To move forward on this topic, I would like to
disclaim that I am not "expert" on this subject,
but rather one who is a "forward thinker." I
have not begun to change how I practice podiatry
or even implemented the suggestions that I have
made in the last two posts. But, we are and will
be progressing in the next few years to
modified “cash based practice” and become very
selective to whom we see and treat. Our
participation in Medicare, Medicaid and other
managed care entities will continue, but over
time these types of patients will be few and far
between.
We are looking for a more "select" patient
population that has a more healthy and
progressive outlook on foot care. The "entitled"
patient mentality and expectation for healthcare
delivery make us enslaved to an insurance
company. We cannot continue to partake in an
industry that does not pay us what we are worth
or deal with a population that does "value" us
enough to pay for the service themselves. This
is the mantra of most patients: "Does my
insurance cover it"? But, as long as a physician
chooses to participate in "the system", then the
end result will be the same. Remember, the
definition of insanity is the same thing over
and over and expecting a different result.
Most of a podiatrist’s patient demographic is
aged, impoverished, and general unhealthy. We
generally see the "worst of the worst". Patients
usually present as referrals from their primary
care providers or make an appointment themselves
after they have seen everyone possible and there
has been no answer to their problem. We become
their last resort. And, we are experts at what
we do and typically diagnose, treat, and provide
a follow-up regimen for their foot condition in
a minimal time frame and cost-effective manner.
This may be the case with some patients, but
most of the patient population we see is for
nail and callus care, heel pain and other
treatments for general foot/ankle maladies,
minor in-office surgery, and the occasional
outpatient foot surgery. That's pretty much our
day in a nutshell. We may have alternate revenue
streams like nursing homes, diabetic wound care,
circulation tests, and durable medical equipment
supplies like Rx orthotics, diabetic shoes,
AFO's, walker boots, and wound care supplies.
All these things are the business of podiatry.
Through the years, we have seen revenue
opportunities come and go like endoscopic
plantar fasciiotomy (EPF), ESWT, Anodyne,
PADnet, wound care in the office (Apligraft and
Dermagraft), subtalar joint arthrodesis and
other procedures have all gone by the wayside
because of regulation, no CPT code, or decrease
or minimal reimbursement. "Riding the wave" to
the next greatest thing has hounded this
profession for years all in the name of making a
living. Unfortunately, with more and more
restrictive insurance guidelines, healthcare
reform, a decreasing fee schedules the ability
to make money in podiatry is getting harder and
harder every year. With the loss of the
potential to make money and the inability to
replace the loss of revenue, retirement or
quitting all together may be the best option for
some. But, for others deeply entrenched in their
practice and still having monetary liabilities,
the only option is to figure out the "next step".
There still many options for a podiatrist to
make a living in spite of the changes to
healthcare. The fact is we all able to change
our destiny as long as we choose a different to
get there. We have enough podiatric services to
provide that will allow us to still make a
decent wage and keep the doors open. For
example, with the advent of FDA approved LASER
technology for fungal nail treatment, a
podiatrist can use this as an excellent revenue
stream to replace lost income to deflated fee
schedules. This can be excellent supplement your
income and continue to provide traditional
treatment regimens for these types of foot
conditions. You may also consider hiring an
aesthetologist and/or certified medical nail
technician. There are other examples of
podiatric care which are considered "non-
covered" services, but if marketed properly and
create "value" in the mind of the potential
customer, then the sky is the limit.
The annual podiatric conventions we attend have
vendors who for so long have concentrated on
demonstrating their products and services as
things we could provide and hence bill insurance
and get paid. But, when you attend look for
vendors who are specializing in wares that can
be sold in your practice. Yes, I said "sell"!
You have to be a salesman to be successful when
you are providing a product or service to the
public. You are the "expert" and you must "sell"
yourself to the patient and build a trust and
confidence in them so that your services can be
rendered, hence "value" is created and you get
paid. No matter what you provide in your
practice, this motto must be followed to be
successful. Stop thinking because a podiatric
service is not covered you will not even
consider offering it the patient.
I would also entertain a “concierge type
practice” (if the demographic allows) which
would eliminate acceptance of any insurance.
This type of business model allows one to take
a "retainer" for annual medical services. This
could really let a practitioner hone in on
a "select" population of patients related to
their interests. Whether it is general foot
care, sports medicine, in-office procedures and
outpatient foot surgery an annual fee could be
collected to cover those expenses. Let's just
say for example you have 250 patients who are
will to pay you a $2000 a year as a retainer for
podiatric care. You do the math.
I hope these posts have helped some, if not
most of my colleagues, understand that the sky
is not falling, but rather it is the perception
that it actually is. Changing your mindset and
convincing yourself that you are the best at
providing foot care to population at-large. Your
training, knowledge and experience have allowed
you to the best at what you do. Now, just go out
there and convince everyone else what you
already know.
Joseph Borreggine, DPM, Charleston, IL,
footfixr@consolidated.net
