Costs and figures... startup Solo podiatry office

Started by Feli
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Stormblest said:
5 fluorouracil works about 50% of the time for me. Can’t get cantharone through my hospital. If fluorouracil doesn’t work after a month or two I offer to cut them out
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When you guys say cut them out, do you guys mean like a formal rotational/transpositional flap or 3:1 elliptical excision? an OR trip or in-office?

I have a few patients with small ones and was considering just using our punch biopsy blades on it and throwing a stitch.

or do you mean numb the area, basically just debride it aggressively (like down to sub Q) and then let it heal by secondary intention overtime and still bill as a 17110?
 
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Best success I had with 5-fu is doing it as a compounding cream with salicylic acid.

The thing about plantar warts is… everyone responds differently to different topicals. Besides cantharone. That stuff is king.

Immuquoid(sp?) never worked for me. And then I prescribed it on a woman with like 35 of them and it was gone overnight.
 
footpainhealer said:
When you guys say cut them out, do you guys mean like a formal rotational/transpositional flap or 3:1 elliptical excision? an OR trip or in-office?

I have a few patients with small ones and was considering just using our punch biopsy blades on it and throwing a stitch.

or do you mean numb the area, basically just debride it aggressively (like down to sub Q) and then let it heal by secondary intention overtime and still bill as a 17110?
Click to expand...

I always close excisional bx with a stitch. It hurts less = fewer phonecalls, fewer 1 star reviews. Downside is no immune response so warts may come back elsewhere.

This is good for adult warts who don't mount an immune response like kids di
 
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Fluorouracil works really well. I dont think ive ever had it not work? (assuming compliance - agree with teenagers).
Gotta debride that wart deep then have them apply it twice daily under duct tape.
Tell them to self debride with pumice stone at home every few days.
The wart will be totally gone in 1-2 weeks.

I typically tell them its painless cream or I numb you up and cut it out which is really quite painful. As a result I think my compliance is high.
 
Not sure what you guys are doing with the suture, etc...
By their nature, verruca won't affect cells below epidermis / basement membrane.

For a sharp excision on verruca, you just need to go with small margin around the clusters (15 blade), can be circle or a bit elliptical.
Then use a sharp curette to scoop it out and get to the (white) basement membrane... curette it. Send one or two to path.
Be a bit lighter on WB areas heel or MPJs... but still try to get down to basement membrane.
Do cautery, silvadene, bandage... bandage, surg shoe, heals by secondary intention over next 2-3wks.
See them around 12d and 21d or so (10d global). Avoid ointments as these need to dry out usually (alc clean, silv cream sites or just betadine rim of excis sites).
Tell them pre-op that it sometimes it leaves a scar (usually it won't if you get technique down).
Do this in OR... sedation, lido w epi below and prox to lesion clusters. Better lights and instruments.
Office is way too messy, inject is very painful, time consuming. Don't be waste time or hurt ppl. That's TFP stuff. 🙂
Code is 1142x family (as many times as you do clusters).... 10d global.

If you do verruca with proper debride + 30-50% sal acid crm (w or w/o 5FU in it), maybe canth... you'll barely need to do any in OR. The debride of callus is more important than the % sal.
90% will resolve in office with sal acid and PROPER DEBRIDE. 95% with canth (I offer it if no progress with a few sal tx). You can try cimetidine PO. Have them use home pumice + sal at home (sell little jars of it as OTC product).
The very few that don't resolve were usually real bad and/or there for years before they came to you. It happens. Board them for OR if they want, keep trying sal if they don't want to do OR.
The sharp excision is rarely needed, but the recur should be very very low... usually minor and at another area (virus is in their body, obviously).
 
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Feli said:
Not sure what you guys are doing with the suture, etc...
By their nature, verruca won't affect cells below epidermis / basement membrane.

For a sharp excision on verruca, you just need to go with small margin around the clusters (15 blade), can be circle or a bit elliptical.
Then use a sharp curette to scoop it out and get to the (white) basement membrane... curette it. Send one or two to path.
Be a bit lighter on WB areas heel or MPJs... but still try to get down to basement membrane.
Do cautery, silvadene, bandage... bandage, surg shoe, heals by secondary intention over next 2-3wks.
See them around 12d and 21d or so (10d global). Avoid ointments as these need to dry out usually (alc clean, silv cream sites or just betadine rim of excis sites).
Tell them pre-op that it sometimes it leaves a scar (usually it won't if you get technique down).
Do this in OR... sedation, lido w epi below and prox to lesion clusters. Better lights and instruments.
Office is way too messy, inject is very painful, time consuming. Don't be waste time or hurt ppl. That's TFP stuff. 🙂
Code is 1142x family (as many times as you do clusters).... 10d global.

If you do verruca with proper debride + 30-50% sal acid crm (w or w/o 5FU in it), maybe canth... you'll barely need to do any in OR. The debride of callus is more important than the % sal.
90% will resolve in office with sal acid and PROPER DEBRIDE. 95% with canth (I offer it if no progress with a few sal tx). You can try cimetidine PO. Have them use home pumice + sal at home (sell little jars of it as OTC product).
The very few that don't resolve were usually real bad and/or there for years before they came to you. It happens. Board them for OR if they want, keep trying sal if they don't want to do OR.
The sharp excision is rarely needed, but the recur should be very very low... usually minor and at another area (virus is in their body, obviously).
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I do have to point out that on an RVU model excision of a wart pays hot garbage (0.68 rvu) for what it involves. Its absolutley not worth my time.

But seriously, fluorouracil works really well, and its painless. Just gotta debride the crap out of it in office. As deep as they can take (so I guess not completely painless..).

I dont have time to take a wart to the OR. With crappy turnovers thats an hour or more for 0.68 production units. Do most insurances even cover wart excision?
 
DYK343 said:
I do have to point out that on an RVU model excision of a wart pays hot garbage (0.68 rvu) for what it involves. Its absolutley not worth my time.

But seriously, fluorouracil works really well, and its painless. Just gotta debride the crap out of it in office. As deep as they can take (so I guess not completely painless..).

I dont have time to take a wart to the OR. With crappy turnovers thats an hour or more for 0.68 production units. Do most insurances even cover wart excision?
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Also the operative time takes several hours because of the need for frozen sections
 
Mia McBhul said:
thanks. I'll look into them. A couple of my friends use Online Medical Equipment & Supplies | Vive Health

I'm curious, does anyone here dispense crutches and compression stockings as well?
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I don't. We're still figuring out exactly what we're going to carry, but I don't know that I'd have the shelf space to add those and I have a lot of shelving. It surprises me to say that, but every extra space is filling up. My experience is also shaped by my past. Patients who needed crutches - mostly showed up with crutches already in hand. My surgery center/hospitals also dispense them already. I have never had that much trauma walking in.
 
is there like a how to bill DME for dummies or anything online? I feel like that’s by far my biggest weakness with opening a practice. Also makes me wonder how much dme to actually buy.
 
Mia McBhul said:
which vendors are you guys using for DME? boots, braces, night splints?
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I think it's earlier in the thread, but I use Chicago Medical Supply for most DME stuff... pod-specific, competitive prices vs big supply companies on the 3 things you mention above. Works well, fast shipping (we also use them for many other supplies, most felt pads, phenol single use, etc).

BeaverBlade said:
is there like a how to bill DME for dummies or anything online? I feel like that’s by far my biggest weakness with opening a practice. Also makes me wonder how much dme to actually buy.
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You can buy a ton... prices only go up and up. I literally buy as much as I can fit (tiny office).
If you are on limited budget early, do something like 3 of each size CAM boot, ankle brace, night splint, post op shoe, PowerStep. Once clearly profitable, you can do quite a bit more for insoles, CAM, braces.
 
Feli said:
I think it's earlier in the thread, but I use Chicago Medical Supply for most DME stuff... pod-specific, competitive prices vs big supply companies on the 3 things you mention above. Works well, fast shipping (we also use them for many other supplies, most felt pads, phenol single use, etc).


You can buy a ton... prices only go up and up. I literally buy as much as I can fit (tiny office).
If you are on limited budget early, do something like 3 of each size CAM boot, ankle brace, night splint, post op shoe, PowerStep. Once clearly profitable, you can do quite a bit more for insoles, CAM, braces.
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Yes but are they always being billed to insurance as far as boots, night splints, ankle brace, etc? Obviously powersteps aren’t.

I did not sign up for Medicare dme
 
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BeaverBlade said:
Yes but are they always being billed to insurance as far as boots, night splints, ankle brace, etc? Obviously powersteps aren’t.

I did not sign up for Medicare dme
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You can bill boot, NS, brace, etc to any payers that you are in network with.
Surg shoes are not covered by any.... make a fair cash price or give them away case by case.

Medicare DME is a personal choice for each pracice... pretty big hassle to sign up, fairly big expense each renew, opens you to audits (can't blame them... sooo much DME fraud). It is predictable in terms of DME pay and probably worth it for bigger offices so they can do boots for surg pts and do DM shoes... but definitely expect audits.

MedicAID is pretty random by state/areas. I would be taking tons of zeros (since I do not do MCR DME), so I try to do minimal DME for MCA pts. You will never be able to cash pay them... bwahahah.

You also can sell any DME (boots, NS, brace, etc) to ppl who you are not in network with their payer for DME (eg, I'm not for Medicare). I put my cash fee sched above this thread #225. You CAN'T have ppl cash pay DME if you are in network for DME with their insurance.

PowerSteps and orthotics and other OTC stuff is obviously not covered, yeah... make a price list (again, mine #225).
 
BeaverBlade said:
Yes but are they always being billed to insurance as far as boots, night splints, ankle brace, etc? Obviously powersteps aren’t.

I did not sign up for Medicare dme
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Never knew insurance would cover night splints. I guess that explains why I see so many other docs give people the dumb things.
 
Boba Foot said:
Never knew insurance would cover night splints. I guess that explains why I see so many other docs give people the dumb things.
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Everything we do is based on reimburse rates. You thought it was based on EBM??? 🤣
Injects, dme, procedures... if insurance wants docs to do something, reimburse well.
Look at nonsense grafts... you think the podiatrists doing them believe in them?
If they don't want a CPT done, cut the pay on it or deny it. Simple.

(fwiw, I do maybe one night splint per month... but plenty DPM groups and supergroups do bilateral ones ftw)
 
Feli said:
Everything we do is based on reimburse rates. You thought it was based on EBM??? 🤣
Injects, dme, procedures... if insurance wants docs to do something, reimburse well.
Look at nonsense grafts... you think the podiatrists doing them believe in them?
If they don't want a CPT done, cut the pay on it or deny it. Simple.

(fwiw, I do maybe one night splint per month... but plenty DPM groups and supergroups do bilateral ones ftw)
Click to expand...
Bilateral nightsplints??? 🤣
 
BeaverBlade said:
Bilateral nightsplints??? 🤣
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We had an office manager when I was in the supergroup state on video call with a couple dozen docs and office mgrs that their protocol, at their location, for heel pain was to do inject, dispense night splint, dispense ankle brace (wtf?), dispense PowerSteps. I told the office manager of the location I worked at to never do that, no matter what "corporate" ever said.

In reality, almost any payer tends to block 2+ DME on same date. So, if you need to dispense a replace CAM boot or somehow need legit bilat ankle braces, etc... do it at different office visits. But yeah... bilateral night splints was a thing (I am sure it still is at some podiatry offices). We are judged by our lowest common denominators.
 
Feli said:
We had an office manager when I was in the supergroup state on video call with a couple dozen docs and office mgrs that their protocol, at their location, for heel pain was to do inject, dispense night splint, dispense ankle brace (wtf?), dispense PowerSteps. I told the office manager of the location I worked at to never do that, no matter what "corporate" ever said.

In reality, almost any payer tends to block 2+ DME on same date. So, if you need to dispense a replace CAM boot or somehow need legit bilat ankle braces, etc... do it at different office visits. But yeah... bilateral night splints was a thing (I am sure it still is at some podiatry offices). We are judged by our lowest common denominators.
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That’s ridiculous.

Here’s my thing do most commercial insurances cover that stuff reliably? Do patients not get pissed if it’s not covered and they get a huge bill?

Like let’s say you get a fifth met avulsion fracture in your clinic. You dispense a boot and bill insurance for the dme. I assume it’ll be covered but if the patient owes a deductible are they paying a $250 boot fee when it could be bought for a fraction on Amazon?

How do you manage these situations when patients get easily pissed over stuff like this?
 
BeaverBlade said:
That’s ridiculous.

Here’s my thing do most commercial insurances cover that stuff reliably? Do patients not get pissed if it’s not covered and they get a huge bill?

Like let’s say you get a fifth met avulsion fracture in your clinic. You dispense a boot and bill insurance for the dme. I assume it’ll be covered but if the patient owes a deductible are they paying a $250 boot fee when it could be bought for a fraction on Amazon?

How do you manage these situations when patients get easily pissed over stuff like this?
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Check your fee schedules. My personal experience is that commercial insurance knows how dumb DME reimbursement is.

At my last office Aetna, Cigna, and BCBS all reimbursed somewhere between $120-150 for a L4361. That's right around or just less than 50% of Medicare. My memory is an ankle brace was about $50 - again, about 50% of Medicare.

At my last office I negotiated a contract with an instate insurance for ...105% E&M/Rads, 130% CPT and I ultimately got them to cave on 100% of Medicare for DME. Not 6 months later I had to negotiate the contract again for my own office and pulled of 115% E&M/Rads, 130% CPT, but they absolutely would not budge on 75% of Medicare DME.
 
In residency, I found an ortho bullets question about plantar fasciitis along the lines of "which of the following devices is the gold standard in management of plantar fasciitis" and the correct answer was night splint, along with a citation backing up this claim. It's one thing to say night splints are better than the other 3 distractors (CAM boot, custom foot orthosis with 3 degree varus post, one other thing I forget), but to say they're the gold standard is a bold claim. Then again, I'm anti-science
 
Feli said:
For a sharp excision on verruca, you just need to go with small margin around the clusters (15 blade), can be circle or a bit elliptical.
Then use a sharp curette to scoop it out and get to the (white) basement membrane... curette it. Send one or two to path.
Be a bit lighter on WB areas heel or MPJs... but still try to get down to basement membrane.
Do cautery, silvadene, bandage... bandage, surg shoe, heals by secondary intention over next 2-3wks.
See them around 12d and 21d or so (10d global). Avoid ointments as these need to dry out usually (alc clean, silv cream sites or just betadine rim of excis sites).
Tell them pre-op that it sometimes it leaves a scar (usually it won't if you get technique down).
Do this in OR... sedation, lido w epi below and prox to lesion clusters. Better lights and instruments.
Office is way too messy, inject is very painful, time consuming. Don't be waste time or hurt ppl. That's TFP stuff. 🙂
Code is 1142x family (as many times as you do clusters).... 10d global.

If you do verruca with proper debride + 30-50% sal acid crm (w or w/o 5FU in it), maybe canth... you'll barely need to do any in OR. The debride of callus is more important than the % sal.
Click to expand...

Don't most dermatologist do this in clinic and they have the little electrocautery handheld things so it's easier for them? I think doing what you're saying (but in-office) and using phenol cauterization is the closest thing I have access to currently.
This particular patient has a 0.8 x 0.8cm wart and told me his old derm removed a wart on his other foot six years ago by numbing it up in clinic and just carving it out and using the electrocautery. So I looked up videos on it and that looks like exactly how derms do it in office.

Also, I am looking my my EMR prescription page and there is no option to sal acid above 26% on the formulary. where are people getting 50-60% from?
 
footpainhealer said:
Don't most dermatologist do this in clinic and they have the little electrocautery handheld things so it's easier for them? I think doing what you're saying (but in-office) and using phenol cauterization is the closest thing I have access to currently.
This particular patient has a 0.8 x 0.8cm wart and told me his old derm removed a wart on his other foot six years ago by numbing it up in clinic and just carving it out and using the electrocautery. So I looked up videos on it and that looks like exactly how derms do it in office.

Also, I am looking my my EMR prescription page and there is no option to sal acid above 26% on the formulary. where are people getting 50-60% from?
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I've done many of them in the office. Lido with epi is a winner. Excise, scrape, paint with phenol once, dressing with coban and go.

The amazing part of medicine is that one person's no go is someone else's every day.
 
footpainhealer said:
Don't most dermatologist do this in clinic and they have the little electrocautery handheld things so it's easier for them? I think doing what you're saying (but in-office) and using phenol cauterization is the closest thing I have access to currently.
This particular patient has a 0.8 x 0.8cm wart and told me his old derm removed a wart on his other foot six years ago by numbing it up in clinic and just carving it out and using the electrocautery. So I looked up videos on it and that looks like exactly how derms do it in office.

Also, I am looking my my EMR prescription page and there is no option to sal acid above 26% on the formulary. where are people getting 50-60% from?
Click to expand...
You can do anything you want. It's your office.

Like I said, I don't like the theatrics. I find it a time waste and hurts the pts to do the sharp excisions in the office (mostly just observation in residency and past jobs... tried a few of my own, quit doing it). The foot is a little different to inject epi, debride vs a finger or thinner skin areas. Remember that probably almost half your wart pts are kids. Crying bleeding kids aren't a good look for the office, stresses the staff, parents. Etc. You also have better instruments, lights in OR. But ymmv. 🙂
 
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Plantar injections are painful (and are why I try to topical my way out of every wart that I can), but so is receiving an anesthesiologist and facility fee bill. I attempt to "pre" block most larger shots. Drop in 1cc quickly to just numb the area. Then put the rest of the block in when they can't really feel it. I also don't inject through the wart.

Here's how I know that warts aren't meant to go to the OR. Because dermatologists do 100% of them in their offices.
 
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Weirdy said:
So not closing skin?
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Almost never. If I truly did something the size of a biopsy I might, but I normally don't. Technically the wart is just in the epidermis though I will concede that you often feel like you have quite a deficit after the procedure. Also - I normally apply 1 application of phenol so I try to let it drain. The patients usually come in with a granular bed and it rapidly heals/closes.

I also never close foreign body ellipsis type procedures. Just let them drain/close.
 
In the market for an autoclave...would you guys recommend getting a refurbished one or buying a brand new one?

The vendors mostly seem to suggest the new one. not sure to believe them or not though
 
Mia McBhul said:
In the market for an autoclave...would you guys recommend getting a refurbished one or buying a brand new one?

The vendors mostly seem to suggest the new one. not sure to believe them or not though
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heybrother

Thread 'Tuttnaeur Valueklave 1730'

There's been a lot of discussion lately about starting your own practice so I briefly want to bring up this device as I believe people likely see it online and think - hey good starting price. I've also seen people advocate for it on Iped.

-It sells on Amazon so you could potentially get 5% back on an Amazon Visa.
-I believe I've seen its price fluctuate between $2500-2700. I'm sure there's some website out there that tracks this.
-Its very easy to set-up. You essentially check the water level and go.
-It comes with straight forward picture driven instructions. I've never used an...
  • Like
 
i bought the valuklave the small one. Haven’t used it yet. Just had to take the staples to get it out of the box to open it that was annoying.
 
Feli said:
heybrother

Thread 'Tuttnaeur Valueklave 1730'

There's been a lot of discussion lately about starting your own practice so I briefly want to bring up this device as I believe people likely see it online and think - hey good starting price. I've also seen people advocate for it on Iped.

-It sells on Amazon so you could potentially get 5% back on an Amazon Visa.
-I believe I've seen its price fluctuate between $2500-2700. I'm sure there's some website out there that tracks this.
-Its very easy to set-up. You essentially check the water level and go.
-It comes with straight forward picture driven instructions. I've never used an...
  • Like
Click to expand...
I raised a question about whether I should have bought the Valueklave in that thread / bought a larger unit, but honestly its been fine. Staff aren't complaining. One has had some difficulty following instructions but the machine is fine and the price is right.

I did ultimately upgrade to a larger x-ray panel and that's been a great decision.
 
I like the Ritter Midmark M11 autoclave, but it comes with a heavier price tag. Their reliability is top notch, imo. You can get a used one for around $5500.
 
BeaverBlade said:
i read SDN and still became a podiatrist. i'm not the smartest
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I'm going to try and save you a step and tell you - NEVER EVER EVER EVER CASH A VIRTUAL CREDIT CARD. If you convert payors to check and then cash a virtual credit card they'll convert you back.

You: Hi - I have a virtual credit card. I want it converted to a check. Do you offer free EFT and ERA?

Rip-off Artist company:

(a) No. We're Zelis. We suck. But we'll send a check. Can consider ACH if you want but its 2% of future transactions which might not be the worst..
(b) No. We're VCard - EFT is $3.75 a transaction but we can send a check and if you ASK we'll tell you how to get free ERA.
(c) ECHO - We can send a check for now and if you individually enroll with a draft number and payment value you can have free EFT/ERA but only if you individually sign up with us for each insurance. If you want to enroll with all insurances we charge a percentage per transaction.
(d) Very rarely - yes, we have an Epayment center that you can individually sign up for that's technically through Zellis but they won't talk about it. Old Surety.
(e) Occasionally someone will have their own EFT/ERA site - like Ohio Mutual has something with Oneinc or something like that.
(f) Humana - sign up for EFT through Availity or they'll ding you $5 a check.
(g) UHC - sign up for Optum Pay. I'm still trying to decide if ERA is free. EFT is free but you may have to upload your own 835s.
(h) bizarrely my Aetna stuff goes through Optum Pay.
 

If you have a private practice and are getting "Quic Remit" cards - download this form. Pre-fill it out so that it has all of your information ie. bank account, Clearinghouse contact information etc - and then save it. Everytime you get a ECHO EOB with Quic Remit card - take the insurance name, draft number, and payment value off and then either upload it to your clearinghouse or mail/fax whatever it off to ECHO. You can then convert all future instances of said insurance to ERA/EFT if desired and get free ERA/EFT posting.

I was overwhelmed by this at first because Trizetto told me to enroll with any of my payors, but essentially once you see a patient and get a payment - then you can enroll and complete the process by having a draft number to submit.
 
I thought it'd be interesting to know what you guys do for advertising especially the ones who are still new/just starting.

things i've done:
- pylon sign outside the office on a busy street.
- google profile (they keep rejecting my photos though, very annoying.)
- facebook account
- instagram account
- apple business (still in process but this evidently gets you on the apple maps.. so let's say someone just searches "Podiatrist" or "podiatry" you'd pop up).

thinking about buying google ads/facebook/instagram. not sure if anyone has done that and if that was worth it.

all of that may not mean as much as going out to PCP's/urgent cares etc but that's also in the works. my oven might put in overtime on cookies
 
BeaverBlade said:
I thought it'd be interesting to know what you guys do for advertising especially the ones who are still new/just starting.

things i've done:
- pylon sign outside the office on a busy street.
- google profile (they keep rejecting my photos though, very annoying.)
- facebook account
- instagram account
- apple business (still in process but this evidently gets you on the apple maps.. so let's say someone just searches "Podiatrist" or "podiatry" you'd pop up).

thinking about buying google ads/facebook/instagram. not sure if anyone has done that and if that was worth it.

all of that may not mean as much as going out to PCP's/urgent cares etc but that's also in the works. my oven might put in overtime on cookies
Click to expand...
Get one of these guys to go with your pylon sign.

flailing-inflatable-tube-man-dancing.gif
 
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BeaverBlade said:
I thought it'd be interesting to know what you guys do for advertising especially the ones who are still new/just starting.

things i've done:
- pylon sign outside the office on a busy street.
- google profile (they keep rejecting my photos though, very annoying.)
- facebook account
- instagram account
- apple business (still in process but this evidently gets you on the apple maps.. so let's say someone just searches "Podiatrist" or "podiatry" you'd pop up).

thinking about buying google ads/facebook/instagram. not sure if anyone has done that and if that was worth it.

all of that may not mean as much as going out to PCP's/urgent cares etc but that's also in the works. my oven might put in overtime on cookies
Click to expand...
Wack wavy inflatable arm guy!
 
BeaverBlade said:
I thought it'd be interesting to know what you guys do for advertising especially the ones who are still new/just starting.

things i've done:
- pylon sign outside the office on a busy street.
- google profile (they keep rejecting my photos though, very annoying.)
- facebook account
- instagram account
- apple business (still in process but this evidently gets you on the apple maps.. so let's say someone just searches "Podiatrist" or "podiatry" you'd pop up).

thinking about buying google ads/facebook/instagram. not sure if anyone has done that and if that was worth it.

all of that may not mean as much as going out to PCP's/urgent cares etc but that's also in the works. my oven might put in overtime on cookies
Click to expand...
Just do the PCP refers. How is that "in the works"? It can be done today, right now with a stack of biz cards + decent outfit + a smile.
It can be followed up on by mailing your new pt note with a handwritten "Thanks for the refer" to the refer office. Double down with token snack gifts a couple times per year (avoid xmas holiday when they are overrun with gifts) if you want to really cement the refer pattern - or if you need to stand out in podiatry-saturated areas (aka all areas). But yeah, the PCP refers will get you a steady stream of well-insured pts who have already been told that you are good; you can get even more good pts (their friends/fam) by taking good care of them.

...Using the paid print or online ads is what supergroups do (FB, google, nextDoor, newspaper, billboard, whatever). That is dumb and attracts all types of ppl (normal, mild drama, totally crazy) and all types of insurances (good, bad, none). Many will not even have a PCP, their mental health buttoned up, a BMI under 35... or maybe not even a shower yet this week. Cmon. Those folks will find you, but why go trying to attract more of them? Once you start to fill with those types (and their friends/fam of same type), you won't have space for better pts. It's very hard to change your pt pool/population type later on. Begin with the end in mind.

The middle ground is ER and UCare refers: most will have insurance and can be useful at first, but you want to evolve largely past those later on. You'd rather have ppl who generally take care of themselves and don't think every little thing is an emergency that needs attention same day.
 
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Feli said:
Just do the PCP refers. How is that "in the works"? It can be done today, right now with a stack of biz cards + decent outfit + a smile.
It can be followed up on by mailing your new pt note with a handwritten "Thanks for the refer" to the refer office. Double down with token snack gifts a couple times per year (avoid xmas holiday when they are overrun with gifts) if you want to really cement the refer pattern - or if you need to stand out in podiatry-saturated areas (aka all areas). But yeah, the PCP refers will get you a steady stream of well-insured pts who have already been told that you are good; you can get even more good pts (their friends/fam) by taking good care of them.

...Using the paid print or online ads is what supergroups do (FB, google, nextDoor, newspaper, billboard, whatever). That is dumb and attracts all types of ppl (normal, mild drama, totally crazy) and all types of insurances (good, bad, none). Many will not even have a PCP, their mental health buttoned up, a BMI under 35... or maybe not even a shower yet this week. Cmon. Those folks will find you, but why go trying to attract more of them? Once you start to fill with those types (and their friends/fam of same type), you won't have space for better pts. It's very hard to change your pt pool/population type later on. Begin with the end in mind.

The middle ground is ER and UCare refers: most will have insurance and can be useful at first, but you want to evolve largely past those later on. You'd rather have ppl who generally take care of themselves and don't think every little thing is an emergency that needs attention same day.
Click to expand...
Good info here.
 
BeaverBlade said:
I thought it'd be interesting to know what you guys do for advertising especially the ones who are still new/just starting.

things i've done:
- pylon sign outside the office on a busy street.
- google profile (they keep rejecting my photos though, very annoying.)
- facebook account
- instagram account
- apple business (still in process but this evidently gets you on the apple maps.. so let's say someone just searches "Podiatrist" or "podiatry" you'd pop up).

thinking about buying google ads/facebook/instagram. not sure if anyone has done that and if that was worth it.

all of that may not mean as much as going out to PCP's/urgent cares etc but that's also in the works. my oven might put in overtime on cookies
Click to expand...
I've got the perfect guy for you. I've personally hired a marketer, recommended by my personal friend who uses him and grew his business significantly. He's been open for two years and already hiring an associate and he only started using the marketer 1 year ago.....my marketing guy can help you with all of the things you just listed. At a relatively heavy price though. I'm having my weekly meeting with him tomorrow. message me if you're interested in hearing him out. I can give you his contact info.
 
Feli said:
...Using the paid print or online ads is what supergroups do (FB, google, nextDoor, newspaper, billboard, whatever). That is dumb and attracts all types of ppl (normal, mild drama, totally crazy) and all types of insurances (good, bad, none). Many will not even have a PCP, their mental health buttoned up, a BMI under 35... or maybe not even a shower yet this week. Cmon. Those folks will find you, but why go trying to attract more of them? Once you start to fill with those types (and their friends/fam of same type), you won't have space for better pts. It's very hard to change your pt pool/population type later on. Begin with the end in mind.
Click to expand...
I think there's probably some variability in markets with this, but I have to disagree. While I haven't begun to run ads yet, ramping up Google Business Profile, building a quality website and improving SEO has made a big difference in my patient mix. I get a lot of young self-refer ingrowns, people who research their doctors before surgical consults, etc. It's widely accepted that about 80% of patients Google their doctors even before accepting a PCP referral, so PCP referral with a poor online presence doesn't mean much. Some patients are just as likely to ignore the referral and go with a doctor they can read real patient testimonials on. It may be a little different in Feli's more rural area, but in larger cities, it is absolutely true.

I haven't begun to do Google Ads yet, but supergroups are actually really bad at them. They hire marketing agencies who want a big budget and then charge a percentage of their budget as their fee. They target expensive keywords like "podiatrist near me" to compete with all the other practices bad at marketing. Then they can tell their client "look, you're #1 on Google!" and keep the gravy train going. The key to ads is targeting long tail keywords with high intent that are usually cheaper to bid on and more likely to convert to an office visit, and one that pays well. But I'm happy to let the supergroups blow their budget on being #1 on Google for "podiatrist near me" that eats away at their margins.
 
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