Dr. Jason Cox: An Interview with musculoskeletal radiologist and Owner at Ultrasound First

Dr. Jason Cox is a musculoskeletal radiologist. He specializes in diagnosing skeletal
disorders with ultrasound and using ultrasound-guided procedures to treat patients.
Diagnostic ultrasound can give you the answers you’re looking for, rule out conditions, or
give additional information that your doctor needs to decide what the next step in
treatment is. Ultrasound First is the first of its kind in the Midwest, and possibly in the
country. Dr. Cox and his staff have created a process that is quick and efficient. They will
have you in and out before you can say “musculoskeletal ultrasound.”


Email: info@ultrasound-first.com
Website: www.ultrasound-first.com
Facebook: https://www.facebook.com/ultrasoundfirst
Instagram: https://www.instagram.com/ultrasoundfirst/
LinkedIn:https://www.linkedin.com/company/ultrasound-first/


https://myrangemaster.com/?afc=11
https://www.lydexar.com/ (Code JSR5)

Transcribed from otter.ai
Hello, and welcome to STL Active St Louis’s premier health and wellness podcast. STL Active aims to give listeners
in the St. Louis area the information they need to succeed and progress with their health and fitness. This podcast is
brought to you by stlouispt.com and hosted by Doctor of Physical Therapy, Greg Judice.
Hey everyone, its Dr. Greg, owner and physical therapist at Judice Sports in Rehab. On this episode of the show, I’m
interviewing Dr. Jason Cox from Ultrasound First. Dr. Cox is a musculoskeletal radiologist specializing in diagnosing
skeletal disorders with ultrasound and using ultrasound guided procedures to treat patients. He is from St. Louis and did his training at Mizzou and is also an Army veteran. In this episode of the show, we of course, talk about 
healthcare as a whole imaging techniques. And of course, why ultrasound is the best option for most people who
need imaging. Without further ado, let’s get into the interview with Dr. Jason Cox. Alright, welcome to the show.
We’ve got Dr. Jason Cox from ultrasound first, thank you so much for being here.
Thanks for having me, Greg. I’m very excited to do this. This is a great podcast to be on. So I looking forward to it.
I am very much looking forward to it as well. I met you What about a month ago, something like that?
Yeah, about a month ago through some mutual providers that we both do business with.
Yeah. And then I went to a presentation of yours and thought it was fascinating and thought, hey, let’s get this guy on
the show. I think it’s he’s got some awesome stuff to share. So let’s do that. Let’s have you tell the audience a bit
about you and your background.
Okay, sounds good. Yeah, so for all you St. Louisins out there I am from St. Louis and I graduated from Ritenour high
school. So we got that out of the way. I, originally from here, went out to the military straight out of high school. And
then after the military, went into medicine, so went to college, I did my medical school, and my residency at University
of Missouri. And I am a diagnostic and interventional musculoskeletal radiologist. And what that means is I did some
additional training called the fellowship to do intervention interventions and diagnosis of the musculoskeletal system,
which would be like bones and joints, tendons and ligaments. So people that either have, you know, aches and pains
or you know, the things that you treat, as physical therapists, or if they have tumors or pain or nerve problems or
things like that, then I can diagnose their problem, and then also treat treat a lot of those things to
very cool. What got you interested in medicine? Did you I mean, most PTS have the same story of Oh, I was injured
as a kid and went through PT in high school. And, you know, that’s a very common PT story, but it’s always a little
different when it comes to medicine. Yeah,
so So basically, you know, the whole reason I went in the military is I was, I was an athlete in high school. And then I
wanted to do something extremely challenging after high school. And whenever I got that college bill, I was like,
Whoa, what is this, you know, I, I just had, I’m the first person that even graduated high school, from my family. So I
had no idea what to do with that. And so I went to the army recruiter and said, Hey, what’s the most challenging thing
that you guys have? And they’re like, Oh, the infantry. So that’s how I did go in there. And, you know, I was always
into athletics and physical fitness, and I, you know, I was the military, I got my personal training certificate and
everything. And then, similar to PT, I dislocated my shoulder during a mission, and ended up seeing an orthopedic
surgeon. And, you know, at that point, I had no idea what you know, I thought I was just gonna be an army my whole
life. And he was like, Oh, you seem like a smart guy. Why don’t you? Why don’t you check out medical school? And
here I am, sister.
Yeah. Very cool. So how old were you? Or how long were you military before you decided to pursue medicine?
So probably three years I was I was in it, you know, I signed up for four years and then three years into it, I was
injured and then had surgery and and all that and that kind of just opened up my eyes to what was out there. You
know, I, I had never even honestly, you know, the only thing I even knew about doctors or anything was you went
there to get your checkup. So Gotcha. And then, you know, from then, I just went and kind of hung out with that
orthopedic surgeon and just kind of learned about more stuff. And then I thought whenever I was getting out I was
going to be sports medicine or, or something like that. And then when I got to medical school, I just kind of fell in love
with radiology, which is, you know, the, the science and medicine of imaging image guided treatment of health
conditions.
So tell us more about radiology in general. Like when I picture a radiologist, I picture somebody in a dark room
wearing glasses. And you know, there’s black images on a computer screen. Yeah, they may not even talk to a
patient, they may not do anything other than write up a report. And that’s my impression of most radiologists. So I’d
love to hear kind of what all does radiology include?
Yeah, yeah. So, so radiology is actually changed a lot over the past, I’d say 40 to 30 years. The invention of
electronic imaging, that’s pretty recent, you know, relatively, that was really became mainstream around the year
2000 or so. Before then, you know, radiologists were just, you know, hanging up X rays on a wall and looking at them
and then writing a report or dictating the report, and then the, the doctor would get it who ordered it, and they would
never see the patient. Well, radiologists have always been in the forefront of interventional procedures, using image
guidance. For instance, the heart catheterization, was invented by a radiologist Charles Dotter do TT er, the
University of Oregon hospital, or the radiology centers named after him. Very interesting guy. And then there’s a lot of
different procedures that have come out of radiology that people don’t know about, because the radiologist isn’t really
in a clinic seeing the patient, the patient gets referred to them from a doctor. Well, there’s plenty of doctors or
radiologists out there that will just sit in that room and look at the screen and in the dark. And that’s all they’ll do all day. But then, the bet the vast majority of radiologists, they’re responsible for doing biopsies, placing drainages into 
abscesses, placing lines for medications, doing lung biopsies or putting in chest tubes, tubes and kidneys if your
kidneys are obstructed, and then which I used to do all that stuff. But then now like with my fellowship training, in
addition to that I do interventions for the musculoskeletal system. And that is a combination of pain medicine,
oncology, Sports, medicine, and different procedures that could have typically previously been done with a surgical
technique but can be done with image guidance and minimally minimally invasive techniques.
Okay. So kind of breaking down the electronic imaging, when you say electronic imaging, I hear MRI CT, what other
ultrasound obviously, yeah. So what other electronic imaging is there?
Sure, yeah. So there’s, so you already touched base with MRI, CT, X rays are now electronic, okay. Nuclear
Medicine, and ultrasound. Now, we, it’s easier to break these down into which ones have radiation, and which ones
don’t have radiation, a CT, and an x ray. And nuclear medicine has radiation. There’s one other thing in there that
uses X ray called fluoroscopy, that also has radiation. And radiation is basically just like taking a picture with a
camera. But what it’s shooting out instead of, you know, light coming, or, you know, absorbing into the receptor. It’s
actually X rays. So was just an energy particle. Yeah, it’s an energy particle. But the difference between light that
touches your skin when you’re outside, and radiation or X rays, is that that X ray can actually cause some damage,
theoretically, to your, to your DNA. And
it’s unlikely that 1 X Ray would cause damage. But if you had 10,000 Over your lifetime, like
just for example, the amount of radiation and an x ray like a chest X rays, the amount of radiation that you would
receive, if you flew from Los Angeles to New York and back, just in an airplane, because there’s actually radiation all
around us all the time. Sure. Sunlight is and the closer you get up to the sun, the more radiation you’re exposed to,
because it’s not filtered out by the atmosphere below. You got it. So most people, you know, if you’ve, if you’ve, you
know, how many flights have people taken throughout their lifetime? I’ve probably been on 100. So I’ve had 100 chest
X rays in my lifetime, right? So and there’s a limit to that and the government looks at it And you’ll hear radiologists or
doctors saying, No, we don’t want to do that, because we don’t want to risk, you know, the radiation risks? Well, we’re
looking at you as a patient from when you’re born is baby all the way until you die. What is your risk going to be from
getting a cancer or something from the X ray throughout your entire lifetime? Most people, it’s not going to bother,
you know, if you had, if you had hundreds of X rays in your life, you’re not going to get cancer from it, right. But what
we do is we also have these other things like MRI, which uses radio waves, just like if you know, on your cell phone
or anything like that, and a magnet to look at the atoms. Whenever you’re looking at X rays, you’re looking at
shadows, from the actual x rays. When you’re looking at MRI, you’re actually looking at the atoms and how they’re
moving due to the influence of the magnetic field. And that’s why when you’re in the MRI, you hear all those loud
noises. That’s the antenna turning on and turning off to make those atoms move in a certain way. And then the those
get transformed into the pictures by a computer. And then the radiologist looks at him and says, okay, yeah, you’ve
got a torn meniscus or whatever. Got it.
So in general, ideally, we’re trying to limit radiation load over a lifetime. So if we can avoid radiation, yeah, that’s,
that’s good. Yeah, it’s not terrible to have an x ray in right. So this situations that it’s necessary, but when there’s an
opportunity to avoid the X ray, avoid the CT avoid the what was the third one that you mentioned? Nuclear nuclear
medicine, yeah, then, of course, we’re trying to avoid those. Radiation, right, the radiation types of
imaging, right, and then that’s kind of where ultrasound comes in. You know, as a, as a, it’s all risk versus benefit to,
you know, like, if you have 100% chance of diagnosing something with an X ray. And it’s very low. Yeah, go for it,
sure, that’s fine, it’s not going to, or let’s just say that there’s a high risk that you could miss something, then you’d
want to just do that X ray. And that’s why that’s why when you go to the doctor, they say, oh, let’s get the X ray
anyway, just to make sure you know, that kind of thing. But then ultrasound, it doesn’t have any radiation, it does
have a theoretical risk for how much energy is deposited into your body from sound waves. So you know, like, it’s, it’s
kind of difficult to describe. But you know, like, if there have been reports, like of people getting sick or something like
that, from, like, in your inner ear, like say, your, say you’re at the concert, or something, and it’s very loud, and your
inner ear is vibrating that whole time, you could start to get a little bit dizzy or sick to your stomach. Those are the
kinds of risks that we’re talking about with ultrasound, but you’re not applying an ultrasound to an inner ear, you’re
applying it to tissue, sure. And then that tissue can actually get a little bit warm. And there is a limit to how much
ultrasound you can do. You know, if you just put an ultrasound probe on your arm for several hours, your arm would
actually heat up a little bit. But it’s not that much that it’s actually noticeable by the by human and most ultrasounds
won’t take less than 20 minutes.
Right. So and I think a lot of people, they hear ultrasound, they hear sound, and they’re like, Well, I don’t I don’t hear
it. Right. But the frequency is high enough that you’re never going to actually hear Yeah,

yeah. The Ultra part means that it’s above what we can hear love a human’s level of hearing. Right. You know, a dog 

is in the room. They may be they might be? Yeah, it just depends. Sure. But, but yeah, the, the ultrasound. And
mainly what I do is, you know, there’s been a lot of initiatives to use ultrasound to make diagnoses that were
previously diagnosed with either CT X ray or MRI. And one of the big areas of that technology is in musculoskeletal
medicine, which you practice as a physical therapist, and I do is radiologist.
So I have a question before you keep going there. You mentioned that over the last 30 or 40 years with the invention
of these electronic image imaging methods. Things have changed a lot, right? Yeah. So when I hear of someone that
had an ACL tear in the 70s, right, and I see them come into my office, they’ve got a eight inch scar. Yep. Right.
Versus if I had someone that had an ACL surgery two years ago, they’re gonna have three puncture wounds and
maybe a one inch scar. Yeah. And basically, what you’re saying is, now that they have the ability to look at things
more closely from the outside rather than opening you up to see the inside. Yeah. It changes the risk. It changes the,
I guess the trauma that’s created by these surgeries.
But yeah, that’s accurate. You know, back then in the 70s ct He had just come out, they didn’t have MRI, ultrasound
was of such poor quality that you really couldn’t see much. And that’s why all those guys that invented that have a
Nobel Prize right now. But they, they basically back then, you know, if they did the physical exam and thought, oh, he
probably has an ACL tear, then they have to just open that up very wide to make sure you know, they’ve got to look
at the collateral ligaments, they’ve got to look at all these other structures that can now be seen on MRI. And then
that kind of prompted the use of scopes, you know, like, hey, if, if we don’t have to open this thing up, and somebody
had the idea, let’s just put a little scope in there. And we don’t have to make that large incision, and it does less
damage in the healings quicker, then, you know, that’s the better way to do the surgery,
right? There’s less trauma to the tissue, there’s less, you know, stretching or cutting through things. It’s a single
puncture hole, that’s what maybe a centimeter person, you
know, like most most scopes range between, you know, for, you know, probably three to four millimeters in diameter.
And then, you know, there’s even microscopes, you know, the very, very small scopes that certain surgeons use
their, you know, even down to one millimeter, like a fiber optic cable type thing to look at things, but they can’t pass,
you know, tools do they’re necessarily sure. But, but yeah, everything that you see right now in medicine is moving
towards minimally invasive techniques. Sure. And that’s either going to be through image guidance, robotic
manipulation, or assistance to the surgeons, or using smaller and smaller devices.
So, tell me more about ultrasound specifically, because obviously, you’ve now built a business around ultrasound,
and it’s called ultrasound first. So obviously, there’s a, you know, kind of some, some psychology behind that of like,
well, why is it called that? So I’m gonna ask you, why is it called ultrasound first?
Yeah, so. So basically, as a musculoskeletal imaging specialist, I get a lot of patients that are sent to me to get rotator
cuffs evaluated wrist injuries, tendons, ligaments, finger injuries, those kinds of things. And traditionally, surgeons and
doctors who treat those things would have ordered an MRI for that. And what was happening is there are only a few
doctors in St. Louis that can do musculoskeletal ultrasound. And, or even in Missouri or in the Midwest, and I’m I just
happened to be one of them. And I was getting patients that would come to me for a rotator cuff evaluation. And the
first thing that they would say is, you know, because, you know, I talked to the patient, I’m like, Hey, tell me your
story. Why are you here? What’s going on? And they would say, Well, you know, they think maybe I have a rotator
cuff tear. And they wanted the doctor wanted an MRI, but they told me to get an ultrasound first. Because if we can
see it on ultrasound, we don’t have to get the MRI. Right. So then these patients were driving from Cape Girardeau,
Rolla, Springfield, I was having people fly in from other states, because the cost of the ultrasound was so much
cheaper than the MRI, where they were from, that the insurance company was willing to pay for their ticket to fly to St.
Louis to just see me.
So let’s talk about the difference in cost then. Right. So so obviously, they both have their place MRI, ultrasound, if
we’re talking musculoskeletal issues, they both have their place. Yeah. Why would I choose ultrasound first?
So there’s a couple reasons. And it kind of depends on the injury or problem that you have. But there was a study
done in 2006. And what they did was they looked at all the MRI diagnose all the diagnoses that came from MRIs for
Medicare patients that were diagnosed on MRI. And they determined that 30 to 40% of those diagnoses could have
been made directly with an ultrasound instead, in order to have saved billions of dollars as a society to do it with the
ultrasound instead,
we think of how many millions of MRIs are done on Medicare patients, right?
Yeah. Because Medicare patients are, you know, they’re older and they have a lot of wear and tear on their body and
they’re gonna have a lot of musculoskeletal problems. So basically, there, there’s, you can replace the MRI with the
ultrasound. It can be an adjunct to that MRI, let’s say the MRI showed like a tendon tear, but we don’t know if it’s thick

enough tear that it would need surgery or not, because the MRI doesn’t have as higher resolution as ultrasound, and 

then I get the doctor you know, they they come to me for it. Or there are people that can’t have an MRI. And the main
reasons for that are either they have Have a medical device like a pacemaker, they have metal in their body
somewhere from, you know, maybe they were in the military and they have shrapnel in them, or most of the time, I
would say the predominant reason why is their welders are working a machine industry, and they have metal in their
eye or in their body somewhere that can’t go in an MRI, got it. And then the other reason is claustrophobia, you would
not believe and, and many of your listeners either know, they’re claustrophobic or they don’t, and you don’t know until
it happens,
right? You get a good experience to not know and be put into that situation,
I have seen, you know, I’ve seen people jump off the MRI table because of claustrophobia. And it’s and it’s nothing,
you know, it’s nothing against them, they can’t help it. No, and there are open MRIs. But whenever you see open
MRI, you think most of the patients, they come in there, they think they’re just gonna sit in this room that we’re in and
just sit there and get through MRI, but it’s still got something around you. Yeah, and depending on how bad your
claustrophobia is, you may or may not be able to tolerate it. So that’s, that’s, that’s the other reason, you know, you
can like like a rotator cuff tear, I’ll do that everybody kind of has heard of that. So I kind of use that as an example,
most often. rotator cuff tear can 100% with a nearly 100% accuracy, be diagnosed with an ultrasound. Instead of
MRI, the cost of that ultrasound is around 150 bucks, the cost of the cheapest MRI that you can get in St. Louis, that
I’ve seen is 350 bucks, okay. And that would be like a cash pay price where you came in and paid for it.
You know, a minimum of twice as much
more minimum of twice as much, if not worse. Because let’s just say that, you know that MRI has contrast with it, or
somebody ordered it with contrast, you’re looking at $1,000. Or if you know that, let’s just say you go in there, and
you know, you need multiple MRIs, that starts to add up quickly, right. And you can do a lot more with that, like
whenever you come in to get the ultrasound, and your doctor is not sure if it’s, say a biceps tear, which I’m sure you
see all the time. You know, sometimes it’s hard to tell is this approximate biceps terror distal biceps tear with a groove
is
so small and yeah, the tendon itself is so small and you know, one sheet to the next sheet. Yeah, you’ve completely
missed the whole thing, right. And
then an ultrasound can only cover about 18 centimeters of area, which is just your shoulder, right? A lot of times,
there’s biceps injury, but a completely normal shoulder, you just went in there, and it can mimic a shoulder injury. You
just went in there and got a shoulder MRI and it showed absolutely nothing and you get a report that says Normal
shoulder, guess what you got to do next, go get another MRI or arm. So now you’re, you’re in 700 bucks, when if you
came into my office and you said hey, if my doctor thinks maybe I’ve got a rotator cuff tear, I look at your biceps
tendon when I do that. And then just based on my physical exam and my ultrasound. If there’s something wrong with
your biceps down below, I’m going to look at that. And you’re gonna get the same diagnosis on that ultrasound as you
would have with two MRIs. And so now now now you see that we’re the cost saving star stuff Shut up.
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code JSR, five for a special discount. You know, the one of the other things that impresses me about your business
is, a lot of times I’ll have folks that call in they’re like, Yeah, you know, I’ve got an appointment scheduled in two
weeks with my primary and he talked about, you know, possibly having to send me to an ortho and then, you know,
once I see the ortho, it’ll be a week or two before I can get into the MRI. And then I got to schedule a follow up from
the MRI to get it read, or four or five, six weeks down the road. And no intervention has been done at all right, where I
referred someone to you a week ago. And you could have gotten them in the same day. Had some other
circumstances not been the case. But the point is, it could have been the same day we could have had an answer
like that. Yeah. And I think that for me, when it comes to someone that’s hurting today is what matters the most.
Because I mean, you and I have talked about this before chronic pain is one of my passions, people that deal with
chronic pain. And chronic pain is basically just any pain that’s lasted more than three months. Well, they’re not going
to come see someone the first day that it hurts They’ve already hurt for a while before they ever started the process.
So an additional four to six weeks makes a huge difference. So speed of intervention matters a lot to me, and it
matters a lot to my patients. So that’s, that’s one thing I see as being a huge benefit for ultrasound, because it’s not,
you know, schedule it out and go see this and go see that it’s give you guys a call. Maybe you need a referral from
your primary, maybe you don’t, but they’re able to give you a call and get in very quickly.

Yeah, yeah. And, and that was one of the reasons you know, I used to practice in a traditional radiology setting. And, 

in my practice, we talked about radiologists do a lot of stuff, right. So in my practice, I would have to read, you know,
20, or 30, MRIs a day, 20, or 30, CTS, a bunch of X rays, ultrasounds for all kinds of other stuff like gall bladders,
pancreas, kidneys, all that other stuff. And then in between those cases, we would allow patients to come in and you
know, we’d schedule maybe one or two, maybe three or four, ultrasounds in a day for MSK stuff for musculoskeletal
problems. And then these would be scheduled out two weeks in advance, I had to be the guy that was there, not one
of my partners, you know, so the reason I took this business and made it into its own clinic was to pull that rate that
ultrasound out of there, so that the MSK ultrasound isn’t competing with the other stuff. You know, because an
imaging center has one or two ultrasound machines. And they have to look at all those other things. You know, if
somebody’s got a pancreas problem, or a gallbladder problem, or kidney problem, or carotid artery or you know, all
this other stuff, you know, they can only do 2020 ultrasounds in a day there because they have one machine, and it
has to do all that stuff. I can do 30 ultrasounds at my place in a day. And all I’m doing is the musculoskeletal
problems. So what that has created is a surplus of availability versus a short shortcoming for availability for that
machine.
Got it? And just for clarity, MSK musculoskeletal you’ll
hear the doc talk like that, you know that. That means musculoskeletal? It’s, you know, it’s kind of a double edged
sword, you know, you want to shorten things down so you don’t have to have that big glob of words, you know,
coming out or syllables and then then nobody knows what you’re talking
about. Right? But Bone and Joint ligament tendon muscle.
Yeah, that kind of stuff and nerves. Okay, so a big part of my practice is nerves when people do have nerve
problems, like compressions or Ruby talking nerve impingements. You know, for pinched nerves, that kind of stuff. If
you have numbness, numbness or tingling in your extremities. Anything outside of the spine is a peripheral nerve.
Okay.
Well, you and I talked about carpal tunnel syndrome. Yeah, yeah, like
carpal tunnel syndrome, I probably diagnosed that 20 times a week. And not only is it quick, it’s, you know, painless.
Typically, that would be diagnosed with a combination of a physical exam and an EMG or electromyogram. And it that
requires needles be stuck into your muscles.
So it’s less fun.
Yeah, just not fun. I’ve had it myself. But the accuracy of say carpal tunnel syndrome diagnosis is near 100%. It’s the
gold standard, they say, you know that you’ll hear that medicine is the gold standard test is EMG. Well, if ultrasound
is 96%, and that’s 100%, that’s pretty good. You know, you’re not going to, you’re not going to miss that diagnosis.
Not only that, you can see structural abnormalities in the the nerve and identify the exact location. And on top of that,
we’re almost to the point now, where we can do an image guided intervention to do a carpal tunnel release, where
you don’t have to have the actual surgery. So that’s, that’s very exciting game coming up in Ranger within a year,
right. And I’ve observed a couple of the carpal tunnel surgeries and they’re very fast, but you still have to be put under
full anesthesia. Yep. You know, you still got to schedule out time at the surgery center. You’re seeing an orthopedic
surgeon hand surgeon? Yeah, I mean, there’s a lot of steps, a lot of costs to a fairly simple five to 15 minute
procedure. Yeah. And now we’re talking about being able to do it in an office. Right, outpatient.
And yeah, and you could do both hands at the same time. The cost savings is huge. You know, because if you go to
a surgery center or a hospital, you have all that nursing and anesthesia and everything. The average cost, I believe,
is about $5,800. Whereas if you had it in an office, it’d be closer to like $2,500. So, you know, we’re looking at a huge
savings here for patients and society, on how much we’re spending on one of the most common diagnoses in the
United States.
So while we’re on the topic of interventions, right, and then we cut and talked about some different image guided
interventions. So other than carpal tunnel, what would that include that you’re able to do right now.
So right now, any any joint, ligament, tendon, or nerve can be treated, but peripheral joint peripheral joints, spine and
neck. While those are able to be done in an outpatient setting with ultrasound guidance, I choose not to because
there are some vital structures in there, if you got into you, you would not want to be in a clinic, right? So what we’re
capable doing now is steroid injections around nerves. So you could do carpal tunnel steroid injection, you could do it
say, if you had a nerve problem in your leg or your foot a nerve entrapment any nerve entrapment can be treated with
a ultrasound guided steroid injection. In addition to that, you can do hydro dissection around nerves, which is
basically pumping the fluid around the nerve to release the scar tissue that’s around it. Using the pressure of the
numbing medicine and some saline, or norm, you know, just sterile fluid.
I’ve never even heard of that. Yeah, so tell me who that would be most appropriate for.

So that’s appropriate for people with carpal tunnel syndrome, okay. tarsal tunnel syndrome and your foot. If you have 

hip pain around the sciatic nerve, if you have had surgery before, and there scar tissue around a nerve, a lot of times
people who have had hernia surgery will get that in their abdomen, and they’ll feel like a pain going down into their
groin. That’s a very good treatment for that. And what’s it called, again, hydrodissection hydrodissection. And
typically, what we’ll do is we’ll put in about, you know, seven to eight milliliters of fluid, which is numbing medicine and
sterile fluid around there and watch it on the ultrasound and watch it pull the tissue away from the nerve.
It’s fascinating. Yeah, you know, the first thing that comes to mind is, I can’t tell you how many people I’ve had that
we’re doing, you know, heavy scar, massage, skin rolling that type of thing, post surgical to try to loosen up the soft
tissue around the joint right? 95% of the time, it’s great. But that 5% Yeah, there’s just they can’t eat, they either can’t
tolerate the pressure that I need to put externally to do something, or it just won’t loosen up. So, you know, I definitely
see there being some room for that from you know, from me, for sure,
yeah. And then one common thing that you’ll see from knee surgeries, as you’ll get some scar tissue, there’s a fat
pad inside your knee, that can become scarred to the lining of the joint. And so what I can do, is, instead of you
having to go into surgery to have that peeled off or cut off at the joint, where the scar tissue is, I can go in there and
release that with a needle and fluid. Interesting. And you do see that pretty often, you know, it’s it’s one of those
things that’s not absolutely all the time there. And most of the time it does get treated by physical therapy. But then
those resistant cases that, you know, just don’t get better. I can diagnose it and treat it with the ultrasound. And that’s
most of why I wanted to chat with you about this is just what you do is so different than anything I’ve ever heard. And
you know, I’ll be honest, it’s hard for me to want to refer someone to an MRI, when I’m 90% Sure. Nothing’s toerner
Yeah, 90% sure that nothing is that significantly wrong with it, knowing that that’s going to be Yeah, 1000 plus dollar
expense for some people. That seems crazy. Like, yeah, we could probably handle it. If we kept going for another
couple of weeks, three weeks, whatever it might be, but knowing that we can figure out an answer quickly. Yeah. And
way less expensive, is powerful for me. Yeah.
And that’s, that’s that third reason to use the ultrasound is a triage or to rule out worst case scenarios, you know, if,
you know, you’re seeing a patient, and they’re like, Hey, Greg, I just noticed this lump on my leg after physical
therapy the other day when I was you know, taking the tape off or, or whatever, and you look at it, and you’re like
that, I don’t know what that is, but I’m gonna refer you back to the doc and, you know, see what they think then the
patient has to go to the doctor, which the appointment who knows when it’s going to be you know, two weeks, four
weeks, the whole time, they’re sitting there worried about it, and then really, they could just come to my office, I’ll do
the ultrasound of it. And then at that point, I get to say, as a tumor specialist, okay, this is just a benign lipoma. You
don’t have anything else to do. And that can be done on the same day.
Right. Just peace of mind. I mean, there’s a lot there’s a lot of benefits to that.
Yeah. And then, you know, it’s it’s nice have, you know the level of expertise involved? In the beginning, instead of,
you know, I, I’m a big proponent of, you know, a medical home, you know, people need to have medical homes, they
need to have a primary care doctor, because you do want to have all that stuff under 111 place, because, you know,
if you come in and you’re like, Hey, I’ve got this problem, this problem, this problem, for example, I’ll just give you
one. Yeah. sarcoidosis, that’s a disease that is not common. It’s, but it’s common enough in my area that I see it all
the time, you know, in what I do, you know, regular doctor, you know, a general practitioner may not see that very
often. But, you know, most people do have one or two patients that have it, but it can, it’s a great mimicker it can do
anything, you know, if like when you’re you’re going to your boards or something and and in there, they’re questioning
you about what this diagnosis is. And you have no clue if you just shout it out sarcoidosis, then a chance you got it,
right. It’s the lupus of how Yeah. And, you know, I had a patient one time that came in for an ultrasound, a
musculoskeletal ultrasound for his finger, because he had a lump there. This patient rolled in the office. And as soon
as I took one look at him, I was like, Huh, that’s interesting. And then I looked at the ultrasound, and I was like, Do
you have sarcoidosis? And he was like, No, I don’t know, I’ve never heard of that, which most people haven’t. And
sure enough, every single symptom this person had was attributable to sarcoidosis. And I diagnosed that off an
ultrasound of a finger. And because of that, he ended up getting all the treatment that he needed. It ended up being
all over the place. And um, you know, and they just had to do steroids, and, you know, the treatments for sarcoidosis.
And this guy’s, you know, so much better now.
Right. And I think that was another thing that was so fascinating. Hearing your presentation a few weeks ago was,
you know, looking at the hand, seeing the joint degeneration for RA, or, you know, similar types of disease
processes, but being able to diagnose or at least monitor progression or regression with just looking at the hand.
Yeah, yeah, I always tell people, the hand is the roadmap to arthritis. And if you ever watched those shows on, you
know, the cable networks, at GAO or Discovery Channel, or whatever, and it’s like medical mysteries, that is

rheumatoid arthritis, and all these arthritis is because they attack people in certain ways. And it always kind of starts 

in the hands, you know, the first, the first signs of it, you know, even if you had Crohn’s disease, or celiac disease, or,
or these kind of things where they’ll have a, it’s called, this is a big word here, in neuropathic arthritis, that stuff can
show up in the hands. And, you know, I’ve had people that have normal labs, and they’ve seen the rheumatologist
and the rheumatologist knows for a fact, this person has a an arthritis, when they come into my office, I look at their
joints, and depending on the pattern of what I see on the on the ultrasound, I’ll be able to tell that person before they
leave that they have rheumatoid arthritis. And they didn’t have that diagnosis before they came in. The
rheumatologist wasn’t, you know, he didn’t have the ammo that he needed to make that diagnosis. And then the
insurance company is telling them, you can’t get your treatment, because you don’t have the evidence
for it. Right? Well, out of the audio immune stuff is kind of a or some of it can be a diagnosis of exclusion. So you’ve
had to test for 30,000 things just be told that it’s none of those. So good luck. Whereas this can actually give you an
answer. Yes, I think is very, very powerful.
Yeah. And, you know, there’s, there’s a lot of evidence out there, a lot of it’s out of Europe, which, you know, that’s,
that’s great medical information out over there. But the way the system is put together over there, they actually use
ultrasound more than they use MRI. United States, the United States has, you know, 45 MRI, you know, there’s 45
people forever MRI here. Whereas there’s, you know, point one people, you know, there’s just so many more MRIs
here, than there is over there. And that is why ultrasound over there is us so much more than it is over here. So a lot
of literature comes out of there and the rheumatologist on this but there’s only 5000 rheumatologists in the United
States. So you know, there’s 330 million people here only 5000 rheumatologists. Do the math. Yeah, it’s very hard to
get into rheumatologist. So if your primary care doc sees that you have arthritis and it’s kind of weird. They can send
you to ultrasound to get the grading done on the ultrasound. They can send you then then you can get into the
rheumatologist
quicker with it because you have the right information, the right answers,
because you know that the reason you treat arthritis is to stop destruction of your joints. Because if this arthritis is an
inflammatory arthritis, you can stop it you don’t have to have that you don’t have to have you know, rheumatoid
arthritis used to be called arthritis to Forman’s, because it causes deformities of the joints, you see these pitchers
chair back in the 20s of these old people lateral shift and all that, yeah, although they just have these deformities of
the body. And that can all be prevented with the new medications that we have seen. So the earlier the diagnosis, the
better.
That’s awesome. STL active is supported by rangemaster, the makers of the very best shoulder pulley in the world.
Most people who have gone through therapy for shoulder issues have used a shoulder pulley in the clinic. But let me
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allowing them to glide smoother and last much longer than the typical pulley shop rangemaster shoulder police and
other rangemaster rehab products using the link in the description. Now back to our regular scheduled program. Is
there is there a perfect client for you, I say that obviously there’s a lot of different things that you’re able to diagnose.
But one thing that kind of stood out to me from your presentation was how specific and when I say specific for the
listeners that’s being able to rule things as this is what it is rather than rule something out. So specific for shoulder
pathologies, you know, and that that was what was so obvious to me that, like if I’ve got someone that’s got a
shoulder issue that, you know, it’s improving, but it’s not improving at the rate that I want it to, or we’ve hit a plateau.
Like that’s an easy referral for me, because it’s inexpensive. It’s, you know, not something that that’s going to take
forever, it’s not something that we’re going to have to pause there before necessarily, it’s quick and easy. Learn more
and be able to judge what’s next for treatment off of that. Yeah. Is there a perfect client? Other than from me,
especially, but is there a perfect client for you? That that, you know, would find you over other providers?
I would say anybody that has a sports injury, a chronic injury of the joints, or ligaments, hand injuries and feet
problems, all of those people can benefit from what I do. And, you know, it’s, it’s one of the difficulties that maybe
your, your subscribers may not understand is the referral process. And,
and that was gonna be my next thought, yeah. How do people get into you? Do they just call your office? Do they talk
to their primary? First, I’d love to kind of hear the different options, or what’s the best case scenario for them?
Yeah, the best case scenario for them is that they have a doctor, that’s gonna write me an order. So first and
foremost, I’m an imaging center, basically the way I function, and an interventional clinic. So if you come to me with
an order from your doctor, and it says, carpal tunnel syndrome, suspected evaluate, you know, that kind of thing, or
rotator cuff tear, or hip pain, or, you know, these kinds of things, then I can, you know, you don’t have to get pre
approved from your insurance, most people, you don’t have to wait, you don’t have to go through all these hoops to
get to come see me.

So the order from the doctor is kind of the golden ticket, it makes things go faster, without any hoops without any.

Yeah, nobody, nobody barks at that, you know, if you are even like, say, say you’re at the urgent care, that would be
a great situation. A lot of people are using urgent cares to get in to see doctors and nurse practitioners and other
providers. Because they have such a long way to get into the regular doctor, or they don’t even have a regular doctor,
that when you go there, you should, you know, you should ask them Can I have an order for an ultrasound before you
leave? And then you can just come straight to me. And then I will actually refer you to the appropriate doctor from
there. So, you know, if you, let’s say you cut your finger. I see this a lot where people have an injury, and it’s a
laceration. They go to urgent care, they sew it up and say follow up with your primary care doctor. Well, they do and
then you know, for example, I had a patient recently who had cut the tendon in his leg. And it had been like this for six
weeks, because he got the MRI, and the MRI didn’t include the area where it was cut. And so the tendon below that
cut was completely normal. So why would you see it on the MRI? It’s normal. So when he came to me, I, you know, I
just took a look at him. You know, it’s kind of like common sense. And I’m like, Hey, This, you know, I’m going to put
my ultrasound probe where this was cut. And sure enough, that tendon was completely cut. And he’s walking around
with a torn, you know, completely severed attracted, retracted for six weeks. And the guy was in tears because he
just finally got his answer. Nobody believed him. Right. You know, his work, he wanted to go back to work, but
couldn’t, you know, so if he would have just got the order? You know, right then a one, right? Yeah, just, hey, can can
you just give me an order for an ultrasound? You know, so I can make sure this gets followed up? Right? Those are
the kind of things that your patients or listeners can do.
And so they can ask for that from the urgent care. Yeah. And,
and, you know, in urgent care may, you know, I do you know, when when I’m reading MRIs and stuff I do get, and I
read MRIs and CTS and things for other groups, they contract with me as an expert to read those for them. So I do
still do that. But I don’t do those in my office. But if if it’s going to be a lot harder for, you know, if you go see an urgent
care that your insurance may or may not cover, you know, they may they may say no, you’ve got to go see an
orthopedic surgeon first. But they’re never gonna say to you, you can’t have an MRI. I’ve never seen somebody
denied for or I mean, you can’t have an ultrasound, right. I’ve never seen someone denied for an ultrasound. That just
doesn’t happen. Because of the cost. Because, yeah, they it’s it’s a non number to the insurance culture. And then
they think, Oh, if there’s a chance that they won’t get the MRI, they’re going to cover it. Sure. And when it’s either
superior or equivalent to an MRI, then it
Yeah, hold on.
Yeah, that’ll better. Yeah. It
when it’s equivalent, or even superior to an MRI, you might as well just go get that ultrasound. There, there are some
cases where I, you know, I did, I did 600 or so ultrasounds last year that I performed on people. I will say that I’ve
you’d be hard pressed to find another doctor in Missouri that has done that many, or Illinois. But it’s, it’s there. And it’s
a good diagnostic tests, and it makes sense to do. So. I don’t know. I would say like, one of the reasons why doctors
don’t order them is number one, they don’t know about it. Number two, they have tried to order it before and they
couldn’t get it because nobody does it. Or, you know, the wait was too long. And then there’s just so many MRI
machines, you can get it done, kind of but I don’t you know, there, there are some orthopedic surgeons that will say I
won’t order them because I don’t know what I’m looking at. You know, when they look at the images they can’t see,
you know, when you look at an MRI, and you’re a surgeon, you know, the anatomy, it makes sense. But ultrasound
doesn’t look like it looks very different. looks very different. So they’re not comfortable with that, because I didn’t train
with it.
Sure. And I’m not trained to read either, but I feel like I can see what’s going on in an MRI because I know the
anatomy. Yeah. But in an ultrasound, it just is very foreign looking.
Right? And if, you know if if I had the opportunity to sit with you, or a doctor or nurse practitioner, and I just said, Hey,
look, here is the tendon, here’s this, here’s this, you would pretty quickly be able to be like, Yeah, I kind of trust that,
right? Because you start to see it and especially one of our do like live motion. And
that was going to be my next point is the fact that you can do it with movement with stress. You can see how the body
responds to things because it’s in real time. It’s not your shoved in a tube and you wait for half an hour. It’s in real
movement.
Yeah. A good example of that is I had an athlete, I I do see quite a few athletes like professional or semi professional
or even, you know, competitive athletes that come to me from certain surgeons. And, you know, when they like I had
a competitive kickboxer that had sprained their ankle, and they had a tournament coming up very soon. And you
know, it was either cush could that person compete or not? When they came to me, I was able to do a stress test with
the ultrasound to see that their ligament was intact. You know, it was, it was sprained. But it wasn’t a torn tear. Yeah,

it wasn’t a complete tear in the ankle wasn’t unstable. You know, and I was able to give all that information, you can’t 

get that information from an MRI. What you can do is say, hey, that is sprained. It’s either completely torn, or it’s
mildly torn, but you don’t get the stability issue there. Right. You know, you can you can presume, you know, if you’ve
got a completely torn ligament on MRI, that it is unstable. Sure. But you don’t have that real time assessment, right.
The physical exam is so important, and I think that’s, you know, a lot of a lot of people become too reliant on the high
level. expensive imaging. Yeah, where as a PT, a lot of our special tests are incredibly accurate at diagnosing. We’re
not allowed to diagnose, but it could diagnose certain things like rotator cuff tear or whatever. But right. Yeah, I mean,
the physical exam along with ultrasound just seems like a no brainer.
Yeah. Oh, yeah. Yeah, that’s, that’s definitely that added benefit that you get, right.
So we were touching on like, what’s the ideal scenario for people to get into you, and that was either get a an order
from their primary order from urgent care, er, wherever. If they don’t have that, right. It’s somebody that’s been say
they’re 35 years old, they’ve never had real medical issue, but they sprained their ankle 15 years ago, and it’s starting
to bother and more over the last year. Yeah, they don’t have a primary, they haven’t been to urgent care. What do
they do?
Well, has this person seen you? Not yet. Okay. So I think that person needs to be evaluated by a physician. I think if
they had the ability to go to a PT, or an athletic trainer, or something like that, that’d be appropriate. But, you know,
there are certain restrictions, right now they limit you guys from doing that.
Yeah, it’s more of a state issue than a quality issue,
quality of data, a statement on your abilities, it’s just, it’s not allowed due to legislation, right. But instead of that,
they’re gonna have to end up going to somebody, you know, though, they’ll have to get evaluated by a physician
somewhere, before they come to me, in those situations, if, let’s just say that, you know, a doctor or something like
that, and they’re willing to give you an order, you can do that you can be like, Hey, give me an order. And they’ll write
you an order or whatnot, you know, and then what I’m noticing lately, and COVID, actually, we haven’t even talked
about that, I guess everybody already has, but it’s, it actually opened up a lot of windows and a lot of doors for doing
things differently. And so let’s just say that this person doesn’t have the money or doesn’t have the trust or the
relationship with a physician, they can do a telemedicine visit. And they can get on that that telemedicine visit.
There’s a lot of different resources for that. And I, I don’t have experience with them, so I can’t grade their quality. But
I have had patients from that where they got on there and they said, hey, look, I had this one lady that had bilateral
shoulder pain. The telemedicine doctor wrote her an order for ultrasounds. from college, she was the telemedicine
lady was in California. And this lady was in Missouri. And she got the order, she looked me up online and found me
and then came and got ultrasounds. And I diagnosed her with a an inflammatory arthropathy or inflammatory arthritis
of both shoulders. And then I referred her to a rheumatologist in town. And then that lady was taken care of within
days, right? So I think if you as a patient, have difficulty getting into a doctor, it’s reasonable to get on to a
telemedicine visit, and do it that way. I think the best case scenario for them is to get in and see a doctor or nurse
practitioner or PA or whatever you want to see. If you go to an urgent care, ask for orders, you know, I’m talking for
anything, you know, if if they’re like, hey, you know, and obviously, if it’s not indicated, they’re not going to do it. But if
they tell you, they’re like, Hey, I think you need to go get an MRI of your ankle. You have the right to say, Can you
give me that order for the MRI? Or could you I can’t afford an MRI or I heard about ultrasound? Would you be able to
give me an ultrasound order for it. And then if you call my office, and I say hey, you’ve got this order for for an ankle,
come on in, I’ll look at it. And then when I’m done evaluating your ankle, if I believe that you do need an MRI, say I
think you have a cartilage injury or something deep in or a fracture or something, then I’m going to say, Okay, you
need to go get this MRI and I’m going to refer you to the right doctor to get treated. Gotcha. Cuz I have a very large
network of doctors I work with, right.
And that was pretty apparent from us. Yeah. Chatting before is, you know, I had I had a few names that you didn’t
know in the PC world, but for the most part, you have a pretty dang large network. So yeah, yeah, very cool. So there
are some limitations to ultrasound right. I know we kind of talked about spine we talked about neck, deeper things
within the joint. I know we we briefly touched on meniscus last time we talked Yeah, where you know, ligament
surface, things more obvious and within the knee, but when it gets deeper within the knee, harder to diagnose.
Yeah, that’s right. And then I loved your example earlier, when you said specific, you know, every test has its ability to
rule in things and rule out things. And when an ultrasound sees a meniscus tear on the surface of the meniscus, or a
cyst coming out of it, it’s highly, it’s highly accurate for saying there is a tear, okay? But if I just see a normal
meniscus, it doesn’t really mean it’s normal, right? You know, cuz the meniscus is, I always tell people meniscus is
like a finger like a hangnail. Right. If, if you’re just seeing the little, you pull on that hangnail on it, you know, starts
pulling back, pulling back, and then you’re in trouble? Well, that’s how a meniscus tear is, a lot of those start as

hangnails at the end of the minute, you know, on the inside of the knee deep, very deep. And what happens is when 

you walk and you get that pinch, it just pulled on that hangnail and it just ripping it on the inside, not on the outside.
So yeah, the meniscus is a limitation. When you have, let’s say, say you sent a patient to me, and, and they had a big
knee joint effusion that’s fluid inside the knee. That that can be a sign of a lot of things. You know, the most common
cause is what we call idiopathic. We don’t know why it happens, but it never causes a problem. Most commonly, it’s
from a cold COVID can do it. You know, it’s it’s from some kind of virus where you just decided that inflammation in
your knee was part of that process. But it can also be a sign of a meniscus tear or some other cartilage injury inside
your knee that may need further evaluation. But, but I can tell you with 100% certainty that you don’t have a tear of
your quadriceps tendon, your patellar tendon, right, your ligaments.
You can rule out some other things, but you can’t necessarily rule out deep meniscus. Yeah,
right. Right. Right. But you know, if if somebody thinks you have a Baker says, Don’t you dare get an MRI. Right?
Like wasted title a waste of time, guys come see me. But But yeah, it’s so deep cartilage stuff. I prefer that that gets
evaluated with with MRI and X ray. And I will tell everybody, you know, we talked a little bit about X ray, but almost all
musculoskeletal workups begin with an X ray. And there’s good reason for that. It’s, it’s a screening test for bone
problems. So I guess to break, but not a break. But other things, you know, like, you’ve all known somebody or you’ve
all, you know, met somebody or heard of the story where, you know, the person stubbed their toe, and then they went
got an x ray. And sure enough, they had a cancer. And it saved their life because they got that X ray and they found
it. That’s what it’s for. You know, it’s it’s not just for making the final diagnosis. Sure. It’s a good screening tool. So I
wouldn’t balk at ever getting no, I in fact, I’d say everybody, you need an X ray, if you’re going to look at something
most of the time. Yeah, there are some other things where you know, like a lipoma. Or a mass on your arm or
something like that. You don’t need the X ray yet. Sure. But I that’s part of my job, right? You know, you come see
me, then my, my job to you, as the provider and the patient is to say, yeah, you need to get the CT or you need to get
the MRI or you need to get the X ray. But if I can make that diagnosis, I’m gonna make it right there and not say you
need anything else. Gotcha.
So now, we talked about this before we started recording, direct pay versus insurance. Yeah. So I don’t know where
you wanted to take that point. But if you have something to comment there, we can we can do that.
Yeah. So you know, there’s there’s a lot of stuff going on right now. And again, I think COVID has been a huge
impetus for this, that access to physicians, you know, nobody ever thought that you wouldn’t have access to
physicians, in time of a pandemic, or any healthcare provider. And that happened, you know, you wouldn’t believe the
number of cancers. And things went undiagnosed during 2020 that are now rearing their head, because nobody had
access. And I think a lot of that access problem, not only was from COVID, but it had to do with the healthcare
system. Hospitals had to lay off doctors, hospitals had to pull nurses from one facility to the other, they had to make
physical therapists do injections, you know, they had to do all these things. And a lot of those decisions weren’t
actually driven by reducing the need for exposure to the virus, a lot of that had to do with, well, we don’t have 1000
patients a day now. So the volume of money coming in is so low that we can’t pay our physical therapists, we can’t
pay our nurse, we can’t pay the doctor. So we’re just going to lay them off, right. But when, when those people are
actually needed for society to see things. Then that was the first time everybody anybody got the indication? Even the
admin administration didn’t even know this could it was possible that hey, our system is reliant on a high volume of
people coming in here sick and when they can’t come in, we can’t afford this. We can’t afford this giant building, you
know, that that giant building off 40 That, you know, it was just built with, you know, $50 million from a generous grant
from whoever, you know that we can’t afford to maintain this the elective surgeries weren’t happening. Yeah, the they
all stopped. And then how do these people live? You know, I? I didn’t get paid for a month during COVID it I, I didn’t
see that comment, you know, and that was before you started your business. Yeah, you were saying as soon as that
happened? Older sound first was born. Right? Yeah. And and it’s not that, you know, it’s it’s not that anybody’s using
their money poorly or whatever, it’s just such a large system that it that it has to be maintained by a base level
amount of money. And that can’t keep happening. Because insurance companies are kind of behind that, you know,
like, when a hospital goes to an insurance company, and the insurance company says, Okay, we’ll, we’ll allow you to
see our patient, because you know, when you have insurance, you have a contract with your insurance provider, you
don’t have this contract with your doctor, right? The doctor is contracted by the insurance, you signed a contract to
pay for services from the insurance company, and there is in the disconnect right there, you lose your ability to
choose who you’re going to see when you’re going to see them. And in order to get rid of that disconnect. Doing a
drug pay model is what I see is the future of medicine. Yeah, because we can’t get rid of insurance. You know, it’s
like, it’s mandated by the government. Now, it’s firmly ingrained in our society and our thought process. Most people
don’t have time to sit down there and evaluate and read their entire insurance policy and find out that it’s, you know,

it’s not that great, but I’m gonna have to pay $15,000 This year, if anything happens to me. And that’s where this is 

going. Right. So if you think about it, it’s like so so for example, I pay for my own insurance, it’s $25,000 a year for me
and my family, and my deductible for each individual’s $5,000. And my deductible for my family is $15,000. So I can
just, so what I have to do is say, I’m gonna pay this $25,000, and I’m gonna put 15 grand aside in the bank, or have a
credit card or something like that, that I can cover that extra 15 grand if it comes up? Well, most medical problems
can be covered for 15,000 or for $25,000. But you already gave that to your insurance company. Right? Right. So
that’s, that’s where direct pay comes in, is that it’s, it cuts the insurance company out of there. The other thing is that
when insurance companies contract with a facility or doctor, they say, we’re only going to pay you this much money,
right? We’re gonna pay you say $40, for an ultrasound that I would usually charge honor and 50 for? Well, I don’t
have a choice as a physician not to take that $40 If I want to see that patient, right. And as a courtesy to my
colleagues, I take most insurances, because I don’t want them to have to go through this process of saying, I, I sent
you a patient and you couldn’t see them because you didn’t want to take $40, for work that you do. And that’s also a
disservice to the patient because
you want to have access to someone like me. And if I can’t see you, because your insurance company decided that
my services aren’t worth their time, then that’s a problem. Well, if you have a $5,000 deductible, how many
ultrasounds can you get in a year for $40? A pop, right? I mean, like, quite a few. So I think the direct pay model is
really where the future is for the patients and the providers to decrease the cost. You know, I increase the
accessibility to these, these testing and these specialists and you know, physical therapy, and all these things that
you can just go there and get it without getting approval from your insurance company. You don’t use it. And you
know, when you pay for your insurance, you’re in the mindset of, I just forked over 25 grand, I’m going to use this
thing. And then you become frustrated because they are going to slow you down. They slow you down. So you can’t
break out of that $5,000 deductible in into their money,
right? The three days of insurance delay, deny decline. That’s right. Yeah. So I could go on a long rant about
insurance. And I feel like I’ve probably already done this on this podcast, but that’s why we don’t deal with insurance
at all. I mean, we’re on a network with anybody. You know, it’s just, it’s not something that either party enjoys from
when it comes to pt. That therapist is frustrated that they have to deal with the insurance company. The client is
frustrated because they don’t even know how much it costs. Yeah, they’re paying a copay, but then they’re still going
to get billed on the other side because they haven’t met their deductible. Yeah, they think they’ve got good coverage.
But then after four visits, it’s over. Well, what am I paying for? So, you know, for us, it’s more about Yeah, it might be
more expensive, but it’s also upfront pricing, you know what you’re gonna get, you’re gonna get a high quality
product. So, and that’s similar to what you’re talking about. Yeah, it may cost 150 instead of 40. But you know that up
front, and you also know that it can be done today.
Yeah, yeah. And just just to highlight this point, yesterday, we got an order from somebody for an ultrasound. That
patient, I ended up diagnosing, with something that was not expected. And I referred them to a neurosurgeon to get it
fixed. I facilitated all that stuff to happen. Well, we spent, my wife works in the office, just so everybody knows that.
But she runs all the insurance and stuff like that. She spent about two hours, trying to figure out if we could take the
patient’s insurance because it was a certain insurance provider, but had, you know, their each insurance provider has
sub insurances plans and different like that. And we take almost all insurances. But this one, we couldn’t take for
some reason. It wasn’t it just wasn’t included in the contract. And so my wife spent, I think, two hours, calling phone
numbers, logging into websites, all this other stuff waiting on hold, waiting on hold. So you know, if you take like, say
minimum wage is going to be 15 bucks an hour. And let’s just say that, my wife was making minimum wage, it cost
me $30, to even approve your $40 payment, right? To come see me for 20 minutes, super. So I got paid less than
minimum wage for that ultrasound, right. But we ended up, we ended up just doing cash pay on her. And I’ll let your
viewers know, like, you know, just because you have insurance, you don’t have to use it. There’s a rule, a legislative
rule called high tech. And what that rule says is that it protects you, as a user of insurance from your insurance
company, finding out about your problems, and then jacking up your rates. And that that’s what the intent of it was.
But it allows you to just say, to your provider, I don’t want to use my insurance. And so your provider should have a
forum that says I elect not to share my information with my insurance company. And that right there is what allows
you to get cash pay instead of because if you came to me and like I take Cigna for example, if you came to me with
your Cigna insurance and you take it I by contract have to take your insurance, unless you have that unless you sign
that document, you can choose not to you can choose not to do it. And a lot of doctors offices, they may or may not
be have the wherewithal to know that or they may not even have allow that to happen because they just don’t want to
deal with stuff. Because a lot of those decisions are made by people that may or may not know about it. And then the
doctor is so busy because they have to do such a high volume of work to make their 10 to make their their 10 bucks

an hour. They just they just don’t know that it’s even happening up there at the front desk. But yeah, that is a 

possibility. So if you ask about that, when you go to a place, you know, they’re like, Hey, I can’t, your insurance said, I
can’t see you until you’ve done this, this and this, that happens a lot. And you say no, I want to be seen sooner than
that you can choose not to pay with your insurance buyers, you’re signing that high tech disclosure form.
Okay. So I think we’re getting close on time here. What would be the best way for people to get in touch with you.
So the the best way is to go onto my website, www dot ultrasound hyphen first.com. That’s all spelled out, not the
hyphen. But and I have a contact there and you can you can actually directly book an appointment with me
we have the same online booking. So yeah, that’s right. We love very easy. Yeah, we love it.
And if you just jump on there and make an appointment, we can see you same day, next day, you know, whatever is
available. I typically have same day appointments available. And you know, but if you know you, you everybody
works, you know, everybody’s got a job, everybody’s got things they got to do. Just look for your appointment that you
like and pick it. That’s the best way. Other than that, you can just call our office at 314-782-2034. And you will either
talk you’ll probably talk to my wife, Lexi, and then she’ll get you set up. And then all of our all of our registration and
that kind of stuff. We’ve cut out all the BS that’s not needed. And we just have the minimum amount of paperwork for
you to do. It’s easy to have online. Yeah, and it’s all online. And if you use the autofill feature on your phone, you’re
going to get most of it done that way. And if you want once you show up, we don’t really have a wait, you know, we’ve
got a beautiful waiting room. But when you show up people you don’t have to show up 15 minutes early, you show up
at time of your appointment. As long as you’ve got your registration stuff filled out, you’re most likely going to walk
feedback and get your study. Very cool.
And where’s your office?
We’re on North New ballasts road 522 North New ballasts in one of the medical buildings over there. Nice. Sweet 270
It’s close to olive in 270 There’s a Panera across the street there you get you’re hungry.
That’s right. Anything else you want to share with the audience?
Yeah, yeah, just take charge of your health care. You know, don’t don’t let things fester. And, you know, it’s, I know,
co people have been putting stuff off for two years. You got to get out there and get it done.
Right. And I think that’s super important. A lot of people are just kind of wait until it gets terrible to deal with
something. And I see that a lot in my world. So yeah, sure you do, too. I do.
And chronic pain, which I know is your passion, Greg. It causes you to be sick. You know, it increases the amount of
cortisol in your body. It it just makes you feel bad. And once you get that taken care of your whole life’s gonna
change. Very good.
All right, anything else? I think that’s it. Good to go. Well, thank you again for being here. I appreciate it.
And thanks for having me. I really enjoyed it.
I absolutely. This has been STL active.
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