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Ancillary Services: Weighing What's Right for Your Medical Practice


Florida physician's "feeding tube diet" is courting controversy, but he says it is like any other ancillary service to capture additional revenue.

You may not know Oliver Di Pietro, a primary-care physician who offers everything from basic exams to bone-density tests in his Bay Harbor Islands, Fla.-based practice. But chances are you’ve heard about the controversial “feeding tube diet” embarked upon by bride-to-be patients, which was featured in the New York Timeslast month.

The article, in which Di Pietro explained the mechanics of the 10-day, enteral-nutrition weight-loss program, a variation of the ketogenic enteral nutrition (KEN) diet in Europe, spread quickly in cyberspace, drawing shock and awe from many readers across the globe (it’s important to note that although Di Pietro is now associated with the diet and has a patent on the name K-E Diet, he didn’t invent it).

But while the diet is sparking fiery debates in the medical and consumer worlds, its popularity also touches on a different issue that’s near and dear to small-practice docs: whether physicians, in a world of declining reimbursement cuts and higher costs, should offer new medical services to patients to generate additional revenue.

“Reimbursement needs to increase for primary-care and family medicine providers,” Di Pietro told Physicians Practice in an e-mail message. “This is why these doctors need to provide high-quality ancillary services within their practices to capture this additional revenue which too often is referred out to other facilities.”

On its website, the practice markets itself as offering “one-stop shopping” to patients, meaning, says Di Pietro, that a patient can come to his office and get nearly everything he needs in one location without having to go into a medical center or hospital, including X-Rays, ultrasounds, blood tests, injections, suturing and splinting, and Pap smears. These and other services are offered to a wide variety of patients, from those with third-party insurance to “Concierge VIP” patients who are willing to pay premium rates.

But it’s the $1,500 feeding tube diet, in which a small nasogastric tube is inserted into the patient for 10 days and nutrients are delivered based on individual patient needs, that is gaining the an increasing amount of interest, according to Di Pietro. He adds that while the practice's primary-care services remain busy, "the interest in the K-E Diet has been impressive." So impressive, in fact, that the practice has seen 10 to 15 new K-E patients per week since the article was published.

And considering the rising rate of adult obesity and Type 2 diabetes, he sees this as a good thing.

“I encourage all primary-care doctors to begin offering novel and evidence-based treatments to their patients such as medically supervised weight loss, which will help greatly in fighting the obesity epidemic,” says Di Pietro. “What better person than a patient’s physician, who knows the patient well both medically and psychologically, can determine the best and safest method of weight loss for that patient?”

Though Di Pietro brings up several good points, he also raises another question: What are the ethical issues, if any, involved in offering something like the feeding-tube diet?

Di Pietro notes that many primary-care physicians offer lucrative aesthetic and anti-aging services to their patients, which are also big revenue generators. And he does have a point: Plastic surgery is such a mainstay in today’s culture that it’s rare a physician would come under fire online and generate multiple news stories for offering would-be brides nose jobs or liposuctions.

Do you agree with Di Pietro’s approach to ancillary services? Are these services you would or would not provide your patients? Weigh in below.

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