Keeping the lines of communication open gives patients a sense that you care about them and are committed to their well-being, says Alexander Rivkin, MD, the leading pioneer of non-surgical rhinoplasty.

By Tonya Johnson

While you were busy at work putting in the extra hours to maintain a successful plastic surgery practice, prior to the Coronavirus (COVID-19) outbreak, Rady Rahban, MD, FACS, Beverly Hills plastic and cosmetic surgeon, says there may have been plenty of other things that you wanted to do to improve on your business, making it more efficient and refined, but you just never got around to doing it. Whether it’s catching up on administrative paperwork, improving the quality of the photos on your digital gallery space, building a stronger social media presence, or redesigning a user-friendly website, now is the time to “take a closer look at your practice, and start making lemonade out of lemons.”

The founding host of “Plastic Surgery Uncensored,” launched in 2019, also likens the current climate of closures to a temporary season of home renovations. “I’m taking this moment to reflect and clean house,” he explains. “You live in your house and you live in your house. Every time you want to do a home renovation, it’s disruptive to the day-to-day activities of your home. Then one day you have to bite the bullet, get into a hotel, and remodel your home.” COVID-19 in 2020 is that time, says Rahban, and it would be a shame to look back and six weeks have past, but you haven’t done anything. Shelter-in-place orders have given him room to finish dictating patient charts, updating web photos, and refreshing outdated page content, as he continues to promote the business through social media congruent with the practice and relevant to his followers, with video posts – for example – that instruct on how to wash hands properly to control the spread of infectious disease. Committed to educating male and female patients, Rahban specializes in rhinoplasty, breast augmentation, mommy makeovers, and more.

Rady Rahban, MD, FACS, Beverly Hills Plastic and Cosmetic Surgeon

THE ECONOMIC IMPACT OF CORONAVIRUS (COVID-19)

In a statement released March 19, by Lynn Jeffers, MD, MBA, FACS, president of the American Society of Plastic Surgeons, based on the Centers for Medicare and Medicaid Services (CMS) guidelines, the Society strongly recommended that all plastic surgeons discontinue any elective or non-essential services (with exception of only urgent or emergent care) in efforts to help flatten the curve of the rapidly growing viral pandemic; to not overwhelm frontline healthcare workers; and to conserve on the limited supply of hospital beds, ICU beds, ventilators, extracorporeal membrane oxygenation (ECMO) machines, and disposable medical supplies.

The financial implications of a practice that is currently not generating any revenue are concerning and each practitioner must do a self-reflection to make the best decision possible depending on their staff volume, Rahban says. Several of his colleagues that were operating large scale facilities with plenty of personnel, had to immediately let a certain number of people go because they couldn’t sustain the overhead. If a business spends a tremendous amount of cash on public relations, marketing, and social media, all of those things are costly. So there’s no luxury of operating a plastic surgery practice at zero income.

Historically, he likes to keep it lean, designating every person in the practice with a distinct purpose, so there’s no overlap. He told Plastic Surgery Practice that senior-level administrators are able to work remotely from home, but all of his entry-level employees have been temporarily furloughed. He has been trying to figure out a way to keep all of his employees on budget, admitting that if he loses them completely, the rehire process will be even more challenging and expensive. What happens next depends on the duration of the quarantine guidelines regulated by federal, state, and local government, in addition to heavy advisories from the Centers for Disease Control and Prevention (CDC), and medical gurus. This latest coronavirus disease (COVID-19), that had never been seen in humans until now, originated in Wuhan, China. At the time of this online posting, the CDC had reported a total of 776,093 cases across the United States, with 41,758 deaths. According to the World Health Organization, there are now more than 2.4 million cases overall.

Before the global health crisis, Alexander Rivkin, MD, the pioneering facial cosmetic surgeon behind the “Non-Surgical Rhinoplasty” approach, was offering his patients the latest in non-invasive, non-ablative cosmetic treatments. As assistant clinical professor at the David Geffen UCLA School of Medicine, he would typically divide his time between patient care, FDA clinical research trials, educating other physicians, media appearances, and lecturing at scientific conferences throughout the world.

Rivkin has maintained the Westside Medical Aesthetics practice in Los Angeles for the past 17 years and agrees with Rahban, wholeheartedly, that finding people to work at the practice can be a difficult task, so he has remained flexible and accommodating to the needs of his employees and their family necessities—for example, like his assistant manager who started working remotely after giving birth to her first child.

In fact, Rivkin shut his entire practice down exactly one week before California Governor Gavin Christopher Newsom ordered a statewide shelter-in-place back in March. “We found it to be ethically unfeasible to run a cosmetic practice in the face of mounting evidence that being at home and not going out was the best way to stop this virus,” he explains. People who are willing to speak up and identify the problem is the only way, Rivkin says, that we can put pressure on those who have the power to correct the problems, to act. “Looking at what happened in China and Italy, he adds, as a country, America had ample time to ramp up testing, resource management, and preparedness. We failed our frontline healthcare workers by not protecting them from the very beginning with proper medical supplies and personal protective equipment needed for them to be successful and do a good job.”

He doesn’t believe that people will suddenly lose their interest in the aesthetics marketplace just because of COVID-19. However, if consumers continue to feel the economic pinch, Rivkin has a strong personal theory that current and potential plastic surgery patients may start to elect for non-surgical treatment options even more, because it’s less expensive. Always, with an ear to the ground, he continues to search for new ways to stay involved and assist in the medical community crisis at-large and keep business afloat during his down time. He supports the nationwide outpouring of doctors and other individuals who continue to volunteer their time, clinical space, supplies and equipment where possible.

COMMUNICATION IS KEY

In the meantime, as he has been busy applying for Small Business Administration (SBA) loans, and additional lines of credit, he implores others to do the same. “Get in touch with everybody that bills you to request a hiatus from your payments. We are renegotiating our IT contract and every expense – line by line.” When it comes to payroll, Rivkin recommends that doctors hold on to key management staff and employees who are able to help with patient outreach and social media, at the very least.

During the COVID-19 outbreak, Alexander Rivkin, MD, has hosted several events @westside_aesthetics on Instagram Live to stay connected with practitioners and patients.

Two of his full-time employees, who were working remotely one day a week before this all started, are still dedicated to social media, public relations, and other patient inquiry duties. Social media, especially Instagram, is a big component of the marketing strategies at the practice, used to post messages out about treatments, practice news, and attract potential patients. Lately, he’s been hosting events on Instagram Live with colleagues in the business to discuss hot topics of interest with practitioners and his patients. He’s also exploring HIPAA Compliant video technology. Because, he says, “Keeping the lines of communication open will give your patients a sense that you still care about them and that you’re somebody who is really committed to their well-being.”

TELEMEDICINE AND PLASTIC SURGERY

Andrew Rosenthal, medical director of plastic surgery at Modernizing Medicine, says this situation is unprecedented, but plastic surgeons needing to connect with patients remotely are not. The healthcare, software company launched its audio and video telemedicine solution to reduce the risk of COVID-19 transmission and provide care to vulnerable patient populations; and serve current and future clients and the healthcare community.

Andrew Rosenthal, medical director of plastic surgery at Modernizing Medicine

“Our specialty has used static pictures and even video chat tools to see consults and check on patients for quite some time,” Rosenthal notes. “It is just a matter of adapting these techniques in a modernized fashion to maintain some semblance of normal patient care during this crisis. Modernizing Medicine’s telehealth-enabled EHR can help plastic surgery practices do just that.”

During this unusual period of social distancing, the company is offering its modmed Telehealth solutions at no additional charge to current and future clients. An educational webinar series on telemedicine for the healthcare community is also available.

Approximately 30% of Rahban’s patients live either out of state or out of the country, so virtual consultation was being utilized at his practice prior to corona. “But a lot of it, he says, also depends on what you’re trying to accomplish through the digital consultation. “Although I cannot exam inside of your nose through a virtual consult, I can determine your candidacy to become a patient to a certain degree. And more importantly, we can start a dialogue about what the procedure entails, and what the recovery period is like.” A patient can get to know a doctor and a doctor can get to know the patient; he describes. In that regard, Rahban says virtual consultation is incredibly successful. “Additionally, and even prior to the coronavirus, as we become busier and people are willing to travel longer distances to get their procedures done, telemedicine has become a more and more useful tool – especially for the new generation of patients in their 20s and 30s, who don’t consider this to be a new concept.”

Another innovative software company that provides remote access, collaboration, and remote solutions, for healthcare practitioners and related organizations, is Splashtop Inc. By implementing its product services on a laptop computer or any mobile device:

  • Patients can view and update their standard patient and insurance information on an iPad; integrate into the EHR system. Avoid paperwork and human error.
  • Teaching hospitals enable medical students to view real time surgical procedures remotely on their iPads to enhance learning.
  • Teaching hospitals simulate surgeries with 3-D graphics and enable students to “perform a procedure” virtually.
  • Biotech companies enable lab techs to securely access their research – using related apps and data from iPads while working in different labs.

The software benefits will:

  • Protect sensitive data with encryption and policy control which helps support HIPAA compliance.
  • Enable IT to maintain complete control of who is using which devices and to access what computers and data, when.
  • Allow Management Console to enable immediate response – if a device is lost or stolen, IT can disable it instantly.
  • Allow the client to securely view desktops and share files, database and medical applications to speed processes along even while working remotely.

Rosenthal told Plastic Surgery Practice that at the end of the day, telemedicine tools are helping plastic surgery practices communicate with their patients and maintain some business. He adds, “Not only is this crucial for a practice’s current and long term health and advancement, but it’s important for patients to be able to receive care in a safe and reliable manner.”

Tonya Johnson is associate editor of Plastic Surgery Practice