Part time nursing home practice

[Pod House]

Does anyone have experience or recommendations in starting a part time nursing home/ mobile podiatry practice? Is the best way to secure a nursing home through cold calling/visiting? Any recommendations for a cheap/basic EMR? I am looking to work a couple days a month

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[Adam Smasher]

Whether we like it or not, this is the side of podiatry that will continue to flourish. Usually I get calls on a monthly basis for them asking for me or one of my partners, so depending on your area you might find yourself busy quickly as word spreads.

No idea what EHRs are cheap. If you plan to open up an office, it will be easier in the long run to get a good EHR that you can grow into (I use e clinical works)

I am grateful that I do fewer nursing homes than I used to. Because you will bill the patient's insurance, you have no relationship with the admins at the home, meaning they might have ZERO interest in whether or not you get paid. So you need to be on top of getting insurance demographic info on every one. And that's the rub. Trimming toenails is consistent, stress-free work but getting your money for it is a headache. If the admins help you and make your time there efficient, and you treat the residents well, it can be great for everyone involved. Unfortunately that's more the exception than the rule.

 

[Feli]

I would do it through some agency if it's only part time (to get you through until PP volume picks up or whatever). Yes, that neuters % kept, but it's not worth it to set up equip, vehicle, marketing, staff, billing for mobile if your main goal is something else. Work for one of the big ones, work for a mustache, or just buy some old retiring guy's work for a reasonable price.

Whatever you want to do, DO IT. Asap.
Save the$ up, start in the role, make the contacts.
...If you want to be an office pod, do it.
...Hospital limb/pus/wound guy? Do it.
...Big recon? Find that role.
...Prefer mobile? Go get it.
...Teach or publish? Good friggin luck, lol.
...Admin/owner/boss? Start making bank and biz contacts... or climbing hospital politics ladder.

Not many start in dream role, but track that way... ie, PP associate to savings to PP owner... or VA lackey to pass ABFAS to real hospital recon guy.

I see no point to picking EMR and setup for nursing home if that's only a bridge plan to keep finances afloat. Plan the true goals and take a lower % on the mobile to not distract from the end game you want. I did the crap mobile work to bridge non-compete gap years ago or supplement income, but it's a total waste of time to admin it if it's only a temp plan. You're better off searching and planning for what you actually want. It's demoralizing to put significant effort into a 'side hustle' you dont enjoy. Jmo.

If mobile is the only type of podiatry you plan to do (definitely seems to be "NO" here), then, yes... run it yourself.

 

[Retrograde_Nail]

I would do it through some agency if it's only part time (to get you through until PP volume picks up or whatever). Yes, that neuters % kept, but it's not worth it to set up equip, vehicle, marketing, staff, billing for mobile if your main goal is something else. Work for one of the big ones, work for a mustache, or just buy some old retiring guy's work for a reasonable price.

Whatever you want to do, DO IT. Asap.
Save the$ up, start in the role, make the contacts.
...If you want to be an office pod, do it.
...Hospital limb/pus/wound guy? Do it.
...Big recon? Find that role.
...Prefer mobile? Go get it.
...Teach or publish? Good friggin luck, lol.
...Admin/owner/boss? Start making bank and biz contacts... or climbing hospital politics ladder.

Not many start in dream role, but track that way... ie, PP associate to savings to PP owner... or VA lackey to pass ABFAS to real hospital recon guy.

I see no point to picking EMR and setup for nursing home if that's only a bridge plan to keep finances afloat. Plan the true goals and take a lower % on the mobile to not distract from the end game you want. I did the crap mobile work to bridge non-compete gap years ago or supplement income, but it's a total waste of time to admin it if it's only a temp plan. You're better off searching and planning for what you actually want. It's demoralizing to put significant effort into a 'side hustle' you dont enjoy. Jmo.

If mobile is the only type of podiatry you plan to do (definitely seems to be "NO" here), then, yes... run it yourself.

It’s much better to do your own thing than work for healthdrive where you keep like 25-30% of every patient encounter. Healthdrive doesn’t even allow E/M. It’s straight chip and clip you are billing. They are even wary about billing for wound care. If the patients happens to have an MSK complaint you can’t bill for that either. It’s a giant rip off.

 

[Jummy Biffett]

...Hospital limb/pus/wound guy? Do it.
...Big recon? Find that role.

If only it were that easy to just go out and 'do it'. Even the pus-bus hospital jobs are very scarce.

 

[Feli]

If only it were that easy to just go out and 'do it'. Even the pus-bus hospital jobs are very scarce.

I realize that, but I'm just saying do something on the trajectory...
Nursing homes isn't on the trajectory to anything.

PP with wound care as one applies to hospital wound jobs is gaining exp.
PP in busy practice is related to eventual PP owner.
Associate PP surgeon will be on path to ABFAS and other surgery jobs.
Etc.

It’s much better to do your own thing than work for healthdrive where you keep like 25-30% of every patient encounter. Healthdrive doesn’t even allow E/M. It’s straight chip and clip you are billing. They are even wary about billing for wound care. If the patients happens to have an MSK complaint you can’t bill for that either. It’s a giant rip off.

Yes, that's absolutely terrible.
When I did house calls, it was 50 or 60% from various moustaches who'd found the pts, and could bill whatever I reasonably wanted to do a few on a Saturday morning or whatever.

The overhead on that stuff is maybe 10% (roughly 5% billing and same admin)... even if they give you vehicle + driver, I couldn't imagine it'd be over 25% overhead.

 

[Pod House]

How often do you do a E/M for nursing home patients? Do most pods typically do it just for the initial visit? I know most encounters are mostly nails and E/Ms are not as common.

I prefer to start on my own rather than a company or PP. The price per encounter is already low and who needs someone taking 30-50% for submitting a bill for you. I figure overhead should be around 8% max if using a billing company/EMR

 

[619]

How often do you do a E/M for nursing home patients? Do most pods typically do it just for the initial visit? I know most encounters are mostly nails and E/Ms are not as common.

I prefer to start on my own rather than a company or PP. The price per encounter is already low and who needs someone taking 30-50% for submitting a bill for you. I figure overhead should be around 8% max if using a billing company/EMR

The question everyone is pondering is what is your end goal? Is your end goal to open your own practice or just do nursing home forever. Or is your end goal to get a hospital, MSG job or VA?

 

[Adam Smasher]

How often do you do a E/M for nursing home patients? Do most pods typically do it just for the initial visit? I know most encounters are mostly nails and E/Ms are not as common.

Always initial visit. Also the occasional paronychia ("recommended warm soaks") but you're not equipped to manage many diagnoses in that environment

 

[GreenHousePub]

Always initial visit. Also the occasional paronychia ("recommended warm soaks") but you're not equipped to manage many diagnoses in that environment

The nice part about the setting is that so many of them are dead at your next trip through that there are plenty of fresh 99203s.

 

[Retrograde_Nail]

The nice part about the setting is that so many of them are dead at your next trip through that there are plenty of fresh 99213s.

You are going to toenail hell sir

 

[ExperiencedDPM]

The issue with having a significant portion of your income based on your own nursing home business is that it can be taken away in a day.

Most facilities really don’t care who’s doing the clipping. So you can be there for 10 years and counting on that income, and a new admin can take over and his cousin’s boyfriend’s uncle is a starving DPM and they decide to close the door to you and have the new guy take over. And that can literally happen in a minute.

A friend of mine had a boat load of nursing homes that were all under the same management. My friend worked very hard and is an honest guy. He did very well financially.

The medical director for all the facilities was replaced and his brother is a DPM who took over and literally destroyed the nursing home practice my friend had for almost 20 years.

Be careful, there is no guarantee that any nursing home gig you get, will be there tomorrow.

 

[Retrograde_Nail]

The issue with having a significant portion of your income based on your own nursing home business is that it can be taken away in a day.

Most facilities really don’t care who’s doing the clipping. So you can be there for 10 years and counting on that income, and a new admin can take over and his cousin’s boyfriend’s uncle is a starving DPM and they decide to close the door to you and have the new guy take over. And that can literally happen in a minute.

A friend of mine had a boat load of nursing homes that were all under the same management. My friend worked very hard and is an honest guy. He did very well financially.

The medical director for all the facilities was replaced and his brother is a DPM who took over and literally destroyed the nursing home practice my friend had for almost 20 years.

Be careful, there is no guarantee that any nursing home gig you get, will be there tomorrow.

Plus healthdrive or a large mobile practice organization could just swoop in and undercut you to admin. They will do it for cheaper because they can afford to and they are paying their DPMs pennies on the dollar for the services anyways. They still make out well.

Nursing homes will take ANYONE with a heart beat to cut granny’s toenails.

 

[Adam Smasher]

Be careful, there is no guarantee that any nursing home gig you get, will be there tomorrow

Nursing homes will take ANYONE with a heart beat to cut granny’s toenails.

Shame shame shame.

Bear in mind that the most of the positions opening up for new grads are projected to arise from the old school C&C docs retiring and this is the type of career path we are subjecting them to. Such a dirty business.

 

[Retrograde_Nail]

Shame shame shame.

Bear in mind that the most of the positions opening up for new grads are projected to arise from the old school C&C docs retiring and this is the type of career path we are subjecting them to. Such a dirty business.

Do old school chip and clip DPMs control the lions share of nursing homes these days? I would argue no. Healthdrive and these other mobile practices are pretty powerful. I wouldn’t be surprised if the majority of nursing home volume is done by one of these bigger organizations which means even less reimbursement for the podiatrists doing this.

 

[icebreaker32]

Many times it is not too hard to find a handful of local nursing homes or assisted living facilities, but it is usually very hard to scale much beyond that longterm.

The few that do this full time on their own work really hard to get and keep relationships/facilities. It is more than just showing up on time. I have heard of gift cards being given out to key people at each facility by podiatrists each time they see patients there. Small gestures, but frequent to make sure they remember your name and like you. Some drive further than their immediate area and overnight to expand their reach. The sales reps stay in the best hotels and I am sure the mobile podiatrists stay in the cheapest ones when traveling....because podiatry.

 

[dtrack22]

Plus healthdrive or a large mobile practice organization could just swoop in and undercut you to admin. They will do it for cheaper because they can afford to and they are paying their DPMs pennies on the dollar for the services anyways.

Not how nursing home care works at all. Healthdrive can’t undercut you. Neither the local podiatrist, or Healthdrive, are billing the facility. You bill the patient who resides at the facility.

What they might be able to do is offer (in theory) coverage across multiple facilities that they claim will be consistent even though we all know they have significant turnover. They can also package optometry and dental services with podiatry which might make them more attractive than the solo DPM. But none of these services cost the facility anything, Healthdrive can’t “do it for cheaper.”