Valuing Your Time, Optimizing Prior Authorization, Acne Treatment, and More

Tip 1: Value to Your Time

You may have a few patients like I do who come in consistently for 4 or 6 or some other low number of Botox units. I have some of these patients paying $50 to $100, but this is a poor use of my time because I do all my own injections. In many cases, I had hoped that they would do fillers or other cosmetic treatments, but all they do is come for this small amount of Botox. 

I have introduced a minimum $200 fee for any Botox that I do, so even 4 units would cost $200; some of these patients may depart, others may add more units to get their $200 worth. In either case, my time will be more fairly valued.

Benjamin Barankin, MD, FRCPC

Toronto, Ontario, Canada 

Tip 2: Reducing Pain

I preload numerous BD-II 0.3 mL 31-gauge syringes by backfilling them with buffered lidocaine with epinephrine, then keep a supply in each exam and procedure room. They hurt considerably less than the 30-gauge needle, and can be perfect for little skin tags, moles, and seborrheic keratosis.

Also, York Downs Pharmacy will compound buffered lidocaine 1% with epinephrine 1:200,000 in 100-mL vials, 10 vials [1L] for less than half the cost of purchasing standard 20-mL vials for $9 each from medical suppliers. For those of us who use a lot of lidocaine, this can be a significant saving.

 Kevin C. Smith, MD, FRCPC 

Niagara Falls, Ontario, Canada 

Tip 3: Managing Delusions of Parasitosis

When treating delusions of parasitosis, speak ambiguously about treating parasitosis. For example, “The insecticides used to treat almost all bugs attack the bug’s nervous system. So, we will use a medication to attack the nervous system of whatever bugs are there. The one we will use will be safe for use in humans; it is used for psychosis in some people, but for you, we will use it off-label to get rid of the bugs.”

Steve Feldman, MD, PhD 

Winston-Salem, NC

Tip 4: Spironolactone for Acne

I often prescribe spironolactone 50 mg twice daily for women with acne; I rarely use antibiotics. I think spironolactone is safer for long-term use and does not require monitoring labs. I will use it even girls, but start with a lower dose.

Barry Ginsburg, MD 

Birmingham, AL

Tip 5: Optimizing Prior Authorizations

I have about 4 staff members who work on prior authorizations. There is one central folder they pass around so we have someone working on them all the time. Additionally, we have a “deep bench” just in case 1 or 2 staff are out sick.

Jane T. Chew, MD 

Columbia, MD 

Dr. Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature. 

Tip 1: Value to Your Time

You may have a few patients like I do who come in consistently for 4 or 6 or some other low number of Botox units. I have some of these patients paying $50 to $100, but this is a poor use of my time because I do all my own injections. In many cases, I had hoped that they would do fillers or other cosmetic treatments, but all they do is come for this small amount of Botox. 

I have introduced a minimum $200 fee for any Botox that I do, so even 4 units would cost $200; some of these patients may depart, others may add more units to get their $200 worth. In either case, my time will be more fairly valued.

Benjamin Barankin, MD, FRCPC

Toronto, Ontario, Canada 

Tip 2: Reducing Pain

I preload numerous BD-II 0.3 mL 31-gauge syringes by backfilling them with buffered lidocaine with epinephrine, then keep a supply in each exam and procedure room. They hurt considerably less than the 30-gauge needle, and can be perfect for little skin tags, moles, and seborrheic keratosis.

Also, York Downs Pharmacy will compound buffered lidocaine 1% with epinephrine 1:200,000 in 100-mL vials, 10 vials [1L] for less than half the cost of purchasing standard 20-mL vials for $9 each from medical suppliers. For those of us who use a lot of lidocaine, this can be a significant saving.

 Kevin C. Smith, MD, FRCPC 

Niagara Falls, Ontario, Canada 

Tip 3: Managing Delusions of Parasitosis

When treating delusions of parasitosis, speak ambiguously about treating parasitosis. For example, “The insecticides used to treat almost all bugs attack the bug’s nervous system. So, we will use a medication to attack the nervous system of whatever bugs are there. The one we will use will be safe for use in humans; it is used for psychosis in some people, but for you, we will use it off-label to get rid of the bugs.”

Steve Feldman, MD, PhD 

Winston-Salem, NC

Tip 4: Spironolactone for Acne

I often prescribe spironolactone 50 mg twice daily for women with acne; I rarely use antibiotics. I think spironolactone is safer for long-term use and does not require monitoring labs. I will use it even girls, but start with a lower dose.

Barry Ginsburg, MD 

Birmingham, AL

Tip 5: Optimizing Prior Authorizations

I have about 4 staff members who work on prior authorizations. There is one central folder they pass around so we have someone working on them all the time. Additionally, we have a “deep bench” just in case 1 or 2 staff are out sick.

Jane T. Chew, MD 

Columbia, MD 

Dr. Barankin is a dermatologist in Toronto, Ontario, Canada. He is author-editor of 7 books in dermatology and is widely published in the dermatology and humanities literature.