Streamlining Podiatry Care: Managing Busy Clinics and Complex Cases

Hey guys down here, welcome to Podiatry Practice Mastery. We go over how to bring your practice to the $1,000,000 mark and beyond. So this is a recording of a, of a Friday. And just so you know, Murali is getting the hang of things, but it it can be quite challenging because we usually see about 20 to 25 patients in the morning.

Everyone is double booked basically patients every 10 minutes. And so he has to put in a lot of information there. I want to go over. I'm not going to go over all the routine. Marjorie was helping me with the nails. There are a few patients of note that had office visits, so I'll talk about those. One was a possible charcoal

foot, like midfoot swelling. Got X-rays on her Level 3 office visit was not charcoal though. Another patient that complained of bunion pain, so I got X-rays. So Level 3 visit because of that and then another pain, another person that had pain to the left, 4th MPJ region and I did a cortisone injection, not into the joint but just dorsal to it where he was having some kind of some nerve pain. That was an office visit.

Next was a patient that we did an office visit for a possible doing a new AFO. She had previously had one about 3 years ago but due to being on Ozempic she lost about 40 lbs. And I find when when patients lose a lot of weight they the the there was pistoning in her AFO and because of that she

would qualify for a new AFO. Even though the last one she paid out of pocket for this one, I think her insurance changed so she would be able to get it. So this one specifically, her son is very involved in her healthcare and she had mass health and Medicare and, or, or something similar to that. But it ended up being that they had to pay for the, the, the last AFO. So they paid fully for it. I guess that's something that happens occasionally, doesn't

happen a ton of times though. Next patient was a patient that

had some calluses and we did this kind of a young, a younger person. So it was a level 2 visit because we kind of talked more about the callous counseling and stuff. So those were the office visits for the morning, for the afternoon. First patient was a 59 year old, got #2 out of 6 for insertional Achilles tendonitis. So there'll be a few more set

up. Next was a 55 year old female, had X-rays, had an ultrasound, had a ultrasound, ultrasound. I did a cortisone injection. She had a bursal SAC, kind of the fifth Met area. Put her on Celebrex, and I also got a uric acid to see if potentially it could have been caused by gout. That was a level 4 visit.

Next was AQ tenza #1 I need to figure out how to put the code into my EMRI know there is a place for Q Tenza, but there was both the billing for the Q Tenza itself and there is the application fee bilaterally. So it tends to be different based on the patient. Sometimes it's buying bill and sometimes it is. We buy it and bill it and then sometimes they get it from the pharmacy. So it really depends on their insurance. Next patient was a 20 year 20 year old guy that had pain to

his ankle. We got an X-ray.

We did a cortisone into his ankle region to see if it'll calm it down if it doesn't get better. I talked to him about getting an MRI for a possible OCD. Next was a 78 year old female. This is a female. This is kind of a weird one. She had a complicated dislocation of the 2nd and 4th digit.

She is totally neuropathic and I don't know if she kicked something, but her digits were kind of like swollen indurated the skin, little bit of brown discoloration mostly from just the swelling and and I tried to relocate them. I was unsuccessful in doing that. But she is 78 totally neuropathic. They don't hurt her, they just look ugly. So for her I'm I'm treating it with fracture care and not not

fracture care. And I did talk to her about like pinning them and putting them in location actually maybe even be easier to either do that or or just do an arthroplasty of them because they are kind of dislocated on the on. So the the middle phalanx is on the top of the proximal failings kind of like a hammer toe. So you could either relocate them and pin them, but I don't exactly know what caused it, nor does she. So this kind of a curious case

here for this patient. Next patient was a 59 year old that had calcaneal fibular ligament issues and cave his foot so I scanned him for orthotics.

Next was a 73 year old that had chronic and groans. We did a left matrixectomy on an edge. Next was a 71 year old female. Number one out of 6 for plantar fascial pain for I'm sorry one out of six shockwave right? Next was a person that has a bilateral third kind of met MC joint pain and I did a cortisone injection bilaterally.

This is like the second time I didn't build an office visit because specifically he came in for this. So I think when patients come in specifically for something, I don't do an office visit because I don't really have to think of anything new and he's going to come back as needed. And then there was another new patient that came in for Achilles tendon pain, did Celebrex night Sprint, more foam rolling, morning stretch and things like that.

And I'm going to see him back in three weeks. So that was the day a question that came out was once again about circulatory studies. There are a lot of different companies. What one we use is we use Padnet mostly because it's paid for and we don't, we didn't ever buy that, whatever that thing is called, the maintenance program kind of like you get with your car.

So it's all paid for. Very few things break on it. It takes a little bit longer. I think like it takes, I have a staff that they, they book them every every 30 minutes. And so we just put them all kind of on days when there's less

doctors in the office. But the thing I like about Modmed is that when you order it, it actually has the, the reasons that we would do it. So for example, if they're diabetic over the age of 50 or non diabetic over the age of 70, those are some of the main reasons that we're doing the the Abis for them in the office. There are a couple of other companies out there. I think they're they're good.

I've heard some issues with the smart ABI with the cuffs and the and the like breaking and giving technical difficulty that way.

You really want something if you're going to do a lot of it, you want it that's going to work every time and really not going to have to guess if it's going to work or not. I think that's the same with shockwave.

So as long as the shock waves are always working because we're, we're using them so much, if, if there's an issue where they break or something happens and you can't use it, you are like out of Commission. And so the same thing with the ABI, think it needs to be an easy device to use. And really sometimes the more technology and more advanced tickets with like Bluetooth and Wi-Fi and all these other things that can make it a little bit more challenging.

But then the benefit though of like I think the smart ABI or some of these other ones is if I recognize patients could benefit from it, I could do it that same day. Whereas I tend to schedule them with the staff on a different day because they take a little bit longer to do. I think these other ones, you just strap them on there. You can do them in probably 5 or 10 minutes. So that is my thought. I, I once again, I do not get

paid by any of those companies. Just someone when people ask me questions, I'd like to share them here with everyone else.

But we are going on week 5 here of Mod Med. It is getting better. My scribe is getting used to it. And eventually I'd like to start to record some videos because I didn't really find many great ones on YouTube about how to do the things that we do. Like I could do it on Q 10s or on X-rays or how we set things up or, or things like that.

I think that would be something that would be beneficial, kind of the same thing I did with Athena when we used to use Athena. But I hope everything is going well. If you guys found this beneficial like this, share this with someone else. And if you have other tips that are working to help your office to get to the $1,000,000 mark, please let me know. OK, thanks.