More than Skin Deep

Joe Cantlupe, for HealthLeaders Media , April 13, 2012
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Success key No.3: Reorganization and cohesive communication
Several years ago, Cleveland Clinic found inefficiencies in the manner in which it organized and generated plastic surgery procedures.

Throughout the campus, plastic surgeons were spread out. Cosmetic surgery was done by plastic surgeons and other subspecialists, and they were competing and duplicating services. The process lacked communication and coordination, says Zins.

"You could get different prices. You could get duplication of services, personnel, equipment, and operating rooms," Zins says. "We got together and looked at all the advances from a multidisciplinary approach. Rather than compete, we organized and began working together to connect the patient with the best person to do the procedure."

The hospital staff has become "verticalized," as each plastic surgeon has an area of clinical focus within the Cleveland Clinic departments of dermatology and plastic surgery, he says. The department of plastic surgery, which includes 17 plastic surgeons, focuses on areas including facial cosmetic surgery, cosmetic and reconstructive breast surgery, and body contouring. Plastic surgery centers have been situated in suburban outpatient facilities to create greater access for patients. "What we have done has become a tremendous opportunity for the patient," Zins says. "We want to provide convenience for the patient, and avoid any possible delay to their busy schedule." 

The Cleveland Clinic also has taken steps to plan for a video conferencing program that would allow patients from anywhere in the country to evaluate possible plastic surgery procedures, he adds.

Success key No.4: Rhinoplasty
Cosmetic procedures in plastic surgery often shift and depend on changing economic conditions, with overall procedures increasing since 2008, primarily due to noninvasive and less costly options such as Botox treatments.

"For some reason, human beings are more tolerant of aging changes in times of down economy," says Winkler. However, he adds, "Rhinoplasty hasn’t been hit as hard as other cosmetic surgery procedures."

Of the costly functional procedures, rhinoplasty "seems to be the only surgical procedure that’s recession proof because parts of the procedure are paid by insurance companies," Winkler says. In the plastic surgery world, rhinoplasty means income for health systems because of its unique appeal, he says.

"It straddles the line between cosmetic and functional. People may need surgery to breathe through their nose, but would like cosmetic changes done as well. Many people have functional problems that need to be fixed and figure it’s a good time to have cosmetic concerns addressed."

Clinically, rhinoplasty is directed toward improving nasal breathing disorders and nasal skin cancer reconstruction. Cosmetically, the procedure is designed to reshape a patient’s nose.

Winkler explains that "although people are still spending money on cosmetic procedures, they are spending it on the clinic-based, temporary and less-expensive ones. I would estimate that about 20% of the surgeries that I do are cosmetic in whole or part—meaning the patient is paying out of pocket."

In the past, Winkler says, "those in my position would do a great deal more cosmetic work. I know from personal communication with colleagues who have been in this business for 10 to 20 years who are doing roughly half as much flat-fee cosmetic work as they were five years ago, before the housing crash."

This article appears in the April 2012 issue of HealthLeaders magazine.

Reprint HLR0412-7


Joe Cantlupe is a senior editor with HealthLeaders Media Online.
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