A TENS Unit For Heel Pain? Questioning The Ethics Behind Some ‘Practice Management’ Lectures

I have had the opportunity to listen to so-called "practice management" presentations at a number of state and APMA component society meetings. To be quite frank about it, the content presented is nothing less than offensive as it advocates profit motive over patient care. What is even more shocking in my opinion is the seeming growing relationship of the APMA with these programs.

It is one matter to instruct practitioners on proper coding and effective management of an office, alert practitioners to changing health care opportunities or advocate other legitimate practice opportunities. It is quite another to advocate selling everything but the kitchen sink to every vulnerable patient. Effective practice management is one thing. Fleecing a patient is another. I wonder how the individuals who advocate some of the "practice management" protocols at our meetings sleep at night, knowing that their primary motivation is based totally on profit and not patient care.

One particular program addresses “protocols” for the treatment of plantar fasciitis. Have you seen or heard this program? Before the patient walks in the examination room, your office staff has already checked on benefits for the patient such as TENS units, physical therapy, orthotics, braces, shoes, etc. TENS units? For heel pain?

All patients are to get X-rays, diagnostic ultrasound and injections of the heel under ultrasound direction. All patients receive an immediate temporary orthotic, which requires several follow-up visits to gradually increase extrinsic posting. After all, we all know that rapidly putting anyone into 4 degrees of rearfoot varus can result in untoward disaster.

Everyone gets as much physical therapy as the insurance ...er ... the patient will tolerate. Then there are more injections. Then there is the real orthotic. Do not forget to sell them the shoes that the orthotic requires. Oh yeah, on the way out, have the patient pick up the night splint, CAM walker and brace.

Did I forget the topical lotions and potions? These are required to get the skin in shape for the mandatory low energy ESWT (provided at a reduced fee for the first three treatments), the radiofrequency coblation or the endoscopic heel spur surgery.

And a TENS unit for heel pain?

I guess they have not heard of platelet-rich plasma (PRP) yet or that would be included. One might also think about socks that make the orthotic more effective by increasing the coefficient of friction between the sock and the orthotic (orthosock?).

In short, sell the patients everything that they or the insurance will pay for.

I often wonder how proud these people are of themselves. I like making a nice living but I do so by hard, honest work.

What bothers me beyond the shear lack of ethics advocated, in my opinion, by these people is the average podiatrist who wonders why we are constantly fighting exclusion from various health care plans and why we are not seen as equals by many insurance carriers.

Simply stated, if you practice in this manner, you cost too much.

This is not providing the patient with the best care regardless of cost. This is providing the doctor with the most profit regardless of need.

Our profession has many legitimate leaders in practice management who pass on wonderful ideas, information and ethical proposals for increasing practice bottom lines.

If you have heard the aforementioned presentation at a meeting, I would love to hear your comments. I would like to extend these comments but I have to go. I have some heel pain patients that need some TENS units. Maybe I can also sell a kitchen sink or two.