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05/28/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Elliot Udell, DPM
For sure, many patients and many physicians love telehealth and we can be certain that there will be attempts to keep it popular long after the COVID-19 pandemic becomes history. From the patient perspective, there are no waits at offices, no need to travel to the doctor, and no fears during flu season about catching anyone else's illness. From doctors' perspectives, the visits are short, payable by insurance companies, and the doctor can do the telehealth call from the privacy of his or bedroom and not have to worry about going to an office. But is telehealth quality medicine? If we say yes, who are we kidding? If you evaluated an infected toe by visually examining the patient over the phone, you might make the correct guess and choose the right antibiotic but can you take a culture? What if you see a pigmented lesion on a patient's foot, can you use your dermoscope to better evaluate it and, if need be, do a biopsy?
As a patient, I most often want my doctor to listen to my chest with his or her stethoscope, palpate by belly, listen to my heart, or look into my ears with an otoscope. None of this is available to him or her via my smartphone. Yes, telehealth will be around for the duration, but it can never replace quality in-person patient care.
Elliot Udell, DPM, Hicksville, NY
Other messages in this thread:
10/05/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Charles Morelli DPM
I have had the pleasure of having many deaf patients in my practice over the years. I can say unequivocally that they are some of the nicest and most patient people I have ever met and are very mindful and understanding of the situation as they have been dealing with this issue for many years themselves. Many are able to read lips perfectly when combined with hand gestures and the assistance of a family member who is usually there to accompany them. We have had few problems communicating.
Additionally, we all have smartphones nowadays, and when we are not sure of what was said, we can simply type it on our phones and show it to each other.
Charles Morelli, DPM, Mamaroneck, NY
10/02/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Steven J. Kaniadakis, DPM
Every patient should be treated as if they're deaf and blind. Furthermore, with all due respect, a written fully informed consent should be witnessed by anyone with any kind of impairment, including the English language.
Steven J. Kaniadakis, DPM, Saint Petersburg, FL
06/18/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
Beginning from my first week in practice, I took 5-10% of every bank deposit and put it into a savings account that I did not touch. When the balance grew, I began an investment program. This system worked well and the earlier you start, the more there will be when you retire. I began in my mid-twenties. The thirty-five to forty years the money was allowed to "percolate" provided the retirement cushion needed.
The magic is the tincture of time. If you can't live on 95% of your income, you probably can't live on 100% either. The second rule is always to live below your means, not above. And finally, clearly distinguish between "needs" and "wants".
Joel Lang, DPM (retired), Cheverly, MD
06/01/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Todd Lamster, DPM
Can a mechanic fix your vehicle over Zoom or Skype? Can a technician fix your A/C over a phone call? I think not. The foot inherently is a mechanical structure, and it requires someone of great skill to thoroughly evaluate it, come up with a solution, and then correct it. That evaluation requires all of our senses. Looking at something through a screen is not enough. Pertinent details are lost, opening people up for misdiagnosis and subsequent litigation. You need to see and palpate something up closely to truly evaluate it. Evaluating the quality and extent of motion through a painful joint is something only a physician can do up close.
Sometimes, even smelling a wound can give you a sense of what's wrong. You may be able to come up with a plan, but how to follow through? Correcting an issue may require administering an injection, removing an ingrown toenail, performing an I&D, doing a biopsy, debriding a wound, or do any other physical task that our patients need daily. While I understand the desire and (small) benefit that comes with telemedicine, it is not enough. We have to be physically there for our patients.
Todd Lamster, DPM, Scottsdale, AZ
05/29/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Robert Kornfeld, DPM
I wholeheartedly agree with Dr. Udell. Treating patients, especially podiatry patients, over the phone is unsatisfying and devoid of reliable diagnosis. In my office, telehealth will cease once we return to "normal" and patients will be able to come to the office. The only thing I will continue telehealth for is presenting a patient with a differential diagnosis with the caveat that I could be missing the actual problem without an examination.
Last week a patient asked me for a prescription for an MRI. This patient never came into the office for an exam. We spoke on the phone for about 30 seconds and I encouraged her to come in for an exam but she simply said that she just wants an MRI. When I told her I had no good cause to prescribe an MRI, she said, "That's okay. I'll find a podiatrist who will give it to me without an exam."
Quality medicine will cease to exist if we grow into a telephone screening service.
Robert Kornfeld, DPM, NY, NY
05/15/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Sam Bell, DPM
I must be missing something, but if you have a significant decrease in income due to mandatory closing or limiting your patients to emergencies, or not having patients come in because the state has been put on pause, etc. due to the COVID-19 virus, how is that not loss of revenue due to the virus?
Sam Bell, DPM, Schenectady, NY
05/13/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY) - PART 1B
From: Dennis Shavelson, DPM, NY, NY
911 was 20 years ago and we still take our shoes off at the airport! A dance studio with a 50% overhead pre-virus and 25 students each class will have 12 students post-pandemic and will close unless it acculturates. The eight bullets presented in the article fall short when it comes to economic survival of one's practice in the future. I would add bullets that will become more important in DPM survival time. These bullets try to find benefits that add income turning lemons into lemonade while adding excitement, marketability, and promotional power to your practice.
1. Add adjacent profit streams (in-office dispensing): CBD. Non-covered services, coaching & monitoring, kinesiology tape.
2. Teleorthotics: Custom orthotics without an office visit.
3. Telepodiatry: develop out-of-network with plans that require large patient contact, waiting rooms and poor reimbursement (especially as a surgeon).
4. Develop a cancellation policy.
5. Invest time, energy and money with a high ROI.
6. Invest in mentors.
7. Outsource as much of your practice as you can, profitably.
8. Most important, evaluate your personality, lifestyle, skills, and experience as a caretaker and decide if you are cut out to be a podiatrist in the future.
Dennis Shavelson, DPM, NY, NY
05/13/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Frank Lattarulo, DPM
Everything Dr. Jacobs says is spot on for everyday proper documentation whether during or in the absence of a global pandemic. But correct me if I’m wrong. I do believe there is a pretty broad stroke here and we are falling under Good Samaritan laws for now.
Frank Lattarulo, DPM, Sleepy Hollow, NY
Editor's comment: PM news does not provide legal advice. Under the CARES Act, federal liabilities protections are afforded to healthcare volunteers during the COVID-19 emergency response. "It clarifies that physicians and other healthcare professionals who provide volunteer medical services during the public health emergency related to COVID-19 shall not be liable for providing such services that relate to the diagnosis, prevention or treatment of COVID-19 or the assessment or care of a patient related to an actual or suspected case of COVID-19. Limited exceptions apply for such things as gross negligence, criminal misconduct and providing care while intoxicated. These protections preempt state and local laws that are inconsistent with the CARES Act. However, state laws that provide greater liability protections are not pre-empted."
These additional protections do not alter your duty to provide podiatric care within the reasonable care standards required for podiatrists.
02/11/2020
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: Joel Lang, DPM
When I was in practice, I made it a point to send a letter to the patient's primary care physician for every new patient, regardless of whether or not the physician referred the patient to me. I included the chief complaint, my findings and my treatment plan, even if it was just as small as a simple corn that was trimmed and padded or a simple palliative nail case. When surgery was involved, I always sent a copy of the op report and discharge summary as well. That way, every PCP in my area got to know my name and what I was able to do.
When I retired, more than 75% of my patients were PCP referred and I had about 40-50 regular referrers in my data base. I would send gifts every year to my main referrers both to the doctor (personal gift) and the staff (a bagel tray). It was a very effective marketing/educational tool, and while it took a little time and actually very little money, it grew my practice effectively. Many of my PCP referrers I never met personally.
Joel Lang, DPM (retired), Cheverly, MD
09/03/2015
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY)
From: David Gurvis, DPM
One of my smaller plans was sending me this type of card that I would enter to my charge card machine. They just offered “real” EFT and ERA and upon signing up, I was informed the charge would be 1.9% of the total they would then take out of my bank account for each payment.
So…now, not only do we get low payments, but we have to pay for the privilege? Is this legal?
David Gurvis, DPM, Avon, IN
04/25/2014
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY) - PART 1B
From: Bob Levoy
Here's another way to deal with a patient's complaint that "Your Fees are Too High"
First, clarify what the patient is saying. “Your fees are too high” could mean any of the following: It’s not worth it. It’s more than my neighbor paid for the same thing. It’s more than I can afford. It’s more than I thought it would be.
Each of these interpretations requires an entirely different response. All that may be needed to clarify the situation is a simple question such as: “What makes you say that? or “Why do you say that?”
Source: 201 Secrets of a High Performance Dental Practice (Elsevier/Mosby) by Bob Levoy
04/25/2014
RESPONSES/COMMENTS (PRACTICE MANAGEMENT TIP OF THE DAY) - PART 1A
From: Lynn Homisak
Rather than offer a response that continues to dwell on the money, why not more confidently say, "Really, Mrs. Jones? That's interesting. Let me ask you - besides the money, what is it you are looking for in a podiatrist?" Changing the focus allows you to inform and educate them on the quality of services and care you can give them - a much more positive conversation!
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