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More than Skin Deep

Joe Cantlupe, for HealthLeaders Media, April 13, 2012
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James E. Zins, MD, chairman of the department of plastic surgery at the 1,300-bed Cleveland Clinic, says hospitals that have developed service lines in plastic surgery have optimized care and outcomes by having both medical and cosmetic programs.

Zins recalls that several years ago, private practice plastic surgeons began sustaining financial reverses from a decline in cosmetic surgeries, which was "very frightening to the private practice cosmetic surgeon."

But systems such as Cleveland Clinic were able to weather recessionary storms in plastic surgery by maintaining cosmetic and medical options through reconstructive surgery, including dermatology and facial plastic surgery. "If the hospital was just doing cosmetic surgery, it would be in big trouble," Zins says. "Our department, for instance, is big and diverse enough that the downturn wasn’t a big hit on us. Now, as it is, noninvasive procedures like Botox and fillers are going up dramatically."

While the number of cosmetic surgeries has been uneven in recent years, often dependent on economic factors, medical procedures in plastic surgery continue to increase, says Andrew Winkler, MD, assistant professor and director of the Visage Center, a facial plastic surgery practice run by the 437-bed University of Colorado Hospital in Aurora. A plastic surgery service line draws patients who like the prospect of a program supported by the depth of medical care, adds Winkler. "For a hospital, it’s important to provide the full service to the community. We want to provide every kind of service. Plastic surgery is that service."

Some hospital systems aren’t eager to develop a plastic surgery service line, but instead keep the programs within specific service lines such as oncology, concentrating on reconstructive rather than cosmetic surgery. "It’s very competitive; you are competing with a lot of outpatient centers," says Marcia Manker, CEO of the 218-staffed-bed Orange Coast Memorial Medical Center in Fountain Valley, CA, referring to hospital-run plastic surgery centers. As opposed to reconstructive surgery, which is typically covered by health plans, cosmetic surgery is "a cash-based program very susceptible to economic forces and very price contrived," she says.

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