Enhance Your Practice Podcast
Enhance Your Practice Podcast
S15 E71: Incorporating Weight Loss Management Into Your Practice
Diana Yoon-Schwartz, MD Host
Jonathan Kaplan, MD Guest
Learn how to successfully integrate weight management programs into medical practices, from logistics to marketing strategies. Dr. Kaplan shares valuable insights on direct shipments from compounding pharmacies, the importance of customer service, and how to scale these programs using existing patient databases. With practical examples and effective marketing techniques, including the power of social media and email marketing, this episode provides a comprehensive guide for any practice looking to add weight management services and significantly boost patient satisfaction and revenue.
You're listening to the enhance your practice podcast series brought to you by ASPS University. I'm Diane Schwartz, chair of practice management committee, and I invite you to check out all of our educational offerings, from professional surgical videos, courses on practice management and much more on ASPS EdNet Build and grow a weight management program in your practice. Today, I'm honored to be joined by a leading expert on this subject, dr Jonathan Kaplan of Pacific Heights Plastic Surgery. He is a board-certified plastic surgeon in San Francisco, as well as founder and CEO of Build my Health a price transparency, lead generation and weight management platform. Jonathan, how are you?
Speaker 2:I'm great Thanks for having me.
Speaker 1:No, thank you for taking the time to speak to us. I know a lot of our members and probably anybody who's listening to this podcast, is really generally interested in the subject, because I think it's both important and an exciting aspect.
Speaker 2:It really is the most interesting thing that's happened in almost all of medicine in so many years, Like within aesthetics. Maybe the most exciting thing since Botox and maybe the most exciting thing since IV fluids and all of medicine.
Speaker 1:I totally agree, especially with the growing prevalence of obesity in the United States. I mean, I was reading something that by like 2035, the US is expected to reach 58% of our population to be, with obesity costing us about over a trillion dollars annually. So this is a very important topic and affects hundreds of millions of people. So okay, so tell me a little bit about how you decided to build a weight management program into your practice. And I guess, to start, had you always had that as part of your practice.
Speaker 2:Not necessarily, and it really is something that I think all plastic surgeons, all aesthetic providers can identify with. We had patients coming in for tummy tucks and other body contouring procedures and some of them, you know, just their BMI was too high. They weren't great candidates for surgery. But then there's even patients who have a reasonable BMI but they have a lot of visceral fat and you just know you're not going to get a great result on a tummy tuck with a patient in that situation. So rather than turning them away and this is a couple of years ago now rather than turning them away, our nurse and nurse practitioner suggested we start a weight management program, and back then all we really had is that they were interested in providing coaching.
Speaker 2:We had access to Fentermain, but it was really before everybody had access to Ozempic and Mojaro and things like that nature. And so after we started about two years ago that's when it became available from the compounding pharmacies, because Ozempic, mojaro, all those name brand drugs went on the FDA shortage list, and so then compounding pharmacies were legally allowed to provide semaglutide, the active ingredient in Ozempic and Wagovi or tierzepatide the active ingredient, and nozepic and wagovi or tirzepatide the active ingredient, and Mujaro, and now Zetbound, that they were able to legally provide those medications, since they're a shortage list, and that's when we started offering it to our patients as part of our weight management program.
Speaker 1:So you would say and I agree with you as a practicing plastic surgeon whether they are at an acceptable BMI or their BMI is too high. I think a lot of our procedures do benefit from additional weight loss and the results will be better. So I think you're absolutely correct that all of us to some degree have some sort of weight management. I would say advice or aspect to our practice. But you said you started doing the compounding about two years ago. How many years had your staff been involved in the sort of supportive weight management program with either the Phentermine or a diet plan or something like that?
Speaker 2:About two and a half years that we had been doing the overall weight management program, and now about a year and a half of having access to the semaglutin Tud, tud or Zep-Tud, so we really just happened to get into this space before those medications became so popular.
Speaker 1:Oh, it's almost like you sort of had the platform geared up and then this became available, which is very serendipitous timing and great for the patients.
Speaker 2:Right. Also, if you're referring to the platform, yeah, that was the platform that I had developed that was dealing with price transparency and e-commerce lead generation. And then, yes, once we started the weight management program and we realized these patients were going to be on medication subscriptions each month, that platform was already in place and so we just used that to process the monthly subscriptions to automate the whole process.
Speaker 1:Yeah, so I actually went on the platform and I think it's amazing because it goes by body part and different procedures, and I did see sort of a dropdown for weight management as part of one of the services or programs that a patient could choose. Now, was that already built in or you had built that in afterwards?
Speaker 2:No. So a lot of, like you said. This is very fortuitous that we had already were allowing patients to check pricing on any procedure you know, botox, surgical services and then they wouldn't see the price until they put in their contact information. So it was combining price transparency and lead generation and then patients were also able to, after seeing the price, could then purchase non-surgical services like Botox. But then we had other providers saying, well, it would be nice to be able to have subscriptions for Botox. And then we had that built in where patients were on a subscription like maybe, for example, they'd be charged a hundred dollars a month and then every third month they could come in and get their 20 units of Botox, which was the equivalent of $300. So we already had that sort of subscription platform in place and then it was just very conducive to supporting weight management, because the patient for people who don't know that medications are once per week injections four times a month, but each month the dose goes up. So these patients have to be on a subscription of some sort to keep getting the medication, because it's not just one pill or one injection. That's the same dose forever. It's like goes up each month. So it was natural for them to be on a subscription.
Speaker 2:So since we already had all that built out, we just implemented it specifically for weight management and just made things really easy for us, made things really easy for the patient because they were able to sign up for the subscriptions online.
Speaker 2:It wasn't like them calling us and giving us their credit card number over the phone and then we had to manually charge the meat smoth. It was done automatically. But the even better part about the automation is not the fact that you don't have to keep a bunch of credit cards on file and remember to charge them manually each month, but it's when their credit card fails. That's really the big hassle if you're doing this manually, because then you have to try to track down the patient and become a bounty hunter to try and get an updated credit card for their charge to go through, whereas with the platform, if their credit card fails, they're flagged in the system. You don't send them their medication. They get an automated email to give them a link to go update their credit card and then they can proceed on after that, after their credit card goes through. So the automation was key and even if you just have a few patients. It makes a big difference to be able to automate it.
Speaker 1:And is this platform readily available to other practitioners, or is this something that you have created, built and is proprietary?
Speaker 2:Yeah, it is something I've created. I didn't realize we were going to talk about the platform this much, so I would have certainly disclosed it more at the beginning if I knew. But yeah, I'm the founder CEO and I started the company about 10 years ago and we were doing the price transparency before the no Surprises Act, which was big on price transparency, before that federal law came into being in 2022. In 2022. But, yeah, yes, I am the founder and CEO and so, yes, it is readily available and we have hundreds of providers using the platform across the country, but it's not. That's the thing is that this kind of take out go into a bigger 30,000 foot view. Excuse me, is that this is for all providers? Not the platform, necessarily, but weight management, because, yes, sure, it makes sense for a plastic surgeon when I explain it that because patients were coming in for body contour procedures, they weren't good candidates, and so that's why weight management makes sense.
Speaker 2:But obesity is affecting every ailment that every provider in the country is treating so like. If you're a dermatologist, even you're thinking well, why would they have a weight management program? Well, obesity is one of the most common causes of acne, so that makes sense for a dermatologist to treat that OBGYN is. One of the most common causes of infertility is obesity Erectile dysfunction. Urologists can be implementing weight management into their practice, and then there's 13 different cancers associated with obesity. So that's what's so crazy about this medication and just healthcare in general, not just aesthetics is that every provider in America should be implementing weight management and kind of realizing that whatever they've been treating the patient for well, if they just treat their obesity, that might ameliorate all of the other things that they're on medications for, like high blood pressure and type 2 diabetes. So that's why this is all so fascinating to me.
Speaker 1:Yeah, no, I absolutely agree with you on every single one of those medical problems and issues. As far as the BMI threshold, I mean, because obviously sometimes there are people who are obviously obese and you know they need to be on these medications. But you know, since you are on the West Coast and there is some, you know, sort of aura about people who maybe don't need to lose weight but are sort of maybe using these drugs in some way. So is there some sort of like evaluation or do you not offer it to certain patients? I mean, I'm thinking like for the surgical patients they may be at optimal BMI but it would be great for them to still lose weight, as we were talking about, for optimal results. Are they still considered candidates for these weight loss medications in your program?
Speaker 2:It's a great question. I'll talk about the BMI part first. So as far about the BMI part first. So as far as the BMI, the technical indication for these medications is a BMI of greater than 27 or an obesity-related condition like high blood pressure, diabetes, sleep apnea or a BMI of greater than 30. And so for the first year that we were offering these medications, we were very strict about the BMI criteria. Again, the BMI criteria also maybe will increase the chances of this being covered by insurance, although statistically that's unlikely. I think only 23% of insurance plans covers these medications. However, in our practice, since we were going the compounding pharmacy route, it was all out of pocket. We weren't dealing with insurance at all. But for the first year we were very strict with the BMI criteria because I wasn't sure what's the risk benefit ratio here. It's like you know, if you're 400 pounds and this will help you lose 100 pounds, 200 pounds that's worth the potential risk of pancreatitis, which we know that's one of the risks of these medications. So that's what we were really wanting to know is, if patients were going to get pancreatitis on a regular basis, then the risk benefit ratio changes.
Speaker 2:But after a year of treating these patients they just really weren't getting the serious side effects of pancreatitis or stomach prowess or gastroparesis that everybody hears about online. They were mostly having nausea and constipation and those were all very treatable. So the patients that we treat are pretty plentiful. We don't have a BMI parameter restriction anymore. The only things that we really restrict is the black box warning. We don't treat patients who have a history of medullary thyroid cancer, even though that really hasn't been seen in humans the way it was seen in lab rats.
Speaker 2:We don't treat people who've had pancreatitis previously due to these medications. If they had gallstone pancreatitis, then that's not the same thing. So if they've had pancreatitis due to these medications, if they had gallstone pancreatitis, then that's not the same thing. So if they've had pancreatitis due to these medications, we wouldn't treat them. If somebody seems like they have an eating disorder, we're not going to treat those people, like I said.
Speaker 2:Like I said before that we had a patient from TikTok that was asking about these medications for bulimia and so we dissuaded them from taking these medications just yet. But then the other group of people that we are using this on is our post-op patients. Maybe we did a tummy tuck on them several years ago and they looked great immediately post-op. But they gained weight through the pandemic. Then they might still have a nice figure underneath. They've just gained some weight. So in the past maybe I would have offered to do more liposuction on them, but that has its own risks. So we now offer them weight loss and these medications and they lose weight and they go back to that figure that they had right after their body contouring procedure and they're really happy. So that's how we've really incorporated into our practice.
Speaker 1:So for patients who are candidates for the prescription therapy, can they also be part of your platform or program, or are these only for people who are maybe like denied or can't afford their co-insurances for their regular medical plan?
Speaker 2:That's pretty interesting. The people that are in our program are from a lot of different backgrounds. But one thing that is a common theme, in California at least, it's patients who are with Kaiser, and Kaiser, at least in Northern California, won't prescribe these medications because Kaiser is the insurance company and the hospital and they don't want to have to pay for the cost of the name brand medication. So the patients can't get a prescription from their Kaiser doctor in Northern California.
Speaker 1:Even if they're obese or have diabetes.
Speaker 2:It's really really strict and based on the crowdsourcing information I've gotten about TikTok and it's funny to keep talking about TikTok in this podcast but that's just really where we're getting a lot of attraction, a lot of questions, and patients are saying that even if they have diabetes, even if they have a, even if they have a BMI at least above 27, they still can't get the provider to write a prescription for them, or they'll make them do like a six-month program first, and so it's a real hassle for Kaiser patients to get these medications. And so they're definitely coming to us because they know that even if they were willing to pay out of pocket for the name brand drug, one it's over $1,000, and two it's on a shortage list and they can't get access to the medication. So a lot of those patients are coming to us because they know it's significantly less expensive. So, for example, semaglutide, the active ingredient in nozepic and wagovi, is $500 in our practice, and tirzepatide, the active ingredient in Mujaro and Zepbound, is $600 in our practice. Now, that's not cheap, but it's obviously significantly less than a thousand to $1,300 for the name brand and, more importantly, it's easily accessible for us through the compounding pharmacy where they can't get the name brand drug. So we have people who have Kaiser that are coming to us.
Speaker 2:We have people that their insurance, just across the board, isn't covering the medication because, again, insurance companies don't want to cover it, and so they're coming to us regardless of their insurance. Or people have gotten believe it or not, people have gotten their insurance to cover it, or they've got a coupon card and they're paying $25 out of pocket each month, or they're paying $550 out of pocket with the ZetBound coupon card. But because there was such shortage, they just got frustrated with having to drive around, call around, looking for pharmacies that had the medication. People were driving to different states to a pharmacy where they found out that they had a supply there, and people just get tired of that. And they were even yo-yo dieting, but in a different context than what we're used to. They would lose the weight while on the medication and then they'd either lose their insurance or couldn't get the medication, and then they'd be off the medication for a month or two and they'd regain the weight.
Speaker 2:So yo-yo dieting in that sense. So they just got tired of that and they realized that with us, or with any of the providers in our network, that they can have a virtual visit, an in-person visit. We get lab work on them and, as long as they're not excluded because of medullary thyroid cancer or eating disorder or something like that, they sign up online, they're entered into an automated monthly subscription and we ship them the medication every month, and they no longer have to drive around to different pharmacies. The medication is just showing up on their doorstep. It's extraordinarily convenient for them.
Speaker 1:Now, is that shipped through your practice or shipped directly from your compound pharmacy?
Speaker 2:It can be either Different people choose to do this in different ways or different providers choose to do this in different ways.
Speaker 2:But we order the medication from the compounding pharmacy to our office and then we ship it out either via UPS or USPS, and we ship it on ice in a styrofoam box and with all the cost of shipping, the post with the.
Speaker 2:You know we ship it on ice in a styrofoam box and, you know, with all the cost of shipping. The postage plus the supplies cost about $20 to ship out each vial and syringe of medication and then we provide the patient with a virtual Zoom training on how to pull up the medication, how to do the injections. We also provide them with a video of how to pull up the medications so they know the appropriate amount to pull out based on their dose for that month, for the four doses of that month. And that's the way we choose to do it, because we control the supply, we're not having to wait on delivery from the compounding pharmacy. But we definitely have other providers we work with that have it shipped directly from the compounding pharmacy and if your compounding pharmacy is efficient and they don't screw up on shipping, then yeah, that works out totally fine.
Speaker 1:Yeah, I actually watched your video on the patient instructions and it was very clear and what I saw from that. As opposed to some of the patients who do the single use, you know you can variably dose and so right. And so I guess for your monthly shipments you just do a monthly shipment and then have them adjust based on their profiles as they change their dosages.
Speaker 2:Right. So that's what's really pretty cool is that with the name brand injector pen, that's like it's predetermined on how much it's going to inject, whether you know if it's semaglutide, 0.25, 0.51, 1.7 or 2.4, but some people we have found, whether it's semaglutide or terazepatide, that maybe they don't really, maybe they don't really need the 1.7 dose, maybe that makes them feel a little nauseated, but the lower dose, the one milligram dose, doesn't really have the same effect. So maybe they need 1.3 milligrams. Well, you can't really do that with the injector pen with any certainty. So that's what's nice about getting the medication from a compounding pharmacy is it comes in a vial and so you can teach the patient how much to pull up, and we never encourage them to take more than they should, but certainly if they want to take a lower dose, then they can customize that for themselves. That's the beauty of getting the vial and having the syringe that we send them, and then we, the way we educate them that they can adjust the dosage that they need that's appropriate for them or that works for them best, and we have a lot of happy patients. And then they they lose the weight, and the thing that's really cool about it is once they lose the weight and get to their goal weight. You know, a lot of them are nervous about stopping, because there's lots of evidence that if you stop the medication just like if you stop your high blood pressure medication you'll regain the weight even in the face of diet and ongoing diet and exercise.
Speaker 2:So what we do is we recognize that the cost of the medication is you know it's high. You don't necessarily want to do it forever, but you could do it forever. So what we do is we switch them over to less expensive maintenance subscriptions. And what that means is that you know normally when they're taking the medication to get down to their goal weight, they're taking one shot a week, four times a month.
Speaker 2:But they might find that one shot suppresses their appetite for more than a week. Maybe it suppresses it for 10 days or two weeks. So they don't need four shots a month. They can get away with three shots or two shots. And patients develop a very, very intimate personal relationship with these medications. They really know how they affect their body and they really get an idea of like okay, I can get away with two shots a month or maybe even just one shot every three weeks. And so we switch them to a less expensive maintenance subscription where we're sending them less medication for fewer injections at a lower price point and it's much easier for them to continue that for as long as they need. And that's again one of the beautiful aspects of getting from a compounding pharmacy is that the vial allows for that customization.
Speaker 1:That's really funny because a patient of mine was going on some sort of vacation with kind of an eating tour involved and didn't want to be nauseous and decided to kind of skip that week's dose for their trip. So it was really interesting how you're absolutely correct they can kind of customize it and tailor it to their lifestyle. I guess to some degree Now you know. I think the other interesting part is how you talk about the GLP-1s, for the name brand medications only have the you know one or two drugs in them, but I've heard that the compounded drugs have other ingredients. Can you comment on that and tell us if your compounder adds additional things like, for example, like B12 or some other agent?
Speaker 2:Well. So we use a lot of compounding pharmacies across the country because all the different doctors in our network depending on what state they're in, they may not be able to get access from one particular pharmacy. So we have a stable of pharmacies we work with, like, for example, anybody that lives in California. They know it's much harder to find compounding pharmacies that ship into California. But we know who those compounding pharmacies are, so we connect our providers with them, but they, if you're in a different state, like Michigan, you may not be able to use that pharmacy but you might be able to use a different one. So we have, like I said, a stable of pharmacies that we work with and they're all licensed in their respective states and multiple states. They're all sourcing the base ingredient from an FDA approved manufacturer. So our whole supply chain is legitimate.
Speaker 2:But there are compounding pharmacies out there and I'm not saying this that this is dishonest or there's something disingenuous about it, but there are compounding pharmacies that will mix the semaglutide base or the tears epitope base. None of them are really using the salt formulation anymore, but they'll mix it with B12. And I don't think that really has. I don't think that does anything deleterious to the medication. But the reason they're doing it is one. People will say, oh, the B12 helps people with nausea and things like that. Well, I don't know if that's really true and that doesn't necessarily hold for everybody. But the other reason I think that they're combining them with B12 is because the compounding pharmacies initially were worried about these medications possibly the name brand drug going off the FDA shortage list. And if they go off the FDA shortage list the compounding pharmacies can no longer make it. But their theory was well, if we're combining semaglutide with B12, well, then that's not a commercially available formulation and then we would be able to continue making the semaglutide even if the Ozempic went off the FDA shortage list. Continue making the semaglutide even if the Ozempic went off the FDA shortage list.
Speaker 2:And the thing is with the FDA is that, yes, that drug may not be commercially available the semaglutide combined with B12. But with the FDA, for you to be able to make something that's commercially available, it either has to be on the shortage list or what you're making has to be materially different. And I don't think just adding B12 to a semaglutide molecule makes it materially different. I think it's just semaglutide with something else. Now, if you change the semaglutide molecule, then, yes, that might be materially different. So my point is that I think that they were preemptively trying to protect their investment by adding B12 so that if these drugs did go off the FDA shortage list, they'll still be able to make it. I don't think the FDA would have gone for that, because you could have, like, said, you're adding B12 to any like high blood pressure medication that just came out on the market.
Speaker 1:That's really expensive, that's like.
Speaker 2:I don't think they would have allowed that. So that was the concern. Is that that's why I think they were adding those additives? Again, I don't think it really made the medication bad. I don't think there's we've happened to not use any of those medications that have those additives, but a lot of patients really like it. So we do offer B12 separately, as a separate injection that they can do weekly and they can do that as a subscription. We can ship out the B12. We source that as well for our providers. We can ship out the B12 along with the semaglutide or the tiered zapotide and it'll come out in the same shipment and the patient will, instead of taking one shot a week, they'll take the two shots a week the semaglutide and the B12. But the other aspect about that is that I don't think they have to worry about these coming off the FDA shortage list Because if you look at the fact that 42% of Americans are considered obese in America and if you take those 42% of Americans and if they're taking one shot per week, you know, four times a month for 12 months out of the year, the manufacturers would have to come up with 7.2 billion billion with a B 7.2 billion injections to keep up with the demand, and that's just for weight loss.
Speaker 2:These also have an indication originally, of course, for type two diabetes. They just added an indication for major cardiac events that these have been shown to reduce major cardiac events like stroke, fatal heart attack, non-fatal heart attack by 20%. They're eventually going to get an indication for heart failure with preserved ejection fraction. Medicare says it can be covered now, but that doesn't necessarily mean people are going to actually get it for free for Medicare. The point I'm making is that there's already a shortage with the three indications they have. There's going to be more indications. There's going to be possibly other insurance companies that cover it. So it's this if you think of these pressures on it, that if you get more indications, the supply goes down. If you get more people covering it third parties covering it the supply goes down. So I think it's going to stay on the shortage list for a long time.
Speaker 2:If you don't believe me, the CEO of Novo Nordisk, the makers of Ozempic and Wagovi. He even said on CNN back in September that he thought it was going to be several years before they could keep up with demand. They're buying up manufacturing plants to try and make more of it, although some of those plans just got delayed by the FTC. And then even if, like Ozempic, came off the FDA shortage list at one point, it's just going to be a revolving door.
Speaker 2:There's another drug called Retatratide that hasn't been FDA approved yet. That's made by Eli Lilly. That mimics glucagon, glp-1, and GIP, and they're saying that that has bariatric surgery type weight loss, and even though that's not FDA approved yet, compounding pharmacies already have the formulation for it. They're already prepared to make that when it comes out as a name brand drug, because that'll quickly go on the FDA shortage list. Amgen's producing a once per month injection. That's kind of hard to make because it's not just a protein, it's a monoclonal antibody which is a more complex protein, and so that's going to be even harder to manufacture.
Speaker 2:So I think something's going to be on the FDA shortage list. It may not be all the same drugs that are on it today, but it's going to be the newer, the latest, the greatest drugs are going to go on the FDA shortage list, and so I think that was all to say that the additives don't really make a difference and I think that they don't have to worry about things. They don't have to add the additives to keep to be able to say they have a commercially, that they have a product that's not commercially available, so they can keep producing it. That was a very long answer to that question, but I think it was encompasses everything I wanted to say.
Speaker 1:I think it was very interesting actually projecting sort of future supply and how it's all going to be organized as well. The other question I've had is with the compounded medications. I've heard that the expiration may be of a shorter period of time potentially. I mean, I don't know what the expiration for the name brand medications, but for patients that you ship a medication to, is that all like on the label or what do you advise them as far as you know how long it's good for?
Speaker 2:Yeah, certainly the expiration dates are on there. The buy use date varies depending on the pharmacy and where they're shipping to. Depending on the pharmacy and where they're shipping to Like, for example, a compounding pharmacy that ships to Texas could have a by-use date. That means when they first put the needle in and drop the medication it could have a by-use date a BUD of six months. But the same compounding pharmacy that ships to California, the by-use date would be 28 days. So I mean you got to go with what the law says, but it's just like kind of like you have to question okay, it's the same medication and depending on what state you go to, the by use state changes.
Speaker 2:But regardless, that's one of the cool things about the compounding pharmacies we work with is that some pharmacies will send you a vial that's got like three months worth of medication. Well, that's not going to be okay in California because it has the by use date is 28 days. You know you don't need three months supply. So that's what's nice about the compounding farmers we work with is that they actually are able to produce one month supply only vials, meaning that there's only enough in it for one month. So if you're charging the patient monthly. It's appropriate because you're charging them for only a one month supply and that's all that's in the vial. You don't have to worry about like two months worth of volume in there.
Speaker 2:That's going to go bad because the Bayou State is only for 28 days and it also makes it less expensive per vial because of the fact that it's just enough medication for a month. So the Bayou States you got to follow them. You don't want to skirt the rules on that, but as far as California, the Bayou State is 28 days. There's other pharmacies that are able to ship the medications not on ice, and their Bayou State is six months. But it really changes depending on the pharmacy and the inspection that they had by the State Board of Pharmacy and what state they're going into. So it's pretty complex. But again, by just shipping the patient a month's worth of medication, you don't have to worry about it. Well, they'll certainly take the medication within 28 days because it's a once per week injection, so it's not even a whole calendar month, it's only 28 days.
Speaker 1:Actually that kind of answered my question. With regard to those who are maybe slightly adjusting their medications or things like that. The drug is probably fine, but it may be just the way the states regulate them. So that was very informative. Now you talk about this sort of like large network of our providers. So can you explain to me, jonathan, because I thought that you were like a solo practice. So could you just elaborate on that again?
Speaker 2:Certainly. Yes, I am in solo practice. But when I was talking about our network providers. I was talking about the providers that are using our platform, Got it? That's all I meant, and they're all across the country dermatologists, OBGYNs, plastic surgeons, from all walks of life.
Speaker 1:Oh, that's great. And how many providers, would you say across the country, do you have on your Build my Health platform?
Speaker 2:It's a couple hundred now.
Speaker 1:Oh wow, in a few years it's a great build.
Speaker 2:It's really taken off and it's just the weight loss space is. The weight loss space is just really exciting because you have these medications that we've always told patients diet and exercise and whether it's insulin resistance or considering obesity to chronic disease, not a failing of self-control that you finally have this medication that really does work and people are quick to say, oh, they haven't been around that long. But people don't really realize that GLP-1s have been around for over 20 years. The first one that was approved by the FDA was Bayeta. That came out in 2005. And I know 2005 wasn't 20 years ago, but to get FDA approved they were obviously doing studies on humans before 2005. So it has been over 20 years.
Speaker 2:And people will say, well, they haven't been approved for weight loss for 20 years. Like, well, that's true, but the way the medication works, the medication itself doesn't take into account whether it's FDA approved for type 2 diabetes or weight loss. I mean, it does what the drug does, and so there's been weight loss effects with Bietta, but more so with Victoz and Zaxinda, which are daily injections of GLP-1s, and people are surprised to find out that Zaxinda is a GLP-1 that was approved for weight loss back in 2014. So that's even been around for 10 years and people are losing about 8% of their weight with that. And it's kind of wild, is that patients? Because these newer drugs Zimbicam, mijar and Zetboun are on the FDA shortage list, people are going back to the liraglutide. The active ingredient is Xenda and Victozine. They're willing to take a daily injection because it does still have weight loss effects, just maybe not as good as the weekly injections with Ozempic and Mijaru.
Speaker 1:And if a provider wants to go on this Build my Health, they would be able to contact you directly or go onto your platform. There must be some sort of link there, correct?
Speaker 2:Yeah, certainly they can go to the website. It's actually buildmybodcom, because we used to be mostly aesthetics. Now we've expanded out to build my health, but we haven't gotten the URL for buildmyhealth yet but buildmybodcom. Or they can just email me at drkaplan at ph, as in pacificheights-plasticsurgerycom. Drkaplan D-R-K-A-P-L-A-N at ph-pscom and we're happy to answer any questions for them. Our nurse practitioner, who helps run our program, is a great resource for other practices that have a weight manager program that want some advice on dosages or on side effect treatment. There's a lot of good medical best practices that I can help them with or a nurse practitioner can help them with.
Speaker 1:And as far as sort of, let's get back to, like, the single practitioner running this through their office. So let's say they decide to have the compound pharmacy deliver to their office. So let's say they decide to have the compound pharmacy deliver to their office, what staffing do you have that does all this like boxing and shipping? I mean, it just seems like I don't know. I'm just imagining like my garage with, like my deep freezer or something like that so how does that exactly work for you as far as the stream?
Speaker 2:So, as you alluded to before, you certainly can have the compounding pharmacy shipped directly to the patient, but then you just don't have as much control over like tracking the package or making sure that it arrives on time, whereas if you have it in your office. I feel like that's how a lot of providers are. They're like oh why would we do all this shipping ourselves? We'll just send it from the compounding pharmacy. But after you have a couple hundred patients, you're going and I think that's totally feasible for everybody to have a lot of patients in their weight management program that the weight management program alone can help cover all of your operational expenses, so that if you book somebody for surgery, that's just like money that can go in your rainy day fund like it's. It's not like Botox or lasers, where you maybe think that some of these things are lost leaders. The weight management itself by itself can be cover all of your operational expenses and everything else is gravy. But the thing is that if you do have a couple hundred patients, if you're having everything shipped directly from the compounding pharmacy to the patient, again the troubles you might have with them shipping it you're going to get tired of that and that's why you're going to want to incorporate it into your own practice eventually, just because it's going to be better customer service for the patient and better a lower anxiety for yourself for your practice.
Speaker 2:So, as far as the staffing, we just utilized our own existing staff. We had, you know, three staff members or four staff members when we started this and we didn't have to add somebody new until we got to about 200 patients. So it's really scalable. You don't have to go out and hire somebody right off the bat to start a weight management program if you only got one patient in it to start. So we waited until we got about 200 patients until we got an additional weight manager, an additional nurse who was a weight management program coordinator, but they were also a nurse, so they could be our recovery room nurse also for the days we had surgery in our in-office operating room.
Speaker 2:So you can be efficient like that and have somebody that has a great skillset. So, yeah, 200 patients before we got a new weight management program coordinator or got a weight management program coordinator. And because of the ability to control the situation more, control your supply, you know, if there's like bad weather, you know and you can't get the medication shipped to you from the compounding pharmacy. If you've got medication in your office, then you don't have to worry about the bad weather, at least getting it from the pharmacy. You can still ship it out to patients, or patients can come in and pick it up.
Speaker 1:Oh, that's what I was going to ask you, if that was feasible for your local patients.
Speaker 2:It is and we really give it, give them the option. So the medication costs that I mentioned the 500 and the $600, that already incorporates the $20 for postage and and and supplies, and that that that includes that is included in the medication, whether they're getting it shipped to them each month or whether they're picking it up. That way you know they don't cause. It would just be a crazy if we took $20 off people's medication with the assumption that they were never going to come in. They were never going to come in, but or that they were always going to come in Right Cause they could possibly do that.
Speaker 2:Yeah, give them that option, and sometimes patients will come in and they'll get Botox while they're picking up their medication. There's some patients that are nervous about giving themselves the injection and they come in every week to get the injection, but that's obviously not the norm and I will tell you that it is very clear to me that that is a big patient satisfier that they can have the medication shipped to them. Because most of these patients have already been on the name brand. They know what a hassle it is to go to the pharmacy to find it or to find a pharmacy, so they really like the fact that it's shipped. So I get that this will sound like a hassle to people that they have that their office would be shipping out the medication, but that's fine.
Speaker 2:Have the compounding pharmacy shipped directly to the patient and after you get to a couple hundred patients and you're having trouble with tracking the shipments and the patients are calling you all the time you'll incorporate it into your practice and you'll be able to and it'll just make everybody happier because you're getting the medications and everything shipped out on time. The other thing is that when you get started with this, as I mentioned, you don't have to go out and hire somebody right off the bat, and the other way to get your office staff on board with this is you offer them a discounted rate on their own medication subscription of semaglutin or Ters Epitide and they all will jump at that. They will all love the idea and they might not be obese, but they want to lose 10 or so pounds and I've determined based on all the research out there and in my own practice that the benefits outweigh the risks and that be at that 200-person kind of profile or are we talking about bigger practices?
Speaker 2:No, what I'm basing on as my practice is that we currently have 634 people in our program. We've treated over 900 people over the year and a half, and so a couple hundred of those have dropped off not because they weren't losing weight, but either because of cost, or maybe they got it approved by their insurance, or maybe they got to their goal weight and they're trying to see if they can maintain their goal weight. So currently we're at 634 of actively of active patients that are either on semaglutide terzapatide at the normal four shot per month dose or they're taking the maintenance. They're on the maintenance package of two or three shots a month. But that's 634 patients, and so the revenue based on that is $346,000 each month.
Speaker 1:Okay, so that's for your own individual practice, and I agree with you that can really kind of probably more than roll over operating costs for your practice and have the rest of it almost be like for fun, right.
Speaker 2:And you're treating a lot of patients who are like you know, we went into surgery partly because we like the instant gratification of operating on somebody and then they wake up with a perkier breast or um, or you've restored function to their leg, I mean, and and so that instant gratification is great, but you can only do so many operations in a month and the instant gratification associated with helping 634 people lose weight is very satisfying and it's made life, uh, happier and easier and I can spend a little bit more time with family. It really does improve a lot of aspects of your life that you're not feeling like you're under the gun to make sure that you have enough surgery this month to cover all your expenses. You can know that all your expenses are covered, all your employees will be paid well and that you can and whatever surgical patients are appropriate to schedule that you can. You don't feel any pressure in regards to that.
Speaker 1:Now you have patients locally. Do you have patients that you don't actually physically see, like people across the country, or are these all patients that at least somebody in your practice has, like, physically examined?
Speaker 2:No, if you want to scale your practice, you'll definitely have to have a portion of it to be virtual and I would say a majority of our patients are virtual and wherever I have licenses in other states I'm able to see them virtually and then we're able to send them the medication and we make sure that that state that they're in, that this particular compounding pharmacy has a license in that state. Just again, make sure we're doing everything as legitimately and correctly as possible. As far as not seeing the patients in person, I'm okay with that. We see them via Zoom. We get their check, their weight. They tell us how much they weigh to start off with their starting weight.
Speaker 2:We get lab work via whatever chain of labs are around them that we can place the order electronically. They can go in get their blood drawn. We get the results back by the next day, or the truth is, people are so labbed up in this country that everybody seems like they have lab work done within the last year, so we don't even necessarily have to repeat the lab work. We just get them to send what they have and they all pretty much have a CBC, a complete metabolic profile, a hemoglobin A1C and a TSH and we get that lab work on everybody, and the thing is that you get the lab work to make sure they don't have any underlying conditions that maybe they aren't aware of. But there's nothing really in the lab work that would actually preclude them from taking the medication. So you don't actually have to wait on the results.
Speaker 2:And let me explain what I mean that if their CBC shows they're a little anemic, well they need to know why they're anemic, they need to get worked up by their primary care doctor, but that's not necessarily going to preclude them from taking the medication. If their complete metabolic profile shows there's maybe some dysfunction mild dysfunction with their liver or their kidneys, well these medications have already been shown to improve fatty liver and to improve chronic kidney disease, so that wouldn't preclude you from taking the medication. And if their hemoglobin A1c is abnormally high, of course these medications are the treatment for that. And if their TSH is high or they have hypothyroidism, well then their hypothyroidism might be contributing to their obesity, and so they certainly should be on levothyroxine for that. But you're not diagnosing medullary thyroid cancer from an abnormal TSH, and so that's why that wouldn't necessarily preclude them from taking these medications. But we definitely check medication on everybody. We get their history with everybody and I feel very comfortable treating these patients virtually.
Speaker 1:Okay, and do you provide any additional recommendations regarding food choices or some sort of exercise guide in conjunction with the medications?
Speaker 2:Well, anybody that signs up for either our coaching program or our non-coaching program, we get lab work on both uh, both of those groups. Everybody gets a bluetooth enabled scale and a journal. And we do give patients the option of signing up for our coaching program where they can meet with our nurse practitioner who enjoys coaching. They can meet with that person of our nurse practitioner up to once per week virtually for six months and that's 11.99 and typically they already paid they've already paid $100 consult fee, so it's $10.99 to move forward with the six-month coaching program if they choose to. That doesn't mean they're locked into the medications for six months, but we definitely give them that option of going with the coaching program. But not everybody wants to do coaching and so in those cases it's $350. If they've already paid the $100 consult fee, then it's $250 to move forward with coaching, which covers the cost of the lab tests and things. And we send them a Bluetooth-enabled scale and a journal as well. But we don't meet with them once per week.
Speaker 2:We do send out a monthly survey to everybody every month to see how they're doing, to check what's their current weight, to see how much weight they've lost. But if anybody's having side effects. They're quick to call in as far as nausea, and so we're very, very quick to call in Zofran for anybody that needs it, and we really, really encourage them. It's, like you know, even though you've got a primary care doctor, since we're the ones prescribing this medication, we want you to reach out to us if you have any side effects and then we can treat those virtually as well. And, knock on wood, over 900 patients probably getting close to 1,000 patients, we've treated over the last year and a half.
Speaker 2:Nobody has had pancreatitis, nobody has had gastroparesis. Certainly nobody's had medullary thyroid cancer. I think that's even important to mention. I already said before that medullary thyroid cancer is mostly only seen in lab rats. But keep in mind that all the FDA studies, all the clinical trials that have been done for Ozempic, wagovi, mujaro, zetbound all of those medications, not one person had medullary thyroid cancer in all of those clinical trials. So again, the class of medications have been around for over 20 years and medullary thyroid cancer in humans has remained rare and unchanged for over 30 years. It's just not really something we're seeing in humans.
Speaker 1:Now, as far I mean, it sounds like your whole platform and program and what you had set up really was already, you know, ripe and perfect as far as additional marketing for something like this. Did you engage in any additional marketing specifically for this weight loss component?
Speaker 2:So I didn't engage in any of the traditional marketing, like certainly not Google AdWords, because that can be expensive, because there's a lot of direct to consumer websites out there that are spending a ton of money on marketing and so that increases your cost per click for Google ads. And keep in mind people are saying, oh well, there's no point in us starting a weight management program with direct to consumer, you know they're so much less expensive. But keep in mind that people are saying, oh, there's no point in us starting a weight management program with direct-to-consumer, you know they're so much less expensive. But keep in mind that direct-to-consumer websites they will start you on a lower price point because the lower dosage medications are less expensive, but each month they go up in cost.
Speaker 2:So it's sort of a bait and switch with the direct-to-consumer websites. The second thing is these medications will have side effects. They're mild, they're treatable, but if a person has a side effect and they're going through a direct-to-consumer website, they don't have anybody to call after hours and by having a provider that they've connected with in a clinic or they're an existing patient, it's going to be natural for them to call you to get the assistance they need or a little bit of hand-holding, and so that's why provider to consumer or practices doctor-patient relationships. That's why this is the better way to go for a patient rather than a direct-to-consumer website. So, going back to your question about marketing, is that it's much more expensive to do Google ads because of the direct-to-consumer websites have drawn up the cost.
Speaker 2:But the thing that has been most effective for me is TikTok, more so than Instagram. We've luckily had a lot of TikTok videos go viral. I do a TikTok live once a week talking about these medications. Email marketing, which is very inexpensive, has been really effective, and when I say TikTok, I'm not talking about paid ads on TikTok, I'm talking about just organic growth and really interesting videos about Ozempic and Wagovi, and there's some marketing issues out there that you know if you use the term Ozempic or you can't use that in a Google ad, if you were going to do that, that patients really know what GLP-1s are. Now so you can say that in a TikTok video or an Instagram video and the AI recognizes what you say and so that will help you not necessarily go viral, but it'll help you get more traction on your video on TikTok or Instagram if you use terms like GLP-1. So that's a little marketing pearl for everybody out there.
Speaker 2:But the cost of marketing has been very minimal. I do pay a person who comes out every week and we record a bunch of videos, but that pales in comparison to the cost of like Google ads, which I don't think would be that effective compared to how much you have to spend. But keep in mind that your existing database of patients in your practice they're all candidates for this medication. So all you have to do is produce an e-blast that you send out once a week, a couple times a month, letting your patients know that you're offering these medications and you're going to get busy quickly from your existing patient base, especially if you make it easy for them where they can do virtual visits or you're shipping the medication to them, or they can sign up for the subscription online. If you make it easy, they will pay. That's kind of my mantra.
Speaker 1:Now, of the, let's say, close to 1,000 patients that have come through your practice. What percentage of that would you say was organic from your own existing database? All of us who do plastic surgery to some degree discuss you know some way for the patient to either lose weight before or to maintain their weight after procedures. So in your percentage, what would you say like? Would you say like early on, at the year and a half ago, they were mostly your existing patients. Or would you say the TikTok viral outsource far exceeds your existing patient database?
Speaker 1:Just so a practitioner could expect, you know.
Speaker 2:Absolutely. You're really right to divide it up by early versus late. So early on, we had a really big email marketing database already, and so we got most of our patients from our existing database of patients, no question about it. But as I've gotten more involved on TikTok and Instagram and social media in general, we are definitely getting more patients from around the country, or at least in states that I have a license. We're definitely getting more patients now from social media, but early on it was definitely our email marketing with our existing patient uh database, and so that's that's. My point is that everybody can start there.
Speaker 1:Uh you.
Speaker 2:You've already got the patients. You don't have to like, think about, oh my God, I've got to go viral on Tik TOK to have a lot of patients. No, no, no. Just just reach out to your existing patients that you've already you've got. The best marketing in the world's, very low cost, is you send out an e-blast to your existing patients and you're going to get a lot of patients that way and then they're going to have a good experience with you.
Speaker 2:If you follow, kind of the recommendations I've made while we've been talking and that's going to spread by word of mouth, and then if you do get involved in social media, then you can certainly start to scale and have patients from all over your state, because that's the thing, it's not just people in your town, because we're not talking about people having to come and pick up the medication. Now the counterpoint people will say is that, oh well, I want everybody to come pick up the medication because that's more foot traffic in my office and they'll come and get Botox and we can upsell them to other things. I'm not denying that that's a possibility, but I think that you're going to irritate more people than you're going to get more Botox treatments. I think you're going to you're going to turn away more people who you require to come in if you do it that way. So, yes, I'm not saying that foot traffic is bad, I'm just saying I think you get more patients by making virtual and shipping available to your patients.
Speaker 1:Yeah, and I think particularly where you are too. I think the coastal areas for people to just get to you could be a whole trek in itself.
Speaker 2:Exactly, and I mentioned charging you mentioned in my area, and so people might say well, this is a higher net worth area. Charging five or $600 a month for the medications is feasible there, but it's not feasible in other states and I've been shocked at how this seems to not follow any economic theory whatsoever. Patients are willing to pay for these medications, no matter where they are in the country. People are. I mean people are. I mean there's providers that are charging more than $600 for tears epitide than you know. I mean people are. I mean there's providers that are charging more than $600 for tears appetite than you know. That's what we charge, but they charge more than $600 and they have lots of patients signing up and they're not necessarily in high net worth areas.
Speaker 2:It's really pretty amazing because I mean, people have been struggling. A lot of people struggle with weight their whole life and that's kind of one of the things I always bring it back to surgery patients. Like you know, you do a mommy makeover on somebody. Maybe they were unhappy with their breast and their tummy since they had their child 10 or 15 years ago, so they've been unhappy for 10 or 15 years and so they're really appreciative when you operate on them and you for their mommy makeover. But weight loss patients they've been struggling with their weight their whole entire life, so they're so extraordinarily appreciative and they'll write you nice reviews on Google or Yelp.
Speaker 2:They'll, if they do get any kind of surgery, even if they don't get surgery, if they send you their before and afters, it's. That's great for social media marketing, which, of course, is not paid. I mean we put I mean if one of the things when we send patients our Bluetooth enabled scale, they can take a screenshot of what the app looks like. It shows their trending decrease in weight loss with their Bluetooth enabled scale from their phone and they send us those screenshots of their graph of the last you know, two, three, six months and it's perfect to post on Instagram stories and that, right, there is great marketing that doesn't cost you anything, that your patients are helping out because they're showing you what their weight loss is and it's just very, very satisfying.
Speaker 1:Yeah, no, I mean, I think this entire discussion was, you know, very eye opening. I think it's something that is definitely value added for any practice. Now, just based on your expertise and after speaking to you, I can think of a few things for new practitioners to absolutely need before they engage in this, and obviously one would be contact with a compound pharmacy. What kind of recommendations can you give to people throughout the country in trying to evaluate or seeking a compound pharmacy to work with?
Speaker 2:So there are several obstacles which we figured out on our own over the last year and a half or more. Now there are definitely some obstacles. So one is finding the compounding pharmacy. That's tricky. Then you can start with Google searches, but that's not going to really tell you all the information you need. You have to find a compounding pharmacy that offers these medications, because they aren't all licensed to do that. Then you got to find a compounding pharmacy that has the lowest cost of goods, because some of them will try to charge you a lot of money or they'll try and offer you atrocious or trochies or lozenges which don't work. So you got to find the pharmacy. You have to see who's got these medications and then the lowest cost of goods. So if we're talking about the business aspect of it is that whenever you're charging, that you have a good profit margin there. And then, because as you get to the higher doses, if the compounding pharmacy is too expensive, then it's really hard for you to charge a patient a thousand dollars for the medication when they can go get the name brand drug for $1,000. Now, granted, there might be a shortage, they might have some more trouble, but that's not going to leave a very good taste in the patient's mouth that they're not even getting the name brand drug for the same price as the name brand drug. So that's why you got to find a compounding pharmacy with low cost of goods and that has a license in your state. That's very hard in California and other states like Mississippi and Alabama or Georgia. So you have to find the compounding pharmacy that has a license in your state.
Speaker 2:And then when you get to the compounding pharmacy, they have to be willing to send you a certificate of analysis, which is what they get from the FDA approved manufacturer where they're getting the base material from.
Speaker 2:That gives you the sense of comfort that what you're getting is really semaglutide base, not the salt, or it really is tiered epitide. And those are all the things you have to find with the compounding pharmacy. That's a lot of check boxes and that's why we have so many people who come to us, because we help them. We wade through all of that. Then the other thing is that some compounding pharmacies will require a minimum order, which may be a hundred vials. That's a big ask right off the bat, or they'll put you on a waiting list, like you might find the right pharmacy, but they'll put you on a wait list and then it'll take forever. Then after that, you know you've got to figure out how you're going to automate this, and if you want to try to manually charge people's card every month, that's just like a terrible idea, especially when the credit card fails.
Speaker 2:As I mentioned before, the dunning is a hassle if you're having to do it manually. So I guess I'm telling you all the pitfalls, all the hurdles but those are all things you have to recognize Absolutely necessary.
Speaker 1:I mean, I think that's, you know, for people to it all sounds good until you sort of work out what it does in terms of actually executing it.
Speaker 2:So I think and I'm not saying everybody has to make $346,000 a month for this to be successful. I mean, I think there's a lot of providers out there would be happy to have an extra $25,000 coming in every month with. I'm not saying with no effort, but just you know it's with with a 66 to 77% profit margin. You know, $25,000 a month, upwards of $50,000 a month, and that's what people can do. Within just a couple months they can get up that high.
Speaker 1:Mm-hmm. Now, in terms of the monthly recurring revenue, there hasn't been any like disruptions, like based on the site, like you know, because everything's on a platform for you which actually is yours, so I guess that's not the case. Actually, that was my question for people who join, build my health. Would they just be able to like join and then also get the compound pharmacy part, or they have to do that on their own?
Speaker 2:No, no, no. What we do is, I think we're almost like a consulting service, because not only do we help you with the sourcing of the compounding pharmacy, the way the system works is that the patient enrolls in your program through our platform. We process their transactions, we send the provider the proceeds from that transaction and then, whenever the patient is charged, our system automatically generates a prescription. That the provider goes into the platform and just reviews the information. That the provider goes into the platform and just reviews the information, makes sure you know, because everything is auto-generated. Because when the patient enrolls, they put in their first name, last name, email address, address and date of birth, all things the compounding pharmacy may need and when you use the platform, the provider puts in their NPI number.
Speaker 2:So when the patient is charged through our platform, that auto-generates a pre-populated prescription that's got the patient's name, date of birth, what the multiple shipping addresses, the doctor's name or the provider's name, the NPI number, and because our system also automatically tracks what dose they're on because, remember, their dose goes up each month and there's a lot of providers out there that are using spreadsheets to track dosing Our system automatically tracks the dosing and automatically increases each month, every time they're charged. So our system is able to auto-populate that prescription. So the provider just reviews the prescription and clicks submit and that goes electronically to the compounding pharmacy. So it's really this whole turnkey system where, yes, we're connected with a compounding pharmacy, but there's even more to it than that we're automating the charges, we're automating the credit card failures, we're automating the prescription creation, we're automating the dosage tracking. There's really no other way to do it if you want to scale.
Speaker 1:Is this for these services? Is it subscription-based or a monthly charge?
Speaker 2:or how does a practitioner go about so if we're talking about our platform, then it's an annual fee of $7,500 for the provider and $7,500 based on you know, if you're charging, if you're just doing semaglutide $500 a month based on the profit margin. If you exclude, if you take out the cost of goods, that you would pay off $7,500 with 21 patients. That could be 21 patients in the first month. There could be seven patients over three months. However you want to do it, after that it's all profit. So they would sign up for the platform for an annual subscription of $7,500. Then they would process all of their patients through the platform and we keep three and a half percent to cover merchant services, credit card fees. And then what we do that's pretty cool and it's actually from a legal perspective. It's actually even better is that when the patient is charged say, for example, $500, the cost of goods for that low dose of semaglutide may be $55. What we do is we withhold the $55 and we send that to the pharmacy. That way, what we're sending to the provider is just the pure net revenue. They don't have some big compounding pharmacy bill at the end of the month.
Speaker 2:Now anybody listening to this might say, oh well, I've got a big compounding pharmacy bill at the end of the month and I use you. Well, that's in the past by the time they hear this podcast. That's how we were doing it. We've already implemented this new way of doing it. That really is a nice way of separating things out. Which makes it even more legal or legit is that instead of sending the doctor all of the money, which includes the cost of goods and their cost for providing the service, now we're just sending the provider their cost of providing the service and we're handling the cost of goods, paying that directly to the pharmacy. So now what the doctor gets is the net revenue and in some ways, other than that initial $7,500 subscription, they're really not having any ongoing out-of-pocket expenses for this weight management program. Because they're not having to pay out-of-pocket expenses for this weight management program, because they're not having to pay out-of-pocket for the cost of goods, that's automatically being deducted from the patient's payment that we process.
Speaker 2:Correct, all right, Thanks, yeah, it'll be. Yes, it'll be three of us on the panel. We're meeting at 8 am on Sunday, september 29th. So for anybody in San Diego, please stick around at least through 9 o'clock Sunday morning on September 29th, or actually 9.30, I think it's an hour anda half panel and it'll be three of us speaking, so it'll be interesting to hear everybody's perspective. And a couple of the presenters have published research on these medications, so that'll be interesting to hear their perspective as well.
Speaker 1:And is there any final thoughts that you'd like to add to our listeners, because I think there are going to be a lot of people probably listening into this podcast.
Speaker 2:Really just reach out. We've like I said myself my nurse practitioner we've really done a lot of the. We've addressed the learning curve. So if you have questions, reach out Again. My practice email address is drkaplan at ph-pscom.
Speaker 2:This is a very exciting field. This is not going away anytime soon. This is certainly not a fad, but there is a right way to do this that is legal and is very satisfying for you as a provider that you're helping patients at scale and it's obviously very good for the patients. They're losing weight and you know people always try to bring up all the negative aspects of oh you don't know what the side effects of the medication. You know gastroparesis, which is rare.
Speaker 2:You know medullary thyroid cancer, and what I always try to explain to people is that the serious side effects of not taking these medications, of getting type 2 diabetes and high blood pressure, are going to be more likely than the serious side effects of you taking the medication. I mean it's clear that taking the medication at this point has so many more benefits than remaining obese and just treating your high blood pressure, treating your type 2 diabetes. I mean the truth is we just need to treat the underlying cause, and so it's been a lot of fun to be a part of this and I appreciate you having me on to speak about it.
Speaker 1:Yeah, Thank you so much. All right, we hope you enjoyed this episode of the Enhance your Practice podcast series brought to you by ASPS University. You can listen to our other episodes on other podcast platforms. You can listen to our other episodes on other podcast platforms or you can download recordings directly from ASPS EdNet. New episodes coming soon.