hoping if you could kind of share with our listeners a little bit about you and like kind of how you've gotten to where you are professionally.
Dr. Paula Muto: Sure. So, and thank you. I like to think we're the best kept secret, but, uh anyway, so I'm, a general and vascular surgeon, probably from birth, My dad was a great surgeon. I'm married to a great surgeon. My brother is a surgeon and two uncles all in Massachusetts for a collective century.
So you can see it's kind of the family. business So I've been in private practice my entire career. You know, I trained in Boston and I'm about 20 miles outside Boston. Working in both, like in for-profit hospital, independent hospital that cannibalized each other. We went through Pre-Romneycare Romneycare, Obamacare.
value-based care, you know, so I'm a kind of a frontline person watching all of this. And then I started to realize the system is terrible and patients are not getting what they need, and they're getting charged way too much and they're getting delayed. So I said, how could I fix this? So I started to write angry letters, so, and angry letters to the Wall Street Journal or New York Times.
But, so then I thought, is it, is it just about writing angry letters or could I try to change it? So I came up with a very simple solution. I said, what if a patient. could Find a doctor who is nearby and available. Make an appointment without making a phone call. And pay a transparent price. What? And make that price a little lower than commercial insurance, but a little above Medicare to be legal.
And then I went to my doctor's, I said, would you take a patient for a little less money if they paid you cash? And of course they said, absolutely. So I went to my doctor's lounge, and then I went to other doctor's lounges. Then I went across the state and then I went to other professions and then specialties.
And I crossed the country multiple times and I couldn't find a doctor who said no to me. So then I knew we had it. We have all of the doctors who are coming to the table to take care of patients through a transparent model. And so that's, how it all started. And so at now I'm 59, so at 52 years old this is my third child,
So I'm married, I have two kids. It's like they went off to college. I'm like, now what? I'm still a practicing surgeon. I see my patients every day because I think it's really important. And we've built this. Platform now in 48 states close to 5,000 doctors, another 5,000 onboarding. We want every doctor to give us a seat in their waiting room for an Uber doc patient.
You know, that doesn't mean you know, it's just next to your Medicare patient, next to your Medicaid patient. Just give a patient, put a seat aside for someone who needs it, who's willing to pay cash to come in to see it. Transparent price, and whatever happens after. that could be. through insurance or between you and the doctor?
Daniel Wrenne: Yeah. That's a lot of physicians. You said 5,000.
Dr. Paula Muto: yeah. We're, joining. We have a lot of doctors and in every specialty 55 specialties, we get, we have really wonderful doctors. So it's everything from an, every doctor's a specialist, so it's everything from a, you know, a pediatrician to a neurosurgeon, to an endocrinologist, to an orthopedic we don't have any mid-level on our platform. So these are all physicians or PhDs in psychia in psychology.
. Yeah, and it sounds like you're growing fast as. we
are growing quickly because doctors are kind of fed up really. And they need a place to see their patients. And we're giving them a place.
Now, I had should say, before Covid we had access to telemedicine cuz the person who created. Telemedicine said, my God, you have the model. It's what I've dreamed about is like putting the technology of telemedicine in the hands of an end user, meaning a brick and mortar doctor to connect better with their patient.
So I said, oh, I don't know why would a doctor, and they're like, why would a surgeon need telemedicine? And now it's like, oh my gosh, we use it all the time. So we added, so when the concept of nearby and available near. Sort of took on a new, definition. So you could find that doctor five miles away, or you could find that doctor 200 miles away in your state that could potentially help you get on the path to finding your definitive care.
Daniel Wrenne: . Yeah it's an interesting model. It's actually pretty simple and, it reminds me a lot of I'll kind of give you the quick story. I was, you know, I've been in the financial services business for years and years and the financial services industry, it's, although it's not the same problems, it has a lot of somewhat similar.
Problems or same, you know, flavor of problems as healthcare. Like the system kind of has a lot of control over the, you know, advisors, I'm saying in air quotes. And there's a lot of products pushed and a lot of incentives that, are questionable. Tons of conflicts of interest in my industry.
And so what I realized, so I used to be kind of in the thick of all that, and what I realized is ultimately the, the client's paying, I mean, it's all kind of hurting the in client. And you know, you just, when I was honest with myself, I'm like, I don't really feel good about what I'm doing. And so I left in 2014 and started my planning business and basically I'm like, okay, I'm gonna cut out.
Junk and we're just gonna charge people and they're gonna pay us and it's a monthly fee Like there's no. nothing else besides people pay us and we provide advice and service.
Dr. Paula Muto: Well, it's called fee for service. Correct. And in the last, you know, few decades, fee for service has gotten a bad wrap.
But if you think about it, we are a service industry and I think that the. the reason fee for service has been just the war on the doctors is like somehow or another, you know, the doctors got painted. That we were too expensive, that we were charging too much, that we were doing unnecessary things. and honestly, if you look at the way the outcomes have gone we hit a z if we were really good with our outcomes, the stuff that we were doing was pretty amazing.
People are living to, a hundred people are living at home. People, you know, your cholesterol is. Control. I don't operate on your arteries anymore. I take, I I, patients of mines go home after surgery. You know, we've had so much amazing technology and during the, and that's because we've been a service profession dedicated to making those changes for the patients.
I think what happens is, like you said, there's a lot of ancillary stuff that kind of gets added to the mix. And when you put a third party in the equation and then you know, the cost can run away. And I think when government steps in and starts to subsidize it's just like college tuition, you know,
It's like, oh, someone else is paying the bill. Well, we can do a little extra. And we saw such a sea change in our profession almost in the last 15 years when, you know, the, when suddenly there was more access to. Beyond the patient, things started to, you know, we started throwing things away. We started wasting things.
, you know, now until Covid, when we suddenly can't throw a mask away anymore. before that, we like literally were told we couldn't reuse things. We could had to throw away things. We had to not be very green. And for not really any good scientific reason. But I think that, you know, the narrative has always been about this kind of like, globalization, standardization.
of healthcare and that there's sort of a one size fits all. and that's just not where medicine is. It's extremely precision. It's the most personal thing in your life is your health. And there's so many wonderful, inexpensive ways to keep you healthy, that, but you have to get to the people who are learning that spend their lifetime in the service to do that.
and, and I think that's what makes us kind of unique in this model is we're trying to return people, push, you know, you know, tell them that there's this option for them.
Daniel Wrenne: Yeah. I like it. so I have a strong belief in the physicians being. ethical and solid and smart, and there's all these qual like very, experienced and specialized in, there's all these good qualities.
I get to work with physicians all the time and I am super confident in the physicians I know. And I think it, a lot of it is the system has caused a lot of these problems and putting, you know, more power in the hands of the physician is, a big step in the right direction and that's essentially what your system.
Your business is doing is it's kind of helping connect the dots directly.
Dr. Paula Muto: It's also reminding the doctor that the patient's paying I think we've forgotten that in this mix. Right? You don't, you never worried about ordering the extra CAT scan or the extra test or the blood test. You know, if you were in academics, it was because it was academic.
It didn't change what you did for the patient. If you were in like practice, you'd say, oh, well I'd feel more comfortable. That was a famous line. I would feel more comfortable if I got another image. It's like, but is it about me feeling more comfortable or you, the patient and at the end of the day, the concern and the fear and the anxiety that generated the test.
Now that test. Is the patient is paying extra for that. And I feel like that generates a whole nother layer of anxiety and pain for the patient. And then not to say that you should ever with withhold important treatment, but but many times, you know, we kind of forgot that there is in fact a patient at the end of that equation that either has to receive that treatment or pay for that treatment.
I think in the 1960s and seventies we had a very paternalistic model of medicine, right. we're born out of this kind of military model. Top down, we know what's best for you. Doctors know what's best for you, right? But over the years it's really shifted. We are much more collaborative with our patients.
Our patients have access to way more. Remember the physician desk reference you didn't even know what a drug. Was the formulary, like how it was constructed. Only a physician could have that book was the magic book, right? Now it's like, you know, you push a button, you can see every medication practically as it's being made.
So, we've shifted a great deal of knowledge and access to information. to the patient, and because of that, we need to meet our patients halfway. So I think we've gone from a top down approach to a much more mutual collaborative approach, and our healthcare system has not followed, in fact, it's gotten worse.
It's worse. It's much more top down than it's ever been, and I think that's where those resources are being squandered.
Daniel Wrenne: Yeah. And so it seems simple to me. It's like, okay, well let's just work outside the system, in certain capacities. But you
Dr. Paula Muto: can't completely work outside the system because people have medical expenses that are too expensive and un.
Un unanticipated expenses. Yeah, like could you drive your car without car insurance? Of course not, because you could, insure your cards cuz in case you get in that accident. But do you use your car insurance for your oil change? Probably not. No. Yeah. Or if you did car insurance would be a lot more expensive.
Daniel Wrenne: or like a tiny fender bender. It's like if it's a $200 claim. Do you really wanna use your insurance? Wait, so Cause they're gonna raise your rates.
Dr. Paula Muto: Exactly. so hello Deduct. you have a high deductible health plan. What's the first thing you do? Is you pay out of pocket anyways. And then you say, I wanna go through my insurance so that my insurance company knows so I can quote, go against my deductible, which you'll never reach, right?
Most patients never reach their deductible. But the insurance company, and it has a record of that. And then the following year when they negotiate the terms of your insurance or with your employer, they. You lost it's kinda like tell your car insurance person.
I dented my fender but it was underneath my deductible. I paid for it. But please make sure you make a record that I had an accident.
Daniel Wrenne: Yeah, that's the way insurance works.
Dr. Paula Muto: but health insurance. we're trained in this kind of odd way. But you need health insurance, you need government subsidy.
Those are things you don't live without, but you don't need them at the level that we have them. I think that the patients need a lot more control of their healthcare dollar, and I think they could spend it better in many places that they perhaps couldn't have spent before. And Uber Doc is just one of those mechanisms to.
People where you can spend that healthcare dollar in a, you know, in a more direct fashion with more value for you, but insurance is, part of the equation. It shouldn't be all of it.
Daniel Wrenne: well, it would be incredibly difficult to like completely exclude insurance or self-insured completely.
And. For an individual especially. And, you just have to have, I mean, there's such a catastrophe type situation. You could come up with that and there is a place for it, but it's these little things that have. Well, it's like primary care, especially, I mean,
Dr. Paula Muto: it's decimated. And so, but also part of getting back to the behavior of the insurance companies you know, they've been enabled quite a bit in the last 20 years.
and they've been allowed to grow and consolidate services, which includes setting the price for medication. Say for example, now I can go to Dr. and she's affordable, so maybe I don't need to carry that huge insurance anymore. Well now, but Dr. Muta is gonna prescribe that medication. And that medication.
Well that medication, it was $5. Now it's $500. Right. So you better buy the insurance to buy that medication. You see how the insurance company out owns the pharmacy benefit manager. So they're the ones who are setting the prices and then there are people like, that are disrupting the model like, mark Cuban's company cost Plus, which is just saying, We can buy it, you can have it for 15%
That's it. Like, in other words, we're not gonna add anything else to this. And I think that those kind of models are important and they're in demand. And ultimately, you know, the congress and the federal government will have to decide how much of our tax dollar wants to continue to go to fuel these middlemen who are like really increasing the price for everyone.
. And I think that's something that needs to be, the voters need to consider very significantly.
Daniel Wrenne: So how might this work for like a. Say I'm a practicing physician, I have maybe a specialized, like say I'm a surgeon. How does this like, fit into my existing practice?
Dr. Paula Muto: So it's built and designed at the level of a fourth grader, which is great. So we're not, we're very we don't integrate electronic work cuz you're really simple. An appointment maker, so that doctor, like most doctors or creatures of habit, you see patients on Monday, you operate on Tuesday, you go to the clinic on Wednesday.
So you just find one of those routine days and say, okay, give me a seat in your waiting room, you start your day at eight 30. Put a seat aside for eight 15. It's like a house seat at a Broadway show. It's like the critic seat and let it. every week for the next 52 weeks. That seats there unless you're on vacation and see if someone buys it.
That's all. So it doesn't disrupt their schedule. They see their patients, they do their show eight times a week like they do for their entire audience. Right. I always think about that way, like you go to a show, everybody bought their ticket a different way, right? You Ticketmaster, ticket Tron, you know, whatever.
You bought it at the box office. It's just the doctor does whatever they do. Normally it's just that patients come into that seat through a direct pay model. And then subs. If the surgeon has to operate, they can say, well, would you wanna use your insurance? Do you wanna go through cash? You know, in other words, at that point, it's still, or you may not need surgery at all.
but for a doctor, it's kind of a nice way of seeing a patient and getting immediate payment for. You're
just
Daniel Wrenne: giving 'em a slot of your time, essentially.
Dr. Paula Muto: Yeah. And sometimes they don't need anything, and if a patient doesn't show up and doesn't cancel appropriately, they get they get to keep, like, you know, the patient loses the $50 and the doctor gets to keep $25.
So it's like, Hey, you know, I put my time aside and the patient didn't show up. And I think that's fair and that's why our no-show rate's like zero because patients, when they pay, they show up, right? So, so that's how we differ from a lot of these appointment makers. Everybody has an appointment maker.
Oh, everybody, you know, book your own appointment. But doctor's offices, that's really tricky because of referrals, authorizations, are you in the network? Are you at a network? We all, that doesn't matter with Uber Doc. Doesn't matter. and then of course, what's the price? They put their price right out there.
So we get a, we price transparency. Access to care. That's what our mission has always been. really, that's all we do. We're very simple. Yeah.
Daniel Wrenne: And so when someone opens up that slot, it's just, you know, they start to experience it. Have you seen people, adopt it more. They're like, well, why don't we do two, two slides?
Dr. Paula Muto: So, so, so some doctors are like, they're so excited. Right. So it depends on the specialty, right? Right. Like psychiatry, you know, like there's a high demand orthopedic e n t, general surgery. Oh, that's like, man, it's like, I always think it's like, dermatology is like a Hamilton ticket.
Ooh, you know, general surgery is kinda like cats, right? It's like, you may not be the top of everybody's list, but. but there's an internet presence. It was very important for me to make sure that my doctors had a page on the internet. They needed to be found on the internet. Even if a patient ends up calling the office and saying, Ooh, there's a surgeon that's located five miles from me, that's still really important because to be able to give that information to people you know, making the Uber doc the appointment to the Uber doc models, fluid, easy, simple one step patients love it, you know, offices so,
It's a foreign to them, right? Because they're so used to saying, excuse me, you have to stop here at the toll booth to let me check your passport. Make here. You have a visa before you walk in, right? There's a process and a workflow in an office, and sometimes it's hard to undo the incumbent, right? Because they're coming in through, you know, this wonderful Pusha button back door.
you don't need to do all of that. Right? Yeah. Unless afterwards you need surgery or an x-ray or something, maybe then you need it. But it, so it's like, so, so, so that's kind of been a little bit of our challenge is that is, some offices that are still like, trying to embrace this easy pass right?
It's like, the people who still go in the toll booth lane. Cuz they haven't gotten their transponder yet. right? Yeah. Like I'm gonna just go in that right. and maybe they have a transponder, but they still end up in the wrong lane. So you know, that's basically, there's a cultural divide sometimes with that.
Daniel Wrenne: are there physicians that would not be able to utilize that due to their, I can imagine like, Hospital employed. So,
Dr. Paula Muto: when we first started this hospital employed, doctors were really anxious to join, and we went to every hospital in Boston and all the, medical leadership and even the CFOs, they were like, oh my God, this is great.
But then of course, hospital administration is like, you know, they're like, how do we get paid by 2032? We're gonna adopt this right? nothing goes very fast, right. and the doctors are really quite frustrated because they're so super talented. Like, I'm like a, you know, a left adrenal specialist. I want more patients.
Right. the challenge at the hospital level was that at the time there were facility charges, which I think that depending on the state, the insurance and the requirements, oftentimes those are not, Allowed billable anymore. They're billable, but they're not collectible. If by a facility charge, it means if I see you in my office, I just bill an in code for the visit.
If I see you in the hospital, the hospital will bill like a piece of that because I'm see, and I'll get a little bit less. Money because that quote, 20% is the overhead. That 20% used to not be collectible. And then some people thought it was collectible. And depending on what deal you have you know, you can get a facility charge.
So to be an Uber doc, a doctor in a, facility, you have to waive that, right? You can't take the facility charge, you're just gonna get paid right? So, and so the doctors always wonder like, well, who gets paid? It's like, I always say, whoever pays your secretary get. Whoever pays your office staff, that's, you know, wherever the money goes from Blue Cross is where the money should go for Uber Doc.
And that's where they sort of push it up the ladder and then nobody has an answer. and so now doctors can join no matter what. We have them all over in the academic hospitals. They're fabulous. They do second opinions, they see patients, they're defiant now. And I, I mean,
Daniel Wrenne: could I be like a 10 99 side hustle side sort of thing?
Dr. Paula Muto:
So, so the. and this is really funny because of the new legislation on like non-competes, right? Yeah, that's right on compete because it really restricts access tremendously. And but if no, if you're a top doctor, you can be on Uber Doc and you can see that patient and patients have like, you know, come into the institution because of that.
People do also digital, you know, second opinion, telemedicine, things like that. But my really, institutions are now looking at us and we're like, oh, wait a minute. This makes sense. this is a Kathleen, I get it now. Right cuz they don't have anyone answering phones. The, this, the hospitals are completely understaffed.
Even on a good day, it's really hard to train and retain people to do the nuclear codes necessary to get a patient in the door and get payment for it. So this actually isn't, is sort of simple and my, my. Dream and my request, and we're beginning to see it now, is that every doctor can be an Uber doc.
Whether you're sitting in a, you know, in a Mayo Clinic as a super specialist, you're sitting in Mississippi in a rural clinic or sitting in, you know, Colorado as a psychiatrist. anyone should give, everyone can be an Uber doc as long as you're credentialed and there's no reason not to.
Daniel Wrenne: it's like a simplified way to interact in. Consult type visits that are necessary, but then they're being bogged down by the system. It's like I go see. Specialists cuz I got, you know, sleep doctors, something like that and I gotta go do the paperwork and wait in the line and go through the system and then the, it takes an hour and a half cuz it's busy at that point in time.
And you know, it's just, or you get
Dr. Paula Muto: delayed. I mean, so many times people get sent for like a bunch of other places before they get that definitive caring. And if the system were staffed by credentialed people. But you know, we've lost 110. And doctors right now, it's hard to find. Your walking clinics are staffed by many mid-levels that are not always completely supervised.
There's a tremendous incentive in the marketplace to cut back on the expensive physicians, you know, emergency medicine has felt this you know, other specialties have felt this. And primary care is decimated as we talked about. And the problem with all that is our outcome. Shifted our outcomes started to go south.
Before Covid, they started to reverse. Because of this trend to consolidation. So at some point we just have to say, This isn't working. Yeah. We need to go back to putting the doctors in charge, but add a little technology to it so that it's better, faster, cheaper. and luckily we've continued to move forward and as a medical.
As med, the medical establishment has continued to grow forward with, you know, AI and the way we develop drugs and treatments. It's like breathtaking speed what's out there and it's just like the whole system is like a drag shoot, holding it back you know, we're still, they're still digging phone lines to put in, like, you know, digging trenches for phone lines.
It's like, we don't need any of that anymore. Right,
Daniel Wrenne: right. Who has a landline
Dr. Paula Muto: well, exactly. and that's because that landline is where the resources, the money, the tradition that paternalistic model of medicine from the sixties was rooted in. And I think we just have to understand it's okay to say it worked then.
It doesn't work now.
Daniel Wrenne: Yeah. And so like a lot of the physicians, it sounds like on your platform, are kind of like in a hybrid, like. They're just kind of opening it up a slice of their day for this sort of setup. And that makes a lot of sense.
Now I know of people I work with and, you know, the direct care model a lot. Some physicians go like, all in on. That,
Dr. Paula Muto: which, which is great. I mean, it's hard to do that depending on where you are in your payer mix and your ec the economics of your this, of the, geography where you're at.
I know many doctors like, you know, who have gone all in for direct pay and they are phenomenal. And then other people who kind of dip their toe in it and other people are kind of scared. We like to be that bridge, you know, and just see what. I think that it is hard again, depending on if you have a lot of Medicare patients, for example, in your panel and then you go direct pay, they, and they, you ask them to pay monthly or annually and some of those patients just can't do it.
And, but they don't wanna give you up. So that's why we like our model cuz it's kind of a la carte concierge. We, at the same time, those same doctors that are reluctant to be a direct pay doctor have. Are booked out six weeks. You can't get in. They tell you go across the street to the walk-in where you have to pay $300
It's like, why don't you just say, go online and book with me tomorrow, I have special seats aside for people that, so why would you give that $300 to like the walk-in where they're going to get prescribed something that you're gonna end up having to take care of. So we're just trying to get doctors to think like, it's okay.
It's like perfectly okay for you to take cash from your own patients and not necessarily, you know, do anything wrong with that. I think there's a great sense that charging a patient anything is wrong. But honestly patients are charged way more in, you know, in what they've put into the system through.
Payroll through their, you know, paycheck, through their taxes, through their insurance, you know? I mean, honestly you know, ultimately, you know, direct a transparent transaction. It's not that expensive seeing a patient in the office or it shouldn't be.
Daniel Wrenne: . Yeah. I mean, it seems pretty straightforward and it seems like a lot of people would.
I think be interested in it, cuz I know there's a lot of people that like the idea of simplifying or, you know, direct to patient or direct care or whatever you want to call it, but they're intimidated by the risk of it all and making the jump and going all in. And there's not a system in their practice or hospital setting that's like helping them to bridge the gap at all.
And so that,
Dr. Paula Muto: It's seems like a, it's just supermarket aisle for cash at some point. Everyone needs to do it. the pushback is that the fear is that if you show a price, you're stuck with that price. But the only fear of showing a price is that the insurers make you afraid to show. They don't want you to show that price.
Right? Because then they're the value of their. Product. right then why would I need to buy all this insurance? Like if I could add up what I pay. So I always like the thought of like individual health equity is what I call it. Like you buying a house with a mortgage or you're paying rent you know, and insurance is like rent, right?
And you pay. A lot of rent and the rent keeps going up and the landlord doesn't pay your electricity anymore. They don't pay your water bill you know, like if you think about it you know, and then, but when you buy a house, you, you're still paying money every month, but some of that, but that month is that, but.
Some that money will come back to you in equity. And I think like if you put into a health savings account, some of that premium be really nice to be able to say, well this is what I can pay out of pocket. Yeah. And ideally if you paid all every doctor visit out of pocket and just used insurance for the hospital or something expensive, that would make a lot of sense.
Daniel Wrenne: And the cost would go way down of the
Dr. Paula Muto: cost would go way down. Doctors would get funded. They would keep their offices open. The problem is like nobody right now, it's like you, you pay this high premium. then you have this deductible, then you still have to pay for your surgery. You still have to pay for your doctor, like the patients have.
They don't understand.
Daniel Wrenne: And prices are skyrocketing put because of the lack of transparency. Partially. I mean, there's a bunch of reasons, but I mean, it's like, it's not going the right
Dr. Paula Muto: direction.
It's, you just have to look at the numbers and see the massive profit. the consumer price index and maybe helping something, but it's not right.
it's not right anymore because it's not the way we practice medicine. Now interfering. It's not facilitating, I will say it's obstructing the way we, and patients are afraid to get care. They're not afraid anymore of their disease. They're afraid of their bill.
, you know? Yeah. And, the doctor can control that piece of. by being transparent if they have the autonomy within their practice to do so. And that's the weapon that I give them with Uber Doc.
Daniel Wrenne: . Yeah. I mean, as a patient I'm like very There's a lot of appeal to me to just paying somebody, you know, a few hundred dollars to get that objectivity and reduction of conflicts and dedicated time and focus and attention and not you're
Dr. Paula Muto: working for your patient.
It's like you're showing up in my office with a bag of grain, right. I used to say like, you deliver someone's baby, they give you a goat. right? I mean, there's like, there's something very pure about that.
Daniel Wrenne: It also increases the patient's. You already mentioned this. I think that was before recording maybe, but like the when someone pays for something, they become more vested in the current healthcare system.
You don't pay for your anything. So it's like, ah, they're not as, the patients are not as,
Dr. Paula Muto: but they are paying, you see? The whole business of like, patients need skin in the game. They have more than skin. They have blood, they have their bodies in the game. Yeah. It's just that they've been told that if you pay it through this third party, like in other words, it's somehow going to be of higher value to you, but the third party payment now is higher than the payment that the physician or the care, actually the cost of care is cheaper than the cost of managing that.
And what I mean by managing care, I mean that kind of insurance, financial healthcare system, you know, data collection so forth, the actual cost of caring for you is much cheaper than that. so, so then you're saying, well, what am I doing all this for? Sharing my data so that, you know, in they con continue to make tables to ultimately ration care.
It's like, you know what? They can get that data in many other ways, and they can get it anonymously. They do not need it. Through all of this massive data collection, and we spend a lot of time and energy on data. We spend more protecting data, and yet we cannot share data. I cannot look at an x-ray from a hospital that I'm no longer part of and my patients can't see it.
They can give me their portal, but I still can't see it. So now I just. Please just take a picture of it on your iPhone. like, you know, I get a disc. They give you a disc. It's like, I don't have a computer that opens a disc.
Daniel Wrenne: Yeah. Well, what do you do with a cd?
Dr. Paula Muto: We are completely, and yet the technology every happens every day with your phone.
I know you share photos all the time. You know, and that's their files that may or may not compress. But at the end of the day, eyes need to look at things to make decisions and get that blood test or figure out what that report was because you just need that piece of information. but now our information is all the lines are crossed and it'll, and, and nothing's shared.
Daniel Wrenne: . So if I'm, a physician that's curious about this or maybe even, you know, like the idea and I want to kind of. Jump on board? can you just be like, go on the website and apply for
video1671739382: something
Dr. Paula Muto: or? Yeah, so we go to, they can go to join uber doc.com or they can go the May, our website's uber-docs.com.
But if they go to join uber.dot com and they just fill out the form and we get them started within like 10 minutes, they can be on the site. As long as they're credentialed. We do have require. you have to be boarded in the specialty that you practice. That's important. You know, in other words, you can't be like a, an orthopedic surgeon that wants do gynecology,
That doesn't, that doesn't understandable. You have to be licensed in the state that you practice. So we follow state line regulations in including telemedicine. You know, Can't be, you can't have telemedicine beyond a state line unless you're licensed in that state. and you have to, if you're a, an interventionalist, you have to have credentials at whatever institution you do your interventions at.
You have to be in good standing there. So we do have those requirements. We don't, we, you can be, you have to be an MD or do you have to be trained. You have to be probably over 30. Yeah, that's cause you can't finish all your training in that. We do have doctors of optometry because they're, the primary care is of the eye doctors and we have clinical psychologists and CDs because they are the, you know, trained professionals for therapy.
But we don't have any other mid-levels.
Daniel Wrenne: How does Uber Dog make.
Dr. Paula Muto: So, from transactions,
Daniel Wrenne: so it's like a transaction on the,
Dr. Paula Muto: we, we, the doctors can don't pay to join Uber doc. They just pay us. When a patient uses the platform, which is about less than what. They would pay for someone to schedule bill, collect, advertise, you know, we kind of give 'em the whole thing probably lower than their overhead percentage.
We give 'em the internet access, the whole thing, the appointment maker and the payment processor. If doctors at, you know, we, we do have subscription models as well. If doctors need something more from us, They need, like, telemedicine perhaps, or if they want a marketing package or if they wanna use us as their booking platform, then we would change the equation to, you know, unlimited usage kind of thing.
But most patients right now we're really going with the transactional model cuz we don't see Uber Doc replacing your entire waiting room. That's not our intention. Our intention is everybody puts a seat aside, right? Everybody puts a seat aside and that's okay. So when a doctor sees 50 patients a week, a couple of those seats or Uber doc patients, that's direct pay that pays their front end.
, if they're, if you have five doctors in the practice, that's gonna pay your nurse. If you have 10 doctors in the practice, that's gonna pay the salary of your doctor. That's how we see it. Just a couple, two or three patients a week is all you need to be able to kind of put a little cash flow into your business and then see what.
see what happens. Like maybe everybody on Friday book, super Doc all the time. And then you open up more slots. I mean that this was meant to be sort of a gentle nudge into the direct pay marketplace and also give doctors a little cash flow, which is always nice to
have.
Daniel Wrenne: . Well, I've been, I've kind of gotten obsessed with the direct care model as, because I just, I feel like it's such a good solution and it. the only solution, like it doesn't cover all of the problems, but especially for primary care and some of these not all specialties, like certain, like you said, like catastrophe type stuff.
You gotta go through the system in some capacity. But I think the direct model is a great solution for some of these like, you know, smaller type ticket items that you can just, and then, and
Dr. Paula Muto: I'm gonna tell you the smaller item, I mean, I operate in my office, right? What I used to do in the operating room technology has allowed me to move that out of the expensive hospital into the office more and more.
doctors are doing this, right? So technology, so, so those quotes, smaller things are better, faster, cheaper now in these outpatient settings. Like look at knee replacement, oh my gosh, patients go home now. I mean, and they're doing beautifully. Like they, outcomes are so much better. And whoever thought that could happen, right?
So, so I think that that when you think about, yes, the insurance for those catastrophic things, but then you think, okay, what can I get? This, is it just a visit? Is it just an exam? No, it isn't. You can get treatment. You don't just get a diagnosis. You can get definitive treatment and, but you cannot get definitive treatment if you're not in front of someone who can offer you a definitive diagnosis.
And our system is not built for that. Now. You spend a lot of time, I always say wandering in the desert, going from less experience to a little more experience to a little more experience. And each step of the way you are. right? You're paying a copay, you're paying an, it may perhaps, you know, a deductible.
You're paying for an image you might not need. but when you go to the expert and they ask you like three questions, it's like, oh my God, DRDO, how did you know my restless leg was related to my veins? It's like, well, guess what? I've seen, you know, I've done this for 25 years, I've seen like 50 million legs and I've heard this I've heard this story before.
, it's like, I don't know, just like, you know, I'm, you know, there is some value to. a specialist,
Daniel Wrenne: right? Yeah. A lot in situations,
Dr. Paula Muto: right? And primary care doctors who have been practicing for centuries or specialists too. Again, Physicians are specialists. and people have to remember that.
Daniel Wrenne: Yeah. I would imagine a lot of direct primary care physicians are referring people to your platform as well. So
Dr. Paula Muto: that's an interesting thing too, is cuz a lot of D p C doctors are kind of ostracized. Like they're kind of out of. And they have no network. It's like, okay. So they are very excited about being able to say, here, go to an Uber doc.
You know, we are creating this family basically. I, I don't like the word network. I like the word family. Like, or the doctor's lounge. We're recreating that. Doctor's lounge, those relationships. You know, I Doctor Gold, who's a, primary care physician, you know, d p c doctor, he and I just wrote a paper together, an article together.
It. you know, a surgeon in a primary care coming together and agreeing, like, and this er doctor like logged in and said, I, you know, that, hear here for that, right? but it's just, you know, the concept of like the old time where you used to, it was a handoff. You picked up the phone, you spoke to your specialist and said I'm concerned about this patient.
Can you see them today? and then you called them back and said, this is what's going on. That's the perfect healthcare, cuz that's the patient in the middle that gets that. The benefit of those minds, working together. And right now there's no mechanism in place for that. In fact the system has completely eliminated the ability to communicate.
Yet we have phones and zooms and text messages. It's like there's no reason there that we can't build this in a way better way.
Daniel Wrenne: Yeah. I had a eye, random eye incident, condition thing. I don't even know how to describe it, but it was, it ended up being nothing, but I had to go see a super specialized, like optim ophthalmologist, neurologist.
and I remember like one of the visits it was like, well, I think they had to reschedule it, and they're like, well, we need to set up a time. But she's booked for six months, so it was.
Dr. Paula Muto: But that she needs to be an Uber doc because then you see, cuz there's always a no-show that what people don't understand is like, a lot of doctors tell us, oh God, I don't need this.
I'm booked six months. I don't need Uber doc. I'm
Daniel Wrenne: booked. Yeah. What's your show
Dr. Paula Muto: rate? But your no-show rate isn't zero. And I guarantee you that even if. Like those 50 patients show up, you're getting paid for 20 of them so it's like, doesn't really matter. Right. I said, so this is a re You have a financial incentive aside, and again, we don't want all 50 of your patients.
We don't want, we don't want you to say, okay, now I'm booked only cash pay. That's not the intention of Uber Doc, in fact. on our platform intentionally. Doctors can only offer three appointments before the next doctor. We do that intentionally to make sure that you find someone, you know, with the closest do you and then the next available, you know, and we make sure to do that so that like everyone kind of is seen.
Cuz we don't, we, our intention is not to empty your waiting room of your patients with appointments. It's just to give people that opportunity, that option to, to skip the line. And they pay. And you pay for it, but you don't have to pay a thousand dollars for it. Right. You're not paying a premium price.
You're actually paying price. That's a fair. Right. And that's what's odd about our model. We are actually we flip the equation, we've increased the access and we've actually lowered the price. Which is like, how, why, how is that possible?
Daniel Wrenne: cut out the fat, you cut out a lot of the fat.
Dr. Paula Muto: right. We cut a lot.
And also it's a really good. business model for a doctor. You wanna see patients in your office that pay you.
Daniel Wrenne: . Well, so as we wrap up, I really wanted to talk to you about entrepreneurship just for a second cuz I'd love entrepreneurship and I think it's such a great solu. I mean, entrepreneurship is about like solving problems and so, I'm curious, would you consider yourself like an entrepreneur?
Like when you were younger where you're like I'm an entrepreneur.
Dr. Paula Muto: I came out of practice and went into practice on my own and so it's actually. You know, running a practice and being independent is kind of like being a business per, you know, you learn how to, you know, balance books, things like that.
So my dad was an inventor. We used to call him crazy inventor and but you'd call him an entrepreneur now cuz he used to invent things like for pacemakers and for, yeah. You know, thoracic, he was a thoracic surgeon. He has like something on a chest tube tray, all these things, and he'd patent them and then he'd sell them to a company that would then, you know put them into their kits and sell them and you'd get like a royalty or something.
He loved it. He loved all the young people he was working with and everything, so. So I found myself kind of in following in those footsteps, like the excitement of creating a platform at technology. The smart people you're with the smart people I've met in within my profession, outside my profession.
It's given me this wonderful like journey. And it's also given me an incredibly good perspective on healthcare. Like I really do understand. What the insurers are thinking and what the employers are thinking. And I've always understood what the patients are thinking. You know, and the physicians in different practices and locations, it's like giving me like a really good understanding.
But entrepreneurship it's not something you just wake up one day and say, I think I'm going to be an entrepreneur. Something you get infected with. You have that. desire to change something and you can't live without trying to fix it. and I think most physicians internally are entrepreneurs because when a patient comes to 'em with a problem, they fix it.
That's why you go into medicine, you wanna fix things.
Daniel Wrenne: Yep. don't, I don't think they equate it to entrepreneurship, but I agree. Like I think physicians are already set up to where they have a lot of the skillsets necessary to be great entrepreneurs and they're in this system that has a lot of problems.
once you start to get into entrepreneurship, you realize it's about solving problems. And so when you're in this system that has all kinds of problems, it's like kind of an entrepreneur's dream in some ways is like,
Dr. Paula Muto: well, it's a challenge. the the challenge too, the challenge is that we are part of the problem
right? we enter into a system with a certain sort of understanding and narrative and we are ready to. In an instant when it comes to a treatment, like if somebody tells us this procedure now replaces this one, or this treatment's better than that one. We change instantly. We adopt technology flawlessly, but we are accused of not being able to handle technology when it came to electronic records.
Why? Because it didn't, gel with our workflow. It actually impeded us. It didn't improve what we did. You know, and because no one. No one said, let's go to the end user and say, here's the technology, help us develop it. They completely pushed us off the table, and then we became we farther and farther away from the decision makers, and then of course when it comes to the financials and everything else.
So the doctors and our patients are not, At the table anymore to dis No, and that's why it's funny because we've created this parallel universe over here where medicine occurs and healthcare is over here, and they don't overlap anymore. The business of healthcare is ver so far from the practice of medicine at this point.
Daniel Wrenne: Yeah. so it's ripe for disruption and.
Dr. Paula Muto: it's right. Be restoration. I like to say restoration is a better word, restoration. But yes, it, you know, it's of course, it's not sustainable. And at least everyone agrees it's not sustainable. It's just that we keep throwing patchworks at it.
Right? Yeah.
Daniel Wrenne: right. Well, that's what I, one of the reasons I love what you're doing it's a solid working solution. to the problem.
Dr. Paula Muto: It's a mechanism. I like to think that Uber doc is just the mechanism for people to pivot toward direct pay without an all or nothing shift.
We're a system agnostic. We do not take down the existing system. We just create another. path. right? That's, you're driving to the same city. You're just using a transponder now and going in a high occupancy lane. You know, you're going high vehicle lane, you know, you know the a commuter as opposed to going through the traffic that's all we're doing.
And eventually, if that commuter lane ends up being crowded, well then you create another one and then that becomes the other way to get there. Right? I mean, so this is all we're doing is just offering an opportunity. Let the end users decide. In this case, it's the. and I fervently believe the patient should own their healthcare dollar.
They are the best people to decide how to spend it. I don't like incentives. I think all those incentives should disappear. don't bonus us for doing our job, just pay us fairly. That's it. and all that extra money in the system that floats around and, and returns into networks and incentives and bonuses and programs.
They should all be directed to the patient because I've just sent you. I don't care for you. Now, I cut you open, pat you up and say, now you gotta go home, Dan and your family has to take care of you. So it's like not on me anymore. So why am I getting, why is the system getting rewarded? That money could go to you?
to fund the social determinants of health. Right. To, to help. Find somebody that will help you walk up your three flights of stairs. You know, or that can stay home with you when you recover. You know, and, we never even consider that. So this is sort of like at the higher levels, this is the beginning of recognizing the importance of that healthcare dollar in the patient's
Daniel Wrenne: hands.
one last question. I'm super curious about this cuz I know, you know, you have a lot of. knowledge about what's going on, like you were talking about earlier. And I'm super curious about the future of direct care and this isn't, you know, we're talking in the future, so it's who knows. But I, I'm curious where it goes, like, with direct care and just healthcare in general, but like, do you see this, I imagine drug care growing a lot and this hybrid kind of middle ground as well, growing, and how does it fit in with the current.
Dr. Paula Muto: So there's no question the d p C world, the direct primary care world, they're leading the way, right? They're the ones who forged the path that Uber doc is following, and the quality of care, the outcomes, they're unbeatable, right? I mean, they're just not like, they're just the, it's just, it's a better way of taking care of patients.
And the reason why is because you've eliminated so much of that middle man. I think the challenge is going to be that in a direct pay marketplace, where's that hybrid gonna occur? Like you have that insurance for the catastrophic, and then out of pocket, what do you do? And I think if we are very transparent with that out of pocket.
then you can create a really beautiful hybrid where your insurance card might have a magnetic strip behind it. right? That, that sort of combines it and is a unified currency. So not 50,000 different insurances with 50,000 different codes, like, you know, just that alone would save money.
So, the challenge becomes is that the current incumbents, the current stakeholders and where people have thrown money at in terms of incentivizing controlling cost, has been toward insurance companies to capitate, to, you know, you know, the, you know, there's been the value-based care. And then before that it was, you know, the H HMO kind of thing and the capitation models, which are.
Rationing healthcare. I think that there's so much political power behind that, that's gonna be a little harder to cha, you know, the direct pay model is gonna come up against that. You know, where do you put your money? I'd like to think that that people have to be super creative.
That I would love to see Congress say, you know, Medicare patients who stay healthy, who do everything, who don't utilize that money rather than going to their network that's managing their Medicare benefit should go back to the Medicare beneficiary in the form of a, he say, health savings account.
And then the following year that HSA pays their direct primary care, pays, their eye doctor, pays their surgeon in their office, and then when they go to the hospital, their benefits that Medicare, you know, kicks in and pays a hundred. I think that's a really lovely model that will incentivize patients to kind of understand the, how their healthcare dollars spent keeps the insurance companies doing what they were intended to do and Medicare intended to do to cover those catastrophic.
And, you know, and those models I think are real. I think they're doable. I think we're not that far away from them. But if you're gonna pay out of pocket, there has to be some benefit. You know, there has to be some decrease in payment somewhere else. You can't just pay out of pocket and pay a massive premium
and it's like, that doesn't work. You know, think, and I'm very hopeful that, that, what I call the dpo, the direct pay option. Start to infiltrate and become you know, a, a nice addition to the healthcare choices.
Daniel Wrenne: Yeah. Well, I, love what you're doing. I think I'm on board with it.
I'm completely a fan of the idea and I appreciate you coming on to chat about it. It's, it's been a fun conversation. I, love digging into this stuff. there's so many directions we take this. So, I appreciate you giving us the lowdown on kind of what you have going on, and thank you for coming on.
Dr. Paula Muto: Well, thank you for having me. It's been a pleasure.
