01/25/2014    Brian Kashan, DPM

Elimination of RFC Patients

I have this debate periodically, with some of my
colleagues, who have the exact same complaint as
you. Namely, that they are inundated with RFC
patients and new patients have to wait weeks to
get in. This results in many of the new patients
going to another doctor, as they can’t wait weeks
for an acute problem. The loss is huge.

I have several suggestions. If possible, perhaps
you can stretch out the time between visits for
the RFC patients. Let’s say from 8 to 10 weeks.
Then, RAISE YOU FEE FOR THIS SERVICE. As RFC is a
non-covered service, you can determine what you
want this fee to be and the patient will either
pay it or go elsewhere. I don’t consider that to
be a loss, as most of us undercharge for RFC
anyway. We generally have one fee for RFC, whether
the patient has a few long nails, or a patient has
20 calluses and corns and wants each one trimmed
to the last cell of the epithelium and has to have
each one padded.

Or how about the patient that comes in every 6
months or a year with their feet in horrible
shape, and tells you to cut everything “as short
as you can”. Consider multiple levels of RFC, like
there are for E&M services. There can be a low
level, intermediate level, and high level of RFC,
depending on what you are doing. I think that is
reasonable and within legal bounds. We bill our
covered diabetic care for nail and lesion
debridements separately, so I assume we can also
consider billing our non-covered RFC similarly.

Regardless, I recommend leaving a couple of slots
a day open, so urgent patients can be put in and
you don’t lose them. This is just my opinion, and
of course subject to all the laws, rules, and
regulations we all deal with on an everyday basis.

Brian Kashan, DPM, Baltimore , MD, drbkas@att.net

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