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Member Highlight: Dr. Ray Altamirano of Casa Salud

5/28/2020

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PictureDr. Ray Altamirano standing next to portrait of his lion San Antonio Business Journal 2020 Man of the Year
Dr. Ray Altamirano, San Antonio Business Journal 2020 Man of the Year, standing next to his lion portrait


For our May issue of the San Antonio Free Market Medical Association, Shankx Web Development chose to highlight the outstanding Dr. Ray Altamirano of Casa Salud Family Medical Clinic .
Dr. Altamirano was chosen as 'Top 40 Under 40’ and ‘2020 Man of the Year’ by the San Antonio Business Journal. He has been featured in San Antonio Current, Fox News, La Prensa, The Kelly Clarkson Show  and  The Doctors.
His collaboration with other brilliant leaders in the medical community around San Antonio has been featured on local news outlets like KSAT this month for helping to contact trace by delivering to-your-door COVID-19 testing.
We have a home 24/7 for those who have tested COVID positive and they can come here to get treated.
How did you become involved in testing?
I reached out to people who were in this group of creative and eager social entrepreneurs like, 'hey, let’s find another way to get tests out there.' What we did is not a matter of competition, the goal is to test as many people as possible. When you look at the objective of testing it’s to help the current system in place, which is Metro Health locally. 

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Metro Health is hiring more contact tracers. If you get more contract tracers you can nip this thing and it’s usually the asymptomatic tracers that are spreading it. That’s what we’re trying to capture by testing more people.
What do you do specifically after testing?
I help those who test positive.

Part of what separates what we’re doing is that we include a telemedicine visit for those who test positive and for those who test negative but are symptomatic they can go to their doctor, or Casa Salud.
How has COVID changed visitations in your clinic?
These last few weeks with this demographic, there are so many courtesy visits that I’m doing without them paying because they can’t. I think [about] doing the right thing for people.
I saw a highlight of you on Univision where you said Texas ​could become the next epicenter. Is that still true?
It’s hard to predict who is going to get super sick.

At first, they thought it was only the elderly, but if you start looking at diabetes and obesity,
San Antonio is the diabetes capital of the United States. Maybe you don’t have it but Gramma could get it.
​

The more you can test, the more you contact trace.
Is there value in people of color joining the free market?
​I’m from the south side. I’m very proud to be Mexican. I’m proud to cater this demographic that doesn’t exclude anybody but serves more blue collar workers that are just working contributing to this country.

They need access. And good access--not just any access. I decided I was not going to wait for a government agency to do it. It has to come from us.

I said, ‘the only way I’m ever coming back to primary care is on my own terms' because I don’t want to be working in the system contributing to these money games with diminished care.
Dr. Altamirano’s Drive
Dr. Altamirano smiling with Love more than yesterday sign in hand
I wanted to be back in the community through primary care and I knew the only way that would work is to be outside of the world of insurance, so that’s why in March of last year I formed my clinic, Casa Salud Family Medical Clinic.
Casa Salud Versus Traditional Practices
There’s definitely more liberty to treat how I see fit. There’s luxury that I have working outside of the world of the networks of insurance. For me, I like staying fee-for-service mostly to fit my demographics. However, I have the luxury of having my ER job and I see my clinic as more of a service for people who don’t have insurance and I’m able to have some staff.
‘No Insurance’ and the Free Market Medical Association
It’s a matter of creating a free market and what I’ve learned about insurance and about labs that take insurance, about imaging centers, etc., is the prices they fill out are completely arbitrary. There are numbers much less than that they’re willing to work with if you’re paying with cash, So that’s definitely what I love about my clinic and how I feel that freedom.
Teaching Cost-Conscious Medicine
The most important thing that I’m doing outside of treating patients is training mid-levels. They learn conscious medicine, putting prices on what they need to do because that’s what people are most worried about.

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Patients are more concerned about what it costs than why they’re sick.

When they see there won't be any back billing that will put them in bankruptcy for a procedure or for anything because I was able to negotiate upfront a price and approach the problem with a price tag to it, it is more effective.
Casa Salud and the San Antonio Community
I really like the service in my community. I think what I’m doing serves as a blueprint for anyone who wants to do that for their own community. If they want to train under me that’d be great. I tell everyone that there is a way to make money and you don’t have to be a specialist. 
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You can be a primary care doctor and still earn a good living through this model and be completely free and have the liberty to practice as you choose and you’re working for your patients not the payer,

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so that’s exactly why I do what I do with my clinic.
Zip Codes Matter
PictureArtwork by Dr. Ray Altamirano

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​"The zip code where I grew up in, that’s where I focus my clinic.

​If you draw a line halfway, highway 90, in the middle of San Antonio, what you see is a 6-1 ratio for doctors in San Antonio in the south.

​There’s less care here for more unhealthy people.


I have hope with the new medical school being nearby. If I could help capture them now and show them by thinking outside of the network of insurance,​

'You’re free. You can make money. You can do it.' There’s no need to go anywhere else.”

​
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Amar es Vivir: To Love is To Live
Dr. Altamirano standing with artwork san antonio
Pictured above: Member of the San Antonio Free Market Medical Association Dr. Ray Altamirano of Casa Salud Family Medicine Clinic holding his artwork from his collection that can be found on Facebook page ‘Amar es Vivir.’
I ran into a patient who needed knee injections, very expensive, he couldn’t afford it, so I was able to convince a pharmacist to sell it for me at wholesale and then retail it. I started selling all my art prints to pay for him and that got on the Kelly Clarkson Show, The Doctors, national TV. We were able to sell enough of my art prints to pay for this man and beyond him that we had people come and donating for other patients.

​That’s how that evolved and
the art is definitely me, it’s a hobby, release, a form of therapy for me. The name of my art is Amar es Vivir, more of a motto of how I want to live and that translates into my practice. My clinic is my gallery.

Interview brought to you by Shankx Web Development and Consulting. For more information, please visit https://shankxwebdev.com


The FMMA was founded in 2014 by Jay Kempton and Dr. Keith Smith based on their mutual desire to fix our broken system. They founded the FMMA based on three pillars. 
  1. Price is not a product. 
  2. Value is mutually determined and requires transparent pricing and quality. 
  3. Cash is king, the equality of price is critical.The FMMA connects true buyers and sellers of healthcare, educating and motivating them to work together based upon a mutually beneficial relationship built on the pillars.

​To learn more, contact sanantonio@fmma.org.
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Member Highlight: Dr. Haverkorn of River City OMS

5/28/2020

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Dr. Mark Haverkorn, DDS, MD receives a Nice List Certificate from Santa Claus
Dr. Mark Haverkorn, DDS, MD receives a Nice List Certificate from Santa Claus during Open House and one year celebration.


FMMA Member Highlight​
The purpose of our member highlights is to shine a spotlight on outstanding individuals who form part of a groundbreaking network as members of the San Antonio Free Market Medical Association. For our December issue, Shankx Web Development chose to sit down and chat with Oral & Maxillofacial Surgeon, Mark Haverkorn, whose clinic River City OMS, recently had an Open House and one year celebration. Congratulations, Dr. Haverkorn!


​​Joining the F​MMA
Dr. Haverkorn joined the FMMA in fall of this year after hearing about the FMMA from the Surgery Center of Oklahoma. Dr. Haverkorn also belongs to the American Dental Association, American Medical Association, American Association of Oral Surgeons.

Locally, Dr. Haverkorn and his wife (also Dr. Haverkorn!) serve as board directors in the San Antonio chapter of the Christian Medical Association.


​Why did you join the FMMA and how do you believe it will help your business?
​I joined FMMA to get the word out. I really believe in being transparent about prices. We have all of our prices posted on our website and Facebook. Currently, River City OMS is the only Oral & Maxillofacial Surgery center with prices as low as ours. I’m hoping that other surgeons will follow and do the same and that coming together through FMMA will help.


What problem does River City OMS solve?

​There’s three groups of patients we deal with:
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  • We’ve got patients who don’t have insurance or who do not have a lot of money, we obviously help them.
We’re the cheapest oral surgeons in the state of Texas, probably in the whole country. The going rate in San Antonio for four wisdom teeth removal is about 3 grand, I do it for $1,000.

  • The patients who want higher-end treatments
You see the commercials that say, “Come in take out all your teeth put in implants in a day!” What they don’t tell you is that it averages $25,000 per jaw, about $50,000 for the mouth. But we can do it for $40,000, that’s 20% off.
We can help the high-end consumers, we can help the folks who are just looking for an affordable way to get care.
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  • Then, in the middle, patients who have insurance and a job are a little more hesitant, but they come out ahead too.​
We had a patient who had two impacted wisdom teeth removed. Our prices are $675. That patient submitted a claim to their dental insurance and got $475 back. That means their out of pocket was a little over $200 to have two impacted wisdom teeth removed.
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$100 a tooth? You will never find that kind of a deal like that. The dental school charges a lot more than that and they have students in residence who are doing it. The clients who come to us and try this do well!
​

Problem wise, I think we help out people who just cannot afford to get treated. All the time, we have patients who walk in. They've been to a couple of other places and they couldn’t afford it and they were just going to have to deal with their problem until they could take care of it.

​Some will fly down to Honduras or Central America to get surgery at a discount, but then you have patients that don’t want to do that, but don’t want to fork out 50 grand so when we come a bit lower, that helps them too.



​Are people wondering what you’re doing to the market?
No one’s angry, but I think a lot of people think it won’t work. In dental school, everyone wanted to be fee-for-service, which we are, but they wanted to be FFS with ridiculously high prices. Like $3,000 for a crown. No one ever talked about being fee-for-service at a price people could afford. They’re intrigued by it.





Who is Dr. Haverkorn?​
Dr. Mark Haverkorn, Dr. Chrissy Navejar, and Mr. Shankar Poncelet
Members of the SATX FMMA pictured left is Mark Haverkorn, DDS/MD of River City OMS, center is Chrissy Navejar, DO of Dominion Primary Care and right is Co-Founder of FMMA and CEO of Shankx Web Development, Mr. Shankar Poncelet.


What do you enjoy most about volunteering?
Giving back. I’m very fortunate that my wife is right on board. We’ve always liked to do charity. We like giving things away and trying to help people. This Wrappin’ Jack will be at Fiesta Texas and we’re collecting donations and sponsoring that. It goes to Family Services Association that started in 1903 serving underprivileged families. The average family makes less than $10,000 per year.


What’s one thing - either industry-related or not - you learned in the last month?
I learned about where the name Camp Bullis came from! There’s a colonel in the army that was fighting on the border in the 1800’s in the Indian War. I was always interested and then I found an article about it.


What's something about you (a fun fact) that not many people know?
​I’m a Cattle Rancher! My father-in-law was a rancher so he taught me. My pickup truck is actually used for that.


Does RCOMS sponsor any entity?
We sponsor a football team! South Texas Rangers. Cops, firefighters, paramedics, everyone on the team is an active officer or relative. They’re growing. We also have a small ranch and we sponsor a local 4-H chapter. We also sponsor a couple of events the Christian Dental Association does every year.


Explain your passion for oral surgery and how it is represented in your company culture.
My passion for oral surgery started from seeing my dad, who was also a surgeon and then discovering there was a lot of variety in this field. We do trauma, pathology, cancer. Some do cleft!


Killers of the Flower Moon by David Grann Book Cover
What's the last book you read?
I really enjoy non-fiction. The last book I read, was Killers of the Flower Moon by David Grann. An Indian tribe in Oklahoma is given a reservation that everyone thought was worthless, but they found oil. They were the wealthiest people in Oklahoma. People came in and tried to take advantage and there were murders. It’s an interesting story!


Interview brought to you by Shankx Web Development and Consulting. For more information, please visit https://shankxwebdev.com





About the Free Market Medical Association
The FMMA was founded in 2014 by Jay Kempton and Dr. Keith Smith based on their mutual desire to fix our broken system. They founded the FMMA based on three pillars.
 1. 
Price is not a product.
 2. 
Value is mutually determined and requires transparent pricing and quality.
 3. 
Cash is king, the equality of price is critical.


​The FMMA connects true buyers and sellers of healthcare, educating and motivating them to work together based upon a mutually beneficial relationship built on the pillars. To learn more, visit www.fmma.org/sanantonio or contact sanantonio@fmma.org.


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Q1 Meeting with Dr. Marty Makary

3/13/2020

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On March 4, 2020, the San Antonio Free Market Medical Association had their first quarterly meeting of the year at the Omni Hotel and Resorts Colonnade San Antonio. Physicians, pharmacists, brokers, patients, employers, imaging, lab, preventive care providers and others gathered together to listen to Dr. Marty Makary explain the vital role the free market plays in healthcare.
Dr. Marty Makary, Antrea Ferguson, Dr. Roger Moczygemba of Direct Med Clinic, Dr. Kristin Held, Bill Cox of Cox Manufacturing, Dave Campbell of San Antonio Manufacturers Association SAMA sitting in Omni Hotel Resorts Colonnade San Antonio ballroom
San Antonio Free Market Medical Association's First Quarterly Meeting of 2020 at the Omni Hotel Colonnade ballroom.
 The meeting was preceded by a VIP Sponsors Dinner where our keynote speaker, Dr. Marty Makary dined exclusively at the Gold Sponsors table with River City OMS, IB-TX, Direct Med Clinic, Shankx Web Development, Cox Manufacturing.
Dr. Marty Makary, Dr. Roger Moczygemba, Dr. Kristin Held, Bill Cox, Joe Denton, Cindy Brenke, Shankar Poncelet, Antrea Ferguson, having dinner with Bill Cox of Cox Manufacturing, Joe Denton of IBTX, Cindy Brenke of IBTX, Deborah Maldonado of Direct Med Clinic, Dr. Kristin Held, Sloane Wembell of Right at Home, Allison De Paoli of Altiqe in Omni Hotel Colonnade.
Dr. Marty Makary having dinner with Gold, Silver and Bronze Sponsors in Omni Hotel Colonnade.
As a leading health expert who has spent time with innovators disrupting healthcare, our sponsors were privileged to have Dr. Makary lend his expertise and facilitate table talk.
Dr. Marty Makary, Dr. Mark Haverkorn, Bill Cox, Dave Campbell, Dr. Roger Moczygemba, having dinner and conversation at table
Our VIP Sponsors Dinner was full of conversation about insurance, Third-Party Administrators (TPA's), Pharmacy Benefit Management (PBM's) and transparency.
“How can an employer tell a good broker?”,“How, as an association, do you serve your population?” and “What are some solutions to money games in healthcare?” These were but some questions that were asked to Dr. Marty Makary and also to one another.
Who is Dr. Marty Makary?
Dr. Marty Makary in white Johns Hopkins scrubs smiling
Martin “Marty” Makary is a physician, author, researcher and health care advocate. He practices surgical oncology at the Johns Hopkins Hospital and is a professor of health policy at the Johns Hopkins Bloomberg School of Public Health.
For anyone unfamiliar with his work, Dr. Marty Makary’s contributions to the field of medicine are nearly enough to fill a library. Makary developed a surgical checklist to monitor hospital infection rates, surgery outcomes and procedure costs used by the World Health Organization. He was also chairman of its technical workgroup in 2011. Dr. Makary has written over 250 articles, is a GI doctor, Health Policy Advisor, Chief of Islet Transplantation Surgery, Editor-In-Chief of MedPage Today, and professor at John Hopkins, to name but some of his roles.
Dr. Marty Makary in scrubs in hospital hallway talking with medical practitioners and students
Dr. Marty Makary in scrubs in hospital hallway talking with medical practitioners and students
Dr. Makary also manages to travel the country to stop the average American patient from being sued. Dr. Makary is often accompanied by his students from his research team.
Sarah Blakemore, student at UT Austin and protégé of Dr. Marty Makary, speaks with Dave Campbell, Chairman of San Antonio Manufacturers Association.
Sarah Blakemore, student at UT Austin and protégé of Dr. Marty Makary, speaks with Dave Campbell, Chairman of San Antonio Manufacturers Association.
In spite of all of these accomplishments, Makary is one of the few doctors willing to take the time--2 years and 22 cities to be exact--to interview healthcare stakeholders of every kind. “I interviewed executives, front line clinicians, insurers, brokers, pharmacists, hospital leaders and patients—in an attempt to answer the question: How can we stop the healthcare cost crisis from destroying the country?” He shares the answer to this question in his latest book, The Price We Pay: What Broke American Health Care--and How to Fix It.

We invited this advocate for fairness and honesty, on the micro and macro level of healthcare, to kick off our first quarter.
​Chapter leaders Dr. Roger Moczygemba of Direct Med Clinic and CEO Shankar Poncelet of Shankx Web Development, talk with Dr. Marty Makary as he autographs his book and discusses the first quarterly meeting.
Dr. Marty Makary autographs his book "The Price We Pay."
​Chapter leaders Dr. Roger Moczygemba of Direct Med Clinic and CEO Shankar Poncelet of Shankx Web Development, talk with Dr. Marty Makary as he autographs his book and discusses the first quarterly meeting.
Throughout the meeting, Makary elaborated on the three fundamental root drivers of the healthcare cost crisis including pricing failures, inappropriate care, and middlemen, which he also lays out in his book, “The Price We Pay: What Broke American Health Care--and How to Fix It.”
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​According to Makary’s research group, healthcare now accounts for nearly 50% of the federal budget. Makary explains that tax dollars are not only being allotted to Medicare and Medicaid, but nearly half of Social Security payments are being used for copays, deductibles and services not covered. He explains that the military and veterans each have their own healthcare system, and that tax money is going to insurance for the 9,000,000 million federal workers and their families. Then, there’s interest. “All in all, nearly half of federal spending goes to healthcare in all its hidden forms.”
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Dr. Makary compares flights with unlisted prices versus listed prices to illustrate price transparency and the impact of making healthcare "shoppable." “What if airlines argued that they couldn't give passengers a price before the flight because they didn’t know whether the flight would be delayed or rerouted? ‘Maybe you’ll consume a beverage!’ If airlines operated without showing their prices and then gave us outrageously high bills, we’d all agree that a lack of price transparency was enabling price gouging.”
Steward on flight standing over beverage cart
The airline industry is more transparent than healthcare.
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Dr. Makary made it clear that just as televisions, toys and cell phones have become transparent in their industry and still profitable, that we are able to make healthcare shoppable. “No one is suggesting that we, surgeons, give patients a price in an operating room during a trauma situation, but most medical care is elective and shoppable. Everyday Americans are asking for honest prices, and we need to respond.”
​We are successfully establishing a network of people that believe changing the way we purchase healthcare services by providing value driven healthcare is possible.
Having quarterly meetings allows different stakeholders to meet together to have true, open, and honest dialogue about how to tackle the overwhelmingly broken healthcare system, and as Dr. Marty Makary has done in his book, not only ask questions, but offer solutions.
​“Policy makers debate how to fund the broken healthcare system, but we really need to talk about how to fix the broken healthcare system. We need to ask how we can spend our healthcare dollars wisely.”
Jaime Farmer, HSE Manager of Lancer Worldwide talking with Dr. Roger Moczygemba of Direct Med Clinic
Jamie Farmer, HSE Manager of Lancer Worldwide and Dr. Roger Moczygemba of Direct Med Clinic
Charlotte P. Davis of Black Nurses Rock at registration table for 1st Quarterly Meeting of 2020
Charlotte P. Davis of Black Nurses Rock at registration table for 1st Quarterly Meeting of 2020
Makary continues the conversation helping us to understand that as we continue to learn about patients want, how we can deliver high-quality care, that this will influence markets.
Dr. Makary not only gave a call to restore medicine to its mission, but to revolutionize healthcare through transparency in San Antonio, believing that, “research should resort in advocacy not just talk in meetings.” He has already seen transparency change clinics, a reduction in hospitalizations and readmissions, ultimately lowering healthcare costs.

​We hope to see the same, and believe as we have more meetings that our discussions will continue to result in the first steps to continuing to see the cost of healthcare become affordable and accessible to people all across San Antonio.


Mark your calendars to come to our next meeting on Wednesday, June 3, 2020.

We wish to extend a final thank you to all of our sponsors for making the event possible:
Gold Sponsors: River City OMS, IB-TX, Direct Med Clinic, Shankx Web Development, Cox Manufacturing.
Silver Sponsors: MyMD Connect, 
Bronze Sponsors: D.O.A. Pest Control, Dr. Kristin S. Held, Atlas Medical Holdings, Right At Home, and Altiqe
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