a sonographer's guide to entrepreneurship

Talking tech

Episode 14: Top 3 Questions of the Week: Mobile Ultrasound

I chat with techs on a daily basis helping them navigate the questions they have before deciding to start their mobile ultrasound business. In this episode I’m giving insight into the top 3 questions of the week: who pays for radiology, what if I only provide a few ultrasound modalities, and how does the ultrasound equipment purchase/lease work?


Jen (00:01):
Hey there, and welcome to the Talking Tech Podcast, a sonographer’s guide to entrepreneurship. I am your host, Jennifer Lindsey, and I am so excited to chat with you today about the top three questions of the week. So I talk with techs across the country all week, every week. And this week, I wanted to pick out the top three questions I got from people, either them sending me DMs or through our discovery calls that I’ve had with a few of you over this week. And so, I picked out the three questions that I think were the top questions people were asking, but secondly, that are really good questions. I know most of you considering starting a mobile ultrasound business are going to have. And so that is always my goal with these podcasts is to get as much information out there as possible because there’s just nothing like this for our industry.

So the top three questions I want to chat with you about today are: who pays for the radiologist or cardiologist when the physician you are working with cannot read their own studies? Such a great question. Number two: what do I do if I specialize in only one or a few ultrasound modalities? And then number three: how does it work trying to get my ultrasound equipment? What does that look like? So I want to touch on each of these for you. The radiologist/cardiologist question and the interpreting doctor question are good. I think you guys will be excited to hear my answer to this because the person that pays for the interpretations is your physician client. Now for our students, we go through exactly how the billing needs to be set up in these scenarios because certain Medicare rules and regulations apply to billing out imaging reads if you are not as the doctor, the one performing those personally yourself.

And so that is a good side note is that there are certain things that need to be done as far as the billing side goes, which, like I said, is something we delve into specifically for our paid students. But I just want to give you an overview today so you kind of understand how that works. So, in general, your physician clients, with the exception of the billing with Medicare, are going to get paid for both the ultrasound itself and the interpretation. Let me delve into that part really quickly. So for those of you who may not have much experience with the billing side of this, there are components to an ultrasound service when it’s billed out. So there is a technical component, which is the actual performance of the ultrasound. The way I remember this, I think it’s a lot easier, is the tech performs the technical component.

So that’s actually doing the ultrasound on the patient. The second part of the exam is the interpretation. So once you send that exam out to the radiologist or cardiologist to be interpreted, that is the professional component. If they’re billed together, these are set up as billing globally. So if you hear those three terms, that’s what those mean. Billing globally is billing for both the professional read component or the technical ultrasound component. So when the physician’s office that you’re working at sends out a request for reimbursement back from the insurance company, and they’re not doing the read on their own, they’re getting paid globally. So both for the professional component and the technical component. And then when they partner with the interpreting physician, they will then pay out a read fee to that radiologist or cardiologist for the actual interpretation. So they’re basically purchasing the read.

Now I know I’m saying this a lot, but I just want to make sure you guys understand there are caveats to exactly how that works because of Medicare rules and regulations, but in general, that’s how it’s set up. So the actual interpretation money does not come from your gross revenue. So that is the exciting part. That’s not something you need to calculate into the revenue stream you are looking at. It’s not one of the costs of doing business for you specifically as the mobile ultrasound provider. Usually, those rates run around $25 a read for general and vascular scans and then around $45 to $50 a read for echo. So that gives you an idea of about what the costs are in general in the industry for interpretation services. And again, that’s something that would come out of your physician’s revenue stream from having the ultrasound in the office, not out of your revenue stream. The cool thing we love having as an option for our students is that we’ve got interpreting physicians in our vendor list, which is really nice. So it’s something you can give to your physician’s office as a turnkey service because a lot of them don’t really have a preference necessarily on who does the read. They don’t want to go out and find a radiologist or cardiologist to do that, and so it’s nice to have that as a service.

You can go in and say, hey, we’re going to be providing ultrasounds in the office. We can also connect you with an interpreting group if you are not able to interpret the studies on your own. So that’s a great question. I love that question because it’s one that I get a lot. So I think it’s important to realize that that’s not something that comes out of your revenue stream as the mobile ultrasound provider. Okay, so let’s move on to question number two. What do I do if I specialize in just one or maybe a couple modalities of ultrasound? I was chatting with someone this week that had this question. I thought it was wonderful because it is kind of confusing sometimes if you only do vascular or if you only do echo; you can think of obviously the fact that being able to provide all the different types of ultrasound services widens your potential client base.

Obviously, my suggestion is if you specialize in just a few modalities of ultrasound, those physicians that utilize those the most are the ones that you are going to want to market to first. And I said this; I think, maybe on last week’s podcast, I was talking about the fact that in the general scheme of things, you really don’t need a ton of clients to start filling up your days. So if we look at it from the stance of, let’s even say, a small account where you’re going in only one-half day a week, you only need ten offices to fill up an entire five-day work week. So if you’ve got offices where, let’s say a smaller offices you’re going in one full day a week, you only need five clients. So if we look at it in the sense of let’s look at focusing on the doctors that are going to use echo the most or echo and vascular the most as an example, or if you’re a general, specialized tech, we would want to look at physicians that do more general ultrasound.

Once you get those first few accounts, I always suggest that looking at the opportunity of hiring another tech to come in and compliment the services that you provide so that you can come in and say to your physicians, hey, I’m in here providing echo and vascular only. Let’s say you work as one of your clients at an internal medicine group. I’m looking at bringing on additional staff to be able to provide general thyroid, abdominal, all of those types of things that I don’t currently provide. Is that something that you would be interested in? And let’s take a look at those numbers. And so you can, once you’re in those few accounts, start looking at the opportunity of adding in additional staff to be able to cover those days. So you would just schedule it out. Perhaps you go in the morning, let’s say you do echo vascular, you go in the morning on Mondays to do all the echo vascular, and then your staff member comes in on the afternoons to do all of the general types of ultrasounds.

So that’s something that you could always look at in the future. So I don’t think it’s necessarily a detriment for you to only specialize in a certain ultrasound modality. I think it is smart to look at once you get those first few accounts. Do I want to add on a staff member to be able to open up the market and the availability to me more? For example, if you just do echo vascular, I’m using that one as an example a lot, but if you just do echo vascular, you wouldn’t be able to market to some of the physicians we market to for our mobile business here in Indiana. We have urologists that really do mainly general ultrasounds. Those types of physicians and specialties wouldn’t be someone necessarily that you would be able to capture a lot of business from because they don’t do a lot of echo scans and those types of things.

They’re doing more abdominal and can always add in and increase your marketability in your local space by adding additional staff members. Okay, and then question number three, how does it work? Getting an ultrasound system, what does that look like? What do I need to do? Do I lease it? Do I buy it? This question I get on a regular basis. And so I think it’s a really good one to cover today in our questions of the week podcast. So the main thing I want you guys to understand is that it does not make business sense to purchase your equipment first when you are getting the business up and going; it takes a few months to do all of the backend work that you need to do to have a business that you can start marketing, you’ve got to get your branding materials done, you’ve got to incorporate your business, you have to get all of your vendors lined up and ready to go.

You need to do a lot of things before you’re ready to go out and market your services. And so it doesn’t make sense that the first thing you would do is grab your equipment and have it sitting there collecting dust while you’re doing all the backend stuff you need to do to get ready. Now, as a tech, that’s the exciting part, isn’t it? Your very own piece of equipment, but it doesn’t make sense to just have it sitting there. So because it doesn’t take a long time to get into you, once you order it, it makes the most sense to wait until you’re ready to start that first account before ordering your equipment. We have students that do all kinds of different things. So we actually started an ultrasound equipment division of our company years and years ago because we had students who either had trouble because they were not doctors getting brand new equipment from major manufacturers, or we had students who would go onto the used market and were getting lied to, for lack of a better explanation.

There was, especially at that time, think ten years ago, PACS systems were not what they were today. I mean, you had to have things very specifically set up to be able to push images out from A to B. And because we’re mobile, we don’t have those systems in the office where we’re just moving them from room to room on a network inside an office; we have to be able to push them up to a cloud basically and then down to the radiologist or cardiologist that’s interpreting them. So especially a long time ago, the type of software and software revision levels were really important on used equipment because of what needed to happen on the backend to get images out to where they needed to go.

I remember the last straw for us before we started our equipment division and really started looking into that was that we had a student who bought a piece of equipment from a used market vendor. When she received it, it wasn’t working, we couldn’t get the connection to work, and so we were going through many different things. We ended up having her get on the back end of the equipment where she could look at the software revision level. We noticed that it was not the revision level she paid for, but the sticker on the back of her machine said that it had the software revision level that we told her she needed to get. And so they had taken the sticker off and put a different sticker on, thinking she’d never figure it out because, at the time, mobile wasn’t super prevalent.

And so sending things from A to B inside a secure network in an office wasn’t as big of a deal as sending it to a cloud, making sure it was going where it needed to go. So they thought she’d never figure it out, and that was one of the first things she figured out, and that was just really the last straw for us. We wanted to make sure that we helped our students get exactly what they needed. And so we, at this point now, it’s been years and years and years, are a vendor for a lot of the major manufacturers, and we love being able to do that because we get wholesale rates as a vendor and can pass those wholesale rates along to our students. So it’s a huge cost saver on the equipment side, which is great.

Then we also obviously know exactly what our students need and can work with them specifically based on the types of ultrasounds they’re doing, what their budget is to make sure they’re getting the type of equipment that is going to work best for them. So our students really do one of two things. I always like to explain a little bit about leasing equipment versus buying equipment because personally, when I hear the word lease, I think of a car where I lease it for three years or five years or whatever it is, and then I have to give the car back at the end of the lease and get a new one. Usually, leasing and capital equipment is set up so you can do a dollar buyout at the end.

You can, and some of them upgrading to a new piece of equipment and just continue on with the lease. There are many different ways to have that setup, and because we do this so often with our students, we suggest a few leasing groups just because they know our business plan. It’s a lot easier to get the approval because of that than it is sometimes for our students to go and try to get a personal loan at the bank. Many of our students have done that. However, sometimes they’ll require additional paperwork, or some banks will say, hey, we need to see revenue into the company before we give you a company loan. And so a lot of times, they’ll do it as just like a personal loan with the collateral being the ultrasound equipment.

So those are a couple different things that our students do. In the past, we also had some rental options for our students, too in the case where either, it was taking a little bit long for them to get the financing part finalized, and they had an account ready to go and wanted to get started. Things of that nature can also be an option, although we don’t have just equipment sitting around waiting for the rental piece. But we’ve done that quite often for students who maybe had an issue with needing something right away and ready to get into that first account and get going. So that’s kind of how the equipment part works. Wait until you’re ready to start that first account because it is going to be the best business decision for you to have the revenue coming in from your first client covering that expense for the actual equipment. Then, it is not sitting there collecting dust while you are doing all the backend stuff you need to be doing to get the business ready to get out there and start marketing those services.

And then either leasing or purchasing the equipment is usually how that works on the backend financial side of that as well.

So I hope that gives you guys some insight into probably some of the questions you have been thinking about because those three are ones I get regularly. I’d love to start doing this maybe once a month, having the top three questions of the week or the top three questions of the month. I think it’s really important to get that basic information out there to you so that you can decide whether or not starting a mobile ultrasound business is a decision you want to look into further. I say this all the time; it is a nightmare trying to Google and find things online about starting a business in the ultrasound industry because that information is just not out there or readily available. And so, my goal is to make sure I get you guys that basic information you need so that you can navigate this and decide if this business opportunity is one you want to take a look at. So I hope you guys enjoyed those questions. If you have more specific questions for me that you want me to kind of keep track of and put on a list to do these questions of the week or questions of the month for a podcast, I would love for you to send those to me because that is why I do these podcasts is specifically for you guys and to get that information out there. So thank you guys so much, and until next week, I’ll talk to you then.

your strategy-obsessed ultrasound business coach.

I'm Jennifer -

Welcome to the Talking Tech podcast, where we answer your questions about legal, marketing, admin, sales, and so much more. After nearly 20 years in the industry running our own mobile ultrasound business and helping techs across the country do the same, I'm so excited to bring you industry insight, mindset, productivity, business tips, and inspiration to help you design the business of your dreams.

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