Hello! Who are you and what business did you start?
Hello, I’m Dr. Tom Ingegno, doctor of acupuncture and Chinese medicine. I own and operate Charm City Integrative Health, a clinic that focuses on improving whole-being health through many different therapies.
Our flagship service has always been acupuncture, but we have stacked that with other services that use different methods to work in synergy with acupuncture’s main functions as understood in modern terms. Rather than list them here, check out our service menu online. Those functions are to improve circulation, reduce inflammation and normalize immune system function.
Currently, we have over 14 different therapies that all work well with each other. We help people customize treatment plans to get the maximum results in the shortest time possible. We also stress that just like going to the gym once and expecting an amazing physique, healthcare is the same way. Our therapies are meant not only to heal but also to keep the body healthy, so we offer memberships to help with that process. People are really starting to understand that that snapshot of health you get during a yearly physical does not paint a complete picture of your health.
With this fact and our genuine caring of patients, our business has really taken off in the last few years. Until the coronavirus outbreak, we were averaging almost 150 service appointments per week. While it’s about taking care of people and not focused on the bottom line, we were averaging about $35,000 per month in gross income with our numbers trending up.
What's your backstory and how did you come up with the idea?
If we’re going all the way back, my family started me at a young age with a line I’m sure many have heard before, “You’re smart you should be a doctor.” Growing up I would help my grandfather in his pharmacy with stocking shelves, cleaning and things like that. I remember him very clearly counting out pills one day and saying to me, “This guy needs to take three of these a day every day of his life.”
The pills cost $5 a piece and for a guy barely making minimum wage that was a huge amount. He then said to me, “You’re going to need to figure it out.” Through a string of events and experiences that I would consider serendipitous, I ended up receiving a postcard from an acupuncture school during the winter break of my junior year of college.
I was enrolled two weeks later and I never looked back.
When I moved to Baltimore in 2006, I was starting from scratch, I still had little business experience, but managed to grow until 2014 when I started to plan Charm City Integrative Health (CCIH). I realized with each office expansion I couldn’t possibly see the number of people I wanted to help even if I was to grind 24/7. I needed help and to tap into other modalities that complimented acupuncture and where in most cases “push-button.” All the new services need to be in alignment with the main actions of acupuncture and I needed people to see it as I envisioned it.
CCIH had to be a center where multiple services and practitioners are aimed at helping you achieve whole-being health. I really liked the concept of human performance and how we can alter ourselves and our environment to feel and perform better. The “biohacker” movement swept me up and inspired me to look all over and all the concepts, at least to me, mirrored those of classical East Asian health principles. It was like the anti-aging, performance and functional medicine fields where all read classical Chinese medicine texts. I soaked it up, I loved being able to look at a person’s health from a bird’s eye view, and now there were countless modern methods that could help me do so.
There’s an expression in Chinese medicine, “One treatment 1000 diseases, one disease 1000 treatments.” This often is used to express that people can have different health issues and receive similar treatments and get results and that sometimes people with similar conditions need different treatments. With this many services, we could easily operate on both sides of that expression. Everything we do at the office shouldn’t just be addressing a symptom, it should improve overall function and help you fix the underlying cause.
When we opened in 2016, I think it took some time for people to “get it.” In many ways, we are a clinic that functions more like a gym. We want people there more frequently to help them thrive. There was a big learning curve for both the clients and the staff, especially me. There were a lot of simple business concepts that I never had been exposed to that when I was smaller was easy enough to manage. At this scale, I needed to catch up on the business side of the practice. I, fortunately, have a network of passionate business people helping me and I’ve been blessed with a good mix of employees, contractors, and renters since we’ve opened. I still have a lot to learn, but now thanks to the clients’ positive feedback it feels like an exciting challenge instead of overwhelming weight.
Take us through the process of designing, prototyping, and manufacturing your first product.
With a background in pre-med, a BS in health science, a Masters in Oriental Medicine, and 15 years in previous clinics, opening CCIH was less prototyping and more of a, “you know what would be cool” experiment. I was trying to be on the crest of the wave of emerging healthcare practices while giving my traditional practice the respect it deserved. I researched so many different therapies. Even some that were pretty out there. I don’t practice “scientism,” and didn’t need services to be mainstream, just good clinical research, some proven track record and, safe and easy to administer. That being said, I’m trying to stay out of the new age realm unless there is some good evidence to explore it. You won’t see a crystal therapy treatment being promoted until someone shows us at least one quality study. I still refer to the clinic as a lab. We are constantly talking about what else would be cool to offer.
To make navigating our service list easier, one of my good friends and business consultant, Joe Mechlinski, from Shift, suggested that we pre-bundle some of our services in intelligent ways to help clients more efficiently and address the most common conditions we see. Our RESET package is one of the most popular. There are now about 6 packages and we still like to consult with people to help them navigate the services. Certain people will respond to something in an amazing way and you then try and maximize that. We have some proprietary methods, but most of them came from looking at research and pairing services that hit the same physiological function in multiple ways. The great thing about treating the center as a lab is that if something is working we can push more in that direction if it's not, we just simply shift away from it. I want to get this place right so we can eventually be able to put down centers all over with predictable, repeatable results. That sounds the same if you’re talking about business or healthcare and in this case, it’s both.
Describe the process of launching the business.
The lease started in May of 2016 and I was on a time crunch to be open and running by July 1st. This wasn’t easy as much of the equipment I ordered was coming from around the world. Whole-body cryotherapy machine was my anticipated “bestseller,” and was taking longer to ship from Poland than I would have liked. At the time Game of Thrones was pretty popular and to promote it I hung a sign in the window while we were preparing for launch and posted it everywhere.
I knew I was onto something when the guy who coined the term “Biohacking,” Dave Asprey, posted a photo of himself in his own chamber. I couldn’t wait to hit the ground running. A few excited people in the neighborhood shared our window signs on multiple Facebook pages and we picked up some good traction.
Fortunately, most of my patients from my previous clinic took a new drive to the office, so I still had income coming in while we were figuring out all the moving pieces.
The funding of all of this was the biggest issue. Once the initial service offerings were mapped out, I wrote a 45-page business plan. Since this was not my forte I used a service called LivePlan to walk me through it. I had already spoken with suppliers of the initial equipment and budgeted a little over $100k for that, I still hadn’t found a space yet but planned on about $25k for the build-out. Looking back, bootstrapping this myself was a good idea, although, in the initial months, the payments were terrifying. I had some professional videos shot which are still on our Youtube channel talking about services that we offered and linking to an Indiegogo campaignwhere people could pre-purchase services.
I knew I wouldn’t sell much but I was trying to create a buzz. Now I wish I had asked for more financing and had gone bigger. There are at least another 4 services I’d love to add and they would require a budget at least double what I spent.
Marketing is another elusive animal for me. What I love about our services may not necessarily be why people do. I had reached out to someone at a local TV station and in the high of summer heat, they loved the idea of doing a piece on cryotherapy. We got lucky with another video on cupping therapy during the summer Olympics thanks to hometown hero, Michael Phelps.
We did an open house in September and I spent a few hundred dollars on ads and between friends, family, past patients, neighborhood folks and some people just looking for something new. We had roughly 100 people through the place that day and caught some good attention. That gave us a little bit of a boost, but it still took a good two years to build a name and reputation. That came through so many different ways from online presence to networking. I have made my poor digital media maven nuts with statements that usually start with, “So, I had his idea” and “You know what would be amazing…” She’s been great and rolled with everything. I think she understands the entrepreneur’s ADHD. I’ve tried to outsource everything I don’t enjoy, to avoid burnout, but even with all the help I still cycle in and out of it.
Since launch, what has worked to attract and retain customers?
Since launch, our two biggest draws are the word of mouth and online presence. We try and be active all over the internet and are constantly looking for ways to partner with other related small businesses. Baltimore is often called Smalltimore and once you find your group, they really support you. I feel like 2019 really started to come together for us, which was shortly after the 3-year mark.
One of the ways we keep people coming back is through our membership program. Before I alluded to our office behaving like a gym and to see results here, some regular treatments will be needed upfront. We stress maintenance and encourage people to listen to how they feel. People from every walk of life are constantly combatting stress and if we can ease that, just for a little they will live happier healthier lives.
We like partnering with local people that have a niche following, we have done IG promotions with a few people and while the AFL was running we had a sponsorship deal with them.
How are you doing today and what does the future look like?
We entered 2020 with the best January and February we’ve ever had. Being that we usually see a drop in visits during those months, it was great to see growth. We were averaging well over 100 service appointments per month and seeing 4-5 new clients/patients per week. March was shaping up to be record-breaking too until COVID-19 hit the east coast hard.
At the time of writing this, I’m sitting in my kitchen and between calling creditors and applying for both federal and state aid, I’m trying to take CEUs, work on some of the business that I can do from home, and set up passive sources of income, so if anything like this happens again, we will be prepared. Some of these endeavors include online classes for patients, selling health-related products online, virtual consultations and helping newer clinicians with their practices.
We exclusively, brick and mortar and sell very little product. We are probably a 95% percent service-based business. So, shutting our doors, even for a few days is really felt, especially since we are carrying equipment loans.
I can’t wait to be back open. I’m going to run out of things to do at home, and I’ve always been a clinician first. I really enjoy treating people.
Through starting the business, have you learned anything particularly helpful or advantageous?
These are many lessons I’m still trying to learn. I’ll give you a couple I had to have beaten into me. Hopefully, someone can sidestep a bit of headache. Try and have a standard procedure for everything you do in your business, it’s easier to write one then edit than to not have one at all. On more than one occasion, I found myself saying I’m not sure what to do here when a scenario keeps popping up. You’ll always have a unique situation that can catch you off guard, but when you have a reoccurring situation, good or bad, a formula to deal with it makes it manageable.
This is another rough one for my ego: You don’t need to know everything. I’ve attempted every little role involved in the functioning of my practice. I was horrible at bookkeeping, web design and a bunch of other necessary tasks that were well out of my skill set. I was stubborn about letting go of control over the years, but outsourcing this stuff to experts has helped. I have realized that you don’t lose control, especially when they give you reports and you still review and approve their work.
In the last year and a half, I’ve realized that when I try and network with other small businesses and try and see what they need, both of our businesses benefit. I’m really big into talking with practitioners and business owners in related fields. Not only can there be long-standing partnerships, but you can really learn from them and figure out common problems together.
What platform/tools do you use for your business?
I’m still searching for the Holy Grail of healthcare office management. There are only one or two big companies that offer a full suite of software under one platform, but they are expensive and have a lot of features I don’t need. I’ve managed to allow technology to handle things that would take an army of people to accomplish, allowing for more time to interact with clients.
I’ve found that I really enjoy using Google docs, sheets and slides for anything that doesn’t have to be HIPAA compliant (regarding patient information). For scheduling, notes and the like, I’ve found that Acuity Scheduling is the best bang for the buck. It’s robust but doesn’t cost an arm and a leg. It also integrates with a lot of other platforms, like Square (our credit card and payroll services) and Mailchimp. Acuity also integrates into most social media platforms allowing people to book appointments without leaving the site. I also like Ring Centralfor our phone system management.
What have been the most influential books, podcasts, or other resources?
I love reading, or should I say I’m always on the go so Audible has been amazing for me. During this odd time of existence, I really enjoy books by Steven Kotlar and Peter Diamandis, the just-released The Future is Faster Than You Think is a great book about how converging technology will help solve most of our current problems.
I think every entrepreneur needs to read The E-Myth Revisited by Michael Gerber.
I love to geek out on studies and research especially when it relates to health. I found out about Dr. Rhonda Patrick on Joe Rogan’s podcastand think she’s amazing. She excels at compiling studies on therapeutic services and breaking them down for people to easily understand. I am aiming to emulate her when talking to patients about our services. Check out her Youtube channel.
An essential practice for my business as well as life has been meditation. I’ve been inconsistent since 1994, but in the last year and a half, I haven’t missed a day. I feel like when I was younger I completely missed the gift my acupuncture mentor and my qigong teacher were trying to give me. Now I’ve employed some tech to keep me accountable and give me feedback on my sessions. I love my Muse Headband. That’s a link for $30 off, yes I get $30 too, but I’d still be talking about it without getting something.
Advice for other entrepreneurs who want to get started or are just starting out?
Have a written out plan! Things won’t go the way you plan but it will give you a guide to follow. Most mistakes I’ve made are because I didn’t properly think something out and plan. When an issue came along, I then felt overwhelmed and either didn’t take the right action or worse, did nothing at all.
I am seeing a trend of healthcare places like mine jumping into new technology and adding services. This is great, but make sure that you aren’t just riding a fad. Does it make sense in your practice’s purpose? When I added cryotherapy to the office I asked my broker, “Is there any way I can get a used unit and save some money?” I was entering uncharted territory and saving anywhere would have been helpful. His answer was that no one had gone out of business. About a year later when we were talking he said that certain cryotherapy shops around the country had priced themselves out of business and I had my pick of any slightly used machine I would want. People had jumped into the fad of the service, it wasn’t part of sustainable practice. It’s okay to look for the next big thing, but it needs to make sense as part of your whole business.
Are you looking to hire for certain positions right now?
Right now being locked at home I’m trying to analyze ways to make the office run smoother and take off some of the managerial burdens that often overwhelms me. I would greatly benefit from someone who used to manage a health clinic or medical office that is flexible enough to take the old school medical office procedures and protocols and adapt them to our non-orthodox approach to healthcare. Ideally, they would run the day to day operations including insurance billing, scheduling and the like. I am looking to be able to have them report to me. This will free up time for me to own the practice and do more articles like this and other outreach events that I enjoy.
I want to be able to go out and talk about these services, but the office that I love needs a lot of attention. I’ve had great employees so far and even had an amazing office manager, but between me not knowing what I needed her to do and someone offering her a full-time job with benefits, I couldn’t keep her. I’m hoping to find someone with a background in medical office management that may be looking for a change.
I would love to see clinics like mine all over the country. I’m also looking for investors and people familiar with the franchising process to help me realize that dream.
I have some great ideas for some products for practitioners like me and would love to interact with people who have CAD design skills and some artists.
I’d also love to do more lectures, podcasts, events, and interviews. I was told by the author and futurist, David Houle, that my office was, “the future of healthcare.” I think especially with this current pandemic we are going to see a huge shift toward health practices that aim at improving overall health.
Where can we go to learn more?
If you have any questions or comments, drop a comment below!
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