PODIATRY IN PRACTICE: Group Practice Achieves Key Economic Advantages And Improved Patient Care

      As DPMs treat a wide variety of patients, they also practice in a wide variety of settings. Podiatrists practice in hospital settings, at academic institutions, solo practices and in group practices with other DPMs.       One such group practice, The Podiatry Group of South Texas (TPG), formed in 2003 when seven independent practices with a total of 12 DPMs merged. The merger was born of “the need and opportunity to consolidate business operations in response to negative pressures from the insurance industry,” according to Robert Vranes, DPM, the president of the group.       The Podiatry Group has several offices in the San Antonio area as well nearly 50 employees. While there were initially “mild to moderate levels of anxiety” among the doctors about merging their practices, Dr. Vranes says the group practice is thriving because of a more “integrated and seamless operational business system.”

Key Benefits Of The Group Practice Model

      According to Dr. Vranes, one key economic advantage of the group practice is having group contracted rates with insurance companies under a single tax ID number. Dr. Vranes estimates these rates are up to 10 to 20 percent higher than rates obtained by solo practitioners.       “The Podiatry Group has gained a measure of respect from insurance carriers and has reversed the downward spiral of those events now common to our profession,” says Dr. Vranes, who is certified by the American Board of Podiatric Surgery.       In terms of other benefits of their group practice, Dr. Vranes says the practice bought a state-of-the-art computer system with an electronic medical record system integrated into the billing system. He says this combination is “not commonly seen” in the podiatry profession.       Furthermore, Dr. Vranes says TPG has a contract with a professional management company that also manages an anesthesia group and a pain group. The management company provides upper-level management services at a flat monthly fee. The DPMs pay a percentage of their monthly gross income to support the central business office, which also provides middle-level management services and billing and collection services.       In addition to recognizing the economies of scale in a group practice, the team of podiatrists is able to offer different areas of expertise under one umbrella. For example, the specialties of the DPMs in the group range from diabetic foot complications and pediatric foot conditions to reconstructive ankle surgery.       “By ‘farming out’ all upper-level management services and most middle-level management services, TPG podiatric physicians have more time and energy to devote to patient care, thus enhancing the level of patient satisfaction,” says Dr. Vranes.       Editor’s note: This article is the first in a series of profiles of podiatric practices that contribute something unique to patient care or practice management. For more information, please contact Senior Editor Brian McCurdy at bmccurdy@hmpcommunications.com.

Study: Alpha-Lipoic Acid Shows Benefits For Neuropathy Pain

      By Brian McCurdy, Senior Editor       Can the antioxidant alpha-lipoic acid (ALA) provide relief from diabetic polyneuropathy? A recent study in Diabetes Care points to positive results using the oral form of the acid.       As part of the study, researchers compared oral alpha-lipoic acid with placebo in 166 patients with diabetic polyneuropathy. After five weeks, mean total symptom scores and burning pain were significantly reduced in patients taking the acid as opposed to the placebo group, according to the study. Study researchers note that symptoms improved in one week for those taking the highest level of ALA (1,800 mg/day) and symptoms improved in two weeks for patients taking 1,200 mg a day or 600 mg. However, the study notes that ALA had no measurable effect on numbness.       The study notes that it is unknown whether the short-term effect of alpha-lipoic acid on nerve pain and deficits can be translated into a long-term slowing of the progression of polyneuropathy.       John Hahn, DPM, ND, has used ALA to treat patients with type 1 and type 2 diabetes who have diabetic neuropathy. He notes he has found the most success in using the antioxidant with acetyl-L-carnitine. He prescribes 400 mg of alpha-lipoic acid along with 500 mg of acetyl-L-carnitine together three to four times a day for people with diabetic neuropathy. Dr. Hahn says he tells his patients to take the medications away from food for the best absorption.

What Other Research Reveals About ALA

      Since alpha-lipoic acid is soluble in both fat and water, Dr. Hahn says it can enter all areas of the cells that are affected by free radicals. Combined with other antioxidants, ALA can lengthen cell life, fight infection, increase energy and detoxify the body, according to Dr. Hahn, who is in private practice in Portland, Ore. He adds that the acid also promotes cellular and muscular energy and is a coenzyme in the metabolism of sugars.       As Dr. Hahn notes, alpha-lipoic acid is approved in Germany for the treatment and prevention of diabetic neuropathy. Dr. Hahn, a member of the American Association of Naturopathic Physicians, theorizes the acid’s effects on neuropathy are due to the antioxidant activity and that its major activity against neuropathy is the correction of the damaged tissue that results from glycosylation.       Dr. Hahn also cites a previous study in Diabetes Care, noting that ALA increases blood flow, lowers oxidative stress and improves distal nerve conduction.