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How to develop body contouring medical practice

Article-How to develop body contouring medical practice

Dr. Revis, Jr.
More than 60 percent of Americans over age 20 are estimated to be overweight — with a large number of these individuals properly classified as morbidly obese, according to the National Institute of Diabetes and Digestive and Kidney Diseases (Flegal KM, Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among U.S. adults, 1999-2000. JAMA. 2002; 288:1723-1727). Bariatric surgery, the surgical treatment of morbid obesity, has experienced explosive growth and is expected to continue in popularity. An estimated 140,640 bariatric procedures were performed in 2004, more than double those performed in 2002, which numbered 63,100, according to the American Society for Bariatric Surgery.

Similarly, plastic surgeons have witnessed an impressive increase in the number of patients requesting body contouring following significant weight loss, because most, if not all bariatric patients will be left with hanging skin, hygiene problems, difficulty finding clothes that fit properly, and some difficulty exercising or performing their normal, daily activities. In 2004, surgeons performed 106,000 body contouring procedures — 56,000 of which followed massive weight loss, according to the American Society of Plastic Surgeons (ASPS).

The goal of this article is to familiarize plastic surgeons with the tools necessary to integrate the increasing number of bariatric patients into their current patient population. Over the last five years, I have witnessed my own post-bariatric body contouring practice grow. I currently dedicate 50 percent of my practice to this complex, challenging and extremely rewarding group of patients.

Step 1: Cultivate referrals

First and foremost, you will need to convey to the bariatric surgeons your genuine interest in body contouring after bariatric surgery as well as the exceptional care you will deliver to their patients. Find out which general surgeons are performing bariatric procedures in your community and express interest in caring for their patients along the spectrum of continuity of care. Offer to speak at support group meetings for postoperative patients. Ask bariatric surgeons in your community to place your business cards or practice brochures in their waiting rooms. Additionally, many bariatric surgeons have practice Web sites and most are willing to exchange links with a plastic surgeon dedicated to improving the quality of life of their patients.

Other referral sources include former patients, local internist(s), radiologists specializing in mammography (and mammography centers in general) and gynecologists. All of these professionals come into contact with numerous bariatric patients who will frequently inquire about plastic surgeons.

Step 2: Decide whether to accept insurance

The decision to accept insurance for these procedures is a very personal one. I have never been an insurance provider and I do not accept insurance for any procedure that I perform. I have found that the level of quality and the intensity of care that I insist upon cannot adequately be delivered for the amounts insurance companies pay for these procedures.

In my practice, it is the quality of the physician-patient relationship, not the quantity of physician-patient relationships that counts. My patients respect this decision and they understand my position. I do, however, offer to provide my patients with any documents from their chart, such as operative reports, history and physicals, and payment receipts so that they may seek reimbursement directly from their insurance company, but my office does not file claims and will not speak directly with a patient's insurance company. Many of my patients have received reimbursement from their insurance companies for the full cost of their procedure(s) performed under my care.

Just because I am not a contracted insurance provider does not, however, mean that I have to turn away every insured patient who presents for a body contouring procedure or who also wishes to have an incisional hernia repaired at the same time under their insurance coverage. I have developed a relationship with several general surgeons in my community whereby the general surgeon accepts insurance for the hernia repair and the remaining cost of my portion of the procedure is borne by the patient. This has worked extremely well in my practice, and the patient's insurance usually will pay for an overnight stay in the hospital as well, when this is determined to be necessary by the general surgeon. I perform this type of combination procedure approximately three to four times each month.

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