Taking A Closer Look At In-Office Dispensing

By Robert Smith, Contributing Editor

In-office product dispensing adds yet another role podiatrists must play for their patients—not only must you be a physician and healer, you now must be a retailer as well. While an increasing number of podiatric practices make products available for sale in treatment rooms, reception areas or even their own retail shops, some still decry the practice as exploitative, greedy or unethical. However, DPMs who dispense products in the office emphatically deny such judgments. “We hear so much about why some podiatrists won’t dispense products,” says Hal Ornstein, DPM, a New Jersey-based practitioner and President of the American Academy of Podiatric Practice Management. “One of the biggest reasons is the ethics—the perception of the patient looking at the doctor or the practice as trying to be a retail store, like you’re just nickel-and-diming them. It is so untrue. Look at dentists, dermatologists and optometrists. For years, their offices have been filled with products they dispense. “When I bought my glasses for $250, they still charged me $3 for the cloth. And, as a patient, I’m OK with that.” Lowell Scott Weil, Sr., DPM, recalls a time when DPMs used to give products away but built those costs into the office visit fee. “So if we dispensed a product in the course of an office visit, instead of charging $25 for the visit, we’d charge $30,” notes Dr. Weil, a Fellow of the American College of Foot and Ankle Surgeons. “This is, of course, going back 10 or 15 years ago, before managed care.” Although initially skeptical about charging patients for products, Dr. Weil was convinced otherwise by a respected colleague and mentor. Approximately 25 years ago, Dr. Weil notes he spent a lot of time with a leading foot surgeon, Hampar Kelikian, MD. He says Dr. Kelikian had a magnificent office that was packed with patients, had a completely booked calendar and a very full surgical schedule. However, one day Dr. Kelikian did something that took Dr. Weil completely by surprise. He escorted a patient to the front desk, handed the nurse foot pads and a route slip and said, “Here’s for her office visit and it’ll be a $1.50 for the pads.” “I almost died. I couldn’t believe this elegant man was going to charge her for the office visit and another $1.50 for the pads,” remembers Dr. Weil. “Right then, I said, ‘If he’s doing it, I’m going to do it.’ That was 25 years ago and I’ve been dispensing that long. I came to the conclusion that it is ethical. It’s OK. As more time went on, everyone came to the same conclusion that it is acceptable.” Dr. Ornstein feels that some DPMs’ aversion to dispensing has to do with a much larger problem between doctors and patients. “Too many times in our profession, we try to get into the patient’s brain,” he suggests. “We start thinking for the patient. That’s why we don’t do more orthotics. We think patients can’t afford it. Let them make that decision.” Emphasizing Convenience And Comprehensive Treatment Indeed, those podiatrists who do dispense find their patients react positively to the convenience of being able to purchase products at the practice. “The idea that patients have this great problem with doctors dispensing products is simply not true,” explains Dr. Ornstein. “ … You’re not insisting they buy it here. You’re saying, ‘Because it is convenient for you, we offer this product here as well.’ Over 95 percent of patients would say, ‘That’s great. Let me get it.’ Right there, your ethics and credibility are fine.” John Guiliana, DPM, who is also based in New Jersey, concurs. “Patients feel, as we do, that it increases the comprehensiveness of their care,” he notes. “Not only are we providing them with the medical treatment, we’re also providing them with the products they need right here at the practice.” Comprehensive treatment is the ultimate plus of in-office dispensing, according to Dr. Ornstein. When patients are sent to the local store to get something, Dr. Ornstein says there’s the possibility that they may not get the right product as well as the highly likely possibility that patients won’t receive instructions on how to use it. “Was I giving comprehensive care before (dispensing products in the office)? I would argue no,” he concludes. “If a patient came in with heel pain and also had dry feet, and I only addressed the heel pain, was I giving comprehensive care? Of course not.

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