Don Pelto, DPM - Podiatry Practice Mastery

Simplifying Shockwave Pricing in Your Practice

Description

How should you price shockwave therapy if your practice already offers laser treatments?

Many podiatrists successfully implement laser therapy packages but run into confusion when adding shockwave therapy. Should the treatments be offered separately? Should the pricing change? And how do you keep it simple for patients and staff while still reflecting the value of the treatment?

In this episode, Don walks through a practical approach to transitioning from laser-only packages to regenerative treatment bundles that include shockwave. He explains how he structures visits, when he charges for office visits versus procedures, and how ultrasound imaging helps patients understand why shockwave therapy is recommended.

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Timestamps

[00:00] A Question About Transitioning to Shockwave

A podiatrist asks how to introduce radial shockwave therapy when she already offers a six-treatment laser package.

[00:50] Combining Laser and Shockwave Into One Package

Why bundling treatments into a single regenerative package can simplify patient decision-making.

[01:40] Example Pricing Structure

Charging $250 per session and building a six-session regenerative package around that model.

[02:30] Avoiding Confusing Pricing Options

Why offering laser and shockwave separately can create unnecessary complexity for patients.

[03:10] Should Shockwave Be Discounted With an Office Visit?

Some doctors bundle procedures into office visits, but Don explains why he prefers keeping them separate.

[04:05] Structuring the Shockwave Treatment Plan

Initial evaluation, follow-up imaging, weekly treatments, and the final visit that reviews the next steps.

[05:00] Weekly vs. Every-Two-Week Shockwave Protocols

A discussion of alternative treatment schedules used by some physicians internationally.

[05:40] Delegating Shockwave and Laser to Staff

How training staff to perform treatments can improve efficiency in the practice.

[06:10] Using Ultrasound to Guide Treatment Decisions

Why ultrasound imaging helps reveal tendon pathology that patients cannot see externally.

[06:50] Ultrasound Billing Strategy

Charging per foot once for ultrasound and using it primarily as a diagnostic and educational tool.

[07:10] Typical Patient Workflow

First visit X-ray, second visit ultrasound, then deciding whether shockwave therapy is the appropriate treatment.

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Key Takeaway

When introducing shockwave therapy into a practice that already offers laser, simplify the decision for patients by bundling regenerative treatments into one clear package and using ultrasound imaging to guide and justify the treatment plan.

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Conclusion

How are you pricing regenerative treatments like laser or shockwave in your practice?

If you have a system that’s working well—or if you’re trying to figure out how to implement one—share your experience or reach out to continue the discussion.

Most Valuable vs. Least Valuable Patients

Why are some pods stuck below $1M despite working nonstop?

In this episode, Don reviews a recent run of patients and categorizes them into “most valuable” and “least valuable.” The difference isn’t about patient importance—it’s about revenue structure, service mix, and scheduling strategy. Certain visits generate only an X-ray follow-up. Others represent 5–15x the revenue of a standard office visit.

If you want to understand why some practices accelerate toward $1M–$2M while others stall, this breakdown makes it concrete: fracture follow-ups, routine rechecks, and low-yield visits must be scheduled differently than shockwave packages, orthotics, DME, and injectables.

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Timestamps (Total: 6:44)

[00:00] Why Patient Mix Matters

Not all visits generate equal revenue—understanding the difference is key to scaling.

[00:40] Least Valuable Example: Fracture Follow-Up

Initial fracture care pays well, but 4-week follow-ups often produce only an X-ray. Solution: limit visits and double-book into 10-minute slots.

[01:25] MVP: Lipazana Injection

$1,500 fat pad replacement—high-value, easier to explain than some biologics, strong candidate selection.

[02:05] MVP: Bilateral Lunula Laser + Fungal Kit

$1,500 laser plus $200 dispensing kit—bundling increases case value.

[02:40] MVP: Bilateral Plantar Fasciitis with Equinus

Two night splints, foam roller, structured dispensing—maximize bilateral opportunities.

[03:15] Shockwave Strategy Shift (3 → 6 Treatments)

Six sessions improve compliance, keep care in-house, and prevent PT from “getting the credit.”

[04:00] MVP: Shockwave + Orthotics Combo

Midfoot arthritis and plantar fasciitis cases combining packages for stronger outcomes and revenue.

[04:45] Lipazana #2 and Advanced Cases

Repeat high-value procedures for heel fat pad atrophy and post-surgical patients.

[05:20] Least Valuable: Post-Op and Stress Fracture Rechecks

Often limited to imaging reimbursement—schedule efficiently.

[05:50] MVP: DME and Balance Braces

Repeat DME (every 5 years) significantly boosts revenue and long-term patient value.

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Key Takeaway

Scaling your practice isn’t about seeing more patients—it’s about structuring your schedule so high-value services (DME, packages, injectables, shockwave) drive revenue while low-value follow-ups are compressed efficiently.

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Conclusion

Audit one week of patients and classify them: MVP or low-yield. Then restructure your template—double-book follow-ups, protect 20-minute revenue-generating slots, and build packages around high-impact treatments.

Your path to $1M–$2M isn’t volume alone—it’s intentional case mix management.

Late-Career Moves That Actually Increase Profit

You’ve got 5–10 good years left—how do you grow without wasting money or energy?

In this episode, Don answers a series of tactical questions from established podiatrists who want stronger profitability, better positioning, and more control over their schedule. From restructuring routine care to improving Google reviews, raising orthotic prices, and evaluating marketing vendors, the theme is clear: systems—not hustle—drive the next level.

If you’re in the back half of your career and want to work less while earning the same (or more), this episode lays out practical first moves that don’t require massive reinvention—just disciplined restructuring.

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Timestamps (Total: 10:13)

[00:00] Back Half of Career: First Three Moves

Block low-value visits into one day, consider hiring a scribe, and double down on services you enjoy and that produce revenue.

[01:25] Closing the Google Review Gap

High-review competitors win because of process. Use QR cards or automated systems (e.g., Swell) to consistently request reviews.

[03:00] Why Reviews Matter for Referrals

Patients and referring providers check reviews—volume signals credibility.

[03:40] Competing with Retail Insert Stores

Study their presentation model. Use dynamic demonstrations (gait review, imaging, education) and confidently prescribe orthotics.

[05:10] Pricing and Belief in Orthotics

If you’re charging $350, reconsider your pricing and your confidence. Strong presentation + belief reduces returns and increases acceptance.

[06:40] Evaluating a $400/Month Marketing Company

At that price point, expectations must be realistic. Ensure basics are done first: Google Business Profile, SEO, email list, tracking numbers—before running paid ads.

[08:00] Transitioning Away from High-Volume, Low-Pay Work

Block routine care, reduce low-value follow-ups, increase per-visit value with procedures, DME, and packaged services.

[09:05] Working Less While Making the Same

Opt out of low-paying insurance plans, tighten scheduling, protect 20-minute high-value slots, and intentionally take time off.

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Key Takeaway

If you want your final 5–10 years to count, don’t overhaul everything—tighten your schedule, increase per-visit value, systematize reviews and marketing, and eliminate low-margin distractions.

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Conclusion

If you’re aiming to work less but earn more over the next five years, start with one structural shift: block low-value care, upgrade your review process, or reassess your payer mix.

Small operational discipline compounds fast—and in the back half of your career, that leverage matters most.

Niche Down Without Losing Revenue

Everyone says “niche down”—but what if 80% of your schedule is routine care?

In this episode, Don answers a practical question many podiatrists face: how do you transition from a generalist, routine-care-heavy practice into a more profitable niche without blowing up your schedule?

He outlines two paths. First, make routine care more profitable by expanding services around those patients. Second, strategically reduce routine care through block scheduling and focused marketing. The key isn’t abrupt change—it’s structured transition.

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Timestamps (Total: 4:37)

[00:00] The Niche Dilemma

When most of your schedule is basic foot care, how does specialization realistically happen?

[00:40] Option 1: Make Routine Care More Profitable

Expand beyond nails: compression garments for edema, ABIs, annual diabetic foot exams, Onyfix, KeryFlex, matrixectomies, orthotics, and fat pad injections.

[01:45] Gradual Integration Strategy

Introduce higher-value services slowly within your existing routine-care base.

[02:15] Option 2: Reduce Routine Care Strategically

Block routine visits into one dedicated day or half-day (“Toenail Tuesday” model).

[02:50] Control Your Marketing Message

Advertise only what you want to see—plantar fasciitis, Achilles tendinitis, shockwave, orthotics—on your website, blog, and in-office materials.

[03:25] Make Low-Value Visits Less Convenient

Reduce unnecessary follow-ups (paronychia, matrixectomy, fracture care) and tighten post-op scheduling.

[04:00] Use Freed Time Intentionally

Spend more time on higher-value conditions, increase DME dispensing, and build systems around services you enjoy and that grow revenue.

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Key Takeaway

You don’t niche down overnight—you control scheduling, tighten follow-ups, expand services strategically, and market only what you want to see.

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Conclusion

If you’re stuck in a routine-care-heavy model, choose one lever this month: block scheduling, service expansion, or marketing repositioning. Small structural changes compound over time.

If you want the full framework for transitioning toward a $1M practice, review the Million Dollar Practice Formula and start implementing step by step.

Adding Fat Pad Injections to Your Practice

Do you have patients with painful fat pad atrophy who aren’t improving with pads and orthotics?

In this episode, Don shares his first experience using Leneva (fat pad replacement injectable) for a patient with severe forefoot fat pad atrophy. After hearing about it at a recent conference, he implemented the treatment in-office—complete with consent workflow, storage protocol, injection technique, post-op plan, pricing strategy, and marketing rollout.

This is a practical breakdown of how to evaluate, introduce, and operationalize a new regenerative-style offering—from patient selection to filming a YouTube explainer. If you’re considering adding higher-value procedures to better serve chronic pain patients, this gives you a real-world starting point.

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Timestamps (Total: 5:48)

[00:00] Why Consider Fat Pad Replacement?

Managing painful calluses and fat pad atrophy when orthotics and pads fail.

[00:45] Discovering Leneva at Conference

Initial exposure, hesitation with similar products, and deciding to trial it.

[01:30] Office Setup and Financial Workflow

$500 deposit, ordering and freezing protocol, consent forms, and tissue documentation.

[02:10] Injection Technique Step-by-Step

V-block anesthesia, thawing and drawing with 18-gauge needle (noting 20-gauge may offer better control), retrograde injection technique, and even distribution under the metatarsal head.

[03:40] Post-Procedure Protocol

Sterile strip closure, offloading padding, surgical shoe, 3 days heel weight bearing, 2 weeks protected weight bearing, gradual transition back to shoes.

[04:30] Pricing and Case Selection

$1,500 per 1.5cc syringe; typically one per metatarsal head depending on severity.

[05:05] Marketing the Procedure

Recording a YouTube video using CapCut, uploading via Google Drive, adding subtitles, and educating patients through email outreach.

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Key Takeaway

If conservative care isn’t enough for fat pad atrophy, adding a structured, well-priced in-office injectable option—supported by proper workflow and marketing—can improve outcomes and elevate revenue per case.

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Conclusion

If you’re evaluating whether to introduce regenerative or specialty injectables, start with one diagnosis, build your consent and pricing structure carefully, and document the process.

Have you added fat pad replacement or similar procedures to your practice? Share your experience—what worked, what didn’t, and how patients responded.

Full Schedule, Flat Revenue? Fix Your Case Mix

Is your schedule packed with routine nail care—yet your revenue doesn’t match your effort?

In this episode, Don answers a question shared by Jim McDonald from Podiatry Growth: how do you shift toward higher-margin care without losing the steady income from routine visits? It’s a common challenge, especially for doctors inheriting established routine-care-heavy practices.

Don outlines a practical strategy: consolidate routine care into structured block time, then intentionally use the freed-up schedule for higher-value services, marketing, or new technology. He also explains how to ethically increase revenue per routine visit through appropriate exams, diagnostics, and in-office services—without abandoning that patient base.

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Timestamps (Total: 3:30)

[00:00] The Core Problem: Busy but Underpaid

A full schedule dominated by routine nail care that doesn’t translate into strong revenue.

[00:40] Strategy #1: Block Routine Care Into One Day

Designate one full day (e.g., Fridays) strictly for routine care to protect the rest of the week.

[01:30] Upgrade the Model: Add a Nail Tech

Transition from a full day to a half-day of routine care by leveraging support staff.

[02:00] Protect the Other Days for Higher-Value Care

Use open time for plantar fasciitis, advanced treatments, marketing outreach, or learning new technologies.

[02:30] Increase Revenue Per Routine Patient

Add appropriate services such as DME for wound care, ABIs for diabetic patients over 50, and annual foot exams to elevate reimbursement ethically.

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Key Takeaway

Don’t eliminate routine care—control it. Block it into dedicated time and intentionally build higher-value services into the rest of your week.

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Conclusion

If your schedule is full but margins are thin, restructure before you work harder. Choose one step this month—block scheduling, staffing support, or adding appropriate in-office diagnostics—and measure the difference.

If you’ve successfully shifted your case mix, share what worked.

Busy but Broke? Fix the Real Bottlenecks

Are you seeing 25–30 patients a day—and still not building wealth?

In this episode, Don shares a listener win from Australia using “Good–Better–Best” treatment sheets, then dives into a bigger issue: why some podiatrists producing $300K–$500K still feel financially stuck. The problem isn’t always volume—it’s structure, service mix, and scheduling strategy.

He outlines three practical levers: packaging treatment options to reduce decision fatigue, consolidating low-revenue routine care into dedicated blocks, and increasing in-house, revenue-generating services. He also shares a marketing update on urgent care referral postcards—and the importance of tracking every campaign with dedicated numbers.

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Timestamps (Total: 13:54)

[00:00] Listener Win: $1,600 from One Treatment Sheet

Jackson implements a Good–Better–Best format and closes a comprehensive $1,600 care plan.

[01:30] Three Treatment Sheet Models

Checklist prescribing, Phase 1/Phase 2 (insurance → non-covered), and Good–Better–Best packaging.

[03:30] Why Packages Reduce Decision Fatigue

Bundling services simplifies patient decisions and increases case acceptance.

[05:00] Busy but Broke: The $300K–$500K Trap

High daily volume doesn’t equal profitability—especially if everything is insurance-dependent.

[06:30] Strategy #1: Block Your “Low-Value” Visits

Consolidate routine nail care into a half or full dedicated day (e.g., “Toenail Fridays”) to protect higher-value clinic time.

[08:30] Strategy #2: Increase Revenue per Patient Ethically

Incorporate shockwave, orthotics, AFOs, regenerative options, in-house imaging, and other services instead of sending them out.

[10:40] Strategy #3: Tighten Follow-Ups and Use 10-Minute Slots

Reduce unnecessary follow-ups and book simple cases efficiently to free 20-minute slots for higher-value visits.

[12:00] Urgent Care Marketing Update

Distributing urgent care postcards to shoe stores—and the key lesson: always use tracking phone numbers to measure ROI.

[13:10] Final Encouragement and Sharing Wins

Invite listeners to share successful systems and marketing ideas.

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Key Takeaway

If you’re busy but not profitable, fix structure—not effort: package treatments, consolidate low-revenue visits, increase in-house services, and track every marketing initiative.

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Conclusion

What’s one bottleneck in your practice right now—case acceptance, scheduling, service mix, or tracking? Identify it, adjust one system this month, and measure the result.

If you’ve implemented something that worked, share it. Your win could help another podiatrist move closer to the million-dollar mark and beyond.

What $1M Providers Do Differently

How are some podiatrists producing $750K–$1M per provider—without working twice as hard?

In this episode, Don breaks down the practical differences between busy practices and high-producing ones. It’s not magic—it’s math, structure, and service mix. From daily visit targets to packaging protocols and opting out of low-paying insurance, he outlines the operational shifts that drive real per-provider growth.

He also answers a second key question: how do you evaluate whether adding cash services like shockwave will actually pay off? Don shares how to think through break-even math, leverage demos, and structure packages so new technology funds itself.

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Timestamps (Total: 8:10)

[00:00] The $1M Question

What are $750K–$1M providers doing differently day to day?

[00:45] Start With the Math

20–25 patients per day at ~$200 per visit = ~$4,000 per day → ~$1M annually.

[01:45] Separate Profitable vs. Non-Profitable Visits

Block routine care into a half day, double book strategically, and protect 20-minute higher-value slots.

[02:40] Add and Automate Services

Imaging (X-ray, ultrasound), in-office procedures, orthotics, DME, and dispensing should be systematized—not optional.

[03:40] Package Everything

Fungal kits, equinus kits, shockwave bundles, laser packages—reduce friction and increase case acceptance.

[04:45] Track Daily Production

Use a daily tracking sheet to monitor imaging, DME, procedures, dispensing, packages, and follow-ups.

[05:20] The Elephant in the Room: Insurance Mix

Opt out of low-paying plans that prevent sustainable margins.

[05:50] Adding Cash Services Without Fear

Use break-even spreadsheets, demo equipment (“puppy dog close”), and shadow experienced doctors.

[07:10] Simple Break-Even Thinking

Often one package per month covers the equipment payment—the rest is upside.

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Key Takeaway

High-producing practices don’t rely on volume alone—they optimize per-visit value, package services, automate imaging and DME, track metrics daily, and make disciplined payer decisions.

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Conclusion

If you’re stuck below your target revenue, don’t work harder—tighten your math. Audit your daily visit value, block low-margin care, package your services, and run the break-even numbers on one new technology this quarter.

If you want the framework Don references, download the $1M Practice Formula and start implementing step by step.

Coverage Gaps and Ownership Mentality

Are unplanned absences quietly straining your practice more than you realize?

In a smaller private practice, even one physician out can create ripple effects across scheduling, workflow, and patient experience. In this episode, Don shares a candid look at what happens when a four-doctor practice temporarily loses one provider to paternity leave—while another is briefly sick. The result? Overloaded schedules, disrupted routines, and subtle but meaningful stress on care delivery.

He breaks down the operational realities: managing overflow follow-ups, compressing 10-minute slots, covering nail care days, and balancing quality with efficiency—even with the support of a scribe. More importantly, he challenges associates and future partners to think beyond “time off policies” and consider the ownership mindset: how reliability, availability, and coverage impact revenue, culture, and long-term opportunity in a smaller group.

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Timestamps

[00:00] Practice Update and Current Strain

A fourth doctor out on paternity leave, another briefly sick—how quickly a four-doctor practice feels stretched thin.

[01:15] The Good: Scribes and Maintaining Quality

How a scribe helps preserve patient interaction and care quality despite increased volume.

[02:05] The Scheduling Squeeze

20-minute visits, added 10-minute slots, and the difficulty of absorbing another doctor’s follow-ups without running behind.

[03:10] Routine Care Disruptions

Covering nail care days and how small workflow changes add stress and reduce perceived quality.

[04:20] Medical Leave vs. Business Reality

The ownership dilemma: respecting leave policies while recognizing daily revenue impact ($4,000–$5,000 per doctor per day).

[05:35] Evaluating Associates and Partners

Why reliability, sick time usage, and time-off patterns matter more in smaller practices than large group or HMO settings.

[06:45] Ownership Mentality in Action

A story from early career: going the extra mile to avoid missing clinic—and how that influenced partnership perception.

[08:00] Final Reflection: Balancing Time Off and Responsibility

The tension between personal time and business sustainability—and why awareness matters.

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Key Takeaway

In a small practice, every physician-day materially impacts revenue, workflow, and patient care—so hiring and partnership decisions should factor in reliability, coverage planning, and true ownership mindset.

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Conclusion

If this resonates with your experience—either as an owner or an associate—consider how your practice handles coverage, leave policies, and expectations around ownership. What systems could reduce strain when someone is out? Share your thoughts or challenges, and let’s continue the discussion.

Why Visiting Other Practices Accelerates Growth

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Episode Description

What if one of the fastest ways to grow as a podiatrist had nothing to do with new marketing tactics or equipment purchases? In this episode, I share a recent experience hosting a visiting physician and why spending your own time and resources to learn from other practices can dramatically shorten your learning curve.

We break down practical takeaways from this visit—from treatment sheet workflows and low-cost in-room patient education to perspectives on shockwave for wounds, MIS surgery in the office, and real-world thoughts on Swift technology costs. This is a candid look at how collaboration, observation, and curiosity can directly influence clinical efficiency and practice design.

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Timestamps

• [00:00] Why hosting visiting doctors benefits both sides

• [01:20] The mindset of investing time and money to learn from others

• [02:35] Treatment sheets, front desk flow, and simple workflow improvements

• [03:50] Using in-room TVs and USB videos for patient education

• [05:05] Shockwave for wounds and navigating insurance hesitation

• [06:30] Office-based MIS surgery as a time-efficient alternative

• [07:40] Swift technology: effectiveness, tip costs, and real frustrations

• [09:05] Why visiting other practices should be intentional and ongoing

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Key Takeaway

Regularly visiting other practices—and paying attention to their systems, not just their medicine—can accelerate your growth faster than trying to figure everything out on your own.

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Conclusion

If you’re early in your career or even years into practice, consider scheduling regular visits to other offices to see how they operate, educate patients, and structure care. If this episode sparked an idea or challenged your thinking, reach out or share your perspective—I always enjoy the dialogue.