In this episode, Dylan McCabe interviews Iris Zink and Chris Title of Lansing Rheumatology in Lansing, Michigan. Listen to hear Iris and Chris share their journey to a nurse practitioner office model and their best practices for successful infusion center management.
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Transcript: How Iris Zink and her husband Chris radically changed the life of one patient
Dylan McCabe: Welcome to WeInfuse Podcast episode number six. Welcome to the WeInfuse Podcast, my name is Dylan McCabe, and each week we give you a behind the scenes look at the infusion practice. And our goal is to really just provide this platform to give you tips, tools and a roadmap to have a successful and thriving infusion practice that really brings about the best possible patient care and is also a successful business model for the people involved. And in this episode, I really want to tell you guys, this is a moving very moving podcast episode because our guests on the show today, Iris Zink and Chris Title, Iris is a certified rheumatology nurse practitioner and she and her husband, Chris have an infusion practice and they have a very moving story about a patient that really has a life-changing experience in their practice. And yes, it’s because of the specialty biologics that are administered, but really it’s about what Iris and Chris do going the extra mile or two or three for these patients. And I mean it’s a tear jerker. So I’m excited about this podcast episode. They’re also going to bring out things that they’ve learned in the practice, having to work with different companies, EMR companies, and stuff like that that have saved them a lot of money, but you are going to be moved by this story so stay tuned and let’s just jump right into it. All right like I said, we have a special guest today. Two guests really from a practice and they happen to be a WeInfuse client. And today on the show, we have Iris Zink certified rheumatology nurse practitioner and the past president of RNS. And we also have Chris Title, Iris’s husband, also a nurse practitioner in the same practice. They do have an infusion practice, and we’re going to hear from them about what they’ve experienced in the infusion practice, the pain points, the light bulb moments, the great things that are happening there, and get into it so guys, thanks for being on the show.
Iris Zink: Thank you.
Chris Title: Thanks for having us.
Iris Zink: So can I tell the story first about how this happened?
Dylan McCabe: Please do.
Iris Zink: So I was with the same doctor for 16 years and she did not take Medicaid and that continued to hurt my heart, that we were not serving the Medicaid population and there was nobody in a 90-mile radius, no rheumatology practice that would see Medicaid patients. So one of the rheumatologists in town that had a massive stroke and she was no longer practicing and another rheumatologist left Michigan a third rheumatologist on our side of town had leukemia. So there was this giant shortage of rheumatologists and so the lady who had had the stroke husband is a cardiologist called me and asked me if we’d buy the practice. And I said, no way, you know, I was with the same doctor for 16 years. I loved my patients. There was no way that I thought I could do that. So Chris, my husband and I talked about it and he had a lot more business sense than I did all I knew was how to see patients. That’s my only skill set. And he had a lot of business background and management background. So we had a nice, honest conversation. And I had this sign from God where my dead mother told me that it was my purpose in life to open a Medicaid clinic for rheumatology patients. And so we discussed it and I said I can’t do this because I have no idea how to order Remicade. This, you spent millions of dollars on drugs, and I have no idea how to do this. And this is going to be so complicated. And he’s like, babe I think we can figure it out. So we opened our doors in 2016, right after the rheumatology conference. So we’re having our two year anniversary and we’ve seen over 2000 patients and we’re doing pretty well. We’re serving about 50% Medicaid population at this point in time. And we’ve seen horribly deformed, young people come to our doors because they could never get care before.
Dylan McCabe: Oh, that’s awesome. That is awesome and I love that because you guys, one thing we like to mention on the podcast is that the infusion practice specifically is one of the only times where sometimes you have a multimillion-dollar business model that is run and governed by people who are predominantly clinically trained.
Iris Zink: Absolutely.
Dylan McCabe: And you brought that out. I mean, Chris is bringing the business acumen and you’re bringing the clinical. I mean, obviously you can have both, but that’s just great. It sounds like you guys have a great partnership there. And obviously being a WeInfuse client brings some stability and streamlines a process a little bit too, but, um, you’ve given a little bit of background. What would you say is your main area of expertise in your practice?
Iris Zink: I wish we had a main area of expertise when we opened the practice. We said that we weren’t going to see lupus patients because they scared me because they were so sick. You can very easily as a young person die from lupus. And yet the referrals poured in and it was mostly young impoverished women who had autoimmune diseases and frequently they had lupus. And so, you know, we had to use our resources through the rheumatology nurses society in order to really reach out to my colleagues in the United States about how to treat these people. And I see a lot of sarcoidosis and we see mostly psoriatic arthritis and ankylosing spondylitis, but we do see rheumatoid arthritis. I thought as nurse practitioners, people would just send me osteoarthritis patients in fibromyalgia patients, but about 80% of our patients are on biologics. So we tend to get a lot of very sick patients.
Dylan McCabe: No kidding. That’s interesting. So you weren’t expecting to see so many lupus patients. So if you’re a nurse listening to this, be ready, you know, you never know what might be or take a big slice of that pie for your patient population. Um, now Chris, what would you say as far as being more on the business side of things? What is your focus with the practice?
Chris Title: Well, my focus up until just recently here has been to try to manage the practice, get it up and running and get the infusion suite up and running, make sure that, you know, we have telephones that work things like that. Uh, but uh, recently Iris has been so busy and I am a nurse practitioner I started seeing patients about 2 months ago and actually I’m up to seeing about 10 patients a day now and I will have a full load according to my business plan, uh, at this time next year I’ll have a full load of patients. She’ll have a full load of patients. We’ve actually hired a, um, um, registered nurse to run the infusion center now. And thanks to WeInfuse and the other policies and procedures we set in place, I can trust this nurse to do that and she’s really great too. It doesn’t hurt to have a really good person working for you in that aspect.
Dylan McCabe: That’s great. So given what you guys have experienced so far when you started infusing about two years ago, is that right? So given what you guys have learned so far, I mean, what’s one big lesson. You would want our listeners to take away from having an infusion practice.
Chris Title: Well the big lesson for us, when we first started the business, we really weren’t going to do infusions right away. We were going to wait and see what happened and see how it developed. Well, Ms. Iris here, she brought the patients in a drove. So we decided to go ahead and go with the infusion suite a little earlier than we thought. Well, the problem was we had signed a contract, with a biller, EHR slash biller RCM that, was charging us 6% for our, billing. Well, when we start billing, our infusions the J code, that’s our entire profit on the J codes. In fact, on some infusions, we were actually losing several hundred dollars on that. Well, we called this EHR Company and we tried to make a deal with them we said, we really didn’t have plans to do this. We’re going to do this now. We want you to grow with us and make some changes in our contract. Well, they let us along for about six months and they never really made the changes that we wanted to make. We ended up having to change our electronic medical record and our billing people all the way around because we were actually losing money on infusions instead of making money. And if that one thing, if you can, fix that one thing out front, make sure you know exactly how much you’re going to pay for even J codes. And many EHR companies will curve out J codes. If they’re going to do your billing for you, they’ll curve it right out, or they’ll give you a much-reduced price or a flat rate or something like that instead of taking the entire percentage that they take on your professional fee billing.
Dylan McCabe: That’s huge. And I mean it’s interesting. I mean, you have zero hesitation mentioning that when I say what’s one big thing, you’d want our listeners to take away. And we talk to different practices every day, all over the US and I hear the same kinds of challenges. And it’s very rare that I hear somebody that has an infusion practice where whatever billing system or company they’re using takes a percentage of those J codes, just because the numbers are so high, the margins are so slim it really just doesn’t work long-term. So that’s great that you can reiterate that for our listeners. And I know a lot of practices that are looked at if you have a rheumatologist that wants to start doing infusions, but scared of the risk of those numbers, with billing and seeing those infusion patients and it’s just great to know that there are solutions out there though. There are software companies out there that don’t bill that way. You can do billing in house. You can learn, we have strategic partners we collaborate with that can teach you how to do the billing for a certain number of months, and then once you’re good to go, they let you go and you can just do it in-house. There are lots of options out there, but a lot of people don’t know those options. So I’m glad you highlighted that. So go ahead.
Iris Zink: WeInfuse advocated for us. I mean, when we were having trouble with this EHR Company, the first people that we reached out to was you all to say, Hey, can you help us? Do you have a relationship with this company we’re struggling here, we’re new. We didn’t realize that this was going to be an issue and it has been. And so you were very much in our corner advocating.
Dylan McCabe: Awesome. That’s great. That’s great to know. So that kind of leads into my next question Maybe we’ll just even get more in the weeds on that, but with all the things, obviously, you have success stories too, and I can’t wait to hear even one story of a patient that was dramatically changed by the infusion therapy, but what would you say has been one of the biggest challenges? Would it just be more into the billing issues in the practice?
Chris Title: I think it is the billing issues and, just figuring, even though I had massive management experience, I managed an intensive care unit. I didn’t manage an office or an infusion suite or so it was just, figuring out the entire, the workflow, if you will, the best way to do things the most efficient way to do things the safest way to do things and then of course you don’t want to lose money at the end of the day. And I do get to say that WeInfuse has helped us with all of those areas. It seems like a very simple program, but it really isn’t, we would have lost several thousand dollars. I estimated at about $40,000 at times because we have actually tried to give infusions too early in the schedule, and we wouldn’t have been paid for those infusions, but WeInfuse, the program stopped you from doing that. And we have, it keeps track of our inventory for us, and it keeps track of our average costs and it’s really a great program, it really is. Like I say, it seems like a simple program seems like anybody can develop that, but it’s really helped us a lot. I really value WeInfuse it. In fact when you’re starting your own business generally, I felt like everybody was just trying to hurt me along the way I have about two or three people and WeInfuse is one of them that I say every single time that they’ve, helped me with every step of developing the business, being safe, delivering the right medication at the right time to the right person and getting paid for it so.
Dylan McCabe: Man, that’s great. And thank you for taking that a hundred dollar bill I just slipped you under the table and that’s a wrap. You just did a great promotion. WeInfuse no, but that, that’s wonderful. And I love to hear that because a lot of times I’m on the front end of introducing people to, WeInfuse me personally and just helping practices get started. But I don’t, a lot of times hear the stories of here’s all the ways this has helped us moving forward, or we made four or five mistakes last year with billing or losing inventory. And now we haven’t made any, and that’s just awesome, awesome to hear because it changes people’s lives. I mean, obviously, you have a business. I mean, you see patients and there’s a huge clinical side to it, but you also have a business. And if that business isn’t run well, you can’t keep your doors open and then you can’t treat patients. So it’s just great to hear the business side. And I’ll just take a moment to say for those of you listening, if you haven’t requested a demo for WeInfuse yet, please do because you will have a benefits investigation process, a scheduling feature, a nurses’ charting area, and inventory management ordering all in one. And I’ve even heard stories. So many stories at this conference at RNS that we’re at right now I just heard of one practice that’s doing about 400 infusions a month. They don’t have any software system for their infusion suite. They do have an EMR for the practice, but they have nothing for the infusion suite. They’re managing their schedule and their inventory in an Excel spreadsheet, two different spreadsheets, one for the schedule, one for the, and the gal that I was speaking to said that they accidentally, they were about to give one patient the wrong order and the wrong inventory and all this stuff, and I’m going, Oh my gosh, this could be so much easier.
Chris Title: They could probably safe 6 or $7,000 a month just in paying people to keep up with those spreadsheets, we tried to do that and it just, I mean, at that point, we were doing 10 infusions a month and we were going crazy Just trying to keep up with the inventory. Are we sure we have the prior authorization in place and it was always double-checking, triple-checking, double-checking and without WeInfuse I know for a fact we would have made at least five errors last year. At least that many in giving people maybe medication they shouldn’t have got or too early or without prior authorization, you know?
Dylan McCabe: Well, thanks for shining a light on that. Let’s share another story. What’s as far as you guys have been in business so far, what’s one of the biggest light bulb moments you’ve had in the infusion practice?
Chris Title: One of the biggest light bulb moments…
Iris Zink: I think when I was with the physician that I was working with, that did not take Medicaid at all or any crappy insurance for that matter. We used a lot more injectables; it was a different population. With the Medicaid population, being young and transient, losing their insurance every five seconds and moving and you just can’t trust that they’re getting their medications that they’re picking it up. They get to the pharmacy and there’s a really high copay they don’t pick up. Are they giving it to their mother? I’ve had that before where the patients are giving their medications away or selling their medications. Whereas if you do an infusion, you’re seeing the patient, knowing the patient is healthy enough, seeing their progress, seeing them in the office and you actually know that they got the medication so that has been a huge light bulb for me, because I know that we have to do more infusions, especially on the patients that we don’t necessarily know that well, or we don’t trust or, whatever situation that they’re in. So we’ve kind of changed our business model because I was just used to using injectables because of the convenience, but you can’t do that. So we do have a great patient story. So when we opened our practice, we had more time, obviously, because there weren’t a whole lot of patients in the beginning. And so we got this young lady who had horrible deformities from rheumatoid arthritis and she’d actually gone deaf secondary complications for her arthritis. So she came in and she told me that she had psoriatic arthritis and she’d been seen by another rheumatologist for several years. And the medication that she was on had caused her hearing loss. And I looked at her questioningly and we’re writing notes back and forth and writing notes back and forth. Because she didn’t do sign language and she couldn’t lip read and so writing notes back and forth Since she said that the other rheumatologists had told her that the medication had caused her hearing loss. So she had not taken anything in a couple of years because she had Medicaid and nobody else in town would see her. So we took her in I figured out that she did not have psoriatic arthritis. She actually had rheumatoid arthritis and then the inflammation and the vasculitis that she had associated with it, which had actually caused her hearing loss. So we put her on a bunch of steroids to see if we could save any hearing that she did have left. She had a little bit left and I promise this family, she didn’t show up for a second appointment cause she couldn’t physically get out of bed. I called her mom and I said where is Cynthia? And they said well Cynthia can’t get out of bed. Cause she’s in so much pain. So Chris and I went to the house, we did a home visit. We talked to her, we prayed with the family. We reassured them that we’re going to take care of them. Of course, then I had a giant nightmare because it took us 90 days to get the medication that I wanted IV for her authorized. And I just kept waking up crying, going. I promise this family, we are going to take care of this girl. And I’ve got this young girl on a ton of steroids trying to save her hearing and we couldn’t get the medication authorized because she had the worst kind of Medicaid. So we were going back and forth and back and forth with what she tried and what’s going on. So finally we got the medication authorized and Chris and I went to her house and lifted her down the stairs to take her out, to bring her to our clinic, to infuse her. Two weeks later, we went back for her next infusion and she walked down the stairs by herself.
Dylan McCabe: Wow.
Iris Zink: And that was a huge moment. Well, Chris is a little bit of a softie. So he acts like he’s a big, tough guy, but he got super attached to this young lady. And he actually drove her down to U of M eight different times and got her cochlear implants. So now she can hear she’s an incredibly loyal patient. She sent us a lot more of her friends and family members because we’ve changed her life I mean, Chris got her hearing back. She was losing her cognitive functioning, which Chris understands much more than I do. But when you lose your hearing at a young age intellectually, it’s very challenging for you because you’re losing one of your entire senses. You’re not perceiving things. You can’t watch TV. You don’t hear the conversations around you and you can’t balance your checkbook. I mean, things, simple tasks become really difficult. So it’s been a huge life-changer for her. Rheumatoid is now in remission and she can hear and is much more social.
Chris Title: I saw her a couple of weeks ago. And she’s really doing well. She can actually when I was driving her to the U of M, which is 90 miles away okay, well, no it’s about 90 minutes away I should say. I would try to talk to her on the way and she could not hear a thing, nothing. I mean, stone deaf just couldn’t hear anything. And we got her cochlear, I took her down for her pre appointments and her surgery and got the activation of her cochlear implant and one of the last times I took her down there, we got back in the car and it was raining and she said, I can hear the rain.
Dylan McCabe: Man. That is awesome.
Iris Zink: I know, totally life changing.
Dylan McCabe: That is just amazing. That’s amazing. I mean, that is completely changing somebody’s life and people need to hear those stories. I think people can get kind of in the weeds of the challenges of a practice or issues with staff or what just, yea just like, but man lives are being dramatically changed. And that is an incredible story. And I heard today of another story you shared yesterday, another story that’s just as dramatic of how you guys helped a patient. And so we can, or we don’t have to go into that here.
Iris Zink: It’s okay.
Dylan McCabe: But it’s just, it’s just amazing to me that you guys specifically are really, there’s, a verse in the Bible where I’m coming from my perspective, a Christian perspective, there’s a verse in the Bible where Jesus says, there’s no greater love than somebody who lays down his life for his friends. And it just brings that to life like that is love when you guys can take that extra step and go the extra mile or two or 20, or a 90 minute drive repeatedly and do all this stuff it’s just awesome. Like you’re really that’s worth living for that’s worth going through all these challenges, that kind of stuff.
Iris Zink: I think when my old practice, I didn’t realize I was burnt out because I was just doing the same thing every day punching in, punching out, seeing as many patients as possible for this doctor, and then getting an hourly wage and feeling like I was doing a good job. Cause I knew my patients really well, but I had lost my passion. I lost my fire when you go to work and you can see that these patients have not listened to nobody’s taking care of them because they have crappy insurance. Nobody seems to care about them and they’re kind of getting shuffled through and lost in the system and they can’t tie their shoes and they can’t do their own hair and their kids are having to help them get dressed in the morning. And then you sit down and you talk to them one on one and you say, you know what? I think I can get you on a medication that’s going to change this and make you feel like Merlin. I mean, you get so attached to these patients and they get so attached to you that it makes it all worth it going to work every single day. We love going to work because we know that every day we have the opportunity to change the life of another person.
Dylan McCabe: That’s awesome. So out of all that, I mean, what’s one thing you would want our listeners to take away from, from all that. I mean, just focus on patients and that’ll bring your passion back. I mean, what’s one.
Iris Zink: I think absolutely. I think that we all have to serve. I think there gotta be a point where you’re serving. I think it’s really sad when doctors tell me that they don’t have time, I hear that all the time. Well, I only have 10 minutes with a patient while I think that’s really frustrating for me because I think that’s a choice. You can spend more time with your patients and you can make a huge difference and you can make that one on one connection and give the patient a hug and hold their hand and get to know their backstory and their family story. And that’s why nursing is so great because we do want to get to know our patients on that backstory because that just makes it all worth it. Then you have successes together. It’s not a business arrangement, it’s a human connection.
Dylan McCabe: That’s huge, that’s great. And it’s so great I mean, you just can’t highlight that enough so well, let’s, let’s switch gears here just` forward-thinking, tell our listeners about what you guys are most excited about right now in your practice.
Chris Title: Well, we’re excited about the growth, I think we’re seeing two to three new patients every single day, every day, we’re open we’re seeing that many new patients, I’m excited to, grow as a nurse practitioner like I say, I have extensive experience in other areas, just not that much in rheumatology, but I’m coming, I’m getting my feet under me I’m going. I’m excited to learn something new every day. That’s why we’re at this conference too. It’s been a great conference to learn new things, to see new things, to meet new people and to make new connections too so in case I need something I can always, I always have Iris of course, but I have other connections throughout the United States now, too. So we’re looking forward to growth. We are looking forward to helping more people. Because I feel like we have not. We’ve just started on the things that we can do. We have big plans for telemedicine. We have big plans for expanding the clinic to make it a multi-specialty clinic. We are big, I mean, these are all years down the road, of course, but we want to try all of those things. We want to try to help as many people as we can help.
Dylan McCabe: That’s great. Go ahead.
Iris Zink: [Inaudible] called a trailblazer and we love Richard Warren. He’s at the conference. He also has his own clinic in Arizona. And this is going to be the new model nurse practitioners and PA’s owning their own practice because there is such a huge shortage of rheumatologists. There’s not enough rheumatologists and fellowship. We have to pick up the patient load. We’re certainly capable of educating patients and managing chronic conditions and so I feel like we’re kind of setting an example of what you can do. Nurse practitioners can go into business here yourself and yes, it’s challenging and yes, you’re gonna be poor for a second. And it’s not like working for a big organization where you get that paycheck, but in the end, it’s so much more worth it. It’s your own, it’s your own baby that you’re growing and cultivating and feeding and you get to have control in my old practice, there were a lot of rules about what I could and could not do with the patients. I was not allowed to do home visits. I was doing them, but I didn’t tell anybody, just simple things like that, that now we can, we’re making our own rules. We can do things that we want to do. We have a bell, in the lobby, which at the old practice, always wanted to have a bell like Arby’s. Where it says above the bell if we’ve changed your life or you feel better when you leave than when you came in and ring the bell. And it’s awesome when Chris and I are in an exam room and you hear that bell ring. Because you know that one person is better today. It’s just huge.
Dylan McCabe: That’s so good. That is so good. I mean, there are so many good things to bring out of that, but we did an interview with Kevin Lyons who at the time of the recording of the podcast is executive director of RNS. And he mentioned that as well, that there are so many opportunities in rheumatology. There’s just not enough clinicians to meet the needs. So that’s great that you guys mentioned that there, I mean we could talk on and on I only have one question left though, and that is what’s one last, just parting piece of advice for our listeners.
Iris Zink: Have friends, the rheumatology nurses society is the only way that I could have done this because I have questions about sick patients with lupus I call Monica Richey at Northwell in New York. If I have questions about patients that have hepatitis or other infections, I call Betsy Kirschner at Cleveland clinic. I have Michelle, who’s a nurse practitioner at Mayo and it’s only because the rheumatology nurses and the networking that I gained here, that I can do that, that I feel comfortable seeing these patients who have rare conditions or very complex medical conditions. Because I know I can email Jack Cush or I can, because of my connections through this networking and this professional organization, which has really been a resource for me.
Dylan McCabe: That’s great. So check out the RNsnurse.org or I can’t remember the name of the website.
Iris Zink: Something like that.
Dylan McCabe: So anyway, just do a Google search for RNS rheumatology nurses society.
Iris Zink: And it’s nurses and PAs and nurse practitioners that we are at PA friendly organization.
Dylan McCabe: RNs nurse.org. Yep. That’s right. Yeah. Nurses, PAs NPS Well, that’s great. You guys, it’s been a real pleasure for me to learn from you and to hear inspiring stories. So thanks again for being on the show.
Iris Zink: Thank you.
Chris Title: Thanks for having us.
Dylan McCabe: All right. I hope you were inspired and encouraged by that story. Like I was, I was amazed to hear of the links that they took to make sure that patient got the best care possible. And so if you want to hear more about the things they said about WeInfuse, they mentioned that without WeInfuse, they probably would have lost about $40,000 in one year in their practice. They also mentioned that a collaboration just really just being a client of WeInfuse, enabled them to have some synergy and collaborate with us to get just expertise on many levels. WeInfuse is a lot more than a software company. You get a level of expertise, especially from the founders and the information that they share with clients and with others, that is oftentimes not surpassed by anyone else. I’ve had multiple conversations with providers with even practices with multiple locations. And I had one guy in particular that had a practice with 14 locations and he said, one phone call with you one hour on the phone with you guys has taught me more than I learned in the last six months from the consultant that I hired. So when you get, WeInfuse, you get much more than a software company, if you haven’t done so yet if you are a provider or a nurse practitioner or a nurse manager, office manager, and you’re thinking, gosh, I would really like to have a tool that could help me manage the benefits investigation process, the schedule, a nurse’s charting function, and also inventory management ordering all in one place that sounds amazing. Well, you can have it just go ahead and schedule a demo with us today. You can go to, weinfuse.com and request a demo and you can see it takes about 30 minutes and you can see if you think the software would bring significant value to your practice. Of course, I believe it will. We believe it will because we talked to practices all over the US and heard the stories of what people are going through trying to manage this process. But, that is a wrap for today. I really hope you were inspired and encouraged by that story. And if you have any questions, do not hesitate to reach out to us. This is Dylan McCabe with the WeInfuse Podcast, and I will catch you in the next episode.
Guest Speaker: Owners of Lansing Rheumatology, Iris Zink, MSN, ANP, RN-BC and Chris Title, opened the first early arthritis intervention center in East Lansing, MI. Prior to opening Lansing Rheumatology, Chris managed 120 nurses at the University of Michigan Hospital. Iris has over 20 years of experience as a rheumatology nurse, and served as President of the Rheumatology Nurses Society (RNS) from 2015 to 2017.
