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Jarrod Shapiro, DPM
Practice Perfect Editor
Assistant Professor,
Dept. of Podiatric Medicine,
Surgery & Biomechanics
College of Podiatric Medicine
Western University of
Health Sciences,
St, Pomona, CA |
“Value-Added”:
Good for the Practice
Does your practice provide top quality care? Would you like to raise your perceived practice quality and volume? Do your patients feel they’re in a top of the line podiatric practice? I know, this sounds like the beginning of a bad advertisement. What I’m talking about is making your practice value added. Wikipedia defines value added this way: "extra" feature(s) of an item of interest (product, service, person etc.) that go beyond the standard expectations and provide something "more" while adding little or nothing to its cost. Value-added features give competitive edges to companies with otherwise more expensive products.”
The reality is that medical services are expensive, but we as providers are unlikely to see any increase in the reimbursement of our services. In fact, we’re more likely to see a continued decline in reimbursement. So why is it that I’m going to advocate value-added services in our practices? I have two simple arguments. First, by maximizing the actual and perceived value by patients, you’re more likely to have those patients return and tell others about your quality establishment – AKA increased practice volume. Second, many value added services will maximize the profitability of each patient interaction – squeeze the blood from that turnip!
Some of the following suggestions don’t cost the practitioner any more than time, while others have a potentially significant price tag. Below is a non-comprehensive list of services that might add value to your practice. You may find you’re already doing some of these – if so, good for you! If you have other ideas, please post them for the rest of our online community on the PRESENT Podiatry website in the eTalk section.
Value-added Services
Prevention – This one’s simple. Consider adding screening services to your patient encounter. Think about the diseases you commonly see. The obvious example is diabetes. Are you aware all diabetics are supposed to have dilated vision examinations and dental screening yearly? The same is true for diabetic foot checks (at least yearly with increasing screens based on the presence of neuropathy, deformity, and prior complications). The easiest way to screen is to add these questions to your intake form. If you find a patient hasn’t had a vision screen, consider adding this to your communications to both your patient and their primary care doctor. You’ll demonstrate to both how involved you are in the medical community, while improving their health outcomes. Regarding diabetic foot screening, Armstrong, Lavery, and Harkless created a validated foot risk index which will add value to your foot screen exams. Follow this link for an article reviewing this index. You might also benefit from adding some of these patients to your surgical schedule for preventative surgical offloading of high risk pedal areas.
ABI – Now, we all know that ABIs are problematic due to their false elevations in diabetics and renal disease patients secondary to tunica media calcification. So, clearly you shouldn’t use the ABI to determine treatment for your diabetic foot ulcer patients. However, ABIs are supported by a lot of strong research that demonstrates its utility to screen for PAD with up to a 95% sensitivity and 95% specificity.1 As it turns out, the vast majority of patients with PAD are asymptomatic, so using claudication symptoms to screen for PAD is not useful. What’s important here, is that a low ABI is a strong predictor of cardiovascular morbidity and mortality. In fact, several studies have found that an ABI < 0.9 demonstrates a 4- 6 times increased risk of cardiovascular mortality.2,3 With this in mind, podiatric physicians are in the perfect position to screen for PAD and then provide recommendations to improve preventative care for our patients. This is value-added service on steroids!
Physical Examination – Consider adding a full set of vital signs done by your staff when they room your patients. You might catch that hypertensive patient that needs further workup. Adding vitals also adds a bullet point to your physical examination, which from a coding standpoint adds complexity and might be the difference between a 99212 and a 99213 or 99214. The same holds true for your general physical examination. Performing a comprehensive physical examination is just good podiatric medicine.
Counseling – Another one you might already be doing. However, I commonly hear complaints from patients, who have seen other physicians, that they received very little counseling from that physician. Have in depth discussions with your patients and consider writing down your treatment plan, recommendations, and referrals. This will have the value-added benefit of your patient’s actually remembering what you’ve told them!
Teaming up with in-office physical therapy – For those of you with the space, consider leasing some of it out to a physical therapist or other specialist. In this way, you can keep your patients in house and you might also see the added benefit of a new referral source.
Technology & Products – Here’s a list of a few technologies and products (of varying cost) that may add value to your practice:
- Digital radiographs
- Arterial testing technology
- Laser Treatment
- Wound care products
- Dispensed products - Cosmetic technologies/creams/moisturizers
- Diabetic shoes
- Orthotic therapy (including video gait and pressure sensing devices)
In the fashion industry, when someone appears ahead of the current trends and looks to the future, they call it fashion forward. I suggest adding some of these ideas to your practice and becoming practice forward.
Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum. Best wishes.
Jarrod Shapiro, DPM
PRESENT Practice Perfect Editor
[email protected]
References:
- Hirsch A, et al. ACC/AHA Clinical Practice Guidelines. J Am College of Cardiology, Mar 2006; 47(6): 1239-1312.
- Vogt M, et al. JAMA, July 1993; 270(4): 465-469.
- Criqui M, et al. New England Journal of Medicine, Feb 1992; 326(6): 381-386.
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