Groupon for Botox by a Licensed PA, Asking for Trouble? Bad Idea?

Hi Marky.  The issue of Groupon and medical services is a sticky one.  According to many state's healthcare laws, including California, an organization or individual cannot be paid for referring a patient to another medical practice.  The laws were set up to avoid conflict of interest and kickbacks among physicians and healthcare organizations.  With that said, there has been no official ruling on this from our state and many others regarding the legality of what Groupon is doing.

With that said, in the business of elective healthcare, there is a cost associated with acquiring new patients - mostly in the form of advertising dollars.  What Groupon does is relieve the burden of finding a new patient for the practice and instead shares revenue from this initial treatment.  So, Groupon assumes the risk and cost of finding new patients and as compensation, the practice shares revenue on the first procedure or series of procedures.

You are correct in thinking that it is virtually impossible for the practice to make a profit on the initial set of services purchased from Groupon.  But if the practice manages to find good long term patients that are willing to pay normal prices for their services, it may indeed work out in the long run for the practice.  At the same time, the consumer gets a low "cost of entry" to test out a new practice or service that they have been considering and otherwise might not have tried if not for the reduced price.

We understand the concept behind Groupon, but question whether it is legal and also whether or not there are enough long term patients to be found to make the business model worthwhile.

My understanding is that Plastic Surgeons cannot use Groupon for Botox.  There are legitimate rebates out there.  Currently, there is a rebate that you get from the manufacturer of Botox.  Allergan is the name of the company.   They will have you sign up for the "Brillliant Distinctions" program.  This program gives loyalty points and rebates.  Beware of other coupons, and dirt cheap Botox.  Seek out an established, experienced injector.

If you pay for a certain number of units, then you are due those units and despite how they dilute the Botox, it is not volume you are paying for, it is the units, so they would have to be given.  The price quoted would not cover the administrative overhead costs of the practice sufficiently. They would be losing money. But as a marketing tool, it would help get you in the door, to learn of the practice and practioners and hopefully have you become a long-term patient returning for other procedures. My concern with Groupon, is that you are buying a procedure for which you have not yet been told by that physician you are a candidate. That decision should be made first and then you should be given the opportunity to get a discount. Physicians should not be forced into a position of telling a patient that they shouldn't have a treatment that they have paid for in advance as the patient will not be as willing to listen to the sage advice.  Furthermore, although this may be construed as an administrative cost to Groupon, it sounds more akin to fee splitting which is not legal in New York and other states.

Just yesterday I saw two patients in my practice.

One had had Botox injections from a non-physician in a non-medical setting and her upper lip had drooped for three months on one side.  She had no idea who the "sponsoring physician" was.

She elected to go back to the same practitioner after she learned that my fee for administering Botox was $75 more than the nurse's.

Another patient, whom I saw the same day, had a filler injected by a nurse practicing on her own in a non-medical setting.  The patient was unaware of who the "sponsoring doctor" was.  The substance swelled over the ensuing years and eventually required surgical removal.  Pathology showed silicone.  The nurse swore up and down she had not injected silicone.  The cost of the injections was $100 less than they would have been in my office.  The patient will face a lifetime of corrective surgeries.

Cost of a partial facial paralysis for three months?  $75

Cost of permanently deformed lips:  $100

Value of the adage:  A fool and her looks are soon parted:  Priceless.

To Groupon or not to Groupon is a very good question. Fee splitting is what this is called and against the California state law  and as far as I know this is no different. You get what you pay for and only the doctor knows how he diluted the Botox!

We plastic surgeons consider awarding cosmetic procedure through things such as Groupon as

unethical, so a plastic surgeon will not do that.  Because a PA is licensed doesn't mean they

know what they are doing necessarily.  Nurses and PA's can be trained to inject Botox, but it should

be done under the guidance of an MD.  Please check out the PA before you let them do anything.

Going cheap can sometimes bite you.

I think Goupon and good medicine do not mix.  I think offering Groupon Botox or anything else that requires time and expertise is foolish and unprofessional on the doctor's part.  I would never go to a doctor who offered Groupon deals.  It's fee splitting and sleazy. 

Frankly, I think based on your post you seem to already know the answer to this question! If you read other posts on the this site you will also come to the realization that the purpose of Groupon (especially Botox offers) is to get you in the door and insist that you buy additional units, usually at an inflated rate, to compensate for the offer they made through Groupon. I agree with every physician who posted on this already, but remember that Botox is a neurotoxin and there can be issues if you get it done by inexperienced injectors. So really, you are best to ignore this offer and buy something that doesn't beg you to ask so many questions!

While it seems there will be no profit from your treatment, they hope you will return in the future for regular, full-priced treatments when you fall in love with Botox (as so many have before you) and the effects wear off. Or better still, they hope that once you're in the office you will see many other cosmetic services they offer and sign up for additional treatments. An aggressive Botox rep can also get free Botox for the office to use for the promotion. Don't let price alone guide your choice as you should have a qualified physician do your injections. Injecting botulinum neuromodulators such as Botox, Dysport and Xeomin is an art that should be customized to each individual patient. It is a mistaken belief that cosmetic procedures such as these are a pure commodity rather than a service. It is as much an art as it is a science. And there is no substitute for experience.

  Forget the whole idea of coupons for medical services and that a PA and not MD is providing the Botox Injections....for that cost, they are loosing money on the cost of a 100 unit bottle of Botox that's around $500 a bottle.  IMHO, never use cost of a treatment or surgery as the determing factor of what you choose and who you have perform it....but rather be certain that they understand and follow the proper aesthetics of facial beauty for the creation of a naturally, more attractive face.  

  You, as a potential consumer, should always remember that there's no inherent magic in Botox, Dysport , fillers or a surgical procedure.  The magic must come from the aesthetic understanding and inspiration of the MD or surgeon providing the service.  IMO, because this fact is often over-looked, ever consumer must understand that it is indeed "Buyer Beware".