Your Villa Magazine - Foothill Cities - December 2023-February 2024

Facial Artistry Gregory J. Vipond MD, Inc. Dr. Gregory VIPOND Everyone involved in healthcare has their own motivations as to why they chose this field. For me, it was the result of being a patient throughout my early childh od, dealing with sports injuries and other mishaps typical of an active boy. I was always drawn to the surgical fields because I liked their emphasis on procedures to correct ailments. I gravitated to Facial 3lastic 6urgery during medical school because I loved the ability to see the before and after changes that such procedures achieved. To this day, I really enjoy looking at the pre and post procedure photos of my patients as well as hearing the impact that these changes have on their lives. Because of the nature of our healthcare system, more and more providers with little or no background in aesthetic and cosmetic medicine are entering the field. $dditionally, there is a trend of increasing encroachment of non-medical personnel in the form of 3rivate (quity 3( firms, Venture &apital V& &ompanies, and investment groups. The involvement of 3( and V& groups is something that is very common in the hospitality and real estate markets, but this involvement is more recent in medicine. In the cosmetic medicine industry, the 3( firms and V& companies have become increasingly active in acquiring medspas to form franchises or national chains as well as acquiring dermatology practices to form regional chains. From a financial point of view, consolidation of these individual entities can bring benefits such as e[perienced management, better infrastructure, access to capital, and standardi]ed processes. &orporate-owned branded chains such as Medspa, Laser$way, and 6kin6pirit are growing across multiple states. &osmetic medicine is very lucrative due to its expanding patient population and low risk for investors. Its strong demand, appealing patient demographics, and the increasing popularity of health and wellness, make medspas ripe for acquisitions as well as new ventures. Recently, 3( firms and other groups have invested heavily in physician practices, largely in dermatology clinics. Many aging physicians are looking to retire or ways to hand oͿ management and financial responsibility. +owever, some firms treat medical practices like investment properties with the goal to ´strip and Áipµ the practice for profit. +owever, there are concerns about the impact of 3( ownership on healthcare costs, quality, and competition. $ general approach by 3( firms is to use a blend of investor funds and debt to acquire companies, aiming to sell them within 10 years for profit. 2ne V3 from an aesthetic franchise company stated, ´They gain business-wise through increased sale values, management fees, and financial strategies. But they often reduce costs by cutting staͿ or using less e[pensive supplies, which may aͿect care quality. They also focus on more profitable procedures and aggressive billing to boost revenue. The 3( model, coupled with regulatory gaps, has enabled these firms to e[pand and consolidate market inÁuence, often bypassing thorough antitrust scrutiny. Many healthcare acquisitions escape mandatory reporting to antitrust authorities because of their si]e, leading to concerns about ¶stealth acquisitions· that may have anti-competitive eͿects.µ In fact, the Medical Board of &alifornia has very strong policies against the corporate practice of medicine. The following is taken from their website Business and 3rofessions &ode B3& , section 20 2, states ´$ny person who practices or attempts to practice, or who holds himself or herself out as practicing...>medicine@ without having at the time of so doing a valid, unrevoked, or unsuspended certificate...is guilty of a public oͿense.µ B3&, section 2 00, states, in part ´&orporations and other artificial entities shall have no professional rights, privileges, or powers.µ This section of the law is intended to prevent unlicensed persons from interfering with, or inÁuencing, the physician·s professional judgment. In addition, the following ´businessµ or ´managementµ decisions and activities, resulting in control over the physician·s practice of medicine, should be made by a licensed California physician and not by an unlicensed person or entity ‡ 2wnership is an indicator of control of a patient·s medical records, including determining the contents thereof, and should be retained by a California-licensed physician; • Decisions regarding coding and billing procedures for patient care services; and ‡ $pproving of the selection of medical equipment and medical supplies for the medical practice. The types of decisions and activities described above cannot be delegated to an unlicensed person, including for e[ample management service organi]ations. While a physician may consult with unlicensed persons in making the ´businessµ or ´managementµ decisions described above, the physician must retain the ultimate responsibility for, or approval of, those decisions. The following types of medical practice ownership and operating structures also are prohibited • Non-physicians owning or operating a business that oͿers patient evaluation, diagnosis, care and or treatment; ‡ Management service organi]ations arranging for, advertising, or providing medical services rather than only providing administrative staͿ and services for a physician·s medical practice non-physician e[ercising controls over a physician·s medical practice, even where physicians own and operate the business and ‡ $ physician acting as ´medical directorµ when the physician does not own the practice. For e[ample, a business oͿering spa treatments that include medical procedures such as Boto[ injections, laser hair removal, and medical microdermabrasion, that contracts with or hires a physician as its ´medical director.µ In the e[amples above, non-physicians would be engaged in the unlicensed practice of medicine, and the physician may be aiding and abetting the unlicensed practice of medicine. $s some of my patients know, when I finished my Fellowship in Facial 3lastic and Reconstructive 6urgery, I first worked for the company, LifestyleLift. Its owner was a physician, but the company was run by non-medical management. I was an employee and officially told that I had complete freedom in making medical decisions. +owever, everything that I did was scrutini]ed by management and I was unofficially told how often and when I could see patients after surgery. I was repeatedly told that I should be operating more quickly and doing more surgeries in a day. I finally decided to leave the company after a long discussion with the &(2 who could not understand why I would do my best for every surgery if the patient was not paying for my best. 3atients were seen as commodities and not as people. This focus on revenue and not outcomes is one of the reasons that LifestyleLift declared bankruptcy. That is my fear with the increased corporati]ation of both medicine and aesthetics. With lack of physician autonomy, decisions about care will not be made with the patient·s best interests in mind, but instead those of the corporation. $s the owner of my practice, my duty is to my patients and my goal is to provide them with the best care that I can regardless of the bottom line. The fundamental tenet in medicine, even cosmetic, is the practice of caring for people who place their trust in us. 3roviders have a responsibility and ethical duty to uphold that trust. I·m not sure what the solution is to private equity in medicine without significant intervention from the government. Nonetheless, every patient should carefully evaluate their healthcare providers and feel comfortable with their medical care recommendations. I·m grateful for all the patients who have trusted me with their care and will continue to strive to prove myself worthy of this trust. *regory -. Vipond, M.D., F.R.&.6.&. Board Certified Facial Plastic and Reconstructive Surgeon