Dr. Joel Foster is revolutionizing podiatric care in Kansas City with his innovative direct care model. As a double board-certified podiatric surgeon with over 24 years of experience, Dr. Foster has transformed his practice to focus exclusively on what matters most: exceptional patient care without the constraints of insurance companies. Utilizing the Direct Care payment model, patients experience affordable, transparent pricing, immediate appointments, and personalized treatment plans—all without the hassle of insurance paperwork or surprise bills.
By eliminating the middleman, Dr. Foster and his dedicated team can spend more time with each patient, provide same-day appointments when needed, and offer advanced procedures at a fraction of hospital costs. Discover why more Kansas City residents are choosing direct care for their foot and ankle needs.
World of Marketing Podcast: Direct Care Podiatry with Dr. Joel Foster
Tom Foster: Hey everybody, it's Tom Foster. Welcome to the World of Marketing where I interview clients and great people in this industry. Today I've got my good friend and client Dr. Joel Foster. I'm really excited to have Joel here today, and I've also got John Spare who does the marketing for Joel's website.
We're going to talk today about Joel's cash pay system that he created after years of dealing with insurance company nonsense. He needed another channel to make revenue that was much more profitable, and he's gone to this cash pay system, which everybody needs to consider. That's really what this is about—you don't need to be afraid to make this transition. We're going to talk about how Joel did it.
With that introduction, Joel, thank you so much for taking the time. I see you've got your gear on—you're obviously right in the middle of your day.
Dr. Joel Foster: Yeah, I'm here right in the clinic, but we've got some time set aside to take care of this, which is great. I really appreciate you having me.
Tom Foster: I appreciate you and the fact that you're willing to sit down and help other doctors and help us to get better. You've been very involved in the marketing process, right John?
John Spare: Absolutely from the get-go.
Dr. Foster's Practice Journey
Tom Foster: Let's talk about where you were. Talk about how you built your practice. Let's start there.
Dr. Joel Foster: I started whatever it's been—23, 24 years ago now in private practice. Actually, I started working for another doctor, and then after a few years, ended up going out on my own. My wife and I started the practice—she's been the practice manager since day one.
Honestly, we didn't know what we were doing. We just knew we wanted to help people get better, and we were going to try to make it happen. Slowly we built and grew, and it was really good from a patient standpoint. We were getting new patients in, we were seeing people, we were helping them get better, but we were struggling so much watching patient care go downhill.
Not because we wanted it to, but as years went on, the insurance companies demanded more and more. Pretty soon we found ourselves spending more time checking the right boxes, asking the questions the insurance company wants, trying to document it in the words they want—and less time actually treating patients. That was one problem.
The other problem was that as the insurance companies demanded more of our time, we needed to hire more people to make sure everything was getting checked off correctly. Our overhead was shooting through the roof, and the only thing you can do from a business standpoint is, if your net profit per patient is continuing to go down, to see more and more people a day. Well, when you're forced to see 40+ people a day, how good of care can you really provide?
That was really our driving factor. When I came into business for myself, I said I wanted to treat every patient in the chair like they were my mom, my dad, my brother, my sister. What would I do with them and how would I want to be treated? I would never run in and out of the room in five minutes with my mom sitting in the chair, yet I found myself doing that with every patient because I had to see so many people a day.
That's when we finally said we have to do something different. We've got to stop, we've got to make a change. We've gone to seminars and talks and watched people do everything, and there's a lot of innovation out there. I think a lot of people are doing some very good things to combat this, but to me, it's almost an ethical issue at some point.
When you see that insurance companies are taking advantage of patients—they're charging them all these premiums, the patients aren't getting the care they need, they're having to wait to get in—at some point you just have to say, "I don't think that's right. I believe that's the wrong way to do it, and there's got to be a better way."
The Direct Care Model
That's how we got to our Direct Care model. We said we're cutting all of that out. We're going to make this simple. We have an upfront, very reasonable cost. We're going to put it out there on the website so everybody knows before they come in what anything's going to cost.
You can come in, have an exam, have X-rays if you need them. We can go through every single option of what's available to help you get better, what the costs are, and then you make a decision. It puts the decision-making back in the hands of the patient.
Instead of the patient having to go to the doctor, sit in the waiting room for an hour, see the doctor for five minutes, have all these tests run without even knowing what happened—and then a month, two months, six months, a year later, all these bills are trickling in. The patient doesn't even know why they had the tests, let alone what they're for half the time. And if they knew, they would have said, "If I would have known this was going to cost me this much money, I would not have even done that."
Tom Foster: Bills from the insurance company, right? That's what they get. They get more bills from the insurance company on top of the premiums that they pay.
Dr. Joel Foster: Exactly. You're paying—and I can tell from when I had traditional insurance—you have a huge monthly premium. Then on top of that, you have a deductible of some amount, which is at minimum for most people $5,000, most is $8,000 and up. Then on top of that, even once you meet that deductible, which most people never do unless you have something significant, you have a 20% typically co-insurance until you meet an out-of-pocket max, which is some other crazy high number.
For most people, I consider all of us uninsured until we've met the deductible. That's the reality.
Tom Foster: Insurance companies are just eating themselves up. They are so greedy. It's ridiculous how they have manipulated the whole system for themselves at the expense of patients.
Dr. Joel Foster: Again, patients were our number one priority. We were like, "We have to provide better care." I want to treat somebody like I would want to be treated. I want somebody to sit down, explain to me what's going on, help me understand my issue—and we've been able to do that.
It's been huge. I can tell for myself, not only am I seeing how much better patients are responding, but I feel better. I feel like I'm really being a doctor again. I'm not processing people—I'm treating patients.
The Marketing Perspective
John Spare: If I can make a side comment based on what Dr. Joel said—when I first met Dr. Joel, and it wasn't really that long ago, it was about four months or so, I knew he was different. I knew him and the whole team there—Hannah, Julie, Michelle, everybody—was different because the first things out of his mouth were about how much he wanted to provide for the patients.
That really resonated with me. As I've worked more with Dr. Joel, I've learned that it's not just that he wants to provide for the patients, but he's also looking after their financial well-being with this Direct Care model. That's something that I really took to heart.
Everybody hears "Direct Care" and thinks it's some type of ruse to put more money in the doctor's pocket. That's not it at all. As Dr. Joel explained it very well, he has the ability now to give the type of service that he wants to give to his clients. It's not rushed, and it's actually better for them financially than dealing with insurance.
Tom Foster: Better for everybody.
Dr. Joel Foster: It's a win-win. Except for the insurance companies.
Tom Foster: That's a great way to stick it to them!
Dr. Joel Foster: It's really the only way. I look at it like this: when you're in the medical field, I have not seen one doctor ever say, "I really love these insurance companies. They're great." Nobody ever does that. But at the same time, we keep doing it. We complain about it constantly—the insurance is horrible, they do this and that—but we keep doing it.
It's like if you went to a restaurant and the service was awful—would you go complain about it and then just keep going back over and over and keep paying more and more money? Of course not. You're going to find somewhere else to go. But when it comes to healthcare, for some reason, doctors and patients just keep complaining about it, but we keep going back and doing the same thing and wondering why it doesn't change.
Well, it's never going to change—it's only gotten worse. The problem is, and this is where we're running into how to solve the problem, most people don't know there's another option. That's why they keep going back, and that's where the marketing and strategies come in.
We're trying to offer something to people that either they don't know exists or don't know how to find it. Sometimes it's easier when you're selling a product that everybody wants, like a car—how do I make my car better than everybody else's? But we're offering a different way of healthcare that most people don't even know they should be looking for.
Once they find it, they don't really even quite get it because all of us our whole life has been, "What's your insurance? How does it work? What does my insurance cover?" All of these things. For a lot of people, as soon as you say, "Well, we're out of network with your insurance," they're like, "Oh, that's done. I don't even want to hear anymore," because their mind says that's not right, it doesn't work.
John Spare: I'll even bring it one step further—most people think that doctors won't see you unless you have insurance.
Dr. Joel Foster: That's very true. A lot of people think that. And what they don't realize is, for the majority of people (there are exceptions like union workers where everything's covered, or people with Medicare and a secondary), it actually saves so much money by going through a direct care route.
I can give you an example: I have a patient that needed a surgery. We have a surgical room set up in our office. We do a lot of office procedures. We can do a surgical procedure in our office for $1,400. That same patient was considering going to the hospital for the procedure. They contacted the hospital and asked, "How much would it cost me with no insurance to do this procedure at the hospital?" Just to walk in the door, they wanted $99,500 for the same thing that I do for $1,400 in my office.
So if you have an $8,000 deductible or a $10,000 deductible, I just saved you $7,000 or something like that. And that's for bigger procedures. Some of these other procedures like hammer toes and things like that, we do for around $800 in the office. They want $5,000 for the patient to go to a hospital, and that's just the beginning—then there's anesthesia charges and all that kind of stuff.
Tom Foster: And the quality of care that they're going to get from the hospital is not as good compared to what they'll get from you, right? They'll be in and out quickly. You don't have to arrive hours before, do all that garbage, sit in the hospital waiting room with your mask on because you don't want to catch something. It's just crazy.
I totally get it, but that's what people think—if they've got an issue, they have to go to the hospital, right? I get it, and I think most people get it. So now it's really about how you educate people, how you reach people that aren't necessarily looking for that.
Marketing Direct Care
Tom Foster: You really need to bring them in the old-fashioned way in terms of marketing. You've got to bring them in the traditional way and then convince them otherwise that they don't need insurance. That's really the marketing surprise—"Surprise, good thing for you, you don't need insurance when you come here."
So tell me, guys, how have you changed the marketing to accommodate that?
John Spare: When I was told I was going to be assigned to Dr. Joel's account back in late September, I started researching it, and I thought, "Okay, Direct Care, I'm familiar with this." I have another client that's a direct care client for the most part in Baltimore.
I made a note when I first met Dr. Joel to ask him about his plan to educate people about this. I don't know if you remember that, Dr. Joel, in our first meeting—"What's your biggest pain point?" I knew it was going to be that, and sure enough, it was.
We just started discussing how to get this message out, how to make sure the audience understands what's involved and how it benefits them.
[John shares his screen showing the website before and after updates]
John Spare: This was the messaging that we had. This was your homepage. One of the first things I pointed out was there's nothing on here in the hero image about Direct Care to explain it—it's a skyline of Kansas City.
This is where we landed through conversations. We changed everything.
Tom Foster: That's much better. It's a great improvement because it shows like, "I'm your guy. I'm going to be your guy there." The other had no connection—just having a skyline. This message is much better.
John Spare: We pushed this live probably in early December or late November.
Dr. Joel Foster: That sounds about right.
Tom Foster: How long did it take for it to start working?
Dr. Joel Foster: It didn't really take very long. One thing we noticed is that when patients are calling now, most of the time my staff isn't trying to explain what we do because they already know—they've been on the website, they've educated themselves. So they know already. That's been really good.
We're definitely seeing things uptick in new patients within the last handful of weeks. We just hope that this is just the beginning and we just keep building from here. People are understanding, people know, people get it before they even come in.
John Spare: If we could boil everything down, Dr. Joel, in three bullet points, what would it be? And this is what we broke down: Affordable Care Without Insurance [with an icon of cutting red tape], Immediate Appointments, and Professional Care.
Tom Foster: Do you have any content yet about the hospital experience? Like why you would want to choose going to Joel's practice over going to the hospital?
John Spare: Not yet.
Tom Foster: That's awesome. I think you should. Like, "Why go to the hospital?" And just talk about all the terrible things that the hospital will do.
Nobody gets excited to go to the hospital—"Boy, I can't wait to go to the hospital!" Unless you're a surgeon making some money. But I get excited to go to my doctor. I have a relationship with him.
That's the other thing too—they build a relationship with you, they know what's going on with you, they know your history, and you'll be there for them if anything goes wrong down the road.
It's no different than when I had plantar fasciitis years ago. I went to Piscataway, New Jersey to see my friend Dr. Peter Wishnie because that's who I trusted. I could have gone anywhere around here, but I trusted him. He fixed me, and I never forgot that experience—how pleasant it was and how well it worked. He's always been there for me if I had any questions.
That's what you will not get in a hospital or at a practice that has completely bowed down to the insurance companies, as you said, Joel. They're going to get five minutes with a doctor who doesn't care.
The Direct Care Difference
Dr. Joel Foster: And on that same line, no matter how good a practice is trying to be, everybody in the typical practice knows that they only get paid if they've checked all the boxes and filled out all the forms. So much of everybody's time, from the person that checks you in to when you talk on the phone, is about "What's your insurance? What's your insurance information?"
When you come to an office that doesn't have to deal with that, the only thing everybody in this office cares about is getting you better. That's it. We don't care about anything else, and people feel it. They can tell from the time they are talking to the staff on the phone. They're just asking, "How fast can we get you in? What are your needs? How can we get you better? How can we accommodate you?"
If somebody calls, 99% of the time somebody's going to answer the phone. They're not going to get a message machine, and if they do, somebody's going to call them back right away. You're not calling a doctor and then waiting for two days to see if somebody gets back with you. It's just a whole different thing, all oriented around patient care.
Tom Foster: I love it. There's nothing more annoying—this happens to me when I go to a new doctor—you call and say, "Hey, I'd like to schedule an appointment," and 9 times out of 10, that receptionist is rude and doesn't give two craps about me making an appointment. The first question out of their mouth is, "What's your insurance?" That's the first question. It's all downhill from there.
John Spare: I can vouch that Dr. Joel and his crew are a special bunch. It's just the desire and the simple courtesy with people—hands down, you get my seal of approval, Dr. Joel, on that.
Marketing Strategies For Direct Care
John Spare: I do want to point out one other thing, Tom, in regards to the marketing for this. Talking about testimonials and current patients—that is like the biggest social proof in the world to me when somebody has something great to say.
When we were digging into this, asking how do we get our message across to people, Dr. Joel had some very good client care testimonial videos. So one of the other options—you won't see it on this page, but this is like one of those cooking shows where you have everything baked already—if I go to this other tab, you can see there's a popup that we created with this amazing testimonial from one of Dr. Joel's patients.
Tom Foster: That popped up for me. That's great.
John Spare: Just in the past 30 days alone, that video alone has had 138 views.
Tom Foster: I want to see you do a good piece and campaign about how terrible the hospitals are. Like, you've got two campaigns here—one is how terrible the hospitals are, and two is how terrible other podiatry practices are that take insurance.
I don't want to say it that way, but you could say it just the way that we did without calling out anybody specifically. It's a choice.
Dr. Joel Foster: In their defense—and we see people all the time that have gone to two or three other doctors—they're like, "Oh my goodness, you guys do everything right. Everything's great. Why doesn't so-and-so do this?" And I say, in their defense, they're probably trying, and they probably want to, but they can't.
They can't serve the insurance company and serve the patient at the same time. They have to pick one, and the insurance has to come first because that's who pays them. You're not paying them, so they have to jump through all the hoops the insurance wants. By us stepping out of it, it lets us do things the right way. So I think a lot of people want to do it right—they just can't.
Tom Foster: There are other big intangibles. The detail of what you're saying is really important because your model allows you to have more resources for client care. Your profits are better, so you can put that back into your own practice by hiring better people, getting better staff, better equipment. You're able to give better care like you said at the beginning—your mindset has changed, and you're able to give better care.
That's really what I want to get across to everybody here listening: this is something that everybody can do. You just need to know how to do it. Joel's a perfect example of somebody that's been through the fire, just like you have, that made the tough decision based on wanting to have better quality care. I think that's the attitude that has to come first to make this work. You can't look at it like, "Oh, this is a cash cow. I'm going to do it that way." You have to have the attitude of giving better care to your patients and taking that additional revenue and investing it back in the practice like you have, Joel.
John Spare: I've got to add this—Dr. Joel doesn't only just talk the talk, he walks the walk too. He strictly believes in direct care for everybody to the point where we're actually letting everybody in Kansas City know who else takes direct care. That's how much he believes in this—what other primary care physicians, chiropractors, dentists, what have you.
We're trying to get the word out not just for Dr. Joel about this, we're trying to get the word out that there are all kinds of other practitioners that have embraced this model for the same reasons that Dr. Joel has. And if there's anyone in the area that's listening to this in the Kansas City area, let us know if you want to be part of our directory.
Tom Foster: You should list other doctors in other states too that do it. That would be fantastic.
[John shares website traffic metrics]
John Spare: This is a report that we generate for all of our clients. It pulls in real-time data from Google Analytics and Search Console. In this time period since we started working together up through yesterday, we've had 18,000 users, and they're mainly new users, which is what you want.
The beautiful thing is this little green number here—that's how much it has increased from the period prior. You've got almost 15,000 more views since before you implemented this. It's pretty impressive.
I'm pointing that out because this works. When you can strategize and implement and everybody can brainstorm and put that into motion, I'm telling you, at the end of the day, it's going to work for you.
Tom Foster: You have to have all the parts. First of all, you have to have the commitment like Joel has, and you have to have the right attitude. You have to work with a partner that can execute this for you—and guess who that can be? That's us. We'll help you do that and make those changes that need to be made and stay on top of it with additional content, like what we just talked about.
You've got to come up with new stuff all the time. I love having your testimonials and your results up there like that on video and as a pop-up—that is brilliant. That's great stuff, and I know you're just getting started.
The Decision to Change
Dr. Joel Foster: I feel like we've made a really good transformation. Going back to the beginning of all this, when I really wanted to do this, I was actually working with another company that was doing my website. I talked to them and said, "Hey, this is what I want to do. I'm going to step out of insurance, I'm going to do this. I really want to make this change."
They were like, "Oh no, don't do that. That's not going to work. It's not a good idea. We don't think you should do that. Let us help you—we can make some changes, and I'm going to get you in contact with somebody else."
I immediately called you guys right after that conversation, and I think I talked to Chad. He was like, "Oh man, we can make this happen. We're going to do it." It was a complete 180 degrees—the complete opposite. He said, "We can do this, we can come up with a plan," and I was like, "Okay, this is it. We're doing it."
In the beginning, we were just kind of trying to make a good website and change everything around, and honestly, it was good—everything was good. But since John's been on board with us, we've really taken this up to a whole new level. Now we're directing this marketing strategy not just to who we are, but to how this works and what Direct Care even is.
It's been great for us to see not only working with you all to say, "Yes, we're going to help you do this," not "No, you can't do it," but then always pushing to say, "We're not content with just having a pretty website. What do we need to do? How can we get more patients? How can we continue to build this thing?"
Because it is frightening. It's scary to drop everything you've been doing for years and everything people tell you that you have to do and say, "We're going to do something different." It's like starting your business all over again. So it's taken time to get to this point. I really feel like we're right on the verge of just really exploding this thing.
We had six new patients on Monday, we had four new patients yesterday, I think we had four or five on Tuesday. So that was the best beginning of a week we've had in a long time. Who knows what next week's going to bring, but if we can keep building on that, we're going to get somewhere for sure.
Marketing Campaigns For Direct Care Providers
Tom Foster: Do you guys have email campaigns going out to your list and all that, John?
John Spare: We have one coming up on Direct Care. That's coming up.
Dr. Joel Foster: We're sending to our current and past patients, and we're also marketing to all these other direct care doctors in our area. We're sending information to them, not only to let them know what we do—for example, we have a CT scanner in the office, so I can do weight-bearing foot and ankle CTs for $249, which is nothing compared to what it would cost to go to the hospital. But a lot of these other doctors don't know that's available.
If they have a patient that needs a CT, they're like, "Well, let me send you to wherever," and see what it's going to cost. So to let people know we have those services—
Tom Foster: That's smart.
Dr. Joel Foster: Orthotics, you know, people that are going to those stores... I don't even want to mention the name of the store.
Tom Foster: Don't mention it. Those guys are marketing juggernauts, man, scamming people.
Dr. Joel Foster: And we're like, "Hey, we can do it for only $375. Come here and let us do it." So we're marketing to other Direct Care providers, and we're really just at the beginning of that. With the page that John was showing about how we're going to promote these other doctors, our goal is to start doing interviews with them about their practices and how they work, really just trying to grow a Direct Care Community starting here in Kansas City and then see where that goes.
Quality of Service For Direct Care Patients
Tom Foster: You will never get good service from a company—it's rare. We're actually surprised when we get good service from a company. When you walk in there and they treat you well—like the Apple Store. They've held up over the years in terms of customer service, and they've gotten better and better. That's one place where you walk in and you're like, "Wow, I feel good about how I was treated in there," even though no matter what, it's busy as hell. They've got great staff.
But you go into another big corporate conglomerate store, they don't give two craps about you. That's why I go to a tailor to get my clothes tailored properly because I'm not going to go to Nordstrom where that guy's getting paid $12 an hour and couldn't care less about you.
It's about the quality of service that you provide. If you are one of those kinds of people that is a doctor that is struggling with this very thing of "I'm not able to give the quality of service to my patients that I want to," this is an avenue—and this is the best avenue to do that and also take care of yourself.
Great job on the pivot, Joel. Great job on the decision that you made, and I cannot thank you enough for choosing us and trusting us and relying on us to do this for you. This is a big, big thing, and we don't take it lightly. We're in it. That's why I wanted to bring John in on this podcast so he could talk about it. You see John's enthusiasm. We're like you—we're not a big corporate company. We're hands-on, we care about you like you care about your patients. We want to make sure that you're successful, that you reach your goals, and that's why we're constantly pushing—what are the next goals? Okay, we achieved that, what's next? How can we make it better?
John Spare: I want to add to the group effort aspect of it. Julie and Hannah are boots on the ground too, out there visiting practitioners and giving them information about working with Dr. Joel to provide direct care. It's just a beautiful thing when you have a team that can work together.
Dr. Joel Foster: Especially when you're a doctor and you know how to treat patients, but you don't know what to do about marketing. For me, Julie and Hannah are like, "Okay, we need to do a video about this. These are the things we need for social media." I kind of do what they tell me to do. And they're working with patients and taking calls and juggling things.
It makes it work too because Julie's answering the phone, so she knows what people are saying when they call. Hannah is an MA at the same time, so she knows the experience that people are getting in the back. They're not just marketing—they're in the middle of it at the same time, and it really works.
Tom Foster: That's another thing too—the quality of your staff. These other practices and the hospital, those people are there to make a paycheck. They have not bought into the idea of "We're here to help our patients." I'm not saying everybody's like that, but for the most part, that's what you find, like with receptionists answering the phone: "What's your insurance?" They don't care.
What about, "What's bothering you?" Could that question come a little later maybe, after you find out if I'm worthy of coming in? That should be the first question—"What's the issue and how can we help you get it better?" That's where it has to start. We'll worry about how you pay later on. Let's get you fixed up first.
Conclusion
Tom Foster: Well, that's the ticket, man. Joel, great job to you, and thank you again for trusting us to help you do that. Looking forward to many years working together and making you more and more successful.
And we're not related, everybody, even though we all have the same last name. That's magical, and that's probably why you're so successful. It's got to be the last name—that's the ticket.
So good luck to everybody that doesn't have a last name of Foster. Hopefully, you can be okay, but you'll never be as good!
Dr. Joel Foster: Almost there.
Tom Foster: Thank you so much for sharing your story, Dr. Joel. John, thank you so much for jumping on—I know you're a busy guy. And everybody, thank you so much for tuning in to the World of Marketing special edition with my buddy Joel Foster, Dr. Joel Foster. Thank you so much again for your time. Appreciate you guys. You guys have a wonderful day.
Dr. Joel Foster: Thank you.