Online Podiatry Stores: Can They Enhance Revenue And Patient Care?

By Brian McCurdy, Associate Editor

   When patients seek out podiatric products, they may be referred to companies and Web sites that may not offer a proper selection. Patients may have to search hours for the right product and podiatrists might lose potential income by not offering the items themselves. However, one company lets doctors sell the products they recommend through customized Web sites. creates Internet storefronts for physicians. Lowell Scott Weil, Jr., DPM, MBA, says the company offers several benefits for podiatrists and their patients. One advantage of the Internet stores is products are marked up between 60 and 100 percent from the wholesale price and the doctor gets all the profit when the patients get products from their doctor’s Web store site, according to John Moroney, Chief Executive Officer of, the parent company of     “(These sites) provide doctors with additional income they would otherwise be losing to someone else,” explains Dr. Weil, a Fellow of the American College of Foot and Ankle Surgeons, and a Medical Director with    Not only are the participating doctors generating additional income, Dr. Weil says they also have reduced overhead as they do not have to carry the inventory or have staff process orders for products. Dr. Weil says sends products directly to the patients. is a consignment wholesale supplier which invoices physicians once a month at wholesale pricing for any items sold on their site, according to Moroney. After patients pay for items, the company reimburses doctors for the full purchase price of the products sold.

Emphasizing The Patient Benefits Of Convenience, Cost Savings And Compliance

   Dr. Weil says there is added convenience and potential savings for the patient. Through these online stores, Dr. Weil notes patients can order products at competitive prices and have the convenience of ordering them from their own computer or the doctor’s office computer. By going directly to a site that has the product they need, patients save the time of searching the Internet or local stores for something the doctor recommended.    Since the online stores are strictly retail, Moroney explains that is not required to bill insurance and can pass the savings onto patients. He says the online stores are perfect for patients whose insurance does not compensate for medical products or uninsured patients who pay for products themselves.    There may also be an additional benefit of facilitating patient compliance. As Dr. Weil points out, doctors often do not carry items in their office and send patients elsewhere to buy the products. Accordingly, “the patients may not get what the doctor wanted (them to get),” points out Dr. Weil.    Ken Rehm, DPM, concurs. His products are available on Dr. Weil’s Web site,, and other sites to ensure his patients get exactly what he recommends to them. Dr. Rehm notes that some patients were unaware of the diabetic cream, which he has sold for 30 years, so he feels the site offers a venue for communicating with patients about the cream and actually showing them the product.     “I think it is phenomenal. I have gotten so much interest through this site,” says Dr. Rehm, who is board certified in the prevention and treatment of diabetic foot wounds.    Dr. Rehm says the time has come for online podiatry stores that doctors can refer their patients to for products. “They are establishing a place for quality products,” adds Dr. Rehm.

Medicare Committee Examines Usual Care Of Chronic Wounds

By Brian McCurdy, Associate Editor    As wound care specialists know, chronic wounds can seriously impact the health of Medicare patients. The Medicare Coverage Advisory Committee (MCAC) recently heard testimony from several experts in the wound care field on the topic of usual care of chronic wounds.    The committee has listed venous ulcers, arterial ulcers, pressure ulcers and diabetic ulcers as chronic wounds. However, Diane L. Krasner, PhD, RN, CWOCN, CWS, FAAN, told the MCAC that this definition of chronic wounds excludes groups of wounds that are prominent among Medicare patients.    She recommended adding six categories to a definition of chronic wounds. These wound categories would include: non-healing surgical and traumatic wounds; ischemic wounds other than those caused by arterial insufficiency; vasculitic wounds; malignant wounds; end of life/palliative wounds; and wounds of mixed etiologies.    The MCAC had defined chronic wounds as those taking longer than 30 days to heal. However, Dr. Krasner, President of the Association for the Advancement of Wound Care (AAWC), recommended shortening the time frame as surgical wounds become chronic once they dehisce on day five.    Dr. Krasner testified that she and the Alliance of Wound Care Stakeholders believe the model of wound care should include nutritional support, vascular testing and psychosocial support. The MCAC had listed debridement, cleansing, dressing, compression, antibiotics and offloading as common care for chronic wounds.

Urging A Common Ground Of Outcome Studies, Common Sense And Reimbursement

   The Centers for Medicare and Medicaid Services (CMS) are progressing toward a disease management model, according to David G. Armstrong, DPM, MSc, PhD, who testified at the meeting. He says major diabetes demonstration projects are in the works and wound healing holds promise as a subject for a similar project.     “The key factors that we emphasized to the MCAC involved marrying common sense with high technology,” says Dr. Armstrong, Professor of Surgery, Chair of Research and Assistant Dean of the William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science. “This is a field that is expanding so rapidly that the technology is outstripping that common sense.”    As new technologies evolve, the committee raised the question of whether new outcome studies are needed to demonstrate a benefit in treating chronic wounds. Dr. Armstrong, a member of the National Board of Directors of the American Diabetes Association, says he hopes improved metrics pertaining to study endpoints and clinical endpoints could be merged with appropriate payment for clinicians’ services.    As he explains, a clinician often has difficulty getting reimbursed for applying a modified removable cast walker. Without such a device to help offload wounds effectively, Dr. Armstrong notes with the first few unprotected steps the patient takes, the $1,000 dressing, device or bioengineered product one places on the wound will be destroyed.     “We have a host of potentially revolutionary modalities either available or soon-to-be available but we are not assessing them as well as we could, and we are not treating our patients as well as we could,” maintains Dr. Armstrong.

Emphasizing The Importance Of Multidisciplinary Care

   As Dr. Krasner told the committee, chronic wounds are symptoms of underlying conditions that must be treated before the wounds can be “jump started to heal.” She emphasized the importance of an interdisciplinary approach among physicians, nurses and physician assistants in healing complex wounds with multiple comorbidities.    Dr. Krasner brought up the example of one patient, who was transferred from a nursing home to a wound healing center with what she called the worst untreated pressure ulcer she had seen in her career.     “She was septic, delirious and in excruciating pain. Unfortunately, the patient was beyond the point where we could save her,” recalled Dr. Krasner. “No one at the nursing home had a clue. That’s a problem.”

Can Denervation Alleviate Sinus Tarsi Pain?

By Brian McCurdy, Associate Editor    Recalcitrant sinus tarsi pain can disrupt the lives of patients but a new study says sinus tarsi denervation can relieve pain and facilitate a quick return to activity with minor post-op complications.    The study, which was recently published in the Journal of the American Podiatric Medical Association, followed 13 patients who had undergone denervation due to sinus tarsi syndrome. Six months after surgery, 10 patients were totally free of pain, were wearing normal shoes and returned to work, according to the study. Authors noted two patients had “a small degree of residual pain” but were performing normal activities in normal footwear. They noted that the one remaining patient experienced pain relief but could not resume regular activities.    Co-author Stephen Barrett, DPM, CWS, notes the denervation approach could be advantageous over some of the other treatments because subtalar joint fusions can fail to fuse and patients may still experience continued post-op pain and more nerve entrapment. Sinus tarsi denervation may also allow continued use of an arthroereisis implant where postoperative pain is present, according to the study.    Dr. Barrett says sinus tarsi denervation is not without a few disadvantages, noting there may be some loss of cutaneous sensation between the dorsal aspect of the second and third toes, and a minor motor loss of the extensor digitorum brevis.     “However, these are relatively minor tradeoffs to eliminate pain,” says Dr. Barrett, an Associate Professor at the Midwestern University College of Health Sciences Arizona Podiatric Medicine Program.    Study authors note diagnostic lidocaine injections can help reassure patients about what to expect postoperatively.

In Brief

   Liberty Medical Supply, Inc., a direct-to-consumer provider of Medicare reimbursable diabetic testing supplies, has partnered with SureFit. Liberty has stopped dispensing diabetic footwear and will provide its customers with information on SureFit’s diabetic footwear, according to the company.

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