Transcript Canadian Presentation - Podiatry Presentations

Go With the Flow
Increasing patient flow and revenue through your
busy Podiatric office.
We all come to these meetings to find the
“secret”, the “key” to running a successful
practice while keeping patients happy and
compliant, staff in check and referrals and
reimbursements flowing.
If only there were a magic wand
Or Ruby Slippers to click together!
Nothing worth working for comes
easy and so. . .

Today we will show you how to

Treat your patients efficiently and
effectively

Improve patient satisfaction and
compliance

Increase practice revenue

AND, MOST IMPORTANTLY. . . . . .
Work together as a TEAM!
Before we begin. . .
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Let's discuss the importance of staff
members (podiatric assistants) playing an
essential role in your office as a “Doctor
Extender.”
This should become a goal of every
practitioner, whether a solo practice or
large group.
Years ago, the role of the podiatric
assistant was. . .
“Good afternoon Mrs. Smith, have a seat,
take off your shoes and socks and the doctor
will be with you shortly.”
Podiatric Assistants can not only perform a
multitude of tasks while “assisting” the doctor.
They can be properly trained to become an
integral part of the entire patient experience.
How many doctors have their
assistants. .
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Drawing injections

Setting up procedures
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Reviewing and preparing surgical consents

Thoroughly evaluating patients

Performing diagnostic testing

Performing PT (ultrasound, TENS, etc.)

Performing vascular testing
There's more

Taking and developing X-rays

Casting and dispensing orthotics
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Casting and ordering custom AFOs

Running your entire Diabetic shoe program

Dispensing all DME items

Managing compliance documents
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Performing orthotic adjustments
Wait, there's still more. . .
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Participating in and documenting your
comprehensive diabetic foot exams
Assisting with office procedures
Foreseeing what will be needed (DME) to
adhere to patient protocols.
Introducing appropriate IOD products
before you step foot in the room.
DOING IT ALL WITH A SMILE!!!!
The list goes on and on, but the
point remains the same.
Train your assistants well, and they will
become an extension of you and your
practice.
“The Right to Left Exercise.”
Shadowing is Key
Make sure you take the time to train your staff
and allow them to shadow you, YES, “YOU”,
the doctor.
Lead by example

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Make sure protocols are set in place,
understood and carried out by all the
members of your staff.
Demonstrate how you want particular tasks
done, procedures set up, and protocols
followed through.
Explain the “science” behind the methods.
Allow your staff to practice a skill and
perfect it before trying it out on your
patients!
In other words. . .
Teach, show and watch them go!
Respect and be respected
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Treat each member of your staff with
respect.
Acknowledge their accomplishments loudly
and criticize their faults softly.
Make sure your staff feels appreciated and
they will appreciate you in return.
Educated and well trained staff has
many benefits to your practice.

Highly trained, well versed, confident staff
influences your patients to

Be more compliant

Purchase more IOD products
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Refer more friends and family members

Grow your practice
You are the captain of the ship
You are the steering wheel that financially
drives your practice, but without a solid
engine (your highly trained staff), you will
never move forward.
Today, we will demonstrate how.
So, sit back, relax, and enjoy the
show!
First impressions
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What does your reception area, not “waiting
room” say about your office?
Is it filled with outdated magazines and
dead plants?
OR

Does it give a proper representation of
your practice?
Inviting and warm
As should be the first faces they
see
You never get a second chance. .
Be aware of what your patients are
seeing.

Reception area décor
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Magazine selection
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Television channel selection
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Receptionists choice of attire and hairstyle

Cleanliness of treatment rooms

These all give your patients an idea of
what your practice is all about.
Patient 1. Diabetic Foot Care
Patient checks in

Have your patients fill out their New patient
encounter forms ahead of time.

Ask them to go to your website (no
matter what age)
OR

Mail out paperwork ahead of time so it's
done prior to their arrival
Only when their appointment is made within
1-2 days should they be wasting time
filling out forms in your office.

Have your patients bring copies of medication
lists, allergies, past medical history and
surgeries. It saves time and assures that your
staff is inputting accurate history upon
evaluation.
Have a seat and let's take off both
your shoes and socks. . .
“I don't see why my primary doc sent me over
here. I can take care of my own nails with a
good steady pair of pliers.”
Upon Evaluation
Discussion and suggestions
Educate and inform
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The assistant can play a key role in
“breaking the ice” for these skeptical
patients.
Informational packets (like CDFE
informational kits) educate patients while
making them aware of complications that
may arise from lack of podiatric care.
And, here comes the DPM. .
Sit and greet your patient at their
level.
The comprehensive diabetic foot
exam (CDFE)
Products to discuss with your diabetic patients.
Only offer medical grade or physician only
formulas. . . .
Products that prevent and treat
Products that they can't find
everywhere.
IT'S ALL ABOUT THE PRESENTATION.
So, don't “SELL” simply OFFER the products
they need for all of their foot and ankle care.
Patient 2. Middle aged woman with
thick, discolored nails
How long has this condition
existed?

Training staff to ask the right questions is
essential.

“How long have your nails looked like
this?”
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“Are your nails painful?”

“Has there been any injury to the nails?”

“Do you have regular pedicures?”
The pick a color theory
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Many women who complain of thickened,
discolored or incurvated nails state that this
condition began after going for regular
pedicures.
“I thought they knew what they were doing,
I pay $45 for my pedicure!”
Pick a color applies to everyone, and that's
not always a good thing!
The assistant doesn't diagnose.

Patients will often ask “what do you think it
is? Is it that fungal thing like on the
commercials with that nasty little animal?”

The assistant should always state that
we see this type of condition all the time,
but only the doctor will be able to tell
exactly what it is.
The good news is. .

If the doctor does diagnose your condition as
a fungal infection, we have all the products
you need to treat your nails and prevent re
infection right here in our office.
The seed has already been planted
Time for the DPM. . . .
Explain the course of treatment

While treating the patient, the DPM has the
opportunity to discuss the possible causes
for infection, and the treatment options.

Give them the treatment options,
discussing the importance of their
involvement through use of your choice
of topical or oral anti fungals as well as
periodic debridement.
Keep their expectations realistic
Try and offer products with money
back guarantees
Less hassle for your office
staff/billing department

By offering products with unconditional
money back guarantees, the patient deals
directly with the manufacturer of the
product rather than requesting money back
from you.

Try it out for yourself. Have a staff
member “test” out the refund process to
make sure it is hassle free.
There are more options than you
think.
Even cosmetic “quick fixes” that
give your patients instant
gratification.
And, you know they don't listen

You know that when you instruct your
female patients NOT to polish their fungal
nails, they aren't going to listen.
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SO, GIVE THEM OPTIONS
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Regular nail polishes contain harsh
chemicals which don't allow the nail to
breathe causing discoloration and
changing the appearance of even the
healthiest nail.
Bring your own polish
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Once your assistant has introduced the
“pick a color” scare tactic and you have
reinforced it. . .
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Discuss the importance of bringing their
own polishes, buffers, and files when
they get their manicures and pedicures.
You can carry all of the most
popular salon colors
Pricing is important

With any item or product dispensed in your
office that is also available online, make
sure your pricing is better.
Example- Dr.'s Remedy nail polish sells
for $16-17 per bottle, not including shipping
in the U.S.

Sell it for $15 per bottle (saves $$$) and
they can pick it up conveniently at the
time of their visit.
Let's talk “specials.”
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Everyone loves a bargain.
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Perception is reality.
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Buy something, get something free is
always an eye catcher.
Try changing “specials” by season and
watch your products move even faster.
Product education
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Before increasing your in office dispensing
(IOD), you must educate your staff.
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Start with a limited inventory and grow
with patient requests and needs
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New items can be tried without incurring
huge costs (order 2 or 3 of a new item to
see how well they move- shoe laces,
sock aides, shoe horns, etc).
Have a staff meeting to educate
TEAM members on products.
Hal's method
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Throw everything in the middle and have
your staff explain what the products are,
how they are used and how they should be
applied.
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Create a price list and be sure it is
always updated.
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Menu type price lists are less intimidating
and allow you to offer without selling.
Questions before we continue?
Patient 3. Gradual onset heel pain
Asking the right questions is key

Upon evaluation, the assistant should very
quickly be able to assess the situation and
anticipate the course of treatment and
protocol to be followed for this patient.

What brings you into the office today?
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“My left heel is killing me.”
How long has this been going on?

“For about 3 months.”
And. . .
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Has the condition improved, worsened or
remained the same?

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“It seems to be getting worse.”
Was there an injury or any changes in
your routine when this pain began?
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“No injury, but I am on my feet a lot more
at work than I used to be.”
And still. . .
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Do you wear any type of orthotic or arch
support?
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Have you tried any icing or stretching
exercises?
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“I tried those gel inserts at the pharmacy,
they didn't help very much.”
“I did try icing a couple of times, only
helped a little though.”
Do you have pain when you first get out
of bed or upon standing?

“I feel like I am 90 years old when I get
up.”
The protocol has been established

At this point, after X-Rays have been taken
or diagnostic ultrasound has been
performed, the assistant is able to prepare
everything the doctor will need to treat the
patient before the doctor enters the room.

Nightsplint has been prepared
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Injection drawn (if part of protocol)
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Biofreeze is placed on table
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Casting material is ready to go
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Stretching instructions are printed
The doctor will be right with you.

Without diagnosing, the assistant is able to
prepare all that is needed to treat this
patient in a timely manner, assuring
compliance and visit maximization.
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The doctor can now simply glance
through the chart note (or take a look at
the products and DME items that have
been prepared) and get right to the
matter at hand (without duplicating
information already given upon thorough
evaluation.)
The doctor enters the treatment
room ready to work.
The DPM gives his “spiel”
Introducing stretching, icing and
strapping techniques
Pick the products you believe in
The doctor finishes up and the
assistant returns
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The nightsplint is dispensed to the patient.
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The technique to dispensing plays a
major role.
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Keeping the patient's goals realistic is
important with compliance and
satisfaction
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Assuring the patient understands the
“process/protocol” is key.
Do you have any questions?

Before the assistant leaves the room and
the patient checks out, the question is
always asked. . .
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This assures that the patient doesn't feel
rushed, or confused
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And, it avoids phone calls later in the
day.
The patient checks out with a sense of
satisfaction. They understand their condition and
course of treatment.
We will revisit this patient at his 3 week re check
appointment.
Patient 4. 12 year old boy with
multiple verrrucae
Patient is hesitant
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The assistant rooms the patient (with his
mother) and asks him to remove both
shoes and socks.

“Why do I have to take off both my
shoes, my warts are only on one foot?”
We always remove both shoes and
socks.
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The assistant explains that the doctor likes
to compare one foot to the other. This way
he can make sure there is nothing on the
“good” foot.
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The patient agrees and removes both
shoes and socks.
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The mother holds her nose and states
“Uggghhh, he has the smelliest feet in
the world.”
The assistant puts things in
perspective.

Seeing that the patient is somewhat
embarrassed, the assistant states the facts.
The doctor will come in and shave down
some of the dead skin surrounding what
we think may be warts.

He will be able to determine what they
are with more certainty once he gets a
better look.
Explaining in a way that they
understand.
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If the doctor determines that these are
warts, he will decide on the best method of
treatment.
No matter what method of treatment is
used, we find that the process is expedited
when our patients take a proactive
approach.
You're not alone
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Many patients who come in with conditions
like these have a few things in common.
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Their feet sweat (a lot)
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They start with one wart and end up with
several.
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They are uncomfortable because of the
callused skin that has formed around the
warts.
Explain the science in their terms
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A wart is a virus, sort of like the common
cold and can enter through the smallest
break in the skin.
Because a wart is a virus, it can spread
(and quickly).
Warts also like damp environments and so
people with sweaty are the perfect host!
For the convenience of our
patients. . .

Because so many of our patients suffer
from the same condition, we offer all of the
products needed to treat warts at home (in
addition to coming for regular visits) right
here in the convenience of our office.
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Drying agent
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Buffing pad
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Wart treatment
They work best when used
together.
Not that we want to see you go. .

We find that when our patients use these
products together and come see us every
2-3 weeks (so the doctor can re evaluate
and treat their condition), they have much
better results (and faster).
The DPM enters the room and the
patient is ready

Now that the DPM is ready to treat, the
patient and his mother are prepared and
understand exactly what to expect.
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The doctor merely reinforces the ideas
that the assistant has introduced.
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The patient and his mother are optimistic
and understand that they need to take an
active role in the course of treatment.
Checking out
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The patient has been treated and he and
his mother proceed to check out.
They make a follow up appointment and
purchase the supplies that have been set
out for them.
The have been fully educated and are
confident that they have chosen the right
facility for their foot care needs.
And, now it's time for. . .
Packaging your products!!
So many of the products in your
office go hand in hand.
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Think about all of the common conditions
you see everyday.
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Which products do you recommend over
and over again?
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How many of these products work better
when used in conjunction with another?

Could you offer better pricing to your
patients if they purchased more than one
product together?
It's a no brainer!!!
Fungal nail patients need. . .
Or, simply appeal to a specific
demographic

Buy 2 nail polishes, get a polish remover
FREE!! (people, especially women, LOVE
FREE!!)
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Make this your fall special, your spring
special, your Mother's day special, your
Valentine's Day special
YOU GET THE IDEA
Wart patients need a wart kit.
Give a discount for kits
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As your patient is educated about the
appropriate product for their condition,
make sure they know the individual price,
then explain the discount.
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Sal gel - $18
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Ostiderm - $20
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Buffing pad - $8
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Wart kit ONLY $42!!!!!!!!!!!
You can even do it with Crocs!!!
Try it and you'll love it!
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Have your patients try on Crocs Rx with a
medical grade orthotic in one shoe and
nothing in the other.
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“It feels like a slipper with an arch
support.”
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Who should wear Crocs? Anyone with
feet.

Offer a discount (Crocs $40, Power steps
$60) Together- $89!!!!!
Let's take a look back at that heel
pain patient...
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Upon returning for his three week follow up,
the assistant greets the patient from the
reception area with a positive tone.

“Hi, Mr. ________ Are you feeling better?

“Actually, I am” the patient replies as he
enters the treatment room.
Positivity counts
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When you greet your patients (especially
for follow up of pain), make sure it is with
assurance that they are feeling better.
Keeping goals realistic, even if they only
express mild to moderate improvement, be
enthusiastic.
“You know, you've had this pain for a while,
and getting better can take some time.
Are you following the doctor's
instructions?
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Make sure that your assistant is reenforcing the treatment protocols (icing,
stretching, resting, etc)
If the patient has followed the “program” so
far and is improving somewhat

OR

Is significantly improved, if you haven't
already. . . .
CAST THEM FOR
ORTHOTICS!!!!
There are many different ways to
cast.
To truly “get better.” . . .
you have to follow the next step
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Discuss with your patient how important
proper support is in their every day
activities.
If they have made mild/moderate
improvement, take it to the “next level.”
If they have made significant improvement,
take the preventative approach.
Either Way. .
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Your patient should leave his follow up
feeling physically better, mentally educated
and prepared to take the next step in their
overall foot health.
Just follow the protocol and let the patient
know that they have chosen the right facility
for all of their foot and ankle needs.
But, what if they argue??
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And, you know a certain percentage will.
So, give them the choice without any
pressure.
Allow them to make a conscious decision
to not follow through with their treatment.
Tell them that you will be here if (but you
know it's when) they ever change their
mind.
Who is casting and dispensing the
orthotics in your office?
When properly trained. . .
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Assistants can be trained to recognize who
belongs in orthotics (WHO DOESN'T?)
They can also be trained to cast in any
technique you prefer to obtain the truest
negative of your patient's feet.
And, they should also be able to dispense,
instruct and if need be modify the devices.
Teach them the basics.
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You were highly trained in biomechanics.
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Your assistants probably were not.
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BUT
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You can once again, teach, show and
watch them go.

Consider the time you would take to cast
and dispense orthotics to your patients
(now add in instruction, and
modifications).
Now consider this. . .
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How many other patients could you have
treated during this time?

The answer is . . . . . . . . A LOT!

Delegation of tasks that can be carried
out by staff members makes sense.

Now let's see how an assistant should
dispense orthotics, we will cast later.
Good afternoon, Mr. _____, here
are your custom orthotics.
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All assistants should know first hand what it
takes to become adjusted to orthotics.
This first rate knowledge will allow them to
educate your patients more effectively and
assure that their expectations are kept
realistic.
So, fit your deserving staff with their own!
Many variations of custom
orthoses
How do you get the word out?
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Marketing for custom orthotics can be fun
and allow you to grow your overall practice.
If a man comes in for shin splints and ends
up with custom orthotics that resolve his
condition, his wife is sure to have her own
made (offer discount for family members, or
second pairs.)
Invite local referring docs
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We all have our favorite referring docs.
They appreciate that fruit basket at
Christmas, but what they really need is a
pair of custom orthotics.
By making a pair of custom orthotics for
your favorite PCPs (for free), you are
raising awareness and greatly increasing
orthotic revenue in your office.
Cash for Clunkers
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Once every couple of years, do what the
car dealerships do and give your patients a
discount for turning in their old orthotics
and having new ones made.
Send letters awaring your patients that as
we get older, our feet tend to change.
Pose questions like, “When was the last time
you had your orthotics checked” and
“Are your orthotics as comfortable as
they used to be?”
Now it gets really good!!
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Our next patient opens up the door to DME
galore (wow that rhymes!)
Orthotics are a great way addition to any
practice (whether starting a program or
improving and growing it), but now it's time
to truly give your patients custom care. . .

THE SUSPENSE > >>>>>>>>>>>>>>>
Patient 5. Ankle pain
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Ankle pain and conditions are tricky.
Lots of DPMs aren't crazy about the idea,
because most problems aren't black and
white (in other words, you can't see
something definitive through X-ray).

BUT, the good news is, patients with
ankle pain, swelling and other types of
related conditions are a protocol
followers dream!
The first type


Assistant rooms the patient (middle aged
man) with chief complaint “my ankle hurts
sometimes.”
She evaluates the patient and finds the
following complaint “My friends and I play
basketball in a men's league on Thursday
nights and afterwards my right ankle
always feels achy and tired.”
Is this only when you are playing?

The patient answers yes, and says that at
work and during normal activities he does
not experience any discomfort.

“Do you wear any type of orthotic or
insert in your shoe or compression
bandage around your ankle?”

“I tried an insert from the store and it
didn't help much, but then I decided to
use an ACE bandage during a game and
it felt a little better.”
Let's take some X-Rays, just to
make sure nothing is out of place.
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The assistant brings the patient to the
orthoposer and takes three ankle views
according to the location of pain.
She pulls the X-rays up on the monitor in
the treatment room and tells the patient the
doctor will be right in.
She leaves the treatment room and knows
to prepare the following braces. . .
The DPM has choices
The doctor is clued in and has
everything at his fingertips.

The doctor goes in and reviews the X-Rays
with the patient. He explains that there are
no evident fractures, but he feels this may
be a tendonitis due to instability of the foot
and ankle.

We have just the thing for you.

He explains the science behind his brace
of choice.
The assistant returns

The assistant places the brace on the
patient's foot/ankle and instructs him on
proper use and care. She warns him that it
may take a little getting use to and instructs
him that he will return to the office in 3
weeks to relay his progress.
When he comes back 3 weeks later.
..

At this point, you have three possible
outcomes.

1. He is feeling some relief with the
brace, so logically you move him up to
the next level of ankle brace.

2. He is feeling 100 percent better and
you tell him to use the brace as needed.

3. He is not improved at all and you send
him for an MRI.

Any way you slice it, you have answers
for your patient.
So let's say he feels some relief
from the brace.

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If you are following protocol, you have
started him with an L1902 (aircast or
gauntlet style brace) or L1906
(multiligamentous brace).
Now it's time to bring out the next level, the
L1971 (some type of non custom brace that
serves as an orthotic as well as an ankle
stabilizer (a favorite is the Ossur Rebound
with stability strap).
L1971 braces
Bring him back in 3 weeks and see.

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
Chances are, if he has done well with the
aircast or other similar brace, he will do
very well with the rebound.
Here is your opportunity to cast him for
orthotics as his tendonitis has calmed down
from immobilization.
He sees the benefit of a foot orthotic as
well as the need for stabilization of his
ankle with increased activity.
You have given your patient
choices.

But, let's say that this patient had more of a
chronic condition.

PTT dysfunction

Chronic sprain

Charcot foot

What happens then??????
Everyone sees these patients
Start off at a higher level.

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
Start this patient with a Rebound or
Velocity brace and show them the benefits
of this “one step below custom” brace.
Make sure to keep goals realistic with
chronic foot and ankle conditions.
Assure that your staff is giving proper break
in instructions and is documenting that they
have done so.
Keep them in the brace “for a bit.”



After about a month, bring the patient back
and check their progress.
Once it has been decided that this type of
brace is improving their symptoms
(somewhat), but the condition will only
worsen over time, take the next logical step
Move them into a custom brace.
Arizona standard
Custom AFOs



Custom ankle foot orthoses can be tricky
but will significantly improve the quality of
life for your patients if the proper style is
selected.
None of this can happen without proper
casting.
Staff members should be doing all casting
for AFOs (YES, WE SAID ALL CASTING)
Train your staff the right way
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There are many techniques for casting of
custom AFOs.
You probably have a “favorite” way that you
learned in school.
This may not be the easiest method for
your staff, so simplify the process.
STS socks make life easy and produce
great results.
STS casting socks come in several
styles and sizes
Make sure they understand why
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When teaching your staff proper casting
techniques (or having someone else teach
them), make sure they understand why it is
so important to cast in a neutral position
and capture the most accurate “negative” of
the patients foot and ankle.
Bad casts keep patients from having the
device they need and slow reimbursement
into your practice.
Practice makes perfect!
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Watch here as we cast a “patient” for an
Arizona brace. . . . . . .
Now, be brave and join us as we cast
eachother.
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You know what they say. . . . (see above!)
Questions, comments, candy refill?
Have we given you enough
information today? Don't worry, it's
almost over!!
We don't have all the answers, but
we give it our best shot!