My plastic surgery patients pay me for their complete care during their surgery.

• the initial consultations
• the surgery
• after care
• complications

The cosmetic surgery fee does not cover

• implant fees
• hospital and anesthesia fees
• fees for new surgeries
• material fees for touch-ups performed in the office

Complications or unknown side effects do occur in plastic surgery, as in all other surgeries. I think it is important for the patient to have the peace of mind to know that future eventualities are taken care of financially as much as is possible. The stress of financial insecurity is one that no patient should have to bear and can negatively affect the medical outcome.

Using this paradigm, the incentive is for me as the surgeon to try my hardest to prevent any complications or untoward effects, as it will mean more work for me with no further reimbursement. On the other hand, I will not be losing money on materials that may be used in continued care.

Complications or patients needing extra visits are a normal part of surgery, and within this model the physician should be compensated enough for each “patient problem” that there continues to be an incentive for quality care rather than dismissing the patients out of hand with a callous “I’m not getting paid for it anyway.”

The idea is that the physician has been paid for a certain quantity of care and now has to deliver that contracted service.

Maybe there should even be an economic penalty for repeated “cases requiring extra care,” since the physician may be straying outside of normal care standards if there are continual such changes. By necessity, the risk factors of patients must be tabulated, since some physicians routinely take care of sicker patients than others. They should, of course, not be penalized for doing so. A well-documented problems list should classify patients correctly into different risk groups.