By Alex R. Thiersch, JD, Founder/Director of the American Med Spa Association (AmSpa)
First, thanks to everyone who commented on the latest blog and statement related to The Dr. Oz Show’s segment on rogue medical spas. We received a TON of feedback on the issue, and I know that all of you are equally concerned about some of the shady practices that go on in this industry. I think that the most important takeaway from all of this is the importance of realizing that each of our individual actions—and those of our medical spas and teams—impacts the entire industry. Although most do the right thing, it’s the few bad actors that give the industry a poor reputation. Perception is reality in this space, and it’s time that each of us take responsibility—and action—for the industry as a whole. If we do that, we’ll flourish.
With that said, many have contacted me with questions about what to do when you know someone is breaking the law or not following applicable regulations. When should you report someone? Also, who do you report them to?
This is obviously a very relevant question, but there’s not necessarily an easy answer. First, it’s important to understand that reporting a competitor—or anyone for that matter—to the medical board is a very serious matter and should not be taken lightly. In my opinion, this should not be done unless you know, for certain and without a doubt, that the provider or medical spa (1) knows the law, and (2) is actively choosing not to follow it. If you are not certain of those two things, I would at least give the person or practice the chance to become compliant.
Remember, many started out in this industry not knowing the first thing about medical spa law. When I first started AmSpa, nearly 100% of the med spas I talked to were non-compliant. It is only through education and the hard work of the industry that we’ve started spreading the word about compliance. Nevertheless, there are still hundreds, if not thousands, of med spas operating right now that have never been told—not by their boards, their professors, or lawyers—that what they’re doing is wrong. It’s not that they don’t want to be compliant, they just don’t know the rules in the first place.
This is NOT an excuse for the bad actors out there, as most of them are taking extreme steps that are obvious to all of us as being illegal.
What I don’t want to happen is for the entire industry to turn on itself and start reporting everyone else for every perceived offense without truly knowing whether the rules are being broken. Remember: Once you report someone, the cat is out of the bag. The medical board (or nursing board, cosmetology board, etc.) is required to conduct an investigation. If they find nothing wrong, the charges are typically dropped. But guess what? They rarely find nothing wrong. Almost all medical spas are doing at least one thing incorrectly, because most have had no training on compliance, and the rules that are in place are incredibly complex.
So, here’s the rub: If the boards are inundated with thousands of complaints about medical spas, state legislatures will do their thing and start over-regulating the industry. This could end up being the worst thing for everyone.
I want to be clear about one thing: If you know of—and are completely certain—that a med spa is performing dangerous procedures, intentionally breaking the law, or endangering patients, I absolutely, 100% want you to report them to the state medical board immediately. Do not pass GO—report them right away. You know who I’m talking about. These are the folks that are burning and deforming people; the ones featured on The Dr. Oz Show. Those people need to be rooted out, and quickly.
If you know a practice is behaving in this manner the first step is to a) find out what license the spa or practitioner is operating under and then b) contact the board that governs that license. Typically physicians and physician assistants are governed by medical boards, nurse practitioners and other nurses are governed by nursing boards, aestheticians are governed by cosmetology boards, etc. In some states, like Illinois for example, license holders are governed by a licensing department like the Illinois Department of Financial and Professional Regulation (IDFPR), in which case reports should go to this licensing body.
However, the much harder case is when you think someone is doing something wrong, or if you know they’re doing something wrong, but you’re not sure if they even know the rule. Again, if there’s danger to patients or others involved, report them right away. But if not, I would reach out to them and let them know, respectfully, that the states are cracking down and that you’re worried they are not in compliance. Refer them to AmSpa. Send them an e-mail with a link to their state page. Send them one of my videos. But try, at least once, to get them on the right side of the law. Again, remember where you were two or three years ago. Wouldn’t it have been nice if someone reached out and tried to inform you? Do it, it’s good karma.
And I know what many of you are thinking: “But it’s a competitor! Won’t it be good for me if they get caught and go down?” No, it wouldn’t. For one, it’s bad corporate karma (unless, again, it’s obvious and necessary to report them for public safety). And two, as described above, tons of complaints coming at once is going to make it harder for everyone to survive, including your own business. Trust me, this industry is just getting started. There’s plenty of money for everyone.
What if the provider or medical spa ignores you and continues to knowingly violate the rules, or puts patients in danger? Then I want you to report them immediately. Call your medical board and tell them exactly what you know, because those are the “rogue” medical spas that need to be weeded out.
Hope this helps … AmSpa is here for you, so keep sending questions!
As the use of influencers increases in medical aesthetics, so does the potential for legal missteps. Though this method of marketing is beginning to proliferate all industries, since medical spas offer medical treatment the regulations that govern influencer marketing in this space are more stringent than with large brands you might see represented on Instagram, YouTube, or other social channels.
The power of social media influencers is beginning to exert itself on the medical aesthetic industry. After all, if an influencer goes to a medical spa for a treatment, he or she may film the entire visit and broadcast it throughout the world on his or her social media channels. If the influencer has a large following, this can have a significant impact on a medical spa’s business.
However, such visits are not always the organic, spontaneous situations they are portrayed as being. More and more, medical spas are compensating influencers with cash and/or free treatments in order to get them to portray their practices in a positive light. If your medical spa is engaging in this sort of advertising, it’s important to try to understand the legal issues surrounding these matters, although by and large, precedent has yet to be established, as this is a relatively new situation and a new medium in which these transactions are occurring.
(For more in-depth information on legal issues with influencer marketing sign up for AmSpa’s webinar on the topic.)
Have Written Agreements in Place
For medical spas, it is very important to have a written agreement with the influencer in place. This agreement should dictate what the influencer’s responsibilities are—for example, how many times they are going to post about the practice and what they are going to post. The practice should attempt to have as much editorial control over the posts as possible, since the influencer’s primary goal is to promote his or her brand—not yours—and it’s likely going to be up to you to keep them on message. You have to do what you can to make sure the deal meets your expectations to ensure that you’re getting your money’s worth. Even if you’re compensating the influencer with a treatment only, you need to make your intentions crystal clear, and a written agreement will help both sides understand the nature of the deal. This also helps you to put a value on the services you are providing.
Medical Advertising Rules
Another reason why you should seek as much editorial control as possible is because as a medical provider, the minute you compensate someone to promote your brand you are subject to medical advertising rules and regulations, which are much stricter and have much more dire consequences for violations than common advertising rules. Primarily, this means that you can’t say anything that can be construed as misleading, untrue, aggrandizing, or exaggerated—everything that’s said about your medical aesthetics practice must be provably true. You can’t simply say that you’re the best injector in the world, for example, because you’ll never be able to prove it, so the advertisement can be construed as being misrepresentative.
When influencers are being paid to represent your medical spa (which includes providing them with free services), they are legally acting as a paid advertiser. As such, you’re responsible for everything they are saying, so if they say that your Botox treatment is the best in the city or your medical director is the best doctor in the country, you are responsible for that message, and the situation can get very sticky if a medical board finds out about it. You will need to make sure that the influencer understands that the medical spa is subject to these restrictions and that he or she needs to be careful about precisely what is said in these videos or blog posts. With a written agreement, you can disclaim some of these factors, which allows you to exert some control over the message.
Disclosure Guidelines for Influencers
There are also a few legal issues that the influencers themselves should be aware of for their own sake. In 2017 the FTC issued warnings to over 90 social media influencers regarding required disclosures when being compensated in exchange for coverage, and included some guidelines for compliance. These include 1) Keep your disclosures unambiguous, 2) Make your disclosures hard to miss, and 3) Avoid hard to read, buried disclosures in string of hashtags that are skipped by readers.
Influencer marketing can be a very powerful tool, but it must be wielded with some care in order for your medical aesthetics practice to remain compliant. As I mentioned earlier, the legal aspect of its use in a medical setting is still developing area, so if you’re unsure about how to proceed, be sure to consult with an experienced healthcare attorney.
Intravenous therapy (or IV therapy) is a medical spa treatment that is growing throughout the country, so questions about the law are starting to come in more and more frequently. It has been around in hospitals and medical practices for decades as a means to quickly provide an infusion of fluids and medicines to patients, however with the growth of non-invasive medical aesthetic practices, more business are attempting to offer quick, alternative ways of improving an individual’s health, look and feel.
As such, IV Bars are a growing trend, allowing individuals quick access to hangover treatments via IV hydration with an infusion of vitamins and nutrients. Additionally, some of these facilities offer ongoing treatment to promote anti-aging and revitalization.
What many owners of these facilities do not realize is that the piercing of skin via the IV is the practice of medicine in many states, including Texas. While these procedures are commonly referred to as “cosmetic treatments,” under Texas law, all procedures that involve the injection of medication or substances for cosmetic purposes are considered medical procedures. In fact, Texas law designates them “nonsurgical medical cosmetic procedures.” As such, this limits the ownership of an IV Bar to only a select number of licensed medical providers in many states due to the corporate practice of medicine doctrine, and the supervision requirements over those providing medical services.
Corporate Practice of Medicine
The first major legal consideration is the prohibition against the “corporate practice of medicine.” This is a rule many states have adopted that prohibits lay people or lay entities from employing physicians or offering professional medical services. States that have strong corporate practice of medicine rules include Texas and California. These states, along with several others, explicitly provide that providing the types of non-invasive, elective procedures that an IV Bar does entails the practice of medicine. As a result, this prohibition must be taken into account when setting up an IV Bar.
The second major consideration in establishing and owning an IV Bar is proper supervision. Each state delineates who can provide certain types of medical services, which in Texas, includes IV Bar services. For example, every state generally requires that only licensed physicians perform surgery on a patient, but not all states specifically outline what kind of licensing and training is required for someone to provide elective non-invasive services. However, the Texas Administrative Code (“TAC”), Section 193.17, “Nonsurgical Medical Cosmetic Procedures” does provide additional guidance on supervision and training for Texas-based medical facilities. Based on this rule, IV Bars must follow the same supervision requirements set forth in the TAC.
Based on the above limitations, those non-physicians, wishing to enter into the nonsurgical cosmetic treatments need to make sure they understand the limitations and develop corporate models that are legal under state laws.
Bradford Adatto is a partner at the business, healthcare, and aesthetic law firm of ByrdAdatto. He has worked with physicians, physician groups, and other medical service providers in developing ambulatory surgical centers, in-office and freestanding ancillary service facilities, and other medical joint ventures. He regularly counsels clients with respect to federal and state health care regulations that impact investments, transactions, and contract terms, including Medicare fraud and abuse, anti-trust, anti-kickback, anti-referral, and private securities laws.
For more information and guidance on setting up IV Bars or staffing an IV Bar please contact Brad at firstname.lastname@example.org or (214) 291-3201.
Posted By Alex R. Thiersch, JD,
Tuesday, May 29, 2018
Medical spa owners and operators must maintain an array of insurance coverage to help protect their practices from everything from medical malpractice penalties to flooding. However, there are some types of coverage that medical spa owners may not realize they need until it is too late. Here is a quick look at a few of them.
Businesses didn’t used to have to worry about people hacking into their networks and stealing customer data. Unfortunately, in 2018, cyber security is a major concern for all companies—even medical spas. Cyber liability insurance helps policyholders endure a cyber attack by paying their recovery expenses.
“Its purpose is to help with the notification process, because every individual who could have been impacted by that breach has to be notified,” explains David Shaffer, vice president of Professional Medical, the health care division of Insurance Office of America and AmSpa Medical Malpractice Insurance Program representative. “You have to offer them credit monitoring, and there are going to be legal fees and various other expenses associated with making the situation whole again.”
Cyber liability insurance also provides crisis management and public relations services that can help a policyholder rebuild its name after a cyber security event.
“A lot of my medical spa accounts often wonder, ‘Why is anyone going to be interested in what I have to offer? Why am I going to end up being a target?’” Shaffer says. “Small businesses are the primary target these days for a few reasons. I think the biggest reason is that small business owners are less likely to have a strong defense against someone trying to hack into their systems, as opposed to a larger organization that’s actually going to spend money on building this infrastructure.”
According to PricewaterhouseCoopers, a cyber attack typically costs a small business between $84,000 and $148,000.1 What’s more, 60% of small businesses that suffer cyber attacks close within six months, according to a Champlain College study.2
Cyber liability insurance is available from most business office package insurers, and some malpractice insurers also offer a token amount of cyber liability coverage. And, of course, it can be purchased as a standalone policy.
Employment Practices Liability
If you run a small business, such as a medical spa, it is somewhat likely that at some point, you will be confronted with an employment-related tort—that is to say, a lawsuit filed by an employee who feels that he or she has been mistreated in some way. Employment practices liability insurance covers claims such as wrongful termination, harassment, failure to hire, failure to promote, wrongful disciplinary actions, libel, slander, and any other type of grievance brought by an employee against an employer.
Many medical spa owners and operators overlook coverage for spoilage, but those who have experienced the problems created by a loss of electricity can attest to the fact that this can save a practice a lot of money.
“Most of these facilities are performing some form of an injection, and a lot of those medications need to be kept refrigerated,” Shaffer explains. “If there’s fire or water damage that shorts out the refrigerator and they can’t get into their medications to try and prevent them from spoiling, they need coverage for those medications that have been lost due to the temperature change.”
This coverage can be obtained as part of a business office package policy, but it is not an automatic coverage—it has to either be acquired through a loan endorsement that can be added to coverage or as part of blanket endorsements that are incorporated into a policy.
If you determine that your practice needs spoilage coverage, it’s probably best to purchase a bit more than you think you need, provided you can afford it.
“I had a couple of clients during hurricanes that, while they had some spoilage coverage, they were inadequately insured—instead of needing $10,000 worth of coverage, they needed $20,000, because they did a lot of injection-based services,” Shaffer says. “I would probably say that’s one that needs to be focused on—at least ask to see if the appropriate amount of coverage is there, if it’s there at all. If it’s not, get that taken care of.”
Kybella is an injectable designed to combat “double chins,” and it is becoming extremely popular in the medical aesthetic industry. It is approved by the U.S. Food and Drug Administration (FDA) for treatment of subcutaneous fat under the jaw line and, as long as it is being used in this manner, it should be covered by most insurers. However, some practices are using Kybella to treat fat deposits elsewhere on the body, and that is where coverage problems can arise.
“Because [practices] have notified their insurers that they’re performing Kybella, they believe that it’s a blanket-type coverage that’s being offered to them,” Shaffer says. “All malpractice policies have wording in them that say non-approved drugs and devices are specifically excluded from coverage, so unless they get written verification from their underwriter that off-label services have been approved, the likelihood of them actually having coverage is probably not as strong as they believe.”
Practices that are using Kybella (and any other drugs, for that matter) for treatments beyond those for which they have been approved should consult with their insurers to make sure that they are covered for this sort of use. If not, they should either amend their policy to cover these treatments, which may be possible, or stop offering them.
Making the Right Decision for Your Practice
For most medical aesthetic practices, the amount of insurance coverage they have is dictated by what they can afford. Generally speaking, most of the issues a medical spa will encounter can be covered by malpractice, general liability, property, and worker’s compensation insurance. Policies such as the ones described above sometimes take a back seat to more common insurance types because they aren’t as obviously valuable on a daily basis. However, if your practice can afford it, you may want to consider investing in the more overlooked coverage covered here. After all, you can’t be too safe.
Negative outcomes from medical spa treatments do exist, as highlighted recently by the Doctor Oz Show, though they are few and far between. While there are bad actors in the industry, it is the American Med Spa Association’s belief that the majority of med spa professionals and practitioners are operating in good faith, and with their patients’ best interests at heart.
The Doctor Oz segment, titled “Rogue Medical Spas”, featured some severe adverse outcomes that were a result of some of these bad actors and negligent practitioners. The show reached out to AmSpa for feedback on the topic, and we were happy to provide the following statement highlighting the industry’s commitment to legal compliance and patient safety.
The fact is that the overwhelming number of med spas in existence are extremely safe and provide quality medical care by qualified practitioners. Most med spas are run by physicians and have qualified nurse practitioners, physician assistants, and RNs on staff providing excellent care in accordance with applicable law. The public should be assured that med spas that are run in a compliant fashion are extremely safe, and most med spa treatments have extraordinarily rare incidents of side effects or bad outcomes.
Unfortunately, because the demand for med spa services has grown dramatically over the past five years, the medical spa industry has grown just as fast. As a consequence, there have been some unqualified practitioners entering the industry looking to make money without following the applicable rules. When those bad actors make mistakes and harm people, news coverage of these events invariably follows, and the entire industry suffers as a result. These incidents do not represent the industry as a whole, which as mentioned is comprised overwhelmingly of safe, professional, competent medical professionals.
AmSpa has been at the forefront of dealing with this issue by implementing two strategies – educational articles and videos, and enforcement. For the past five years, AmSpa has been publishing, speaking, and educating both the industry and consumers on what constitutes a safe, compliant med spa. AmSpa is an organization founded on compliance, and its core purpose is to disseminate the applicable rules and regulations so that the industry – and the public – is safe. AmSpa’s website is the only resource where professionals and consumers can obtain information about the rules governing a safe med spa, as unfortunately, the state agencies charged with oversight don’t have the resources to publish, educate or often enforce existing rules. AmSpa’s entire mission is to both publish and educate about this hard-to-obtain information.
In addition, AmSpa has launched an initiative, with the help of medical spa owners, physicians, and regulators, to draft a core set of rules that the industry can universally adopt. This is a complicated process and, although the process has begun, it will take time for these rules to be developed and approved.
In the meantime, there are certain things that the public can and should watch out for when choosing a med spa.
The first is that the public must recognize that medical spas are providing mostly medical treatment. Although some treatments at med spas are non-medical (facials, light chemical peels, light dermabrasions), most of the treatments are medical in nature and should be treated as such. Patients should always be seen by a doctor, a nurse practitioner, or physician assistant, depending on their state. If a med spa offers to treat a patient without being seen by one of those three license-holders, red flags should go up and the patient should seek treatment elsewhere.
Second, patients must do their homework to ensure that the practitioners performing treatments are licensed and trained to perform those treatments. Infrequently, there have been unlicensed, unqualified practitioners who have entered the industry. This is a minute fraction of the industry, but it is also the side that gets the most publicity (and rightfully so, given some of the recent results). The physicians and underlying practitioners must be trained in the procedures they are performing and the only way the public can find this out is by doing some homework. Research the doctor online. Ask for their relevant licensure. Call the medical board and nursing board and look up their license. Get referrals. Because the state agencies tasked with enforcing med spas are overwhelmed with many tasks (the opioid crisis, to name a big one), there isn’t as much enforcement in this area as is needed. So the burden falls upon the consumer – and the med spa owners – to regulate themselves. AmSpa is doing its part, but it’s a big industry and is growing daily.
Third, many of the med spas who perform poor treatments (or offer treatments by unqualified individuals) tend to offer treatments for steep discounts. Aesthetic treatments need to be done carefully and artfully and, as with many things, you get what you pay for. If a med spa is offering highly discounted costs or offering mega deals through discount programs, head the other way.
Finally, most states do not necessarily require a physician to be on site at the med spa while the treatment is being administered, provided that (i) the physician (or nurse practitioner or physician assistant) has examined the patient first, (ii) the physician is immediately available by telephone or other electronic means to respond to questions or emergencies, and, most importantly, (iii) the practitioner who is performing the treatment is trained, experienced, and qualified. But regardless of who’s performing the treatment, there should always be an RN on site, at a minimum, to oversee the procedures. Each state has its own set of regulations about on-site supervision.
I would reiterate that the vast majority of med spa owners and personnel are qualified medical professionals dedicated to helping patients feel better about themselves. This is a great industry and it’s unfortunate that a few bad apples have caused bad publicity. AmSpa is committed to educating the industry and public to ensure all med spas are safe moving forward.
Click here for more information on Doctor Oz segment.
Posted By Administration,
Tuesday, May 22, 2018
Updated: Thursday, May 24, 2018
Injectable treatments like toxins and fillers are central in the medical aesthetic industry, and licensed practical nurses (LPNs) can be valuable pieces of the medical spa puzzle. They typically provide excellent care to patients and can be relied upon to perform a number of non-medical tasks throughout the practice. In many medical aesthetic practices, LPNs even perform injections of fillers and Botox.
Unfortunately for those practices, though, this may create more problems than it solves, since in most states injecting patients falls outside an LPN’s scope of practice. (AmSpa members: check your state’s medical aesthetic legal summary to see who can inject in your practice.)
Before going any further, it’s helpful to understand what an LPN’s qualifications are. An LPN typically has undergone two years of training at a nursing school, and he or she has passed the National Council Licensure Examination-Practical Nurse (NCLEX-PN), which is administered by the National Council of State Boards of Nursing. In terms of the hierarchy of nursing, an LPN comes in below registered nurses (RNs) and nurse practitioners (NPs). An RN has earned a degree in nursing and passed the more rigorous NCLEX-Registered Nurse exam, while a nurse practitioner has done all this, earned an advanced degree in nursing, and passed a national board certification exam.
Of these levels of nursing, only a nurse practitioner is allowed to perform medical procedures in most states and, unfortunately for those who use LPNs to administer injections, most states recognize injections to be medical procedures. Therefore, LPNs should not be performing injections. AmSpa recommends that if your medical aesthetic practice is using LPNs to administer injections, it should stop doing so immediately. If a patient happens to suffer a bad outcome and raises a case with a state medical board, the practice, the supervising physician, and the LPN could be cited for practicing medicine without a license. This could result in severe financial penalties and possibly even create issues with the physician’s medical license.
There is a bit of a grey area here, however. If a physician can prove that an LPN has developed expertise in administering injections, a medical board may see fit to permit the LPN to continue performing these procedures. However, it is nearly impossible for a physician to prove that an LPN demonstrates unusually advanced injection skills, and there is no widely recognized certification specifically designed for injections, so physicians probably should not plan to use this defense if they are caught using an LPN to administer injectables. Physicians and practices should also be wary of LPNs who profess to have an expertise in this area.
It may seem like a good idea to use LPNs to perform injections of fillers and Botox, since doing so conceivably frees up more highly paid nurse practitioners and physicians to perform more lucrative procedures. However, doing so may very well place your practice in peril. Consult an experienced health care attorney to learn about the minutiae of the matter in your state, and stay tuned to AmSpa for any further developments in the matter. LPNs are valuable members of medical aesthetic teams; however, as with all medical spa employees, they must stay within their scope of practice in order for businesses to remain compliant.
(Author’s note: The American Med Spa Association (AmSpa) works with the national law firm of ByrdAdatto that focuses on medical aesthetic legalities and AmSpa members receive an annual complimentary legal consultation. Become an AmSpa member today!)
Posted By Eric Atienza,
Tuesday, May 8, 2018
Updated: Tuesday, May 8, 2018
If practice ownership is your objective, then your first step in reaching that goal is to develop a well-thought-out business plan that establishes the viability of your proposed venture. A business plan details the financial structure and day-to-day operations of your practice. It demonstrates that you have a realistic roadmap for success based on carefully considered ideas about how to develop and manage your business.
Here are five good reasons why developing a business plan is critical:
1) Helps you achieve your goals
Experience has shown that people who document their plans are generally more likely to achieve their goals as non-planners. Actually taking the steps to create a written plan - to think, dream, and research and document your objectives potentially increases the likelihood of ultimately reaching your destination and controlling your business career. In addition, developing a business plan helps you better understand your business. It informs you of your practice's place in the market, so you know the actions that need to be taken to improve and grow your business.
2) Allows you to be proactive
A business plan helps you see potential risks in the market and develop strategies for responding to them. Rather than simply reacting to whatever changes come your way - whether they emanate internally or from outside influences - you have a roadmap that defines precisely where you want to go. You therefore know how to respond to inevitable fluctuations in the business environment. Without a documented plan, your practice is essentially rudderless, with no destination in sight and no guideline for responding to unforeseen circumstances, such as a significant drop in the market, or new technology opportunities.
3) Functions as a communications tool
As a business owner, you may need to borrow funds or hire service providers at some point in your career. Your business plan is an indispensable tool for communicating your business objectives to lenders, contractors, equipment vendors, and others who need to understand your practice vision. The business plan serves as an introduction to you and your practice. It tells your lender that you have the personal know-how and professional means to help ensure practice success. It demonstrates that your future practice is based on a solid grasp of both the local market and outside influences. And it provides the financial rationale for lending funds for your practice purchase or start-up based on historical or projected performance.
4) Provides a competitive edge
With a documented vision of your future in hand, you will be better prepared to take on existing competition as your business plan describes the marketing activities you will use to announce your opening, attract patients, and grow your practice. You will also have a jump-start on new competition - namely, all those graduates who have not yet formulated their career plans.
5) Forms the basis for an exit strategy
A business plan is not only a roadmap for you, but also for your potential buyers. It helps them understand how your practice evolved, whether it met or perhaps exceeded expectations, and whether your vision for future growth was realized. If you sell your practice before your business plan is fully implemented, it can serve as a useful guideline for future owners to further develop the practice.
There are many more excellent reasons for creating a business plan - for example, to share your vision with family members and employees, build a framework to help attract new associates or investors, and provide a foundation for practice valuation. In summary, careful formulation of a business plan will help you focus your vision for the future and ultimately enhance your success. If you don't already have one, get started working on your business plan today.
Visit the Wells Fargo Works for Small Business® and the Business Plan Center page for more information: wellsfargoworks.com/plan.
About the Author
Greg Owens is the Regional Manager East for Wells Fargo Practice Finance. As an experienced consultant and finance expert, he speaks nationally to healthcare professionals advising in practice planning strategies for emerging and established practitioners. His industry background offers practitioners a unique perspective as they approach some of the most important decisions in their professional lives. With more than 25 years of healthcare experience, Wells Fargo Practice Finance specializes in helping healthcare professionals acquire, start and expand their practices with various financing options and a signature Practice Success Program.
Posted By Administration,
Saturday, May 5, 2018
Updated: Friday, May 4, 2018
By Alex R. Thiersch, JD, Founder/Director of the American Med Spa Association (AmSpa)
Alex: Congratulations Terri Ross on being selected AmSpa’s Member Feature of the Month! Tell us about your med spa, Lasky Aesthetics & Laser Center. What’s been going on?
Terri: Growth. Exponential growth. I’m really proud that we’ve hit the 3 million dollar mark in just 3 years. We’ve brought on new providers, new treatments and services, and really just learned how to perfect the infrastructure.
Alex: Lasky Aesthetics seems like a fairly laser-heavy practice. What’s the biggest money-maker treatment in your med spa right now?
Terri: Definitely Laser Skin Resurfacing, Alma Fractional, Skin-Tightening, and CoolSculpting.
Alex: Were these treatments a conscious choice of you based upon numbers. or was this just kind of the way that it happened?
Terri: Lasky is a little unique. Four Doctors own it and when they developed the business back in 2010, they all had their own practice off-site. They did their own injectables, so by default the practice became laser heavy. They kept their own patients. It was a grass-roots business at the time.
Well that failed. When they brought me in on 2014, the med spa was doing about a half million dollars. Realizing that we had to make a shift in the business infrastructure, I came in and really treated it like a start-up. I re-evaluated the overhead, the cost of goods, figured out what treatments were yielding the most money, learned what the patient market demand wanted, and decided what was best to do different.
Alex: Do you still offer injectables? Or, is it mostly laser treatments?
Terri: We do. It’s just a smaller percent of the business. But we’re finding that it’s allowed us to become a niche. We really are known for treating very difficult skin conditions. As a provider, if you don’t have that kind of a background or have years of experience as an extender, then you don’t have the skillset to diagnose. It’s blended well for us.
Alex: Okay, you can’t name yourself in this next question, but what do you attribute to being the number one factor of success for Lasky? #LLC
Terri: It’s honestly the hiring of impeccable staff and investing in them. We’ve heard this throughout the last couple of days here at the AmSpa Boot Camp, it’s about good staff. Having them trained properly, adequately understand what treatments you offer, customer service, and just business acumen. Whether it’s me or anyone else. This is not an easy business to be in. It’s highly competitive, especially in Beverly Hills. Utilize the resources that are available, especially with AmSpa.
Alex: That’s what we do here at AmSpa! Thank you Terri for your continued support and we wish you the best of luck in the future success at Lasky.
If you were to create a Venn diagram displaying the relationship between retail sales and medicine, the overlap would represent the medical aesthetic industry. It’s a unique business model that requires the combined efforts of physicians who are experts at treating people and salespeople who excel at getting people in the door.
However, many physicians find the sales side of the equation difficult to engage with. Typically, doctors are taught that medical treatment is not a commodity to be sold—it’s something that is provided when needed. Therefore, when sales enters the equation, as it must in the medical aesthetic business, physicians tend to feel a bit skittish about it.
But sales, at its core, is about building trust and providing education, which in and of itself is not as pernicious as many medical professionals perceive. These people should not be afraid of selling, because all they’re really doing is providing information and building trust so that a patient can make his or her own decision regarding their care. They don’t have to engage in the sort of oily salesmanship they fear if they don’t want to.
For the purposes of medical aesthetic practices, sales are vital. Successful medical spas have established ways to attract and retain patients, and they involve everyone in the practice, from the physician to the receptionist. That requires sales, and it needs processes to work as efficiently as possible.
However, doctors and nurses may be hesitant to engage in sales, because they feel that by doing so, they are in essence forcing treatments upon patients. I’ve heard physicians say that they never sell to anybody, because they don’t believe selling medical treatments is appropriate and never want to feel as though they are using their expertise to profit from a patient who doesn’t know any better.
I can see why they would feel this way, but if properly practiced, selling is not exploitation. Effective sales and marketing is not about forcing anything on anybody. In fact, it’s the opposite—it’s building trust between the provider and the patient, and providing the patient with information so that the patient can make his or her own decision. When doctors are selling most effectively, they are giving their opinions and developing trusting relationships with their patients.
The most effective sales tool at medical spas is a very sincere belief in the services being provided, and that belief must also be shared by everyone working there. Everyone must provide all the information that patients need, so that the patients develop trust and feel comfortable. In time, they’ll make the decisions that are best for them. There’s nothing underhanded about this. Sales equals trust plus education.
Physicians who are skittish about sales should consider that if you’re doing it right, you’re not really “selling” anything—you’re simply giving the clients the tools to make their own choices. It’s absolutely vital that aesthetics practices have this in their toolbox and have a structure for it, because if they don’t, another medical spa absolutely will. Successful practices understand that sales in this space is about education, and they have ways to track what is resonating with clientele and what is not.
Doctors and nurses need to get over their fear of sales by recalibrating their perception of what it means to sell. Simply suggesting a course of treatment and providing supporting information is not nefarious if the doctor doing this genuinely believes in what he or she is saying. You don’t need to get down in the muck if you don’t want to. A physician who shoots straight and tells the truth is likely going to find more success than one who always says what the patient wants to hear in order to make a buck.
Posted By Administration,
Wednesday, April 25, 2018
By Alex R. Thiersch, JD, Founder/Director of the American Med Spa Association (AmSpa)
These days, it is not at all unusual to hear experts talk about how certain generations of people are affecting business. You’ll hear about how the wealth of Baby Boomers impacts the economy as they enter their retirement years. You’ll hear about how Millennials are driving markets and marketing with their somewhat inscrutable spending habits. And you’ll hear about how Generation Z is getting things done using social media and moxie; we featured a look at Generation Z a few weeks ago, in fact.
However, you don’t hear a lot about Generation X—the post-Boomers who came of age in the late ‘80s, ‘90s, and early ‘00s. The youngest Xers are currently staring down middle age and, as boomers continue to retire, they are the ones who are going to be in charge, if they aren’t already. CNBC.com recently published this piece by Stephanie Neal and Richard Wellins, which describes how and why members of Gen X are quietly beginning to dominate leadership positions in businesses.
One of the key takeaways of this article is that while Millennials are typically considered to be the most tech-savvy generation to date, Generation X is, if anything, even more plugged in. On Facebook, Instagram, and YouTube, many of the “stars” are Millennials, but Gen Xers are just as connected—they always have a phone in their hand, and they’re always on the Internet. They don’t produce as much content as Millennials, but they’re just as adept at viewing and manipulating it. Many of them came of age just as the Internet did, and they played significant roles in its evolution. But because many of them began their careers when the internet played a much smaller role in business, they inherited many of the same character traits as the Boomers—they are industrious, hard-working, and entrepreneurial. They feature useful traits of the generations directly before and after them—a combination of the analog and digital, if you will.
As a result, and as a consequence of their age, Gen Xers are going to have an enormous impact on business—including the medical aesthetics industry—for the foreseeable future. They’re going to be running medical spas, device manufacturers, and marketing firms for many, many years to come, so their influence is underestimated at one’s peril. Consumers drive business, and since Millennials are such an enormous population, they’re very important in this regard. But many of the people running businesses and pushing them in exciting new directions are Gen Xers.
At AmSpa’s Boot Camps (join us in Denver on May 19 and 20) and The Medical Spa Show (save the date—February 8 - 10, 2019), the overwhelming majority of the medical spa owners I meet are Gen Xers. They’re in their upper 30s and 40s, and they’re getting things done. Understanding how these people think is going to be a key to finding success, especially in terms of establishing business-to-business relationships. So don’t sleep on Generation X—understanding them is going to be very important for a long time.