Anyone working in the health care industry is intimately familiar with the Health Insurance Portability and Accountability Act of 1996, better known as HIPAA. Generally, the purpose of HIPAA is to establish minimum federal standards for protecting the privacy of protected health information (PHI). While it is widely understood that health plans, health care clearinghouses, and health care providers are potentially subject to HIPAA regulation at the federal level for maintaining patient privacy, what may be less well known is how the patient privacy standard of care established under HIPAA applies to a private right of action.
Only the U.S. Department of Health and Human Services Office for Civil Rights (HHS) and the state attorneys general can enforce HIPAA violations. As a result, HIPAA lacks a private right of action. This means that an individual whose PHI has been used or disclosed by a health care provider in violation of HIPAA may not bring a civil claim against the provider under HIPAA. HIPAA also preempts state privacy laws that are contrary to HIPAA, the exception being when a state law is “more stringent” than HIPAA regarding privacy protection.
With data breaches becoming increasingly common, individuals have attempted to circumvent HIPAA’s lack of individual enforcement power by bringing negligence claims under state law based on violations of HIPAA. Using HIPAA as the patient privacy standard of care in negligence cases is beginning to look more like the equivalent of a private right of action under HIPAA, which HIPAA does not allow. This essentially means that a violation of the HIPAA rules may be used to establish that a health care provider has breached the duty of care owed to a patient under state law negligence claims relating to the improper disclosure of patient PHI. As a result, health care providers should understand that a HIPAA violation may result in a variety of state law claims.
Perhaps even more alarming than the attempted private right of action as a HIPAA workaround is the recent trend of state courts both finding in favor of the plaintiffs bringing the private rights of action, as well as finding that HIPAA violation claims can be brought at the state level. In California, for example, a medical center found itself at the center of a major data attack, with 4.5 million patients affected by the breach. After suspecting suspicious activity on its network, it contacted the FBI for help. Although it took close to nine months to notify the patients of the breach, HHS ultimately found that the medical center followed appropriate protocol and was satisfied with the health system’s post-breach efforts to improve security. However, despite the findings by HHS, a California state court found that the medical center failed to notify its patients of a data breach in a timely manner and awarded a settlement of $7.5 million in favor of patients who had filed the class-action suit.
The Arizona Court of Appeals also added itself to a number of courts across several states holding that HIPAA may define the standard of care for state law claims. The claim before the Arizona court alleged a privacy violation by a Costco pharmacist when the pharmacist verbally joked about a man’s erectile dysfunction medication to the man’s ex-wife. The long and short of it is, the Arizona Court of Appeals ruled that negligence claims using HIPAA as the patient privacy standard of care could be brought against Costco in Arizona courts.
While data breaches occur in virtually every state, health care providers in Texas have the added burden that the state has led the country in total hacking breaches reported to HIPAA for four of the past five years. In light of other rulings similar to those in California and Arizona, it is no surprise that Texas hospitals have recently been devoting more resources to cybersecurity. The added protection seems to be working—data shows that despite Texas often being in the top two states in terms of total hacking attempts over the past five years, it is further down the list when it comes to individual records actually breached.
Since it is becoming increasingly common for state courts to find HIPAA as the patient privacy standard of care for private rights of action, health care providers should re-evaluate, establish and enforce HIPAA compliance and training programs within their organizations. Otherwise, not safeguarding against HIPAA violations could result in substantial penalties against an organization.
AmSpa members receive a complimentary 20-minute Introductory Compliance Assessment with a ByrdAdatto attorney. Click here to learn how to join AmSpa today!
As the daughter of a periodontist, Courtney P. Cowan has been fascinated by the health care field since childhood. She often accompanied her father to his office, where she developed an appreciation for physicians and their respective practices. Having absolutely none of the dexterity that is required to be a surgeon, however, Cowan instead decided to pursue a degree in business while attending Baylor University. It wasn’t until she was required to take a business law course that she discovered her passion for the law. After graduating from Southern Methodist University Dedman School of Law, Cowan serendipitously connected with ByrdAdatto and now assists clients by combining her business background with her enthusiasm for health care and the law.
The Medical Board of California (MBC) has warned physicians against using unlicensed persons for hair transplant procedures in the summer issue of its newsletter. (The issue is available here, with the article appearing on page 12.) It states that the MBC has become aware of many physicians or clinics that are employing trained but unlicensed persons, referred to as medical assistants (MAs), to perform or assist with hair transplant procedures. The article gives the example of MAs creating holes or slits in the patient’s scalp using a needle, scalpel or other device as being prohibited. While it does not explicitly state that this is the case, its warning would seem to apply equally to harvesting follicles as it would to preparing the follicle implantation sites.
In California, MAs have a very limited scope of tasks they are permitted to perform. They are permitted to perform only “basic administrative, clerical and technical supportive services,” with several procedures specifically authorized in 16 CCR § 1366. With the exception of puncturing skin or vein for purposes of drawing blood, their other authorized tasks are non-invasive and include tasks such as trimming nails and ear lavage. Likewise, the MBC has stated that MAs may not inject fillers, nor may they fire lasers. The article warns that physicians who violate this restriction are aiding the unlicensed practice of medicine, which can carry penalties of fines or imprisonment. If you are employing MAs in your practice, you will want to carefully review what tasks you are assigning to them and ensure that the delegations are legally permitted.
Michael S. Byrd is a partner at the law firm of ByrdAdatto, a national business and health care boutique law firm with offices in Dallas and Chicago. As the son of a doctor and entrepreneur, he has a personal connection to both business and medicine. He has blended these life experiences to become a leading advocate for doctors and dentists throughout the United States. He routinely lectures at continuing education seminars on the various business and legal issues that professionals face. Outside of health care, Michael has used these same skills to handle sensitive and complicated business matters for entrepreneurs, business owners, attorneys, CPAs, high-net-worth individuals and public figures. He has been named to Texas Rising Stars and Texas Super Lawyers, published by Thompson Reuters, for multiple years (2009-2019), was named a Top Rated Lawyer by the Dallas Morning News (2016), and has been recognized as a Best Lawyer in Dallas in health care by D Magazine (2013, 2016-2019).
Posted By Administration,
Thursday, September 12, 2019
By Patrick O’Brien, JD, legal coordinator, American Med Spa Association
In this space, we previously have discussed the importance of getting high-quality training and instruction in every procedure you perform, but lately some AmSpa members have asked us if laser and injector courses that offer “certification” are better than “regular” training courses. The short answer is that, for the most part, there is not any recognized certifying or governing body in the medical spa world, so having “certification” in this context may not add much value.
What Is a Certification?
A certification or certificate is essentially a piece of paper. A high school diploma is a certification—it is your high school “certifying” that you attended the required classes and achieved the minimum grades to graduate. However, it does not by itself make a statement about what you learned or how well you really did; after all, the valedictorian gets the same piece of paper as the “C” student. Instead, certifications achieve their value through what other people think of them. This is why a degree from Harvard is more likely to land you a job than one from a regional university; they both may offer fine educations, but one has built a reputation for education that is widely recognized, while the other is not as well known.
It is the same case with certifications for medical spa procedures. A training “certification” is merely a piece of paper saying you attended the training—it does not speak to what you learned. Part of the value of any training comes from the reputation of the instructor or the company that is offering the course. A device manufacturer may offer certifications for their devices, and it may carry more weight than a third-party training, at least in terms of public perception. Conversely, a third-party master class on a single procedure may be more useful than the general device manufacturer’s certification. Like many things, it all depends on context.
As we discussed in a previous article, all the training in the world does not matter if you aren’t legally allowed to perform the task. Similarly, a certificate or certification isn’t going to matter if the regulatory body doesn’t accept or require it. Most state medical and nurse licensing boards recognize the board-certified specialties that are granted by national organizations such as the American Board of Physician Specialties and the American Board of Medical Specialties. In addition, some states require that you attend a specific approved certification course to be a laser technician or medical assistant. These certifications are important because the regulatory body both recognizes and requires them. However, there presently is no nationally recognized accrediting body for medical aesthetic procedures.
State nursing and medical boards are not looking for “certification” in injecting, lasers or PRP—they are looking for documentation of the training and evidence that the training was appropriate. For example, the Oregon State Board of Nursing, which we discussed previously, requires that nurses maintain and provide “evidence of documented education in cosmetics nursing practice and for each cosmetic procedure performed.” The Texas Medical Board requires that physicians keep records of their training in each non-surgical medical cosmetic procedure they perform or delegate, and that training must be appropriate and include a “hands-on” component. Most medical and nursing licensing boards share similar rules.
Do not fall for hype or meaningless marketing terms; instead, look for well-respected and skilled instructors and seek curricula that fit your needs and skill level. Every trainer should be able to verify that you attended his or her course and what was taught there. What matters most is the quality of training you receive—not buzzwords such as “certified,” “specialist,” “approved” or “master.” After all, a licensing board will not care if you are “certified in x” when it is investigating your training credentials and competency.
Online presence is one of the most critical elements of a successful marketing program. In the era of technology, many—if not most—prospective patients will first come across your office through an Internet search. Your website must be eye-catching, professional and thorough. It should paint the complete picture of your office: individualized services, state-of-the-art technology and professional staff. In the first few seconds of accessing your website, prospective patients will form an opinion of your office. Therefore, it is critical to invest in high-quality website engineers, content writers and marketing personnel. (Click here to read more about how internet marketing ties into a successful marketing program).
With internet marketing especially, you may be tempted to find ways to cut corners and lower your overall costs. However, doing so will substantially weaken your marketing program and cut into your overall profitability. Invest in a high-quality, experienced marketing team to build a solid online platform for your medical aesthetics practice. The rewards will far outweigh the cost.
Invest in high-quality website engineers or staff from the get-go. While you may be able to find companies to create a website for a low price, the product reflects the cost. And it’s far more complicated to scrap a website and create a new one, especially when you consider that it needs to be properly integrated into search engines such as Google. The takeaway message here is that you’ll spend more money hiring the right team to correct a poorly formed and developed website than you will if you pay to have it done right the first time.
Your website needs to be clean, professional and easy to navigate. Steer clear of flashy designs and complicated navigational tools. You want prospective patients to navigate your website with ease so they can quickly and efficiently learn about the services, products and technology you offer. Make it easy to return to the homepage by having a banner on each page. Keep in mind that many people will access your website through a mobile device, so you’ll want to make sure your website can adapt to any screen. Lastly, make your contact information easily accessible, either in the footer or in the main menu. You don’t want prospective patients to struggle to find ways to get more information or reach out to your office. Make it obvious. Read more about these and other ways to improve your website design in this article from the Huffington Post.
Aside from a clean and professional design, the content is the most critical component of your website. It won’t mean much that your website is easy to navigate if the pages don’t lead to well-developed, informative content. Your website should effectively illustrate all the key details of your office—your services, technology and staff—in a consolidated space. This means you’ll need to invest in highly talented writers and content developers. Writers can either be hired in-house or contracted out. Either way, be careful in your selection; ideally, you want professionals with experience in both the writing and medical fields. Your website content needs to be original—not duplicated from a similar site—in order to be searchable on platforms such as Google. Well-developed website content also will contain robust inbound/outbound links, as well as searchable keywords, phrases and page titles. (Click here to read more about how to successfully incorporate SEO elements into your website content). The takeaway here is that the content on your website needs to be original, professional and searchable.
High-quality content goes hand in hand with proper link development. Inbound links are like the gateway to your office—you want them to be logical, well-placed and natural. Ideally, the team you hire for website initialization and content development will have experience in link building. Beware of companies that sell inexpensive links in bulk. More is not always better—in many cases, these bulk-type links are poorly developed and placed on totally unrelated pages, negatively impacting your presence on search engines such as Google. The cost to repair this damage will far exceed the cost of having an experienced SEO team develop high-quality links the first time around.
Return on Investment
There are several important numbers you need to know to track the progress of your marketing program, as outlined in this article. As with every marketing avenue, you’ll need to know your internet marketing return on investment (ROI) every quarter. How many prospective patients first learn about your office through an online search? How many patients inquire about your services through website forms? These are key numbers that will help you determine your projected and actual ROI.
They’ll also help you plan for the future and tailor your marketing program to the times. For example, if you notice a 50% decrease in the number of prospective patients visiting your website, you may need to invest more in SEO and link development. An increased number of well-placed and tailored inbound links will lead to increased online traffic, contributing to your overall visibility. The idea is that this will ultimately lead to increased patient conversion. Keeping track of the numbers allows you to gauge the success of your online marketing plan and implement targeted changes to improve your online presence.
Online marketing is a central element of your marketing program. Invest in a high-quality professional team to develop and maintain a clean, informative and well-guided website.
Click here to complete Terri's 10-point checklist.
Terri Ross brings more than 20 years of sales and management experience to the field, having worked with leading-edge medical device companies such as Zeltiq, Medicis, EMD Serono, Merck Schering Plough and Indigo Medical, a surgical division of Johnson.
Ross’ vast knowledge and experience as a sales director managing upwards of $20M in revenue and successful teams has allowed her to become a renowned plastic surgery management consultant helping aesthetic practices thrive.
To optimize revenues and business performance, Ross’ practice management consulting services help physicians evaluate practice processes including, but not limited to, overall-operating efficiencies, staff skill assessment, customer service and operating efficiency strategies. The goal is to develop a comprehensive plan of action to improve productivity, quality, efficiency and return on investment.
Posted By Administration,
Tuesday, September 10, 2019
By Patrick O’Brien, JD, legal coordinator, American Med Spa Association
Recently, AmSpa has been getting a lot of emails and calls telling us they have been informed that in Texas, unlicensed people can own a medical spa and simply hire a medical director. This contradicts our information, as well as ByrdAdatto’s research on the subject: Texas’ corporate practice of medicine (CPOM) policy generally prohibits non-physicians, lay corporations and other entities from employing a physician to practice medicine. We understand how there can be some confusion, as the various authority and elements that make up the legal basis for Texas’s CPOM policy are scattered in a number of places. However, we wanted to provide our Texas members with some additional information on this, because it is important to stay in compliance with the policy; failing to do so can open the physician up to discipline for abetting the unlicensed practice of medicine, and can subject the non-physician owners to fines and penalties as well. You only need to look to the Texas Medical Board’s June 27, 2019 press release for examples of the board taking action. In one instance, a physician was prohibited from performing, supervising or delegating medical spa procedures for five years for aiding the unlicensed practice of medicine and lending his license to a medical spa. In two other cases, unlicensed medical spa owners entered into agreed cease-and-desist orders with the board; they had been engaging in the unlicensed practice of medicine by advertising and providing medical cosmetic procedures. This article will explore some of the main sources of this policy and attempt to dispel some of the confusion.
A discussion of this topic should begin with the Texas Occupations Code Chapter 3 Subtitle B, collectively referred to as the “Medical Practice Act.” Section 155.001 requires that a person must hold a license to practice medicine. Section 155.003 make it clear that only a person who has completed the required educational steps may hold a license to practice medicine. Section 165.152 make it a violation subject to penalties for a person to practice medicine in violation of the Medical Practice Act. Section 165.156 also make it a violation for a “person, partnership, trust, association or corporation” to use any letters, words or terms in any manner that indicate it is licensed to practice medicine if it is not, in fact, licensed to practice medicine. In Section 164.052, the code states that a physician is subject to discipline if he or she “directly or indirectly aids or abets the practice of medicine by a person, partnership, association or corporation that is not licensed to practice medicine by the board.” Section 165.155 prohibits a physician from paying or rewarding any person or entity for soliciting or securing patients. Taken together, it is clear that an unlicensed person, corporation or other entity cannot advertise that they practice medicine or offer medical services, and they cannot simply hire a physician to lend a license to their business.
Now, there are a number of exceptions to this general prohibition on employing physicians. The Texas Medical Board has adopted Rule §177.17 and provided a FAQ article on CPOM that provides a helpful summary of the information and possible exemptions. Rule §177.17 lists various exempt hospitals, non-profits and institutions. However, those entities are not applicable to a privately owned medical spa. Corporations and other entities properly formed and owned under Title 7 (Professional Entities) of the Texas Business Organizations Code are also exempt. A properly owned professional medical corporation may hire physicians and offer medical services.
The Texas Medical Board’s FAQ also mentions that physicians may enter into an independent contractor relationship, though it is a question of law and facts whether it is a permitted independent contractor or a prohibited employment relationship. Under 151.055, hospitals may enter into independent contractor agreements with physicians. However, for other physician and non-physician relationships the navigation can be incredibly tricky. Any independent contractor arrangement must still comply fully with the Medical Practices Act, as well as not fall into any aspects that would make it a prohibited employment relationship. Each of the listed court cases and attorney general opinions addresses different aspects used in determining independent contractor status from employment relationships. Some of the issues examined are the flow of funds, setting of fees, ownership, control over medical decisions, control over services or employees, and advertising. This means that even if your agreement says “independent contractor,” it may still be a prohibited employer/employee relationship if it does not satisfy all these elements.
For example, in the case of F.W.B. Rockett v. Texas State Board of Medical Examiners, the physician saw patients and reviewed X-rays for a non-physician-owned clinic; for his services, he was paid a flat monthly fee. In this case, the physician lost his license because he was permitting an unlicensed person to practice medicine. Similarly, in Flynn Brothers, Inc. v. First Medical Associates, the physician claimed to be an independent contractor, but the court found him to be an employee because, among other reasons, the non-professional entity retained two thirds of the physician’s collected fees.
Taken all together, the case law and statutes form a complex balancing act. The Texas Medical Association recently published a white paper detailing its explanation of the doctrine, and it largely reflects the views of AmSpa on the matter. Additionally, the medical service organization (MSO) model allows medical spas in Texas a way to navigate these situations. If you are not familiar with the MSO model, see articles about it here and here, and the concept will be covered by an attorney from ByrdAdatto at the upcoming AmSpa Medical Spa & Aesthetic Boot Camp in Dallas. Because of the highly technical nature of the CPOM, the board’s FAQ recommends that you consult an attorney before entering any actual arrangement. Also, do not base your business plan on any article, even—and especially—this one. You need specific and tailored advice from an attorney who is intimately familiar with the Texas CPOM, professional organizations law and medical spas.
We at ByrdAdatto receive numerous questions each week from providers, medical spas, wellness counselors and other businesses in the aesthetic space. These questions range from entity structuring to employee disputes to lease negotiations, but questions relating to patient reward programs for referring friends are among the most frequently asked.
Patient referral rewards come with multiple overlapping layers of laws and regulations. In order to understand the risk you might incur by using these referral programs, it is critical to seek advice from a health care attorney before implementing a rewards system or referral incentive initiative.
The federal Anti-Kickback Statute is the starting point for understanding the implications for rewarding a patient for referring a friend. This law states that providers cannot offer remuneration in cash or in kind to induce the referral of a business or service covered by a federal health care program. Stated another way, a provider cannot give a person gift cards, cash, discounted services or anything else of value in exchange for referrals when federal insurance programs, such as Medicare and Medicaid, are involved. The federal Anti-Kickback Statute likely does not apply to your aesthetic practice, since such aesthetic practices are typically cash-based, but it serves as an important building block.
Most states have their own version of an anti-kickback law that uses the federal language as a base, but broadens the restrictions to varying degrees. For example, Texas, New York, Florida and California all have laws that prohibit providing remuneration to a person for referrals, regardless of whether patients are paying with cash or insurance. In these states, giving a patient cash, gift cards or generally anything of value for referring a friend will create the risk of violating the state anti-kickback law. On the other hand, Illinois law only prohibits remuneration for referrals when insurance is involved and does not regulate paying for referrals where the practice is cash-based.
Finally, the regulatory boards—medical boards, nursing boards, etc.—can issue their own rules and regulations that tighten or otherwise modify state anti-kickback laws. Continuing the Illinois example, while its state law does not prohibit providing remuneration for referrals when cash payors are involved, the medical board has opined that it views this practice as unprofessional and unethical. This can result in a medical provider being at risk for loss of license, reprimands, fines and more from the medical board if he or she pays for referrals.
The complexity of health care laws and the importance of identifying the laws applicable to your practice make the risk of creating a patient referral program without talking to a health care attorney too great. There also may be alternative solutions to boost patient numbers, such as installing membership discount systems, that avoid creating a regulatory headache.
Posted By Administration,
Friday, September 6, 2019
When Chris Bailey founded his medical spa in 2006, he was new to the industry. The practice was a franchise, though, so he felt he could count on the support of the franchisor. Six months after the practice opened, however, the franchisor went out of business, so Bailey picked up the phone and called every medical aesthetics professional he could track down, asking those who would talk to him about every aspect of the business. He developed a number of long-term relationships with highly respected members of the industry and, before long, his practice—renamed Ovation Med Spa—was thriving. Bailey spoke with AmSpa Content Writer/Editor Michael Meyer about how he and his practice rebounded from a rocky start to become one of the most successful medical spas in the Houston area.
Michael Meyer: What inspired you to open your practice?
Chris Bailey: I spent 15 or 16 years in corporate America and I was getting burned out. I was bored. Fourteen or 15 years ago, I was in LaGuardia Airport a couple of weeks before Christmas, coming home from a client meeting. I'm looking around the airport, and there are people 10 or 20 years older than me, and I'm just sitting there thinking, “I can't be doing the same thing in 10 years or 20 years.” And I remember standing at the magazine rack and flipping through Entrepreneur magazine—the Franchise 500 edition—thinking, “I don't want to make sandwiches, I don't want to be a janitor and I probably don't want to own a daycare.” And then I saw some medical spa franchises, and I'm like, “Huh—that's interesting. People are getting older, and they don't want to look older. Maybe I should look into this.” I started doing a bunch of research, and a year and all my money later, I opened our business. That's where it started.
MM: What would you say is different about your practice now versus when you opened it?
CB: We opened about 13 years ago, and at the time, you could categorize what we did as skin rejuvenation. We did injectables, we did IPL and different things for skin rejuvenation. Body contouring wasn't really even a category yet, because there were no devices that really did it. Today, we do everything from skin rejuvenation, body contouring, vaginal rejuvenation, erectile dysfunction, hormone replacement—it's really the gamut of anything you can do nonsurgically to someone to make them look or feel better.
MM: What is your most popular treatment, and what brings in the most revenue?
CB: The most popular treatment can vary by season. Certain times of the year, our Sciton Halo is very popular for skin rejuvenation; we get to the summer and that's not quite as popular. We do a lot of CoolSculpting. We do a lot of Emsculpt treatments—the new body contouring device. One of the fastest-growing segments has been vaginal rejuvenation, which has been kind of surprising to all of us.
What brings in the most revenue? We're pretty balanced. It's probably a fairly even mix between skin rejuvenation and body contouring. And things like vaginal rejuvenation and hormone replacement are smaller percentages but growing.
MM: What would you say is the most important factor to your success?
CB: I think some of it is that we've continued to innovate. We have close to 40 different FDA-approved devices; I think the average medical spa might have three or four. We have always stayed on top of technology, and we have multiple options to do similar things. We've never wanted to be in the position where someone comes in and we have to tell them, “You need x, and y happens to be the only thing we have.” We're in a unique position where we can truly customize treatment plans for people based on their needs because we've got all kinds of different technology to accomplish that.
MM: What sets your medical spa apart from others?
CB: I think some of it is what I was just talking about—the continuous innovation and the technology that we have. No one has the technology we have, I don't think, anywhere in the country. And then you marry that with our outstanding service providers—we've got employees who've been with us since day one, for 13 years, and we've got very low turnover. Our staff is excellent. They get great training, and they do great treatments, and they provide great customer service. We have customers that we've literally had for 13 years, since we opened our doors. Our unique selling proposition is that we don't sell a one-size-fits-all solution—we can truly customize treatment plans for what people actually need.
MM: Who inspires you?
CB: My father has always inspired me. He is probably the person, from when I was a young child, who taught me to dream bigger dreams, think big and believe we can do things beyond what we are doing today. He's always been an inspiration my life.
MM: What do you love most about aesthetics?
CB: I think some of it is the opportunity—and this is always hard to say without offending someone—to help people become what they believe are better versions of themselves. It's just fun to have someone come in, unhappy with some aspect of how they feel or how they look, and be able to make a positive change and have them be happy that they were able to accomplish that. That's one of the most fun things about it.
MM: What do you love about being an entrepreneur?
CB: Some of it is the constant challenge and the constant change and the constant need to be creative and innovate. If we think about how the aesthetics market has changed in the 13 years we've been in it, it's so amazing. It's different this year than it was last year. It changes so rapidly, and it continues to change. That constant challenge is what keeps me engaged.
MM: What was the goal with the spa design you chose?
CB: We don't want to look like a medical office, and, and we don't necessarily look like a real frou-frou spa. Our design is clean and efficient. We're not trying to look like the Taj Mahal, but we want an efficient, clean, visually appealing space. But we don't want you to think you're in your family practice doctor's office either.
MM: What advice would you give to medical spa owners?
CB: Keep your overhead low—as low as possible—and network with as many different people around the country as you can who do similar things as you. When I started this company, we actually had purchased a franchise. I spent all the money I had and borrowed more money than anyone should have let me, and we started this franchise. Six months after we opened our doors, the franchisor went out of business. And so here I am—I paid all this money for all this help, training and assistance I was promised, and it's now vanished. But I have no other choice—I have to make this work because I'm deeply in debt at that point and have no job. So, I literally got on the phone and called anyone in the country who would talk to me just to ask questions. Because of that, I've developed some great long-term relationships with some very top-end doctors in the aesthetics world that have really been beneficial to me.
What's interesting about that story is no one in Houston would talk to me, and I still find that fascinating—in the business world, we talked to our competitors, and we understood they're competitors, but we would talk and share ideas. Entering this medical space, it was, at least on a local level, a very closed community, especially to someone who wasn't a medical provider coming into it.
Because of all that pain and suffering I had to go through in the beginning to survive and make relationships, we've had some opportunities that just never would have come along otherwise. As an example, as a non-doctor, I was the first person in the country to have the Emsculpt device. I had developed a relationship with the people at BTL, and they knew we were innovative, and they loaned us one in the very beginning to try to help figure out what it did. And so, I'm the only non-medical person listed on some of these published studies for the Emsculpt. Those kinds of opportunities really stem back to those early days of networking with people around the country and building our reputation through asking for and sharing ideas with people. My business wouldn't exist had I not been able to network and do those things early on.
I get calls all the time, and I'm always willing to talk to anyone who wants to call and ask questions, because I did the same thing. It's surprising to me how many people either are afraid to reach out and ask questions or assume that they won't help you because you’re a competitor. I laugh at that. I'm in Houston, Texas, right? If every aesthetic facility in the city was running at full capacity, we couldn't serve everyone who wants treatment. It's just not even possible. It's millions of people, and I just laugh sometimes when people are so worried about competition. Just do a better job. If you do a great job, there's plenty of business for everyone. As an industry, we can make the entire industry better if we actually talk to each other and help each other.
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Posted By Administration,
Wednesday, September 4, 2019
By Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa)
Starting next Saturday, September 14, AmSpa will host its Dallas Medical Spa & Aesthetic Boot Camp at the Doubletree Dallas Campbell Centre. We’re extremely excited for the opportunity to help medical aesthetic professionals in the Lone Star State develop their practices, and we can’t wait to once again visit Big D. There’s still time to register for the event—just click here to sign up.
Here is a quick overview of the program:
Saturday, September 14
The Boot Camp begins at 8 a.m. with a continental breakfast, followed at 8:30 a.m. with my opening keynote. From there, we will move into the main program:
9 – 10:30 a.m.: The Plan,presented by Bryan Durocher (Durocher Enterprises)—What are the most effective ways to develop a business plan for your medical spa? Medical Spa Consultant Bryan Durocher discusses the ins and outs of the planning process and helps determine how long it realistically takes to open a practice.
10:45 – 11:45 a.m.: The Lessons,presented by Louis Frisina—Every medical spa is different, but the successful ones share several common traits. In this session, Business Strategy Consultant Louis Frisina discusses the qualities that are typically found in practices that bring in a significant amount of revenue.
12:45 – 1:30 p.m.: Medical Aesthetic Hot Topics Panel,featuring Tim Sawyer (Crystal Clear Digital Marketing), Bobby Calhoun (Environ Skincare), and Jamie Bergeron (Bellus Medical) and Page Piland (Galderma)—This panel, moderated by yours truly, will feature a spirited discussion of the current issues and events that concern medical spa owners and operators.
1:30 – 3:30 p.m.: The Law,presented by Alex Thiersch (AmSpa) and Bradford Adatto (ByrdAdatto)—In this presentation, we’ll discuss the long-standing and emerging legal issues that every medical spa owner needs to know about. As you can imagine, there is a lot to cover here, since new concerns seem to be arising daily lately.
4:15 – 5 p.m.: The Treatments,presented by Terri Ross (Terri Ross Consulting)—Learn about the most profitable and popular treatments available to your practice, and find out how to best determine which treatments are right for you based on the state of your practice.
5 – 6 p.m.: The Digital Marketing Ecosystem,presented by Tim Sawyer (Crystal Clear Digital Marketing)—Find out how to effectively spread the word about your medical aesthetic practice and how best to determine what’s working and what’s not. Your practice’s digital presence is more important than ever before, and curating it should be a top priority.
Saturday will wrap up with a cocktail reception from 6 – 7:30 p.m.
Sunday, September 15
Once again, the Boot Camp begins at 8 a.m. with a continental breakfast.
8:30 – 9 a.m.: Anatomy of a $5-Million Med Spa,presented by Alex Thiersch (AmSpa)—Have you ever wondered what the difference is between your medical spa and one that’s mega-successful? It might be less significant than you think. This presentation will show what a $5-million med spa is doing right—and what you might be doing wrong.
9 – 10 a.m.: The Financials,presented by Bryan Durocher (Durocher Enterprises)—At the end of the day, the money you’re bringing in is the most important measure of your practice’s success. This presentation will, among other things, demonstrate how to properly develop a budget and use metrics to determine your med spa’s strengths and weaknesses.
10:30 – 11:30 a.m.: The Long-term Revenue,presented by Brandon and Jenny Robinson (Skin Body Soul MedSpa)—Simply being successful isn’t enough for a medical aesthetic practice; you have to know how to maintain and grow your success. In this session, Brandon and Jenny will show you how to build patient loyalty and move your business forward.
11:30 a.m. – 12:15 p.m.: The Consultation,presented by Terri Ross (Terri Ross Consulting)—As the old saying goes, you never get a second chance to make a first impression. Learn how to put your best foot forward with effective patient consultations—and how to turn them into consistent business.
1 – 2 p.m.: The Marketing Plan and Social Media,presented by Brandon and Jenny Robinson (Skin Body Soul MedSpa)—This session will help you determine how to most effectively market your medical aesthetic practice using both traditional methods and cutting-edge techniques.
2 – 3 p.m.: The Team,presented by Bryan Durocher (Durocher Enterprises)—A medical spa is only as good as its personnel, so it’s important to make sure that you hire a staff that can do everything you want it to—and more. In this session, you’ll learn about recruiting, hiring and retaining employees who can make your medical spa dreams come true.
Also, you’ll have the chance to visit with a number of exceptional vendors during this event. Attend the Seattle Medical Spa & Aesthetic Boot Camp to check out the latest and greatest from the following companies:
We hope you can join us in Dallas next weekend. This Boot Camp is a tremendous opportunity to get a medical aesthetic business started off on the right foot, as well as learn how to take an already successful business to the next level. Click here to register!
Posted By Administration,
Tuesday, September 3, 2019
Watch this video to learn about Lily Nizam, PA-C, CPCP, and Sami Nizam II, MD, DMD, of Alabama Surgical Arts in Montgomery, Alabama—a vibrant year-old practice where a medical spa coexists alongside oral surgery and facial cosmetic surgery practices.
Lily joined the American Med Spa Assocation (AmSpa) before Alabama Surgical Arts opened in order to learn about the industry. In addition to taking advantage of the many material perks offered with AmSpa membership—including discounts from vendors and access to legal updates—Lily has become a regular attendee of AmSpa events, where she has found new inspiration.
To learn more about Alabama Surgical Arts, click here to visit its website.
AmSpa’s Medical Spa & Aesthetic Boot Camps are intensive two-day seminars covering legal and business best practices in the medical spa industry. These events are designed for all medical spa professionals looking to run efficient, compliant and profitable aesthetic practices. Click here to learn more about upcoming Boot Camps, and click here for information about The Medical Spa Show 2020, the premier conference and trade show for non-invasive medical aesthetics.
When Lasky Aesthetics and Laser Center opened in 2010, it was a much different business than the $3-million-per-year Beverly Hills fixture it has become. In fact, it struggled mightily until medical spa professional Terri Ross joined the practice as managing partner. AmSpa Content Writer/Editor Michael Meyer spoke with Ross—who now operates Terri Ross Consulting—about her role in turning Lasky Aesthetics into one of the most successful medical aesthetic practices in this beauty-obsessed city.
Michael Meyer: What's different about the practice now versus when you started working there?
Terri Ross: All of the owners are physicians who practice offsite and in different specialties—cosmetic dermatology to facial plastic surgeons and a general plastic. They opened the business in 2010 to keep everything in house and refer their patients to the nonsurgical aspect of the business, but it was poorly run. It was a grassroots operation at the time with two employees, no website, no system, no infrastructure—no nothing, which was why they hired me. They invested a lot of money, and at the time it was only generating under a half a million. So, I basically came in and treated it like a startup. I think the takeaway is that there's so much opportunity to grow, but you have to have the proper structure internally to do that.
MM: What do you think is the most important factor to your success?
TR: I think you need to have an operational savvy business. You have to train your providers, train your staff, which is an investment, and which is what I see not happening. You have to have the proper software to track and measure your data. You have to have a high-performing website—it’s your virtual brochure on the outside. And then when patients come in the door, you really need five-star customer service to be different.
MM: What is your unique service proposition?
TR: Aside from the physicians and their pedigree and their background, which has credibility, I would say it's our protocols. You can't come into our center without a consultation. We charge for the consultation. You can't get a treatment without prepping beforehand. We have a very systematic approach, which ultimately retains the patients, and they have better outcomes.
MM: What specific metrics do you use to determine success?
TR: We look at the number of new leads coming in. We measure conversion ratios. We measure revenue per hour per provider. We measure no-show rates. We measure retention. Those are the top KPIs.
MM: What's the metric that you look at more than any other?
TR: At the end of the day, revenue. I look at what our goals are for the month, and I look at revenue, new patient acquisition and conversion.
MM: Who Inspires you and why?
TR: Brené Brown. Tony Robbins. I think that it's all about gratitude. It's all about living your best life. It's all about determination. It's all about how failing is okay. Making mistakes is how you grow. And this is a very competitive environment. It's a very commoditized environment, especially where I'm located in Beverly Hills, and it's the ability to seize opportunity.
MM: What do you love most about aesthetics?
TR: I love that it's an area of medicine that can be looked at two ways. It can be looked at as superficial, and it can be looked at as people want to stay youthful and invest in looking healthy. And if we're able to provide such services with quality care and make a person feel better about themselves, that's what inspires me. And that's what makes me feel good about wanting to run a successful operation.
MM: What do you love most about being an entrepreneur?
TR: I love that I can make an impact. I spent 20 years in corporate, and I think it's the ability to make change and to make a difference. I'm humbled that I've had an opportunity to be in corporate, and I've had an opportunity to run a practice and have a case study that's successful, and now I want to be able to give back the things that I've learned and the successes I've had to other practices.
MM: What advice would you give to med spa owners?
TR: I would say that if you don't know something, it's imperative that you ask or seek professionals to help you so you are not making costly mistakes, and do not try to pinch pennies. And you really need to have the proper infrastructure and the proper team in place to have a successful business and to be different and stand out.
MM: What was the goal of the design that you chose?
TR: I think Beverly Hills is the Mecca of beauty, so it's very contemporary. It's very white, very open, very airy. People who are spending their own disposable income don't want to come and have it feel like a doctor's office, so it's very warm. It's very warm and welcoming—not cold. I think it’s important to have a place where they feel very comfortable and that’s aesthetically pleasing since, this is the environment that we're in.
MM: What was your inspiration for that design?
TR: I don't know that I had an inspiration. I hired a phenomenal designer and I had been around other practices to see what that was all about. The inspiration was to make people feel like they’re walking into this warm and inviting place, but yet kind of having that feeling of, “Wow,” right? This is a really, really well-designed, beautiful place. It makes them feel like that's going to equate to the kind of service that we provide.
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