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Discount dilemmas: Rollbacks can create a new set of problems


National report - When patients request discounts, dermatologists generally acquiesce - though they might later regret it, sources say.

Key Points

"It's always been our practice - regardless of the economic downturn - that if a patient asks for help with the price, we're certainly going to work with that patient," especially with long-standing patients, says Stephen M. Schleicher, M.D., medical director of DermDx Centers for Dermatology, Hazleton, Pa.

"If you bend over backwards for patients," he says, "they will be very happy with your attitude. And when times are better, they'll come back for more fillers and Botox (botulinum toxin A, Allergan)."

If the practice can whittle down its price, he says, "That might persuade them to do it that day." He says that throughout the field of dermatology, discounting occurs most commonly on Botox (botulinum A, Allergan) treatments.

In his mostly medical-practice Glendale office, Dr. Mehrabi says, "We are in the process of deeply discounting cosmetic procedures in hopes that we can move more product."

Ideas he is considering include offering patients the options of buying one Radiesse (calcium hydroxylapatite, Bioform Medical) syringe, and getting one for half off; an immediate $100 discount on any Juvéderm (hyaluronic acid, Allergan) syringe; and Botox at $10 a unit for December and January.

Bargain shoppers

Dr. Mehrabi says that in this economy, "You're more willing to discount some of your services in order to retain the patient." But, he cautions, "In the future, they may always expect some sort of discount."

Offering discounts also might attract "bargain shoppers rather than people who appreciate your expertise," he says. As a result, "We may be changing the dynamics of the practice."

Debra Jaliman, M.D., a Manhattan dermatologist in private practice and associate professor of dermatology at Mount Sinai School of Medicine, New York, also has fielded more requests for discounts since the fall. Patients frequently mention the economy, she says, "But often it's just an excuse.

"I have patients with 12 houses and hedge funds who ask me for discounts," usually cosmetic, she says. Because they're very good patients, "I'll still give them a discount, because I don't want to lose the patient."

However, Dr. Jaliman says she'd never reduce her rates permanently. "I'd rather do less volume on the cosmetic side," she says.

Conversely, in 2008, Michael H. Wojtanowski, M.D., president and director of the Ohio Clinic for Aesthetic Plastic Surgery in Cleveland, instituted fee reductions for timely procedure bookings.

Specifically, patients who book procedures within four weeks of their consultations get 20 percent off; those who book within eight or 12 weeks get 10 percent or 5 percent off, respectively.

"That's been very successful," says Dr. Wojtanowski, who also deducts his $75 consultation fee from his surgical fees.

Preemptive strike

Other physicians take a preemptive approach.

"Before patients even ask for a discount," says Leyda Elizabeth Bowes, M.D., a Miami, Fla., dermatologist in private practice, "at least for now, we're offering packages" for treatments such as Fraxel (Reliant) and laser hair removal, which require multiple sessions.

These packages cut patients' per-visit costs 10 percent to 15 percent.

"Doing it as a package helps patients financially and commits them to three or four treatments," she says.

Disclosure: Drs. Schleicher, Mehrabi, Jaliman, Bowes and Wojtanowski report no relevant financial interests.

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