Here’s what to keep in mind when purchasing or replacing software for your practice

Anyone who has shopped for roses knows that there in not always a direct relationship between a flow­er’s price and its quality. A florist in the tony part of town can easily charge twice as much as a more humble establishment for the same specimen. And the seller at the farmer’s market with dirt underneath his or her fingernails may offer the least expensive option for the most fragrant and best looking long-stem roses in town.

Imagine if there were 1,000 florists to choose from, and they all offered different hybrids and said theirs were the best. Mind numbing? Yes. Especially for someone who does not know what he or she is looking for.

Searching for software for a plastic  surgery practice is at least as complicated. According to Peter Legorburu, the president of Brickell Research in Miami, the number of companies that manufacture software for plastic surgery clinics fluctuates between 800 and more than 1,000. These companies’ backstories often goes something like this: A plastic surgeon writes a software program for use in his or her own practice, is happy with it, and decides to market it.

Some of these manufacturers are huge and have thousands of customers, and their software is used by tens of thousands of plastic surgeons. Medium-sized suppliers service hundreds of clients and a few thousand physicians. There are also small mom-and-pop companies who have only a few clients. These smaller operations are usually not around for very long, because they do not realize how much support they have to provide their clients to become successful, and they are unable or unwilling to provide it.

To get the inside skinny on how to make smart software choices for a plastic surgery office, Plastic Surgery Products spoke extensively with Legorburu, who frequently writes about software and lectures on issues that concern plastic surgeons and their practices. As the president of a software company, he says some surprising things. For instance, he believes that a new system is not always a better system.

“I’m not saying that people shouldn’t change when it’s necessary,” Legorburu says. “I’m just saying that they shouldn’t change unless it’s necessary.”

Legorburu believes that you should take a conservative business approach from a risk-mitigation standpoint. For instance, if you are planning to invest a lot of money on marketing campaigns, you should have a software program in place that can track the campaigns’ effectiveness. Spending money is a risk, and the conservative thing to do is to buy a system that will track it.

Before Taking the Plunge

This is a no-brainer: An office that does not have a practice-management system in place needs to get one. Filling out paperwork by hand or trying to do business without having a system is not going to work. Even using a general-accounting product is unlikely to address the needs of a plastic surgery practice, because this field of medicine is unique and decisions about software have a direct effect on the practice’s success. Running an inefficient practice is incredibly expensive and can lead to its demise, just like having an insecure server in place.

But don’t worry about these things right now. Instead, if you are planning to buy a new software system for your practice, you should answer these questions:

• Do you understand what is happening with cash flow?

• If the business is dependent on insurance, do you understand how well these claims are being handled?

• Are secondary claims going out on time?

• How long is the average dollar out there for a given carrier?

• How long are they taking to pay?

Even practices that rely on insurance reimbursements for only a small part of their income should know the details about how these claims are handled. If your practice does not deal with insurance, there is still one big question to ask yourself: “What do you want to improve, and why?” If you have answers for that, than you can move onto the next step and forget about computers.

You read correctly. Forget about the machines themselves. For folks who are seduced by the siren song of the latest bells and whistles, this is going to be tough.  “You cannot, in an office setting, afford to be enamored of technology,” Legorburu says. “It’s just a tool like a stapler or anything else. It’s not glamorous.”

Unlike high-end art in the waiting room or a sexy, flat-screen monitor for the reception area, software does not communicate anything about the practice itself. Rather, it has a much more important role: It directly addresses the needs of your practice. Once you have articulated your practice’s needs, you are ready to talk to sales representatives—just do not make a decision in haste.

“Most installations of practice-management systems probably don’t meet client expectations or what their a priori expectations are,” Legorburu says. “So, after a lot of installations, people will hold out a year, 2 years, 3 years, and they’re looking to replace systems again. If you talk to people in the industry, you’ll see that there are many practices that have replaced their systems three times.”

Costly on Multiple Fronts

Replacing a software system—as well as installing one from scratch—is costly on multiple fronts. Beyond the obvious reasons, such as having to purchase new software, there are other costs involved, like retraining staff. Even in ideal situations, there is always a dip in productivity when a new system is put into place, according to Legorburu. Experts call this “transitional inefficiency.”

A poor or uninformed choice can have negative ramifications that are difficult to quantify: If a system is underperforming its billing function, money is slipping through the cracks. How much is tough to quantify. (If the software system was sophisticated enough to measure that figure, it would probably run properly in the first place.)

The potential for underperformance highlights the importance of putting in the necessary amount of time and research before buying a system. The good news? If a good choice is made, the practice will reap the benefits for years to come.

The flipside of that coin can be compared to building a ski house without thinking about insulation: Not only will you lose energy and therefore money, but it will also be costly and irritating to fix the problem.

Legorburu hasn’t seen a number put on it, but he thinks that the combination of poor billing practices and missed opportunities for follow-up visits and procedures have cost plastic surgery practices hundreds of millions of dollars.

A Myriad of Choices

There are systems on the market to suit every surgeon’s budget—from simple and basic programs for thrifty, pennywise, or pound-foolish surgeons, to high-end programs that come complete with plenty of features and services. The cost can be as little as $500 for an entry-level system, and it can easily rise to between $15,000 and $40,000 for a high-end package serving practices with a large number of concurrent users.

Many vertical systems for a plastic surgery practice cost in the neighborhood of $5,000. Unlike those used at a typical physician’s office, these programs often focus on both medical and retail aspects of the practice. Some of them feature inventory management, the capability to handle a mixture of insurance clients and noninsurance clients, and bar-code scanning.

One caveat? Beware of systems that appear to be too simple.

“There are some companies that focus on creating products that sell really easily,” Legorburu says. “They’ll have a few, big, happy-looking buttons that look really simple and sell to novice users. Those products may not sell as well to experienced billers and experienced office personnel, but they have a niche.”

Systems that are simple are often easy to learn and integrate. Unfortunately, the programs’ limited abilities do not meet the practice’s needs for long. Therefore, surgeons are often back in the software-buyer’s market more quickly than they would like.

Price Options Are Abundant

When it comes to pricing, a lot of options are out there—from the prix fixe, all-inclusive price to a figure that includes a line item for each component, such as software-licensing fees, annual maintenance, and training. The software-licensing fee often amounts to about 20% of the system’s total cost. It can be determined by the amount of servers and concurrent users, by the price per surgeon and server, or simply per surgeon.

The price of maintenance includes software updates, software upgrades, and technical support related to any problem. Training is also a line item. The amount of training varies widely from company to company—some favor more, others less—but ranges generally between 1 and 3 days. Usually, the majority of the training will take place initially, and the rest will be spread out over the first month or two.

The cost for training is often different for different companies. For practices that do offer this line item, it is often possible to tailor the amount of instruction to your needs. Since effective training often translates into increased efficiency, it is something worth considering.

Some software companies offer discounts and will wheel and deal. These companies often price monolithically. Sure, they may give you 10% off the price, but it is difficult to ascertain how that price was determined. Other manufacturers are like the Saturn car company, which does not negotiate on pricing. There are also those that will offer their product free or heavily discounted to high-profile surgeons.

A good software company will offer references. Check up on them, and find out if customers are satisfied with their levels of service.

Security is Paramount

The need for security is paramount for plastic surgery practices, HIPAA regulations notwithstanding. You owe it to your patients and the success of your practice to keep your patients’ personal information private. Without this confidentiality, they may never return to your practice.

Broad classes of issues relate to security. Data security is one. What happens if a server is stolen or a natural disaster destroys your computer system? Or, what if one of your employees runs a report that lists all of your clients upon whom you have performed facial procedures during the last 6 months?

Some programs limit who can run reports and also keep a record of those who have run reports in the past. This can be an important safeguard in a competitive field like plastic surgery. Servers can and have been stolen and destroyed, so having an off-site backup is also important.

The enemy often comes from the outside in the form of “malware,” which is defined by Microsoft as “short for malicious software and is typically used as a catch-all term to refer to any software designed to cause damage to a single computer, server, or computer network, whether it’s a virus, spyware, et al.”1

Some protection can be a modest investment. A well-configured firewall can go far to protect your system. In addition to this, there are some inexpensive, even free, ways to protect your data. One is particularly easy and does not require regular applications: Run a browser other than Internet Explorer®. Firefox® and similar programs have fewer malware issues.

There are also many programs that scan for viruses. Programs like Spybot™ Search and Destroy are free. But, and this is a big “but,” it is paramount that you get the correct software. Some shysters in the online world package their malware as malware protection. Customers end up unwittingly and unintentionally downloading programs that they were hoping to protect themselves from directly onto their systems.

Nightmare Scenario

What is the worst-case scenario if you do not take steps to protect your data? Your computer will be commandeered by these programs. Legorburu visited a practice in which an employee had downloaded what he or she thought was malware-protection software—but it was the opposite. Instead of protecting the data, the malware had installed a program to hide all the computer files from the operating system. Even Norton AntiVirus® programs could not find the files.

To make matters worse, once the spyware was injected, it became a conduit for injecting other spyware. By the time all of this was discovered, 45 pieces of malware were installed on the system.

There are also programs to stop pop-ups and adware. Scared yet? All of this information can make you a little paranoid. That is healthy, and it can be remedied by educating yourself, figuring out what software you need, and finding a software company you can trust to provide you with the best system for your practice.

Like a good florist, a good software company will be able to tell you what is necessary for your practice and what is superfluous. Then, it can point you toward the best roses, as well as tell you when only a carnation is necessary. PSP

Stephen Krcmar is a contributing writer for Plastic Surgery Products.


1. Microsoft’s malware definition. Available at: Accessed March 9, 2006.