Boosting Podiatry Care with Systems, Shockwave, and Orthotics

Hey guys down here. Welcome to Podiatry. Rex Mastery kind of going over the I call the $1,000,000 minute. They said things to help to get to the $1,000,000 mic and beyond. This is a recording of a day in the clinic on a Tuesday. So this is a full day. I'm in my my Worcester office. So good, bad and ugly. First patient was a no show and I had another patient 10:00 that was a no show, but the other ones kind of showed up. So let's go over.

First patient was a a Lamisil. Follow up 31 year old male got my fungal nail kit and the Lamisil. So one thing I've started to do, if you've seen my treatment sheet for for gibenophen, for Lamisil, it has like visit 1 nail sample. I'm not the way I'm kind of

explaining it now is I just crossed it off and I say, you know, this could they could bill your insurance a couple $100 for this nail sample. So I'm not going to do that. I'll save you this money, save you the visit. We'll start the treatment. If we see clearing, that's great. If we're not seeing clearing, we'll either take a sample or switch it to another medication. So that's kind of how I'm doing it. And I have this all on my 11 sheet that I give them.

And then I find like the key. And I was listening to a guy that I really like, Alex Ramosi. He talks a lot about marketing and business. And one of the reasons we a lot of, we don't have a system, if you don't have a system of how to explain things to patients, you're not going to do as much of the self pay or a lot, a lot of the procedures, you have to have a system. So I find this paper really

gives me a system. It's all written down kind of the process, the, the medication, the LFT and then all of the, the treatment, other things like the biotin, the shoes app and the, and the shoe spray. It's all in like a system. And so it's able to bring up the per visit value for my fungal nails higher than anyone else's.

And, and so I think if you can do this, not just with your nail fungus, but if you can find a way to do this with, for example, your plantar fasciitis, your at least tendonitis, these other things. I, I used to use presentations. Now I like the paper a little bit better, either one that I have in my pocket, my little prescription sheet that I use or the printed one. And if you have the system, you have all of the like your, hey, this is how we do things here.

So you can do this with like plantar fasciitis, as I've explained as well. And it just really delineates the process and makes it easier and clearer for patients of what you're going to do. So that's why all my patients get this fungal kit. My staff know what it is. Sometimes they say no to it, but for the most part it, it just makes it a lot easier. So just just a recommendation

for you. If there's things that you're you have that you're not doing that you believe in, it's probably because you're too busy and you don't have a system. There are certain things that you have that you don't believe in. So let me give you an example. I have Formula 7 here. I don't really believe it that works that well. So I don't have it in a system, but I do have my my with the other things in there, like for example, the foam roller and the night splint and the and, and,

and the anatomic shoes. And these are kind of all in, in the, in the system of how ioffer things to patients. And this is how you can get the per visit value up. Also orthotics and other types of things like that. It's part of the the system of how we treat patients. OK, enough on that blurb. Next patient was she has a midfoot arthritis and she had a cortisone injection to a couple

of those joints. One thing we've learned with the new EMR is that with Mod Med, when you do an injection, you have to, there's a kind of a screen that you can see body parts like tendons, ligaments, joints. So when you do a joint injection, you have to pick the joint pitcher which you're selecting. But she did 2 joints. And the nice thing with with Modman anyway is it bills for both of those joints.

And I did it with ultrasound guidance and she felt better afterward and she's going to come back as needed. Next was a number six out of six. This was a anterior calcaneal beak fracture that was not healing for a few months in a Cam boot. And we did 6 sessions of Shockwave. I'm going to see her back in six weeks to see how it's doing and get an X-ray at that time. Next was this is a patient.

I've never had anyone that's done this many, but she's on Swift number 7 and I and I also just throw on kanthurdin. So one thing I've learned if I do swift and kanthurdin, they get kind of mad if I bill insurance at the same time. So I either do the swift and just throw on the Kanthurdin as a, as a bonus type of thing. I don't bill them for that

because then it's just, it's too prohibitively expensive. Or I'll, I'll just do the Swift without the kanthurdin. But in her case, it's been so long, I can tell it's getting better because I find with Swift that the, the, the warts become less kind of less thick, less elevated, less bumpy and stuff like that. So she, I think she's almost there and I'm going to do a six week follow up. So usually for Swift, first four I do weekly.

I'm sorry. First four I do monthly and then as I'm doing additional ones, I'm adding like time to it like 6 weeks or a little bit longer just to give the immune system time. Next was another patient with

midfoot arthritis that had orthotics and she had her orthotics, but she also got a a cortisone injection for those. No follow up. Next was a patient that got a diabetic foot exam and he had some plantar fascial pain. So we got a plantar fascial injection and he's going to be seen back every three months for for routine care.

So an office visit with those things. Next was a 51 year old that had a poor old keratoma. So I did that lesion destruction for that. So in my new EMR, it's going to say borrow possible wart. And So what would be the diagnosis because that's what's covered by insurance. Then she also has a lateral scar on the lateral ankle with a surgery by another doctor. And in in that I talked to her about doing some like treatments for the scar laser can sometimes help.

So she was going to be thinking about that, but I did offer her that the laser, the laser I just do it's for scar.

I do laser. It's can sometimes heat it up and kind of help lay down the scar a little bit better, a little bit in a more organized fashion. Next was a ulcer kind of that came back, kind of brided the ulcer. He's going to come back in two weeks. Next was a 58 year old that had once again lesion destruction as well, kind of poor keratoma type of thing, or IPK. Next was a six year old little boy. He's he had a kind of a unique

thing. He had this like elevated 2nd digit, like a curly toe bilaterally and it's overlapping the bunion in a little bit or the the hallux doesn't really have a bunion, but it overlapped, overlapped the hallux. So I recommended him 0 shoes,

Xero and correct toes. And then he also had a retro Nicky on the left hallux. I don't know what caused this, but he had a retro Nicky with kind of swelling at the base erythema. I don't think his shoes were too small. They may have if anything been too big but we're just going to let it be to see if it gets better. I don't really have great solutions for this. I told him that the nail might get thickened and then we might have to take off the nail.

I don't know if anyone has any other great inject things if anyone's tried like cortical steroid injections for these or anything else that's worked for these. But usually I just abolce the nail and or just wait and deal with the nail changes that happen. Next patient was a #4 out of 6 plantar fascia. She I added to her. So she had done 3 sessions and then she came back six weeks later. Now this is number we're going to set number 45 and six up.

So I did #4 today I encourage you to do foam rolling in bed. Some of the older patients, they can't do foam rolling on the floor. They can't get down to the floor. So I have them do foam rolling in the bed. Next was a X-ray for status post exostectomy and a medial 5th toe. This is like one of my favorite procedures to do.

So she has this and she's also going to be having a bunionectomy here in a couple months. For the bunion, she was scheduled two months before a wedding she needed to go to. So I advised her to wait till after the wedding. Now this changing of surgeries can kind of be a pain for my surgery schedule. So recently we had a office meeting and we're going to start like doing like a an admin fee. I think it's like a $200 or something like that to change that because it takes a lot of

extra work. I don't know if anyone else does that, but if they have everything scheduled and then they want to change it for like a a random thing, do you guys charge for that? I'd like to know if other people charge. We're going to try it. I just hope it doesn't come back to bite us in the butt, but that's something we're going to be doing here until it changes. If it changes, I'll let you know. Next was this was my MVP, my most valuable patient.

He's a 63 year old guy. He has bilateral aquinus, really big calves, plantar fasciitis bilaterally, but it hurts worse

on the left. So the way I determined which one is worse is I did an ultrasound and in the left was really thicker, darker. And so the plan is he's going to treat the Aquinas on both sides with bilateral night splints just so he doesn't have to wear them more than three hours. And he's going to do shockwave on the left side. And I did start shockwave that same day for him.

So he did number one out of six. He's going to get bilateral night splints, foam rolling and I'm going to see him back in a week to do the next ones. So that was my MVP patient and at the third visit I, I told him he's going to be scanned for orthotics. So I tell them like after a few weeks then that's what we're going to scan for the orthotics. Next patient was number of shockwave, 4 out of 6 for

plantar fasciitis. Next patient was a 58 year old female follow up on a fracture got X-rays and it did show some cortical irregularity and so just confirm that that I didn't see last time because it was a a newer 1.

Next patient was a 12 year old boy that originally was seen for flat feet and apophysitis. His orthotics, he was really wearing them they're kind of worn out. So we got a second pair actually with the, the company we use to get a second pair for just the scanning fee. So it's $100. And so they did that one. They want a another pair. So they, they paid full price 600 for one and got us and then got that other one for 100. And then the next one we'll do at 100 as well.

So we're just kind of going back and forth for that. This was a little 12 year old boy and the next patient was a 39 year old for did kanthered in for a wart. Next was another kanthered in for a wart. And there's another patient that had some neuropathy and so we did gabapentin for this one. And he is kind of a challenging 1 because he had a kind of a blunt trauma that kind of caused like an RSD on a, on the plantar sesmoid region.

And we've, we've done shockwave, done orthotics, nothing's really helped him. He's been really shrugged off by a lot of other doctors and he's like asking for a sesmoidectomy or a neurectomy. And I was like, I just have never done one of those for this condition. So I sent him to get a second opinion with one of my, one of my, my buddies here. So Yep. So that was the day. Hope that was helpful for you. Just trying to share kind of what my thought processes and

things. Hope this is beneficial for you guys. Just so you know, we're, we're, we're starting some touches on developing a, a mastermind kind of a small group. I'm going to limit it to, I think it's 5 or 6 people that we're going to be meeting to do like a hot seat kind of mastermind group. So if you guys are interested, shoot me an e-mail don@podiatrypracticemaster.com. And if there's other things that you do that I'm not like talking about, let me know and I'll I'll

share it with other people. OK, thanks.