Home Forums Discussions General Discussion extra income with cosmetic medicine, a good idea?

Hi,

I just find my Medicare rate is reduced in 2012. Not much, but I feel it's harder & harder to stay afloat in this tough economy with revenue shrinking and cost goes up. I think us as soloist will face more and more financial challenge in the future; maybe some of us already have this problem. One solution is to work harder, see more patients; but you will probably burn out faster. Is there any way we could turn things around: increase revenue, control the # of pts you see everyday and also provide service that pts needed?

I was thinking very hard. Does anyone have experience with non-invasive fat reduction treatment (a huge market)? If we could identify one or two such methods, we could easily add it to our practice as a side service to our pts. It must meet the following criteria?s:

1. It has to be safe and effective.
2. It does not require the involvement of the physician; a trained & certified staff can run it.
3. It should cost less or much less than current invasive methods (i.e.: smartlipo) so more people could afford it.

Yes, it's against what most of us intends to do when we entered into medicine field originally. But we should adapter in order to survive.

One of the advantages for us is "marketing". Everyone has a large patient?s base, and if we offer something pts want, we don't have to spend a fortune to market it. And from the limited amount of research I did, there are more and more solo medical practices start to enter this field (probably being forced into).

Please comment on:

1. Do you think it is morally right to do this?
2. Will this affect our image in our patients?
3. Which non-invasive fat reducing treatment is the best for this? Why?
4. If you already ahead of us and running a side job like this, which treatment are you using? Any experience? What do you think that is critical to the success? Population? Income level? Marketing strategy? Staff quality? Selection of the right patient?

We cannot just sit idle and waiting for the mercy of insurance companies and Medicare to not drop our rates too fast. We have to fight back!

Cindy,

This may not be exactly what you are looking for, but as a patient, a family member and I did a series of Doctor supervised HCG treatments last year. Taking into account the bounce-back after coming off the program, I am still down 45+ pounds.

As a Type 2, it had the immediate effect of bringing down my fasting BS, as well as reducing required medication and other benefits.

It required a significant amount of commitment on our part, but it was transformative, and I would recommend it to others.

It required Doc supervision of the weekly checkups because several meds had to be adjusted, but I think the model works well, serves the patient well, and there are several food items that you can source in volume and resell with margin that will still be better priced than what they cost when they can be found. I helped figure out some of the business aspects, so I can vouch for the business model.

Indy,

And we all pictured you as a 24 year old with 6 pack abs who worked out daily.......

Gene

Crack me up!

I hit 51 this week, but I am carefully laddering up my bench, and as much as I hate running, I am also adding distance to my interval training.

Next time we meetup in Tahoe I am determined to lead on one of the shorter legs of the Rim Trail.

Correction, Gene...a 51 year old with 6 pack abs who works out daily.

Jon's wiry, I think both he and Beverly are willing to take on any young bucks that want to try and keep pace on our next 'mountain stroll'.

Oh sorry, I guess I was thinking of Harrison Ford.......

Gene

The AMA disproved HCG in the 1970's for weight loss.... just sayin' It's the 500 kcal diet along with it that seems to cause the weight loss.

If you plan to do cosmetics, I recommend you keep it separate from the medical side. I don't see a problem making people feel 100% better with a cosmetic result, if it works, instead of with Prozac.

Cindy, it is really tough having to face a really bad work situation and decide what has to be sacrificed first; ideals, career, geography, whatnot.

Twenty years ago, I was so miserable in my job that I actually considered leaving medicine, and answered an ad to become an aeromedical evacuation pilot in the Maldives. Between the time that it took to send my cable and get a reply ("Telephone soonest. Operations officer, Male, Maldives"), I had some brief flash of sanity, and realized I was seeking the wrong solution. My answer was to leave my group, go solo, and take on a gigantic project helping the small airlines in Alaska (and there are a couple hundred of them) comply with Federal anti-drug laws. The latter project still supplies me with a modest but nevertheless significant income. The former saved my sanity. It was really scary, but the alternative looked only like a long dark tunnel, with no light at the end.

So, rather than focus on obesity management (which very possibly does not "taste right" to you... else why pose the question here?), I'd suggest you get a big piece of paper and list every option you can. Don't dismiss anything outright. Want to work in the prison system? Get training in occupational medicine? Join the Public Health Service or the Army? Move to Alaska? My guess is, that in the broad world of medicine, something will really click if you let it, and you won't be asking us our opinion.

David,

That was a great reply! Glad you posted.

Tom

Cindy,
I think the simplest answer is often overlooked. It is not practicing medicine that is the problem. It is the payment system. So, consider going non-par or opting out of Medicare, drop your low paying, or all, insurers. Work on developing a "retail" practice where you can set your fees and be paid fairly. I have thought long and hard about the same issues. Concierge practices are all around, but did not feel right to me. So, I have done the above, and have only one insurance contract remaining. It can be done in steps to minimize the risk. For me, it has renewed a feeling of dignity and control. Decide what you are worth, and don't accept less. Ultimately, if I cannot survive doing this, I will find something else to do. But, for now, this has allowed me to be happy to continue in my solo practice.

It was it Ann Landers who said "No one can take advantage of you without your permission". Let's stop giving the insurers permission.

Happened to read this today. Is is about products, not services, but speaks to some of the questions raised.


Physicians Selling Products: Legal and Ethical Considerations
By Ericka L. Adler | February 8, 2012

As physicians look for ways to improve their bottom line, many are looking to alternative sources of revenue through the sale of products such as vitamins, creams, and diet supplements. Most physicians seem to believe that if the item is not covered by Medicare, there are no restrictions. This is simply not true.

Although many individuals are smart consumers, some patients will willingly purchase a cream recommended to reduce wrinkles or a nutritional supplement, whether needed or not, if a physician recommends it. Perhaps this is because of trust in their physician?s recommendation or maybe they?re too uncomfortable to refuse.

Before selling any product, physicians must consider all legal and ethical limitations. Under the AMA Code of Medical Ethics, Opinion 8.063, which addresses the sale of non-prescription products that provide a ?health? benefit, the AMA raises several concerns about products sold to patients, such as whether it creates a financial conflict of interest; places undue stress on the patient; erodes patient trust; or undermines the primary obligation of physicians to serve the interests of patients before their own. These concerns exist not only when a physician dispenses items in exchange for money, but also when he or she endorses a product that the patient may order or purchase elsewhere which results in remuneration for the physician.

In its guidance, the AMA states physicians should not sell health-related products whose claims lack scientific validity and should rely on peer-reviewed literature and unbiased scientific sources to review products. Additionally, physicians must take steps to minimize financial conflicts of interest by disclosing financial arrangements with a manufacturer or supplier and by letting the patient know where else the products can be obtained.

With regard to selling non-health related goods, the AMA also provides guidance under opinion 8.062 which indicates a physician may sell low-cost non-health-related goods for the benefit of community organizations, provided that: (1) the goods in question are low-cost; (2) the physician takes no share in profit from their sale; (3) such sales are not a regular part of the physician?s business; (4) sales are conducted in a dignified manner; and (5) sales are conducted in such a way as to assure that patients are not pressured into making purchases. It should be noted that AMA guidance is intended to apply whether the products are sold in the physician?s office or through a practice website.

Thanks all, Indy,David and Donna for your suggestions. Sale of supplyments is not ethical by my standard. And take a side job might not solve my problem with limited involvement. I already stop seeing some of pts with too lowest paying insurance. Problem is not only low pay, it is also rising cost (at least in east MA). That's why I am thinking of fat reducing business. First, this will be separated from medical practice; and this does not need my time.

The author of this piece, Ericka Adler, may not have been aware, as we are, that the AMA's support for the present health care restructuring is predicted to hasten the end of small private practices. The subsequent entities created by this consolidation (ACO's, mega-practices owned by insurers, hospital, investors and the like) will not hesitate in any way to market all manner of products and services to the "covered lives" enrolled with their organization. I am already seeing this trend in my locale. So this posturing by the AMA seems ironic to me.

I have no plan to profit from my patient's trust. But it seems professional ethics is another intangible that doctors won't be paid to preserve.

"Grub first, then ethics" -- Bertolt Brecht

Thank you, John.
I will only take ethics recommendations from the AMA when I can't get a hold of a blackmailer, car thief, or politician.

I did cosmetics, specifically sclerotherapy of varicose veins many years ago. I went out to a training course, got certified by the society and started doing it. It was ok, but it was hard for me to jump from a cancer patient trying to stay alive to a middle aged person with no medical problems all concerned about a little spider vein. If you do it, you should do the cosmetics on a different day and train the staff that on this day priorities are different. Maybe even have different part time staff for that day.

Why shouldn't physicians make a profit? Why should the be low cost? I can understand #4 and 5, even 3 unless the business is the providers main business (i.e Dr. Wheeler's super rejuvenation clinic and elixer (I wish :))

Interesting that the AMA has no issue with making a profit off the CPT codes.

Wow, I didn't realize that I would unleash all of the pent up anger against the AMA by copying that article.

I haven't belonged to the AMA for years either....

I am not angry at them... I actually belong for some insurances and buy some books from them from time to time... but find them largely irrelevant. When I was young, I considered them the "Fat old men of medicine", whose image was of a fellow double parking his Cadillacs enroute to Wednesday golf. Now, I simply have no idea whom they represent, and don't much care.

To quote a younger friend of mine from earlier today, "Definitely not feein' the love."

No real anger, well maybe....
If they are supposed to be our "trade group" then they would have our and our patients best interests at heart. That clip alone shows they do not have our best interests. The RBRVS which they championed shows they do not have patient care at best interest.

Like Indy says, not feelin' the love.

I wonder if that AMA stance includes selling "Farm Fresh Eggs" in the office? Many, many of our patients love it. They make special trips in to buy them. Many have asked when we are going to sell sausage, bacon and ground beef. I have considered it seriously.

Leslie,
You realize that to meet the AMA guidelines, you must not make a profit on the eggs. Seriously.

Our office sells supplements is that against the AMA rules? Is it illegal?

Thanks!

Ben

Screw the AMA

Well now, according to Donna's post above the immoral AMA would consider that unethical IFF you did not believe them to be of benefit and you should disclose whether you have financial arrangements with the manufacturer and where else these products can be obtained.

Personally I think that is appropriate and agree with Leslie's comment above.

Our practice revolves around trying to heal your body naturally. The doctors still write scripts, but will try to incorporate supplements as well.

As far as pricing I was thinking about lowering our pricing to match the average online prices (If the doctors agree to this).

Thanks!

Ben

I feel that if your medical opinion brings you to recommend a particular supplement or substance; and that item is not otherwise readily available locally; and, you can look at yourself in the mirror and honestly say that you are not coercing a patient to buy from you or bending reality to recommend that item; then making it available is providing a service. I think what you charge is not an issue. I would think of this as a variation of the definition of "Fair Market Value":

1. Prospective buyers and sellers are reasonably knowledgeable about the asset; they are behaving in their own best interests and are free of undue pressure to trade.

2. A reasonable time period is given for the transaction to be completed.

The AMA is only concerned with the image of medicine. A more practical matter is the government's regulations.

http://www.vitaminshoppe.com/content/en/support/help/sales_tax.jsp

This website lists the exclusions for sales tax based on your state regulations. Most states tax supplements. Not sure how that applies to your practice.

Bummer if your local government determines you to be a revenue source and comes looking for the overdue sales taxes for the last 3 years, and the money is spent or the records are sparse.

Fortunately Michigan is exempt (Entire Order Except: Food, Herbs, Supplements, Vitamins, Water, Candy).

But I am more concerned about being obedient to my Lord and Savior Jesus. Looking at some of our practices is convicting. While I am not a doctor, I am largely responsible for alot of the financial and IT day to day.
Maybe we are "coaxing" patients into supplements to much and this does raise a question in my mind that for sure we are charging too much for the supplements. I will have to look in to this further.

Thank you for all the thought provoking comments!

Ben