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Medical Consulting Opportunities with Gerson Lehrman Group (GLG)

Gerson Lehrman Group (GLG) is a large platform connecting professionals with expertise in many sectors (including medicine and surgery) with their clients which include businesses and nonprofits in the industrial, technology, life science, investment and financial fields. Currently, professionals such as physicians sign up to be “council members”. Council members include over 650,000 professionals from many fields including former C-suite executives, academics, scientists, policy specialists, former public sector leaders, and subject-matter experts on almost any topic. Registered council members are offered to participate in consultations that are tailored to GLG’s clients’ specific needs, ranging from phone calls with experts to live roundtables, to surveys and quantitative insights, to packaged insights and reports. Council members can set their own hourly rates for consultation (usually between $100-$200 per hour), although some consulting offers come with set compensation (e.g. $500 for an in-person consultation, $50 to fill in a survey in your area of expertise, etc.) Membership is open, and you can request membership on their membership signup page. Their consulting setup can include: » Phone consultations: One-on-one phone conversations with members » Meetings: In-person conversations with members » Roundtables: Conversations with thought leaders and a group of clients » Quantitative Insights: Curated online samplings of member and consumer opinions » Strategic projects: Reports and projects executed by members and top consultants » Site visits: On-site meetings, reviews, and tours

Use Online Patient Reviews to Educate Your Patients

Online patient reviews on social media sites can be an effective tool in helping medical practices market and educate patients. A recent example highlighting the use of online patient reviews by dermatology practices to educate about minimally-invasive fat reduction procedures was recently published. As a background, body contouring is one of the fast growing areas of dermatology. According to the American Society of Dermatologic Surgery, body sculpting procedures are among the top four treatments patients request. Consequently, knowing what patients do and don’t like about them and how they rate their experiences can help clinicians influence patient choices, study authors say. “Minimally-invasive and non-invasive fat reduction procedures are rated extensively online,” says study author Sreya Talasila, M.D., a dermatologist with Northwestern University Feinberg School of Medicine. “Aesthetic providers should use this available information to guide decision-making around minimally-invasive technique selection and price setting within their own practices.” The study, published in Dermatologic Surgery, analyzed 11,871 patient reviews on fat-reduction procedures from the website RealSelf.com, a well-known aesthetics platform where patients share their experiences. The website’s reviews, extracted by researchers in 2017, divided patient satisfaction ratings into “worth it” (positive), “not worth it” (negative), and “not sure” (neutral). For more accurate comparisons, Dr. Talasila says, the team grouped reviews of 13 unique minimally-invasive procedures into five body contouring modality categories: laser, cryolipolysis, injectables, radio frequency, and ultrasound. The ratings only included patient satisfaction feedback and did not offer information about patient demographics, including body mass index, age, or treatment goals. Investigators also compared these reviews to patient responses on invasive body contouring (traditional liposuction). The overall intent, Dr. Talasila says, was to determine which body contouring procedures are most popular and accepted among patients, especially newer ones that are used less-widely to date. “With all the different procedures and the different number of treatments that need to be done, dermatologists should discuss treatment length and cost variability with patients upfront,” she says. “This is a growing field right now, and patients are interested. Clinicians need to be aware and be able to discuss it freely.” Being knowledgeable of online satisfaction assessments can help dermatologists manage patient expectations and set benchmarks for procedure length-of-treatment and outcomes, she says. According to study results, researchers reviewed 7,170 patient reviews that encompassed all five minimally-invasive procedure categories. The overall satisfaction rating was 58 percent. But, despite being more expensive and more invasive, liposuction, which had 4,645 patient reviews, still had a higher satisfaction rating of 66 percent. The average cost for minimally-invasive procedures ranges from $1,350-$6,025. Liposuction’s price tag can be up to $7,000. Conversations about cost can be important because minimally-invasive procedures are typically paid for out-of-pocket. Clinicians should be prepared to discuss the possibility that costs may vary for patients based on the individual number of treatments they will need to achieve the desired results, Dr. Talasila says. In addition, researchers also analyzed and compared patient reviews of tumescent liposuction, a intermediately-invasive fat reduction technique. This procedure, which can be performed in one session, can address larger volume patient cases than minimally-invasive procedures, but it doesn’t require the operating room and anesthetist needed for traditional liposuction. In reviews, patients gave tumescent liposuction a 63-percent satisfaction rating. Despite having a lower umbrella positive rating than more traditional, extensive techniques, the minimally-invasive procedures still had a median global rating of 81 percent satisfaction. Laser procedures received 3,565 reviews and a 61-percent satisfaction score. Patients completed 2,707 cryoplipolysis reviews, giving the technique a 55-percent satisfaction score. A total of 319 patients reviewed injectable treatments, resulting in a 49-percent satisfaction score. And, 314 patients reviewed radio frequency techniques, and 275 patients expressed opinions about ultrasound, giving these options satisfaction scores of 63 percent and 73 percent, respectively. The researchers highlighted patient responses for some specific procedures, as well. Zerona, a laser procedure, received 43-percent satisfaction, and CoolSculpting, a cyrolipolysis technique scored a 55-percent satisfaction rating. Kybella (injectable), Liposonix (radio frequency), and UltraShape Power (ultrasound) received satisfaction scores of 49 percent, 43 percent, and 91 percent, respectively. The study did not delve into the reasons why patients gave positive or negative reviews, however, Dr. Talasila says, noting further research would be necessary to pinpoint their reasons, such as procedural pain or disappointment in effectiveness and results. “Patient choices are different, and we didn’t parse out the demographic data to further stratify their differences,” she says. “This information could be most helpful for clinical cost setting because cost data is available on RealSelf. It may encourage aesthetic and cosmetic providers to be aware of the website for benchmarking and even modality selection. They need to know what patients are aware of.” This information could also help clinicians better understand how patients view the benefits and pitfalls of these minimally-invasive procedures from a real-world perspective. Based on data from other industries, Dr. Talasila says, online reviews have been shown to directly impact customer decisions, indicating popularity, consumer demand, and product awareness. Consequently, the more aesthetic providers can tell patients about how other individuals have responded to these body contouring techniques, the more informed the patient’s overall decision will be, she says. Staying abreast of what patients say online about these medical procedures can also give clinicians the tools they need to correct any misperceptions or misinformation patients gather from searching about fat reduction techniques online. While patient reviews can include factual information about one individual’s experience, not all online resources provide accurate assessments of patient satisfaction or of a procedure’s efficacy and safety. For example, in a recent study, published in JAMA Facial Plastic Surgery, researchers from Rutgers New Jersey Medical School found the majority of YouTube videos on facial plastic surgery procedures were misleading marketing campaigns. Out of 240 videos with 160 million combined views, only 72 videos included a board-certified physician qualified to accurately assess the procedures and offer information to patients. Consequently, aesthetic providers should familiarize themselves with online reviews, such as those on RealSelf.com, so they will be better prepared to help patients make the right decisions that fall best in line with the patient’s medical history, Dr. Talasila says. “Social media is one of the easiest ways for people to get reviews of other people’s experiences,” she says. “Clinicians should want to see what information is out there and what their patients are gleaning from it.” REFERENCE Evers-Metlzer R, Talasila S, Xu S. Social Media Ratings of Minimally-Invasive Fat Reduction Procedure’s: Bench-marking Against Traditional Liposuction, Dermatologic Surgery (2018); doi:10.1097/DSS.0000000000001509 Alaeddin I, Nicheporuck BS, Paskhover B, Ward B, Ward M. Assessments of YouTube as an Informative Resources on Facial Plastic Surgery, JAMA Facial Plastic Surgery (2018); doi:10.1001/jamafacial.2018.0822

Furor erupts over withdrawn dermatology paper exposing corporatization of dermatology practices

On October 5, the Journal of the American Academy of Dermatology published an accepted manuscript in its “In Press” section by Dr. Sailesh Konda and Dr. Joseph Francis, both dermatologists at UFHealth, the medical arm of the University of Florida. In it, the authors discussed the rapid entrance of private equity firms into the specialty by buying and running practices around the country. Eight days later, after an outcry from private equity executives and dermatologists associated with private equity firms, the editor of the publication removed the paper from the site. No reason was given. According to the New York Times, Dr. Dirk Elston, the journal’s editor, stated that the article was temporarily removed “after receiving multiple calls and emails expressing concerns about the accuracy of a few parts of the article.” Nearly two weeks after removing the article, the Journal offered the authors to either correct the “factual errors” or retract the paper. The authors refuted the claim that the article contained any factual errors. You can read the full story on the New York Times website. The article raises a very important point. According to the New York Times article, the practices that the private equity firms acquired were the ones that were billing outliers, i.e. they were practices that were at the highest end of the spectrum for number of well-reimbursed procedures performed, and consequently, Medicare billing. This obviously highlights the reason why private equity firms go into the healthcare industry – to make profit. One has to caution, however, that eventually, private equity firms would want a return on their investment, whether by maximizing profits, or eventually selling these practices to another entity. Physicians need to be careful in losing control of their practices to Corporate America. By giving up control, physicians risk becoming just another cog in the wheel. This may happen despite the initial financial reward from the buy-out, and subsequent “stock option” arrangements may not work well for physicians beyond the first round. In addition, can physicians trust corporate America to safeguard patient care versus profit?    

9 ways how doctors have it worse than any other profession

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An interesting article appeared in Modern Medicine showing how physicians have it worse than any other profession.For example, what if every other profession had to go through maintenance of certification every Few years to keep their job? What if police officers had to compete with the expertise of random people the same way physicians had to deal with Dr. Google? How about if Employers denied paid to employees the same way physicians are denied reimbursement by the insurance companies?What if controlling a plane or traffic lights whereas complicated and lacking interoperability like electronic medical records? What if firefighters had to obtain preauthorization before they were allowed to put out a fire? What if the weatherman could get sued for inaccurate weather forecasting? How about if your lawyer needed to exceed a certain threshold of cases won or else be reported to the bar and lose his license to practice? Taking this further, what about Stark law? While I am not in favor of any kickback scheme, these are rampant in other professions, For example affiliate programs and Referral fees and other perks in business, political lobbyists in Washington and that the state level, etc. You may also have heard about financial advisers and the fiduciary law that was proposed that would have made them all subject to acting in the best interest of their client? Can you imagine a physician that would be allowed to perform any operation not necessarily in the patient’s best interest but if it was a reasonable thing to do? That would not only be unethical, but it would be downright illegal. But then again, physicians are not financial advisers or lawyers. One thing that made me laugh with incredulity was that lawyers revolted when their Bar Association proposed an amendment that it would be considered unethical if a lawyer have sex with their clients!!! Makes you wonder what goes on….

A sad but true consequence of the socially connected world we live in

The following satirical cartoon appeared recently on the website, DiagnosticImaging.com. It brings to light the fact that physicians have more than lawsuits to worry about in the present age of social media that is so ingrained in our daily life. While a lawsuit would undoubtedly be more catastrophic to any physician’s practice, a bad review on the major review sites or social media with undoubtedly be harmful to prospective patients that are looking your practice up prior to making a decision prior to selecting their physician or provider. While you can never please everybody, every physician’s practice should make efforts to create a positive customer relationship with their patients, past or present and seek to immediately rectify any negative situations before a disgruntled patient decides to make the situation public by posting negative reviews on Google, Facebook, Yelp and other dedicated physician review sites such as HealthGrades and vitals.com.

Malpractice: What to Do if You Get Sued

This course on Medscape covers the vital information that physicians need at every step of the way to win or avoid a judgment against them if they are named in a lawsuit. It will also describe effective steps to take to avoid getting sued. Physicians will gain detailed knowledge of the elements of a malpractice lawsuit and the best course of action at each juncture; how to prepare for depositions and trial; and the types of settlements that they may have to choose. In this course:
  • How plaintiffs win their cases, requirements to prove negligence, and the role of expert witnesses;
  • Key issues in lawsuits with multiple defendants and steps to be wary of as a lawsuit progresses;
  • The role of mediation and arbitration, types of settlements, and the pros and cons of each; and
  • Preparing for depositions and trial, your right to appeal, and how to prevent a lawsuit.
Click here to access the course.

Why should hospitals get a special tax exemption when physician offices that offer more affordable care don’t?

A recent article in Medical Economics highlights the above unfair break for “nonprofit” hospitals. The author is Craig M Wax, Do, a primary care physician who is the vice president for health policy at Practicing Physicians of America and blogs on independent physician practices. When Medicare got established in 1965, it’s aim was to provide medical insurance for the “aged” over 65, then the life expectancy. Medicaid was also established at the same time, but to provide means-tested insurance benefits for the “poor and indigent.” Medicaid from its inception until today provided reimbursement that didn’t cover the costs of care, so hospitals raised their asking list prices, called chargemaster pricing. In this way, they could recover a higher percent reimbursement from Medicare, private insurance, and self-pay patients. Following the passage of Medicare, in 1969 the IRS removed the requirement that non-profit hospitals offer a portion of care without charge or at rates below cost. Revenue Ruling 69-545 created what has become known as the “community benefit standard.” A further competitive advantage was thus handed to hospitals, not available to independent physicians or other medical facilities. In recent decades, as the unsustainability of Medicare has become clear, Congress, hand in hand with the HHS, has fixed Medicare prices. In addition to securing higher payment levels for hospitals relative to other sites of care, the hospital cartel raised prices on other patients to compensate further. The disparity of the non-profit status combined with facility fees have encouraged hospital predatory acquisitions of independent physician practices. While independent practices close their doors, non-profit hospital systems are thriving. While CEOs of non-profit hospitals average base salary was $595,781 in 2009, according to JAMA, the top earners have upped the ante since.  In 2014, CHOP CEO Steven Altschuler received total pay of $4.7 million, according to a Philadelphia Inquirer report. In the same year, PENN CEO Ralph Mueller made $2.4 million dollars in salary and benefits, according to The Daily Pennsylvanian. These shocking stats lead to an obvious question: Why should hospitals get a special tax exemption when other healthcare entities that offer more affordable care, like physician offices and independent labs, don’t? So, hospitals dodge taxes, overcharge patients with inflated chargemaster prices, pay executives millions, and leave the state taxpayers holding the bag. It is time for hospitals to post prices, compete on price and quality, cancel their cronyism with government, and pay their fair share of taxes. Read the full article here.

Informed Consent Ruling May Disrupt the Practice of Medicine and Medical Research Nationwide

In 2008, a surgeon by the name of Steven Toms, MD signed up Megan Shinal for reoperative surgery. She had a recurrent craniopharyngioma that required resection. He discussed the risks of surgery with the patient including the fact that either a subtotal or total resection (with higher risk of complications) may be needed, and the actual procedure (whether subtotal or total resection) was left open. A longer discussion regarding the specific risks of surgery including informed consent was held by his physician assistant, not by the surgeon himself. Shinal decided to undergo surgery, but the question of whether to proceed with total vs subtotal resection was unresolved at the time of the initial consultation with Toms, the authors note. Shinal subsequently spoke with the physician assistant about scarring, the craniotomy incision, potential radiation, and the date for surgery. During surgery, the surgeon unfortunately perforated the carotid artery, leading to permanent severe neurologic injury. The patient sued arguing that if she knew that total resection carried such a high risk, she would have opted for the lesser risk procedure. Holly Fernandez Lynch, JD, MBE, and colleagues from the Department of Medical Ethics and Health Policy at the University of Pennsylvania Perelman School of Medicine in Philadelphia, examined the potential consequences of a 2017 decision from the Pennsylvania Supreme Court. In a 4-to-3 decision, the court ruled that a physician may not “fulfill through an intermediary the duty to provide sufficient information to obtain a patient’s informed consent.” Shinal signed a consent form indicating that she had discussed the risks and benefits of alternative treatments. “However, the form did not specifically address the differential risks of the two surgical options,” Lynch and colleagues write. Dr Toms testified at trial that he discussed with Shinal her goals and the risks and benefits of total vs subtotal resection, including the potential harm that ultimately occurred, Lynch and colleagues explain. As a result of this supreme court of Pennsylvania decision, excess caution for obtaining informed consent canu nnecessarily burden physicians and sideline other qualified healthcare professionals from the process of helping patients understand risks and benefits of treatments, according to lawyers who’ve studied the case Shinal v Toms. Read more here.

A Prominent Attorney’s Legal Gamble Backfires – Wrong-Surgery Victim’s Family Gets No Award

For the relatives of an elderly Michigan woman who died after unnecessary cranial surgery—instead of the correct jaw surgery—the price of their lawyer’s ill-advised legal gamble may have totaled millions of dollars, according to a February 16th story in the Washington Post, among other news outlets. Knowing that Michigan caps noneconomic damage awards in medical malpractice but not ordinary negligence cases, the plaintiff’s lawyer (who previously represented Jack Kevorkian) alleged ordinary negligence in the family’s initial claim against the Dearborn hospital and staff. A trial court, however, dismissed that claim, arguing that the suit should be viewed in the context of medical negligence. The lawyer thereupon refiled the family’s suit as a medical malpractice claim. At trial, the hospital conceded medical negligence, but the plaintiff’s legal team continued to present the case as ordinary negligence, apparently rolling the dice in order to win a judgment that wouldn’t be restricted by the state’s lid on noneconomic damages. It eventually backfired, and due to the miscalculated gamble of the plaintiff’s attorney, the plaintiff ended up with no [ordinary] negligence claim and no medical malpractice claim, and consequentially, zero monetary award. Read the full article here.

Manhattan gynecologist sues patient for $1 million for posting negative reviews online on Yelp and other review sites

A Manhattan woman is facing legal troubles after posting a bad review of a local doctor online. Michelle Levine told CBS New York she’s already spent close to $20,000 fighting the million-dollar suit, which accuses her of defamation, libel and causing emotional distress. Read full story here