Physicians Speak Out Against Marketing Article

Having been a member of the Los Angeles County Medical Association for 37 years and a lifelong member of the American Medical Association, I feel compelled to comment on the October article, "Marketing Secrets," in the Southern California Physician series on medical spas.

I paid my dues to LACMA in October, but it will be the final year unless our association gets back to medicine. The marketing article is nothing more than unpaid advertising at its worst. The so-called experts are emergency room physicians-not dermatologists, plastic surgeons or anyone familiar with the treatment and care of the cosmetic patient.

I wonder what the topic of medical spas is doing in our journal anyway. Dermatology associations nationwide are trying to educate the public on reasonable and effective treatments, while the recognized publication of LACMA is promoting the marketing of these services by often unqualified and unsupervised personnel.

Articles about the flagrant promotion of nonmedical and inappropriate services do not belong in legitimate publications. Let us not promote more degradation to the medical profession. Being called a provider is bad enough. Let those promoting their spas and hiding behind an MD degree advertise in the supermarket tabloids, Los Angeles Magazine and the many free-for-the-taking papers in Los Angeles. Please keep the official publication of a long-respected organization focused on professionalism in medicine-not obvious self-promotion. 

Lauren L. Reager, MD
Dermatology
Santa Monica

I was surprised and dismayed by the "Marketing Secrets" article on how to market a skin spa. I doubt I am the only doctor who objects to this type of article in our publication. The article should have been in some type of journal where professionalism isn't an issue.

Physicians are debating the ethics of managing a skin spa, especially when that management is by doctors who are not properly trained in the spa procedures. In addition, there are extremely important questions about who actually provides treatment in skin spas and their qualifications. There are also issues as to why skin spas even exist. However, this could have been another article, which may have been more appropriate for the magazine.

An article about marketing at a time when physicians are struggling to maintain their role as professionals dedicated to the health of patients seemed totally out of place. Perhaps, in the future, professionalism will be the goal rather than commercialism.

Daniel Gross, MD
Dermatology
Tarzana

Editor's Note:

Southern California Physician welcomes readers' comments on this topic and wishes to clarify its intent in discussing medical spa marketing. The topic was not meant to detract from the professionalism of physicians, but simply to illustrate how physicians with medical spas go about reaching patients. Medical spa advertising is so prevalent in the media that it seemed worthy of exploring.

The medical spa article on Page 23 in this issue represents the final piece of our series. We hope that we have shed light on all aspects of the unmistakable trend and unequivocal growth of medical spas.

As always, the magazine appreciates feedback. Publisher/Editor Janis Rizzuto can be reached at 714/978-1100 or janisr@socalphys.com. Southern California Physician strives to reflect the interests and needs of physicians, so guidance on topics you want covered is helpful.

About Physicians, Diagnosis Codes and Unintended Consequences

I listened with great interest to the lady who detailed to the Medical Staff Quality Assurance Committee a new, enhanced program for capturing a complete list of diagnoses on inpatients. She pointed out how much better the work of our medical staff would look if a level of severity, as described by the proper diagnoses and their codes, were recorded in the physician's chart notes.

Our hospital's mortality rate in proportion to our morbidity rate would be far more reflective of the excellent institution we know ourselves to be. She pointed out that soon we would all be judged by these numbers. Underperforming hospitals are going to have their reimbursements diverted in favor of higher performing hospitals. Medicare and other insurance payers are in the process of relentlessly rolling out this plan. We clearly needed her help to get in front of all this so our staff and hospital don't get left behind.

Then, hospital administrators helpfully reminded us of how their substantial investment in computerized order entry systems makes it easier for the medical staff to participate.

In brooding about this, I remembered the shock I felt about 10 years ago when I got my first insurance premium billing after I'd had a thallium scan. I had a substantial surcharge. After many calls, I determined that my physician used a cardiac diagnosis so my insurance would pay. That diagnosis entry became the basis for my surcharge. I appealed the decision. I spoke directly to the insurance company medical director. I pointed out that the test-and all subsequent tests-were negative for heart trouble. He complimented me on my good health. The surcharge stayed. I have paid for that thallium scan many, many times over since then.

I have recently seen-and, so far, ignored-new forms for laboratory tests now requiring me to enter a diagnosis. Not to be too simplistic, but, if I was sure of the diagnosis, why would I order the test? I suppose it will all catch up with me, and I'll dutifully put down some diagnosis in order to do my work for patients.

I'm left with a nagging question. Who will correct the billing record if the test is negative? What will happen to my patient's ability to afford health insurance as a consequence of my input?

What works for an individual can have unanticipated consequences when generalized to the many. I wonder what insurers will do in response to the up tick in severity of illness they will observe in the population at the St. Joseph Health System? I fear the insurers will use that change to justify adjusting all premiums upward for the area to account for the severity (never mind that the premiums they receive now are adequate to pay hospitals and still support a substantial executive bonus system).

Health insurance will become more expensive and more patients will have to do without it. I don't expect the insurance industry to accept the argument from patient advocates like physicians that the level of "underreporting" was uniform across the system and that increased premiums would only generate windfall profits. Why should they?

Insurance managers believe that in totaling charges, they are directly enumerating the elements of healthcare itself. It's a small leap for them to say that in the obligatory clinical recording of healthcare, physicians are concurrently obligated to record billing information. It's no wonder they see the physician as their frontline biller.

Forcing the recording of clinical events into a financial narrative template will degrade the value of any retrospective review. The inpatient chart is already a poor chronicle of what happened to the patient because of the onslaught of malpractice attorneys. Public health data will surely deteriorate in a system driven by billing requirements. Turning the clinical chart into an itemized bill will complete its destruction.
Is there no other way?

Norman J. Harris, MD
Otolaryngology
Fullerton