title: Logistics of building a laser practice for the treatment of hypertrophic burn scars.
abstract: BACKGROUND
  Although lasers can improve burn scars, such treatment has not been adopted universally, due to operational challenges starting a practice and the perception that such a program is not financially viable. We report the logistics of building a laser practice for the treatment of hypertrophic burn scars.
  
  
  METHODS
  We analyzed the clinical, operational, and financial components of our laser practice, focusing on treatment of hypertrophic burn scars, using pulsed dye laser, fractional CO2 laser, and intense pulsed light. Cases were performed in an operating room, with anesthesia, after preauthorization. We examined professional charges and collections, case time, variable and indirect expenses, and breakeven volumes.
  
  
  RESULTS
  Our practice grew as follows: 2008, 1 case; 2009, 44 cases; 2010, 169 cases; and 2011, 415 cases. Overall collection rate was 32.1%. Expenses incurred by the provider, per 8-hour session, included laser rental/lease ($2375), personnel salaries ($1900), and physician overhead ($808), for a total cost of $5083. Mean charge was $1642 per case; mean collection was $527 per case. Median case time (procedure plus turnover) was 40 minutes. In this model, breakeven volume is 9.7 cases per day; breakeven time is 49.7 minutes. Provider profit margin for 10 cases per day, or 83% capacity utilization, is $187 per day (income - expenses = $5270 - $5083).
  
  
  CONCLUSIONS
  Despite high costs associated with starting and operating a laser practice for the treatment of hypertrophic burn scars, a sustainable enterprise can be achieved when the provider has accrued enough volume to batch cases over an entire day. Critical to achieving breakeven is preauthorization, controlling overhead, and efficient throughput.
authors.affiliation: Division of Plastic Surgery, University of North Carolina Health Care System, Chapel Hill, NC 27516-7195, USA. cshult@med.unc.edu
authors.forename: Charles Scott
authors.initials: CS
authors.lastname: Hultman
authors.forename: Renee E
authors.initials: RE
authors.lastname: Edkins
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Meyer
mesh_terms: D002056:Burns / Q000150:complications* / Q000191:economics; D017439:Cicatrix, Hypertrophic / Q000191:economics / Q000209:etiology / Q000601:surgery*; D005251:Fees, Medical / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D053685:Laser Therapy / Q000009:adverse effects / Q000191:economics* / Q000379:methods / Q000706:statistics & numerical data; D054025:Lasers, Dye / Q000627:therapeutic use; D054020:Lasers, Gas / Q000627:therapeutic use; D054023:Lasers, Semiconductor / Q000627:therapeutic use; D053844:Lasers, Solid-State / Q000627:therapeutic use; D009657:North Carolina; D061646:Operative Time; D018579:Patient Selection; D011216:Practice Management, Medical / Q000191:economics* / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D012189:Retrospective Studies