Risk Management

Message from the Chairman addresses coverage for cosmetic procedures and a spa setting

No area of ophthalmology is more controversial and difficult to underwrite than oculoplastic and oculofacial procedures. For this reason, OMIC has always had an oculoplastic specialist involved in making coverage decisions on what I will refer to here as “cosmetic” procedures. This includes past underwriting Committee chair, Michael J. Hawes, MD. Additionally, OMIC has maintained an ongoing educational cooperative venture with the American Society of Ophthalmic Plastic and Reconstructive Surgery since 1998. Thus, we feel very confident in our ability to assess the liability risks of ophthalmologists who perform cosmetic procedures and to establish the underwriting guidelines and requirements to minimize these risks. We believe it is because of these guidelines that we have a record of low frequency and severity of cosmetic surgery related claims.

Historically, these procedures were usually performed by oculoplastic specialists on established patients in a medical office or surgery center. With storefront medical spas now cropping up in malls and on street corners, patients can walk in and have laser hair removal, microdermabrasion, and other cosmetic procedures performed on the spot. Needless to say, this makes the underwriting process more challenging than when it simply involved individual ophthalmologists offering cosmetic procedures to their own patients in their own office or clinic.

Because cosmetic procedures are not generally included in ophthalmology residency programs, OMIC must verify that an applicant is qualified and has received the proper training to perform such procedures. Applicants are asked to provide information on the number of procedures they will perform annually, the areas of the body they will treat, the venue where they will provide these procedures, and their advertising of these procedures, if any. Applicants agree to abide by OMIC’s underwriting requirements and to inform us of any changes to their application responses. When OMIC is reasonably confident that the insured intends to offer these services in an ethical and professional manner with appropriate informed consent and preserve patient safety, coverage for cosmetic services will usually be approved.

The issue of where cosmetic procedures are rendered first arose in 2002 following FDA approval of cosmetic Botox. OMIC began to receive inquiries as to whether spas or even house parties were acceptable venues for injections. OMIC has been very clear that medical treatments such as Botox need to be provided in settings that have proper medical equipment and personnel.

“Medi-spas” present a hybrid environment that is not quite a medical office or clinic, but is more than a simple spa giving massages and facials. To further complicate matters, ophthalmologists may have an ownership interest in the medi-spa and/or serve as its medical director. Coverage for the liability risks associated with medi-spas may only be extended after an OMIC insured has completed a 10-page questionnaire. Failure to honestly complete this underwriting process puts the insured at risk of not being covered should a claim arise.

As long as ophthalmologists continue to expand their scope of practice, OMIC will continue to cover what they do and will work with insureds to carefully integrate new procedures into their practice with patient safety as the top priority.

Richard L. Abbott, MD OMIC Chairman of the Board