Re: supplement sales

[Guest guest]

I worked with someone who sold Metagenics supplements in the office, which patients picked up and paid for on their way out, and sold Juice Plus on-line. This one is an MLM and patients get billed and refilled automatically every 90 days once you get them to sign up for it. As you know, there are multiple levels to the pyramid MLMs so to make money it depends where you are.

Per your request, no discussion of ethics: however, patients who changed their bank accounts or credit cards and the auto payment bounced were turned over to collections, even though they didn't really owe anything, and that upset people who then left the practice. So...dealing with these kinds of MLM companies may cause you to actually lose patients.

Wyatt

To: practiceimprovement1 <practiceimprovement1 >Sent: Tue, April 20, 2010 8:21:52 PMSubject: supplement sales

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like thatany of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

[Guest guest]

I can speak to this. In other offices, I have sold Juice Plus, primarily on-line or through a consultant who just placed all the orders for the patient in the practice. Although at that time, 10 yr ago, it had a pretty narrow product line, it was a very good, and effective product for weight loss, and for general anti-oxidant, getting your fruits and veggies, without the fiber. Patients for the most part were very happy with it, and generally we had them call the consultant to change or cancel orders. Usually they didn't go on the "autoship", but would buy a 3 month or one month supply, and then if they wanted more, called her to continue. This was an easy set up, patients got a real person for service, but we didn't have to have the hassle, and the product was of good quality.

I don't think I am objective enough to speak to the ethics of selling products in the office. I started doing it with some issues 10 yr ago. I no longer have a problem with it, although I did at first. Now I sell skin care products, Botox, Latisse, Wrinkle fillers, and Laser services. I have no ethical problem with selling a product that I make money on. In fact, I'd like to say, hey, this is a business, we are trying to make a profit, not a killing, just a normal 5-10% profit. If the product is legitimate (must decide for yourself in each case), and there is no harm, and they want it, I don't see the issue. As far as the skin stuff, I generally let the medical clients ask me. If they ask me about a vitamin, I can recommend some, Juice Plus, Monavie, Metagenics, all I don't sell, but I consider good. I do sell a few Nikken products, as I use them myself, so it isn't any trouble to add one extra if I am ordering, but I don't stock anything. I have many patients who routinely spend lots of money on supplements I consider anywhere from worthless to of marginal value at the health food store. A local store is constantly telling peole they have adrenal insufficiency, and selling them $300 of Vitamins, I would never do that, and think I can do better, if they ask.

Just started a diet program, Transitions, a lifestyle change, and some supplements, a cross between Mediterranean, and low glycemic index diet. It is a multilevel plan, through Market America, so many are, even Optifast or Medifast. I sent letters to patients with dx of DM II or obesity, to invite them to informational meeting. Outside of office hours. If they wanted they can sign up, it gets them 12 wk of diet training with me and a RD in my office, about 6 wk of supplements, some DVD's, and a journal.

We spent 3 months looking at lots of diet plans, and even have a slide of what Craig, Nutrisystem, and Weight watcher's cost, and their relative effectiveness. When you consider that Joining Craig or Nutrisystem costs $300 before they can even get the food, and there is no actual dietician involved, or MD, what is wrong with a doctor or a dietician or both doing it, at least we have more training. People need to loose weight, it affects EVERYTHING and loosing weight makes so many things better, why don't WE help our patients loose weight instead of letting them fumble around with other programs.

It has been very successful as far as the clients loosing inches in their waist and thighs (waist highly correlates with visceral fat). We are 9 wk into it, and the patients are just now starting to reorder some of the supplements. I make sure they know the supplements are only to get a jump start, and don't have to be continued. There are four, some continue 1, 2, 3 or none. It is their choice. We had a session on what was in each, and precautions for people with certain conditions. No ephedra or stimulants, I don't believe in that. They order on-line, I don't stock. I can have an option to send them to a consultant like I did with Juice Plus, but don't feel it is busy enough for that. I think in the case of selling products, it has to be 1. easy for you or staff, 2. Effective, 3. No harm, 4. No stocking, too much money sitting around, and space taken up. Almost all companies let the customers order for themselves on line, under you, if they don't and demand you carry product, ask them to get with the 21st century.

On another topic, and I will make a separate post. I went to the ASBP society meeting here in Seattle last wk. American Society of Bariatric Physicians, excellent conference, excellent science, and biochemistry (eek!), and learned a ton. Anyone wishing to learn about weight loss, please check out their web site, and consider going to a meeting or ordering information. I should be getting a CD soon, and would be willing to pass along to anyone who wants to make a copy.

Just like IMP's they were very big on spending time with the patients to figure out what would work best for them, and totally against, spending 5 min, giving them a pre-printed diet sheet, and a Rx for Phentermine, and f/u in 1 wk. Sorry for the long post. But felt I have done many of these things, and could supply another perspective.

Cote' MD

MD Cote, Medical, Laser, and Spa

supplement sales

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like thatany of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

[Guest guest]

Hi ,I was approached by a naturpath who is trying to get me interested in Market America and their weight loss program and supplements but I'm pretty sure he told me I would have to stock product if I signed up. Did I misunderstand this? I wanted to join because I like their liquid isotonic vitamins but did not want to get into having to purchase a certain amount of product.Kathy aka beansSubject: Re: supplement salesTo: Date: Wednesday, April 21, 2010, 8:18 PM

I can speak to this. In other offices, I have sold Juice Plus, primarily on-line or through a consultant who just placed all the orders for the patient in the practice. Although at that time, 10 yr ago, it had a pretty narrow product line, it was a very good, and effective product for weight loss, and for general anti-oxidant, getting your fruits and veggies, without the fiber. Patients for the most part were very happy with it, and generally we had them call the consultant to change or cancel orders. Usually they didn't go on the "autoship", but would buy a 3 month or one month supply, and then if they wanted more, called her to continue. This was an easy set up, patients got a real person for service, but we didn't have to have the hassle, and the product was of good quality.

I don't think I am objective enough to speak to the ethics of selling products in the office. I started doing it with some issues 10 yr ago. I no longer have a problem with it, although I did at first. Now I sell skin care products, Botox, Latisse, Wrinkle fillers, and Laser services. I have no ethical problem with selling a product that I make money on. In fact, I'd like to say, hey, this is a business, we are trying to make a profit, not a killing, just a normal 5-10% profit. If the product is legitimate (must decide for yourself in each case), and there is no harm, and they want it, I don't see the issue. As far as the skin stuff, I generally let the medical clients ask me. If they ask me about a vitamin, I can recommend some, Juice Plus, Monavie, Metagenics, all I don't sell, but I consider good. I do sell a few Nikken products, as I use them myself, so it isn't any trouble to add one extra

if I am ordering, but I don't stock anything. I have many patients who routinely spend lots of money on supplements I consider anywhere from worthless to of marginal value at the health food store. A local store is constantly telling peole they have adrenal insufficiency, and selling them $300 of Vitamins, I would never do that, and think I can do better, if they ask.

Just started a diet program, Transitions, a lifestyle change, and some supplements, a cross between Mediterranean, and low glycemic index diet. It is a multilevel plan, through Market America, so many are, even Optifast or Medifast. I sent letters to patients with dx of DM II or obesity, to invite them to informational meeting. Outside of office hours. If they wanted they can sign up, it gets them 12 wk of diet training with me and a RD in my office, about 6 wk of supplements, some DVD's, and a journal.

We spent 3 months looking at lots of diet plans, and even have a slide of what Craig, Nutrisystem, and Weight watcher's cost, and their relative effectiveness. When you consider that Joining Craig or Nutrisystem costs $300 before they can even get the food, and there is no actual dietician involved, or MD, what is wrong with a doctor or a dietician or both doing it, at least we have more training. People need to loose weight, it affects EVERYTHING and loosing weight makes so many things better, why don't WE help our patients loose weight instead of letting them fumble around with other programs.

It has been very successful as far as the clients loosing inches in their waist and thighs (waist highly correlates with visceral fat). We are 9 wk into it, and the patients are just now starting to reorder some of the supplements. I make sure they know the supplements are only to get a jump start, and don't have to be continued. There are four, some continue 1, 2, 3 or none. It is their choice. We had a session on what was in each, and precautions for people with certain conditions. No ephedra or stimulants, I don't believe in that. They order on-line, I don't stock. I can have an option to send them to a consultant like I did with Juice Plus, but don't feel it is busy enough for that. I think in the case of selling products, it has to be 1. easy for you or staff, 2. Effective, 3. No harm, 4. No stocking, too much money sitting around, and space taken up.

Almost all companies let the customers order for themselves on line, under you, if they don't and demand you carry product, ask them to get with the 21st century.

On another topic, and I will make a separate post. I went to the ASBP society meeting here in Seattle last wk. American Society of Bariatric Physicians, excellent conference, excellent science, and biochemistry (eek!), and learned a ton. Anyone wishing to learn about weight loss, please check out their web site, and consider going to a meeting or ordering information. I should be getting a CD soon, and would be willing to pass along to anyone who wants to make a copy.

Just like IMP's they were very big on spending time with the patients to figure out what would work best for them, and totally against, spending 5 min, giving them a pre-printed diet sheet, and a Rx for Phentermine, and f/u in 1 wk. Sorry for the long post. But felt I have done many of these things, and could supply another perspective.

Cote' MD

MD Cote, Medical, Laser, and Spa

[Practiceimprovemen t1] supplement sales

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like thatany of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

[Guest guest]

Both Marty Shulman and I use Doctor's Vitamin Pharmacy for online sales of vitamins/supplements. They host my website as well, I'm not sure about Marty. Marty was selling a few things through his site, but I sell hardly anything. I am not too thrilled with it, to tell you the truth, but I could see how it might work for some.LonnaSubject: supplement salesTo: "practiceimprovement1" <practiceimprovement1 >Date: Tuesday, April 20, 2010, 8:21 PM

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like that

any of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

[Guest guest]

And what do you tell the patients who see this study?http://www.thelocal.se/25978/20100409/

Both Marty Shulman and I use Doctor's Vitamin Pharmacy for online sales of vitamins/supplements.  They host my website as well, I'm not sure about Marty.  Marty was selling a few things through his site, but I sell hardly anything.  I am not too thrilled with it, to tell you the truth, but I could see how it might work for some.

Lonna

Subject: supplement salesTo: " practiceimprovement1 " <practiceimprovement1 >

Date: Tuesday, April 20, 2010, 8:21 PM

 

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office.  it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like that

any of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

-- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.

[Guest guest]

I tell them it's not clear cut. See this one: http://www.webmd.com/breast-cancer/news/20100419/multivitamins-may-cut-breast-cancer-risk?src=RSS_PUBLIC.--- Subject: Re: supplement salesTo: Date: Thursday, April 22, 2010, 10:57 PM

And what do you tell the patients who see this study?http://www.thelocal .se/25978/ 20100409/

On Fri, Apr 23, 2010 at 5:52 PM, Lonna Larsh <larshlonnayahoo (DOT) com> wrote:

Both Marty Shulman and I use Doctor's Vitamin Pharmacy for online sales of vitamins/supplement s. They host my website as well, I'm not sure about Marty. Marty was selling a few things through his site, but I sell hardly anything. I am not too thrilled with it, to tell you the truth, but I could see how it might work for some.

Lonna

From: Gordon <cygnusdavegmail (DOT) com>Subject: [Practiceimprovemen t1] supplement salesTo: "practiceimprovement 1" <practiceimprovement 1yahoogroups (DOT) com>

Date: Tuesday, April 20, 2010, 8:21 PM

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like that

any of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

-- Graham Chiuhttp://www.compkaro ri.co.nz: 8090/Synapse - the use from anywhere EMR.

[Guest guest]

http://www.ncbi.nlm.nih.gov/pubmed/20335555So, we are comparing a prospective study of 35,000 women followed for a mean of 9.5 years which showed a RR of 1.19 for developing breast cancer when taking multivitamins, vs a recall questionnaire covering 5 years of 700 women showing some benefit.

The former is at a higher level of evidence than the latter. Unless my patients have known nutritional deficiencies, I do not use multivitamins, and this reinforces my practice.

I tell them it's not clear cut.  See this one: http://www.webmd.com/breast-cancer/news/20100419/multivitamins-may-cut-breast-cancer-risk?src=RSS_PUBLIC.

From: Gordon <cygnusdavegmail (DOT) com>Subject: [Practiceimprovemen t1] supplement salesTo: " practiceimprovement 1 " <practiceimprovement 1yahoogroups (DOT) com>

Date: Tuesday, April 20, 2010, 8:21 PM

 

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office.  it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like that

any of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

-- Graham Chiuhttp://www.compkaro ri.co.nz: 8090/Synapse - the use from anywhere EMR.

-- Graham Chiuhttp://www.compkarori.co.nz:8090/Synapse - the use from anywhere EMR.

[Guest guest]

Yes, a prospective study of 35,000 is certainly much better than a diet recall study. Thanks for the education, Graham.

From: Gordon <cygnusdavegmail (DOT) com>Subject: [Practiceimprovemen t1] supplement salesTo: "practiceimprovement 1" <practiceimprovement 1yahoogroups (DOT) com>

Date: Tuesday, April 20, 2010, 8:21 PM

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like that

any of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

-- Graham Chiuhttp://www.compkaro ri.co.nz: 8090/Synapse - the use from anywhere EMR.

-- Graham Chiuhttp://www.compkaro ri.co.nz: 8090/Synapse - the use from anywhere EMR.

[Guest guest]

Yes, it is very confusing. I was initially approached by a former patient who is "under" an Internist near me. The patient told me I would have to stock, and that my initial order had to be $300. When I had trouble placing it, I called the Internist, who said, "why are you trying to stock product, and why are you putting in an order before you have people to buy it?" So she came and talked to me.

Here is the real deal. So There is a web portal for any client who wants to go in, and they can buy at retail, have stuff sent to them, and you don't have to have a website, or anything. You won't get any credit for it, but if you just want to tell people, then their orders are placed under anyone, in some kind of a rotation. You can sign up, and get a web portal or not. The web portal is an extra $20 a month, but it can link through your website. That is you have a website, put the Nutrametrix link on it, and they click through and order under you. Each time this happens you get an email saying who ordered and what, and a chance to move it around under a differenct category(leg)- I don't understand this part yet. Not really interested in building a networking business, but it may have interfered with my getting paid one month.

Anyway. I just wanted the diet program, so I sent out a flyer to all my patients with the diagnosis of DM II, or obesity in my EMR, and also had flyers in the office. Anyone interested came to an introductory meeting, where if they wanted to join the class, they signed up, and paid. Once I had a small group signed up for classes, I used that money to place my first order for Mega Loose kits for all of them. I still had to pay a joining fee, and order some monthly supplements for myself, but this way you aren't stocking anything, and you aren't really out any money, as the class fee more than pays for the supplements. I am currently running the class in my office, in waiting room, but if it was bigger, would have to have a bigger space. My biggest expense really has been the dietician, as she wanted a fee to teach class equal to her hourly reimbursement from insurance. Most doctors who run the class don't do that. I didn't really have that many to cover that fee, so we just split the profit, and it came to about half her fee. Most doctors either teach it themselves or get a lower wage type person to co-teach with them so they don't have to be there every week. I opted to have the dietician, as I think it helps credibility, and then I don't have to teach every week if I don't want to. This round we were both there every time, as I actually did the program myself. I can't ask anyone to do something I can't do myself. I felt with a doctor, and a RD both at all the classes I could charge more. This next round that starts end of May I think I am going to split the dates with the dietician, as we have both been through the whole thing now.

You can set your own fee for the class, or not have a class, and just let them buy the Transitions "mega loose kit" : some supplements, journal, DVD, and have them work with you in regular appts, bill out to insurance for the condition, not obesity. That is insuance will pay for a visit on DM II, HTN, Hyperlipidemia, other assoc conditions of obesity. So far I am very happy with the weight loss plan, and the quality of the supplements. But the ordering is kind of difficult, as Market america sells everything from phone card to detergent, not just supplements, and I think there website is kind of clunky.

Hope this helps. If the Naturopath is still doing this, ask if he has an MD or other health care provider upline who has been doing it longer and if you could talk to both of them, likely he/she doesn't know any better, and may just be relatively new or stumbling themselves.

Cote' MD

MD Cote' Medical, Laser, and Spa

Now adding weight loss, will advertise that for first time, next wk [Practiceimprovemen t1] supplement sales

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like thatany of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

[Guest guest]

Thanks for the info. So if you pay $20 a month for the web portal, do you make any money on the sales? Do you have to order a minimum amount of product to keep active?Also, how much do you charge for the classes? I was thinking about doing the weight loss one too. I am a psychiatrist but many of my patients have metabolic syndrome at a minimum.Kathy

From: magnetdoctor@ comcast.net <magnetdoctor@ comcast.net>Subject: Re: [Practiceimprovemen t1] supplement salesTo: Practiceimprovement 1yahoogroups (DOT) comDate: Wednesday, April 21, 2010, 8:18 PM

I can speak to this. In other offices, I have sold Juice Plus, primarily on-line or through a consultant who just placed all the orders for the patient in the practice. Although at that time, 10 yr ago, it had a pretty narrow product line, it was a very good, and effective product for weight loss, and for general anti-oxidant, getting your fruits and veggies, without the fiber. Patients for the most part were very happy with it, and generally we had them call the consultant to change or cancel orders. Usually they didn't go on the "autoship", but would buy a 3 month or one month supply, and then if they wanted more, called her to continue. This was an easy set up, patients got a real person for service, but we didn't have to have the hassle, and the product was of good quality.

I don't think I am objective enough to speak to the ethics of selling products in the office. I started doing it with some issues 10 yr ago. I no longer have a problem with it, although I did at first. Now I sell skin care products, Botox, Latisse, Wrinkle fillers, and Laser services. I have no ethical problem with selling a product that I make money on. In fact, I'd like to say, hey, this is a business, we are trying to make a profit, not a killing, just a normal 5-10% profit. If the product is legitimate (must decide for yourself in each case), and there is no harm, and they want it, I don't see the issue. As far as the skin stuff, I generally let the medical clients ask me. If they ask me about a vitamin, I can recommend some, Juice Plus, Monavie, Metagenics, all I don't sell, but I consider good. I do sell a few Nikken products, as I use them myself, so it isn't any trouble to add one extra

if I am ordering, but I don't stock anything. I have many patients who routinely spend lots of money on supplements I consider anywhere from worthless to of marginal value at the health food store. A local store is constantly telling peole they have adrenal insufficiency, and selling them $300 of Vitamins, I would never do that, and think I can do better, if they ask.

Just started a diet program, Transitions, a lifestyle change, and some supplements, a cross between Mediterranean, and low glycemic index diet. It is a multilevel plan, through Market America, so many are, even Optifast or Medifast. I sent letters to patients with dx of DM II or obesity, to invite them to informational meeting. Outside of office hours. If they wanted they can sign up, it gets them 12 wk of diet training with me and a RD in my office, about 6 wk of supplements, some DVD's, and a journal.

We spent 3 months looking at lots of diet plans, and even have a slide of what Craig, Nutrisystem, and Weight watcher's cost, and their relative effectiveness. When you consider that Joining Craig or Nutrisystem costs $300 before they can even get the food, and there is no actual dietician involved, or MD, what is wrong with a doctor or a dietician or both doing it, at least we have more training. People need to loose weight, it affects EVERYTHING and loosing weight makes so many things better, why don't WE help our patients loose weight instead of letting them fumble around with other programs.

It has been very successful as far as the clients loosing inches in their waist and thighs (waist highly correlates with visceral fat). We are 9 wk into it, and the patients are just now starting to reorder some of the supplements. I make sure they know the supplements are only to get a jump start, and don't have to be continued. There are four, some continue 1, 2, 3 or none. It is their choice. We had a session on what was in each, and precautions for people with certain conditions. No ephedra or stimulants, I don't believe in that. They order on-line, I don't stock. I can have an option to send them to a consultant like I did with Juice Plus, but don't feel it is busy enough for that. I think in the case of selling products, it has to be 1. easy for you or staff, 2. Effective, 3. No harm, 4. No stocking, too much money sitting around, and space taken up.

Almost all companies let the customers order for themselves on line, under you, if they don't and demand you carry product, ask them to get with the 21st century.

On another topic, and I will make a separate post. I went to the ASBP society meeting here in Seattle last wk. American Society of Bariatric Physicians, excellent conference, excellent science, and biochemistry (eek!), and learned a ton. Anyone wishing to learn about weight loss, please check out their web site, and consider going to a meeting or ordering information. I should be getting a CD soon, and would be willing to pass along to anyone who wants to make a copy.

Just like IMP's they were very big on spending time with the patients to figure out what would work best for them, and totally against, spending 5 min, giving them a pre-printed diet sheet, and a Rx for Phentermine, and f/u in 1 wk. Sorry for the long post. But felt I have done many of these things, and could supply another perspective.

Cote' MD

MD Cote, Medical, Laser, and Spa

[Practiceimprovemen t1] supplement sales

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like thatany of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

[Guest guest]

If you pay your 20$ you do make money on the supplements, the difference between the wholesale, and retail price. For instance one supplement I order for myself is 32 at wholesale, but the retail is 40 something. I think the mark-up is about 20%. You have to have a minimum of $50 monthly in BV not quite the same as wholesale, but close. The way it was explained to me originally was to have one of my staff sign up, as my "other leg"- this is a binary Networking company, then use the monthly supplement sales under both to qualify for both peoples 50$. Then have the staff person in charge of this, and for their pay, they get to order wholesale, and also any profit that goes thru them. Alternately my patient who signed me up offered to do the ordering for me. Apparently she does the above for Dr Hosada, and when patients call, or need something, she just orders it, as the doctor is too busy. Still no-one is carrying stock.

I charge $495 for the 12 wk class, the supplements cost about $149 Wholesale with a journal. People who have to journal their food, often eat less. The journal also has relaxation exercises, and motivalional tips for the first 3 wk of a 4 wk journal. They don't take any supplements the first wk, then I have them a lower than it says on the bottle dose, usually last them 6-8 wks. I don't want them to them the supplement does it all, just that it is a tool to help them. I was also advised to order each of them a DVD set, essentially goes over what is supposed to be covered in each class. Polled them, no one watching them. Will do again, and emphasize more, the DVD costs about $10, each.

The internist near me lives in a more rural farming area, and only charges $395 for her classes, as she doesn't think the market will bear the higher amount in the current recession. This has been the fee for the entire 3 years she has been doing it. She gives a discount for referring someone, or 2 friends taking together, I think they each get $25 off. I offered $50 off for friends joining together, but so far hasn't happened. I think there is a local surgeon who does lap band surgeries, and he charged 595$, and has his MA teach it. I hear his classes are very small, either no one wants to pay the extra, or the MA isn't very effective as a teacher.

Also both she and I tell them it's a lifetime fee, so as long as we are running the class they can keep returning for no additional fee. This is good for them, and us, keeps them on the path, and then the continuing students help in class, by giving testimonies; about their success, their challenges, and how they solved them, etc. Also don't want people to quit d/t family crisis, and feel they lost their money, or have to have them get some back. Of course no one comes every time, as everyone has life, and vacations, as well, and that is what the DVD's are supposed to be for, even if they didn't have the ability to keep coming back.

I am supposed to be getting a DVD from the Bariatric society on the pro's and con's of cash vs insurance for weight loss. Since you are a psychiatrist, can you bill insurance for metabolic syndrome or DM II, I mean you are still an MD, or would they fuss, as they do with me, if I use a complicated depression code, saying I can't charge that as I'm not a psychiatrist, ?. So far I am doing this all outside of office hours, class only, but am interested in maybe doing some through insurance. I feel like I've given a lot of weight loss, diet, and exercise advise for years as an add on, that was un-reimbursed. LIkely still would be as even without that, most times I am getting 3-4 codes on a chart. Unless I bill on time counseling, it wouldn'r really change what I do now.

Hope this helps.

Cote' MD

[Practiceimprovemen t1] supplement sales

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like thatany of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

[Guest guest]

Thank you so much. This is really helpful. The naturpath and his wife who are trying to get me interested often don't get to the point and we live over 2 hours from each other so getting together is difficult. Guess we should Skype. I like the idea that it is a life time fee. I think I might be able to get what you charge but not sure. I guess the people who don't want to -go to weight watchers for 10 a week or whatever it is.As far as billing insurance, I was going to keep this out of the insurance loop and I'm not sure if they would pay me for diabetes codes. I suppose if I could fight for it since I am a physician. I am out of network for regular insurance but taking Medicare. not sure I want to mess with Medicare right now-they are on a witch hunt! I can always give people a bill with codes and tell them to try to get paid on their own.

When you get that DVD from the Bariatric society and if you have time or remember, let me know if you find out anything useful.Based on what you've shared with me, I am more comfortable moving ahead with this program. In my area, lots of people are doing First Line Therapy through Metagenics so I thought I would offer something different. I'm sure they both are effective.All the best,Kathleen aka beans

From: magnetdoctor@ comcast.net <magnetdoctor@ comcast.net>Subject: Re: [Practiceimprovemen t1] supplement salesTo: Practiceimprovement 1yahoogroups (DOT) comDate: Wednesday, April 21, 2010, 8:18 PM

I can speak to this. In other offices, I have sold Juice Plus, primarily on-line or through a consultant who just placed all the orders for the patient in the practice. Although at that time, 10 yr ago, it had a pretty narrow product line, it was a very good, and effective product for weight loss, and for general anti-oxidant, getting your fruits and veggies, without the fiber. Patients for the most part were very happy with it, and generally we had them call the consultant to change or cancel orders. Usually they didn't go on the "autoship", but would buy a 3 month or one month supply, and then if they wanted more, called her to continue. This was an easy set up, patients got a real person for service, but we didn't have to have the hassle, and the product was of good quality.

I don't think I am objective enough to speak to the ethics of selling products in the office. I started doing it with some issues 10 yr ago. I no longer have a problem with it, although I did at first. Now I sell skin care products, Botox, Latisse, Wrinkle fillers, and Laser services. I have no ethical problem with selling a product that I make money on. In fact, I'd like to say, hey, this is a business, we are trying to make a profit, not a killing, just a normal 5-10% profit. If the product is legitimate (must decide for yourself in each case), and there is no harm, and they want it, I don't see the issue. As far as the skin stuff, I generally let the medical clients ask me. If they ask me about a vitamin, I can recommend some, Juice Plus, Monavie, Metagenics, all I don't sell, but I consider good. I do sell a few Nikken products, as I use them myself, so it isn't any trouble to add one extra

if I am ordering, but I don't stock anything. I have many patients who routinely spend lots of money on supplements I consider anywhere from worthless to of marginal value at the health food store. A local store is constantly telling peole they have adrenal insufficiency, and selling them $300 of Vitamins, I would never do that, and think I can do better, if they ask.

Just started a diet program, Transitions, a lifestyle change, and some supplements, a cross between Mediterranean, and low glycemic index diet. It is a multilevel plan, through Market America, so many are, even Optifast or Medifast. I sent letters to patients with dx of DM II or obesity, to invite them to informational meeting. Outside of office hours. If they wanted they can sign up, it gets them 12 wk of diet training with me and a RD in my office, about 6 wk of supplements, some DVD's, and a journal.

We spent 3 months looking at lots of diet plans, and even have a slide of what Craig, Nutrisystem, and Weight watcher's cost, and their relative effectiveness. When you consider that Joining Craig or Nutrisystem costs $300 before they can even get the food, and there is no actual dietician involved, or MD, what is wrong with a doctor or a dietician or both doing it, at least we have more training. People need to loose weight, it affects EVERYTHING and loosing weight makes so many things better, why don't WE help our patients loose weight instead of letting them fumble around with other programs.

It has been very successful as far as the clients loosing inches in their waist and thighs (waist highly correlates with visceral fat). We are 9 wk into it, and the patients are just now starting to reorder some of the supplements. I make sure they know the supplements are only to get a jump start, and don't have to be continued. There are four, some continue 1, 2, 3 or none. It is their choice. We had a session on what was in each, and precautions for people with certain conditions. No ephedra or stimulants, I don't believe in that. They order on-line, I don't stock. I can have an option to send them to a consultant like I did with Juice Plus, but don't feel it is busy enough for that. I think in the case of selling products, it has to be 1. easy for you or staff, 2. Effective, 3. No harm, 4. No stocking, too much money sitting around, and space taken up.

Almost all companies let the customers order for themselves on line, under you, if they don't and demand you carry product, ask them to get with the 21st century.

On another topic, and I will make a separate post. I went to the ASBP society meeting here in Seattle last wk. American Society of Bariatric Physicians, excellent conference, excellent science, and biochemistry (eek!), and learned a ton. Anyone wishing to learn about weight loss, please check out their web site, and consider going to a meeting or ordering information. I should be getting a CD soon, and would be willing to pass along to anyone who wants to make a copy.

Just like IMP's they were very big on spending time with the patients to figure out what would work best for them, and totally against, spending 5 min, giving them a pre-printed diet sheet, and a Rx for Phentermine, and f/u in 1 wk. Sorry for the long post. But felt I have done many of these things, and could supply another perspective.

Cote' MD

MD Cote, Medical, Laser, and Spa

[Practiceimprovemen t1] supplement sales

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like thatany of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread

[Guest guest]

I live in an area where people are mostly managers, and professionals, or dual income couples, mostly younger, and higher income, so I felt it would fly, and so far it has. I definately do have people who still go to weight watchers, as I have cash medical clients also, and it is more economical for them. The low down from the bariatrics society was there is no perfect diet plan, only the one you can get them to do, may have to individualize. All the best, contact me again if you have other questions.

Cote' MD [Practiceimprovemen t1] supplement sales

i believe there was someone that was generating revenue from supplement sales but not by selling them out of there office. it was a setup where patients bought online but you got a percentage of the sale or whatever amount over cost it was marked up - something like thatany of this sound familiar?thanksplease no discussions on ethics or evidence based of selling or using supplements in this thread