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Non insurance practice
Started by Jenore
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Not realistic. It takes a large population base to potentially support a cosmetic only practice. Outside those areas, most plastic surgeons do a little bit of everything (skin cancers, pressure sores/wounds, hand surgery, trauma) except pediatric and struggle to get many cosmetic cases. They tend to be employed on an RVU based pay scheme.
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An out-of-network plastic surgeon could possibly succeed in a rural setting. Here is how that would need to be set up to have a shot:
-First, the surgeon would need to offer services that are unique to the area. Not unique to the field, or to the country at large, just that area. Be the "micro" guy, or the "hand guy", or the "wound guy", or something along those lines. This will allow leverage when negotiating OON single case agreements.
-You would need to take ED call and the patient insurance mix would need to have a significant mix of commercial insurance and not just the "underinsured", or medicare/medicaid. If the rural area had a strong middle class component with good jobs, then you would probably be ok dropping OON bills in the ED. You would need to outsource your billing, and have a billing attorney ready to work on a percentage of collections, but that's no big deal. Those guys are out there.
-You would need to be careful with your cosmetic cases initially. Any complications, or unhappy patients, early in your practice in a small town will make life hard for you. But if you are safe, and conservative, as you build up, you could get a nice little practice going no matter your location. I'd start with easier cosmetic cases like body lipo, abdominoplasty, eyelids, fillers/botox. Then ease your way into the face. I personally would stay away from rhinoplasties as these patients are the hardest to please imho and are not worth the trouble. Do not do thigh lifts, or brachioplasties, just trust me.
That's pretty much it. The OON ED call will be your main source of revenue for the first few years, maybe longer. The elective OON surgery will really depend on whether the patient has OON benefits, and if there are in-network alternatives for the proposed surgery. The cosmetic component of your practice should be carefully nurtured from day 1, with a plan to go all cosmetic in subsequent years when you are on strong financial footing, and can afford to give up the recon, and ED call. Good luck.
-First, the surgeon would need to offer services that are unique to the area. Not unique to the field, or to the country at large, just that area. Be the "micro" guy, or the "hand guy", or the "wound guy", or something along those lines. This will allow leverage when negotiating OON single case agreements.
-You would need to take ED call and the patient insurance mix would need to have a significant mix of commercial insurance and not just the "underinsured", or medicare/medicaid. If the rural area had a strong middle class component with good jobs, then you would probably be ok dropping OON bills in the ED. You would need to outsource your billing, and have a billing attorney ready to work on a percentage of collections, but that's no big deal. Those guys are out there.
-You would need to be careful with your cosmetic cases initially. Any complications, or unhappy patients, early in your practice in a small town will make life hard for you. But if you are safe, and conservative, as you build up, you could get a nice little practice going no matter your location. I'd start with easier cosmetic cases like body lipo, abdominoplasty, eyelids, fillers/botox. Then ease your way into the face. I personally would stay away from rhinoplasties as these patients are the hardest to please imho and are not worth the trouble. Do not do thigh lifts, or brachioplasties, just trust me.
That's pretty much it. The OON ED call will be your main source of revenue for the first few years, maybe longer. The elective OON surgery will really depend on whether the patient has OON benefits, and if there are in-network alternatives for the proposed surgery. The cosmetic component of your practice should be carefully nurtured from day 1, with a plan to go all cosmetic in subsequent years when you are on strong financial footing, and can afford to give up the recon, and ED call. Good luck.
