Today, I received notice from the New York State Podiatric Medical Association that discounting lasers for nail fungus on Groupon and other similar sites is actually illegal fee splitting in the eyes of New York State. (This information is true as of the date of this writing. Stay tuned to see if any legislation changes.)

It is in violation of both 6509(a) of the New York State Education Law and Section 29.1(b)(4) Title 8 of the Official Compilation of Codes, Rules and Regulations of the State of New York.

Apparently, the way Groupon is structured, they get a percentage of the fee for service paid to the physician. This is called ‘fee splitting’ and is illegal.

It is perfectly legal to pay for advertising, but when the physician splits the individual fees based on how much they receive it becomes illegal.

To my colleagues out there using Groupon, be careful. In addition to providing services that are destined to not work as I’ve outlined in my previous post (click “Groupon discount for laser nail fungus treatment”), you may be subject to discipline from the Office of Professional Misconduct.

Dr. Silverberg

I have been using the Cutera Laser for nail fungus or about eight months now. Patients have been coming back recently with some promising results.

When the Cutera was tested for FDA clearance the results showed around 70% efficacy. I have been seeing right around the same amount of success.

I always tell people in advance that the laser does not work for everyone. I advise them that the success rate is seven out of ten and that although chances are in their favor, the treatment may not work.

I find that the success rate is also dependent on how severe the case of nail fungus is. Common sense dictates this, but none of the literature I have read documents any real data to confirm this. I think there are reasons for this. Deciding the severity of individuals’ nail fungus is a bit subjective.

Nail fungus can range from just some mild discoloration to severe disruption of the normal architecture of the nail plate. Nails can be different thicknesses. There can be different amounts of crumbling of the nail. You can see that there is no objective measurement to make in order to classify the amount of nail fungus.

Additionally, it is very hard for me to predict who will be successful with laser for nail fungus. Sometimes people come in with what I consider a mild case of nail fungus and the laser does not work. On the other hand, sometimes people come in with very severe cases of nail fungus and the laser works perfectly. Because of this discrepancy, I don’t make promises either way to patients prior to starting their laser treatment.

Obviously I always feel bad when the treatment does not work. Fortunately, there are no adverse effects of a failed laser for nail fungus, but only economic downside.

Often when the laser does not work completely, there is some improvement to the nails. This is not a complete failure, but also of some disappointment to me and the patient.

Getting back to my success rates… I have been experimenting with my new Cutera Laser a bit. On a few patients where the laser did not work after the second or third treatment, I have tried changing the settings on the machine a little.

I have found that turning up the power (Joules) did not increase success rate. I did notice that performing more pulses of light does work better. I have even seen lower power setting with increased number of pulses works. For this reason, I now give 3,000 pulses of light to people when all ten toes are involved. (Less when there are less effected toes)

And now, a little self promotion, why not?

Why Drs. Silverberg, Shastri, Lupoli and Kudla at City Footcare should be the podiatrists you choose for your Laser for Toenail Fungus:

The most important reason is our success rate is better than other doctors. We do the most lasers in New York City. We have the most experience with the Cutera Laser for nail fungus which is the newest and most advanced laser for nail fungus that is FDA approved.

This extensive experience allows us to experiment with changes to the treatment to enhance the success rate, just like I have discussed above.

We are young, ethical doctors that care about our patients and not just making a buck selling a laser. We feel that if your laser is successful, you will refer us many other patients for laser treatments, and for anything else that we treat as podiatrists. You will go tell you other doctors how well we treated you and they will send us patients. We see the big picture! Do the right thing and we will be rewarded.

We offer the lowest price in Manhattan and NYC for laser fungal nail treatments. We charge only $600 for three treatments. Not $600 each, $600 total for all three. The only additional charge will be $49 for topical medicine that enhances the success of the laser treatment. Often, we will perform additional treatments beyond the three for a discount, or for free.

We will not take your money if we feel the laser treatment will not work. If there is any question whether or not you have fungus, we will first do a biopsy to make sure it really is fungus. If the biopsy comes back negative, the laser will not work, and we will not take your $600. Ethical and honest treatment from altruistic physicians.

Thanks for reading and feel free to ask questions or comment.

Dr. Silverberg

This week I turned down three patients for laser nail fungus treatment. That’s right, I told three people NOT to pay me $600 each, $1800!

All three had separation of the nail form the nail bed soft tissue attachment. This causes the nail to look different in color in the area that it is separated.

This discoloration of the nail looks like nail fungus to the untrained eye. Very often, people come to my office with this separation of the nail from the nail bed, thinking it is fungus when it is not!

Laser will not fix this problem. Neither will topical medicines alone.

Treatment for separation of nails:

The only fix for this is to remove the part of the nail that is separated, all the way back to the area of good soft tissue attachment with cutting and grinding of the nail.

Once this removal is performed, then I advise patients to use topical medicine for the nails. I have formulated my own topical medicine for this purpose. This medicine also has an anti fungal medicine in it.

My product is called NailPure by Dr. Silverberg (Click for more info and to purchase online). The anti fungal ingredient is Tolnaftate. The multiple oil vehicle allows the Tolnaftate to penetrate the hard nail plate to reach the fungus. (Disclaimer: Tolnaftate is FDA approved for the treatment of athlete’s foot  (tinea pedis) and not for nail fungus (onychomycosis)) In the case of nail plate separation, however, it’s not the anti fungal that is important. It is the multiple oil vehicle. It contains tea tree oil, manuka tree oil, jojoba oil, sunflower seed oil, and sweet almond oil (and vitamin E). This unique combination of essential oils penetrate, emulsify, soften and hydrate the nail and surrounding skin. Additionally, NailPure contains acetic acid that whitens the nail to make it appear more normal very quickly. Acetic acid is a natural acid that makes vinegar have its characteristic smell and taste.

By treating the skin and nail, NailPure allows the nail to grow in and reattach to the nail bed having normal color and looking healthy.

The best topical antifungal for nails also works on nail bed separation:

Wow, what a tangent! I was talking about doing the right thing for these three patients, and got excited about introducing my new topical nail fungus treatment. I spent one and a half years working with my chemist in Florida to perfect NailPure. I tried many different combinations of ingredients and vehicles until I came up with the proper formula. I tested it on dozens of my patients and waited patiently while their nails grew in healthier without fungus, whiter, thinner, and more clear. I then discovered how well it worked for nails that were separated from the nail bed. I used to use topical urea gel or cream for these patients but I discovered that NailPure worked so much better.

Honestly, when I started developing NailPure, I did not think to use if for nail separation, but when I discovered how well the oil vehicle worked on the nail and skin, it was obvious. I had stumbled upon a new, amazing treatment for a previously very difficult problem to solve.

Going back to my original topic, these three patients were very grateful that I saved them *$531 by not performing the laser for nail fungus, that would have been unsuccessful. *Note: $600 minus $69 for the NailPure.

Unfortunately, many doctors as not as honest, ethical and altruistic as I am. They would have performed the laser nail fungus treatment for the money. You see, studies have shown the laser nail fungus treatment to be 70-80% effective. These doctors hide behind that statistic and tell these people that is why the laser did not work.

Other doctors may be mistaken to make an improper diagnosis of nail fungus when in fact it is separation of the nail plate. In my opinion, this is why many nail fungus treatments fail. It was never fungus.

Choosing a provider for Laser Nail Fungus Treatment:

In summary, when choosing a provider to take care of your nail fungus, make sure you go to a doctor that you know and trust. Get a recommendation from a friend or another doctor (or come to NYC to my practice). Question your doctor about if it is really nail fungus or separation of the nail plate. When in doubt, your doctor will send a (painless) clipping to the lab for evaluation under the microscope. And lastly, be weary of doctors advertising for laser nail fungus treatments. A doctor spending money on advertising will be looking for return on investment and willing to perform lasers on everyone that comes through the door inquiring. Keep in mind too, that the lasers are very expense pieces of equipment and doctors will be looking to pay off their leases… However, with all at said, most doctors are still ethical. There are just a few that are not to look out for.

As always, feel free to send me email questions on this topic. Dr. Silverberg

Policy for Laser Nail Fungus Procedure:

LAST UPDATED: 02-JUNE-2011

I have been performing lots of Laser treatments for nail fungus. There have been many questions about the pricing and procedures leading up to the laser treatment so I will take this opportunity to outline them here.

When people call for a the laser nail fungus procedure, the first step is to determine if they are a candidate for the procedure. We will evaluate you when you come in for a consultation.

If we feel that your nail problem will not benefit from the laser procedure, we will tell you this and save you the money! At the same time, we will then recommend a different treatment to resolve your nail problem.

At the initial consultation we will examine you and if there is any question as to whether your nail problem is fungal or not,  we will take a painless biopsy of the nail in order to confirm that your problem in fact nail fungus. The laser procedure will not work if your problem is not fungus.

If we think your problem is fungal we will then perform the laser procedure right away in our office. If we are not sure if your problem is fungal then you will require this painless nail biopsy and you will not be able to have the laser procedure on your initial visit. You will have to wait for the biopsy result to come back. This usually takes one week. If the biopsy comes back negative we will then recommend different treatment options. If the biopsy comes back positive we will then schedule your return visit for your laser procedure.

Believe it or not, many other problems look like nail fungus, but are not fungus. If you do not have nail fungus, the laser will not work, and you will have wasted your money. As ethical physicians, we are very honest and want you to be happy with your laser treatment. We will always sacrifice the money we make on the laser treatment if we feel the laser will not help you.

Right before your laser procedure we will take photographs of your nails. Then, we will use our highly specialized, cooling spray nail grinder to reduce the thickness of the nail as much as possible. (Usually painless). We have found that grinding the nail thin with our special cooling spray grinder significantly increases the penetration and the success rate of the laser procedure.

The laser procedure is performed right in our office with our latest technology laser. After evaluation and grinding, the procedure takes 10 – 20 minutes depending on how many nails are infected and how severe your problem is. It requires no anesthesia and causes very little pain. Most people report that they feel the heat generated by the laser but not pain.

(Many people travel from great distances for the laser nail procedure. For these people we will occasionally skip the nail biopsy procedure and perform the laser even if we are not sure if your problem is fungal or not. This saves you the long traveling time. If we perform the laser and your problem was not fungal, there is no harm done but the problem will not be solved. If we are sure that it is not fungal, we will not perform the procedure and will make other suggestions for your treatment.)

Costs of Laser Nail Fungus Procedure:

The initial consultation will usually be covered by your health insurance. If it is not covered ,or you do not have health insurance that we take, or you do not have any health insurance, the charge for the consult will be $50 which is applied towards your laser procedure. If we do your initial consultation and decide that you are not a candidate for the laser procedure your total charge will be just the $50 for the consult and we will have saved you money by not doing a laser procedure that will not work. Just for our laser clients, this $50 is discounted from our usual consultation rates. This charge will cover our time and also you will receive alternative treatment options for your nail problem. If you are a candidate, and we go forward with the laser, this $50 will be applied to the cost of the laser.

This laser procedure for nail fungus is currently not covered by any insurance. You may use your flexible spending or medical savings account.

The cost of the laser procedure is $600. We will do 3 laser procedures for this $600. We have found that while many people respond to just one treatment, we have gotten a much greater success rate by performing 3 separate procedures. There is no additional cost to you for the second and third treatments.

The $600 must be paid in advance of performing the procedure. We take cash and charge (MasterCard, Visa & American Express)

Refunds and cancellation policy:

If you cancel in advance of the laser you will not be charged for the procedure.  If you have the initial consultation and opt not to perform the laser for any reason, your $50 consultation fee will not be refunded. If we determine that you are not a candidate for the laser, your initial consultation fee will not be refunded.

There are no refunds once the laser procedure is performed. We make no guarantees as to a successful outcome and cure of nail fungus. In the event that the procedure does not work, we will recommend other treatment alternatives or rarely, a repeat procedure (3 treatments for an additional $600). (Unfortunately, just like every other treatment for nail fungus, the laser procedure will not work for everyone.)

Practice Philosophy:

We are here to help you and we care about our patients! We are a group of young, ethical and friendly physicians. We are always out for the best interest of our patients and give truly altruistic care. Our practice philosophy is that by providing altruistic care with happy clients, our practice will grow.

Feel free to call our office at any time or email us.

Sincerely,

Lawrence Silverberg, DPM

Founder City Footcare

I have been performing laser toenail fungus surgery since the technology first came to market.

Improved Results, Lower Cost:

UPDATED: 02-June-2011

I have been performing laser toenail fungus surgery since the technology first came to market.

In the Beginning:

At first, I was less than satisfied with the results of laser toenail surgery. Approximately fifty percent of my patients got better with one treatment. At the cost of twelve hundred dollars per treatment I found this was unacceptable. I discussed this in detail with patients prior to performing their procedures. Often, patients would decide not to have the procedure due to the cost. Some chose to pay the full amount knowing that there was only a fifty percent chance of success.

Evolution: Better Results, Lower Cost!

The most profound change has been switching from the original PinPointe Laser to the new Cutera Genesis Laser. The Cutera is 20 times stronger at 80 Watts compared to only 4 Watts.

I found early on that combining laser treatment with other treatments produced better results. I have combined the laser treatment with topical antifungals. Particularly, I find good results with NailPure, and NFT-20.

I also found that repeating the laser procedure three times produced much more satisfactory results. With a combination of repeat procedures and application of topical antifungals my results improved to approximately 75-80% success. This is equal to the success rate of using oral antifungal medication like Lamisil but without the systemic side effects that the oral medicines cause.

In summary: I am now able to perform laser toenail surgery for a cost of $600 for 3 treatments.