Revolutionizing Access: A Seamless Patient Experience with Dr. Paula Muto
Hello. Welcome to the Healthy Enterprise. If you're returning, welcome back. If it's your first time, then thanks for joining us. My guest today is doctor Paula Muto.
Heath Fletcher:She is a general and vascular surgeon out of her clinic, the Muto Vein Center in North Andover, Massachusetts. She's also the founder and president of UberDoc. UberDoc is an online system that provides priority access to the best doctors at an affordable transparent price. It's designed to help you get the care you need when you need it in just a few clicks. So if you wanna learn more about this as badly as I do, then stay tuned.
Heath Fletcher:We'll be right back. Welcome, Paula, to this episode, and thank you for joining me today. I'm excited for you to share your journey as a surgeon and also as an entrepreneur because you've got some interesting you had some interesting interesting things going on. And so let's start with, you know, explaining to everybody your background, where you came from, and what you're doing.
Paula Muto:Great. Well, first of all, thank you, Heath, for for inviting me today. I'm really excited to be here. It's a great podcast. So I am a surgeon.
Paula Muto:I'm a, a vascular trained general surgeon. I have, come from a long line of surgeons. My dad was a surgeon. My My brother is a surgeon. I'm married to a surgeon and two uncles, all in health care, all in Massachusetts for a collective century.
Paula Muto:So that's who that's who I am. I am I live out I live outside Boston. Lived here pretty much my life. I have a couple of kids. And and I'm trying to disrupt or rather restore health care because I'm very passionate about it.
Heath Fletcher:Amazing. So so yeah. That's a generations of of surgeons. Now are the kids on the same track?
Paula Muto:No. I have one who's an engineer and one who's a an aspiring actor and producer.
Heath Fletcher:Okay. Okay. Awesome. So the backstop story,
Paula Muto:I say. Talked with us. Okay.
Heath Fletcher:So, well, first, tell us about Muuto Vein Center because that's that you've you've been running that company a little bit longer, and then we we can get into Uber Doc after that.
Paula Muto:Sure. So I've been a solo private practice surgeon pretty much my whole career. After I finished my vascular training, I worked very briefly for a a group. Had my second child. I had my first child while I was in fellowship, my second child.
Paula Muto:And and then and then actually kinda came back from maternity leave and lost my job for being gone too long on maternity leave. A three month unpaid maternity leave. So, yeah, things have changed maybe. Yeah. So I sort of, like, landed my dad's office in inner city Lawrence, which is a poor community outside Boston.
Paula Muto:He'd been a surgeon there for twenty plus years, and I just landed in my dad's office. And I said, okay, I'm going to not work for anyone else again. And so I became a solo private practice doctor almost by necessity at first and by by, by, choice soon after. And so it gave me a unique perspective of running a practice, you know, the ins, the outs, the billing, the collecting, everything. So nothing was a mystery to me.
Paula Muto:So as, and so with that, you know, I ran my practice. My husband was with me for a while, then I sold him to the hospital. He's, again, was chief of trauma, chief of surgery. He's sort of at leadership positions. And so then I was always doing vascular, and I began to do ambulatory venous procedures, which was started back in 2005 and 02/2006.
Paula Muto:We were one of we were one of the first centers. Actually, we were the first center in Massachusetts to be nationally certified. I have a brilliant team around me, a wonderful group of people who've been with me that for many years. And we do a good job for our patients. And so so I built this the vein center, and I still do general surgery call now.
Paula Muto:We have lovely residents in both family practice as well as general surgery. And so I really like young people a great deal. And we're just trying to keep the, keep the access to care in the community open, to to good and high level care.
Heath Fletcher:Okay. You brought up leadership, and and, you have a great team. And and, yeah, we can't do things on our own. We have Yeah. People with us.
Heath Fletcher:So how how do you how do you lead a team of people in in your organization?
Paula Muto:So I always say the best people I never chose, they came to me. I'm a I'm a I mean, I've been an employer for, oh my gosh, whatever, almost thirty years. Right? And there are lots of people and that you've had along the way and some good, some bad. You know?
Paula Muto:And most doctors will most business people will tell you this. Right? You know? Who works for you and so forth? You you have to know you you learn a lot when you lose an employee and you or they you find out they haven't been doing something.
Paula Muto:You suddenly learn to do that. The problem with, as a woman entrepreneur, as a woman in charge is that we tend to do everybody's work for them. Like, you know, women's style of leadership is like, oh, my biller wasn't doing that. I'll just do that. You know?
Paula Muto:And then I'll do that. And then next thing you know, you take on so much so much responsibility that you're, like, sort of under, you know, not enough time to do the things that you're actually trained to do at the highest level with the best revenue.
Heath Fletcher:Right.
Paula Muto:So so, so how do you do it with leadership? I mean, you you take a lot of punches. Right? You you have to roll with the you have you take you had roll with the punches rather. You really have to be flexible, and you have to understand people and what their limitations are.
Paula Muto:Not everyone is going to understand when you turn on electronic record how it works.
Heath Fletcher:Right.
Paula Muto:Right? Right. Not everyone's gonna understand even can put a a sequence of 15 numbers into the computer properly in it in and reliably. Right? There's just you have to just know the limitations of the people around you.
Paula Muto:And then like I said, the best people grew with me. I had a nurse that was with me for twenty five years, and she was an ICU nurse for forty. And she was, you know, she was amazing. She is amazing. She retired.
Paula Muto:And it's like, you know, she wore the white stockings, the white shoes. She wore the hat if she could, and she trained every nurse, in the community. It was a true angel. And it was amazing that my patients would meet her in the office and then wake up in the ICU, there she'd be. Oh my god.
Paula Muto:Doctor Amuto's nurse is here to take care of me. So I can't have to say made my work shine. Right? And I get and, of course, my dad was a great surgeon with a great reputation. My husband also everyone the the ones that everyone show you know, when you need someone, they go.
Paula Muto:Right. They show up. So but but that's it. You know, you you surround yourself with good people.
Heath Fletcher:That type of dedication too, is that something that is learned, or is that innate in some people? Like, I mean, this this nurse that you were referring to, it's like she was on the spot when she needed to be, and and do you find that we were we've lost some of that in in
Paula Muto:our society? I think so. I think that because there's so much gratification in taking care of someone well. There's so much. And right now, our doctors feel so lost because they are either forced to not take care of a patient well, which is leads to moral injury, right, and burnout.
Paula Muto:Right? Or they they are on they're unable. You know, like, they're not connected enough to the patient. You know, at primary care, their patient's really sick. They end up in the hospital, and the hospitals takes care of them.
Paula Muto:Right? So at the time of need at the sickest, they oftentimes don't see their their patient. Right? And and I think that those relationships are are are forged when the patient's in the most amount of need is the is the highest amount of trust that they give you. As a surgeon, you're lucky because, you know, you do work in a hospital, you do in the off you know, I mean, you have a very different relationship with your patients.
Paula Muto:But but I think that that for sure, you know, we've lost a little of it just because of the way we practice medicine today.
Heath Fletcher:And, guess, probably the strains to health care too. Right? We just don't have the time or the availability or the staff to do.
Paula Muto:So my I see so my nurse, Barbara, used to talk about the seventy minute hour. Right? Like, other words, in sixty you have sixty minutes because you gotta do seventy minutes worth of tasks. And and and and I and and 90% of them have nothing to do with taking care of the patient. They have to do with, you know, taking care of, like, you know, a documentation or some type of, like, get a medication of the Pyxis.
Paula Muto:There's so many steps involved in everything. You know, I have to say that, hopefully, that will change with AI and some of the technology that we kind of are returning back to much more common sense approach, because all that data can be captured in so many more efficient ways than to waste the, you know, the the the caretaker's time accumulating it.
Heath Fletcher:Right. What are some of the other challenges that you've overcome over the years, during this experience?
Paula Muto:You have a long no. How long have you gone? So as experienced as a surgeon, you know, I have to say that, you know, as a woman surgeon, there's all sorts of challenges there. The biggest challenge, of course, is being you know, is compensation. You know, people women doctors still make 70 to 80% of a man, even though we do the same thing.
Paula Muto:Right? My husband and do the same thing, but it's just different. So you have to work a little harder, you have to fight a little harder, and you have to do a little better. Like, your patients, there's not as much wiggle room. So that's why, you know, study after study show that women doctors, especially surgeons, have better outcomes.
Paula Muto:And I think it's because we can't afford a bad one. Right? You know? And that's and that's it's so weird because, you know, 50% of medical students are women. 50% of our surgical training is are women, but it sort of doesn't trickle all the way up.
Heath Fletcher:Yeah. It's hard to believe we're still hearing this. You know? You know, even though it says public and as and we're you know, people are aware of this, but we hear it, but then we think, oh, well, I'm I'm hearing it. It's somebody must be resolving this.
Heath Fletcher:And where do you resolve that? How do you how do
Paula Muto:you resolve that? Know what? I think it's economic hate, and it's and if you look at the economics of the 80% world, we're still 80%. Right? And I think that, that that we tend to be distracted with other things like opportunities and, know, we're gonna give you a promotion and this.
Paula Muto:But, you know, when you really look under the hood, you see that women start at a lower starting salary in every profession. Mhmm. And then they get promoted accordingly, but they start lower. Mhmm. So until you change the boardroom to 30% women, until you get enough women at the top of the heap but, again, if each everyone's trying to get there, it's just harder.
Paula Muto:Mhmm. So I think I think those I don't have all the answers, but I think those I I'm very, very cognizant of making sure people are still aware of that. Now I'm sort of a maverick. Right? I work for myself Right.
Paula Muto:Because I'm not gonna work for anybody else. Right? And that comes with its pros and cons and its economic challenges as well. And when the economy is good and the reimbursements are good, you're good. When, you know, the costs go up and the reimbursements go down, you're not.
Paula Muto:Right? It's like you don't have that, like, salary to rely on. Right. It's gonna happen no matter what. Right?
Paula Muto:You know, if my husband's patient doesn't pay him, but he still gets his paycheck. Well, maybe now he was a steward doctor, so I don't know. It's like, I'm gonna go there. But for me, I can do, like, 10 cases. And if the insurance doesn't pay me, like, or the patient has to pay me and does can't afford it because they didn't know their deductible or what coinsurance, you know, I it's me.
Paula Muto:Right? I gotta pay my staff. It just falls on me. So so those are the challenges. But I do think that so those as in terms of surgery, yes, the surgery but surgery is a brilliant field.
Paula Muto:We've made so much technology. Just my vein center alone, what I used to do in the Operating Room for two to three hours, I do in my office in eight minutes with a much better result. And, you know, I don't even operate on your carotids. I I give you statins. You know, we have our wound care is phenomenal, so we are able to salvage so many limbs and keep people walking and keep their legs with them without a lot of interventions that were really were very difficult for patients.
Paula Muto:Hours in the Operating Room, hour you know, days in the ICU, and and all those those those procedures now are really technology has improved them incredibly. And that's one of the reasons why I I wanted to disrupt health care because I saw that we were changing how we take care of patients, and we still have this clunker of a system built in the sixties when everybody got admitted. And it's like, no. No. No.
Paula Muto:No. No. Time out. We have to meet meet patients where they are. We have a new system, and we need to bring the technology of health care to match the technology of medicine.
Paula Muto:And that's what inspired UberDoc.
Heath Fletcher:Yes. Great segue, by the way.
Paula Muto:I just kinda have to well, no. I mean, it literally happened with a lot of angry letters. Right?
Heath Fletcher:UberDoc. Yes. That that is, you know, I dug into the website a little bit, but very, very cool. I'm I like where you're going with this. So explain.
Heath Fletcher:Tell us about UberDoc and and what what brought you to this decision.
Paula Muto:So I think, again, everyone always asks me, what was it? You know, when you're an entrepreneur, you wake up with it sort of edgy. Now my dad was an inventor. He was a great thoracic surgeon, a lot of inventions. He modified a lot of things.
Paula Muto:He saw a problem. He said, I wanna solve this. Very much like my son, the engineer. I was a problem I wanna solve. Right?
Paula Muto:Right. And, my daughter, she sees a problem. She wants to create a fiction. Right? An actor, she wants to, you know, produce something.
Paula Muto:You know? Again, it's solving problems. Right? You wanna create a work. So so what so he was very passionate about making inventions and working with young people, and and he would patent them, and then he'd sell them out to a company, the company would manufacture it.
Paula Muto:So so I was having an itch. Right? I I really felt that being in the trenches, I could see so many of the trends happening ahead of my colleagues. Right? Because I wasn't just getting a paycheck.
Paula Muto:I understood. And I used to see my patients struggle, right, all the time with their deductibles, their referrals, or authorizations. I worked with, like, a lot of inner city people with limited resources and limited access to, you know, insurance and so forth. I witnessed, the pre Obamacare, Romneycare, Obamacare. Like, I lived through all of that.
Paula Muto:Right. So I saw how it impacted patients and the flow of traffic and patient care. And me, I saw the so seeing all of those, I'm like, wow. There's a big disconnect. I noticed it right away.
Paula Muto:Huge disconnect between being able to service a patient in a modern way and what the and what the narrative is. Yeah. Oh my god. We need billions of dollars for this. It's like, but do we?
Paula Muto:We don't need billions of dollars. If a patient comes directly with a breast lump to a breast surgeon, you can put a needle in it. You can figure it out. Right? Because I do a lot of women's health, a lot of breast work.
Paula Muto:And it's like, but no. Let's have them come back and then come back again, and let's do one breast. Let's do the other breast because the sum of the parts is greater than the whole because now you can generate five billable events
Heath Fletcher:Oh, no. As opposed
Paula Muto:to one. But it's like, but you have a patient with a lot of anxiety. You wanna just nip it in the bud.
Heath Fletcher:Yeah.
Paula Muto:But nipping in the bud is not in some boardrooms, and I'm gonna say, like, probably, HBS boardrooms. They looked at that and said, recurring revenue model, you've gotta bring them back five times. Right? As opposed to understanding how patient care really happens. You take care of that patient efficiently.
Paula Muto:You can have four new patients in your waiting room the next day, and that's where all of the delays come from. That mentality of breaking patients into, I say, horcruxes, like multiple pieces.
Heath Fletcher:Yeah.
Paula Muto:Right?
Heath Fletcher:It's not putting
Paula Muto:opposed to just taking care of their problem.
Heath Fletcher:Yeah. And it's not putting the patient first. It's putting the
Paula Muto:company first. It's putting the billable event
Heath Fletcher:first. Yeah. Right.
Paula Muto:Yeah. You know?
Heath Fletcher:Okay. So how's UberDoc gonna fix this?
Paula Muto:So so I had, thought, well, I wanna just solve one problem. Yeah. Access. That's it. I just wanna make it easy.
Paula Muto:That's it. I I didn't I didn't think that if a patient went to the emergency room and said, you know, you have a kidney stone. And they said, okay. Now what do do? You you need a urologist.
Paula Muto:Okay. I don't you know, go to your primary. I don't have one. That's a common discussion about the treatment. So it's like, okay.
Paula Muto:What could you do? You could if you could go online and find a urologist nearby available and make an appointment. Now what stops you from doing that? Well, the system stops you at the door. Do you have the right insurance?
Paula Muto:Do you have the right referral? Do you have the right authorization? Do you have the right employer? Do you have the right money? Like, are you the right zodiac sign?
Paula Muto:Right? I mean, there's a million things that stalk you. Right? So how do you get rid of all that? You make it cash.
Paula Muto:But rather than make that price prohibitively high, you made that price just above Medicare for legality. K. So so with our Uber doc model, what we were trying to do is solve that one problem. Find a doctor nearby available, make an appointment. We're an appointment maker and a payment processor, but the payments are not through insurance.
Paula Muto:They're through direct pay with your credit card or health savings account. So in other words, the patient now is empowered to make that appointment and pay that, and the doctor's giving a transparent price. And the price is fair. It's not a super high price, and it's not a super low price. It's a doctor price, and it's compatible with in compliant with Medicare.
Paula Muto:So it's like a 1.25, 1.5 Medicare price. What does that mean? It means that the patient can now go find a specialist nearby. They will make an appointment, get an answer, get right in priority access, and get it all paid. And the doctor is very happy because they're getting paid for that visit at the time of the visit.
Paula Muto:It sounds very simple Yeah. That it's in transactional, but it's completely opposite of how things happen now. Yeah. And then subsequent care could be through insurance. It could be through direct pay.
Paula Muto:You might not need anything else.
Heath Fletcher:Right.
Paula Muto:But now you've seen an expert. You've gotten your question answered. So rather than, like, you know, if you twist your ankle and you go to an urgent care, they may do some X rays, which you're paying for, then you go to your primary, which you're paying for, and then they send you for more X rays, which you're paying for. And then they send you to the orthopedic, which you're paying for. So now you've left work five times.
Paula Muto:Right? And and you haven't gotten your problem solved. Your ankle still hurts. What if you could just, instead of going to the urgent care, just walk into an ankle surgeon or an ankle specialist immediately Right. And pay a transparent price?
Paula Muto:And that's where what Uber Doc does. It allows direct access to definitive care for a transparent price. And then we're only the first date. We're only the first date. You know?
Paula Muto:We're not a bundled care. We're not we do have all our orthopedics will snap that picture of your wrist because it's they already have the tech employed. It cost them nothing. It probably cost them more to bill that X Right. Be very sure.
Paula Muto:They're gonna get paid $12. They're gonna pay $15 to bill. Right? So people who understand how billing occurs and collecting occurs are very happy to take payment up front to take care of you because that means so UberDoc was created for doctors to have give me a seat in their waiting room, improve access, and a little bit of cash flow. One or two UberDoc patients a week can pay your front end.
Paula Muto:Right? And it was created for patients to have convenience
Heath Fletcher:Right.
Paula Muto:Accessibility to definitive care. There's a lot of access points out there in digital health. You can talk to Talkspace. You can talk to MAs. You can talk to probably AI bots at this point.
Paula Muto:Right. You know, there's, like, a lot of, like, unclear care out there. And I have to say, UberDoc is in person, but we also have telemedicine as well. Doctors can be available both. Right.
Paula Muto:And and so it's really about access and price transparency to definitive care.
Heath Fletcher:And it's geographic too. So it it you're dealing with the patient in their geographic location.
Paula Muto:In their geographic location. Telemedicine allows us to go to the state borders, but we follow all of the rules. Nobody is you're only talking to someone licensed in the state. But but, really, most of our doctors are in person. Most of this is the orthopedic or I need to see or have a breast lump or I want to just I want a second opinion on something.
Paula Muto:I mean, that's who uses UberDoc. Right? They just wanna get in. They you know, either because it's situational, they're traveling, and they need to get seen. They're, you know, they're nervous.
Paula Muto:They wanna just be you know? And now it's like everyone's paying so much to just go to their doctor with insurance. It's like it's becoming, like, much more efficient and cheaper to not use your
Heath Fletcher:insurance. Mhmm. And then that
Paula Muto:And, also, I believe that patients should have choice. I I don't think your employer should decide where you should get your care. That I find Yeah. Profoundly offensive because it's a it's an invasion of your privacy. And and there's no reason why you have to drive 50 miles to see a doctor when that urologist might be, like, two miles away from your work.
Heath Fletcher:Do you see insurance companies maybe, being becoming more flexible in in this type of a model?
Paula Muto:Oh, for sure. Insurance companies from the very beginning loved UberDoc. I gotta tell you. Right. Because we were tasked by CMS early on.
Paula Muto:They really liked our model to say, well, talk to Medicare Advantage folks. We don't want them to we don't want our Medicare Advantage folks. So a lot of them said, you know, they had such restricted networks. They liked UberDoc as a second choice because they knew the price was guaranteed. And and in Medicare, it's really funny because for a Medicare patient, we're completely compliant.
Paula Muto:It's only $50. You they put you pay $50, and then you can bill Medicare the rest. So it's like it's just $50. So we always say we give patients the advantage for only $50. Yeah.
Paula Muto:That's good. In a Medicare Advantage model, it's it's like everything else. It's gonna be the full price because it's like insurance. But it was interesting how CMS really wanted to encourage this model of of choice because it gave more access. At the end of the day, people just want to make sure that there's affordable access to qualified individuals, and that's the that is the space UberDoc fills.
Paula Muto:And it's funny because our relationship with the government continues because our one of our biggest customers is actually we do we we manage appointments for, the veterans, disabled, fit for duty.
Heath Fletcher:Oh, perfect.
Paula Muto:Yeah. Yeah. So so people who under you really need to make appointments, and they there's no really easy way to make an appointment for these folks.
Heath Fletcher:Did you have resistance in the beginning? Like, was this when you started pitching this idea? Did you have setbacks? Oh, this isn't gonna work or oh,
Paula Muto:I don't know. When I I started my doctor's lounge. Right? And I it was only for six core surgical specialties at the beginning. Like, the orthopedics, the ENTs, the gynecologist.
Paula Muto:And I pitched them. It was like, oh, yeah. Sure. Like, we'll take a patient for cash because because a surgeon, a specialist is thinking of a case. Right?
Paula Muto:Right. I don't like like, I I learned this through my many, many years in my vein center. We do what we call free vein screens. Right? I put an ad in the paper with ugly legs, and then people come in and say, oh my gosh.
Paula Muto:I have restless leg. I didn't know, and that it was related to veins. And then it's like lures, like, come from all over. Right? And you solve their problem, and they kiss you.
Paula Muto:So it's like, this is great. So so there so the concept of, like, jumping directly in front of the patient with with care, direct to consumer medicine, I think, is for sure. Doctors need to be front and center with their skill sets to the patient. You you can't wait till it gets filtered through Yeah. Whatever the acceptable red you know, systems are and so forth, because I do think there's a lot of creative innovation out there and really a lot of relief, and there's a lot of trust with doctors.
Paula Muto:Right? I mean, you know, again, qualified doctors. There's a lot of trust. So so so that's so so that's how, like, you know, that's how we kind of built, you know, the concept of, I didn't get any resistance among the doctors. The the the places I started to see resistance was were actually the offices.
Paula Muto:Oh. Because now, you know, an office manager is, like, you know, is, like, you know, they're evangelists for insurance. Right. Like, need your copay. I need your deductible.
Paula Muto:Go home unless, you know, those big signs in the office. Do not even think of coming into the window until your insurance card has been, you know, with you know? So there's been a lot of, like, front end people who are so used to taking insurance. They can't understand a patient who just wants to be cash. And then what's happened recently is all the consolidation has produced centralized scheduling, which is the most impersonal way to deal with patients so that the doctor in the front end who's dealing with the patients gets like the older patient who shows up on Tuesday.
Paula Muto:Their appointment was supposed to be Thursday. Oh. And the and the office manager has no way of opening the window in Epic because the windows have been closed off to them because they are supposed to be central scheduling, which is now overseas. What? It's not even like, you know, which which is a whole issue with with protecting patient data.
Paula Muto:And the one of the biggest reasons data is hacked all the time is because these overseas the central scheduling has been outsourced, and there's not a lot tech issues there. Yeah. That's one of the biggest reasons you where things get hacked because, you know, unless you're under one roof, it's HIPAA. If you cross if you try to communicate if I'm HIPAA and you're HIPAA and I try to hand you something, the the connection is not secure. Right?
Paula Muto:It's not physically possible to secure HIPAA HIPAA secure connection. Yeah. So it's like the Houthi rebels, right, in the Gulf Of Aden. Like right? I mean, it's like it's you're so those are some of the challenges we've had in terms of implementation.
Paula Muto:The physicians have always been on board. The systems have been on board. And like I said, the insurance companies don't care. They're not paying. Anytime you go without insurance, they're perfectly happy.
Paula Muto:As long as they get their premium, they don't. And as long as they had the Medicare Advantage folks were like, well, if they need surgery, do they still need approval? I said, of course. If you're paying for it, you still follow the same rules.
Heath Fletcher:Right. So when this so when this rolled out, you started with just just surgeons or just Pacific Care. And then how did it how did it expand from there? What what did you do to grow?
Paula Muto:Doctors were like, why can't I be on this? Why can't I be on this? And then we realized it was actually the direct paid primary care doctors who have now really come to the forefront as the highest, standard best outcomes Oh. For, you know, medicine, who said we we want a bigger network, and and we wanna be part of it. So I just followed the lead, and then I decided we were very at the very beginning, we were a subscription model.
Paula Muto:So I pulled the subscription. I said, any doctor can join this qualified for free. We put a freemium model it. It said, just give me a seat in your waiting room. So now we have closing in all about 6,000 doctors that are joining the platform.
Paula Muto:People join every day, actually. Amazing. And it's just like my goal is to have seat in everyone's waiting room. My my dream was that you could walk into anywhere and see the Uber dock sign in the window. Like, you know, it's like Discover card or something.
Paula Muto:It's like, oh, you're Uber dock. Oh, good. I'm gonna I'm gonna pay with my HSA. Right? You must you know?
Paula Muto:Or I can make an appointment differently. Like, the concept that that becomes a cash price that's already negotiated. It's already predetermined because most of the time, the front end doesn't know. Like, you know, you look at my charge master, it's $500 to see doctor Muto, but it's not really. That's the charge, which is, like, you know, inflated, and the actual price is somewhere buried in there.
Heath Fletcher:Yeah.
Paula Muto:You know? And, you know, so I think that that helps, you know, again, transparency and access are are mission is the mission.
Heath Fletcher:So someone gets on the site, they find the type of doctor they need, they choose from the list, they submit it there. What's the turnaround? Like, how quickly do they get an appointment?
Paula Muto:Well, they they can choose. Like, the doctors are ranked by, I think, proximity and availability. So doctor one miles ahead of doctor two miles, but doctor I think, actually, availability might refers doctor Monday as ahead of doctor Tuesday. So they're ranked by availability and proximity. And then you just choose an appointment, and they're infinite appointments.
Paula Muto:If you go to the page, they keep they those the doctors basically post one or two appointment slots, and they appear in in in and finitum. So it's kinda like house seats at a Broadway show.
Heath Fletcher:Right. Right. So they make and then they
Paula Muto:And so you could you can choose when. You could be seen as soon as tomorrow. You can't be seen the same day. We're not an emergency platform.
Heath Fletcher:No. But, so they made their payment, and then the office is notified of the appointment.
Paula Muto:Yep. And it's booked in. Patient asked for they they put in the chief complaint in their own in their own words. There's no data.
Heath Fletcher:Interesting.
Paula Muto:Wow. They say my right thumb hurts. Right? Now if you're a neurologist, you're like, I don't care. No.
Paula Muto:Yeah. But no. But, or gastro hurts when I do this. My right thumb hurts. So, okay, you're a hand surgeon.
Paula Muto:You say, okay. So the doctor just has to they get a ping. The office or the doctor gets a ping on their phone saying, you have an appointment, and you just say thumbs up. That's it. Just thumbs up.
Paula Muto:That's all you say. Wow. You just make it quick and easy. And then immediately when that occurs, money is debited from the patient's account into the doctor's account, and an email is sent to the patient with daytime and reminder. And then, and then when the patient sees the doctor, they can dictate you know, they can put them in their sched into their record.
Paula Muto:They can dictate whatever they want, and then they just push a button, say appointment complete, and they get the other payment. So we don't integrate with electronic records purposely purposely because we don't want any you know, it's it's supposed to be that simple. We don't want any you know, we don't need any sort of complex data sharing or anything like that. And and if the patient doesn't show up and doesn't cancel, the doctor, they forfeit the $50. If the doctor has an emergency, cancels the patient gets refunded.
Paula Muto:So it's very seamless, the appointment. So it's we it's it's you you get $50 to make the appointment and then whatever the balance is, which is on the average about $200 for the appointment.
Heath Fletcher:It sounds so simple. It is credible. Why is this why
Paula Muto:so Why isn't everybody using it? Right? Well, we built we built the platform with a fourth grader involved. Like, literally, we did it at the fourth grade level. We did not want it to be complicated.
Heath Fletcher:Friendly. That's a whole concept.
Paula Muto:Right? Needed to see a doctor. It needed to be simple, and doctors are inundated with a lot of complexity. It needed to be simple. We have a lot of young, talented doctors out there who are sitting behind a army of Krabby Patties at the front desk, and all they wanna do is, like, I am, like I just trained.
Paula Muto:I'm so good at fixing your wrist. I'm so good at fixing your reflux. You know, they just wanna crack at you.
Heath Fletcher:Yeah.
Paula Muto:Right? They they just want and so we feel like the younger generation should be much more mobile, like, on their cell phones
Heath Fletcher:Yeah.
Paula Muto:Connecting directly to patients in that appointment realm, not just you know? And I feel like what we talked about at the beginning, this isolation that we we we're, like, we're 10 steps removed from our patients
Heath Fletcher:that
Paula Muto:we wanna get rid of all that.
Heath Fletcher:It's all it almost could be back to the house
Paula Muto:call. In in some ways Like,
Heath Fletcher:you know, if they were if you're if, you know, if the next generation is actually wants to be as mobile as they like to be Right. Right, where they are they choose where they wanna work and how they wanna work, you know, that we could it could we could end up this could take them back to the potential, well, I'm in your neighborhood. I'll just stop by your house.
Paula Muto:Well, remember how everything changed. So we started at pretelemedicine, but I'll tell you a funny story. About a year into it, when we were building our network, Milton Chan, who is the, who is considered the father of modern telemedicine in the sense that he was the first one who figured out how to do video conferencing securely for the space station.
Heath Fletcher:Yes.
Paula Muto:Okay. Remember, video conferencing like this is no big deal, but if we're in an examining room, it's a big deal. Right? Like, you can't let anybody just jump in. No.
Paula Muto:So he came he reached out and said, you know, I really love your model, and and we do we I I have telemedicine, and I want to put it in the hands of end users. And I'm like, what do you mean? He said, I want doctors, every like, doctors and specialists to use telemedicine. And this was back in, like, 2017, '20 yeah. It was, like, 2017.
Paula Muto:I said, Milton, what's the surgeon gonna do with telemedicine? Right? You're crazy. But whatever whatever you want, you can have my specialty network. Oh my gosh.
Paula Muto:Like like, then, like, COVID happens and and all of a sudden like, so we started introducing telemedicine to our doctors as a way to connect. Right. Like, I can have appointments in my office, but I can also have telemedicine. And it's very hard to connect, collect co pays with telemedicine. It's really hard to, like, collect insurance cards with telemedicine, but you make it cash.
Paula Muto:It's easy as pie. Yeah. Right? And and so so there are some really great specialists out there who have telemedicine practices. We have one of them on our platform, doctor Deanna Gurnita, who's probably one of the best rheumatologists in the country, and she's the biggest expert on gout.
Paula Muto:And it's fantastic. She's not just licensed in one state. She's licensed in a number of states, so she can really help. You know, there's eight million people with gout. There's, like, I think, three or 4,000 rheumatologists.
Paula Muto:There's just not enough out there.
Heath Fletcher:Right.
Paula Muto:Right? So to be able to take someone like that and and and and allow her to connect with more people in a meaningful way, more again, very much definitive care. And and it's not the Teladoc world. Right? Those are one off.
Paula Muto:Very different they're very, very different model. Right? I need I have a UTI. You know, I have I wanna get a prescription for something. Right?
Paula Muto:I have a rash. You know, those are one offs. Right? This is a little different. These are specialists.
Paula Muto:They may be a one off, but they're they're a little bit different. UberDoc is a little different. We we all sort of sit in the same sandbox a little bit, but we all do something a little bit different. And UberDoc's always been UberDoc above everybody. That's why we use the name for universal access to specialty, like not the average doctor.
Paula Muto:And we don't have any mid levels on our platform, although mid levels are participating in our hero serve program, to help with the with the vets. So
Heath Fletcher:I love that. And you actually never I didn't make that connection even though I'm a marketer. I I didn't make that connection that Uber Uber doc was also Uber as in best best doc.
Paula Muto:Well, that's why we used it. We used I
Heath Fletcher:also is a you know?
Paula Muto:Well, now it's a
Heath Fletcher:another another association.
Paula Muto:And everything else. And and like I said, in there, you know, we're and they want my trademark name. But but they I got trademarked. I mean, I have it.
Heath Fletcher:Good. They're challenged. That's good. But it has it's that's got some perks to it too or some advantage advantages as well.
Paula Muto:We we I defend my I've defend my trademark because we we didn't we it's really it's something to do with transportation. No. And, you know, there's a lot that's
Heath Fletcher:in access, which is a form of yeah. And, you know, we can look at it, transportation, but it's it's accessibility.
Paula Muto:Yeah. But so was Amazon, so was Google. Mean, think about it. There's a lot of things.
Heath Fletcher:I think it's a great alignment. I think it's really neat. When you were talking we're we're talking earlier about, building your team. So when you were, building UberDoc, how did you build your team? Like, it's a different it's a different beast of a business.
Heath Fletcher:So how did you build your team for for this?
Paula Muto:So so when I started UberDoc, I put a bunch of people in a room. Doctors, you know, who had been entrepreneurs as well, you know, and, as well as, you know, managed care experts, local business people, and mostly in health care.
Heath Fletcher:Again,
Paula Muto:I put them all in a room, and I said, I have this idea. What do you think? And they said, okay. That sounds good. Let's do it.
Paula Muto:And, and so that was my first check was from, you know, one of the physician business people you know, the physician is still in practice and who was, like, really dedicated to the concept. And then, you know, and then we needed to build the site, which was a a platform, and that was really the most fun. The agile techno agile method was fantastic. They said I was really good at it because I'm a surgeon, so it was easy to make decisions. Right?
Paula Muto:Good, bad, you had to make a decision to move forward.
Heath Fletcher:Right.
Paula Muto:So we they went lightning pace, really economically built a solid gold, you know, platform that, knock on wood, has functioned beautifully for for
Heath Fletcher:It's a beautiful
Paula Muto:website. Eight years. Yeah. We you know, and it really runs beautifully because it was built really well. And, and we learned early on, and so we had a really good team, and that was actually somebody I play squash with who was one of our early advisers whose brother ran a was an art a digital architect, you know, was a and was able to so we had a wonderful team.
Paula Muto:We had a Ukrainian team briefly for a while that built helped build the site, and then they unfortunately fell apart with the whole thing. We have a team now, a developer from Brazil who's fabulous. So we've been god bless. Our technology has been great. You know, I had a cofounder, you know, Brianna Sochi, who's wonderful young person.
Paula Muto:She's off doing sort of moving on to bigger things and or different things and, you know, who was very interested in marketing and very enthusiastic, and was really, you know, a very important, member of the team, always there to build things, build and then, and I have other members of my family actually that were participating. My COO was my niece's husband, and he came into it. You know? So it was kind of a family affair. My sister-in-law was very instrumental in all of this because she was a marketing person.
Paula Muto:She was, like, the first CMO for Constant Contact, really understood how customers know? And she has had a startup of her own, and she sat with me in the Nordstrom's Cafe with the back of a napkin helping me wireframe what you needed to do to create a business model for this type of product. So I have to say I'm really blessed. And my brother is a doctor, of course, and I have another brother who's a a computer expert. Right?
Paula Muto:So and he installs and was part of the whole electronic record implementation offices, so he knew who we were dealing with. Right? He knew the office staff.
Heath Fletcher:Yeah. And then side.
Paula Muto:Oh, he designed the whole interface to make it so bloody simple. I like to say anti epic so that it would be flawless, seamless, so that would be easily adopted. So so, yes, we had all the right people in place. Over years, you know, it has to do with funding. It has to do with resources.
Paula Muto:Right? I mean, I bootstrapped this company. We recently got acquired by a company in Canada, with plans to go public in the Canadian markets, and we have a new CEO who's been phenomenal. So I'm, like, really excited because, you know, you know, people have recognized that it's time for UberDoc to you know, it's time to not put baby in the corner.
Heath Fletcher:Right.
Paula Muto:Right?
Heath Fletcher:So you're expanding now to, it's this is country number two. So you haven't
Paula Muto:Well, we're not expanding necessarily in Canada. Right? It's just Canadian investors.
Heath Fletcher:Oh, I
Paula Muto:investors who are there are a lot of Canadian investors who invest heavily in the American health care market.
Heath Fletcher:Right.
Paula Muto:Right? So these are Canadian investors. We're an American company still. Canadian investors who've been working with us for two years are absolutely wonderful, really super supportive, really believe in our vision, and really believe in the company. And so, so we have been you know, so we went through, you know, we moved into this next phase, which is super exciting Yeah.
Paula Muto:Because, you know, capital infusion and expansion, and to really because we have a lot of work in front of us. We have a lot of appointments to book, and, and you need to have capital to be able to do that. As far as the consumer model, we love UberDoc, but it's very expensive to advertise the consumer. Yeah. Very expensive.
Paula Muto:So and we have been waiting in the wings. You know, it's sort of interesting because a lot of people have spent a lot of money, and I'm just watching them. Right? You know, you know, we're the back end to a company called Sesame. They're a lovely organ people.
Paula Muto:They they're trying to do direct pay health care. Little bit different sort of lower end sort of appointments, but still they're in that space, and we we work with them. And, you know, and if we of course, everyone's followed always the Teladoc and things like that. But direct to consumer, you know, Roe and, Roman there and, and, you know, Hims and Hers, you know, there's been some forays into the direct to consumer space. A little different than us.
Paula Muto:Again, not like they're very much more isolated to particular kinds of disease processes where we're just specialty care. You know? We're kinda generalists. But, but, you know, a lot of money's put into consumer, and I don't think that nut's been cracked.
Heath Fletcher:Right. So a faster uptake on the on the doctor side, not as quick an uptake on
Paula Muto:the consumer. I think we live because the doctors are gonna bring their patients. Sure. When the doctors convert
Heath Fletcher:Yeah.
Paula Muto:To direct pay, and they're close. They're close. And and when the employers want the direct pay. Right? Everyone just wants a price.
Paula Muto:Like, everyone's tired of the smoke and mirrors. You know? And this is and, again, we are system agnostic. We're not taking down Medicare or Medicaid. We're not telling you empty your waiting room and put in a con you know, we're not a concierge model in the sense that we're, you know, you have to pay to see the doctor.
Paula Muto:You only have to pay for that seat.
Heath Fletcher:Right.
Paula Muto:Right? That doctor takes those other insurances. You're just getting in.
Heath Fletcher:Yeah. You're just getting in the door. Yeah.
Paula Muto:Ultimately, I think all doctor visits should be cash. I think, you know, I think, you know, health savings accounts and health vouchers, Medicare savings accounts, I mean, EBT cards should be paying primaries. I think all the primary cares, all these wonderful doctors should just be paid in a transactional immediate way Yeah. And and stop the and stop all these claims. The claims cost a lot, a lot of data.
Paula Muto:They're really unnecessary.
Heath Fletcher:Yeah. Well, I think you found
Paula Muto:Save insurance for the big stuff.
Heath Fletcher:Yeah. Yeah. Exactly. And and I think you you kinda found a way to balance sort of you're using technology to balance out this the human touch, right, where you're actually getting people to their doctor using technology and and simplifying the process.
Paula Muto:Simplifying. You just want a doctor and a patient room together. Yeah. I can't tell you how many times in my career, like, somebody walks in and I can diagnose them in, like, thirty seconds or, like, think I'm a genius. It's like, no.
Paula Muto:I've seen a billion legs or a million breaths or whatever. It's like, I'm not a rocket scientist. It's just what I do all the time. Right? And I think that we tend to wander in the desert.
Paula Muto:Right? People go to doctor Google and now chat GPT and AI, and then they go to the urgent care, and then they go to the walk in, and then they go, you know, the primary care isn't there to see them, and they have, you know, some very new newly minted nurse practitioner who doesn't wanna kill you. So, like, you have a headache. I think you need a CAT scan. You could have a brain tumor.
Paula Muto:It's like, well, no. I mean, you know Well, I could mean, it's like
Heath Fletcher:I could see how this would be like, you know, a parent with a child who's got something's wrong, and you either go sit in ER for nine hours or ten hours or however long it takes to get through before something that may be significantly minor. But if they could see a doctor, you know, quicker
Paula Muto:So I'll tell you one of the things that some of the pushback we get sometimes is like, oh, first of all, they say, oh, my doc my office is really efficient. We don't need that. Like, a lot of the orthopedics have consolidated, and they have all sorts of fancy websites. But you try them, it's all the same. Right.
Paula Muto:Right here, we're putting in information. There's still a human on the other side who has to process it. It's like we take the human out of it. It's like, we're just going right to that you know, you're just you're literally just going right to the doctor to say thumbs up. Right?
Paula Muto:You're you're giving the autonomy back to that physician doctor relationship. Right? So that's the so that's that's that's part of the the sometimes some of the challenge that we see. And, also, we see, I'm so busy. I'm so busy.
Paula Muto:I I I'm booked out for six months. It's like, yeah. That's why you'd sell your seat.
Heath Fletcher:Right.
Paula Muto:Because no one has a zero no show rate. At the best, you have 5% and average is twelve to twenty percent.
Heath Fletcher:Right.
Paula Muto:Right? The patients just don't
Heath Fletcher:show up. Right.
Paula Muto:And more patients don't show up now because when you get your appointment, it's six months from now. Right? And I say, oh, no. I don't know where I'm gonna be in six months, but that's when your appointment is. Right?
Paula Muto:And you sort of feel like, you know, there's a lot of miscommunication, a lot of no show. So so I always joke with those doctors saying, well, you're like a Hamilton ticket. I I said, you're so I said, people are gonna you know, you're gonna they're you're gonna sell it. I mean, you know, and maybe a general surgeon's more like cats. Maybe nobody wants to see Right?
Paula Muto:But but for some, like, you know, for that special, like, dermatologist, it's like you're gonna be the top of the list. Yeah. So so I think that that there it for my purposes, it's very important for doctors to acknowledge direct pay. One of the challenges also is that insurance contracts oftentimes say it's a violation if you treat an insurance patient without their insurance card. But we get around that because the patients sign a special form, a HIPAA form when they sign up for UberDoc.
Paula Muto:So it's the safe way to do direct pay. And it's pretty mindless. As you said, you were on the website. It's pretty mindless.
Heath Fletcher:Pretty straightforward.
Paula Muto:And there's no barrier to entry on the doctors. And and, again, a lot of doctors are consolidated, but that doesn't mean that they can't control these appointments themselves. Right? You just have to figure out where that payment goes. Does it go to your institution?
Paula Muto:Does it go to your bank account? Whose bank account does it go to? But but I honestly it's the important thing is taking back medicine and and put the doctors back in charge because, again, getting back to you know, medicine is very different than it used to be.
Heath Fletcher:Yeah.
Paula Muto:You know, I don't admit you anymore. I don't keep you under my watchful gaze until you're perfectly healthy. I operate on you and kick you out.
Heath Fletcher:Yeah.
Paula Muto:And then it's your family that has to take care of you. Right? And think about that. We don't fund any of that.
Heath Fletcher:No. Right? No. Absolutely.
Paula Muto:Social determinants of health that determine the outcome, and we put $0 into that. Instead, we fund we we buy beds. We sell beds. Yeah. Right?
Paula Muto:And that, you know, that's, you know, that's my own hospital was part of the steward network, they sold beds. They were they created beds as a commodity, as a business model. Right?
Heath Fletcher:Yeah. And that does not put the patient first.
Paula Muto:Well, I don't think it's a modern approach anymore.
Heath Fletcher:You can
Paula Muto:sell beds all you want, but you won't fill them all. No. No. You can fill them all, but, not economically because when, you know, you're you're, you know, you're operating in your office, you're sending people home, you're managing people with telemedicine and remote monitoring and a little AI mixed in, you're preventing a lot of those things. And so that's where health care is.
Paula Muto:It's super fantastic, but it's, but it's delivered in a very different way. I mean, look at cancer. I mean, gosh, cancer used to be in the hospital, in the ICU, or in the cancer wards with, you know, fusion therapies, and now it's you're at home with a pill that was made just for you
Heath Fletcher:Mhmm.
Paula Muto:With your genetic footprint on it.
Heath Fletcher:Yeah. Yeah. We've come a long way. And it's gonna just
Paula Muto:come a long way.
Heath Fletcher:It's just gonna go at at lightning speed as we
Paula Muto:move forward. Yeah. And that's what I always imagine health care is. Like, medicine is like a drag racer, and and health care is the drag shoot. Right.
Paula Muto:Holding it back. Right? The business of health
Heath Fletcher:care is
Paula Muto:holding back.
Heath Fletcher:Yeah.
Paula Muto:Like, the race car going forward. Right? Because because and that's where the young people come in because we we need to turn this around for those talented young people that we're training that are doing amazing innovation. And and I think that, you know, there's plenty of hope to there's a lot I'm very hopeful person. I'm very optimistic.
Paula Muto:I think we just gotta get over around get a get a around where we are. We gotta get out of our own way. You know? And I think that a little AI, a little doge would help. Doge would go a long way here.
Heath Fletcher:You know? Thank you so much, Paula, for sharing your story with me and with our listeners. It's just been really interesting to hear your Uber adventure. And, yeah, I just do you have do you have anything you'd wanna share to, you know, anyone sort of walking your path, but maybe
Paula Muto:Walking my path. So, so I would say that, first of all, anyone can contact me. If there people listening on this who are health benefit people, who are work in hospitals, think this is really great, physicians out there, just contact me. Paula@uber-docs.com. I mean, please, you know, my contact info.
Paula Muto:I'm very happy to to talk. Again, my goal is to get a seat in everybody's waiting room. Right? I want every doctor to join. You know, as far as walking the journey, I think that you have to be it is about the journey.
Paula Muto:It's not about the destination. I've met some fantastic people. I've learned a lot. I've learned a lot about about my my own practice of medicine. I've learned a lot.
Paula Muto:I can listen to my patients a lot more because I understand what is going on. And I also respect my colleagues in a different way because I I'm not just in a silo of surgeons. I talk to everyone. Right? The direct primary care is the primary care is the pediatricians, the neurologists, rheumatologists, the orthopedic.
Paula Muto:It's like everybody's part of this this this family, like to say. It's not just a network of doctors. It's a family of really well trained well trained doctors who who just wanna do the right thing for their patients. Right? They love what they do.
Paula Muto:They they don't train seven, ten plus years because they don't like it.
Heath Fletcher:Right.
Paula Muto:And and so it's it's heartbreaking to me when you hear people getting delayed. People can't find anyone. I mean, you know, rural hospitals closing. Women can't deliver babies.
Heath Fletcher:Yeah. Something's
Paula Muto:probably gonna heartbreak because there's lots of people out there who are really well trained who want to take care of patients. We're just in a mismatch.
Heath Fletcher:Well, I think you found a solution to towards fixing a lot of these problems. So congratulations on that, and I really look forward to see where where UberDoc goes. And maybe we'll talk again and see where you are, you know, six months or a year from now.
Paula Muto:Yeah. It would be great. Yes. Very exciting time.
Heath Fletcher:Well, excellent. Thank you again so much for being on on on this episode, and thanks to our listeners for for listening in. Well, we've heard it before and we heard it again today that entrepreneurs love to find solutions to problems, and that's exactly what doctor Palamuto did was she found, a way to get easier access for patients to doctors through UberDoc. And she's, built a team of exceptional people in order to help her see her goal is to have UberDoc in every doctor's waiting room. So I wish her all the best of luck.
Heath Fletcher:And if you'd like to learn more about UberDoc, you can visit the website at uber, uber,-docs,d0cs,.com. And she's also invited you to connect with her on LinkedIn if you have further questions. Thank you for listening to another episode of the healthy enterprise. Stay healthy, and we'll see you soon.
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