The Future of Payments in the Practice with Ben Brideaux

Announcer (00:06):
You are listening to the Aesthetically Speaking podcast presented by Nextech.

Robin Ntoh (00:10):
Welcome back to the Aesthetically Speaking podcast presented by Nextech. I'm Robin Ntoh, and today we have Ben Brideaux with us, our SVP of Financial Services. Ben, welcome.

Ben Brideaux (00:20):
Pleasure to be here.

Robin Ntoh (00:22):
You've been in financial technology for a few years, I think. Tell us a little bit about your background, how you're at Nextech now, which is healthcare technology. Tell us a little bit about your journey.

Ben Brideaux (00:34):
Yeah, certainly. I think I've had a bit of an interesting one in that I actually started life as a lawyer, of all things, but I was presented with an opportunity in Australia actually with a colleague to jump into the world of FinTech about 15 years ago. And I haven't really, really looked back. I think I've certainly found my passion over the last five to six years. I've even found a deeper niche in practice management FinTech specifically, which is an area that is just full of tremendous innovation at the moment. So previously was working with a company called Clio, which is effectively Nextech, but for lawyers. And it's amazing to see some of the similarities in opportunities and challenges that those respective professions present to one another. But needless to say, I am incredibly excited to have joined Nextech and to be leading out really this evolution of financial services and the payments business for Nextech.

Robin Ntoh (01:30):
Yeah, okay, let's get into it. So we talk about payments and we talk about the evolution of payments and how we see it embedded in software systems. Now a lot is going on in this space, just broadly speaking, you've seen a lot of change. Give us a little history and journey and a little bit of understanding about what that looks like then and now and where you think the future is.

Ben Brideaux (01:56):
Yeah, that's a great question. So over the last, I would say one to two decades realistically at this point in time, we have seen a tremendous amount of innovation within the financial technology or FinTech space that really has allowed for the advancement of the patient experience, the operational efficiency that practices can get access to that can make a meaningful difference to the bottom line of whatever that business is. And of course that includes healthcare and Nextech. And so if I had to bucket this, I think certainly it's an oversimplification, but over the last decade or two, we've seen financial platforms start to reduce the barriers to entry for technology platforms like Nextech to build really interesting and bespoke solutions for their respective vertical or specialty. So previously the way in which a provider or a healthcare physician would look to accept payments is they would usually go to their legacy financial institution. They'd go to their bank that was providing them with their bank accounts and with their credit cards.

Robin Ntoh (03:07):
Right.

Ben Brideaux (03:07):
But over time we started to see an evolution where these financial technology companies were able to bring more bespoke, more specialized payment solutions to these physicians to solve additional problems that perhaps these larger financial and legacy institutions weren't able to sort of accommodate. And that sort of solution, like FinTech 2.0 is what it's sometime referred to as, drove again, a tremendous amount of innovation and focus in this area. But ultimately I think what we've seen over the last five years is this next evolution, where now all of the industry leading verticalized technology businesses like Nextech like Clio, like Shopify for instance, are really trying to build out their own native financial service solutions, a native payment solutions. And the reason that we want to do this is because that we can go a layer deeper and add a tremendous amount of new value, again, new operational efficiency, improved practice and patient experiences that someone like a traditional financial institution who's just giving you a terminal to stick on top of your countertop, really can't accomplish or deliver. And what this ultimately turns into for the practice and the patients is a better overall experience, which is something that certainly top of mind for us.

Robin Ntoh (04:32):
So Ben, one of the things that I have found not just at this show but historically with practices is that we think about an all-in-one system. We think about all the things that we bring to provide value, not just to the practice, but what they can do to extend that to their patient. But yet, I hear practices say to me, I don't care that my staff have to go through extra clicks, that they have to do additional steps. They lean more into the patient experience, patient experience, patient experience, patient experience. We've heard it all day long. We know that's the focus. We know that people are driving towards that. But I am going to go back to the question, why would it be valuable to think about embedded payments as being a safety for you as a practice? Let alone, okay, so you don't care about the fact that your staff have extra clicks. Okay, fine, but what are the other risks that come with not having something embed directly into your system?

Ben Brideaux (05:32):
So that's a great question, but I'm going to answer that second with respect to what are the risks that we think should be top of mind for a physician. But I want to go back to the notion that you said in relation to having the physician focused on actually delivering the healthcare services like the medical services, and oftentimes it's the back office staff who are having to deal with some of the business complexity and operational complexity that can occur when you're having to live across multiple different systems. And I think that that's certainly something that is top of mind for us and we're really seeing the industry move towards a direction where everyone is looking for platform consolidation and efficiency. And this might not always be top of mind for a physician because again, let's be honest, these individuals are incredibly busy and to your earlier comment, their superpower is being able to spend time with patients and being able to spend time in the operating room to deliver the healthcare services that they need.

(06:39):
Whereas the practice manager is oftentimes the one who's feeling the brunt of a slightly inefficient service. And where this can start to actually hurt the practice as a whole is the fact that one, you might be impacting your patient experience where they're having to spend more time at either check in or checkout in order to interact with your practice, and that has a risk of actually impacting your brand. Secondly, you've got an operational efficiency element within your practice that again, as a physician you may not see because it might only be a minute more to reconcile a transaction. It might only be three additional hours or five additional hours at the end of a month in order to reconcile your books and look to close your accounts with your accounting practice. But over time, and as your practice scales, these things can really, really add up.

(07:34):
Ultimately, if you are not adopting these new process improvements, these new technologies and taking advantage of the investments that companies like Nextech are making in the likes of Nextech payments to make these seamless financial journeys, you're ultimately starting to fall behind your competition. This is the direction that the industry is moving across pretty much every single verticalized specialty or verticalized technology platform that I see. And ultimately it's just we can deliver such a richer experience across both the patient and the practice journey that I really don't see many reasons why practitioners shouldn't be looking to move in this direction.

Robin Ntoh (08:18):
Well, I also think about, there's so many things that you could really apply to what you just said. So let's just talk about differentiation. A practice is striving to always be different. How am I unique? You can't just lean in and say, I'm board certified any longer and be unique. People start to talk about the patient experience and what am I doing to really stand out? Well, part of that patient experience comes back to are you offering them the flexibility to get the financing or pay the way that they need to, but more importantly, are you doing it their convenience?

Ben Brideaux (08:52):
Absolutely.

Robin Ntoh (08:53):
And convenience doesn't just mean their wallet, but it also means when, and so I think about a lot of times practices don't even offer online scheduling because they're afraid that it's going to disrupt their schedule or they are not concerned or they're more concerned about, well, I've got to make sure I have the ability to collect deposits. I go back to this is the whole component of building something embedded in your system because payments touches every piece of it, every part of the journey, that is all part of it. And if we think that it's going to be easier or harder for our staff, yeah, that's important, but it's also the most important part of it is thinking about that patient and ultimately they're going to go someplace else because you didn't give them what they needed. And that convenience is a big part of it.

Ben Brideaux (09:41):
That's exactly it. I talk a lot with my team about the notion of meeting the patients where they are. We've seen tectonic shifts in the expectations that a patient will expect when they're engaging with any different type of service provider. Gone are the days where you could just say, Hey, this is the way in which I as the practitioner demand to be paid, or when there was just frankly only cash and check payment options available to these different providers. With the advent of obviously iPhones, digital wallets, the step function changes in the ability to gain access to patient financing, to help spread out your ability to access, spread out those payments so you can get access to more treatments. If you are not adopting best in class and meeting your patient's experiences, again, you're inviting a world whereby a provider down the road might be looking to solve for that patient's problem and they might think about going in a different direction.

Robin Ntoh (10:48):
Well, yeah, you've got the generational influence too. You've got those patients, or prospects depends upon your collective effort here, that they're used to going up and just using their watch to just pay for something. I mean, I talk to physicians all the time, they're like, yeah, my kids just have access to my credit cards attached to their Apple Pay. I don't have to worry about giving them a credit card. But then I mean, everything is about the technological changes around the payments industry and what's happening there and the effort it provides inconvenience for people.

Ben Brideaux (11:22):
And what I think is really exciting here is that it's actually opening up new patient engagement opportunities. What I mean by that is, again, the traditional, let's say engagement with a physician would be that you would come in, you would have a consultation to discuss your needs, a quote would be presented at some point in time in the future, you would then have the procedure and then you would look to make payment. Now we can actually engineer a financial journey for both the patient and the practice that starts to streamline and make that feel like a richer experience. So you can allow for a patient to pre-pay for a consultation. You can allow for a patient to pay over time with something like the Nextech payments payment plan solution. We've obviously spoken about patient financing, and so what we see as best in class, and we've got some amazing physicians on our platform who have really set up this incredible white glove structure, is a patient is able to now come in, fill out their paperwork and immediately just put their credit card, for instance, on file. Then at the end of a consultation, a treatment, a conversation, they don't even need to pull out their wallet or their purse. They can just say, thank you so much, doctor, walk out the door and everything is conducted behind the scenes. That's a really great experience that I think creates not only brand rapport, but that repeat customer.

Robin Ntoh (12:48):
Well, it also opens up the opportunity for people to be more willing to spend because it just seems less painful. They're still paying for it at the end of the day. I think about that Amazon model where your credit card is stored, you basically go in and pick what you want, put it in your basket, you click a button, and of course, if I am prime, I'm going to get it the next day hopefully, or even later that day. They've just reduced all the barrier to make it easy and as easy as possible. We need to take a page from their playbook and think about it because a lot of times in healthcare, we tend to be falling behind. We just don't stay up with the things that are expected. And in plastic surgery we know that we're supposed to be the leaders in patient experience and how we deliver on that comes across in many ways.

(13:35):
And I think that this is an important conversation. It's an important component of a practice. I want to shift for a minute. I want to talk about, we've talked about the patient experience, and I think that that's key. I want to go back and think about risk in a practice. I cannot even remember or count the number of times I've been involved in practices that have had embezzlement or theft. I mean the stories and the creativity, that's what amazes me. I'm like, people come up with the most creative ways to steal from practices, and we're not just talking about just stealing product out of a practice. We're talking about things like having patients write checks to the provider. Well, patients don't necessarily know the structure of a practice. They don't know that that provider is really an employee and is getting paid by the practice.

(14:20):
They might think that that is a contractor and that they should be doing that. Tell you right now, it's happened and we're talking about a quarter of a million dollars, half a million dollars in loss that is gone. These practices cannot get that back. And every single time I've been party to that and seen that happen, I go back to systems and processes that were broken because they had too many ways to have workarounds. There was breaks in the process, and some of those breaks were because they just didn't build into it as much integration as they could.

Ben Brideaux (14:58):
Yeah, so I think that's a great point, Robin, and ultimately goes back to the conversation we were having earlier about the benefits of platform consolidation and why having a system of record as that base for your entire business is so incredibly valuable and important because if you have multiple disparate systems that aren't designed from the ground up to talk to one another, you're inviting this sort of risk to enter into your business. And there again, there are innocent examples of this where sometimes you could just accidentally forget to reconcile a transaction, for instance. That's fine, of course it's going to happen. Everyone is human. But that takes additional time for you to need to go in and ultimately correct, correct that error. But I think again, what you started to highlight, which is a reality in a number of different businesses, is that there are bad actors that exist within this space. And so obviously as a prudent business owner, we want to be taking every reasonable step that we can in order to mitigate those risks to design a solution that takes away from that opportunity for someone to do something that not only could damage your practice, your brand, but also potentially really financially harm either a patient or the practice.

Robin Ntoh (16:19):
Well, I also think about the perspective of risk is also in you're trying to put controls in place and for example, you want to do as a physician, you want to be in the OR. That's where your love is. That's what you went to school. You didn't go to school and get all this training to be a business manager. And I get that. But at the end of the day, so you're trying to be prudent and you're trying to put those controls in place. So you do the banking, you go to the bank. Well, okay, that's time. It's energy. And I'm going to give you a little bit of a story about a practice where the physician was, most of it was credit card transactions. Okay, normal, great. But there's still patients that pay by check. It's accepted. We still have checks. I don't remember the last time I wrote a check though, to be honest with you. But needless to say, okay, people still write checks, and you want to take those to the bank in a timely fashion. But in this particular practice, a physician was waiting months and months before he would go to the bank because it wasn't like the primary component of what he needed to pay his bills. He had all that other revenue. Well, he would wait so long that by the time he went to the bank,

Ben Brideaux (17:27):
The patients are not going to be happy.

Robin Ntoh (17:28):
Yes, he had some real, and guess what? Those patients in many cases were so upset that he had to turn around and lose the money because the patients didn't do it. And I think about, again, going back to, there's technology to solve for this. Why are we running from it? Why are we making this difficult?

Ben Brideaux (17:49):
Absolutely. And again, I think if we're honest with ourselves, this probably happens a lot more than the physicians and the practice managers are wanting.

Robin Ntoh (17:58):
They're listening to us and they're probably nodding their head, yep, that's me, that's me.

Ben Brideaux (18:01):
I've been there, absolutely. And so one of the other concepts that we talk about and we think about a lot on the Nextech payment side is the idea of speed to revenue. Because again, time is money. And every day that you don't have those funds in your bank account, essentially you are for all intents and purposes out of pocket. So checks were an incredible invention back in the day, and they still are used in a number of different day-to-day business practices. But certainly we've seen their use case diminish over time. And again, I think that there is a cultural and a customery element to that in terms of the familiarity of new payment methods, like digital wallets that are going to supplant that. But again, there are also limitations with respect to check usage, for instance, that you highlight ,such as the time it can take for that check to be processed and to be cleared. I also, I'll address something that I have heard in industry and I don't necessarily think is accurate, where people think that checks are safer than online and digital payments. And yeah, I don't think that that's an appropriate viewpoint in so far as checks can also be charged back or returned just like a credit card transaction.

(19:21):
And that can present a lot of risk to the financial health of your business. So again, I'm not saying that my recommendation is not that every practice tears up their ability to serve checks, comes back to this notion of certainly looking to manage and meet your patients where they are in terms of their financial journey and how they want to pay. But certainly we should be thinking about the health of the operational efficiency of a practice and speed to revenue as a consideration of what are the payment methods that you want to prioritize at least, and look to have your staff build processes around.

Robin Ntoh (20:06):
I'm going to shift gears for a minute. I want to talk about PCI compliance. Now, there's a lot of people out there that just don't understand what that is and what it means. And I can tell you right now, a lot of practices still write credit card numbers down, or they type them into the patient notes tab and they're not clearly concerned about the risk. That brings, again, stories that I could tell about people that have gone in and they've used patient social security numbers or they've taken those credit card numbers and use them, and there's been fraudulent activity. So let's talk about PCI compliance. I think we need a basic premise on what it is because a lot of people don't understand it. So let's not assume, and then let's talk about where we want that to be solved. How do we want that to be best managed?

Ben Brideaux (20:56):
So Robin, the analogy I'll use with PCI compliance is that it is effectively HIPAA, but for the payments industry. So the high level version of what we need to do as a PCI compliant organization or what a PCI compliant organization needs to do is ensure that there are safeguards in place to protect the credit card information and bank account information and payment information of people who are essentially accepting payments. And the reason for that, of course, is that we don't want to have a situation whereby our patient's payment information is being exposed, is being stolen, is being used for inappropriate means. Not only is that going to be a horrible experience for a patient, but also it's going to have tremendous negative implications to a practice in the event that the breach, the leak of this financial data occurred at the medical practitioner's offices. So something that transparently, I think, again, still happens far too much in our industry and which again, I'm sure a lot of our listeners here will be thinking, oh gosh, I think I might still be doing this from time to time, is where we're doing things like writing down credit card information on post-IT notes because you're on the phone and you're multitasking.

(22:19):
That is arguably a breach of PCI compliance. And I think actually this can go so far as even to being a breach of HIPAA compliance.

Robin Ntoh (22:29):
Yeah.

Ben Brideaux (22:29):
So again, this actually comes back to the idea of the value of having a healthcare specific payment solution like Nextech payments that is built for the ground up for healthcare payments and the healthcare financial workflow. And we want to remove the opportunity or the need for this risk to be exposed wherever possible.

Robin Ntoh (22:51):
I also think about this from the standpoint, but that we are required as a healthcare company to be compliant across many different spectrums. PCI is one component of it and it's standard in the industry. I think about QuickBooks, if you accept credit cards through QuickBooks, there's PCI compliance. So it's not just a Nextech requirement, it's a standard in the industry. We're certainly compliant with that and we afford it. But I want to talk about a component that we haven't really touched on, which is the administrative piece of everything related to financials within a practice. And the unsung hero a lot of times is the practice manager who does the monthly reconciliation, who has to dig out of that mess of paperwork, so to speak, really, did I balance? Did I get the money all in the bank? What I put into my practice management system, did it actually go to the bank?

(23:45):
What I put in the credit card processing, did it actually go to the practice management software? And did all of these things match up? And so when I look at my statement, how much time am I spending at the end of the month reconciling, but there's a lot of people out there that don't even reconcile anymore, or may not even know how to do it. I'll be very frank and honest about that one. I've seen that one. But the practices that I've seen that do do it, I think about, again, physicians are not as worried about their efficiencies. They just want it done. They think, okay, it's done. I don't care. But those practice managers, they're just looking for something to be straightforward and easy and getting that all their ducks in a row, so to speak, so that it just is easy to manage. It's ideal for them.

Ben Brideaux (24:31):
It is. And I don't know of a profession that is juggling more balls or wearing more hats than the practice manager. They are so incredibly time poor. They're getting pulled in 10 different directions at any given time. So again, any way that we can engineer a solution that can give them back time to either help the practice grow, help the patient get a higher level of service, or answer some of the questions that perhaps the physician has, again, is I think is a no-brainer. These are the problems that we want to be solving for. And again, this ultimately comes down to what I refer to as the business of medicine. And we are, again, practice management has come so far in the last decade or two with respect to new cloud-based solutions, expansion into patient engagement, of course, the billing payments and collections automations. But obviously we're just at the start of what is going to be an absolutely transformational period over the coming years as we think about the impacts of AI across the financial workflows as well. So this is something that I, myself and the team are thinking about monitoring a lot, and we're incredibly excited to see the innovation and the direction that this takes.

Robin Ntoh (25:53):
Yeah, it is exciting. I look forward to see where we go next. What is it, FinTech 3.0?

Ben Brideaux (25:59):
I think I've lost count 4.0, 100.0. It's coming.

Robin Ntoh (26:03):
Alright. Ben, we've talked a lot about payments, risk, we've talked about efficiencies, et cetera. If you were to leave one pearl for listeners, what would that be?

Ben Brideaux (26:15):
Ooh, that's a hard question.

Robin Ntoh (26:17):
Too many things.

Ben Brideaux (26:19):
There's a lot. I think something that I always invite or suggest is a really healthy habit for practice owners, and certainly physicians to do on a regular occurrence, is go and look at your financial statements. And, sorry, when I say financial statements, I mean specifically your payment statements. Look at what are you actually paying for and what are you receiving terms of the value? Because again, with the innovation and the changes in this landscape over time, what you might've signed up to pay for X years ago or decades ago in some instances, I think may not necessarily be what you think you're paying for or what you understand you're paying for today. And so again, oftentimes we'll see a lot of different complicated lines on your statement that you don't necessarily understand. So unpack those and try to get closer to understand what value is your provider providing you today and compare that against what now exists within the market. Are you getting the richest set of features that is truly helping your practice run as efficiently as it can whilst also delivering a truly great patient experience.

Robin Ntoh (27:34):
Yeah, I think that's a great, great takeaway because a lot of times we just lean into, well, this is my cost, but what is the value it's bringing back to me and to my patients? Thank you very much.

Ben Brideaux (27:46):
Absolutely. Thank you so much, Robin. I really appreciate the time.

Announcer (27:50):
Thanks for listening to Aesthetically Speaking, the podcast where beauty meets business, presented by Nextech. Follow and subscribe on Apple, Spotify, YouTube, or wherever you like to listen to podcasts. Links to the resources mentioned on this podcast or available in your show notes. For more information about Nextech visit nextech.com or to learn more about TouchMD, go to touchmd.com. Aesthetically Speaking is a production of The Axis, theaxis.io.