Dr. Tammy Wu, Board Certified Plastic Surgeon in Modesto, CA, got asked about considering professional liability coverage for a few general surgeons and OB/GYNs in California who are applying for coverage of SmartLipo. Dr. Wu explains her take on the situation
What is Smart Lipo?
SmartLipo by itself is not a dangerous procedure, it is laser-assisted liposuction, which has been shown to have a greater rate of seroma formation (as does ultrasound-assisted liposuction) and greater surrounding fatty tissue damage, possibly resulting in a greater potential for contour irregularities or deformities compared to traditional liposuction (old-fashioned way). Both laser and ultrasound are modalities used to “melt the fat” so that it makes it easier for the surgeon to do the liposuction. Traditional liposuction of sucking out the fat is still necessary, after the fat has been “melted”, so it is really not that different from traditional liposuction. It does not benefit the patient much, more for the surgeon. Of course, the marketing would have you believe that this is the greatest thing ever invented by mankind – NOT TRUE. We have seen complications of the procedure which includes scar formation with the adipose tissue which has complicated some tummy tuck surgeries. But we have also seen some wonderful work done with the device.
Dr. Tammy Wu prefers Traditional Liposuction over Smart Lipo
Personally, because of the higher rate of seroma and surrounding tissue injury, I believe that traditional liposuction is superior; it is more work on the surgeon’s part, but I think of it as liposuction art created by hand rather than by machine.
Non-Core Physicians doing Liposuction out of their own offices.
SmartLipo is a procedure marketed by the SmartLipo company catering to those who operate out of their offices (either b/c they prefer to do so, or they can’t get privileges at the hospitals to do it b/c they are not core physicians, ie, plastic surgeons). I think the risk may be low for those non-core physicians doing these procedures, b/c I think they would be more conservative and less aggressive (hopefully). As an in- office-procedure, the amount of liposuction should be limited to a safe limit.
What does the ASPS say about Safe Liposuction Limits?
The ASPS (American Society of Plastic Surgeons) recommends no more than 5L of total suction aspirate when liposuction is done in an office surgery suite, or surgery center by board certified plastic surgeons. Of course, all members of the ASPS (plastic surgeons) need to operate out of accredited surgery suites /centers. The non-core physicians may or may not have these restrictions.
Changes in Health Care is driving more non-core physicians to Liposuction.
Unfortunately, the way medicine and insurance is going, we are going to see more and more non-core physicians performing cosmetic procedures. We have to decide as a company what we want to do.
Dr. Wu says if they can prove good training, and are good physicians, then they have a chance at being good at Smart Lipo.
My personal opinion is that if they are well-trained in their specialty, and they have shown a responsible attitude (through office visits and claims history, as well as peer review opinions, etc.), it’s ok to approve them to do the procedure. However, I believe the following should be done before approval:
1. a site-visit is a must to evaluate the OR setting to make sure that they are equipped to react when the worse case scenario happens and to make sure that the suite/ center is accredited. Also the operating site should be in close proximity to a major hospital with ER in case of emergencies.
2. the physician should provide proof of training, and submit the number of cases performed, hopefully under supervision (for non-core physicians, not plastic surgeons – we get this stuff in residency and /or fellowship) to demonstrate competency in the procedure.
3. Preferably these are physicians who have no claims in the past in their own specialty. The reason for this is b/c plastic /cosmetic patients are very demanding and require a lot of TLC and patience. IF they have done well in their own specialty with good patient rapport, they most likely will continue to do so. I would not approve anyone who has had multiple claims for whatever reason, to do this procedure.
4. Limit their total liposuction aspirate to maybe 3L for each patient (for every surgery they do). This will minimize risks associated with large-volume liposuction (fat embolism, DVT, contour irregularities due to surgeon fatigue, etc.). We can consider having a clause saying that we would not cover the procedure if they do more than 3L at one setting.
5. We can also consider setting up a Risk Management Seminar specifically geared toward non-core physicians wishing to perform cosmetic procedures such as this. The seminar would probably be more medical, ie, the risks associated with liposuction, what to look for, what to avoid, etc. and require these non-core physicians to attend before approval.
Disclaimer: These are just her thoughts at the moment
These are my thoughts. It is a difficult market place out there. I would have normally said “no” to approving these physicians, but they are going to be a significant portion of those who attempt to resist joining large groups and try to stay on their own. We are a company that has historically catered to the small group and solo physicians, as an attempt to continue to support them, I think we may have to shift our thinking. As I said before, cosmetic and plastic surgery and some variations thereof (concierge medicine) will be the only ones standing alone amongst all of the recent and near future health care / insurance changes.
Dr. Wu is available to answer further questions to help professional liability companies consider coverage of Smart Lipo.
I hope this helps somewhat in answering your question. Let me know if you have any other questions.