Reconstructive and Managed Care Liabilities

November 16, 2018

As the market for aesthetic surgery continues to grow and patients generalize their expectations of what plastic surgeons can achieve, the expectations that patients have for reconstructive surgery grows as well. Patients have as many demands and unrealistic expectations for reconstructive surgery as they may express for aesthetic surgery. In your practice you should present realistic options and procedures to the patient; only after the patient has a clear understanding of the procedures and knowingly accepts the risks and range of outcomes should you proceed with treatment. If you provide service through an emergency room and are not on the patient’s managed-care panel, it is good practice to try and see the patient postoperatively without charge and document their satisfactory progress.


Managed care issues raise additional potential legal concerns; these matters should be addressed with the patient and should be well documented. Your request for authorization letter should be complete, state all facts, and be straightforward in asserting why treatment is medically necessary and appropriate. As you know, it is not uncommon to receive a denial, but it is incumbent on you to provide the best patient care to remain a patient advocate and appeal the initial determination as appropriate and necessary. 


The Affordable Care Act creates physician liability for treatment by others in your practice; the liability for patient care is on you even if a physician’s assistant or nurse practitioner may actually see the patient. As your practice grows, it will be difficult if not impossible for you to screen, consult with and treat every patient. Patients will experience delays in treatment and some care may be rationed. 


As you recruit and rely upon other health care providers (such as PA’s, nurse practitioners and aestheticians), make sure that your practice establishes appropriate criteria for patient selection, treatment options, and supervision. Doing so will ensure that you are following regulatory requirements and guidelines for good patient care and patient safety, and will go a long way toward mitigating the risk of litigation.



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