Costs and figures... startup Solo podiatry office

[BeaverBlade]

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I do a LOT of shoes. Prior to joining my group, my partner trained the staff on this. Personally, I just tick off boxes and sign a set of forms in 3 places and that's the extent of the work I do. Unfortunately, I can't change the system and I've become a part of it.

With respect to staff time: they'd just spend the time scrolling their phones so idgaf
With respect to storage: I have the space, but a lot of vendors are switching over to 3D scanner apps which saves on foam boxes
With respect to audits: my partner used to do a lot of custom molded shoes (A5501 not A5500) and those were the only things we got audited on. I dunno, maybe I'm due.
With respect to customer service: patients get 2 retries before they're banned for life

I think I posted elsewhere our group's profit in 2025 was about $75k off shoes alone. You decide if you want to give it to Hanger.

I'm intrigued I just thought it was a pain to get signed up with the medicare DME process. don't you have to put down a ton of money in a bond or something? I don't quite understand the process.

 

[Adam Smasher]

I'm intrigued I just thought it was a pain to get signed up with the medicare DME process. don't you have to put down a ton of money in a bond or something? I don't quite understand the process.

I don't believe so:

 

[Weirdy]

I'm intrigued I just thought it was a pain to get signed up with the medicare DME process. don't you have to put down a ton of money in a bond or something? I don't quite understand the process.

You fill out an application, pay the fee (was around 600 for mine)

Then you get an accredited 3rd party to check if your facility adheres to standards to dispense (think Joint Commission etc, there's a list, same people that do it for labs and hospitals)

Edit: I still havn't gotten the accrediting party to come out and tour my office. I asked if I still needed it since I am sharing space with a medicine group who's already approved because of inhouse labs. They said I still needed one done because that is a different entity.

 

[Boba Foot]

I think I posted elsewhere our group's profit in 2025 was about $75k off shoes alone. You decide if you want to give it to Hanger.

Guess I need to look into shoes and become Al Bundy.

 

[Adam Smasher]

Guess I need to look into shoes and become Al Bundy.

In one episode, he called his job a "minimum-wage paying slow death." That's stuck with me for years.

Edit:

 

[Mia McBhul]

You fill out an application, pay the fee (was around 600 for mine)

Then you get an accredited 3rd party to check if your facility adheres to standards to dispense (think Joint Commission etc, there's a list, same people that do it for labs and hospitals)

Edit: I still havn't gotten the accrediting party to come out and tour my office. I asked if I still needed it since I am sharing space with a medicine group who's already approved because of inhouse labs. They said I still needed one done because that is a different entity.

right now there is a moratorium for DME licenses per federal government so no new licenses will be given to practices until they lift it

 

[Weirdy]

right now there is a moratorium for DME licenses per federal government so no new licenses will be given to practices until they lift it

Thought this only applied to DME suppliers?

 

[Boba Foot]

The nationwide CMS temporary six-month moratorium on new Medicare enrollments for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) [expired on August 27, 2026]. [1, 2]

💡 Current Status of DME Moratoria

• • ✅ CMS Medicare Moratorium: Expired August 27, 2026; applications are now accepted.
  • ⚠️ Application Backlog: Expect processing delays due to high volume.
  • 📌 State-Specific Rules: Check local state Medicaid programs (e.g., Florida's separate state moratorium ran through Sept 20, 2026). [1, 2]

If you are applying in a specific state or need help with Round 2028 of the DMEPOS Competitive Bidding Program, let me know your state and supplier category so I can provide precise guidance.

 

[air bud]

There is a TFP deep down in every podiatrist.

The surgeon was forged in the fire....the TFP was birthright

 

[Mia McBhul]

The nationwide CMS temporary six-month moratorium on new Medicare enrollments for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) [expired on August 27, 2026]. [1, 2]

💡 Current Status of DME Moratoria

• • ✅ CMS Medicare Moratorium: Expired August 27, 2026; applications are now accepted.
  • ⚠️ Application Backlog: Expect processing delays due to high volume.
  • 📌 State-Specific Rules: Check local state Medicaid programs (e.g., Florida's separate state moratorium ran through Sept 20, 2026). [1, 2]

If you are applying in a specific state or need help with Round 2028 of the DMEPOS Competitive Bidding Program, let me know your state and supplier category so I can provide precise guidance.

already tried. The moratorium is still in effect until further notice. I have everything ready to submit my application just waiting for them to lift it.

 

[Aresnebula]

The nationwide CMS temporary six-month moratorium on new Medicare enrollments for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) [expired on August 27, 2026]. [1, 2]

💡 Current Status of DME Moratoria

• • ✅ CMS Medicare Moratorium: Expired August 27, 2026; applications are now accepted.
  • ⚠️ Application Backlog: Expect processing delays due to high volume.
  • 📌 State-Specific Rules: Check local state Medicaid programs (e.g., Florida's separate state moratorium ran through Sept 20, 2026). [1, 2]

If you are applying in a specific state or need help with Round 2028 of the DMEPOS Competitive Bidding Program, let me know your state and supplier category so I can provide precise guidance.

Is it to house DME in your PP or to prescribe DME to medicare patients only? Would someone explain> Just trying to learn all the ropes.

 

[Feli]

Stuff like this DME headache for MCR with sign-up and cost and audits and nonsense is why anyone who plans to practice for awhile can't plan on the govt plans to be your boon. Again, I have never collected one dime from MCR for DME or DM shoes (I give it free, they cash pay it, or get Rx for DME store).

The pay from govt insurance plans don't really increase. They seesaw a bit on rates but have been stagnant rates for decades. ( <-- link courtesy of @heybrother a year or two ago)
That means they have effectively decreased drastically when you consider inflation. That will continue.

(courtesy @Dermato Fight Club last year ^^^)

Now sadly, most PPOs (and HMO, etc) will also base fee schedules off of the govt plans (MCR mainly). MCR is, and will be, "the standard." That's lame.

So, what to do about it?

• Go to a place where people are WELL employed. The fee schedules will be better than avg (esp proced). MCR will be there, but less of the pie. MCA will obviously be even less in those areas (mainly just kids, rare poverty/disabled ppl).
• The workers' families will be same insurance. They will pay their medium-sized copays, usually pay their bills when you mail them.
• Network with mainly PCPs who have those well-insured patients. If you bond for refers with ones with mostly MCA, guess what you'll get?
• Offer OTC products and services and cash pay services. Again, in a well-employed area, those will do fine. Some people even will pay cash for that and copays (figure it out).
• Have a reasonable cash-pay fee schedule... I posted mine (and OTC list) a few pages back in this thread. Those patients are great; cash up front and no waiting and no fees (if they pay cash).
• Live cheap, pay your loans, invest/save a LOT, grow your money. Healthcare in general is tough, getting tougher. Tuition is insane. Inflation of everything does not stop... staffing, rent, supplies, utilities, marketing. MCR doesn't increase. Podiatry's saturated. But yeah, you can do well - despite all of that.

On the other end of spectrum, MCA will be more abundant in areas with more un/underemployment. You will logically see more pts for less pay. Not good, but it doesn't end there. People without good/any jobs will very rarely have money for any OTC stuff. They won't usually pay their medical bills... or even their tiny copays. You can even expect theft of office supplies, tougher time finding decent/honest employees, possibly even physical security concerns for the office. Worst of all, more govt insurance opens you to more audits. This is a recipe for burnout, delayed retire, a much tougher PP situation overall.

Don't start out the career race with a hamstring pull and from a starting line that's further back than it needs to be. Let the supergroup associates or hospital RVU pod or some other PP person who failed the boards see the 350lb Charcot wounds with MCA. Limit the herd of RFC if you like by scheduling them further out (it's sure not urgent) and effectively steering them to other pods in the area. This is your life, your practice, your results, your money. If that sounds "selfish," realize that you will give out toooooons of DME and OTC stuff... and tons of people won't pay their copays or their bill (even surgery)... and you will do curbside consults or professional courtesy visits free of charge. That is your "charity." You are the owner and can do what you want... from free clotrimazole crm to free CAM boot to even free visits sometimes. Feel good about what you do. But you need to draw the line somewhere to take care of yourself, your family, your employees; have standards and do well with your biz. There is nothing wrong with that. 🙂

Is it to house DME in your PP or to prescribe DME to medicare patients only? Would someone explain> Just trying to learn all the ropes.

You only need the DME license to dispense it MCR, MCR adv plans, MCA (you don't to private insurances).

You can Rx it to any plan.

 

[Mia McBhul]

Is it to house DME in your PP or to prescribe DME to medicare patients only? Would someone explain> Just trying to learn all the ropes.

The DME license is for medicare patients only. I can still dispense DME to commercial insurances, just need a PA majority of the time.

 

[heybrother]

So - I took a few days off and came back to find out that my Xerox printer stopped printing when it ran out of yellow toner. The printer had long since been set to only print black and white, but its obviously still depleting all 3. Red and Cyan frustratingly are at 10%. We were purchasing ink from a non-Xerox site that sold high capacity toner because I wanted to buy as much black ink as possible. They sell Color toner in high capacity for $357 (tax and shipping) per cartridge. I'm definitely realizing I should have bought a black/white only printer.

This never came up at my last office because we just printed in color and pissed away money on it. We had so many printer issues the office just hired a company to maintain the printer, but it was just a huge line item cost that wasn't being controlled.

 

[Taziel]

For what its worth you can pretty reliably get cheap Chinese clone toners off Amazon that last almost as long as the legit ones, even the color ones. I havent paid full price for my Canon laser printer toner in a long time, but I guess your mileage may vary since you have Xerox.

 

[BeaverBlade]

1. checks eligibility. Humana requires referral
2. patient says they don't need referral
3. calls humana they say patient doesn't need a referral
4. claim denied needs referral.

is this my new life?

 

[heybrother]

1. checks eligibility. Humana requires referral
2. patient says they don't need referral
3. calls humana they say patient doesn't need a referral
4. claim denied needs referral.

is this my new life?

Don't see Humana. 😉

Is this a Medicare Advantage? Commercial? HMO, PPO?

What did the card actually say. And obviously if its a regional insurnace that doxes you then eh, but just curious if you can elaborate.

 

[heybrother]

For what its worth you can pretty reliably get cheap Chinese clone toners off Amazon that last almost as long as the legit ones, even the color ones. I havent paid full price for my Canon laser printer toner in a long time, but I guess your mileage may vary since you have Xerox.

I think the battle on this is a sunk cost fallacy question.

Yeah - I can buy cheaper toner on Amazon potentially. However, will the toner keep depleting and requiring replacement even though I'm not using it - the answer is likely yes. AI simultaneously says - no, toner is dry and won't deplete, but simultaneously says the printer often checks itself / puts some down toner to stay functional. I spent quite a bit of time trying to understand my bills, but this is one I didn't fully explore because I was shielded from it in the past.

Another argument is to have toner and just save it for when I need it or want to print in color... which isn't very often.

 

[Weirdy]

1. checks eligibility. Humana requires referral
2. patient says they don't need referral
3. calls humana they say patient doesn't need a referral
4. claim denied needs referral.

is this my new life?

We just had one of those.

But add in the patient screaming at 2 of my staff already and calling non stop for 2 weeks straight.

Tempted to call them back and fire them if they treat me the same way after reaching out to their pcp office.

 

[BeaverBlade]

I think the battle on this is a sunk cost fallacy question.

Yeah - I can buy cheaper toner on Amazon potentially. However, will the toner keep depleting and requiring replacement even though I'm not using it - the answer is likely yes. AI simultaneously says - no, toner is dry and won't deplete, but simultaneously says the printer often checks itself / puts some down toner to stay functional. I spent quite a bit of time trying to understand my bills, but this is one I didn't fully explore because I was shielded from it in the past.

Another argument is to have toner and just save it for when I need it or want to print in color... which isn't very often.

I’m sure @heybrother uses a Brother printer right?

A lot of Amazon reviews on knockoff toners for my brother printer said they suck and deplete quicker so I’m buying the real deal although it is expensive.

 

[heybrother]

I’m sure @heybrother uses a Brother printer right?

A lot of Amazon reviews on knockoff toners for my brother printer said they suck and deplete quicker so I’m buying the real deal although it is expensive.

Ha. I purchased Xerox. Should have stuck with my name sake.

Got tons of rain. Developed 2 new leaks in brand new roof. Roofing company came out very fast.

And a podiatry chair crapped out as I was about to perform a matrixectomy.

Trying to hire someone who speaks Spanish. Not blown away by anyone yet.

You don't have to worry about any of these things when you lean into your friend, Private Equity.

 

[Mia McBhul]

Brother Printer is the only way to go

 

[eyeeye_captain]

You don't have to worry about any of these things when you lean into your friend, Private Equity.

Nah fam, they never love you back

 

[BeaverBlade]

anybody else in private practice have a hard time getting patients who are referred by pcp's to answer their phones?

Feel like my hit on this is less than 50%. Patients who call directly or schedule online for me actually show up. But these referrals I’m not sure if they don’t want to come or what but yeah they don’t even answer usually.

 

[Weirdy]

Are the referrals done and MAs have attempted to call/reach out to schedule appointment?
I have the problem on the back end where I'm getting referrals but MAs are having a hard time keeping up to get them done and in the office so patient gets upset they haven't seen the foot doctor yet.

 

[BeaverBlade]

Are the referrals done and MAs have attempted to call/reach out to schedule appointment?

yes, i'm not busy enough to be behind on these yet. patients just don't answer the phone.

i did have a problem where my number was being labeled spam by most carriers (this could be it's own thread), but that has been resolved. my referrals so far have mostly been very basic podiatry things like callues, ingrown nails, etc. I feel like the less important things like calluses the 75 year old patient may just never call back or answer?

 

[Weirdy]

yes, i'm not busy enough to be behind on these yet. patients just don't answer the phone.

i did have a problem where my number was being labeled spam by most carriers (this could be it's own thread), but that has been resolved. my referrals so far have mostly been very basic podiatry things like callues, ingrown nails, etc. I feel like the less important things like calluses the 75 year old patient may just never call back or answer?

Yup. My older patients almost never pick up the phone. Sometimes they'll show up unannounced wanting to be same day which is fine- but again by far the most no answer patient are the older ones that I'm not seeing for weekly stuff like wounds etc.

 

[heybrother]

anybody else in private practice have a hard time getting patients who are referred by pcp's to answer their phones?

Feel like my hit on this is less than 50%. Patients who call directly or schedule online for me actually show up. But these referrals I’m not sure if they don’t want to come or what but yeah they don’t even answer usually.

This is a real problem and to the best of my ability we don't schedule an appointment with a patient until we've spoken to the patient. PCP scheduled visits have low compliance unless the patient is normal and has a real problem ie. infected ingrown toenail.

A lot of people with plenty of problems go to the PCP and unload all of their issues. The PCP sits their and schedules referrals and the patients don't attend. Life goes on.

Marketplace-gov plans from the county hospital have low attendance rates in my office.

 

[Boba Foot]

anybody else in private practice have a hard time getting patients who are referred by pcp's to answer their phones?

Feel like my hit on this is less than 50%. Patients who call directly or schedule online for me actually show up. But these referrals I’m not sure if they don’t want to come or what but yeah they don’t even answer usually.

Are they on high deductible plans? Everything is expensive now and some people might not want to pay an $80 copay + Trump war gas prices to get evaluated for low acuity problems.

 

[BeaverBlade]

Are they on high deductible plans? Everything is expensive now and some people might not want to pay an $80 copay + Trump war gas prices to get evaluated for low acuity problems.

Good point. Yeah usually