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Practice Builders

How To Improve Patient Care While Increasing Revenue

As we prepare for the start of 2015 and the uncertainty of what is around the corner with accountable care organizations, ICD-10, decreasing reimbursements, hospital consolidations, hospitals purchasing referral sources and more, it is easy to get discouraged and give up. Many people will throw in the towel and just continue to see and treat their patients without trying to do anything to improve the practice or the practice revenue.

Others will see opportunity and seize it. A year ago, we founded Foot and Ankle Business Innovations (FABI) to help clinicians who wanted to improve their position and continue to grow their practices. Nearly a year into this experience, 11 podiatric physicians representing nine practices from all around the country have experienced increased billings (30 to 40 percent), increased revenues (15 to 30 percent) and increased excitement for their chosen profession in comparison to the same time last year.

There are many things that go into improving one’s practice. Marketing, employee training, finding revenue sources, coding, understanding financial situations, putting money to work, closing the sale, handling employees and team building are many examples. Let us take a closer look at five ways to improve patient care while increasing revenue.

Why It Pays To Invest In Technology In Your Office

There is an overall reluctance to invest in technology. It is costly. You do not know if you will get reimbursement. You do not know if you will use the technology. Will it break? I have heard all the excuses and they are real concerns. However, you have to spend money to make money.

Musculoskeletal ultrasound investment is a smart choice. Not only can it help diagnose pathologies of the foot and ankle, but many studies have shown that ultrasound guided injections are more efficacious.1-5 Why would you send a patient to a technician for diagnostic ultrasound when you know the anatomy and pathology far better than a technician or radiologist? Properly performing those ultrasound studies (which most insurances reimburse) allows a podiatric physician the opportunity to diagnose in a more timely fashion and start appropriate treatment sooner, leading to better patient outcomes and satisfaction.

Using that same ultrasound device, the proper placement of injections will enhance your patient experience with less pain during the procedure, lead to better results following the procedure and create a “wow factor” that one should not discount. Patients want a modern and progressive experience, and will comment on that regularly. The reimbursement associated with this improved procedure is well worth the time and effort. There is a wide array of costs for ultrasound machines but there are many affordable devices on the market. They may not have all the bells and whistles of other devices, but are extremely effective.

For small groups who refer two to four magnetic resonance image (MRI) studies a week, consider purchasing your own extremity MRI. There are extremely affordable extremity MRI machines that are powerful enough to pass all the requirements of insurance companies. These units are small enough to fit into a treatment room in your office without much retrofitting necessary.

With the proper training, office staff can perform the studies that can yield excellent pictures, help you diagnose pathology more efficiently and start treatments more quickly. Furthermore, patients love the convenience of being able to get their MRI during their appointment and not having to deal with making another appointment, the delay in getting the study and taking time away from their life and work.

Ten years ago, I was lecturing and writing about the benefits of extracorporeal shockwave therapy (ESWT). It was a hot topic that has cooled tremendously in the ensuing years. However, the benefits of ESWT have not. A huge amount of literature from the United States and internationally has continued to prove that ESWT is a successful treatment for a variety of orthopedic and wound related problems. Podiatric expertise in both the surgical and non-surgical management of foot and ankle conditions makes our profession unique and superior to other providers. Shockwave is a perfect addition to any practice that sees plantar fasciopathy, Achilles tendinopathy and other tendinopathies as well as bone and wound problems.

While insurance does not typically cover ESWT, patients commonly accept having to pay cash, given the alternative of surgery and a longer recovery. The cost of ESWT has changed tremendously and now in-office devices are very affordable. There isn’t a week that goes by that I do not hear from patients how appreciative they were to have ESWT and how it changed their lives.

You may look at these options and wonder how to afford them. There is no better time to use small business loans to invest in your practice. The historically low interest rates give you the opportunity to use debt in a very positive way. The increased revenue that these technologies will provide can easily offset the loan payments.

Current Insights On Providing DME And Physical Therapy

Most offices offer a limited amount of durable medical equipment (DME) like removable walking boots and surgical shoes. However, there are so many opportunities with DME that your patients need and appreciate. There are numerous companies that provide bracing for the ankle, foot and toes that are extremely beneficial and insurance reimbursable if one uses them properly. When it comes to DME, most people get caught thinking they won’t get reimbursement or they will just give the DME away. Learning the proper coding and utilizing the DME appropriately can ensure better patient results with increased revenue.

A problem that many people run into with DME is inventory. Proper inventory management is crucial to a successful DME program.

Providing physical therapy services is a great way to improve the patient experience. For some reason, we underutilize physical therapy for the foot and ankle in comparison to other orthopedic providers. For every knee, hip and shoulder surgery, patients get referrals to physical therapy. Why would the foot and ankle be any different? Is the range of motion of the first metatarsophalangeal joint less important than the knee joint? Of course not but it has not been standard to make those referrals.

A great way to provide physical therapy services within your office is to foster a relationship with a local physical therapist or physical therapy company. Explain your needs and see how things work out after referring some patients. If things go well, offer the therapist the opportunity to rent space in your office (for fair market value) in exchange for you referring all the appropriate cases. This is a great way to provide on-site care for your patients while bringing in some revenue.

How Having Retail In The Office Can Raise Revenue

Many people have talked and written about the benefits of providing retail options in your office. The reality is that when you do it correctly, it works extremely well. Patients appreciate having access to products that they would otherwise have to search for themselves at stores or online.

When getting started in this arena, begin with things that many patients need, like arch supports, topical creams such as antifungal medications and other low-cost products like attractive compression stockings. When deciding which arch supports to carry, don’t choose one that is readily available at other stores or online, but pick some that are more unique. There are many companies that provide such arch supports. Don’t be afraid that it will cut into your orthotic business. Use it as a bridge to orthotics. It takes several weeks to fabricate orthotics and patients can use arch supports in the interim.

Once you feel good about your retail offerings, moving into shoes is the real winner. Patients are always seeking shoe gear advice and recommendations from their podiatrist. There are several companies that now offer attractive, supportive shoes that patients will really appreciate. Vionic has now created a program of shoes, sandals and tasteful displays along with training and marketing materials that make this direction more reasonable. Take on retail in a thoughtful way and you will see dividends for your patients and practice.

How Clinical Research Can Be Lucrative

We often think of research as a daunting thing that is limited to very academic-minded physicians in our profession. While that can be true, there are numerous opportunities to get involved in clinical research. There is a ridiculous amount of money that is earmarked for research in the foot and ankle, and companies are looking for patients to participate. Research benefits patients as they may get cutting edge technology to which they otherwise would not have access.

Additionally, some of the technology is cost prohibitive for physicians to use but research obviates the costs. Not all research occurs on hugely expensive devices or products, and can be on more seemingly mundane things that are in all of our practices. Research is a necessity for medical advancement and by participating in studies, you help improve the delivery of medical care for the world.

When participating in research, there are usually payments involved on a per patient basis from the sponsoring companies. Those payments can be in the $100/patient range to the multiple thousands of dollars for more advanced studies. At FABI, we have started a foot and ankle research network. This network will facilitate companies interested in doing research in the foot and ankle space by finding them physicians with a patient population appropriate for their study. By participating in this network, physicians will have access to a tremendous amount of research opportunities and the revenue that comes with it.

In Conclusion

We all hear that things are getting tougher and practice is getting harder. Are you satisfied with surviving or are you interested in thriving? Join Foot and Ankle Business Innovations in January to explore these areas further and others to help spring your practice into 2015 and beyond. Visit for more information.

Dr. Weil is the President of the Weil Foot and Ankle Institute, which has 28 physicians in 20 Chicagoland, southern Wisconsin and northwest Indiana locations. He is a Partner of Foot and Ankle Business Innovations, an organization that helps practices realize their full profitability.

1. Morgan PA, Monaghan W, Richards S. A systematic review of ultrasound-guided and non ultrasound-guided therapeutic injections to treat Morton’s neuroma. J Am Podiatr Med Assoc. 2014; 104(4):337-48.
2. Amber KT, Landy DC, Amber I, et al. Comparing the accuracy of ultrasound versus fluoroscopy in glenohumeral injections: a systematic review and meta-analysis. J Clin Ultrasound. 2014;42(7):411-6.
3. Furtado RN, Pereira DF, da Luz KR, et al. Effectiveness of imaging-guided intra-articular injection: a comparison study between fluoroscopy and ultrasound. Rev Bras Reumatol. 2013;53(6):476-82.
4. Nam SH, Kim J, Lee JH, et al. Palpation versus ultrasound-guided corticosteroid injections and short-term effect in the distal radioulnar joint disorder: a randomized, prospective single-blinded study. Clin Rheumatol. 2013; epub Aug 11.
5. Ustün N, Tok F, Yagz AE, et al. Ultrasound-guided vs. blind steroid injections in carpal tunnel syndrome: A single-blind randomized prospective study. Am J Phys Med Rehabil. 2013;92(11):999-1004.

Practice Builders
Lowell Weil, Jr., DPM, MBA
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