3 considerations for providing elective procedures

Deb Beaulieu

Deb Beaulieu

"New Year, new you!" As the saying goes, 'tis the season to reflect on their lives and vow to make improvements.

As I wrote last year, it's a great opportunity to leverage--and attempt to prolong--patients' gusto for living healthier. And for physicians who offer certain elective and cosmetic procedures, it might also be a time for discussions with patients about procedures to help enhance their appearance or quality of life. Even if you don't perform the procedures yourself, you might be asked to recommend a physician who does.

These conversations, however, might not be as cut and dried as those focused on care that is medically necessary. With elective healthcare, whether orthopedic, cosmetic or of some other nature, the "wants" and "needs" of the patient can become a matter of perspective, especially when there are large amounts of revenue and/or medical risks involved.

How each physician approaches patients' desires for their healthcare is a matter of individual preference and circumstances. But for perspective on how some of these issues can play out, it's worth taking a look at some recent related news stories and the questions they raise:

1. Should elective procedures have appropriateness criteria?

A recent commentary published in the New England Journal of Medicine called for the United States, like other countries, to adopt evidence-based criteria for the appropriateness of elective procedures to "combat increasing healthcare costs while enhancing access and quality."

Most likely, the use of appropriateness guidelines would result in fewer procedures, or at least those that would be reimbursed by insurance, the authors predicted. While this could be bad news to some physicians' pocketbooks, it would also in theory protect them from the risks of bad outcomes with procedures that were objectively identified as ineffective or unsafe upfront.

Although physicians already evaluate whether to take cases based on their medical opinions, patients' demands can put doctors in a difficult position. Some surgeons, such as Marshall K. Steele, have systems in place to assess patients' risks by collecting patient-reported outcomes data. While it remains to be seen what approach commercial payers or the government will ultimately take, it's fair to expect that conversations around these issues will continue well into the era of accountable care.

2. Should you rethink where you get pharmaceuticals?

The U.S. Food and Drug Administration last month informed 350 medical practices that they may have received unapproved versions of Botox, which may have been contaminated, improperly stored, ineffective and/or unsafe, according to a statement.

"Medical practices that purchase and administer illegal and unapproved medications from foreign sources are placing patients at risk and potentially depriving them of proper treatment," the advisory continued. Similarly to the ongoing meningitis outbreak linked to contaminated steroid injections from a now-defunct compounding pharmacy in Massachusetts, the headline regarding "Bargain Botox" from Medpage Today suggests that physicians purchased the drugs from a foreign source to cut costs.

While these stories don't necessarily mean that all lower-cost suppliers make bad products, they may change the way some doctors make their purchasing decisions. Possibly, patients could begin asking more questions about how drug quality is verified, giving practices a chance to educate patients about measures put in place to protect their safety.

3. Are your sales tactics sound?

In the United Kingdom, a recent report based on feedback from patients, physicians and others called for a crackdown on high-pressure sales tactics for cosmetic surgery, BBC News reported. In addition to a call for stricter safety regulations, some panelists recommended a ban on free consultations for cosmetic surgery, particularly when provided by a salesperson rather than a physician, as well as eliminating time-limited deals, which may pressure patients to agree to surgery quickly. Many respondents also favored giving patients more detailed information on the risks of cosmetic procedures, including photos depicting what kind of bruising to expect.

Overall, cosmetic surgeons said procedures should not be sold as "a commodity" and favored rules that would help "restore confidence" in their field. While the U.K. review followed a scandal regarding a certain type of breast implant, the United States has seen its share of unethical and even fake cosmetic doctors. As mentioned, whether you perform elective procedures or not, you can play an important role in educating patients about sales tactics or safety concerns to watch out for.

As always, we're interested to hear your take on these issues. In the meantime, we wish you and your patients a very happy and healthy 2013! - Deb (@PracticeMgt)

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