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How Do You Name a Medical Spa in New York (And Elsewhere)?

Posted By Administration, Wednesday, August 7, 2019

new york city

By Patrick O’Brien, JD, legal coordinator for the American Med Spa Association

Choosing a name for a new business is one of the more difficult decisions entrepreneurs have to make, and this is especially true in the medical aesthetic industry. A medical spa needs a unique and memorable name that conjures thoughts of vitality, health and beauty, but it also must follow the rules for naming medical and professional entities. As we’ve discussed in the past, most states consider medical spas to be medical practices, and every state has its own rules or standards when it comes to naming and advertising medical practices.

New York state has particularly stringent rules regulating physician advertising. Fortunately, the New York State Office of the Professions provides a useful resource for navigating the rules for naming a professional entity in the state. While these rules are specific to New York, the concepts are similar in many other states.

The requirement that the name of a professional entity must appropriately describe the profession and the professional service being offered is the first and largest hurdle to overcome. In the medical spa setting, the professional services being offered will be “medicine” or “medical”—or, for independent nurse practitioners, “nursing.” But these terms are very generic and don’t accurately convey the type of experience and services offered in most medical spas. To provide a better description, you might be tempted to use terms such as “aesthetic,” “esthetic” or “anti-aging” to describe medical spa services, but these terms fall under the “specialty area” naming rules in New York. Essentially, if you want to use a special branch of a profession—in this case medicine—the Office of the Professions requires that you submit proof of certification in that specialty practice. While physicians may obtain board certifications in dermatology and plastic surgery, practicing in the area of aesthetic medicine does not come with specialty board certifications.

Could you add “medical spa” to the end of the name for your professional entity? Using the term “medical spa” reflects the required “medical” professional practice area, and “spa” makes it clear to the public what types of aesthetics services you plan to offer. This seems like a good alternative, but, unfortunately, the term “spa” in connection with “medical” are among a list of words specifically prohibited as being misleading in New York. And it isn’t only “misleading” terms that are prohibited: Professional entity names cannot suggest an affiliation with another entity or imply professional superiority. Therefore, whether intentional or not, the chosen name can’t be too similar to the name of another entity, and it also can’t include ideas such as “best,” “advanced” or “expert.”

To add an additional twist, New York medical spas face the same restrictions when choosing an assumed name under which to practice, also known as a “doing business as” or “d/b/a” name. Many states have particular rules in naming the registered professional entity, but they often allow more flexibility in using assumed names. This is not the case in New York—the assumed names of professional entities must follow the same naming requirements.

While New York is particularly strict, each state has its own rules that govern business naming, especially for businesses that provide medical services. Before you spend valuable time and money on signage, web design, advertising and marketing, it is important make sure that you choose a name that complies with your local and state laws. If you want to learn more about effective medical spa marketing and business practices, attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps.

Tags:  Business and Financials  Med Spa Law  Med Spa Trends 

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QP Extra: Q&A with Eliza Parker, MD, of Cadella Aesthetics and Wellness Center

Posted By Administration, Friday, August 2, 2019

Eliza Parker of Cadella Aesthetics

At Cadella Aesthetics and Wellness Center in Chicago, a medical aesthetic treatment is just part an overall experience that’s designed to help patients not only look better, but also feel better. Practice owner Eliza Parker, MD, recently spoke with AmSpa Content Writer/Editor Michael Meyer about how Cadella came to be and how its customer service helps sets it apart.

Michael Meyer: What inspired you to open your practice?

 Eliza Parker: I really love what I do. So there are a couple things. One, I love the artistic part of aesthetics. It's just so much fun to restore and rejuvenate how people look and feel. I think also, coming from intensive medicine, I love the wellness side of the approach. You're seeing people and you're making them feel good, and they're coming from a healthy place. It was a really nice change. And also, I just love people, and if you like people, this may be one of the best industries to be in, because throughout the day, you meet so many people from different walks of life who are doing different things. It never, ever gets boring. It's so fun.

MM: What would you say is different about your practice now versus when you opened it?

 EP: It's really evolved and developed and grown on all fronts. When you first start, you have a vision—I can keep this so simple, and I'm not going to have to do X, Y, and Z. And then you learn that you have to do X, Y, and Z, and it gets more complicated, but it also gets richer. Experience changes everything—not only with patients, but also with the business and with how you outreach, with how you manage goals and all these various parts of it. And the more people you meet and talk to any industry, the more you see things that you do and don't want to do—I think there are as many don'ts as there are dos. You think, “I don't think that's the way I want to go,” but you have to try. I feel like as you try different things, the business grows really fast. When I first started, I kept it very simple. I had a very straight idea of how I wanted to grow. Now it is at the place where I have this very mature, experienced staff. I have a very well-established business model, and it makes it so when we add something new, we have all this infrastructure to grow with. I think it's just very solid. It's awesome.

MM: What is your most popular treatment?

 EP: It's definitely my liquid facelift. If you just walk into a med spa off the street, you won't be able to get those kinds of long-lasting results. But to actually get a nonsurgical liquid facelift, it changes people's whole perspective of themselves. For me, it's just so much fun because I can take pictures of how they looked 20 or 30 years ago, and we can restore that. They're always so amazed that you can recreate what they were and keep that moving forward, and it definitely brings in the most revenue for sure. I think fillers are an amazing way to make transformational change, and the time it takes to do them is less exhaustive than some of the other procedures.

MM: What would you say is the most important factor to your success?

 EP: Loving what I do and finding staff who love what they do. I have had all of the ups and downs, but when you get people in different positions in your business who truly love to come into work every day, it just naturally grows exponentially. That's, I think, why it's gone in such a positive direction. We have a mission statement—we go through it every team meeting, we all are on the same page and I don't feel like everyone has different goals. We all are working with each other for the same goal, so it works well.

MM: What makes your medical spa different from others?

 EP: It's hard to say, because I don't personally go to a lot of other medical spas, but what I hear from my patients is that they feel like they're really well taken care of. We tend to really try to find out what the patient wants and needs. What is going to make their experience better? It may have to do with us changing their parking position, or it may mean we have to help them get to their next appointment and call ahead. How can we make their day better? We actively try to look at how we can improve not just their Botox experience, but also their life. We truly do care, and I think it comes across, and I think patients feel that way. It's very intimate, and we know everybody. Even though we are very big, we really work hard at making everything very personal.

MM: Who inspires you?

 EP: I'm constantly reading books, and I get them from different people who I'm working with, or one book leads to the next. I think being well informed is always key, but I would have to say the thing that really keeps propelling me is my patients. There's so much information you get every day from every encounter that propels this business, and it is inspirational. You meet people and hear their different stories, and if you really analyze every single one, it can also make you crazy, because if you have a lot of bad experiences you may not feel inspired. But at least for me, most of the time I find my patients extremely inspiring.

It's also my kids. I created this business and used their names—Cadella is a combination of my daughters’ names—and I know this whole business was forged with them in mind; that always inspires me. And working with people who I enjoy working with inspires me. I think it's definitely a lot of factors.

MM: What do you love most about aesthetics?

 EP: A couple things. One, the field is growing daily, so it's very, very fun. There's so much innovation. It's not stagnant or boring. Every couple of months, somebody's got some new product, some new device or some new way of trying to improve the aging process, so it's never boring. I think that every single person you treat reacts or responds slightly differently, so you're applying new algorithms for each person, so it's not boring. Also, you're making people really happy. What's not to love about that?

MM: What do you love about being an entrepreneur?

 EP: It's the best, because you come up with ideas and then you try them out, and you constantly are going for it. When I started, I was so frightened because there are so many big financial risks you take in this field. It's kind of hard to believe that I did it. But you take these financial risks, and then you don't think that failure is an option, and then it doesn't become an option and you just make it work. I think that once you've learned that you can do that, you start applying it to all parts of your life. I think that's one of the best parts, for sure. I love it.

MM: What was your goal with the interior design that you chose?

 EP: It’s just my taste. I love it. I wanted to make it very relaxed and refined for my patients, so when they come here, they feel like it’s private and they can feel safe. I also wanted to make sure they feel that they are not stuck in some random waiting room. I wanted them to feel fairly relaxed, like this is a place that they're welcome to come any time. I wanted to make them feel like it was more than just a medical office—it’s a very safe space and a really pleasant space to be in.

interior design

MM: What advice would you give to other med spa owners?

 EP: If you think it's a get-rich-quick scheme, you are wrong. It is not. You can do very well financially, but it costs a lot. Your motivations for doing it have to be aligned with loving it. If you're doing it because you want to make a lot of money, I just don't think that's a great approach and I haven't seen people who have that attitude do very well. I've seen a lot of people fail at this business and I’ve seen a lot of people succeed, but I've seen more failures than success. So I think you should know, right from the get-go, that this is not a cookie-cutter, easy business to jump into. The patients, the consumers, are extremely savvy. They have a lot of choices. You have to be really good at what you do if you want to be successful, and it's going to take as much time as any other profession to get good at it. It's not easy to find an injector and make a ton of money off Botox—you have to find an amazing injector, and then, over time, you will make money.

Also, talk to colleagues—it needs to happen so much more than it does. I've had the privilege of being in a group of medical spa owners—we meet and talk about our failures and our successes, and it really expedites growth. I think people tend to stay quiet and think that they are coming up with the only solution, and they don't want to share because they want to be the only one to have it. I think that's a really sad approach. I feel like if we're all talking together, everyone moves faster, and patients are going to choose who they want, no matter what you do in your business. There are enough patients for everybody. There's plenty of business out there. It would be so nice if people were more open.

AmSpa members receive QP every quarter. Click here to learn how to become a member and make your med spa the next aesthetic success story.

Tags:  Business and Financials  Med Spa Trends  QP 

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The Aesthetic Platinum Rule

Posted By Administration, Thursday, August 1, 2019

By Tyler Terry, vice president of sales, TouchMD

In life, it's said that living by the Platinum Rule will ensure that you're optimally treating your fellow man the way that he or she wants to be treated. For those who have never heard of the Platinum Rule, it means you should treat others the way that they want to be treated. We've all heard of the Golden Rule, which states you should treat people the way that you want to be treated. The Golden Rule has good intentions, but it's not attending to the core of what really matters, which is how the person with whom you’re interacting wants to be treated.

When it comes to consulting your patients, the Platinum Rule couldn't be more valuable. This simple guideline will help you maximize each and every consult by treating and consulting your patients the way that they want to be treated and consulted. One key to bringing this rule to life is to take a picture of your patient and give him or her access to that picture to look at and draw on while he or she is waiting in your consult room. This can simply mean printing off their picture or having that picture pulled up on an iPad or computer and allowing the patient to circle any areas of concern. The talk track would go something like this: “Ashley, while you're waiting, the doctor would like you to circle any areas that you would like to enhance. This will help us provide the very best consult, leading to excellent care and satisfaction of your treatment plan.” At this point, Ashley would have the opportunity to look at her picture subjectively and point out what she feels is most important for her overall satisfaction.

After implementing the Platinum Rule in your consultations, you will be amazed at what your patients point out and share with you. They are essentially telling you how they would like to be treated—telling you how to sell to them—and giving you the opportunity to consult them as the expert. By doing this, you are providing them with the treatment plan that they specifically want and need to feel good about their treatment and experience with your practice.

The Platinum Rule allows your patients to be the “compass” of their aesthetic journey with your practice and allows you to be the “captain” of the consult, as you feel confident navigating through the various stages of the patient's journey. This rule can be applied to so many aspects of our lives. The key is to be willing to genuinely ask and listen.

TouchMD is a visual consultation, marketing and imaging software utilizing touch-screen technology that enhances the patient experience with proven revenue generation.

Tags:  Business and Financials  Guest Post 

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Front Office Training: 7 Steps to a Positive First Impression

Posted By Administration, Wednesday, July 31, 2019

By Terri Ross, Terri Ross Consulting

When you first walk into a medical office for an appointment, what are your expectations? How do you want the staff to greet you, and what are some of the things that make you say, “I’m never coming back here again”? As a business owner, do you meet those expectations? The front office is often a patient’s first glimpse into the workings of a practice, and if a patient has a positive experience with your front office staff, it sets the stage for a positive experience overall.

As with any business, effective communication in the medical aesthetic office is key. The first interaction you have with potential patients is often a phone call. Office staff should be trained on how to begin and execute a productive and engaging phone call. In their interactions with patients, front office staff should strive to be enthusiastic, knowledgeable and engaging.

1. Be enthusiastic, engaging and confident: A positive attitude is infectious and an important element of success in any business. This article from the Huffington Post explains the importance of a positive attitude in business. Convey a positive attitude, speak and articulate information with confidence, and engage the patient in dialogue to ensure you have gathered all of the facts about them and what they are requesting. This will set you apart significantly from others practices that don’t invest in training their staff. 

2. Listen first: Listen to prospective patients—assess their needs and desires before pitching a service or treatment. Strive to make a genuine connection with each patient. You want to “land the patient.” See TSIA’s explanation of the Land, Adopt, Renew, Expand (LAER) model here. The LAER model I teach is Listen, Acknowledge, Explore, Respond. Most often, people tend to listen and respond without really understanding  patient needs. Explore more details, show empathy and acknowledge that you fully understand what the patient is telling you.

3. Ask questions: Your ability to connect, ask questions, and engage with potential patients is critical. The medical aesthetics space is very competitive, and the consumers are very educated and have numerous resources to explore. They also have many choices, so your ability to articulate with conviction by credentialing the business and providers, as well as knowing the products and treatments you offer over the competition is paramount to a prospective patient wanting to schedule with you over another office.  

4. Never say no: If a patient asks if you offer Ulthera and you don’t, do not say no, or you’ve lost them. Instead, say, “May I ask who is calling? Hi [patient name]—so you are interested in skin tightening, is that correct?” This means you must know your technology and your competition and be able to effectively convince them that what you offer is equally as good if not better than another option. More importantly, your knowledge and skill set will make them want to schedule with you. If that doesn’t work, ask if you can follow up with them.

5. Respond to patient needs in a timely fashion: If a patient calls or emails with a question or need, make it a point to respond immediately—usually within 1 ¬– 3 hours, or 24 hours at the very latest. There are several different types of patient inquiries, and one of them is new leads. This is critical, as they are shopping but haven’t yet decided on your practice. Current patients are the ones who know you, trust you, and already have a relationship with you. However, communication with current patients is equally as important, as this helps to establish patient retention. If a patient asks a question to which you don’t immediately know the answer, say that you are searching for the answer and will respond as soon as possible. This lets them know that they are important.

6. Be the expert: It is essential for you to know every product and service offered in your office. Do your homework. You need to know every treatment: What it does, what it’s used for and how it can be incorporated into a personalized treatment plan. By knowing your services and how they compare to your competitors’, you engage patients and make them feel they have landed at the right office.

7. Go beyond what is expected: In attitude, knowledge and service, go beyond the patient’s general expectations. Make sure the patient has a positive experience from start to finish. Are you the Four Seasons or the Marriott?

Now that you’ve read these seven steps, picture yourself as a patient walking into your office, and ask yourself if you’d return for a next visit. Even if you’ve answered yes, there might be some room for improvement in certain aspects, and I want to make sure you have reached the point of a perfect first impression. Please download the complimentary checklist to evaluate where the holes in your staff training might be.

Is your office running at maximum capacity? Have you invested in staff training or sales consulting? Click here to download 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.

Tags:  Business and Financials  Compliance is Cool  Med Spa Ownership  Med Spa Trends 

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Alabama Board of Medical Examiners Publishes Statement on Use of Lasers and Other Devices

Posted By Administration, Tuesday, July 30, 2019

coolsculpting blog

By Patrick O’Brien, JD, legal coordinator for the American Med Spa Association

The most recent issue of the Alabama Medical Digest (published July 24, 2019) contains an interesting article that clarifies the Alabama Board of Medical Examiners’ stance on the use of lasers, intense pulsed light (IPL) and other energy devices that affect living tissue. According to the article, it was motivated by the number of questions the board gets about what devices a non-physician can use and how new technologies, such as CoolSculpting, are treated. (A portion of these questions were very likely mine!) To provide answers, the article relies heavily on the board rules under Chapter 540-X-11 of the board’s administrative code, titled Guidelines for the Use of Lasers and Other Modalities Affecting Living Tissue.

On new devices and technologies, the board’s position is that any device that is capable of affecting the tissue below the stratum corneum is a medical device regardless of the particular energy or technology used. Such devices must be used only by a physician or someone under a physician’s delegation and supervision. In this case, cryolipolysis devices such as CoolSculpting and radio frequency heating devices such as Exilis would be considered medical devices and would fall under the board’s rules—specifically the 540-X-11 guidelines. 

These guidelines divide energy- and chemical-based treatments into two broad categories: ablative and non-ablative. Ablative treatments are those that are expected or intended to remove, burn or vaporize tissue. These procedures and treatments may not be delegated to non-physicians and can only be performed personally by physicians. Non-ablative treatments include all other uses of lasers, energy or chemicals, as well as laser hair removal. Under the rules, non-ablative treatments may be delegated to non-physicians in some circumstances—the physician must examine the patient, establish the patient’s treatment plan and sign the patient’s chart, after which the treatment can be delegated to a person who meets the education requirements under chapters 540-X-11.07 or 540-X-11.08. When delegating these treatments, the physician must provide onsite supervision, meaning he or she is physically present in the facility and available to immediately respond if needed. However, when this treatment is delegated to a physician assistant (PA) or a nurse practitioner (NP) who practices at a remote site, the physician is not required to by physically onsite, but still must complete the initial patient examination, treatment plan and chart signing steps.   

The article also touches on the use of telemedicine when the physician performs the patient assessment and examination. The board states that the physician is able to utilize telemedicine for these exams, provided it meets the same standard of care as if the physician were seeing the patient in person.  However, as the article notes, using telemedicine in these cases make little practical sense when the physician must be onsite anyway to supervise the treatments, although telemedicine could be used for PAs and NPs at remote practice sites where the physician’s physical presence is not required.

In all, this article does not drastically change the practice landscape in Alabama. In fact, Alabama AmSpa members familiar with their State Legal Summary will not be surprised by the positions of this article. It does, however, give additional insight to how the Alabama Board of Medical Examiners views its duties, as well as serves as an important reminder that medical and nursing boards across the country are increasingly aware of and taking action in the medical aesthetic industry.

Tags:  Med Spa Law 

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Microneedling Joins Toxins and Fillers as a Leading Medical Spa Treatment

Posted By Administration, Monday, July 29, 2019

procedures

By Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa)

It should come as no surprise that injections of botulinum toxin and hyaluronic acid fillers are the treatments most commonly offered by medical aesthetic practices. After all, they provide good return-on-investment (ROI) and are constantly in demand. According to the 2019 Medical Spa State of the Industry Report, 88% of respondents’ medical spas offer botulinum toxin. Furthermore, 73% of respondents’ medical spas cite it as being among their top three most frequently performed treatments, and 56% state that it is the most common treatment for first-time patients.

Hyaluronic acid filler injections are similarly widely available—they are offered by 88% of medical spas—but are not quite as widely administered, appearing in 58% of med spas’ top three most frequently performed treatments.

In the 2017 version of this report, botulinum toxin and fillers were combined as one option, and they were found to be available at 82% of medical aesthetic practices, so their availability is still growing.

And while it finished fourth in terms of availability, microneedling’s ascent into the pantheon of medical aesthetic treatments is perhaps the biggest story of this report. In the 2017 survey, microneedling was mentioned on only a handful of responses; today, it is available at 84% of responding medical spas and is among the top three most popular treatments at 20% of them. 

AmSpa Basic Members receive an executive summary of the 2019 Medical Spa State of the Industry Report, while AmSpa Plus Members receive the entire report. Click here to learn about this and all the other great benefits of becoming an AmSpa Member, and sign up today.

Tags:  AmSpa's 2019 Medical Spa Statistical Survey  Med Spa Law  Med Spa Trends 

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QP Extra: Q&A with Vic Owoc of Ageless Medical

Posted By Administration, Friday, July 26, 2019

ageless medical

“You can't manage what you can't measure,” says Vic Owoc, MBA, co-owner of Ageless Medical in suburban Fort Lauderdale, Florida. Since the practice opened in 2006, he has used his expertise in metrics to make it exceptionally successful. Owoc recently spoke with AmSpa Content Writer/Editor Michael Meyer about his history in the medical aesthetics industry and how he maintains his practice’s success.

Michael Meyer: What inspired you to open your practice?

Vic Owoc: Before opening up this business, I was involved in a health and supplementation business called Vital Pharmaceuticals. The business has really grown quite a bit now. I don't know if you've ever heard of a product called Bang energy drink or Redline—they just surpassed Rockstar as the number-three energy drink. So prior to this I was involved in that business, and we had some anti-aging products, as well as a lot of health and fitness-related products. So when I met Erin (Owoc, ARNP)—she's my partner in this and she's a nurse practitioner—it was a very natural progression, once I sold off that business, to the whole idea of health and making people look their very best. Moving over to a medical aesthetics practice was fairly logical for us. Erin had been doing procedures—Botox and hair removal and tattoo removal and all that—for a dermatologist for quite some years, and me being more the entrepreneur, I had several small businesses before we opened up this. We thought it was such a great fit. I had the business background and the entrepreneurial risk, and she doesn't have a lot of that, but she had a great following and a lot of knowledge in this area. So together we thought it just was a wonderful fit for this type of business.

MM: What would you say is different about your practice now versus when you opened it?

VO: The size of the business, certainly the number of patients and our location. We ended up buying our building, as well—one thing that I think is very important in this business is to own the real estate. Part of it was moving out of an area that was a smaller strip mall area to something that was bigger and had much more of a professional look and feel to it.

MM: What is your most popular treatment?

VO: We've got eight areas of business here, and I run this almost like eight different businesses. We've got our medical-grade products business. We've got a Botox, Dysport and Xeomin business. We've got our dermal filler Sculptra business. We've got a laser hair removal business. We’ve got a tattoo removal business. We've got a fat reduction business. We've got an aesthetics business, which is your facials, Hydroderm and SkinPen. And then we've got a medical aesthetics business, and that's where we have the more advanced stuff, including CO2 and Vivace and IPL and laser resurfacing—things typically an aesthetician can't do. I've always run this business as multiple businesses, so I can tell how this particular business is doing, what kind of marketing we're doing for this particular business, etc. I always say that our business is doing the best when all eight cylinders are running. 

But to answer your question, as far as revenue, it's fairly well balanced. The top three would be, the injectable businesses—your Botox, Dysport and all that, and then your dermal fillers. That is probably 30 – 40% of our business. And then from there, it's pretty much all balanced out. Our aesthetics business, 15%; hair removal, 15%; medical aesthetics, 15%; fat reduction, 15%. I've tried to get everything balanced together because you don't want a business—at least I don't want a business—where you've got all your eggs in one basket. Then, all of a sudden, a product comes out—for example, it could be topical Botox, which a lot of people are talking about. If you had 70% of your money in injectables, you're like, “Wow, I'm taking a big hit.”

So I believe in running a balanced business, like all eight cylinders in a car. But today, the injectable business is still the most profitable, if you had to break that out.

MM: What do you think makes your spa different from others?

VO: If I look at the competition, the biggest thing that I see is the discounting—trying to get patients by lowering price. It's a different type of patient. Yes, we'll have promotions here and there—not that often—but we're not going to discount lower than the next guy to get business. We don't want that type of patient. I hear it from some from some of the patients when I do a survey—your prices are a teeny bit higher, but I go there because of Lisa. I go there because of Erin. I go there because of how great the front desk makes me feel. When you start discounting, you train people to look for that. When I look at other practices that are continually having promotions and trying to bring people in through pricing, that's not what we do.

MM: What specific metrics do you use to determine success?

VO: I'm kind of a metric maniac. I start with daily metrics—how many leads have come in and how much revenue is coming in. Those are metrics that we manage by. And then how many of those leads that have come in—and this starts going on more of a monthly basis—come in for consults? How many of those leads as consults come for business? That's a very important metric for me because it allows me to say I'm spending this amount of money on this particular type of marketing, and who's coming in, how many are coming in, the percentage that is coming in for consults and how many who are coming in for consults are coming in for procedures. So that's a big metric area that I look at.

As far as other financial metrics, at the end of each month, we look at every single service that we do compared to how that service did last year and the percentage of business—like I said, the injectables being around 35%—that particular service brings in. I have this sheet that we look at during our team meetings and say, okay, our medical aesthetics business is down 2%, and within that business you notice that a laser, IPL or something else is what’s that's dragging that along. I always say, you can't manage what you can't measure.

It's very clear every month where our money's coming in, what services are bringing people in, and what is growing year over year. Knowing that is very important for each business. And then I jump into that in a little bit more detail, and that is, what's the profitability? I run the metrics on the profitability of each of those services so I can get a gross margin so I can say, okay, this particular service I'm emphasizing a lot, it's not growing, but here's what it's really doing to my bottom line. And then I do the same thing for the providers. What is the profitability of each provider that I have?

To really understand your business, and it's real clear, you have to know which services you’re making money on. Here's where I'm going with them, here are the providers I have, here's how much I'm paying them, here's the gross margin on each of them. When you do that, you really understand the health of your business. You understand where your marketing dollars are going and what's bringing you the most return, and for the providers you have, which ones are doing the best and bring in most of the bottom line, and the same thing with services.

There's one that I do on a daily basis looking at the revenue coming into leads. There's a monthly-basis one that's profitability on each of the services and how the services grew year over year. And then there's more that I run every quarter to six months. But there's a lot of them, and I do run this business on a metric base, because I just can't say this money I'm spending here on marketing, I think it's doing well; it looks like I'm a little busier. Or I want to get into vaginal rejuvenation but I'm not really sure. You have to measure it, and you have to be ready to drop a service or change out a provider, because once you have this data, what do you do with it? You can try to change the costs associated with those services, and the same thing with the providers. You have to be ready to make changes.

vic owoc

MM: What do you love most about the aesthetics business?

VO: I love that we're helping people. Our slogan is, ‘We make people look as young as they feel.’ Especially here in South Florida, people don't want to look like they've aged. When people come in here, they feel good. I can't tell you how many times my wife has told me, and I've seen it on occasion, that the patients cry. They've done dermal fillers on their face because that's something immediately you can see, and they look at themselves and they cry, and that's how much this bothered them. It's just amazing what you can do with some treatments of IPL to take the pigmentation off their face, some fillers for if they have folds on their face, and treating wrinkles around the forehead with Botox, you can make them look 10 years younger. It's just beautiful.

MM: What do you love about being an entrepreneur?

VO: Being able to call my own shots. I worked for large corporations for years. Reporting to someone else and being responsible—if you're a real mover and shaker and you want to change things, it’s very difficult to do in a corporation. But as an entrepreneur, if you can handle the risk, and you may make some mistakes and you may have some issues with that, but the ability to create your own success, to manifest your own destiny to me is exciting. I really love being able to take an educated risk, and of course the benefits from that. All the positives of being your own boss and running a successful business that helps people. I couldn't see it any other way.

MM: Who inspires you?

VO: My wife. She's the lead provider at Ageless Medical. She's just a very smart person. The patients come in so often to see Erin, it's almost a problem for the other nurse practitioners that have to go against her. Not only is she well credentialed, being a national trainer, she's just awesome.

MM: What advice would you give to other medical spa owners?

VO: Create a high-end brand. If you start your medical spa business and your brand is just okay, it's hard to go up, so start off with a great customer-centric brand. Also, you need to have the right people. When we bring someone on board and they know that we pay more than the other medical spas, they know we expect more. The people are so important. Hire the very best people. Pay them more. Because I will tell you, this is a business about people. A lot of people have the same technology that we have, but not everybody has our people. Attracting, training and retaining the right people are, by far, the most important things.

MM: What would you say is one word to describe your med spa journey?

VO: It's been exciting. You have to love this business. When I say exciting, it's all the changes that go on—you have to be excited about them. There are changes in technology, sometimes changes in policy, changes in your types of patients—now it’s becoming more and more millennial-based, for example. I'm excited about the changes. The business itself has been changing, but my feeling about the whole thing has just been excitement.

AmSpa members receive QP every quarter. Click here to learn how to become a member and make your med spa the next aesthetic success story.

Tags:  Business and Financials  Med Spa Trends  QP 

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5 Tips for Managing Patient Photos to Keep Your Medical Spa HIPAA Compliant

Posted By Administration, Thursday, July 25, 2019

doctor photographer

By Emily Alten, on behalf of RxPhoto

Before-and-after photos and photos used to document patient procedures are considered protected health information (PHI) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), regardless of whether or not clients are using health insurance to pay for their services. Therefore, it is essential that your practice properly secures patient photos to avoid potential fees for improper PHI handling. Here are five things to keep in mind to ensure that your patient photos remain HIPAA compliant.

Storage

Do not leave photos stored on devices indefinitely, and no photography equipment should ever leave the practice unless it has been wiped of photos. Remote-wipe technologies exist, but if you have set up this capability, make sure you are up to date on the most recent Health Information Technology for Economic and Clinical Health Act (HITECH) regulations. (Click here to learn more.) If using a DSLR camera, photos must be uploaded to a computer regularly and the SD card must be wiped clean so that photos cannot be accessed outside the practice or by anyone other than a trained staff member. If using a mobile device, the simplest way to remain HIPAA compliant is to use a service that stores photos in a HIPAA-compliant cloud server for you. That way, when photos are taken, they are automatically stored on the cloud and never stored on the device itself.

Communication

Sending or receiving photos of clients is an easy way to fall into HIPAA non-compliance. Emails are a big no-no. HIPAA requires that electronic communications with any PHI—including photos, names, any medical information or anything that can be used to identify a patient—be properly encrypted to ensure privacy. Also, be aware that sharing information with another party requires a consent form from the client to acknowledge that he or she is aware of what information being shared and with whom. HIPAA also states that communication between two parties should only include the minimum necessary information to properly care for the patient; however, if the client is a mutual patient of the two parties sharing health information, it can be freely shared.

Marketing

It may be obvious that consent forms are required to use any client’s information or likeness in order to market your product, but you should be aware that blacking out a subject’s eyes or even face is not enough to remove all possible identifying features or information. Getting consent forms and being transparent with clients about how their information might be used by the practice is the most prudent move.

Social Media

Social media is an excellent way to market to and communicate with present and potential clients. However, it is easy to slip into HIPAA-violating familiarities online. Even confirmation that an online persona is a client violates HIPAA rules. Make sure that any online communication from the practice does not include any of the following information:

  • Recognition that someone is a client—“It was nice to see you the other day,” or, “Glad you enjoyed your visit”;
  • Discussion or comment on a treatment—“We’re glad you’re happy with your Botox”; or
  • Recommendations for treatments, which could be considered medical advice from a non-MD source—or, worse, public medical advice violating patient confidentiality.

Educate Your Staff

Your staff should be educated on HIPAA and HIPAA compliance to ensure that your practice is doing everything it can to remain above-board. There are numerous resources, including online courses, that offer HIPAA training for medical staff; pricing averages approximately $25 per employee. (HHS.gov, HIPAAExams.com and MyHIPAATraining.com are among the sites that offer these training opportunities). This will not only keep your practice HIPAA compliant, but also help keep any staff/client communication professional and courteous.

Writing enthusiast and biology nerd, Emily Alten specializes in educational health care and medicine content. She is a Magna Cum Laude graduate from Columbia University with a degree in biological sciences/pre-medical studies.

Tags:  Guest Post  Med Spa Law  Med Spa Trends 

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Crackdown on Fraud and Abuse Serves as Warning to Medical Practices

Posted By Administration, Wednesday, July 24, 2019

doctor in handcuffs

Jay Reyero, JD, Partner, ByrdAdatto

In addition to the bright sun being so prevalent during these warm summer months, the fraud and abuse enforcement spotlight shines bright on Oklahoma and Florida.

In Oklahoma, two cases were filed involving a total of three physicians and five marketers, who all were charged with anti-kickback violations involving compounded prescription drugs. In one case, the fallout continues from the compounding pharmacy prescription scheme involving OK Compounding, where three physicians and a marketer were charged with anti-kickback violations and other criminal offenses. The allegations involve kickback payments disguised through medical director and consulting arrangements with the pharmacies. In a second case, a Texas marketer was charged with conspiracy to pay health care kickbacks for recruiting physicians to prescribe compounded drugs in exchange for a commission based upon reimbursed prescriptions. In a final case, three marketers were charged with kickback violations for a direct payment to a prescribing physician.

These cases offer a reminder that medical director, consulting and marketing arrangements are heavily scrutinized and will not disguise any intent to pay for referrals. Parties must carefully analyze their arrangements and ensure the intent and substance behind the arrangement matches the form of the contract.

In Florida, an owner of a substance abuse facility pled guilty in a massive $57-million money laundering conspiracy involving hospital pass-through billing. In the scheme, the owner arranged for his facility to send patient urine samples to a laboratory for testing in exchange for 40% of the insurance reimbursement. The laboratory, in turn, entered into arrangements with rural hospitals to have the testing billed under the hospital’s provider number using hospital in-network contracts. The owner also arranged for other substance abuse facilities to participate and receive 30% of the insurance reimbursement while he received the other 10%.

Hospital pass-through billing arrangements have become problematic as hospitals, clinical laboratories, and other parties seek arrangements to maximize both operations and profits.  Arrangements between hospitals and laboratories must be closely scrutinized and regulatory compliance carefully analyzed.

If you want to keep your medical spa compliant with state regulations and move your business forward without engaging in illegal activities, click here to learn how to join AmSpa.

Tags:  ByrdAdatto  Med Spa Law 

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The Legalities Behind HIPAA and Social Media

Posted By Administration, Monday, July 22, 2019

social media

By Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa)

A well-executed social media campaign can be extremely beneficial to a medical aesthetics practice. Millions of businesses use social media channels—such as Twitter, Facebook and Instagram—to increase their brand awareness, and successful social media campaigns can help build strong bonds between practices and their patients.

Unfortunately, medical aesthetic practices and medical spas are particularly susceptible to certain types of social media violations that can attract the attention of the federal government, and investigators will not care whether or not you were aware of these transgressions. You must educate yourself about what you can and can’t post on social media channels to stay on the right side of health care privacy laws.

Understanding Your Identity

It’s important that medical aesthetic and medical spa physicians, owners and operators understand that these practices are, in fact, medical institutions—unorthodox medical institutions, certainly, but medical institutions nonetheless. However, they exist in an unusual market. The services they offer are elective, so they typically market themselves in ways that traditional health care outlets do not. They often present their services as commodities, in much the same way as outlets such as traditional spas and salons do. And because the medical aesthetics market is expanding, there is a great deal of competition for a prospective client’s attention, so marketing campaigns need to be cost-efficient and effective.

This is why many medical aesthetic practices and medical spas turn to social media to help publicize their businesses. However, it is shockingly easy for such a practice to expose itself to patient privacy issues with even the most harmless-seeming social media activity.

An Introduction to HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a piece of legislation that regulates the many ways in which the business of health care is conducted in the United States. Since its adoption, however, it has become virtually synonymous with the issue of patient privacy. HIPAA’s Privacy Rule prohibits medical institutions from sharing protected health information, which it defines as anything that can be used to identify a patient. This includes any information at all that could possibly reveal the identity of the patient—his or her e-mail address, street address, name, birth date, Social Security number, etc. All this must be kept completely confidential.

If a medical institution is found to have violated HIPAA, it may be subject to very substantial fines—sometimes hundreds of thousands of dollars per violation. Additionally, many states enforce even stricter patient privacy statutes, so medical institutions must go to great lengths to ensure that absolute patient privacy is observed at all times.

See No Evil

There are three major ways that medical aesthetic facilities and medical spas often violate patient privacy laws on social media without even being aware of it.

1. Publicly reaching out to a patient. If you are connected with clients via a social media channel, such as Facebook or Twitter, it might seem like a good idea to reach out to them after a visit to publicly thank them for coming in. Ideally, this could build a relationship with these clients and entice their friends to follow suit. Unfortunately, this seemingly innocuous act may constitute a violation of HIPAA (and possibly a gaggle of state laws), because you’re revealing that person is one of your patients.

You can still thank your patients via social media; however, you just need to be very careful about how you go about doing it. Consider reaching out to your patients using the private messaging feature of whichever social media platform you are using. You will not be able to reach your client’s friends, but you’ll still strengthen your relationship with your client. However, as any number of disgraced celebrities will tell you, it’s very easy to post something to the public that you intended to keep private. Use extreme caution if you decide you want to attempt this.

Also, if you’re starting a Facebook campaign, establish a fan page rather than a standard user page. That way, your facility’s followers won’t be visible to users.

2. Publicly responding to a positive comment from a patient. Let’s say that one of your clients posts the following on your practice’s Facebook wall: “Had a great Botox treatment here today!” You may be inclined to post a response, such as: “Thanks! We hope to see you again soon!” However, it is important to understand that even this can represent a breach of a patient’s privacy, since you’re confirming that your practice provided the customer with treatment.

This is an emerging legal issue that has yet to be put to the test by litigation, and it could be argued that, by publicly posting that message, the patient is tacitly waiving his or her HIPAA protection. Unfortunately, HIPAA and other state-based privacy laws are very strict, so it’s probably not a good idea to test them.

You can attempt to avoid falling into this trap by stating on your social media channels that, although you appreciate all comments, the best way to deliver them is via e-mail or to call the practice directly. If you do this, you can avoid appearing unappreciative and reduce your potential exposure to patient privacy violations. Alternatively, you can try to draft a form that acknowledges that a patient who signs it wishes to waive his or her HIPAA protection for social media; however, this form would need to be very complex in order to stand up to legal scrutiny.

3. Responding to negative reviews. Yelp is a social media service that allows users to rate the experiences they have with businesses. As of the fourth quarter of 2015, more than 86 million unique visitors per month use mobile devices and 75 million unique visitors per month use desktop computers to refer to Yelp’s more than 95 million user-generated reviews, so make no mistake: This service is immensely powerful. The success or failure of businesses can be determined by their Yelp reviews alone.

This can empower ordinary people and, ideally, lead businesses to provide exceptional service to everyone. Yelp even encourages the businesses that are critiqued to become part of conversation, allowing owners and operators to respond to reviews and engage with users.

Unfortunately, Yelp’s enforcement of its user content guidelines is spotty, so it can have a dark side for businesses. Some reviews are unfair, made by people who have ridiculous expectations or axes to grind. Additionally, some Yelp users post negative reviews if they aren’t allowed to pay the prices they want to pay for products and services, regardless of whether those prices are reasonable. And those negative reviews can impact prospective customers—even if a business has a preponderance of four- and five-star reviews, readers are often compelled to peruse the handful of one-star reviews for entertainment purposes or to familiarize themselves with the worst-case scenarios.

Most businesses have recourse for dealing with problematic Yelp reviews—they can openly engage critical users using the service and attempt to demonstrate that they’ve done nothing wrong. The owners and operators of medical aesthetic practices, however, absolutely cannot respond to these posts, because if they do, they could identify unhappy users as patients, thereby violating patient privacy statutes.

The best way for medical spas to combat bad Yelp reviews—the only way, really—is to encourage satisfied customers to post positive reviews. Unfortunately, this means that you’re essentially asking customers to work to promote your business for free, but there is little else that can be done to address the situation without violating patient privacy laws.

Given the importance of Yelp and the lack of a level playing field regarding its reviews, the owners and operators of medical aesthetic facilities may be tempted to engage in what is known as “astroturfing”—using employees or associates to post fake positive reviews in order to bolster ratings. However, they must resist that urge, as astroturfing can be interpreted as consumer fraud. New York state regulators recently issued enormous fines to several facilities for astroturfing.

The Final Word

Social media can be a valuable tool in the promotion of a medical aesthetic practice, but its use can also be fraught with peril. Owners and operators of these practices should make sure that everyone involved in their social media campaigns—as few people as possible, ideally—understands that it is critically important that patient privacy be respected at all times. Few practices can survive the penalties associated with these violations, so they must be avoided at all costs.

Tags:  Business and Financials  Med Spa Law  Med Spa Trends 

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