The connection between medicine and mass marketing has never been stronger: Pharmaceutical advertisements fill the airwaves and consumers are more invested in their care. In response, single-therapy medical centers have proliferated.
Explore This IssueSeptember 2015
The recent demise of Lifestyle Lift, one of the more well-known chains of cosmetic surgery centers, raises many questions about how well this business model holds up in today’s medical field, however. Is this a valid business model for otolaryngology? What are the benefits and drawbacks of these clinics? Is this the best way to serve patients?
The model for single-therapy clinics centers around offering a single, unique treatment, with patients often paying significantly less than they would in a traditional medical setting.
Anti-aging medical treatments such as rhytidectomy are popular choices, and snoring centers represent another large model segment, said Mas Takashima, MD, associate professor, residency program director, and director of The Sinus Center at the department of otolaryngology-head and neck surgery at the Baylor College of Medicine in Houston. “The marketing and advertising is pretty good, focusing on snoring because it’s a tangible problem for a patient’s partner,” he said. “The tagline often reads something like, ‘Treat your snoring—you’ll sleep better.’”
“It is, in some ways, an innovative business plan,” said Stephen Park, MD, professor and vice chair of the department of otolaryngology-head and neck surgery at the University of Virginia in Charlottesville, and president of the American Academy of Facial Plastic and Reconstructive Surgery. “They offered a face-lift for a reduced fee, with less overhead, and people flocked to it. In this model, much of the pre-operative and post-operative care was delivered by nurses or other staff, rather than the physician. That came at a price.”
One of the reasons for the model’s profitability is insurance reimbursement rates, said Dr. Takashima.
“Whenever a patient is operated on in a hospital setting, it ends up costing insurance more; if they can shift that model to an office setting, it ends up being less expensive for insurance companies but with a higher physician reimbursement,” he explained. “For example, if I perform a full-house sinus surgery with disease in all the sinuses in a hospital or clinical setting, it will take about two hours, with a physician payment of about $800 to $1,000. If I perform a balloon sinuplasty in an office setting, the physician reimbursement is about $9,000 to $10,000, not including the machine cost.”
It’s important to understand the difference between marketing a single treatment modality and marketing a specific created brand, said Anthony Brissett, MD, director of facial plastic and reconstructive surgery in the department of otolaryngology-head and neck surgery at the Baylor College of Medicine. “A business like Lifestyle Lift was marketing a brand, a modification of certain techniques,” he said. “They were very successful—they lasted almost a decade—and were able to reach a wide range of people. On the downside, that particular lift provided a service that lacked any specific characteristics catered toward individual patients.”
A Cookie Cutter Approach
Whether or not the single-therapy business model is right for a physician’s practice, there is some concern among traditional practitioners that it may cause a lack of individualization in patient diagnosis and care and a strain on the relationship between patient and physician.
“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.”
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.”
“Clearly, financial gain influences these centers,” said Dr. Takashima. “I see many patients who have had their snoring reduced at these outpatient clinics; however, they have not had their obstructive sleep apnea adequately addressed. I’ve seen patients with allergic symptoms and/or the common cold who have had all their sinuses ballooned. The physician has a fiduciary duty to their patients to diagnose and treat them in the best way possible, regardless of the discrepancies in reimbursement. This is the ideal that we hope to impart to our residents in our training program.”
Dr. Park believes the best way to advocate for patients is to speak up if you believe service integrity may be compromised. “Probably the single best way to stand up for patients is to be ambassadors for a common mission toward patient safety,” he explained. “This may mean speaking out during medical staff meetings, broaching uncomfortable subjects with patients, and practicing ‘soft rules,’ such as never operating on the first visit. Most surgeons feel that we have a committed, lasting relationship with our patients; there’s a tremendous mutual investment before the trip to the operating room.”
“Business models certainly do need to be looked at within the lens of patients’ best interests,” added Dr. Brissett. “All otolaryngologists should ask themselves if every treatment will enhance patient care and improve outcomes.”
Amy E. Hamaker is a freelance medical writer based in California.