Boosting Podiatry Care Revenue: Lessons From a $1M Practice

Hey guys, Don here. Welcome to Podiatry practice. Master. I'm going to go over the $1,000,000 minute. So these are things that I go over that would help what things that help me get to the $1,000,000 mark and beyond. So I, I'm still struggling a little bit with my new medical record of, of writing down all the patient information. I think it's because I'm more preoccupied with my charting right now that I am like documenting these things. I just, a lot of times just want

to get, get done. It used to be a little bit easier. The, the print out of the patient list was a little bit easier. The, the newer 1 doesn't leave me enough room. So I'm, I'm trying a different 1. So I'll go over the main ones here. So the first one was a 53 year old female. They got a Lamisil booster. They originally had tinipedis. Things are doing better. So kind of medication management that's continuing with this medication. Next was a 45 year old man. He got the Pelto special.

So that night splint foam rolling morning stretch due to plantar fasciitis and we're starting a shockwave number one out of three. The reason I'm doing less versus the like the 6th probably because I think I prejudged this patient, frankly, I, I, and also I think he only had pain for a couple of months and so that's why I put it down to three.

I'm trying to do more 6, but I'm still finding that my tendency of if they haven't had it longer, I'm starting on with a lower number and then I can do more later. I also did an ultrasound same day. I think there's a big key with doing shockwave and doing it the same day and along with the ultrasound.

I find that when I'm doing ultrasound the same day, I can show them the anatomy on one side, the other, and that's really my number one thing that helps explain to patients that the anatomy is different. That's the reason for the shockwave. And then if I can start the shockwave the exact same day, it really speeds things up with patients adherence because they already start the process and then they'll continue on with the other treatments. It makes it much more efficient for them.

I think in the past I used to, I was like I was too busy and I was kind of scheduling things out. I just find if if I can take the five to seven minutes and just do it that day, it's much better to start treatment same day when you're doing when you're doing shockwave. So just so everyone knows when I talk Shockwave, we have two radial machines and then we have a focused and a soft wave.

So we have radial in both offices and then one of our offices focused and one of them has a soft wave when we kind of use them interchangeably. And my results seem to be interchangeable at this point. Just so you guys know, next was a 73 year old female, kind of had a bad ankle sprain and I put them in an ankle brace and I'm going to follow up in about 3 weeks with possible ultrasound to look at the ligaments.

I, I don't, I didn't do the ligaments the first day just because of all the swelling and I was going to do it at the follow up one. It might be more of a like a confidence level on my, on my end of things looking at the lateral ankle ligaments and maybe I should be doing it the first visit for these patients. But I, I, I wasn't doing the ultrasound. If anyone was really good at ultrasound looking at the ligaments, let me know if you do it the first visit. I'd like to know what other

people are doing next. Was this is that that anterior calcaneal kind of beak fracture that we're doing? We're #5 out of 6 for this female. She's feeling better kind of getting out of her Cam boot. I'm hoping that's healing in there. I'm going to do #6 next time and I'll get an X-ray at that time. Next was a 62 year old. This is a woman that came in. She had previously had a kind of a midfoot fusion, first, second, third, my cuneiform joints. And that was about four years

ago. That that surgery looks solid and she is here now. She had a ankle sprain and she fractured her fibula. So I put her in a tall Cam boot. She's a very active like pickleball player, at least pickleball. I tend to find that they're really active and they want to do anything they do they can to get better faster. And so for her, I am doing 4

sessions of, of shockwave, both to get down the swelling, but also to help kind of heal things a little bit faster with the, with the focused shockwave. So we're going to be doing that for her. Now. This would be kind of an MVP most valuable patient because of the shockwave for this patient, because you get the, you get the, the non operative fracture treatment, you get the office visit, you get the Cam boot and then you get the four sessions

of shockwave. Who are the ones that are wanting to do shockwave for fractures? It's usually the ones that are in a hurry to get back to activity. Now, can the shockwave heal the bone faster? It might heal a little bit faster, but what the research shows is that return to play or return to activity is speeded up.

And for her, this is what's important. So because we know it's longer than the six to eight weeks that takes to heal this the return to activity because of the the tissue around it as well. So I'm going to be treating the tissue around with the radial and then the fracture side itself. And then I think you might speed it up maybe 20% with the fracture healing, but the return to activity will be increased that that's anyway the way I understand it. I'd like to know what other

people think about this. Shoot me an e-mail don@podiatrypracticemastery.com if you have any comments on these things or if you guys practice a little bit different and I will share it with with other people. Next was a, this was a patient that had a fourth and 5th digit maceration. I want to talk through this one.

So 4th and 5th digit maceration kind of have toes that were tight been that way for years kind of has a bunion, tailor's bunion that are pushing the toes together. So the kind of the take away to make this like kind of more of a larger check is when I, when I originally when she came in, there was a Cellulitis. So I put her on antibiotic. There was an ulcer. So I had to briided the ulcers was ulcer to bribe the first time had lambs wool betadine dried out. Second visit today wearing kind

of wider shoes. Maceration is getting better and we, I talked to her about possibly doing an arthroplasty in the future because the toes, the bones are kind of rubbing against each other. So I, I think the mistakes I've made in the past is when there was a maceration in there, I just kind of curetted some of the maceration out, but I did not debride the ulcer. So in this case, debride in the ulcer really kind of brings up the level of the visit,

especially with the antibiotics. And then instead of just like, OK, C maceration or a lot of these ulcers, I think we're seeing the ulcers, we're dividing the ulcers, but we're maybe treating them as calluses or not billing fully. So I think this is something just to keep keep in mind.

And I think a lot of times, frankly, it's because the documentation is, is challenging and we're doing it because we're lazy, because it's easier just to trim a callus and, and even though it is an ulcer and but the documentation for the ulcers a little bit more challenging. So just something to to kind of

think about. Next was a 13 year old. I did an Ind for an ingrown toenail. No follow up. Next was a 35 year old. This was a this fibular sesmoidectomy. She had a little bit of sutures, some vicryls that were kind of coming out of the incision. So I removed those. She's still kind of recovering from that. Next was a 55 year old that a partial nail avulsion and debrided a couple of the nails. Next was a 69 year old female with posterior tibial tendonitis.

So this is kind of a challenging one. She has a lot of ankle arthritis, midfoot arthritis, but what's hurting her is the posterior tibial tendon. And she thought she had gout. So she had a kind of a slightly elevated uric acid and she was treated kind of with gout with like a Medrol dose pack. But where her pain really is is the medial ankle towards the tendons like the posterior tibial tendon, maybe the flexor digitorum.

I did an ultrasound today. I saw some thickening and effusion around those tendons and she's going to be going on a vacation. So I, I did a little bit of cortisone in that area and I talked to her about when she gets back from vacation to start shockwave. So that'll be, I'm going to see her back in about four to six weeks. I tend to, if I do cortisone, I don't do shockwave for four to six weeks to get that out of

their system. And then I'll start some shockwave because you know, she has kind of a Pez planovalgus type of a foot and versus like a surgical repair. I think getting her with a shockwave with that tendon and then getting her into some type of an AFO would if she's willing to do that, either AFO or an orthotic. I find a lot of times females are quite vain and are not wanting to wear the AF OS. They do a little bit better with a more of a stability orthotic. Next was a 72 year old.

This is a female that has she had a cyst trained twice and she had a bilateral bunion. So she had said there was a

ganglion over the bunion. It didn't really come back. She she said she didn't want to get X-rays. So this was 1. I don't know if I was just busy or what. Usually patients come in a lot of times they tell my staff they don't want X-rays. I can usually have them get X-rays when I talk to them

explaining that to them. I, I sometimes find when patients have a strong accent, I have a hard time being more kind of authoritative with them or telling them what they need because of, because, because of the language barrier. I find sometimes this language barrier can be a challenge like, and, and so this, this patient, she was, I have a lot of Albanian patients and I just, I just find it hard with the, with

the accent. Maybe I'm afraid they're not understanding me why they need the X-rays, but she does need X-rays. She just did not want to do them yesterday. And, and, and then I then I get, I get struggle with the accent and I just kind of go on and, and OK, forget about it. But probably would have been better to get the X-rays, at least some baseline X-rays for her. She said she had them somewhere

else. That's why she didn't want to repeat them and she was worried more about the quote UN quote cyst. But she does know me from the hospital. She works at the hospital and she's wanting to consider bunion surgery, but maybe just not today. So I, I did not get the X-rays today. Probably for practice management would have been better to get those X-rays. And she did bring a friend with her that had bunions as well. So we talked to her about her friends bunions as well.

Next was a 82 year old female. She had kind of like 2nd and 3rd digit hammer toes that were dorsally dislocated or contracted and she had painful second metatarsal head and a callus down there. So I trimmed the callus but I

really said she needed more work with that second metatarsal. There's really no fat pad underneath there. So we talked to her about orthotics. She didn't, I think she was a little upset. I think she might have been waiting a little bit. And this was one that was kind of a struggle when they're waiting and you feel bad because you're already you're already starting behind and they're already frustrated. So I didn't do much for her and I felt like she wasn't too

pleased. So I'm probably going to call her and make sure she's doing OK today. So these are those ones that, you know, she came in, I didn't really help her that much. She didn't have much of A callus down there. And I actually felt guilty for charging her for the callus because I was running behind. So these are I'm just kind of sharing kind of the emotions that I feel throughout the day. And so for this one, I feel like

I didn't do too much. I, I didn't, I didn't she feel like she was connecting with me. She was kind of like standoffish, you know, wanted to get out of there, you know, very curt in her in her responses. And then the last patient was a

onycolytic nail bilaterally that this patient kind of got it snagged on something. I didn't trim it all the way back to where it was attached. And in a couple weeks she'll come in for a carry flex. And I actually had another patient that came in for bilateral carry flex as well this day. So this was the day I think the MVPS were these would tend to be the shock waves that I was doing

for these patients. And I feel like now that things are calming down with the new medical record, I'm able to focus more on and these types of patients once again, I'm doing a, a new kind of a, a section in Podiatry management and, and the next article is going to be on how to get a new associate busy. So I'd like to know if, if you've had associates and if you've been successful getting them busy, what you kind of did?

Because I think one of the struggles when doctors are starting out, they don't have very many patients. And how do we get them busy besides just kind of giving it time? Do you throw money at AdWords? Do you have them get out into the community? What, what is it that you do to get the patients busy? If, if, if you have good tips or things that don't work, let me know. Okay, So I can include that newsletter. Shoot me an e-mail

don@podiatricpracticemastery.com. Also, just let me know how you're liking this if you find this beneficial. Okay, have a great day.