Hi, Don here. Welcome to Podiatry Practice
Mastery, where we're going to go over the things that help get
your practice to the $1,000,000 mark and beyond.
I want to share kind of one of the challenges and kind of a
potential solution for something in our office.
What we're, what we're finding is as we do more and more
shockwave therapy, it's taking up more and more spaces in the
office. And, and sometimes patients are,
are used to seeing us and they maybe don't want to see another
provider. I'm kind of preparing myself to
say, hey, if I have, let's say I don't know 15 or 20 patients a
week that I'm doing shockwave on, is there a way that a
portion of those would see someone else?
And I want to take an analogy that I heard recently for like a
restaurant. So some restaurants, let's say
they are busy on the weekend, on Saturday and Sunday, Friday,
Saturday, Sunday, but there there's less time during the
week. And so one option is to charge
20% more Friday, Saturday, Sunday.
But it's all how you frame it like charging 20% more to use it
on the weekends isn't a good idea, but you could do it just
the opposite. What you could do is you could
charge 20% less during the week. And that way people think, well,
if I go on the weekend, I'm going to pay normal price, but
I'll get it 20% less if I do it on on during the weekday.
So a way that we could institute that in our office would be
charging, let's say 20% less for the shockwave by having a
certain trained assistant do it for us.
That way, my thoughts are I could do the 1st and the 6th,
but then I could have the other medical assistant or other
person that would be doing it. They would charge a little bit
less. You would just pay them whatever
their hourly rate is and then they could do the shockwave or
they could do other things for us in the office.
So it's a way of getting the patients would maybe want to see
someone else like that. You could say, oh, you could see
doctor Pelto for these or you could see this other person.
And if they do that, you could get a discount for for doing
that because I'm it's not up taking my time.
OK, So what what's happening today?
One thing I always like to say kind of things that embarrass me
as well. So I got caught not wearing
gloves. So let me explain what this
meant in when I make my videos for my YouTube shorts, I I
usually do the whole treatment process and then I will get out
my phone and I'll record a YouTube short for that patient
encounter. If you go, if you want to see
them, you can go to my YouTube, which is doctor Pelto dot doctor
Pelto at YouTube, or you can see it on LinkedIn or other places
where I do these shorts. But usually I do it with a glove
off only because I've already done all the treatments and I'm
just kind of pointing out things.
But someone poked, poked fun of me on, on LinkedIn.
They said, called me out on it and they said, hey, doc, you
should be wearing gloves. So a little bit of embarrassing
moment, but I, I just want to say I'm going to start now when
I do videos, I'll start wearing gloves for that.
OK, so let's, let's do my recording.
This is a recording for a Tuesday in the office.
And I'll kind of explain the rationale between some of these
patients. So the first patient was a 58
year old female. She had anterior calcaneal
fracture that was noticed and she was kind of overweight and
wasn't really a good surgical candidate.
And really there wasn't a great surgery for that.
I did 6 sessions of Shockwave and now she's about 80 to 85%
better. I got X-rays now comparing it to
like 6 weeks or actually more than like more like 3 months ago
and it's there's still there's healing in crossing over over
that fracture site. So I did that.
That was I didn't do another session of Shockwave.
This was a follow up I did. She also asked for nails and
callous care so I did that. I'm going to see her back in
three months, get another X-ray at that time.
But this is really just the shockwave follow up.
So she was a a success and she's feeling so much better.
She's out of her Cam boot. Next was a 56 year old male.
He's a orthotic A6 week follow up and he also had a question
about one of his nails. So I debrided that nail so it
would be an office visit. His orthotics are feeling good.
No follow up, but I did debride that thick nail.
So I think a lot of times if you see a patient, for example, with
with a callus or with a thick nail, you're not going to see
them back for for for a long time or you maybe not seeing
them back. But I think just adding that on
can add, can it do a bump up in your in your office charge?
I'm always an advocate of what you can do that provides value
to the patient, but then we'll also increase the per visit
value for that specific visit for the patient.
So just adding simple things like adding a callus and maybe
they even know it's not covered so they'll charge for, you'll
charge for that or adding a foot cream or adding something else
like that just can increase that amount for the visit.
So it would be something that's a typical normal office visit.
It can increase that amount and that and that's one of the I
think the easiest low hanging fruit to get to the $1,000,000
mark. Next patient was an 83 year old
female. She had bilateral hallux
rigidus. We did X-rays bilaterally.
We talked about that. So we had the office visit for
that Level 3 visit and then we did nail care.
She also wanted nail care and so she's going to be seen back in
three months by my nail technician.
So I also introduced my nail technician saying that she would
be the one that would be doing the care.
Next patient was a 45 year old female.
She had bilateral insertional Achilles tendonitis.
I did bilateral shockwave for her combo which is radial and
then non radial and that was #2 out of 6.
Now I want to explain about this patient.
So she, she originally last session I only did one side and,
and both sides were bothering her.
And this is kind of a kind of a, not a kind of an ethical and
financial dilemma. So I feel bad for this patient.
I did bilateral ultrasounds today for her and it showed that
they were both there's a fusion and swelling at the insertion.
She has a spur on the on the good side, there was a kind of
normal thickness, but on the bad side, she's had 10 jet on that
before and it's just really thick.
And I couldn't in good conscience only do the only do
one side because that's all she could afford.
So what I told her is I'll do both sides.
I'll kind of chalk it up as a pro bono.
And she she works at like a urgent, a convenient urgent care
as a rad tech. And so I said, you just, you
know, try to refer more patients.
I think that's going to create a lot of goodwill.
Some patients that can't afford the bilateral, a lot of times
I'll add it in because it doesn't take me much longer and
I just feel better about doing that.
And I think from that goodwill, many other patients will be
referred to the office. Next patient was a 79 year old
man. He had sciatica and he came in
from his primary care. I looked at his X-rays, he has
some foot manifestations and he's already going to PT.
He's already on gabapentin. I talked to him about doing an
orthotic and that's something that he he wanted to do.
So we did orthotics for him. Next patient was a fracture of
the second metatarsal and she also had a bunion.
So for her she had a stress fracture in that area from doing
a lot of walking while she was on vacation.
I gave her a Cam boot and an even up.
So once again, as we're talking about increasing the per visit
value, anytime you can add something.
So one thing we always add when, when patients get a Cam boot is
they say you're going to get an even up.
So even up is something that evens up the the height so it
doesn't throw their hips off. Another thing that patients get,
so when they're doing matrix ectomy, they're always getting
the post op kit. So these are things that you're
adding on to things that you're already doing.
I think this is obvious, but I'm just kind of being clear to to
kind of instruct on how to get to the the $1,000,000 mark.
Next patient was a 75 year old female hallux fracture follow up
and X-ray only. So if I'm talking about least
valuable patient, this is probably the least valuable
patient of the day. She had a fracture.
It's doing better. I only got the X-ray.
I didn't get any office visit. She didn't really have any other
issues. I don't know any other way
except just reducing the amount of follow-ups for these that you
can reduce the low value patients.
I guess one option would be, I'm just thinking about it out loud.
The same way that I see my matrix follow-ups in a 10 minute
slot in three weeks. If it's going to be a simple
fracture, I could do my fracture follow-ups with X-rays in my 10
minute slot. So kind of reserving those 10
minute slots in my schedule to accommodate the things that
wouldn't, you know, relegate to a higher level visit and we'd be
just only an X-ray. So that would be something that
I can also do in the future. So I'm, I'm starting to develop
as a list of like 10 minute appointments that are going to
be quick and usually easy. So I can add this to this.
Like usually it's a matrix follow up.
Apparently I'm not even seeing back maybe even like a simple
orthotic follow up, putting these in these 10 minute slots.
I think that might be a good reason to, to do the to do
those. Next patient was a 60 year old
female, had bilateral ankle replacements and this was done
by another person in Boston and she was here to see me to get
the orthotics afterwards. So she currently has orthotics.
I did a new pair of orthotics for her.
We scanned her and then she will be seen for follow up at the six
week follow up. Now even even I'm just thinking
out loud here. So even some of these patients
that I always see for six week follow up for orthotics, in this
specific case, if she's been used to them, they're fitting
fine. She might not need that six week
follow up. The next patient was a 84 year
old man. He was here for after his
Lamisil booster. 9 out of the 10 toes got better.
I think that's considered success and he has one toe that
has something. I could potentially switch him
to something else like a Diflucan or a Sporinox.
But in his specific case at his age, I'm just going to call good
enough alone and I'm going to leave it.
So just the office visit for that one.
Next patient was a 73 year old female.
They had calluses. I trimmed those calluses and
there was just like a self pay. I don't know how she got into my
my non routine day, but I think it's because she was just saying
she had painful feet, maybe a wart.
That's what she called it. But when I looked it was a
little over a year. She was here for those calluses.
So I did counseling for calluses.
So that was a level 2 office visit.
I don't do many of those level twos, but level 2 office visit
counseled about calluses, orthotics, and then I did the
calluses which were $75.00 for that patient.
Next was a 85 year old with a matrix follow up.
That was a quick one. Once again, these are my 10
minute slots that I'm using. Next was a kind of an
interesting patient. This was a 42 year old female
that likes to do a lot of running and she had an MRI done
in a tibialis anterior tear, tear at the insertion and we
talked about different treatment options.
She's already been in a Cam boot for about two months and it's
still not better. So we set up number one out of
six of her shockwave. So she did shockwave today and
she also has a wart on the right foot so the tib Ant tear is on
the left and for the award we did kanthridin on the right
side. So we were able to get the
kanthridin bill and as well the follow up MRI and the shockwave
for her next patient was a 65 year old man.
He had a recurrent ulcer on the tip of the hallux due to a
previous first MPJ fusion where it caused a kind of a cocked
down hallux. I'm going to see him back in
three weeks and I debrided it. So I got the office visit, the
debridement and the and the follow up and I have a, a short,
how do you say a short referral patients.
So if he's not better in a few weeks, I'm going to send him to
the wound care center. I don't do a ton of wounds, as
you can tell by my these little discussions we have here.
Next patient was Swift number six.
He I usually do for swift, but today he needed another one.
So he was number six and I'm going to see him for a one month
follow up. I did Kanthordin as well.
So one other thing about Swift, usually I do Swifts and if I add
on Kanthordin, I'm not billing for the Kanthordin and the
Swift. I just sometimes feel like it's
double dipping and Catherine doesn't really take that much.
Yes, you have the liquid you put on there and the bandages, but
in his case he's already on #6 so I will just do the Catherine
without charging it. I guess one other option is you
could do the Swift without charging it, but I tend to do
the Catherine without charging it.
One other option I've kind of thought about if you do use
Swift, I know they have a, a benefit, I guess they say like
if you do a video about your Swift, they will give you, they
will credit you, I think a box of Swift tips.
So I'm just thinking about this out loud.
So potentially if, if, if you do videos on some of the patients
that maybe can't afford Swift, you could theoretically not
charge them because they would get the, the the box that comes
with the Swift. It's one of the added benefits
of of making video or doing social media stuff for them,
like sending them the video that you did and then and then doing
it kind of pro bono for some of these patients that maybe can't
afford it. I thought it's kind of a neat
idea and just say, hey, if you do this video, we can do it for
free because they're going to give me a free box and a box
will have so many, so many tips in there.
That was just an idea I had today.
And then the final follow up was the 65 year old for a right 5th.
I'm trying to read my handwriting fifth met resection.
I think what I did that for this one here is I did canthered in
on this one. So it like a fifth met canthered
in for this patient. OK, that was the day.
Once again, I have a, a practice like $1,000,000 practice
blueprint on our on my website Podiatry practice master.
If you found this beneficial, I kind of do a deep dive into all
these topics that I'm talking about here, you might find it
beneficial. I'd love to share that with you.
And also if you want to do my see my daily treatment tracker,
This is what I use every day to to kind of track what I do.
And I think it keeps it to front of mind.
So even if you're like not going to record your own podcast, I
think recording it and kind of keeping value the most valuable
patient out there is a is a good thing to do.
OK, until tomorrow. Thanks guys.