Group Visit Series Part 5: Functional Medicine on Insurance

Welcome to the Evolution of Medicine podcast! In this episode, we sit down with Cheng Ruan, MD, a practicing physician in Houston, TX and founder of the Texas Center for Lifestyle Medicine. His passion for functional medicine stems from his childhood; he comes from a family of Chinese medical doctors. His background and education allow him to combine beneficial aspects of both Eastern and Western medicine approaches to achieve health and wellness for his patients. Dr. Ruan is also on the cutting edge of building communities with group visits and using data to track patient outcomes.

In this insightful 45-minute episode, Dr. Ruan discusses his journey to practicing functional medicine, his work with group visits and billing insurance, how he educates and connects with patients on social media, and how he uses outcomes data to further his practice and the practice of functional medicine on a global scale. Listening to this episode and the insight Dr. Ruan shares, you will feel a new level of confidence in the knowledge that functional medicine is the future. Highlights include:

• How he learned the business behind healthcare and insurance, and used that knowledge to successfully navigate billing in his practice
• How to build preeminence, in addition to sharing clinical knowledge, with your patients
• How to start sharing and educating on social media, and Dr. Ruan’s “golden rules” for marketing on these platforms
• What social media algorithms mean for functional medicine education, and how to continue sharing valuable, evidence-based information with your patients via these platforms
• The biggest mistake he sees with practitioners just starting out with group visits, and how to avoid it
• How he builds thriving communities with the Group Visit Toolkit
• Why outcomes data is vitally important to practitioners in the functional medicine space
• And so much more!

Resources mentioned in this podcast:
www.lifestylematrix.com/group-visit-toolkits
www.lifestylematrix.com
www.grandrounds.ifm.org
www.texascenterforlifestylemedicine.org

James Maskell: Hello, and welcome to the podcast. We have an absolute treat for you here on the Evolution of Medicine podcast. We’re going to be with Dr. Cheng Ruan. He is a physician in Houston. He’s built a very successful practice with seven practitioners. He’s also been on the cutting edge of group visits. He’s tracking his outcomes. He’s doing Grand Rounds in the biggest hospital system in the world in Houston. This is truly an awesome 45 minutes and should give you a lot of confidence that functional medicine is the future. Enjoy.

James Maskell: So, a warm welcome to the podcast, Dr. Cheng Ruan. Welcome, doc.

Cheng Ruan: Thank you so much. I appreciate it.

James Maskell: Great to have you here for the first time on the Evolution of Medicine podcast. I’m really excited to connect with you because I would sort of call you a little bit of a dark horse in the industry. I didn’t really know that much about you. I knew that you were in the Practice Accelerator. Didn’t know that much about your clinic, but just over the last few months, started to hear a lot more about your work with group visits, with billing insurance, with Grand Rounds. You’ve got a lot going on down there in Texas. So maybe we could just start with a little bit of a journey of how you ended up practicing functional medicine, and I guess get to the point where you are today, with the sort of scope of what you’re doing.

Cheng Ruan: Sure. No problem. So, the journey really started a few years ago. I finished residency in 2012, started practicing some hospital-space medicine in New York, and then transitioned to here in Houston. This is my hometown.

So, my mother does acupuncture and herbs. She’s a Chinese medical doctor. And my father is one of the deans of pharmacology at University of Houston. So I’ve always had an integrative mindset, from the get-go. And so, as I started practicing medicine and seeing a bunch of patients a day, I realized that there’s so much more that I have to offer. And so, what initially happened in 2013 to 2014 is that I tried to include social media as an educational tool for my patients, because, you know, I was booked for 10-minute and 15-minute blocks for my patients on the outpatient. And I was still doing in-patients and ICU and all the stuff like that.

So, obviously, you know, the burnout in that type of practice is very, very large. But I’ve always been passionate about using food as medicine, because that’s what I grew up with. And so, why not do it on social media, right? It’s free. People can have access to it. And what ended up happening was something that I did not expect.

So, I started talking about fitness and working out and ways to do bench presses and stuff like that. Went on into revealing other people’s blogs, like Dr. Hyman’s, Dr. Perlmutter’s blog, and everything like that, you know, Dr. O’Bryan. And then I started talking about research data behind everything, and then it just kind of blossomed into this environment and this network where the patients who are coming into my practice have already seen hours of my video on social media. So, when they sat down with me, it wasn’t hard to convince them to change some of the lifestyle, because they already know what I’m going to tell them anyways.

And so, from that, it makes it a lot easier. So, I went from a relatively kind of a burnt-out physician into practicing medicine that’s really worthwhile because I incorporated social media into it. And so, I’m like, “Wow, everyone should do this.” I think everyone should enjoy practicing primary care. Everyone should enjoy food-based medicines. And then, so I started to tackle one population, the diabetic population. The very, very large diabetic population.

And so, in the diabetic population, I was a very compliant physician using the ADA diets, using a lot of standard approaches to diabetes. But I wasn’t getting the results I wanted. My target A1C for my patients was 5.5, which is bonkers for a lot of conventional docs, because their target’s usually 7.0 for age 65 and above, and 6.5 for everyone below that. And so my ideal was like, “Well, we really want to target 5.5 because, as evidence shows, that 5.5 is very indicative of someone who may be at risk for dementia, with an A1C of 5.5 and above.” And I thought, “Well, everyone is at risk for dementia, and so I want everyone’s target to be that way.”

So, with the ADA diet, I couldn’t get anywhere, and I was doing in-patient medicine. And for those docs who have done in-patient medicine, we have to choose a diet for our patients when they go into the hospital. And these diets are from the American Heart Association diet, the American Diabetic Association diet, and not much else beyond that. Except there’s an option for a gluten-free diet. So what ended up happening is that I saw in the hospital that though patients who saw my blogs, was compliant with their diet as an out-patient, they didn’t do so well when they entered the hospital, and their blood sugars were crazy and all over the place, and it’s because they were eating significantly more carbohydrates in the hospital, in the form of pancakes, even they were on the American Diabetic Association diet.

And I was like, “Well…” I wasn’t really fond of that. So I started tweaking my diet regimens of the diet orders I had in the hospital, and the hospital wasn’t very happy with that either because it increases their expenses in terms of food. And so I realized, quickly, that I had to convince the hospital for me to make some diet recommendations because we were seeing pretty good results. So I actually did a mini study, my patients, about 22 patients, and showed that for those people who I put a gluten-free diet in the hospital, a lot of them didn’t need what’s called insulin coverage in the hospital. Basically, when you get admitted to the hospital, you’re supposed to be on insulin if you’re diabetic because their sugars never really rose. And so they were actually saving thousands of dollars on medication administration while spending a little more on food, which is the concept I wanted to bring into the out-patient world.

So I’m like, “Well, how the heck can I do that?” So I started to recruit one of my friends, Mimi Chan. She’s a dietician, and then we went hardcore into creating a new type of diet called the Layers of Living Success. And we launched it in the practice, and then we started getting community together and gave this pamphlet to about 6,000 people, and actually gave some data on it. So, from 2014 to 2015, we were able to reduce almost everyone’s medications. So 591 patients actually met their goal A1C of 5.5 without any medicines. And if they were to have adjustments to medicine, it would be taking them off of medicine. And 117 people got off of insulin, who were insulin-dependent type 2 diabetics. And the average number of days to get off the insulin was 7.5 days. So seven-and-a-half days to get off the insulin using this sort of a modified keto type of diet, right?

So, that became a real powerful thing, and it’s like a “holy crap” moment for me, where we’re like, “Well, we need to get this out to the masses.” So I decided to write a few things up, put some recipes in there, shot some pictures myself, and self-published on Amazon, and that’s how the book came out in 2014, which is called The Ultimate Guide for Type 2 Diabetes Reversal.

And so, and this is all before I even knew what functional medicine was. And so about a year later, one of my friends from med school, he’s like, “Yeah, I do this cool thing called functional medicine in Austin.” And I looked it up. So, from me trying to Google what functional medicine is, I dove into Mark Hyman and Dr. Bland and everything like that. And I stayed up the entire night watching videos of this entire community that I didn’t know existed, that were so science- and evidence-based. I just got very mesmerized by the entire community.

James Maskell: Yeah, that’s so great. It can be amazing, the first time you come into something that’s aligned with what you’re seeing every day in clinical practice, and see it being communicated through an education organization can be a game-changer, because you know that you’re not alone.

Cheng Ruan: Yeah. Absolutely. And of course, the minute I found out about that, I signed up for my first Institute of Functional Medicine conference, which is the cardiometabolic conference in Austin, and met up with my friend who introduced me to it. And everything’s started steamrolling since then. And so what ended up happening is I wanted to create a way where functional medicine will be considered conventional medicine at some point in the future, as soon as possible. Because, once you learn about it, I mean the passion just kind of drives there.

So, multiple things had to happen for that to happen. I had to understand the structure of the healthcare business, insurance business. I had to understand the politics and the bureaucracy behind it. I had to be a billing expert, and I had to really come up with new things that no one else is doing in the insured world. And so all the functional med docs I made friends with at the conference, they all were at cash practices, which is great, because I’m a very, very huge supporter of that. But my philosophy behind this, while there’s plenty of practitioners doing this, but how can we do this in the insurance model?

And my mindset growing up, it’s always whether we can do it or not, it’s how we can do it. So I started to really dig in very deeply and learn a lot about medical billing. I learned a lot about how these codes that they come up with to allow a completely new design and structure of what the new practice would be.

So the practice is Texas Center for Lifestyle Medicine. That was open July 3rd of 2017. And so I haven’t been around for very long. So July 3rd, that practice opened, and we learned so much in the last year and 10 months I guess we’ve been open. So even before the practice opened, one of the booths at IFM gave me this really cool idea to do group visits. And there’s group visit toolkit, and there were just so many tools that other practitioners have already started with in the insurance model, so I’m like, “You know, let’s give this a try.” So when we started the group visits back in July, our first group visit…Because I didn’t put a cap on it, we actually had 48 patients show up to our first group visit. Which is a lot.

James Maskell: Yeah, that’s way more people than a group visit, for sure.

Cheng Ruan: Yeah. So that turned out to be a lot, and I never want to do that many again. Just because the logistics behind getting vitals done and doing a quick exam, it’s very labor-intensive, even though we actually have six practitioners on board. So all six practitioners were there. It started on a Saturday, with the group visit. It turned out to be a real big success, and I talked about all sorts of different things. I talked about gluten. I talked about pesticides. I talked about the wheat industry and all the stuff like that. It turned out to be a really good event. It was just very tiresome and very laborious.

So, there’s been many permutations of what that was supposed to look like over the next year. But it was very helpful to have that sort of experience and understand that people are very driven by something like this. And there’s so much conversation that can happen in a group that it becomes a real wonderful conversation. And I think the compliance rate is much better in a group session. Anyways.

So, we started with some group visits. Mostly as one-on-one visits. And then, you know, another hurdle was I’m in the state of Texas, so we have to make sure that we’re compliant with the Texas medical board when it comes to group visits, when it comes to advertising, and all the stuff like that. So that’s a whole other hurdle that we have to jump across.

So fast forward six weeks, and Hurricane Harvey happens. And Hurricane Harvey pretty much almost crippled my practice. More than half the city was under water. My own house was completely flooded as well. And so, financially, it was very devastating, especially getting out the bat with six practitioners all at once. And then, you know, my practice didn’t flood, but the surrounding neighborhoods did. And so that was a very big learning experience. Probably one of the darkest times of my life, just because I didn’t know if the practice was going to go on or not. But from that came something that’s absolutely fantastic.

I tapped into my social media and put up there what has happened to our city. And the entire integrated health community was so supportive. And there were donations that were given to our patients. There were food drives. Bottle Choice Seafood actually gave us like a ton, literally, a ton, 1,000 pounds of salmon to be donated, because we were wanting to offer a gluten-free donation drive. You know, we’d like to give people a lot more than just bagels and donuts for the donations for Hurricane Harvey, especially with those in the celiac population, the gluten sensitivity population.

And so, so that became a huge media success and we were able to recover the following month, after some adjustments in the clinic. And so, from then on, a lot of it was really guess and trial and playing with the insurance and looking at coding and seeing what we can do. And the passion behind this entire project really rests on the fact that, hey, we’re here. We’re medical providers as well. We want everyone to have good access to integrative health and functional medicine. And that’s really where everything kind of just went on and on.

And now, I think our…there’s about a three to four-month wait, even with seven practitioners now in our practice. So it’s becoming a pretty big success, and we’re going to continue to hurry on still.

James Maskell: That’s awesome. Well, congratulations, first. I guess I wanted everyone to hear just sort of like the journey so far, because I think it’s super exciting and I know there’s a lot of exciting things happening in the future, especially with regards to tracking the outcomes of what you’re doing honestly, and that.

But let’s just unpack some of those pieces piece by piece because you say that you did a little bit on social media, but it seems like you actually have over 600,000 followers on Facebook. So obviously, in the Practice Accelerator, we teach practitioners to build preeminence, and that’s something you sort of referred to there for a moment, with like, they already knew what you stood for. They already knew what you were going to recommend. What’s some sort of specific recommendations that you would have to other practitioners who either are doing it but aren’t seeing those kind of results, or haven’t started yet because maybe they feel like this isn’t really within their medical scope?

Cheng Ruan: Okay, yeah. This is a really good question, James, and I’m glad we’re talking about this in your forum. Because every practitioner starts out on social media completely incorrect. And so, I’ll give some examples. And so, this is what I see a lot of practitioners do. They go on social media and they talk about a subject, and that’s it. And they’re like, “Well, why aren’t patients rolling through?” This and that. Right? And so, it’s all about continuity. The more content you have, the more organic reach you’re going to get. And that’s just a basic rule. That’s number one.

Number two is the one golden rule that I educate all the practitioners to do. Don’t say anything on social media that you don’t want your great-great-grandchildren to hear. Because they will hear it, because right now, our great-great-grandparents are on paper, but we are in a digital world. And our generations down the line are going to hear what we had to say. So definitely don’t do anything that’s negative. Always be on the positive side. And just educate, educate, educate.

Number three, Facebook will shut down your account with wild claims. And I’ve seen this in multiple practitioners as well. And so, the idea is to teach, it’s to educate, it’s to not necessarily claim anything that’s really out there. But if you do, also have some data to back it up. So one of the things that we notice with Facebook algorithm when we started this marketing process was that the more data and resources you have either in your videos or your blog, whatever, the more organic reach it gets. And a few years ago, Facebook started kind of scrubbing a lot of the medical community to make sure there’s no wild claims using Facebook Ads or anything like that. But as long as you’re providing that value, as long as you’re quoting data, as long as you’re educating, then you should be ok.

So, after 100,000 followers, by the way, Facebook is on you like white on rice. And so, after that first 100,000 followers, everything that you say will be scrubbed and then what we do in trending social media is that we actually look at what are the most popular videos, and what the reach is, and we noticed that the ones that we just purely educate people, don’t sell anybody anything, no coupons or anything like that, the ones that we purely educate people, have so much organic reach. And so, we took those videos, looked at the structures of the videos, and then we continued to make videos that were similar to those videos. And what ended up happening is top lists, like top three, top five, top 10, and stuff like that, which accelerated the growth of the page tremendously.

And so, but also, people are watching it…we call it a three-second watch time. So a lot of people aren’t watching it for more than three seconds. If you get someone to watch more than 10 seconds on your Facebook video, you’re definitely doing something right. And so, those numbers we looked at very, very closely so that we know what type of content to populate.

So, as it turns out, this is a really good strategy, because honestly, I think it made me a really better practitioner. Because I was out there, I was looking at data, I was quoting other people’s data. I was looking at scientific publications, and these had tremendous, tremendous organic reach. Like, tremendous organic reach.

James Maskell: It’s interesting, because I think, maybe a lot of practitioners feel like the time that they’re spending to educate, or to read about, you know, educate themselves, is kind of lost time financially. But if you can read a paper, take the information, turn it around into a social media video, it could end up being a net positive to the bottom line.

Cheng Ruan: Right. And so, one of my favorite strategies, and that’s bullet point number four, is to see what’s trending on Twitter. See what people are talking about, anything on the health side. Like, for example, that whole paper about coconut oil being hazardous to your health, that was a huge trending thing that everyone had a response to. And you can jump on that as well. You know, what are your points on that? And then getting some data from that. So that was one of our more popular videos.

And then videos I did five, six years ago. There’s one that is Advil versus Tylenol. I think that has like 1.3 million views on it, or something like that. You know? And so you never know what’s going to be viral. You never know what’s going to be out there. And you can’t will it to go a certain way. There’s no control over this. It’s whatever is trending at that time.

And so, my thing to rapidly grow is that we’re practitioners. We’re always educating ourselves. And everything that you learn yourself, you want to be able to share with a community, okay? And so, would learn something and I would regurgitate it onto social media. I will learn something else, I will regurgitate it onto social media. I will be inspired by something, and I will regurgitate it on social media.

Now, of course, don’t violate any HIPAA or anything like that. That would be really bad. But if there are some cases that inspire you, then go out and do some research on what inspires you about that case. And just have a 30-second to 60-second talk about what this is. And honestly, the one- to two-minute videos are the ones that do the best, as well.

James Maskell: That’s great. Yeah, and so it’s some great resources on there. So now you’ve built preeminence. People know who you are. People are starting to come into the practice. Let’s talk a little bit about the groups, because you mentioned the Lifestyle Matrix Resource Center, and their Group Visit Toolkits. What kind of, what did you learn from the toolkits and what advice do you have for practitioners who maybe either have tried a group visit and maybe it hasn’t gone that well…maybe it’s been on the other end of the spectrum, that not many people have shown up rather than a lot of people. What has been, or maybe they just have been afraid to try it, or, again, just didn’t want to do something?

Cheng Ruan: Okay. Yeah, that’s a really good question. So, man, I have so much to say about this. Okay, so, I think the first thing to think about the group visits…I think most people think about it, “Okay, well I can spend an hour of my time and educate the masses.” Right? But that’s just the tip of the iceberg. What’s great about the group visits is that, in that time that you’re educating, you’re also receiving some feedback from your patients, and your patients can also receive feedback from other patients. It becomes a very cohesive community. Right?

And so, the great thing about the toolkits is that, within the toolkit, you know, they give you tools for documentation. And so I really divide it into two different groups. There’s the toolkits for the people who submit to insurance and the people who do not. The people who do not submit to insurance, then they’re cash pay, I mean, that’s easier. You charge cash for the group visits and you do education. The ones that go on the insurance side is a little more complicated. The coding and the structures in there are always changing. And, in fact, there’s so many things that are different in 2019 in terms of coding for visits and group visits that didn’t occur in 2018.

And so, so for the insurance population, what’s great about the toolkits is that they give you tools. You know, there’s videos they can show patients. The best thing about are those handouts. Those handouts are amazing. Those visuals provides you with a lot of different tools and it helps the patients engage. So, for those people who have done group visits and they haven’t done, quote, unquote, well, I always tell people this, is that, “Okay, well is it that people don’t get enough value out of the group visits or people get tremendous value out of the group visits but you don’t have too many scheduled in the group?”

And so, if people aren’t getting enough value in the group visits, I think the toolkit can be very beneficial. Once you start adding some visuals into it, right? Once you start having people participate in their own health with these visuals, with the tear-offs, I mean, it’s awesome. And then, for those people who have tremendous value in their group visits, and who may not have had a lot of people booking into them, how are you getting the group visits out? What value are the group visits that you’re marketing to your patients?

And so, I always say that as long as you’re trying to provide value in the group visits, you’ll do just fine. I think a big mistake that I did in the beginning, and even a lot of practitioners do, is try to stuff too many things into one group visit. And what we find is that that’s a terrible idea. And people will just get really overwhelmed. I do think that it’s really good to have a subset of your patients do one focused target on the group visits. You know? For example, meditation. That’s simply it. Meditation group visits. And the people who are responding well to that are the people who are going to be enjoying meditation, are already on-board with this stuff. Right?

And then, so for…what we first did is that we started having group visits on like, gut health. And I think gut health is good, except it’s just so broad. But then when we divided out into Crohn’s and colitis versus irritable bowel syndrome diarrhea versus irritable bowel syndrome constipation, we’re able to do so much more in the short time, and people were giving us tremendous ideas from it. And they were sharing, you know, what worked, what supplements worked, have you tried this? And it ended up being a great strategy where you have a lot of like-minded people in here.

Now, granted, this does require a high volume to do something like this on consistent group visit schedules, which we generally do, just because the fact that we do functional medicine, we take insurance, and we take Medicare as well. So, when you first start, you can make it broad, but you can narrow it up afterwards, after a little while, to say, “Hey, I have enough population doing this now, ok?”

And then, the last portion of that is I like to use the stuff in the toolkit for marketing purposes. So there was a post that I did on gut health, and there were different aspects about gut health, and then there’s one on detox, stage one through three detox, liver detoxification mechanisms, and what do they really mean. So that went pretty well on social media, and I start making a video, just discussing that flyer in detail that was provided to me in the Group Visit Toolkit.

And so, that turned into nine or 10 different videos on liver detox series that I did. And so, a lot of the stuff that’s in the kit, I think people just look and just try to give patients, but I do think that social media plays a really important part when you’re trying to educate. And it makes people really excited, because all of the sudden your patient starts commenting on these things. “Yeah, I was there for this talk. It was super exciting.” And then all of the sudden 20 people want to sign up for it.

And so, the more you share, the better it becomes. And plus, you know, I think also the more you share, the more people think that you are the expert in the industry, which is a good thing when it comes to integrative health.

James Maskell: Yeah, absolutely. Yeah, so much you shared there that is so important. And what about the sort of cohesiveness of the group? Is there anything that you found to get the people sort of to engage with each other, and to learn from each other? Because that seems to be, you know, it comes up again and again as one of the core benefits of doing the group.

Cheng Ruan: The cohesiveness of the group is something really, really special, actually. And there’s no group that’s more cohesive than our oncology population, the cancer population, right? And I think that’s a really good place to give an example. So, we have IV infusion center. We do insurance as well as some of the integrative IV strategies, high-dose vitamin C, as adjunct with regimen from MD Anderson and other oncology places.

So, those people in a group, in a room, are so supportive of each other, and they actually drive the value of the practice to the Nth degree, to a really, really high value. And so that is probably the most cohesive of the groups. And then, you have some other groups that are quite cohesive. We see a lot of people with POTS syndrome, postural orthostatic tachycardia syndrome. Very, very cohesive group. We see a lot of people with autoimmune disease. Hashimoto’s is a very cohesive group.

And so, what happens is that these groups, since they’re all your patients, they know what you do. They know that value that in which you do it. And that actually accelerates your expertise, accelerates your social media reach, accelerates…it accelerates your ability to communicate with some of these people. And it also, the most important part about every group and the cohesiveness of it, is that, in any situation, they will always come up with useful questions to help you improve your practice. Because we ask for feedback all the time. Because we need to know what people are doing, what people are seeing on the outside, what people are reading. We want to know what people are Googling these days. And because we don’t have time to do it all, we really reach out to the patients and do so.

And what ends up happening is that it allows us to be more comprehensive in our approach. We know exactly what people are reading out there, because half of practicing integrated health is managing expectations. And when people’s expectations are in the control of Google search, you kind of need to know what’s in Google search as well. So I really enjoy the groups giving us feedback about that as well.

The other cool thing about the groups is that you can group them into email lists. So those people with Hashimoto’s, those people with POTS syndrome, those people with rheumatoid arthritis. And then anything that I look at on data out there, I can just use my CRM and just say, “Hey, this is my group.” And, “Hey, did you guys see this data out there? I’m really excited about it.” And that starts a whole other conversation as well.

James Maskell: Yeah, I’m so glad you shared that, because one of the key things that we try to get all practitioners…the key thing that happens in the practice accelerator is to get people onto some sort of system to be able to target and automate some of their education and details. And so, putting people into different groups so that you can communicate to them as a group, it makes so much sense, because not everything is going to be relevant to everyone, but you can actually sort of, you know, get the right information to the right patients and keep them engaged between visits, which seems to make a big difference. What kind of time of day do you do your groups to get the most people in? Did you find that there was a certain time of the week, time of the day that was better for people?

Cheng Ruan: Oh, well, in the beginning, doing the weekends thing was kind of tough, and overhead-wise, I had to have a lot of staff there. So we kind of stopped doing that. Over a period of time, we actually had to restructure our group visits down to different days, just for availability purposes.

So, for me, I have a different situation, is where, how do we fit all these people into our day? Rather than, where do most people want to have the group visits? Because I think the demand is just so big. So I can’t really say for sure, how Tuesdays and Thursdays are better than Mondays and Fridays, or anything like that. Just because we’re trying to fit people into different schedules. So, a lot of our scheduling is based on our availability, our practitioners’ availability. And sometimes we have guest speakers’ availability as well.

But obviously, when you first start out, weekends are a huge hit. Especially Saturday mornings, after people work out. They like to attend stuff like this. I think that’s a really good place to start out. And then, for some reason, everyone requests Thursdays. I don’t know why. But a lot of people request Thursdays as well.

James Maskell: That’s great. I appreciate you sharing that.

Cheng Ruan: Yeah, and I think another thing about the group visits is that it also determines when I post onto social media. So, if I’m doing a video about Hashimoto’s, right, on a Monday…so the following group visits on thyroid, I mean, they’ll fill up quick. Doesn’t matter what day it is. And so, I always like to say that we have some control over who walks into our door to be seen. And that’s based on what’s out there. So I’ll…so one week, there’s a two-week period where I did a video series on Hashimoto’s, and 80% of the patients who scheduled to see us the next week were Hashimoto’s patients. And there’s one week that I did a video on rheumatoid arthritis, and then 80% of the next week we are filled up with rheumatoid arthritis patients.

And I think, once you kind of put it out there into the universe, you will receive it. So, and especially with a large social media following.

James Maskell: Yeah, absolutely. Well, there’s so many pieces in there that are key.

James Maskell: Hey, doc, so one of the things I saw that looked really interesting was the Grand Rounds that you’re doing at the clinic. Can you tell us about how that came about and what it’s going to mean?

Cheng Ruan: Yes. The Functional Medicine Grand Rounds is really to educate not just integrative practitioners, but doctors of conventional medicine, and really integrating the idea of that practicing medicine is evidence-based, and whatever we’re doing in the functional medicine world is truly evidence-based as well.

And so, the first two Grand Rounds I had in my facility. We had a knock-out turnout. And then this third one that’s coming up, that’s going to be April 27, 2019 at the Texas Medical Center and the Intercontinental Hotel. That one is really trying to get a lot of the people in the medical center together and say, “Hey, what exactly is functional medicine?” Number one. Number two, putting some evidence-based data behind what we’re talking about. So this next one is on the gut-brain connection, so we’re going to have gastroenterologists, GI surgeons…in fact, one of my speakers is an integrative bariatric surgeon which, I didn’t know they existed, but he’s the only one I know.

And then, Dr. Thomas O’Bryan, actually, is speaking at that one as well, just right before he speaks at Paleo FX here in Austin. And so, we’re getting a lot of traction through what we’re doing, and population a lot of evidence-based data into a lot of the stuff that we’re already doing. And so, my idea for this really came about because, as I was attending functional medicine conferences, and I’m hearing all this data, and I would look around me and I think people in education, clinical faculty, should really be listening to what I’m hearing as well. You know?

And so, I wanted to have that into the medical center, where it’s really accessible to doctors, medical students, nurse practitioners, physician’s assistants, surgeons, whoever it is. So to truly tie in the integrative and functional medicine community to the largest medical center in the world.

James Maskell: Wow. Yeah, I’m sure that’s going to make an incredible impact.

James Maskell: You know, doc, I don’t think this is going to be the last time we’re going to hear from you. I know you’re going to be sharing some of your outcomes data at the thought leaders conference with Dr. Bland in October. So I will be there, and we’ll be shooting video, so we’ll look forward to connecting there. But the last thing I want to just touch on about, you know, one of the things that we have encouraged everyone to do is to track their patient outcomes. And ultimately, it doesn’t necessarily make sense, mathematically or financially, for a small practice always to go and track their outcomes, because kind of, what’s the point? So you see maybe Parsley Health is doing it and Cleveland Clinic is doing it, and I know it’s a big thing that you’ve taken on in your practice. Why was this such a big deal for you, and what advice would you give to other practitioners in the functional medicine space at this exact moment in history, where the evidence base is not really in our favor?

Cheng Ruan: Yeah, that’s a really good question. And as small functional medicine practices go, I think it’s even more crucial for them to get data, compared to the larger facilities like Cleveland Clinic. And there’s multiple reasons for this. Number one, we want to know that we’re doing a good job. Right? And number two, until you get data, you’re just assuming you’re doing a good job. Right? And then you can say, “Well, we can look for patient feedback.” Well, patient feedback is not necessarily data. It’s just managing expectations. They expect to get better, and they get better, and that’s good, and we can pat ourselves on the back, right?

But what’s really going on? And this is going back to when I wrote my diabetes book. How many people can we reverse in diabetes? I didn’t expect to reverse 570 people, but we did. And so, what I look at in my data is I look at a lot of different labs and scoring systems that’s already out there into the conventional medicine. So I’ll give you an example. Homocysteine, for example. So, homocysteine is an independent marker for heart disease. We know that’s an independent marker for dementia. We know that as well in conventional medicine. We also know that as well.

And so, we can apply this data and say, “Hey, how good are we in getting this homocysteine down as an independent marker?” Same thing with HACRP, same thing with hemoglobin A1C, homo scores and everything like that, right? These are already-established biomarkers that we can look at. So that’s number one. And to do that, your EMR has to be able to extrapolate data and look at this data. And it actually doesn’t take very long for you to see the trends over time.

And then there’s diagnosis-related data. So how good are we in treating rheumatoid arthritis? How many people leave the practice? How many people are continuing to stay with the practice? What medical symptom questionnaire scores are they getting? So these scores, once you put it in front of you, even if you do like 10 patients, once you put it in front of you, these scores, you start to realize, people in conventional medicines, there’s no way they will get these scores. There’s no way.

And then you look at these scores based on what’s already published. Let’s say, “Hey, I’m on REMICADE and I have 47 improvement in my polyarthritis score.” Right? Well, you say, “Well, my patients are not on REMICADE. They have rheumatoid arthritis, and based on what we do, we have a 67 improvement in our scores.” Right? And that’s something that you can put out there. You don’t have to publish it. You can if you want to. That’s something you can say, “Hey, this is the data that we see in our practice. I’m really proud of it.” And there’s no reason not to share that.

So, in small functional medicine practices, I think it’s imperative to even just look at data of like, five to ten patients, and then come up with some sort of value that you’re driving to your practice. I think one, it’s really important for marketing. Two, I think it’s very important for reputation management, which is something I could talk about for hours. And number three, I think it’s also important to know that you’re doing the right thing as a practitioner. Or, if you’re doing the wrong thing, then switch up what you’re trying to do.

And a lot of times, in functional integrated health, I think we get inundated by supplement reps, and companies come out with all sorts of cool stuff, and we’re always changing different things that we do based on, I guess, whatever is marketed the right way, or some obscure data. But what we like to do is change the things that we do based on our actual clinical data, rather than just some obscure thing that’s really out there. And if we can get all this data and compile it together, and especially what Parsley’s trying to do, which is awesome, then we’re looking at joining forces to truly make functional integrative health a very viable thing to be part of conventional medicine.

James Maskell: Amen. Well, look, hey, I just wanted to say thank you for everything that you’ve been doing. I know that doing the work in the trenches is where all the action’s really happening, and I know that the city of Houston and the greater area are very lucky to have you there, and I know that you’re just getting started and you’ve got big dreams and big visions of where you want to take this to, so thank you for all the amazing work. I think there was so much great information here in the podcast, and as I said, I look forward to shooting more content and trying to get this word out to more practitioners, because I think just stories of doctors who have made the transition to functional medicine, who love their job and are making a big impact in how their patients can’t travel far enough at this point.

So, thanks for being part of the Evolution of Medicine podcast and look forward to more in the future.

Cheng Ruan: Yeah, thanks very much. I appreciate it.

James Maskell: So this has been the Evolution of Medicine podcast. We’ve been with Dr. Cheng Ruan. You can check out his website. I’m your host, James Maskell, and this has been the Group Visit Series. Thank you so much for listening, and we’ll see you next time.