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There have been many articles over the last several years that discuss podiatrist practice-building techniques and offer suggestions on how to increase revenues, but most would have physicians working harder, not smarter. Numerous editorials advise doctors to just see more patients. But do more patients equal more revenue? Other publications suggest doctors should invest their marketing dollars in direct-mail and Yellow Pages advertising or retool their practice through partnerships. Does spending money guarantee a profitable return? Do partnerships mean bigger dollars? It has been said "that if your practice is not growing, it's shrinking."

When medical students choose a career in podiatry, they often envision a nice office, multiple locations, a flexible schedule, paying patients and profitability. However, despite a medical degree and hundreds of training hours spent learning their craft, many podiatrists enter the field with no idea how to bring their practice to life. Medical schools do not teach the essential business skills needed to start and grow a thriving practice. Today's physicians wear many hats, maintaining two jobs simultaneously: the medical doctor delivering essential services to the community, and the chief executive officer of their business. This creates time and learning challenges as doctors are consumed by their day-to-day responsibilities, thus making it difficult to capitalize on the many nuances of the business of medicine.

For physicians already in practice and established within their respective communities, it is essential to assess the health of your practice regularly. All aspects should be evaluated with both patient and staff considerations topping the list. Assessing patient demographics is critical; use this information to dictate how your practice can be better positioned within the community. A broad- based comprehensive practice is typically less volatile and more financially stable as it will succeed in capturing more business opportunities. Once a practice's scope of service is determined, staffing considerations must be made. This is a pivotal step and will lay the foundation for a successful practice as key personal supplement the doctor's time through managing other business- related obligations and objectives.

With the economic downturn, the rise in unemployment and the decrease in the number of insured patients, there has been a decline in elective services and treatments. Despite that trend, the purely functional medical/surgical aspect remains strong. To compensate for the economic climate shift, doctors should take a baseline history and physical of what their scheduling book looks like today in terms of volume and the revenue yielded per patient visit. Next, dig deeper and analyze the payer mix and reimbursement schedules. Examine payments you receive from third-party insurers. This will expose ares of opportunity as two very similar products and/or treatments can have very different reimbursement rates. Finally, eliminate underperforming products and treatments for interchangeable and more profitable ones.

Traditional thinking dictates that a comprehensive, primarily insurance-based practice must see more patients per hour and accept less reimbursement in order to generate greater revenue. Instead, evaluate and restructure your appointment calendars to maximize each patient visit. The key to financial health is structuring your calendar for those conditions you want to treat, not simply accepting every patient who calls. Restructuring a percentage of your practice or even overhauling your entire office not only changes the number of people you will see but how you see them. From a doctor's vantage point this can mean higher profitability and a better quality of life for all.

Partnerships and multispecialty practices are another way to fight off high overhead and low reimbursements. With doctors feeling the squeeze, partnerships can offer decreased costs and increased geographic and marketing reach, helping to capture a greater portion of the patient population. Review and evaluate current partnership agreements to ensure they are appropriate for future growth. If a partnership is still in the conceptual stages, make sure you are choosing the right partner as economies of scale is not guaranteed. The multispecialty practice model offers doctors an alternative to private practice with incentives that include reduced expenses, direct and indirect patient referrals, and a higher quality of patient care. Both options offer physicians an alternative to building an independent practice from scratch or maintaining a struggling solo practice.

A doctor's marketing wheel is a key area that also requires close attention. A practice that is primarily insurance- based should expect an 8 to 10% reduction in reimbursements annually. To counter this, consider the addition of supplemental services and reduced outsourcing. It is paramount for doctors to study and learn HCPCS and CPT coding to help maximize product and procedural revenues. The sale of podiatry products can account for as much as 15 to 20% of practice revenues. By scrutinizing this information doctors will have a better understanding on how to make more money without working harder to do it. This understanding will provide physicians with an edge in dealing with insurance companies, their patients and their competitors. Your patient's visit to your practice should begin with an assessment of their physical health or specific needs followed by an educational conversation and introduction to a product and or treatment, knowing coding will pay dividends.

Proactive business planning is another essential exercise. Your schedule should be dissected to better understand the individual components. Build a forecast model of the future of what you want your schedule to look like. This starts by simply defining how many weeks and how many days per week you want to work per year. Physicians must also consider what they want their scheduling template to look like in terms of the types of patients and the volume of patients. They should review their historical numbers of revenue generated and patients seen. This includes patient visits for which there was a charge as well as patient visits with no charge, which can include post-operative visits. Doctors should also calculate revenues realized from hospital consults, emergency room calls, clinics and nursing homes visits. It is often significantly less than servicing patients from your own practice.

It is also important to examine the expense side of a practice. Managing every line item of profit and loss is essential in determining the solvency of a practice. Evaluate insurance policies annually and secure multiple bids in an effort to control cost. This also applies to medical supplies. Complacency is all too common, with many practices developing relationships with medical supply companies and ordering supplies without ever reevaluating price points or monitoring invoices to ensure they are being charged appropriately. Physicians that do not own the building in which they practice should appraise their lease agreement as real estate is now a buyer's market. Consider renegotiating your terms or purchasing your own multi-unit facility, which can house your practice and generate additional income through the leasing of space to tenants. Consider in-house elective and non- elective product treatments instead of outsourcing and sending patients to an alternative facility for treatment. Patients will see the dispensing of products in office as convenient and the practice will generate considerable revenue without doctor and staff having to work harder. Challenge yourself to become smarter, more efficient and improve your practice one day at a time.

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