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When Do You Need a Medical Spa Business Attorney?

Posted By Administration, Friday, September 21, 2018

By Michael S. Byrd, Partner, ByrdAdatto

Compliance is cool, but do you have a compliance plan? Are you aware of any state laws that could affect your med spa ownership structure? A common problem among clients is the struggle with this common question: When do you need to hire a business attorney? Consistent with the adage “an ounce of prevention,” our most successful business clients follow the 5/50 rule.

The 5/50 rule is actually a choice we present to our clients when this very question is posed. The choice is whether the client would like to pay $5 now to proactively structure their business, set up compliance protocols, or address legal issues in their business. The alternative choice is to do nothing now and pay $50 to clean up the mess later. Though admittedly we should adjust the rule to realistic dollar comparisons, the 5/50 ratio is realistic. In making the choice more personal by drawing an analogy to one’s personal health, we ask our clients whether they would rather stick to an annual wellness treatment plan and pay the associated costs or go to the doctor and react to a stage 4 cancer diagnosis.

Our clients often then ask how to know whether they are properly using legal counsel to guide their business. A great litmus test is to look at budget and spending for legal counsel for the business. If a business has budgeted or spent under $12,000 in an uneventful year for legal fees, the business is not utilizing legal counsel proactively. Most on-going businesses spend between $18,000-$30,000 per year when using counsel to advise and proactively address the legal needs of the business. Smaller businesses or single-owner physician practices may spend less, but still be in the $12,000 range on the low end.

The first step to change how and when legal counsel is used is to shift thinking in budgeting and shift thinking on utilization. Good attorneys think strategically and creatively and can be a great confidante for new business ideas or issues.  Start calling your business attorney as a sounding board to work through these ideas and issues.  It does not have to be lonely at the top.

ByrdAdatto has created a platform to ease this transition. Specifically, our Access+ monthly retainer program creates a set monthly fee for a defined scope of work suitable for the typical needs of a business. The key to this program is unlimited access by phone and email to the attorneys at ByrdAdatto. The hope is that this will incentivize proactive communication with us to help keep the business on the 5 side of the 5/50 rule.

For more ways to build and run your medical spa practice legally and profitably attend an AmSpa Medical Spa & Aesthetic Boot Camp and be the next med spa success story.

Michael S. Byrd , JD, is a partner with the law firm of ByrdAdatto. With his background as both a litigator and transactional attorney, Michael brings a comprehensive perspective to business and health care issues. He has been named to Texas Rising Stars and Texas Super Lawyers, published by Thompson Reuters, for multiple years (2009-2016) and recognized as a Best Lawyer in Dallas by D Magazine (2013, 2016).

 

Tags:  AmSpa's Med Spa & Aesthetic Boot Camps  ByrdAdatto  Med Spa Law 

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Physician Liability in Med Spas

Posted By Administration, Thursday, September 20, 2018

By Renee Elise Coover, JD, ByrdAdatto

Physicians in the medical spa industry are lured by the lucrative income and flexible nature of med spa ownership but as the popularity of this business model increases, so does the risk for liability. 

The number of med spas in this country is at a record high. Dermatologists, plastic and cosmetic surgeons are opening med spas or adding med spa services to existing practices as the demand for non-invasive cosmetic procedures rapidly grows. Additionally, non-core physicians, mid-level practitioners, and entrepreneurs are beginning to outpace core doctors in the medical spa space, according to the 2017 Medical Spa State of the Industry Report

Though med spas offer non-invasive and fairly simple medical treatments like Botox and laser hair removal, these procedures carry the same risk of litigation as any other medical procedure. Due to the aesthetic nature of the treatments and spa-like setting where most treatments are performed, there is a public perception that med spa procedures are risk-free. This misconception has contributed, in part, to the recent rise in litigation, putting med spas in the spotlight for all the wrong reasons. 

Physicians now must be especially cautious when signing on as a “medical director” of a med spa, offering med spa-like treatments or opening a med spa of their own. As the saying goes, ignorance is not an excuse; but for many physicians, ignorance of the law can also cost them their license.

There are several common patient allegations that put physicians at risk of losing their medical license. Lawsuits are often filed by patients due to allegations of lack of supervision of medical treatments, inadequately trained med spa personnel, less than optimal results, and lack of informed patient consent. 

For more information about medical malpractice lawsuits listen to the recent episode of AmSpa’s Medical Spa Insider podcast with patient advocate law firm Sukhman|Yagoda.

 

Perhaps the most problematic issue that most patients are not even aware of is improper ownership of the med spa. In many states med spas must be physician-owned in accordance with that state’s medical practice rules, but many physicians either do not know the laws or they are trying to get around them. If a physician signs on as a “medical director” of a medical spa but has no ownership and no supervision of the medical procedures, the med spa will be charged with the unauthorized practice of medicine in several states and the physician could lose his or her license.

Non-physicians interested in participating in medical spa ownership should click here to learn about MSO ownership structures.

In Illinois, the Department of Professional Regulation has put med spas on their radar and in the past few years, hundreds of physicians have been fined, suspended or lost their licenses due to allegations of improper ownership or lack of supervision in the med spa setting. 

Physicians must be very cautious when opening a med spa or offering med spa services as part of an existing practice.  To reduce the risk of liability, physicians should educate themselves and their staff regarding written protocols, relevant laws and regulations for their particular state, legal and regulatory issues associated with med spas, adequate supervision and proper delegation of medical procedures, and risk management

AmSpa members can view the legal summary of medical aesthetic regulations or schedule their complimentary annual 20-minute consultation call with an attorney from ByrdAdatto.

For more guidelines on how to open and run a legally compliant and sustainably profitable medical spa practice attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps

Tags:  AmSpa's Med Spa & Aesthetic Boot Camps  Med Spa Law  Med Spa Ownership 

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Effectively Marketing Your Med Spa Practice

Posted By Administration, Wednesday, September 19, 2018

By Bryan Durocher, Founder and President of Durocher Enterprises

Marketing and advertising techniques for medical spas are key to bringing new patients into your practice. Since med spas are medical practices there are specific compliance concerns regarding truth in advertising, social media marketing, and your website that you need to know. Once your legal bases are covered, though, there’s still the business of getting patients into your doors. Continue reading to learn the keys to creating your med spa marketing plan.

The Web 24/7 Shopping – Are You Waking Up with Money in Your Inbox Every Morning?

Your website IS your first impression! Is it easy to navigate and can your customer or prospect easily drill down to what they are most likely to be interested in? Almost all small businesses use their own website to motivate consumers. 

We use WooCommerce and their e-commerce platform for our clients when designing in WordPress. It is a plugin that allows you to sell anything, beautifully, and it is built to integrate seamlessly with WordPress.

A typical consumer will visit your site 5-7 times before making a point of contact. If they are looking to buy a product make it easy for them. 

Think like Amazon! Why did they develop the “One Click” option? They knew people were leaving millions of dollars in their shopping carts and not coming back. Whether it’s a move of the mouse or a call to action icon or incentive, have something in place to not to lose the sale. 

Make sure your site is Mobile responsive! Mobile searches now exceed the desktop. Consumers want all the functionality on their phone just like in their home or office. 

Social Media and Cashing In

Companies are on trend to spend over 20% of their advertising budget on social media in the next few years. It’s no mystery that social media is a popular way to promote offerings.

Facebook now has 1.6 billion users and a vast number only on mobile. 66% of all shares on “i” devices are delivered via Facebook. Users on this platform are more likely to have completed college or have advanced degrees than any other social media platform, according the Pew Research, and are more likely to have higher incomes.

Pinterest gets the dollars in. Pinterest allows businesses to create pages aimed at promoting their businesses online. Such pages can serve as a “virtual storefront”. In one case study of a fashion website, users visiting from Pinterest spent $180 compared with $85 spent from users coming from Facebook. These users spent less time on the company’s website, choosing instead to browse from the company’s pinboard. People may be more attracted to pins of products and images than of people.

Have a YouTube channel and have videos on your own site. Almost 50% of online consumers look for a video of a product before visiting a store, according to digital marketing platform Hubspot, and video drives a 157% increase in organic traffic from search engines.

Are you using Instagram to buy the items pictured with the tap of a finger? It is a terrific platform for building your brand. Mobile shopping takes a few clicks, but the only thing you have to do is “heart” the photo. 

Vogue is using a platform called LIKEtoKnow:IT, a RewardStyle offshoot for Instagram, that shows users where to purchase the outfit or item they “hearted” as soon as you sign up with the platform. In the past two years since launch, LikeToKnow:IT has generated more than $100 million in revenue, with 1.5 million users subscribed to the system and more than 1,000 LTKI posts created every day. Though RewardStyle has been operating under the radar, it has grown to generate more than $1 billion in sales for its 4,000 retailers and 575,000 brands worldwide since launching in 2011.

The Reviews are In!

You don’t have to be number one organically on the page to attract the most attention. Have five star reviews show up on your Google My Business page which in turn shows up next to your Google search listing and even though you may rank number 4 for a term you will be your prospective customer’s 1st choice!

It’s impossible to overstate the importance of collecting testimonials and reviews from your patients, with companies like Demandforce making it easy to get feedback from your customers to use as a marketing tool. Be mindful though as Google likes original content and you should have your own reviews on your site and not a link or duplicated reviews from somewhere else. 

Online directories and review sites are also popular, with potential patients using portals like RealSelf to gather information on treatments and providers before making their purchasing decisions.

Community Connection

83 percent of U.S. consumers prefer dealing with human beings over digital channels to solve customer services issues, according to new research from Accenture (NYSE: ACN). 

The report also found that 52% of consumers have switched provider in the past year due to poor customer service, with banks, retailers, and cable and satellite television providers being the worst offenders. This is striking because new patient acquisition can cost 3-5 times as much as current patient retention, and in the U.S., the estimated cost of customers switching due to poor service is $1.6 trillion. 

An increasing number of consumers are seeking premium products and services with a connection to a group/community to discuss the information, uses, and satisfaction around them. People want to feel a sense of community and be connected to your brand. Facebook is great platform for connection, and a forum or comments section on your website creates a place for your customers to ask questions, post reviews and be part of your community.

Forget the Competition

“You compete with Your Client’s Lifestyle Choices.” Many times it’s not the guy down the street you have to worry about. It’s about convincing your customer to choose your service to bring them personal happiness and satisfaction over a vacation or other lifestyle investment.

Selling Points Matter

What are your USPs? It’s your “Unique” approach or offerings of products and services. They can be simpler than you think. Do you have late hours for busy working professionals? Do you have ample and available parking so your clients don’t have to drive around for 30 minutes like a vulture eyeing for the elusive parking spot? Do you customize a unique experience just for them? Perhaps you are the only one to retail a certain product in your geographic zone. These are selling points and should be highlighted in all of your detailed marketing materials.

It’s all About the Bennies

People only buy for two reasons: You are offering a solution to their problem or you are providing the opportunity for good feelings. If it isn’t one of these they are not going to buy. 

What are your business’ features and benefits? Remember the features and sell by the benefits!

Loyalty rewards programs are used by some of the most successful businesses including GNC, American Airlines, and others. We do not have to reinvent the wheel when it comes to these programs. Offer clients acknowledgement and value added incentives for being your best clients and they are more likely to keep doing business with you.

VIP Programs not only create client loyalty they can be an excellent source of cash flow. Gift card companies can custom make VIP cards with your business name and logo which you then can retail to your clients.

Why Clients Consider Your Products or Services

Why are clients considering you? Is it Ageing, A Self Esteem Boost, A Special Occasion, Lifestyle Change, or Work Related? Key in to their need and plan a strategy with them to win. Include the timeline and steps it will take to get them to their finish line. This is also very helpful if they have their own deadline date. Be their coach!

Communication Fast or Slow? You Will Market Better by Understanding Who You Know

One size fits all communication doesn’t work! Some people buy into the latest products and services immediately others take their time to see the results from the early adopters. You need to know how to communicate effectively to your potential consumer to close the deal.

Have you ever talked with a friend, client, co-worker, or your boss and felt what you were saying was going right over their heads? You are not alone. Some of our biggest frustrations communicating with others is not being heard correctly or misinterpreting someone else’s message. This is the classic example of relating vs. relatedness, which means moving from simply observing someone’s communication to truly walking beside them and understanding their perspective.

Being an effective communicator takes more than just listening. We have to listen contextually and hear between the lines of our communication partner to understand where they are coming from. This can be a great challenge unless we know what to look for.

It’s about people, communication and the four natural styles. When we understand and recognize another person’s natural style of communicating, we can mirror their style and produce a more positive result, avoiding the barriers that breakdown communication, cause frustration, and take away from your personal and professional quality of life.

Consultation Closer

Tell the client what to expect. If there isn’t a magic wand handy give them the idea of the real results they can achieve. Provide before and after and or testimonials to show your prospective client all the happy people who have enjoyed the results of what you have provided.

Quote the investment and be confident about it! People with a lack of confidence or people who truly don’t believe in your products or services don’t close sales! If your staff member thinks it’s too expensive for example they are going to “mind your client’s wallets” and not make a recommendation in the first place. 

All team members need to believe in the quality and experience of your service and products and that they enhance your client’s lifestyle. Provide a lot of training and feedback with this aspect of your business. Spot check with secret shoppers and record calls with programs like CallHub, RingCentral, InContact. Follow up! It may take more than four follow ups via phone, mail, or e-mail before a client makes a buying decision.

Let’s review how you can take your business to the next level:

  1. Create or tweak your website so it works for the user
  2. Establish your presence on social media because that is where you customers are talking about you
  3. Get your reviews on your Google My Business page so they show up in search results
  4. Use social media and your website to create an interactive community for your present and future customers
  5. Position your services and products as a lifestyle investment
  6. Write a USP (unique selling proposition) that all your staff knows and when anyone asks why your services and products, the USP is the official answer
  7. When writing your USP, mention the features but put the focus on the benefits
  8. Identify your customers by their needs and cater to them
  9. Learn your communication style and how to communicate more effectively with clients and staff
  10. Train everyone to sell everything

For more information on systems and best-practices to build your medical spa profitably and legally, attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps.

Bryan Durocher is the author of Wakeup Live the Life You Love in Beauty, and is the founder of Essentials Spa Consulting and Durocher Enterprises. Durocher was named one of the “Top 20 People to Know in the Beauty Industry” by Global Cosmetic Industry magazine, and provides coaching, consulting, global industry trends, and marketing solutions for medical spa, spa and industry professionals internationally. He has published many articles and has provided business education internationally at a variety of national and international industry events including AmSpa’s Medical Spa & Aesthetic Boot Camps and The Medical Spa Show.

 

Tags:  Business and Financials  Med Spa Ownership 

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Tennessee Law Aims to Make Medical Spas Transparent

Posted By Administration, Tuesday, September 18, 2018

By Alex Thiersch, Founder and Director of the American Med Spa Association (AmSpa)

Tennessee medical spas are, for the most part, governed by laws that are very similar to the laws that regulate such practices in other states. (AmSpa members can check their medical aesthetic legal summary to find the laws governing their practice.) However, as part of a bill that was passed in 2015, Tennessee has taken the extremely unusual added step of defining “medical spa”. 

The Definition

According to the law, which can be read here, a medical spa is “any entity, however named or organized, which offers or performs ‘cosmetic medical services.’” The law also requires all medical spas, and medical spa medical directors, to register with the state’s health professional boards. Lawmakers hope that this regulation will help practitioners in the Volunteer State become more transparent.

Registration

For example, if you are the medical director or supervising physician of a medical spa in Tennessee, you are required to fill out a form to register with the state. Likewise, if you are running a medical facility that offers cosmetic medical services primarily, you must register with the state of Tennessee.

Other requirements in the law lay out what must be disclosed in this registration, and in the practice’s advertising. For example, if the medical director is not board-certified as a plastic surgeon or a dermatologist, that fact must be divulged. This is a laudable step, as it ensures the public has a significant amount of information available to it. It tells consumers right up front that a practice is a medical spa, and it allows them to know, in no uncertain terms, which doctors are affiliated with the practice. Click here to read about general best practices to make sure your medical spa advertising is legally compliant.

Treatments

Aside from the registry, Tennessee’s regulations are fairly similar to those of other states, in that some are very specific and can be defined narrowly, while others are more vague and present some grey areas. Generally speaking, though, all treatments that are offered at a typical medical spa—light-emitting devices, laser treatments, Botox, etc.—are considered to be medical treatments. Click here to read more about medical vs non-medical treatments in med spas.

Delegation

Tennessee has a fairly broad, yet restrictive delegation statute, which appears to say that a physician is authorized to delegate treatments only to LPNs, RNs, NPs, PAs, and, oddly enough, pharmacists. However, this statute does not provide any direction when it comes to delegation to unlicensed individuals. Therefore, it must be assumed that in Tennessee, you must be a licensed practitioner to fire a laser, for example. This is unlike similar delegation statutes in other states, such as Texas and Illinois, which allow physicians to essentially delegate to whoever they want, provided that person is operating within his or her scope of practice. Click here to see AmSpa’s webinar on the basics of medical spa delegation, free to AmSpa Plus members.

Ownership

Tennessee does not allow anyone other than a physician to own a medical spa, although in some instances, PAs and NPs can own practices and can enter into contracts with physicians. If you are a PA or NP who wishes to look into medical spa ownership, you should reach out to ByrdAdatto to discuss how to structure it. A consultation is free to AmSpa members. Of course, an MSO is a possible solution that permits a certain amount of ownership to a non-physician, but as we don’t want anyone to be a test case, the prudent and conservative approach in Tennessee is to make sure a physician owns the facility.

See the Tennessee medical aesthetic legal summary for more information about laws governing medical spa practices in the Volunteer State.

We’ll be discussing these regulations and many others at our Medical Spa & Aesthetic Boot Camp at the Doubletree Nashville Downtown in Nashville on Oct. 15 and 16. Join us there to learn all about how to run a compliant, successful medical spa in Tennessee and throughout the country. Click here to learn more and register, and click here to see the full schedule of Boot Camp dates.

 

Tags:  AmSpa's Med Spa & Aesthetic Boot Camps  Med Spa Law 

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CareCredit Establishes New Partnership with American Med Spa Association to Help Drive Growth Among Spa Providers

Posted By Administration, Monday, September 17, 2018

Sponsored Content: CareCredit

CareCredit has partnered with the American Med Spa Association to help spa and med spa industry professionals bring the benefits of CareCredit to their practices. Providers can now offer clients access to more treatments and services while also expanding their potential client base to CareCredit’s 11 million cardholders. Participating spas and med spas will also become a part of the CareCredit network of qualified providers, which receives more than 850,000 searches per month.

The partnership was developed in conjunction with CareCredit’s recent expansion into the day and medical spa markets—helping spa providers drive growth by providing an additional payment option for consumers. Day and medical spas are an attractive growth segment for CareCredit. According to the Global Wellness Institute Global Economy Monitor, wellness is a growing trend showing no sign of slowing down, having become a $3.4 trillion-dollar global industry as of January 2017. Over the next five years, the medical spa market opportunity is expected to grow at a rate of 8% year over year through 2022.  

Working with more than 200,000 providers across a broad range of specialties including medical care, beauty, dental and veterinary services, CareCredit helps people care for themselves and focus on their overall wellbeing, while also helping small business owners offer more payment options.  In turn, small business owners can enjoy peace of mind while using CareCredit to grow their business and clientele.

All AmSpa Members receive 20% off merchant fees on purchases over $200. Click here to learn more about CareCredit.

 

Tags:  Business and Financials  Sponsored Content 

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Connecticut Allows Private Cause of Action for HIPAA Violations

Posted By Administration, Friday, September 14, 2018

Jay Reyero, JD, Partner, ByrdAdatto

As a medical facility, any med spa must be HIPAA compliant. While HIPAA does not contain a rule or regulation providing an individual a remedy for a breach nor are violations of HIPAA a specific cause of action, HIPAA is increasingly being accepted as the standard of care with respect to handling confidential patient information. 

In a recent Supreme Court decision, Connecticut joined the list of other states recognizing a private cause of action against health care providers for HIPAA violations.

In the case, a healthcare provider received a subpoena requesting production of all the medical records of one of its patient involved in a paternity suit. In response to the subpoena the healthcare provider mailed a copy of the medical records to the court. As a result, the other party of the paternity suit obtained access to the medical records and began harassing the patient. The patient sued on multiple negligence counts and breach of contract.

In its opinion, the Connecticut Supreme Court concluded that “a duty of confidentiality arises from the physician-patient relationship and that unauthorized disclosure of confidential information obtained in the course of that relationship gives rise to a cause of action sounding in tort against the health care provider, unless the disclosure is otherwise allowed by law.” To determine whether disclosure was allowed by law, the Supreme Court pointed to the requirements under HIPAA for responding to a subpoena because:

“to the extent it has become the common practice for Connecticut health care providers to follow the procedures required under HIPAA in rendering services to their patients, HIPAA and its implementing regulations may be utilized to inform the standard of care applicable to such claims arising from allegations of negligence in the disclosure of patients’ medical records pursuant to a subpoena.”

While most healthcare providers think of HIPAA as only an enforcement tool utilized by the Federal Government, this case further demonstrates the increasing use of HIPAA as the standard of care when it comes to common-law causes of action. Regardless of whether HIPAA is applicable to a particular healthcare provider, all healthcare providers need to be cognizant of its rules and regulations, as they may be held to such standards and rules. 

HIPAA isn’t the only standard that could come into play as typically there are other standards such as state law, licensing board rules, and ethical rules. Healthcare providers would be wise to reevaluate their policies and procedures and ensure they are in line with the applicable rules and standards to ensure the proper handling of confidential patient information within their organization. AmSpa members can check their state’s medical aesthetic legal summary to find the laws governing their practice.

For more information on patient privacy requirements in medical spas sign up for AmSpa’s live webinar on the topic, free to AmSpa members.

Jay Reyero, JD, is a partner at the business, healthcare, and aesthetic law firm of ByrdAdatto. He has a background as both a litigator and transactional attorney, bringing a unique and balanced perspective to the firm’s clients. His health care and regulatory expertise involves the counseling and advising of physicians, physician groups, other medical service providers and non-professionals. Specific areas of expertise include Federal and State health care regulations and how they impact investments, transactions and various contractual arrangements, particularly in the areas of Federal and State anti-referral, anti-kickback and HIPAA compliance.

 

Tags:  ByrdAdatto  Med Spa Law 

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Physician Supervision: Keeping the “Medical” in Medical Spas

Posted By Administration, Thursday, September 13, 2018

By Renee E. Coover, JD, ByrdAdatto

Medical spa laws regarding physician supervision can be critical to a practice’s compliance plan, particularly if the practice utilizes nurse practitioners, physician assistants, nurse injectors, laser techs, or other non-physician providers to administer treatments.

Given the current economic landscape for medical practices, an increasing number of physicians are seeking alternative sources of revenue outside the traditional practice of medicine. Many physicians are turning to medical spas as an additional or alternative source of income, not wrought with the same Medicare/Medicaid and insurance issues currently plaguing the healthcare industry. But as physicians flock to medical spas in the hopes of making an easy income, many overlook the fact that a certain level of supervision is still required for all medical treatment. At the end of the day, the physician is responsible for every patient and if something goes awry, the physician’s license is on the line. 

Recently, our law firm has exploded with calls from physicians and med spa employees asking questions about physician supervision like: 

  • Does the doctor need to be present at all times? 
  • Does the doctor need to see every patient? 
  • What if the doctor consults with the patient over Skype- is that allowable? 

Of course, the answers to these questions, and many others, depend upon your particular state’s laws and regulations. AmSpa members can check their state’s medical aesthetic legal summary to find the answers to their med spa compliance questions.

The Practice of Medicine

First and foremost, it is crucial to know what med spa services require physician supervision in your particular state and what constitutes an adequate amount of supervision. In California, for example, all medical treatments – including Botox and laser hair removal – require physician supervision. Although a physician may delegate medical treatments and initial patient consults to nurse practitioners (NPs) and physician assistants (PAs), the physician must be involved and available to patients in the event of an emergency. 

Ultimately, the physician is responsible for each patient that walks through the door of a med spa. Some states have additional oversight requirements as well. In Illinois, a medical professional must be onsite at the med spa at all times when medical procedures are performed. This means that if a physician owner only has one other employee and that individual is a non-medical professional, the physician must be onsite at all times to supervise the medical procedures. 

Many physicians don’t realize, at least not right away, that treating patients in a med spa is just like any other practice. Most medical spa treatments by and large are still considered the practice of medicine, and the physician must assume ultimate responsibility for all of the patients that are seen and treated at the med spa. The physician must ensure that proper protocols are in place, oversee treatment plans, and safeguard patient confidentiality. While many of these tasks can be delegated, it is the physician, not the med spa owner or the employees, who is going to be held responsible if something goes wrong.

Experience and Training

One pitfall is the physicians’ notion that they can supervise medical tasks outside of their specialty practice, but in most states a physician in a med spa must specialize in, or at least have experience and training in, aesthetic medicine. In other words, the physician overseeing the medical spa and whose license is ultimately on the line, must actually practice aesthetic medicine.

Frequently, general practitioners, OB/GYN’s and emergency room physicians are quick to sign on as “medical directors” of med spas even though they have no experience or training in injectables, laser treatments, or any other aesthetic procedures, but this can get them in trouble fast. Even dermatologists and plastic surgeons should seek out training in these types of medical treatments in order to properly supervise the aesthetic treatments being offered at the med spa.

For more information on medical spa supervision and delegation requirements watch AmSpa’s medical spa webinar on the topic, presented by Michael Byrd, JD, partner at ByrdAdatto.

Telemedicine

With the advent of telemedicine, physicians frequently want to know if they can use real-time interactive communication on programs like Skype or Facetime to consult with and examine patients instead of meeting each new patient in-person, but this remains a gray area in the law. There is a fine line between giving generic health information over a smartphone and actually diagnosing or treating a patient.  Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face method of providing medical care and in some states it is being cautiously embraced. In Oklahoma, for instance, the state medical board recently passed telemedicine rules exempting physicians from face-to-face meetings with patients if certain criteria are met. Not every state is on board with this and only time will tell if telemedicine will be the future of medicine. Read more on telemedicine in medical spas here.

The bottom line is that physician supervision in the medical setting is a key component to running a successful and legally compliant med spa business. If you are unclear about the level of physician supervision required in your state, you should seek legal guidance from an experienced attorney immediately. AmSpa members can take advantage of their 20-30 minute annual compliance consultation with an attorney from ByrdAdatto.

For more ways to build and run your medical spa practice legally and profitably attend an AmSpa Medical Spa & Aesthetic Boot Camp and be the next med spa success story.

Renee E. Coover, JD, is an associate with ByrdAdatto, a law firm focusing on business, healthcare, and aesthetics. She has a unique background, blending litigation with healthcare law. A former litigator in high-stakes employment cases, Renee has extensive experience with counseling and representing businesses in employment matters, policies, and contract disputes, and defending business owners in state and federal trials. She has also served as General Counsel for the American Med Spa Association, advising health care professionals on regulatory and legal issues governing the medical spa industry.

Tags:  AmSpa's Med Spa & Aesthetic Boot Camps  Med Spa Employee Types  Med Spa Law 

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Getting a Loan for Your Medical Spa Practice: Q&A With Wells Fargo

Posted By Administration, Wednesday, September 12, 2018

Sponsored Content: Wells Fargo

Being approved for a business loan for a medical spa practice isn’t a process that many are familiar with, and the thought of it can seem daunting. AmSpa recently recorded an episode of the Medical Spa Insider podcast with Jeremiah Johnson and Chris Maiwald of Wells Fargo. Check out the quick Q&A below and listen to the episode to get answers to your medical spa lending questions.

 
1. People tend to either be unfamiliar with commercial lending or intimidated by it. Can you describe how you, as a lender, approach the lending process with a new entrepreneur? Is it a difficult process or relatively painless?

Each lending scenario is different. However, I find the lending process to be relatively painless when the borrower/entrepreneur is responsive. My approach to lending is to offer financial expertise to my clients based on their business’ unique needs. My team and I work with our customers to offer them a range of financial services, including credit and cash management. 

 
2. Getting a commercial loan has been difficult, at least historically, in this industry. Are startup loans for med spas available? How hard are they to get?

Yes, start up loans for med spas are available. While each scenario and loan application is different, it is important to work with your banker to determine your best loan options. 

 
3. How does the overall process work? How long does it take? What information does the borrower need?

Although we have a standard process that all loans will follow, each customers’ business scenario and needs are different. Therefore, the timing will vary from customer to customer.

Most loan applications can take between 45 – 60 days depending on the complexity of the project. Projects that include real estate can take up to 60 days, due to the time it takes to obtain appraisals and environmental assessments. A start-up loan without real estate generally takes less time.

Equipment-only loans generally can take anywhere from 3-21 days depending on the documents needed and how fast the entrepreneur submits them.

Typically, we need a copy of an application, personal financial statement, 3 years of business and/or personal tax returns, and a resume.

 
4. How detailed a business plan should the entrepreneur have? Should they have pro formas for 1 year, 3 years, 5 years? How specific/detailed should it be?

Your business plan should serve as a road map to the success of your business. A detailed plan is great, but from a bank’s perspective, we look at a range of different numbers, what type of project you are taking on and the associated risk. 

 
5. Typically how much of a down payment does the entrepreneur have to come up with? Any rule of thumb?

Every loan transaction and customer is different and evaluated on their own merits. Generally, down payment requirements are up to 30% of the total project cost.

I always encourage our customers to call their banker to discuss the project they have in mind. This allows our team to get a better understanding of the customer’s needs and develop a plan for their specific business scenario. 

 
6. Are these loans typically personally guaranteed?

Not all business loans require a guarantee, but all SBA loans do require a personal guarantee. Talk with your banker to learn more about guarantees required by the lender. 

 
7. Why is it important to use a lender familiar with health care? Medical aesthetics specifically?

Lenders who fully understand the healthcare and medical aesthetics industry can speak the language that can help get borrowers through the application process and, if eligible and approved, get the project funded. Our team knows the industry thoroughly, so we are able to help our customers choose the right loan program that fits their needs and ultimately help to achieve their long-term plan. We understand all aspects of a business plan from the complete start-up cost to marketing. We also understand what it takes to be a fee for service business and how to approach cash flow needs from that perspective.

 
8. What about lending for capital equipment purchases, like a laser – do you handle that and how difficult is it to obtain this type of loan?

We have a healthcare equipment lending group that we will engage to help you evaluate potential options to finance this type of request. Our equipment lending group only lends on equipment and offers highly specialized expertise in this area.

Ultimately I would recommend reaching out to your banker who can make suggestions based on your unique situation.

 

For more information reach out to:

 Jeremiah Johnson
Vice-President–Healthcare Specialist
817-505-3641
jeremiah.a.johnson@wellsfargo.com

Chris Maiwald
Vice President¬–Business Banking
682-213-0711
chris.maiwald@wellsfargo.com

Tags:  Business and Financials  Medical Spa Insider Podcast  Sponsored Content 

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The Importance of Reading Contracts for Medical Spa Owners and Physicians

Posted By Administration, Tuesday, September 11, 2018

By Alex Thiersch, JD, Founder and Director of the American Med Spa Association

An employment contract between a medical practice and a physician must benefit both the employer and employee; otherwise, it likely will be unsatisfactory for one or both sides. If one or both sides don’t take the time to read the contract, they could find themselves disappointed with the outcome. Here are a few things that physicians and practices should find within a mutually beneficial contract.

For more information on medical spa employment contracts, view AmSpa’s webinar on the topic (free to AmSpa Plus members.) 

A Clearly Articulated Goal

Before a contract with a physician is finalized, the practice should consider what it wants to accomplish. Does it want to fill a need? Does it want to service more patients? Does it want to transition ownership to this individual? The answer to this can affect the way an employment agreement is designed and the type of person the practice wants to recruit (i.e., a younger doctor versus a more experienced one). If a practice hires a physician who has entrepreneurial aspirations to simply tend to patients, for example, neither side is likely to be particularly happy, and the relationship likely will not last very long.

The practice must clearly communicate its intentions during the recruitment process and make sure that the contract is built around that philosophy.

From the other perspective, a physician must honestly evaluate his or her goals when negotiating a contract. Physician contracts typically last for one to two years, but both sides typically expect that the relationship between the practice and the physician will continue thereafter, so a physician must consider his or her long-term plan. Is this where he or she wants to build a career? This can influence how the contract is negotiated.

The physician also needs to consider his or her “plan B”—if this arrangement does not work out, what’s next? The answer to this question heavily influences how he or she evaluates the contract. For example, if the physician wants to live in the city where the practice is located but the contract has a restrictive non-compete clause, that clause will need to be negotiated, as it severely restricts his or her options if it the relationship with the medical spa does not work out. Click here to read more on non-compete and non-solicitation clauses

A Fair Wage

A medical spa should balance the economics of the practice, the risk tolerance of the owners, and the realities of the market in terms of salary when negotiating a contract. A competitive guaranteed base salary with some form of incentive-based bonus system can make a difference when it comes to obtaining top talent who might be considering other options. There are multiple ways this can be arranged depending on what suits the physician.

The prospective employee, on the other hand, must come to terms with his or her risk tolerance. While a high base/low bonus structure might appeal to some, others might want to bet on themselves with a low base/high bonus structure. It is up to the physician to determine his or her comfort level with the contract’s salary structure and negotiate if it is not optimal.

The physician also must be sensible when determining his or her actual earning power. If there is not enough potential business in the market to justify taking a low base/high bonus salary, the physician should negotiate a different deal.

Ownership Considerations

The practice must determine what it wants to accomplish in terms of ownership with the hire, since it will affect everything from scheduling and coordination to top-level decision-making. The owner(s) of the practice also must consider if this transaction constitutes part of their exit strategy; if so, the contract must be structured with that in mind.

The physician, meanwhile, must determine his or her goals in building the practice and figure out how the ancillary revenue streams offered by the practice compare to those offered by others. Ownership has different appearances for different entities, so the physician must think about what he or wants and what the practice can provide. What is the cost of the investment? What is the potential return? What is the risk? All these questions should be answered in the contract.

A contract is a complicated matter. Both sides must assess the value of the risks and rewards, and they must be willing to compromise on matters that may not be as important. A careful reading of a contract is absolutely imperative, however—if a physician or practice doesn’t thoroughly read the contract, they have nobody to blame for their unhappiness but themselves.

For more information on structuring your medical spa profitably and compliantly, attend an AmSpa Medical Spa & Aesthetic Boot Camp and be the next med spa success story.

 

Tags:  AmSpa's Med Spa & Aesthetic Boot Camps  Business and Financials  Med Spa Ownership 

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SkinPen® Remains the Only FDA-Cleared Device for Microneedling

Posted By Administration, Monday, September 10, 2018
Sponsored Content: Bellus Medical

Aesthetic medical providers beware: The FDA codified its classification order for microneedling, likely putting practices using non-cleared devices at greater risk.

“In many medical device liability cases, a doctor is shielded from liability when properly using a cleared and compliant device, since the FDA review and clearance would ensure all likely hazards are controlled,” said Marc C. Sanchez, an FDA attorney who worked on Bellus Medical’s microneedling De Novo submission. “That defense is totally washed away when using an unapproved medical device.”

As of March 1, there is only one FDA-cleared microneedling device: SkinPen® by Bellus Medical. According to Sanchez, the classification order makes all non-cleared microneedling devices of any kind subject to enforcement actions, such as refusing entry for imported derma rollers and pens as well as issuing warning letters to non-compliant manufacturers.

Read Sanchez’s post on FDA Atty to learn more about the classification order and the new risks for doctors and aestheticians.

Click here for more information on Bellus Medical, and click here to read more about the SkinPen® in AmSpa’s medical spa treatment directory.
 

Tags:  Med Spa Trends  Sponsored Content 

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