An Introduction to Offering Aesthetic Laser Services In The Primary Care Office

An Introduction To Offering Aesthetic Laser Services In The Primary Care Office.

Mr. Andy Nimmo, Publisher of Physicians Office Resource - Our readers are largely primary care providers who have chosen their profession out of a desire to help patients live better and longer lives according to the Hippocratic Oath.  But the winds of change are blowing stronger across the landscape of medical practices throughout America.  Now, more than ever, practitioners wishing to fulfill their calling are increasingly challenged on all sides by the pressures of time, patient demands, and complexity in the health insurance industry, government involvement and economics.  It is this last point that the upcoming series of editorials will focus upon.  Many primary care providers (PCPs) find themselves on a treadmill, trying to maintain the highest standards of care while also endeavoring to achieve the rewards they and their families deserve to compensate the years and high cost of medical training and the long hours devoted to this most noble profession.  There are several strategies to bring the economics of medical practice back into balance:  work more hours and see more patients (not usually possible); raise fees (not practical given insurance industry dynamics); cut costs further (many practices are already close to a point of diminishing returns); or offer new, cash-based medical services.  To explore this last topic we’ve asked an industry expert to contribute on a regular basis to this column and share his knowledge of the most logical, lucrative and dynamic way in which to offer popular medical-aesthetic procedures and thus rebalance the economic equation while simultaneously satisfying existing and growing patient demand.  Dr. Paul Efremkin, Ph.D., is the Chief Executive Officer of Aerolase Corporation, a Tarrytown, NY based manufacturer of aesthetic lasers marketed primarily to the PCP.  Dr. Efremkin is particularly well suited to write this column because of his 12 year background in the medical and aesthetic laser industry and his leadership in the US scientific and business community that led the transition of medical lasers from experimental devices to mass market technology.  Dr. Efremkin also sits on the Industry Advisory Council to the American Society for Laser Medicine and Surgery.   However, Dr. Efremkin’s chief qualification to participate in this column is that he spends his time understanding the challenges of the PCP and crafting strategies to help with the economic demands you face on a daily basis.

Dr. Paul Efremkin, Ph.D. - The first question many PCPs have when they consider the topic of offering aesthetic laser services is: are these procedures medical treatments?  Let me answer that in two ways.  First, all aesthetic lasers currently on the market from Aerolase and others are federally regulated medical devices under the jurisdiction of CDRH/FDA.  Virtually every state regulates the use of these lasers and limits their use to either a medical doctor (M.D., D.O., D.M.D.-M.D.) or to a nurse or physician’s assistant, operating the device under the license and supervision of the doctor.  The second answer goes a bit deeper.  Since the time of Hippocrates, physicians have focused on healing the sick and injured.  During the last 20 years or so, physicians have increasingly turned their attention to patients who were neither sick nor injured in a traditional sense.  Consider the dramatic rise in prescriptions for conditions such as clinical depression, anxiety, incontinence, restless leg syndrome, insomnia and many other conditions that are not typically life-threatening.  Society has now accepted the idea that part of a person’s health and wellbeing relates to their emotions and their psychology.  And not surprisingly wellbeing is strongly linked to physical appearance.  So it is understandable that once basic health needs of populations have been satisfied, patients want to look and feel better.  These new expectations are part of an evolving definition of total health and, thus, should be included in the protocol of modern medical care delivery.  Therefore, we can view the PCP offering medically based aesthetic treatments as simply another point on a continuum of care that aims to treat the patient in their totality as a physically, mentally and an emotionally complete person.  This is completely logical as patients live longer (fifty is the new forty, etc.).  And because these expanding needs are so widespread in society, there is a powerful trend of expanding aesthetic and rejuvenation medicine beyond the exclusive realm of dermatologists and plastic surgeons whose numbers are quite small compared to the number of PCPs.  New technology now allows the PCPs to perform many desired procedures easily, safely and effectively. These procedures are also becoming more cost effective as new laser technology drives equipment prices lower.  But the more important reason for this trend is that patients trust their primary care practitioner and would prefer the convenience of being treated by the same practitioner who manages their total healthcare needs.  

Let’s review some statistics that will bring these trends into clearer perspective inside the practice of OB/GYN, a specialty hit hard by economic demands.  In a 2008 survey performed by the journal Contemporary OB/GYN, those specialists reported that 63.3% offered the ancillary service of radiology/ultrasound (not very surprising).  But fifth from the top of the list was “cosmetic procedures” with 16.3% offering those services to their patients.  That’s nearly one in five OB/GYNs offering cosmetic procedures where lasers play a key role.  Laser hair removal was the most frequently performed procedure by these physicians with 9.2 procedures per month being performed on average by those offering the service.  Other laser procedures performed by this group included skin rejuvenation – 6.8 procedures per month; spider vein removal – 6 procedures per month and Rosacea treatment – 5.5 per month on average.  Converting those treatments into dollars (and remember most of these are cash-based, not reimbursed) Contemporary OB/GYN found that laser hair removal added on average $2,757 per month to the practices offering those services; spider vein removal added $2,520 on average, skin rejuvenation added $2,413 per month on average and Rosacea treatments added $1,972 per month on average in those practices offering those various services.  Obviously, many practices owning the appropriate laser offer several or all of the above, some just one or two services.  Patient demand for aesthetic services in the U.S. now stands at over $14 billion and is still growing at double digit rates, despite the downturn in the economy over the last 8 months.  The patients in PCP waiting rooms right now are the very people who want these treatments, not only for the sake of vanity, but precisely because of the stagnant economy.  Many realize that to compete in today’s job market, it is imperative they look more youthful and healthy in the job interview.  It’s truly amazing that the same patient who will argue with your office manager over the exact amount of their co-payment will immediately write a personal check for $250 or so, for a 15 minute laser hair removal treatment which obviously needs no complicated coding or delayed billing.  When Aerolase is invited to consult on how to integrate these aesthetic services, we stress that to be successful, the PCP needs to properly integrate these aesthetic treatments into the core practice which is not difficult to do.  But the PCP needs to give proper consideration to what treatments to offer, what device to use, cost, safety, presentation of services and integration of them into the medical practice.  The answers need to be specifically tailored to the individual practice.  What is suitable for a specialized cosmetic dermatology or plastic surgery practice may not be suitable for an FP or OB/GYN and we have customers in every specialty.  An appropriate integration of aesthetics with medical procedures typically requires a minimum of time away from the core medical practice (many PCP’s prefer not to spend more than half a day a week).  That level of involvement can bring approximately $60,000 to $100,000 or more in annual profit to the practice bottom line.  In the following issues of Physicians Office Resource, I’ll go deeper into specifics and metrics.  We encourage you to help us with these future columns by sending in your questions and input.  Please let us know what specific topics or questions you have by e-mailing us at myexpert@aerolase.com or email us at editorials@physiciansofficeresource.com  We look forward to hearing from you.