“This kind of model tends to remove a very important doctor/patient relationship, analogous to Jiffy Lube,” said Dr. Park. “You go in one side and come out the other. A nurse screens you and takes your money, you meet your doctor on the day of your procedure, your surgery is done, and then you don’t see the physician again—the follow-up is with the nurse. My fear is that something very important gets lost. It has a tendency to reduce physicians to merely technicians. Operating is only a small part of being a doctor.”
Explore This IssueSeptember 2015
Dr. Brissett is concerned about rhytidectomy procedures that are offered without an anesthesiologist, pre- and post-operative oversight, and intraoperative care. “As a result, of course, patients don’t have to pay for ‘extras’ that most of us recognize as being standard,” he said. “Many commercials in this business model never describe the procedure, so patients may not understand they’re signing up for surgery.”
Dr. Takashima believes that the one-size-fits-all approach to snoring cessation may be doing a disservice to sleep disorder specialists and their patients. “Snoring is really an alarm that there might be something else going on; otolaryngologists need to look into the possibility of sleep apnea. Snoring cessation procedures may turn off that alarm instead of signaling a potential problem.”
“Sleep-disordered breathing requires time and effort to diagnose and is relatively new in terms of diagnosis and treatment,” he continued. “Prolonged oxygen deprivation from sleep apnea has been linked to dementia, cardiovascular problems, and strokes. We might not see a lot of at-risk patients because it’s the initial snoring that prompts a deeper look. Without a sleep study, identifying those who have significant desaturation and are really in danger of increasing their morbidity is very difficult.”
A Model for the Future?
Dr. Park believes that this business model will continue to be popular for rhytidectomy modalities. “The popularity of anti-aging cosmetic techniques is exploding, with more people wanting fillers and injectables” (see “Rhytidectomy Popularity,” left).
“I think this model could place providers in a very compromising position,” said Dr. Brissett. “As providers, we’re morally and ethically responsible to provide the best care for our patients and do what’s in their best interest. But in this model, there’s an inherent conflict between whether a procedure is right for a patient, or whether it isn’t right but would make money for the clinic. It’s a challenging model to sustain.”