¶ Leveraging urgent care pages to fill clinic schedules
Hi, Don here. Welcome to Podiatric Practice Mastery. We're helping you get to the $1,000,000 mark and beyond. So I'm going to go over, this is a recording of a Wednesday in my office. So it was a, it was a nice day. We, we put up this new web page on urgent care. So it's nice because it's filling up the, the, the actual schedule.
¶ Training virtual assistants to handle increased call volumes
So I had kind of a light schedule that it ended up filling up thanks to my, my staff. Just so you know as well, we are training a new virtual assistant. She was being trained yesterday by my surgery scheduler and she's going to be only answering the phones because we're having a little bit of a hard time answering phones. I just heard we had a little rebellion in the clinic, not really rebellion, but like the staff because they don't want to answer the phones.
They just turn the volume down so they can't hear them. So they just show up visually and they're not answering them. So just so many calls, which is kind of a good thing and kind of a bad thing. But the problem is just letting them all go to the recording and then they get the transcript of the recording and then they take care of them in that in the system that we have called Clara. So just kind of a funny thing that I heard. Funny or sad? OK, first patient, she's a 62
year old female. She had a nail sample.
¶ Managing nail fungus follow-ups and plantar fibromas
Follow up, did not show fungus, so I did not do anything for her toenail. She also has a plantar fibroma I am not dealing with right now because it's not bothering her. Next patient was a 33 year old. This was a little girl. She came in, little girl. She's 33, I guess I'm 40, I'm 47, so I can call her a little girl.
¶ Addressing severe arthritis in a Taylor's bunion patient
She has some Taylor's bunions bilaterally. That's where she came in for. That's it. And when I looked at this young woman's X-rays, I was like, Oh my goodness, what happened? Because she had like no subtaylor joint in the right foot and beaking between the Taylor and the vicular joint and just all this arthritis and I was like, what's going on here? You're here for this Taylor's Bunny. Is there something else going
on? She said yeah, I had a car accident years ago and my foot's all messed up and like, do you want that fixed? And she says yeah, it just hurts. I'm just used to having it hurt every day. So I referred her to one of my colleagues for possible fusion of the of the rear foot for her. Next patient was a 45 year old young man. He was on Terbenefin many years ago and he did the whole protocol and it came back. And so for this guy, I'm doing the protocol again. I gave him tribenophen.
He has the UV light, shoe spray, biotin, stuff like that.
¶ Toenail fungus recurrence and prevention strategies
And I just talked to him about possibly after using a topical like Lamisil cream once everything is gone, Lamisil cream once a week. I don't know if anyone else does that but I've heard about doing that along with the shoe treatment so it doesn't come back, but it came back right on the same toe and he was totally cleared out in the past. So I started that process. Next patient was a 57 year old follow up for Achilles tendonitis.
Now he is OF there are certain patients as I mentioned before, they just don't want to spend money. So these ones I don't spend much time on.
¶ Managing Achilles tendonitis with PT and shockwave options
I just sent him to physical therapy and I'm like if this doesn't work then we're going to do shockwave for him. I don't really have as much patience. I think shockwave would be better. He just doesn't want to to spend. Next patient was a 71 year old female. She had on the right foot a hammer toe. It looked like a fifth hammer toe.
But when I got an X-ray it showed like a calcific Bursa on that area and I I told her, you know, you could remove that or you can just kind of wear wider shoes. I recommended wider shoes for her. Next patient was a patient that came in for a Trybenfin follow up and wasn't really clearing out.
¶ Treating neuromas with ultrasound-guided cortisone injections
So I put that patient on Diflucan. Next patient was a 88 year old person that had a kissing corn between the 4th and 5th toes. Talked about wider shoes, something to space the toes out, and an exostectomy if that doesn't work. Next patient was a 63 year old that had a neuroma so I did an ultrasound guided cortisone injection for that and those neuroma symptoms. No follow up as needed. Next patient was a 65 year old
female. She had bilateral second pain and I did bilateral shockwave on her.
¶ Bilateral shockwave therapy for second metatarsal pain
This was a pet #4 out of 6 so she has another two and she's already starting to feel a little bit better. Next patient was a 56 year old that had a carry flex 1 toenail. She's the one that comes in. She likes to do this. She comes in every three months for this. I'm trying to get her to see my my nail tech but she keeps wanting to see me. Next patient was a 48 year old. This is a kind of a nice active guy.
He has pain. We reviewed an MRI and he has some sub tailor joint arthritis, a bone marrow oedema and kind of the anterior aspect of it based on the the MRI.
¶ Using focused shockwave for bone marrow edema
So there's not many options for this young guy. He likes to be active. So he's done cortisone that helped a little bit. But really what I'm going to do focus shockwave just on that area of bone marrow oedema. So if I can help him feel better with that. So we're going to set up four sessions of shockwave kind of because it's for the bone. I'm doing 4. Maybe I should have done 6, but for this guy, I'm just going to do 4 to start out. I didn't have time to do it with
him there. Next patient was E pad #2 on a six for plantar fascial pain. Next patient, this gentleman, he was kind of a guess, a train wreck I guess.
¶ Complex Lisfranc injury management and treatment decisions
Unfortunately he had a Liszt Franc injury from a motocross accident on his right foot. And he had already had had a actually on his left foot and he had a fusion already of the 1st and 2nd tarsal metatarsal joints and they were going to do the inter cuneiform joints. That's what they were planning on doing. But he didn't come in for the left foot. He came in for the right foot where he had sesmoiditis from probably his change in his gait.
So I talked to him about different sesmoid treatment, shockwave, cortisone injection, but he opted for doing nothing because he I think he was here just more for a second opinion.
¶ Best practices for foreign body detection and ultrasound use
Next patient was a foreign body that she had on the on that this is 1. These are some of these that are added on. So that's why I had them written down here. Foreign body that was added on. It was I got X-ray. I forgot to get an ultrasound on this one. I probably should get an ultrasound. She has a little bump that was there. I didn't really see anything she didn't want like an an incision and drainage. If I could do it over again, I probably would have done the
ultrasound. For some reason I'm always thinking ultrasound, but I didn't think it was funny. My my scribe actually reminded me afterwards. Did you do an ultrasound? I'm like, no, I didn't do an ultrasound so I probably should have.
¶ Managing DIPJ cysts and recurrence prevention strategies
Next patient was a patient with a DIPJ 2nd digit cyst and we popped it and wrapped it with Cobain. She has popped it a couple of times. I I went through my whole spiel about the high recurrence rate and needing to fuse the joint if the the popping and wrapping doesn't work. And then there was also a, this is a 64 year old that she had bilateral second Med head as well. Pain. And she is a shockwave #9 out of nine out of nine. So she's done. She, I'm going to see her back
in three months. She's substantially better than
¶ Final shockwave sessions and long-term follow-up results
when I originally started. Originally she couldn't tolerate anything. I think it's partially like a nerve issue and she's better, but she's not perfect. So that, that's a struggle that one. There next was a 37 year old with a left fibula fracture. Gave her a tall Cam, but she came in from the urgent care.
¶ Bilateral heel pain solutions with night splints and foam rolling
Next patient was patient had bilateral heel pain, talked about foam roller. Since she had bilateral heel pain, I gave her bilateral night splints so she only had to wear them three hours instead of 6 hours. Right. Switching feet and and then we're still yeah then we're still struggling with mod Med.
¶ Resolving EMR billing challenges with practical workarounds
I think we figured out one problem with Mod Med for us has been we put in like all the shockwave stuff. I put in like a bill where it shows up when they check out, but the problem is when the staff checks them out, they can't reconcile that bill. So they have the bill I put in and then they have the payment. They can post payment for 2:50 for the Shockwave, but they can't post it to the actual bill that I put in there. For some reason. It's an accounting issue, so it's a pain.
So we have to figure out a different way. A workaround is for us just when we do the follow up, just to write in kind of what they have going on and how to how to bill them, what the staff should build them. So anyway, that's what has been going on in the office. Tell me kind of what's working for you. Reach out to me. I'd love to hear what things are going well. Any new ideas that you have so I can share it with others here in the program? Okay, have a good one.