RE: update malpractice / esthetics

[Guest guest]

That still seems surprising to me that Botox or LASER would not increase

malpractice costs. You could do some real damage with either of these.

Even though Botox is not permanent you could still inject a nerve or blood

vessel, get infection, etc. Especially surprising that these do not raise

your premium but some carriers actually charge more for D.O.'s that do OMT

(manipulation). Seems contradictory to me.

update malpractice / esthetics

I don't mean to open a new can of worms but I do want to update folks

interested in esthetic work like laser or Botox about malpractice.

Yesterday I spoke with an underwriter for my malpractice company (MLMIC,

which I believe is the biggest in NY). She said that I will need a letter

stating what services will be included and document formal training. Her

experience is the premium does NOT change for a family doc with basic

office surgery included. That is, it's no more a malpractice coverage

than for lumps/bumps/lac repair/etc.

Tim

[Guest guest]

That still seems surprising to me that Botox or LASER would not increase

malpractice costs. You could do some real damage with either of these.

Even though Botox is not permanent you could still inject a nerve or blood

vessel, get infection, etc. Especially surprising that these do not raise

your premium but some carriers actually charge more for D.O.'s that do OMT

(manipulation). Seems contradictory to me.

update malpractice / esthetics

I don't mean to open a new can of worms but I do want to update folks

interested in esthetic work like laser or Botox about malpractice.

Yesterday I spoke with an underwriter for my malpractice company (MLMIC,

which I believe is the biggest in NY). She said that I will need a letter

stating what services will be included and document formal training. Her

experience is the premium does NOT change for a family doc with basic

office surgery included. That is, it's no more a malpractice coverage

than for lumps/bumps/lac repair/etc.

Tim

[Guest guest]

--- Brock DO wrote:

Even though Botox is not permanent you could still inject a nerve or

blood vessel, get infection, etc

,

Most injections are very superficial, it not necessary to inject the

needle, hit periosteum and inject. A basic knowledge of the facial

anatomy is all that is needed to avoid such complications (though i

have not heard of these ie hitting blood vessels, infection). How often

are diabetics getting infections from injecting insulin? At a recent

workshop I attended (not for botox), the plastic surgeon who presented

made the argument that the injection of botox is safer (less

complications ) than from taking an aspirin daily. Food for thought.

The reality is that patients will pay for the service, they are very

happy with results, it easy to do, and in a low overhead model, would

be a perfect complement.

rocky

> That still seems surprising to me that Botox or LASER would not

> increase

> malpractice costs. You could do some real damage with either of

> these.

> . Especially surprising that these do not

> raise

> your premium but some carriers actually charge more for D.O.'s that

> do OMT

> (manipulation). Seems contradictory to me.

>

>

>

> update malpractice / esthetics

>

> I don't mean to open a new can of worms but I do want to update folks

> interested in esthetic work like laser or Botox about malpractice.

> Yesterday I spoke with an underwriter for my malpractice company

> (MLMIC,

> which I believe is the biggest in NY). She said that I will need a

> letter

> stating what services will be included and document formal training.

> Her

> experience is the premium does NOT change for a family doc with basic

> office surgery included. That is, it's no more a malpractice

> coverage

> than for lumps/bumps/lac repair/etc.

> Tim

>

>

>

>

>

>

>

[Guest guest]

--- Brock DO wrote:

Even though Botox is not permanent you could still inject a nerve or

blood vessel, get infection, etc

,

Most injections are very superficial, it not necessary to inject the

needle, hit periosteum and inject. A basic knowledge of the facial

anatomy is all that is needed to avoid such complications (though i

have not heard of these ie hitting blood vessels, infection). How often

are diabetics getting infections from injecting insulin? At a recent

workshop I attended (not for botox), the plastic surgeon who presented

made the argument that the injection of botox is safer (less

complications ) than from taking an aspirin daily. Food for thought.

The reality is that patients will pay for the service, they are very

happy with results, it easy to do, and in a low overhead model, would

be a perfect complement.

rocky

> That still seems surprising to me that Botox or LASER would not

> increase

> malpractice costs. You could do some real damage with either of

> these.

> . Especially surprising that these do not

> raise

> your premium but some carriers actually charge more for D.O.'s that

> do OMT

> (manipulation). Seems contradictory to me.

>

>

>

> update malpractice / esthetics

>

> I don't mean to open a new can of worms but I do want to update folks

> interested in esthetic work like laser or Botox about malpractice.

> Yesterday I spoke with an underwriter for my malpractice company

> (MLMIC,

> which I believe is the biggest in NY). She said that I will need a

> letter

> stating what services will be included and document formal training.

> Her

> experience is the premium does NOT change for a family doc with basic

> office surgery included. That is, it's no more a malpractice

> coverage

> than for lumps/bumps/lac repair/etc.

> Tim

>

>

>

>

>

>

>

[Guest guest]

Unfortunately, the patients in my rural area would almost certainly not pay

for Botox (or much of anything medically related) out of pocket. They fight

us every year just to pay their Medicare deductibles, etc. People here

would say: " oh insurance doesn't cover it? Then I don't want it. " I

realize I choose to work where I do, but I'm just saying that " extras " like

Botox will not go over in some geographic areas. Things are VERY different

in many rural or even semi-rural (almost suburban) areas in the US versus

urban areas.

update malpractice / esthetics

>

> I don't mean to open a new can of worms but I do want to update folks

> interested in esthetic work like laser or Botox about malpractice.

> Yesterday I spoke with an underwriter for my malpractice company

> (MLMIC,

> which I believe is the biggest in NY). She said that I will need a

> letter

> stating what services will be included and document formal training.

> Her

> experience is the premium does NOT change for a family doc with basic

> office surgery included. That is, it's no more a malpractice

> coverage

> than for lumps/bumps/lac repair/etc.

> Tim

>

>

>

>

>

>

>

[Guest guest]

Unfortunately, the patients in my rural area would almost certainly not pay

for Botox (or much of anything medically related) out of pocket. They fight

us every year just to pay their Medicare deductibles, etc. People here

would say: " oh insurance doesn't cover it? Then I don't want it. " I

realize I choose to work where I do, but I'm just saying that " extras " like

Botox will not go over in some geographic areas. Things are VERY different

in many rural or even semi-rural (almost suburban) areas in the US versus

urban areas.

update malpractice / esthetics

>

> I don't mean to open a new can of worms but I do want to update folks

> interested in esthetic work like laser or Botox about malpractice.

> Yesterday I spoke with an underwriter for my malpractice company

> (MLMIC,

> which I believe is the biggest in NY). She said that I will need a

> letter

> stating what services will be included and document formal training.

> Her

> experience is the premium does NOT change for a family doc with basic

> office surgery included. That is, it's no more a malpractice

> coverage

> than for lumps/bumps/lac repair/etc.

> Tim

>

>

>

>

>

>

>

[Guest guest]

This is what I mean by areas having "mental" borders. I am probably 30-40 minutes from Dr. Brock and my patients would TOTALLY pay for botox and would NEVER take their kids to the health dept for shots. I had a patient who was a self pay today (recent job loss, definitely not independently wealthy) who said there was no way she was going to the health dept. so she paid out of pocket. I think it is really important to know your patients before you spend a ton of money on any service.

Also, our malpractice insurance covers many aspects of being a physician, including injections. I agree with rocky, there really doesn't seem to be much risk with doing botox injections. I also think the malpractice underwriters probably have the proof.

[Guest guest]

That might be true in terms of the area you practice. i suppose I am

fortunate to be in the " big city " . But I still have those same HMO

patients that bitch and moan about there $10 copay, but in the same

breath are willing to plunk down $400 for botox or other aesthetic

services without blinking an eye. All I am saying is you might be

surprised. I can see the marketing now...Big City looks, small town

prices

rocky

--- Brock DO wrote:

> Unfortunately, the patients in my rural area would almost certainly

> not pay

> for Botox (or much of anything medically related) out of pocket.

> They fight

> us every year just to pay their Medicare deductibles, etc. People

> here

> would say: " oh insurance doesn't cover it? Then I don't want it. " I

> realize I choose to work where I do, but I'm just saying that

> " extras " like

> Botox will not go over in some geographic areas. Things are VERY

> different

> in many rural or even semi-rural (almost suburban) areas in the US

> versus

> urban areas.

>

>

>

> update malpractice / esthetics

> >

> > I don't mean to open a new can of worms but I do want to update

> folks

> > interested in esthetic work like laser or Botox about malpractice.

> > Yesterday I spoke with an underwriter for my malpractice company

> > (MLMIC,

> > which I believe is the biggest in NY). She said that I will need a

> > letter

> > stating what services will be included and document formal

> training.

> > Her

> > experience is the premium does NOT change for a family doc with

> basic

> > office surgery included. That is, it's no more a malpractice

> > coverage

> > than for lumps/bumps/lac repair/etc.

> > Tim

> >

> >

> >

> >

> >

> >

> >

[Guest guest]

Yes, from all I can tell the procedures are easier and safer than many

things we deal with every day. Like anything they pose some risk and the

patients deserve to be educated about those. Consents do need to be

signed etc, that's only proper. But compared to risks of some

prescriptions we give or the risk of skin biopsies, endometrial biopsies,

etc, these are not bad at all. I guess that's why malpractice wouldn't

need to change.

Tim

> --- Brock DO wrote:

> Even though Botox is not permanent you could still inject a nerve or

> blood vessel, get infection, etc

>

> ,

>

> Most injections are very superficial, it not necessary to inject the

> needle, hit periosteum and inject. A basic knowledge of the facial

> anatomy is all that is needed to avoid such complications (though i have

> not heard of these ie hitting blood vessels, infection). How often are

> diabetics getting infections from injecting insulin? At a recent

> workshop I attended (not for botox), the plastic surgeon who presented

> made the argument that the injection of botox is safer (less

> complications ) than from taking an aspirin daily. Food for thought.

>

> The reality is that patients will pay for the service, they are very

> happy with results, it easy to do, and in a low overhead model, would be

> a perfect complement.

>

> rocky

>

>

>> That still seems surprising to me that Botox or LASER would not

>> increase

>> malpractice costs. You could do some real damage with either of

>> these.

>> . Especially surprising that these do not

>> raise

>> your premium but some carriers actually charge more for D.O.'s that do

>> OMT

>> (manipulation). Seems contradictory to me.

>>

>>

>>

>> update malpractice / esthetics

>>

>> I don't mean to open a new can of worms but I do want to update folks

>> interested in esthetic work like laser or Botox about malpractice.

>> Yesterday I spoke with an underwriter for my malpractice company

>> (MLMIC,

>> which I believe is the biggest in NY). She said that I will need a

>> letter

>> stating what services will be included and document formal training.

>> Her

>> experience is the premium does NOT change for a family doc with basic

>> office surgery included. That is, it's no more a malpractice

>> coverage

>> than for lumps/bumps/lac repair/etc.

>> Tim

>>

>>

>>

>>

>>

>>

>>

[Guest guest]

I guess I was thinking more of docs that are using Botox for things like

migraines, nerve pain, etc rather than just cosmetics (wrinkles, etc).

Those non-cosmetic things would certainly have to be considered

non-proven/experimental.

update malpractice / esthetics

>>

>> I don't mean to open a new can of worms but I do want to update folks

>> interested in esthetic work like laser or Botox about malpractice.

>> Yesterday I spoke with an underwriter for my malpractice company

>> (MLMIC,

>> which I believe is the biggest in NY). She said that I will need a

>> letter

>> stating what services will be included and document formal training.

>> Her

>> experience is the premium does NOT change for a family doc with basic

>> office surgery included. That is, it's no more a malpractice

>> coverage

>> than for lumps/bumps/lac repair/etc.

>> Tim

>>

>>

>>

>>

>>

>>

>>