Six Ways To Achieve Practice Excellence

By Brian McCurdy, Associate Editor

Do enough people know about your practice? Do enough primary care doctors know about your practice? Are you getting enough referrals or are most of them going to the DPM two blocks over? Several DPMs and a podiatric assistant say you have to be skilled in patient empathy, excel at staff relations and be a savvy marketer, among other things, if you want to build and sustain a thriving podiatric practice. 1. Emphasize empathy and pay close attention to patient needs. Jim Ritchlin, DPM, takes notes on his patients’ lives, not just on their foot conditions, which he keeps in their medical charts. Before patients visit his office, he reviews the personal information so he can chat about their lives with them. “They perk right up when I know who they are. They’re not just a number,” says Dr. Ritchlin, who has been in practice for 37 years. “I’m picking their brains. I like to know what makes them tick.” Dr. Ritchlin sees 40 to 50 patients a day. He sees five or six new patients a day and notes the number of patients he sees has increased by 15 percent in the last year. “I’m on stage all day. I love to schmooze people,” explains Dr. Ritchlin. “To me, practicing is fun.” Patients are first and foremost for William McCann, DPM, the President-Elect of the American Academy of Podiatric Practice Management. “They hire you, literally, and you’re working for them,” says Dr. McCann. “You really need to have their best interests at heart at all times.” Combine Honesty With Empathy Renee Silva, DPM, agrees. She has been in practice for five years, half of it as part of a group and now on her own. Dr. Silva says part of the secret to being successful is truly listening to your patients and presenting medical options to them as opposed to dictating courses of treatment. She says you should avoid giving patients a short-term fix to make them happy. Instead, Dr. Silva advises DPMs to tell patients what may happen as a result of certain treatment options and even suggest getting second opinions in certain cases. “Really be honest with them,” urges Dr. Silva. “Don’t sell them podiatry. Tell them what really works.” While seeing dozens of patients a day may foster a sense of tunnel vision, successful DPMs say it’s essential to be aware of the whole patient instead of just zeroing in on their feet. “We treat our patients well as people. I always try to remember there’s a person attached to that foot,” notes Peter Brieloff, DPM, who has been in practice for 15 years and runs the five offices of Brieloff Foot Centers in Cumberland, Md. “We have to treat the patient comprehensively,” agrees Hal Ornstein, the President of the American Academy of Podiatric Practice Management. “We, as podiatrists, have to do comprehensive care.” Recognize And Encourage Staff Excellence 2. Treat your staff like gold. Dr. McCann points out that your staff members need to be “real ambassadors” of the practice. “People are calling in with pain and it’s so important that the empathy factor is there,” notes Dr. McCann. That’s just one of many reasons why you should do everything you can to treat your staff well, especially when they are your right-hand men and women in the office. A longtime podiatric medical assistant says a good relationship between DPMs and their staff is vital. Lynn Homisak, PMAC, says the respect doctors have given her has kept her in the field for over 30 years. She adds that the experience of assistants can be a valuable asset for any podiatric practice. In her office, Homisak does all the padding and strapping of patients, takes their blood pressure, clips nails, gives foot massages, provides chairside and surgical assistance and does casting for orthotics, all of which she is trained to do. She says her doctor has given her “leeway from day one” to do such things. Homisak says letting staff do more for doctors increases practice revenue and reduces stress. While podiatrists may express reservations about paying trained assistants more to perform extra duties, Homisak counters that they can make up the increased costs with extra revenue, since doctors are able to see more patients when certified assistants take on some more work. Of course, if you want your staff to take on more responsibilities, it helps to be respectful and cognizant of their workloads. In dealing with his staff, Dr. Ornstein says he “treats everyone like gold. Feeling valued is the root of all this.” Dr. Ritchlin says he tries to keep a sense of humor in his practice. If his staff members are in a good mood and he respects them and does not “jump all over them” for errors, he notes they do not feel they are under the gun or stressed out. He says he maintains an “atmosphere of friendliness” in his office. Dr. McCann says his partners and staff have to be on the same page as far as the mission of the practice and the timeframe for getting things done. “If everybody gets on the same page with those things, that to me is probably the single most important thing,” he says. “The most important thing is to just surround yourself with the right kind of people.” How To Increase Efficiency 3. Run a tight ship. In a typical day, successful podiatrists may see dozens of patients and it can be challenging to keep up with the pace. Several DPMs advise those just starting out to maximize their time and use a highly-trained staff to keep things running smoothly. Dr. Ritchlin says his staff is great, well-trained and can keep up with the dozens of patients he sees every day. His office has six treatment rooms and all his patients are lined up and ready to go so he can see patients more efficiently. He adds that he arrives for work an hour early so he can line up his schedule for the day and determine a game plan for seeing so many patients. It’s vital to schedule the right amount of time to treat each patient. For example, Dr. McCann says checking a patient’s nails should take five to six minutes, not a half-hour. “Scheduling efficiently is truly important in this day and age and your staff needs to be well trained in that,” emphasizes Dr. McCann. When new patients call to make an appointment at Dr. Brieloff’s office, they’re able to fill out new patient information packages at home so they don’t waste time filling them out in the office. His assistant determines what kind of pain the patient has and determines an initial workup for the patient. To keep things moving smoothly, Dr. Brieloff examines the patient’s X-rays before seeing him or her and delegates ancillary procedures to staff. Jake Goldstein, DPM, concurs, noting that one of his employees often will talk to a patient about a product while he sees another patient. Homisak adds that having all staff trained for front and back office work enables them to cover for each other, which reduces stress and maintains peak efficiency. Turbocharge Your Incoming Referrals 4. Maximize the marketing of your practice. Since referrals are essential for building your patient base, it’s important to maintain a good relationship with primary care physicians. Dr. Brieloff and Kristen Titko, DPM, say you should meet with local family practitioners to build awareness of your practice and what services you can provide for their patients. Dr. Titko runs seminars on basic foot conditions for primary doctors and also does in-services for nurses. “We educate them and they have a better understanding of what they’re doing,” she says. Dr. Ornstein’s staff takes it one step further. One of Dr. Ornstein’s assistants has a “lunch and learn” with primary care doctors’ office managers and the doctors themselves. The assistant brings lunch and presents information on what podiatrists do and to which insurance plans the DPM belongs. Every few months, Dr. Ornstein’s assistant stops by the primary care practices with updated insurance information. According to Dr. Ornstein, these visits enhance the visibility of his practice by giving primary docs and their staff a familiar face to remember when they need to refer a patient. In order to keep the referrals coming, many DPMs recommend sending thank-you notes to referring docs and information on how they handled the patient’s care. Dr. Brieloff says when primary physicians see his letterhead cross their desks, they will know to whom they should send future referrals. Dr. Ornstein adds that he even gets patient visits from the staff of primary care docs because they’re familiar with his letterhead on follow-up notes. Patients can spread the word as well, points out Dr. Titko, who sends letters or gifts to patients who refer others to her practice. Consider The Various Advertising Vehicles What about advertising? When the school year begins, Dr. Titko places a blurb in the local newspaper to advertise her practice, which she has maintained for eight years. To keep his name visible, Dr. Brieloff makes two cable TV ads every year that are focused on heel pain and diabetic foot problems. He says the ads are a big hit and patients enjoy the appearances of his 9-year-old daughter, Alyssa. “They’ve just gone over really well,” he says of the commercials. “I try and educate about conditions and what we as podiatrists can do to help them.” Managed care has altered how Dr. Ornstein markets his office. He says advertising in the Yellow Pages has “lost its value” since patients now obtain information on doctors from insurance company reference books. Dr. Ornstein recommends Internet marketing, noting that it’s a good way to differentiate yourself from others in practice. He notes that the Web page of the American Academy of Podiatric Practice Management ( has increased visibility for himself and other DPMs. Build A Presence In The Community If you’re just starting out in podiatry, Dr. Brieloff advises you to choose the location of your practice wisely. He recommends staying away from large cities with plenty of podiatrists and instead setting up shop in a more rural area. To that end, DPMs say it’s important to establish yourself in the local community. Last October, Dr. Ornstein volunteered his services at “Ground Zero” of the World Trade Center ruins, treating patients’ foot problems and consoling them after the terrorist attacks. The services of podiatrists and a legion of other specialists had been requested after the Sept. 11 attacks. As Dr. Ornstein told a newspaper last fall, while offering his podiatric services was important, it was just as vital to give comfort to the injured. Dr. Ornstein is involved in his own community and has served as president of his local Chamber of Commerce. “You have to put your time in. It’s an investment of time and energy. If you don’t do it, you can’t complain,” maintains Dr. Ornstein. Fight The Good Fight With Insurance Companies 5. Manage the managed care hurdles. For many podiatrists, there’s no way to get around dealing with a managed care system. While the system does present an array of daily challenges, successful DPMs says the obstacles aren’t insurmountable. To be successful, Dr. McCann says you need to deal adeptly with insurance companies to get reimbursed for your services. He pays attention to proper coding to help ensure compliance with codes and enhanced profitability. Once a year, Dr. Titko goes through ICD and other coding books, and makes sure her practice reflects recent codes. Dr. McCann suggests trying to deal with the same person each time at an insurance company, since dealing with one person who is used to you helps ensure that you will get reimbursed quicker. While some may be tempted to take shortcuts, Dr. Titko strongly advises against it. “Keep it ethical and don’t try to cheat the system or you’re going to get caught,” offers Dr. Titko. “If you keep it honest, you’re going to be more successful than your wildest dreams.” However, “Don’t lie down and die” if the insurance company denies you payment for treating a patient, advises Dr. McCann. He says you must train your staff to “go out and fight” if you feel an insurance company has treated you unfairly. If the company does not have a particular code or a confusing one for a podiatric service, work with the insurance company to develop a solution. Dr. McCann says it’s critical for you and your staff to understand and constantly review the explanation of benefits. “There’s never a time when you should stop reviewing those claims because you need to know what you’re getting paid for and what you’re not getting paid for,” explains Dr. McCann. “In an office setting, we need to keep pace with the changes in medicine.” Final Notes 6. Keep an eye out for potential revenue streams you can bring into your practice. Dr. Ornstein says a “winning trend” in podiatry, one which can increase your revenue, is dispensing products in the office. He was reluctant to do this at first, since he did not want to be seen as a retailer. However, since he started to dispense products a few months ago, he has found that it enhances patient satisfaction and increases his income. Patients see the dispensing of products in his office as convenient and they note the office has high-quality podiatric products. Dr. Ornstein adds that some doctors have created separate offices to house their podiatry products and selling such products can account for as much as 10 percent of their revenue.

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