a sonographer's guide to entrepreneurship

Talking tech

Episode 20: Creating your offer suite for your ultrasound business

Knowing what you services you can provide and how to diversify your income in your mobile ultrasound business is key. Come hang with me as I share 9 service options you have as a mobile ultrasound provider.


Grab a seat and a cup of coffee because you just enrolled in Ultrasound Business School. We are obsessed with all things ultrasound and are here to take you on a journey through the messy and the magical side of business ownership. Think marketing, contracts, vendors, admin, growth mindset, and that’s just the tip of the iceberg. This is the Talking Tech Podcast, a sonographer’s guide to entrepreneurship. Here’s your host, Jennifer Lindsey.

Jen (00:31):
Hey, hey there, guys. Podcast episode number 20 coming at you. We are talking about mapping out your offer suite today. I am so excited for this podcast episode because one of the things most often when someone is considering starting their own business, the first thing they’ve got to figure out is what they’re actually going to offer and what’s their service going to be. And it really can be one of the hardest things to determine because even though someone may have an idea of what they’d like to do or an industry they’d like to be in, most of the time, honing in on that exact service can take a while, not so with starting an ultrasound business as an ultrasound tech, the service is ultrasound. It’s already in your wheelhouse. You’re already an expert at it. I honestly never thought about this until the podcast I did with my client, Peyton.

And here’s why. As you may or may not know, I myself am not an ultrasound tech, okay? So, I knew I wanted to be in business for myself. I had that entrepreneurial heart and spirit since I was a kid. I knew someday I wanted to own my own business. So when I was considering what I wanted to do, I had a laundry list of things, and I knew I wanted it to be in healthcare. And as a side note, I am so grateful for that, especially with everything that has gone on in the world in 2020. I knew I wanted it to be in healthcare, but I had no idea exactly what that would look like. I had to do research, research, research to figure out what was even possible for me. And so, it honestly took me years to figure out the exact niche that I wanted to be in.

Now, as I mentioned for you as an ultrasound tech, this is covered. Peyton mentioned that to me in our podcast together, and it was such an epiphany because, honestly, again, one of the hardest parts about the startup is figuring out what you will do. And you guys, as techs, already have that handled. You’re providing the services you’ve been providing for patients all along, but now you can do it on your own terms as a business owner, and all that hard work you’re putting in and effort that you’re giving out is going to have revenue that’s going straight into your pocket instead of someone else’s. If you haven’t listened to the podcast I did with Peyton, it is really good. It’s episode number 10 if you want to go check that out. All right, so now that we’ve done a little happy dance that a major part of a business startup has already decided and set for you, let’s chat about setting up your offer suite.

Now what I mean by that is the services that you are going to provide your patients; yes, we’re providing ultrasound, right? But the exact services, what we’re providing, and the different options you have as a business owner are something that I think will be so great for you guys to hear. There are so many different options for providing services, and I actually got the idea of doing this particular podcast topic from another client of mine named Jeff. He scheduled a coaching call with me a couple of months ago and wanted to talk about some of the options in his area because he had some doctors and some patients reaching out, and they were asking him if he could provide some specific services. And it really got me thinking about how many of you, either those considering starting your business or those that already have their own business, might not realize the plethora of opportunities out there.

And so, I just want to go through some main points that you can use today on some service options that you can continue to add into your offer suite for your patients and physicians. So that’s what we’re going to chat about today in this episode. And the cool thing about this is that you can start small with your main service, your passion, what you want to provide, and expand from there. I think in any business, having a multitude of revenue streams to diversify your income is really key. Let’s chat about ways to provide ultrasound services in your business. Okay, starting off as a standard, providing mobile ultrasound services in physician offices. When I have students hop into our Ultrasound Business Academy, this is the way we suggest starting out. You’ve got to have a contract to do so.

It’s got to be set up by a healthcare attorney. The one we use, I think, is 17 pages or something like that. It’s the one our students have access to. This is absolutely imperative, and as I’ve chatted about in other podcast episodes, you have to have this contract, and it’s got to be set up by the healthcare attorney so that you are insured to have all of the pieces of the puzzle put together because there are so many different rules and regulations when it comes to Medicare and providing these types of services. The moment you bring in the ultrasound machine, there are a million different rules and regulations that apply when you go in just as a tech; as you guys probably know, if you’re just a tech and you’re staffing, or you’re going into different offices with when they have their own equipment, you can charge by the patient, you can charge by the hour, you can do whatever you want.

As soon as you, as the tech, are bringing in the ultrasound equipment, a bunch of other rules and regulations apply. You got to have that contract. Sorry to go off on a tangent there, but I just have to reiterate how important that is. So if you don’t do all services when you’re providing this service going into the physician’s office, you can always add some employees after starting. The way that this standard kind of setup is achieved is that you will partner with physician offices in your area. You’ll have that contract, as I discussed. You’ll be providing services on a fee-for-service basis. So you will determine the average amount of ultrasounds they’re providing in your sales process. That way, you can come up with a specific schedule. That’s how we suggest our students set it up so that you’re going in, let’s say to Dr. Smith’s office every Tuesday from 8:00 AM to noon. That’s your set aside time. 

They know that’s when you come in; they schedule all their patients during that timeframe. You provide the services during that four-hour block of time and charge them monthly in an invoice for everything you did the previous month. So if you go there every Tuesday, that is 16 hours a month, you’d charge them for 16 hours a month that you did the previous month in an invoice directly to them. They pay you back, bill insurance, get all the revenue from insurance, and pay you out of that revenue. Everything left over is profit for them, and it’s a lot less expensive for the patients to come back into their own physician practice as opposed to going out into the hospital. So it is a win-win situation. I absolutely love that mobile ultrasound provides benefits for all parties involved in the physician’s office, you as the mobile provider, and the patients.

And it’s just the best way to do business to me. So that’s the standard. That’s how we always suggest people get started up. Now let’s talk a little bit about becoming an IDTF, an independent diagnostic testing facility. This is where you are the one as the mobile provider billing insurance. Now I always suggest, as I mentioned, starting out with that fee-for-service model, as I just mentioned a moment ago, where you have that contract. You can be providing those services and getting paid because the doctor is already credentialed with insurance, okay? They can bill, they pay you money the end; it is the cheapest way to get set up as a mobile provider because the problem with getting set up as an IDTF, as a mobile IDTF first is that Medicare requires that you have your everything that you need to provide those services and be able to put all that information on your credentialing paperwork to send into them to request to be a provider.

So there’s paperwork you’ll fill out for Medicare and all of the other insurance groups requesting to be a credentialed provider in their network, right? So that you can send in requests for reimbursement, they send you back the money, and then you get paid then directly from the insurance company. This process can take a very, very long time; it’s very time-consuming. And the problem is that you have to purchase your ultrasound equipment ahead of time because they require that the make, model, and serial number of the equipment that you’re going to use be on your initial paperwork. I’ve been doing this for almost 20 years now; I don’t think it makes a whole lot of business sense to set it up that way initially because you are going to be paying on a piece of equipment that is sitting there waiting for you when you could be out doing services, on a service fee basis first.

Does that make sense? So my suggestion is if you are looking at becoming a mobile IDTF, start with a few clients on a contract basis so that you can pay for your equipment with the revenue you’re making in your business while you are waiting for all the paperwork to be completed sent in and the finalization for the credentialing to be done. So you’re actually making money while waiting on all the insurance paperwork. Does that make sense? So if you want to become a mobile IDTF, I suggest starting out with a few contract-based physician offices. First, make money while doing all the paperwork because it can take a long time. And when you’re done with the credentialing, once you’ve become a provider for the insurance groups, then you’ll have two service options, which I think is really cool.

So then, another way of diversifying your income, it opens up your market to physicians that don’t want to bill on their own. You have the option to bill for them, bill insurance directly for them, or physicians that do want to bill. You have the option to provide services on a contract basis. And so that is the way that I suggest if you’re looking at becoming a mobile IDTF, that you get things started first as a contract basis, fee for service model while you’re waiting on all that paperwork because it really can take a very long time. Okay, let’s move on to another service option: screening services. Couple different options here. I actually have a client; she’s been a client for years and years at this point. She does complete screening services, she doesn’t do any diagnostics in her business at all, and she is booming like she has an amazingly successful business.

She actually works for her clients, who are employers. They do it as preventive options for their employees. And so she will set up different sessions at their sites. So she goes around to different sites. Her and her employees go around to different sites, and they provide these packages of preventive screening ultrasounds. The benefit for the employer is that they’re able to save on their insurance costs because they can show their insurers a lot of times, you know, for health insurance purposes and that type of thing for employees, for big companies, if you can show that you’re providing preventive options for your employees, your insurance costs go down so they save on insurance costs because they can show the insurer that they’re providing preventive services and the employees then of course if anything’s going on, can have the option then to go see their physician to look at any further diagnostic services that they may need.

But she has a huge business doing that, which is a cool option many people may not consider. You can also add screening services to your regular diagnostic services. So if you are the one billing as the mobile provider, you can have just cash rates for these, much like Lifeline screenings; I think everyone probably has heard of Lifeline. They go out to different places, like community centers, churches, and provide screening services directly to the patient. So they market directly from business to consumer; they partner with the patient themselves. The patient comes out to whatever location they’re at, they provide the service, send the report back directly to the patient, and then the patient, if there’s anything wrong, needs to take that to their physician for any further diagnostic testing. So if you add this into your regular services, if you’re going out to your physician practices, you can tell them, Hey, I can also provide this list of screening services.

And so the cool thing about that is if your doc is the one billing insurance, they can just have cash rates for these. You would just charge your hourly rate to come in. Let’s say that Dr. Smith’s office again from 8 to 12 on Tuesdays; they just pop in those patients wherever they want them on the schedule because it’s just another patient; the doctor’s office is charging the patient a self-pay rate for this because screenings aren’t covered by insurance with a couple of caveats of course, but screenings are usually not covered by insurance. So they would just have a cash rate for that, and they would just pop them in on the schedule. You’d charge your regular hourly rate, and there you go the other way; if you are the one doing the billing, you would just have cash rates for those, and you would charge the patient directly those cash rates for providing those screening services.

I will tell you I’ve talked to a couple of physicians that we work with personally with our mobile ultrasound business. They really like having this as an option. Although they love Lifeline and what they’re providing, they have told me it’s so nice to know that the same people doing my diagnostic ultrasounds are also doing the screenings because I know who is doing the ultrasound and who is reading it. It makes me feel more comfortable with the information I’m receiving because I already know you guys. I already know the radiologists that are reading it. It’s not coming from a completely separate company. And so I think that’s kind of a cool thing to be able to add in as an additional service option. So obviously, that would be something that, you know, would increase the amount of patients you were able to see at a physician practice because it would be both diagnostic and screening services as an option in the physician practice.

All right, so that’s an idea for screenings. And then the other option too is providing in-home services; there are a couple of ways that you could do this. So you could partner up with a home health group, a mobile doc group, or something like that to provide this. In that scenario, you would partner up with that actual health group. So either like a, like I said, a mobile health group or a mobile physician group to provide the services. They would bill insurance, and you’d charge your hourly rate to provide those services. You could also market, of course, directly to consumers. So if you wanted to do it that way, I probably just kind of off the cuff here without thinking into this too specifically, but I would probably say it would be easier to market directly to the actual home health or mobile doc providers just because that is a few groups.

Whereas if you’re trying to market to consumers, that’s a lot more marketing dollars that you’re likely going to be putting out. But you could market directly to consumers. We’ve had some people really get on board with this lately, either working with mobile doctors or home health groups or marketing directly to consumers just because of everything going on with Covid because there’s a lot of people that don’t want to go to a big hospital, they don’t want to be around people, they don’t want any of those things. And being able to have someone come and provide services directly in their home is something that, in certain areas, I have talked to a ton of techs that are really looking at adding that as an option for patients in their area. So that is a thought as well. Something similar is providing services out at nursing facilities, so skilled nursing facilities, rehab centers, those types of places.

So, the interesting thing about, let’s talk about nursing facilities for a moment. Most of the time, nursing facilities are set up with Medicare to receive a bulk amount of money for each patient. They don’t charge Medicare like a doctor’s office does for each individual service they provide. They don’t get paid for each individual service they provide. They get a bulk amount of money, and out of that money that they get paid, they have to, as the facility, pay for any of the services that the patient needs. So let’s think about this for a second. If there is a nursing facility that has a patient that needs an ultrasound, most of the time, the patient is a patient that needs to have an ambulance come to pick them up, take them to the hospital, and have the ultrasound done; they are charged for both.

The ultrasound and the read are always separate when you get things done at the hospital. So this can cost the nursing facility $1500 to $2000 for that entire, you know, list of services, the transport, the ultrasound, the reed, all of those things. Now they have to pay for that. They don’t charge Medicare for each of those services. Remember, they must pay that out of the bulk sum they got for that particular patient. So does it make more sense to do that, or does it make more sense to partner with a mobile group that can come out and bring the ultrasound tech, the ultrasound equipment, and the supplies, provide the interpretation, and have a one-stop shop cost, let’s say a couple hundred bucks as an example. Does it make more sense for them to do that or to pay two grand and have the patient have to be transported and all those other things?

I mean, it’s such an amazing service to be able to provide these services into skilled nursing facilities because it’s such a cost saver, and it’s so much easier on the patient. So that is kind of how things work at skilled nursing facilities in general for the most part. And the cool part too about nursing facilities is that their rules and regulations are different from physician practices. So we have to charge an hourly rate for physician practices because of the way that everything is set up with the rules and regulations for Medicare. And this goes for Medicare patients and private pay patients because there can’t really be a separation between the two when you’re working with a group, like you can’t charge an hourly rate for the Medicare patients and then a per-patient rate for everything else. It gets too murky, and you can get in trouble for that.

So I highly suggest just always doing an hourly rate, making sure you’re in compliance with Medicare rules. However, skilled nursing facilities, hospitals, and places like that have different rules so that you can charge by the patient for those groups. So it makes sense to do that for nursing facilities because a lot of times, you know you’re going to be called, you’re not going to set aside like a Tuesday from 8 to 12  at the nursing facility. Usually, they’ll call you and say, Hey, I’ve got a patient that needs this type of ultrasound. When can you come out and say, oh, I’ve got a spot in my schedule tomorrow. So usually, it’s more of like kind of an on-call basis. The cool part about owning your own business you can make that on-call time whatever you want.

It doesn’t have to be at night; it doesn’t have to be on the weekends. It can be; this is when I provide services, it’s Monday through Friday, and I will make sure that I am responding and getting that ultrasound done within one business day or two business days or whatever you decide works for you and the client. So, the other way that you could provide these services is if you are getting set up as a mobile IDTF, you would be credentialed with Medicare, and you can charge Medicare directly as the provider for these services. So in that scenario, it would cost the nursing facility nothing because you are charging Medicare for the services provided in that skilled nursing facility. So those are a couple of different ways to provide services to nursing facilities, and it can be such a huge cost saver for them either way that you do that.

The other cool option, too, is we’ve got quite a few clients who focus on OB. They love it. It’s one of their favorite things to do. And so we’ve got quite a few clients over, over the last, gosh, over a decade that have worked with us that do elective 3D/4D or they add in OB/GYN diagnostics to that as well. We have some that do it mobile, we have some that provide in affixed location, so they have an office space, patients come to them. We also have some that do both nowadays. It’s so easy to grab those.  I don’t even know what you would call them, I guess, but they’re in a big office space, and they usually have a reception area and that type of thing. But then you, as the business owner, are just renting out a small space within that, and then usually they have conference rooms that you can rent when needed and those types of things.

But it’s a really cool way to be able to actually have a facility without paying for an entire office space. And so we’ve got a multitude of clients who have done that, not just for 3D/4D, but if they want to have an office space, which I’ll talk about in a second, that’s a great option for that. And so that is definitely something that is an option, and I think patients really love the fact; I mean, most pregnant ladies want a 3D ultrasound, I would assume. And so we’ve got a lot that want to do it. But having it done by an actual, registered tech with years of experience in ultrasound, we always recommend getting it reviewed by a radiologist. We would do that anytime we did any 3D/4D stuff for our mobile business. We actually used to partner with a couple of OB offices that really wanted to have that as an option.

We don’t do a whole lot of the 3D/4D any longer. The two groups we had for years and years and years, one of the guys retired, and the other one decided to partner up with a hospital, and so they, of course, all their services had to go through them. So we don’t do a lot of 3D/4D stuff anymore, but we used to do quite a bit, and we always had the OB look at everything just to make sure things were fine. It’s just a nice kind of second check, and I think it also makes patients feel more comfortable. So that’s an option, too, for the 3D/4D, more elective stuff. But like I said, you can also add the diagnostics there. The machines do both; they do both diagnostic and 3D/4D, so you might as well diversify; again, talking about diversifying income, you might as well diversify income that way and have both options available to the patients.

Okay, so next up, I kind of touched on this briefly a second ago, but having an office space and, you know, getting a space in one of those bigger buildings where you’re just paying for your little area can be a really inexpensive way to have a fixed location. For our own mobile ultrasound business, we have a fixed location as well; just we do obviously coaching and consulting. We have an entire division that works with individuals, not just our clients but other individuals and physician offices, those types of things for purchasing ultrasound equipment at wholesale prices. And so we’ve got a ton of different things that we do where we really do need an admin office. And so we have an entire office suite and all of that, and we have created a place in there for patients to come, as you know, a fixed site location.

And so we’ve got a little waiting room and our ultrasound exam room and all of that, but that is also an option for you. And so what you can do at this fixed location is provide self, self-pay diagnostic ultrasounds. As I mentioned before, you could do the 3D/4D if that’s your thing. But providing those self-pay ultrasounds, as you know, as one of the services that you provide because you can do it like we do; most of our services are mobile, but we love having an option in our community just because so many patients these days either have HSA health savings accounts or they’ve got super high deductibles. I mean, I do; I’ve got a really high deductible, so whenever I need anything done, I’m always shopping around for the best pricing. And so for them to be able to come to a place and get the same quality services that they would get going somewhere else and paying a fraction of the cost is such an awesome opportunity that we love being able to provide.

And then, because we can also bill insurance, we can see patients who have insurance or those who don’t. But if you are set up when you initially get started, and you’re set up as a fee-for-service provider for your mobile services out in physician offices, if you want to have that fixed location, you can easily charge self-pay rates for your patients. You give them out a detailed receipt with the CPT and the diagnosis code that they can turn into insurance themselves to have it applied to that big deductible, or they can pay with their HSA, you know, a debit card that they have. And so it’s a, it’s a cool option if that’s something that you want to do and really pretty easily done with a fairly low overhead with those really cool office space options that I was just talking about.

And again, if you are credentialed with insurance, then as well, that can be one of your sites that you go to is your own site, and so you can bill insurance and also do self-pay patients from that location. We’ve got quite a few clients that do this as well. Okay, so one of the other options, too, is providing staffing services. So this is something nice that you are able to add as an option if you’ve got available days that you are looking to fill. It could be something where you offer local staffing services to facilities or physician offices that have their own machine, but for times when people are on vacation, there’s maternity leave, those types of things. As an ultrasound provider ourselves for our own business here in Indiana, I know how difficult it is to get PRN people on a whim.

So to have this option in your local area, if you’ve got additional days where you could go in there and provide staffing, I think would be great. I would love that as an option here for us in Indiana. The other cool thing you can do providing staffing services, and there’s a caveat to that that I’ll talk about too, is having this as an option for hospitals. I talked about this in another podcast and had one of our clients ask me about this. I just did a  strategy call with her yesterday, chatting about this a little bit further in depth. But she was asking me, well, how, why would you work with hospitals because they usually already have their own equipment and techs. And I was like, yes, absolutely they do. Now one of the things is if somebody’s on vacation or those, those you know, maternity leave, those different options, it could be something where you just have your name out there, they know you are a PRN tech for lack of a better word with your own company though.

And in that scenario, you can charge more, and they just know, hey, if somebody is sick or on vacation, I can call their company and see if they have anyone available. But the one of the things that we do here for our mobile business is we’ve got a couple of groups that we work with. For example, we work with an orthopedic hospital that, in the beginning when we started working with them, they just did not have the ultrasound volume for it to make sense for them to have an ultrasound machine and a tech providing those services just because they did mostly MRI and x-ray rehab facilities are another group that just bec, even though they are big facilities, may not have the ultrasound volume for it to make sense for them to have an actual, tech and machine on site.

Or perhaps they’ve got a machine just available when needed, but they don’t have a regular tech. And so those are some options for working with hospitals. And you wouldn’t know this information until you reached out to them. So it would just be something during your marketing that you’re reaching out to some of these hospitals that have the potential of maybe not having their own tech there available all the time, like orthopedic groups, like rehab facilities. Another option is adding in additional services outside of ultrasound. So I have- as a couple of examples, I have a client who has added EKG into their ultrasound options because it was something that their local groups were asking about. And I think that’s the best way to add in additional services is if you have the idea, go to your current clients and say, Hey, I’m looking at the potential of adding in EKG because I know maybe through conversation or whatever it is that you guys don’t have that available here. You have to send patients out for that.

If I got an EKG system, would that be something we could add in as the service options that we provide? We’ve got another client who has added in nerve conduction studies, and they are like killing it with that. It’s been great for them because the physicians in their area wanted to have that option. It was something that they could provide to them. So it’s a great way, as I said, to add into groups that you’re already working with and then expand on it from there because if you know that the business is going to come, it makes it easier to buy and fork out that extra money to have different types of equipment. Obviously, you can’t do nerve conduction studies or a straight EKG with an ultrasound machine. You need to buy additional equipment to be able to do that.

But if you know your local doctors are going to, your current clients are going to order stuff; it makes it so much easier to build that into your budget and say, okay, these, I’m going to immediately start seeing revenue from this because my current clients are going to start ordering and then when I go out and market to new clients, I have additional service options because I’m already doing those in other groups. Okay, guys, I have given you nine different options as ways to expand your revenue with your mobile ultrasound business. Now don’t do it all at once. I’m not saying that you should consider this all at once. Start small, start where you’re comfortable, and start where your passion is, but know that you have so many different options to continue to grow and flourish as a business owner in this industry. All right, guys. Until next time, I will be over here cheering you on,

Ready to see what it takes to start your own mobile ultrasound business? Grab our completely free startup guide and learn how you can make a thousand dollars a day with your own business. Head to our website, www.aic-ultrasound.com, to check it out.

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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