Jeffrey N. Thaxton, MD, the lone plastic surgeon in Vail, Colo, treats everyone—from cancer victim to injured skier

Vail, Colo, is home to some of the best winter snow skiing in the country. But—more than the lure of the slopes—it was a world-class cancer center that brought plastic surgeon Jeffrey N. Thaxton, MD, to this Rocky Mountain resort town 2 years ago, giving him the distinction as being Vail’s lone specialist in the art and science of face and body remaking.

“During my plastic surgery training at Columbia University’s Harlem Hospital Center in New York City, I made a trip to Vail to attend a conference and discovered that a facility called Shaw Regional Cancer Center had only a short time before opened its doors,” Thaxton says. “And the one thing I really wanted was to be involved with a cancer center.”

As it happened, Shaw Regional Cancer Center—a venture of Vail Valley Medical Center—did not have any plastic surgeons participating on its tumor board because there were no plastic surgeons in the area. “The population here is small—on the borderline of just being able to support a plastic surgery practice,” Thaxton says in explaining the dearth of practitioners.

“The reason it can support a practice at all is that so many of those who live and vacation here are extraordinarily affluent, success-oriented, and active-lifestyle people who tend to need and want plastic surgery services,” Thaxton continues. “But then you add to that the drawing power of the cancer center, and Vail becomes a place where it’s possible for a plastic surgeon to be happy and successful.”

PRACTICE PROFILE
Name: Jeffrey N. Thaxton, MD
Location: Vail, Colo
Specialties: Face, breast reconstruction; aesthetic face and body plastic surgery
Years in practice: 2
Number of patients per day: 15
Number of new patients per year: 400
Days worked per week: 4
Days surgery performed per week:
Number of employees in practice: 3
Office square footage: 1,400

Early Involvement
Only about one fourth of Thaxton’s cases originate with the Shaw center, where Thaxton is now on staff. “I participate on the tumor board,” he says. “I am also called in by the surgeons when they require assistance following removal of the cancer. Mainly, I perform reconstructions of postmastectomy breasts and cosmetic camouflaging of places where head or neck cancers grew before excision.”

Regardless of how he is brought into a cancer case, Thaxton’s initial consultation with the patient is almost always a one-on-one encounter. However, beginning in October, the cancer center will institute a multidisciplinary approach in which Thaxton and the specialists from the various other involved fields will all sit down as a group with each patient.

“The feeling is that by working as a true team, we’re going to be able to further increase the quality of care the patients receive and, at the same time, make things a lot more convenient for them,” Thaxton says.

Some of the most interesting clinical challenges arise with Thaxton’s postmastectomy patients. For example, a moderately overweight patient he recently helped presented with cancer in one of her large contralateral breasts. “There was a strong history of breast cancer in her family. She wanted a mastectomy of both the involved and uninvolved breast as well as a reconstruction of the two,” he says.

“The reconstruction entailed use of a bilateral tram flap—a fairly complicated procedure because of the amount of extra body weight this patient was carrying. I was in surgery 10 hours, but the result was very nice,” he explains.

He says that breast-cancer reconstructions are his most satisfying cases. “I feel like I’m making an important contribution to a woman’s sense of closure for a problem that has taken a terrible emotional toll on her for many months. Breast-cancer treatment is hard for anyone to go through, what with having to endure the sickness produced by chemotherapy and the disfigurement of mastectomy.

“I’m helping to get these patients started back on the road to reclaiming their self-esteem. And because breast reconstruction is not a one-shot procedure, I get to develop a longer-term relationship with the patient, which is also very satisfying,” he notes.

Rarified Air
Because his is not a high-volume practice, Thaxton can allot more time to each of his noncancer cases—at least a full hour for the initial consult. He sees patients in his 1,400-square-foot office on Monday afternoons and Tuesday and Thursday mornings. The remainder of his schedule is taken up by surgeries, which he performs either at Vail Valley Medical Center or at a nearby outpatient surgery center.

“I like being able to take a very individualized approach with my cases,” he says. “I work very closely with the patient to identify his or her needs, lifestyle preferences, and financial situation, and from that input we together develop the most appropriate surgical plan based on a thorough exploration of the available options. For example, on a breast reconstruction, we look at the pros and cons of various implants, autologous tissue, free tissue transfer, and others.”

Notably, Thaxton finds there is little he need do to help most of his patients prepare for surgery. “They have such healthy lifestyles to begin with that giving them nutrition and exercise counseling and putting them on vitamins or other dietary supplements isn’t necessary,” he says.

“My understanding and experience are that people who live in Colorado—Vail in particular—are as a whole among the leanest and most physically fit in the nation,” he continues. “But that’s probably to be expected. After all, what’s the point of living in Vail if you’re not going to be an active lifestyler?”

Still, Vail is 8,100 feet above sea level, which means Thaxton not infrequently sends patients home with a prescription for a couple of days’ worth of oxygen, usually dispensed through small, easily portable bottle-style tanks or a room-based concentrator. “The air’s kind of thin up here,” he says. “The high altitude doesn’t affect surgery or the ability to heal, but quite a few of my patients—especially the ones who normally live in places closer to sea level—have a hard time catching their breath after surgery.”

Thaxton earns good marks from his patients for minimizing their postoperative pain and speeding up their recovery. “Pain pumps—I use them a lot,” he says. “They do represent an extra expense, add a few extra steps during surgery, and are a bit bulky. But patients like them because, after surgery, they feel hardly any pain or discomfort.

“As to shortening postop recovery time, one way I foster that is by placing as few restrictions as practical on my patients in the days following surgery. I encourage them to get up, move around, be active—within reason, of course.

“I’m of the view that the better job I do with regard to reducing pain and accelerating recovery, the more delighted the patients are going to be and the more willing they’ll be to refer me to their relatives, friends, and coworkers,” he explains.

Broadened His Horizons
Thaxton remembers that it was while a teenager in his hometown of Sissonville, WVa, that he realized a career in medicine was right for him. Accordingly, he became a premed student at Marshall University in Huntington, WVa, where he graduated in 1988 with a degree in chemistry.

He continued at the same university for his medical schooling, completing it in 1992. For residency in general surgery, Thaxton moved on to West Virginia University in Morgantown—he put in 2 years there, then began practicing emergency medicine for the next 6.

During his residency, Thaxton was exposed to plastic surgery, and he found himself fascinated by it. “I quickly recognized that, in plastic surgery, a procedure was never done exactly the same way twice because every patient is different,” he says. “Plastic surgery offered considerable room for developing a treatment plan unique to the patient. It also presented opportunities for artistic creativity—individual tailoring and artistry being essential, since the result of the procedure would be visible to all.”

In 2000, Thaxton applied for admission to the plastic surgery residency program at Columbia University, choosing that school over others closer to home because he believed that only Columbia could give him maximum exposure to world-renowned experts in reconstructive and aesthetic plastic surgery.

“While I was in the Columbia program, I spent several months at Memorial Sloan-Kettering Cancer Center,” he relates. “They had a multidisciplinary team approach to treating patients, and I credit my experiences on that team with leading me toward wanting to make breast reconstruction a significant part of the private practice I eventually would launch. Until I served on that team, I had no notion that I would find breast reconstruction so gratifying.”

Season’s Gleanings
An immutable characteristic of the Vail market is its seasonality, and that has an impact on Thaxton’s practice.

“Vail is most crowded during the winter because it’s such a big destination for skiers,” he says. “But things are picking up in the summer now as Vail becomes more and more known for hiking and mountain biking.”

A significant portion of the cases Thaxton handles during the winter and summer involve reconstructions necessitated by sports-related injuries as severe as compound fractures but, more commonly, facial lacerations. These sometimes happen when a downhill racer does little more than lean too steeply into a turn and the edge of the ski connects with his cheek, chin, nose, or forehead. Then, when the snow melts and the skis are put away until next winter, Thaxton’s aesthetic business increases.

“During the spring and fall—our off-season—is when patients here have the time to think about a facelift, liposuction, or breast augmentation,” he says. “In terms of practice volume, if you look at the shifts in demand patterns over the course of the entire year, I manage to stay pretty busy from January to December.”

A Healthy Balance
Thaxton is aware of the tendency of plastic surgery practices to start out with an emphasis on reconstructive work, then evolve into predominantly aesthetic-focused enterprises. He says his preference is to maintain a healthy balance between the two for as long as possible. At present, his case mix is just under two-to-one reconstructive versus aesthetic.

“Maybe in another 15 years I’ll want to make the transition to a primarily cosmetic practice,” he says. “But, in the here and now, I’m very happy with the current composition of things. I enjoy reconstructions and derive a lot of satisfaction from them.”

At the same time, though, he indicates he would like to begin positioning the practice so that it can be ready for the day when aesthetic volume outstrips the demand for reconstructive procedures. “I want to be able in the future to offer a package of services to better support the patient seeking a more attractive face, body, or both,” he says.

“For example, I’d like to have other providers in place in my practice who can offer advice and programs for healthier living and better self-image. The market certainly wants this. I’m going to do my best to satisfy that want.” PSP

Rich Smith is a contributing writer for Plastic Surgery Products.

His Insurance Maven
Despite performing almost twice the number of reconstructive plastic surgeries as aesthetic procedures, the Vail, Colo, practice of Jeffrey N. Thaxton, MD, is doing well financially. For that, he can thank in no small part the helping hand he receives from his wife, Rebecca McGraw Thaxton, MD. A general practitioner, McGraw Thaxton does not perform adjunctive clinical services—she supplies only administrative support, including the vitally important job of making sure insurance companies pay all that they owe and in a timely manner.

 “The thing I do more of is pressure insurance companies to pay for procedures they try to argue are either not covered or not medically indicated,” she says. “A favorite trick of insurance companies is to drag their feet and delay as long as possible having to pay, because the longer the money stays in their hands, the more interest they can earn on it.”

The countertactic that seems to work best when delays are encountered over clean (defined by law) claims is threatening to lodge a complaint with the state insurance commissioner. “One thing insurers try hard to avoid is being dinged by attracting regulatory attention to themselves,” she says.

“But this approach is effective only if you know the law and the insurer knows that you know the law. That’s why I include in my letters of warning to the insurance companies a rundown of the applicable laws.”

Claims Examiner
McGraw Thaxton is attuned to the ways of insurance companies because she works part-time for one in West Virginia.

“When I came out of residency training, I received an offer from a hospital to work at a rural health center, which subsequently developed a specialty clinic in occupational health. I became the main physician for that and was soon very deeply involved in workers’ compensation cases,” she says.

“That led to an invitation from the state’s Department of Health and Human Resources to review disability claims for it on the side, and I became a certified independent medical examiner,” she continues. “Later, the insurance company I’m now working for recruited me as a claims reviewer.”

Something else she has helped her husband accomplish is the minimization of problems having to do with preauthorizations. “For example, sometimes breast reductions and tummy tucks will be covered by insurance—I know how to look at the patient’s insurance policy and then weigh it against insurance law,” she says.

“If, after my assessment of those two elements, I determine there’s no way on earth the work will be reimbursed, I let my husband know that so that he doesn’t waste time trying to push it through and, by the same token, doesn’t cause the patient a lot of unnecessary frustration.”

Ensuring Success
McGraw Thaxton doesn’t screen every case for her husband. Instead, she has devised a set of algorithms that he and his billing staff can use to quickly gauge the reimbursement potential of the cases before him. She also is available to help Thaxton strengthen the arguments he submits to insurers in seeking to gain preauthorization.

“If a patient comes in seeking a breast reduction and she wants insurance to pay for it, the best way to ensure that it does is to include with the request for preuthorization a description of the medical symptoms linked to the macromastia—for example, significant back pain, neck pain, and refractory rash,” she says. “Without a list of symptoms, the insurance company won’t be able to see the medical necessity of the breast reduction.”

This partnership may not have formed if McGraw and Thaxton had not met while she was a medical-school student and he was a general surgery resident at West Virginia University. They became reacquainted after a few years of going separate ways when she phoned him to say hello and catch up on events in his life since school.

During the course of that chat, he asked her out to dinner. She accepted, and love blossomed from there. It ultimately ripened into marriage—they celebrated their 10th anniversary this year. They have a daughter, MacKenzie, 6, and a son, Maverik, 3.
—RS