Concierge Medical Practice

Frustrated with the direction your medical practice is headed? Are tired of seeing more patients, making less money and working evenings or weekends just to keep up? If so, a concierge or “direct pay practice” conversion may be the answer been looking for. Concierge medical practices have increased tenfold over the past four years. Understandably so, since physicians and specialists who have converted to a direct pay or concierge practice report that they feel a stronger sense of control over their lives, income and how they deliver patient care. The Concierge Department works with physicians to find qualified patients. Our sponsors underwrite part of the searches.

Eyelid Complication

Eyelid complications related to patient dissatisfaction may be preventable before or correctable after surgery. To avoid aesthetic eyelid complications, it is important for a patient to understand the procedure and what kind of results to expect. Patients may complain of being unable to close their eyes completely. If the surgeon removes too much skin during the initial surgery, the surgeon may harvest tissue from the mouth to elevate the tissue on the inside of the eyelid. Alternatively, the doctor may decide to use skin from behind the ear, which closely resembles eyelid skin. Some patients end up unhappy with the results of eye surgery and require corrective cosmetic procedures as well as functional surgery. Revision surgery can be complex in nature. Tissue around the eyes and lids is extremely sensitive and surgery can cause several issues. On many occasions, eye surgery alters the shape of the eye: the rounded shape of the eye corners appears instead of the natural shape. In many cases, the natural shape of the eyes is also not symmetrical. Misshapen eyelids can cause irritation when blinking and often patients complain of dry eyes. Eyelid complications are the potential risks associated with eyelid surgery. The risk of eyelid complications is relatively rare, though when they do occur they can be quite injurious. There are a number of different types of blepharoplasty complications. Patients may be dissatisfied with the results because of unrealistic expectations, poor surgical choices by an inept surgeon who performed an under correction, or resulted in asymmetry. There are also significant medical complications associated with eyelid surgery. Eyelid complications may be associated with the actual surgery or be problems that develop during the recovery period.

FDA Medical Device Registration

Owners or operators of places of business that are involved in the production and distribution of medical devices intended for use in the United States must register annually with the FDA, which is a process known as establishment registration. Congress has authorized FDA to collect an annual establishment registration fee for device establishment registrations. A detailed list of all those establishment types that have to pay the registration fee is available at "Who Must Register, List and Pay the Fee." There are no reductions in annual establishment registration fees for small businesses or any other group. Most establishments that are required to register with the FDA are also required to list the devices made there and the functions of those devices. If a device requires pre-market approval or notification before marketed in the U.S., then the owner/operator should also submit the FDA pre-market submission number. The amendments to the Medical Device User Fee Modernization Act require that after September 30, 2007, all businesses submit registration and listing information electronically. Registration and listing provides the FDA with the location of medical device establishments and the devices manufactured at those establishments. This information augments the ability of the United States to prepare for and respond to public health emergencies.

Adjustable Gastric Band

A laparoscopic adjustable gastric band, commonly referred to as a lap band, is an inflatable silicone device that a surgeon places around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity. Adjustable gastric band surgery is an example of bariatric surgery designed for obese patients with a body mass index (BMI) of 40 or greater, or between 35 to 40 in cases of patients with certain co-morbidities that are known to improve with weight loss, such as sleep apnea, diabetes, osteoarthritis, high blood pressure or metabolic syndrome, among others. Gastric banding is the least invasive surgery of all bariatric surgeries. Gastric banding using laparoscopic surgery usually results in a shorter hospital stay, faster recovery, smaller scars, and less pain than open surgical procedures. The patient can continue to absorb nutrients from food normally. Gastric bands are made entirely of biocompatible materials, so they can stay in the body without causing harm. However, not all patients are eligible for laparoscopy. Patients who are extremely obese, who have had previous abdominal surgery or have complicating medical problems may require a more open surgery approach. The surgeon creates a small incision near the belly button and pumps carbon dioxide into the abdomen to create a workspace. Then the surgeon inserts a small laparoscopic camera through the incision into the abdomen. The camera sends a picture of the stomach and abdominal cavity to a video monitor. It gives the surgeon a good view of the key structures in the abdominal cavity. The surgeon makes more small incisions in the abdomen. The surgeon watches the video monitor and works through these small incisions using instruments with long handles to complete the procedure. The surgeon creates a small, circular tunnel behind the stomach, inserts the gastric band through the tunnel and locks the band around the stomach. Clinical studies of laparoscopic bariatric surgery patients found that they felt better, spent more time doing recreational and physical activities, benefited from enhanced productivity and economic opportunities and had more self-confidence than they did before surgery. The placement of the band creates a small pouch, or stoma, at the top of the stomach. This pouch holds approximately one half cup of food. A typical stomach holds about six cups of food. The pouch fills with food quickly, and the band slows the passage of food from the pouch to the lower part of the stomach, causing the sensation of being full. As the upper part of the stomach registers as full, the message to the brain is that the entire stomach is full, and this sensation helps a person to be hungry less often, feel full more quickly and for a longer period, eat smaller portions, and lose weight over time. As patients lose weight, their bands will need adjustments, or "fills," to ensure comfort and effectiveness. The surgeon can adjust the gastric band by introducing a saline solution into a small access port just under the skin. There are many port designs and a surgeon may place them in varying positions, but they always connect to the muscle wall in and around the diaphragm via sutures or staples.