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Spreading the health – Incorporating Aesthetics into a Medical Practice

November 4, 2008 |

Facing declining pay rates from private and government insurers and patients who are demanding more convenient care, Triad physicians practices are adding new services to bring in new patients and shore up their financial health.

In recent months, practices have found ways to take advantage of training their doctors already possess to broaden their offerings into elective procedures for patients who mostly pay cash.

And these offices are extending hours or performing procedures traditionally sought in a hospital or even emergency setting to increase access, lure first-time patients and in some cases, save patients costly hospital fees and insurance deductibles.

It’s also a move to find new sources of income. Last month, the national Medical Group Managers Association found that for family practice, orthopedics and basic specialists, operating costs rose about 6 percent in the past year while revenue was down about 1 percent.

“Revenues are going down because physicians are getting less reimbursement, and that’s not a new issue,” said Wilma Bailess, executive director of the Greater Greensboro Society of Medicine. “Where you see cost of living increases or adjustments everywhere else, they don’t happen in medicine. It certainly makes sense that you would try to create some new revenue streams.”

Mike Edwards, a spokesman for the N.C. Medical Society, said the moves are largely driven by consumer demand.

“Physicians practices are small businesses, and doctors will respond to demands,” he said. “Consumers want health care in a friendly way that’s close to where they work and live. The practices that understand that (trend) realize it’s either time to add staff or extend their hours. You’ll see a lot more of this take place.”

One of the most popular additions to practices this fall has been ear, nose and throat doctors — whose residency training always includes facial cosmetic procedures — putting their training to use.

At Piedmont Ear, Nose and Throat Associates, administrator Cheryl Fatzinger said work will begin Nov. 17 on upfitting a procedure room for a newly hired physician who just completed a fellowship in facial plastic surgery and reconstruction.

Fatzinger said the office renovations will cost about $160,000, plus another $80,000 for surgical equipment. But the practice also saved some startup costs by bringing in MBA students from Wake Forest University to develop at no cost a marketing plan for the new cosmetic practice, including whether patients might expect other services — such as make-up supplies, transportation or even a hotel stay during recovery.

“If it’s not a cosmetic procedure because of some kind of trauma, then it’s almost always self-pay,” Fatzinger said. “We’re not going through insurance, and that’s where we’re really getting the squeeze at this point.”

Treating those cash-paying patients in the office also cuts out a need for complex billing operations. And Fatzinger said it should provide Piedmont Ear, Nose and Throat Associates an advantage over practices whose sole focus is plastic surgery: patients are saved the cost of a facility fee and anesthesia fee usually charged by a hospital or other outpatient center.

Costs and returns

Likewise, the Greensboro Ear Nose and Throat practice in October officially announced a similar addition, opening the Greensboro Center for Facial Rejuvenation.

Dr. David Shoemaker, a specialist with the practice, said the center has hired a full-time medical assistant and receptionist/scheduler. Four of the practice’s six doctors will spend about a half-day a week each at the new facial rejuvenation center.

Other investment costs included about $100,000 for new medical chairs and other furniture at the center. The practice is also now leasing a laser for some skin care procedures. Once the center decides to buy lasers, they will cost about $150,000 each, Shoemaker said.

“Taking care of scars and other skin care is a big part of what we do every day anyway,” he said. “We decided to start out slowly, but we’ve been able to generate a lot of interest already.”

Shoemaker said the practice, which has about 12,000 new patient visits per year, is seeing about 25 new patients per day at the new facial center.

And even though their new services target cash — and usually more affluent — patients, Shoemaker and Fatzinger both acknowledged some anxiety about launching a practice for elective procedures during an economic downturn that has more consumers holding tight to their money.

“The economy is a concern,” Shoemaker said. “Patients may have a limited amount to spend on something like this. But that might mean they can’t spend $10,000 on a face lift (with a competing practice), but they might spend $400 for a series of Botox injections.”

Elsewhere in the Triad, practices are seeking ways to bring in new patients by offering convenience and affordability.

Renee Choplin, marketing director for Orthopaedic Specialists of the Carolinas in Winston-Salem, said the practice in late August opened an extended-hours urgent-care clinic.

The clinic is staffed by doctors and physicians assistants already on staff from 9 a.m. to 7 p.m. on weekdays and from 8 a.m. to noon on Saturdays.

She said it’s a benefit to patients because they receive treatment for a common sprain or fracture for an office-visit copay of $30 or so, compared to a copay that’s often at least $100 for treatment in a hospital emergency room, which is where after-hours patient tend to end up.

Choplin said starting the clinic took a minimal advertising budget and no additional hires thanks to shuffling schedules around. And it’s been popular so far, bringing in an average of 20 patients per day who are totally new to the practice.

“I will tell you the referring physicians love it,” Choplin said. “They call our office and get them in right away.”

And at Valaoras & Lewis obstetrics and gynecology practice in Winston-Salem, doctors there have begun procedures — such as a 90-second procedure to remove the uterine lining or a 15-minute procedure for permanent sterilization — that formerly had to be performed in a hospital.

“With so much in the news regarding the cost of health care,” said Julie Jacobson, the practice manager, “our physicians pride themselves on being able to provide the best care medically available and assisting patients with decreasing their costs by providing these services in our office.”

Reach Steve Ivey at (336) 370-2909 or


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