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Why a Risk Assessment Is Critical for Your Practice

Posted By Administration, Monday, March 25, 2019

checklist risk assessment

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

For a medical aesthetics practice to best serve its patients and maintain a viable business, it needs to understand the ways in which it may be compromising patient safety or otherwise violating the law. Therefore, if your practice has not undergone a thorough risk assessment recently, it should do so as soon as possible.

“A risk assessment establishes the baseline of where a practice is from a compliance perspective and helps identify risk areas that need to be fixed,” said Michael Byrd, partner at ByrdAdatto, a Dallas-based law firm that specializes in business and health care law. “Let’s get a baseline of where you are so we can figure out what needs to happen.”

A properly conducted risk assessment will cover both business and medical concerns, and it will identify areas where the practice is compliant, areas where the practice needs to be mindful to remain in compliance, and areas where the practice is not compliant that need to be corrected.

“A risk assessment is essentially a blend of legal and clinical evaluation of compliance,” Byrd said. “From a legal perspective, we’re making sure that the ownership is set up in a compliant way, and then that the policies and procedures are set up in a compliant manner. Clinically, do they have appropriate policies and procedures as it relates to treatment, delegation and supervision, OSHA, telemedicine, HIPAA, etc.? A lot of times when we’re doing a risk assessment, we have a lawyer look at it, plus a clinical person, and sometimes even an IT person helping to evaluate if there’s a cyber-security risk from a HIPAA perspective.”

To begin the process of conducting a risk assessment, a practice should engage with a health care law firm that has a great deal of experience conducting such investigations. Additionally, stakeholders need to be prepared to be as open as possible so evaluators can get a clear idea of what is going on at the practice.

“We’ll identify the ownership documents to send us, and then if it’s a full risk assessment, we’ll involve a clinical consultant who’ll look at it from a clinical perspective, and then we’ll work together to make sure that the policies and procedures navigate that particular state’s laws,” Byrd said. “There’s a big element of knowing who’s doing the initial exams and who can be delegated to provide the treatment, and even by procedure, there are certain procedures that are only appropriate for certain providers. That’s a lot of the back and forth we’ll have with the consultant.”

If this sounds like a major undertaking, well… it is. However, it is assuredly better to know the areas in which your practice falls short of compliance and what can be done to correct that rather than remain ignorant and be surprised when an investigation uncovers violations.

“It can be overwhelming, but if it can be integrated as part of the culture of the business, our clients are very successful,” Byrd said. “A risk assessment is really just a starting point, but then you have a culture of following these procedures and evaluating as laws change, technology and procedures change, and your personnel changes, evolving your compliance plan with that. The clients that adopt that as part of the culture of their business have been really successful in minimizing that risk.”

Byrd says that after his firm conducts a risk assessment, it typically will check in with clients every three months to make sure that everything is on track. If a firm does not offer periodic check-ins, he recommends repeating the risk assessment process annually.

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

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You Can’t Pay for Patients and Call it “Marketing”

Posted By Administration, Friday, March 15, 2019

money changing hands

By Patrick O’Brien, J.D., Legal Coordinator for the American Med Spa Association

Finding customers is the biggest challenge for any business. You can offer the finest product or the best service, but none of it will matter unless you can find people willing to walk in the door and buy from you. Therefore, marketing and advertising are critical to a business’s success. This is especially true for medical spas and others in the aesthetic health industry. There are many effective marketing strategies to use, each with its own legal issues. We’ve previously written about issues with email marketing and text message marketing.

The referral is one of the most effective marketing tools. Satisfied customers can be your best advocates and salespeople by simply going out into the world and telling their friends about how great you are. A recommendation from a friend or trusted acquaintance can be hugely credible, so incentivizing people to make more of these referrals for you might seem like a great idea. However, since medical spas offer medical procedures, they are subject to a slew of laws that make rewarding referrals very difficult to do.  Many states prohibit physicians or licensed healthcare providers from paying or accepting money or other types of value for referring a patient.

Consider the ongoing saga of Forest Park Medical Center in Dallas, where doctors (allegedly) enacted an elaborate plan of paying other physicians for referrals to the center for elective surgeries and ran afoul of anti-bribery laws. Forest Park apparently was paying hundreds of thousands dollars per month to physicians for referrals and calling it “marketing.” Obviously, most medical spas are not able to pay millions a month in “marketing,” and very few seek reimbursement from insurance. So what do they have to worry about? Texas’ patient solicitation law prohibits paying “any remuneration in cash or in kind” for “securing or soliciting” a patient. (Confusingly, this particular law is not the one at play in the Forest Park case, but it does apply to other Texas medical practices). So while it might seem nice to give a gift card to someone for bringing a patient to you, it very likely is an offense under this section.

Texas isn’t the only state to look unkindly at paying for patient referrals. Many other states have similar “anti-kickback” laws or general prohibitions on physicians “fee-splitting” with others. New York, for example, clearly prohibits a licensee from offering, giving or receiving any fee or consideration to a third party for the referral of a patient. If you think this seems broadly written, you would be correct—and New York and Texas are far from the only states that have laws such as these on the books; most traditionally have viewed paying for referrals as subverting a patient’s interests. After all, the patient is relying on the person to provide a recommendation that is in his or her best interest, and the introduction of a financial motive may influence that recommendation.

You also may notice that payments for more traditional advertising could fall into this broad definition if the fee is based on results. Depending on the specific facts of the case and the state in which it occurs, this could be the case. California has accounted for this possibility by providing an exemption for certain advertising relationships in its anti-kickback statute. The California Business and Professions Code § 650 prohibits a licensee from offering or accepting any payment as compensation or to induce the referral of patients. However, it does allow for the payment of services (but not payment for referrals) based on gross revenue or a similar arrangement if it is consistent with the fair market value of those services. But even in states like California that explicitly carve out advertising from the anti-kickback rules, not all advertising relationships are permitted. Paying for advertising based on results or consumer response always will appear to be a paid referral and is certainly a risky arrangement. Before implementing any marketing strategy, it is always a good idea to review your state’s fee-splitting and anti-kickback laws, as well as your licensing board’s guidance on professional conduct.

If you would like to learn more about marketing that won’t land you in the same hot water as the physicians at Forest Park Medical Center, consider attending one of our Boot Camps this year. We also have a number of webinars that cover various issues and aspects of marketing that you may find helpful.

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

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In Just 15 Minutes, You Can Help the Medical Aesthetics Industry

Posted By Administration, Friday, March 15, 2019

taking a surveyBy: Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa)

From now until March 28, AmSpa is conducting the 2019 Medical Spa State of the Industry survey, and if you’re the owner or managing business director of a medial aesthetics practice, your participation is vital to helping us gain a better understanding of what’s going on throughout the industry. The survey takes approximately 15 minutes to complete, and once you finish, you’ll be entered in a drawing for valuable prizes. Click here to take the survey now.

This survey is extremely important to AmSpa and its members, and the information you provide can help us determine emerging trends and topics of concern that affect everyone in the industry. The more data we can gather, the better—it allows us to determine what is happening with a greater degree of certainty, and it helps bring to light perspectives that might not have been considered before. In other words, your opinion is incredibly valuable to us and to everyone else in the industry.

If you complete the survey, you’ll receive a free executive summary of the results when the survey is completed, as well as a promo code for $100 off a ticket to any 2019 AmSpa Medical Spa & Aesthetic Boot Camp, so if you’re a qualified respondent and you’re considering attending any of these events, it’s certainly worth your while to participate. Additionally, you will be entered in a drawing to win one of two $500 Visa gift cards.

Participation in the survey is limited to owners and managing business directors of medical aesthetics practices, and we ask that only one person per practice respond; however, if you don’t personally have access to the information you need to answer a particular question, we encourage you to solicit that information from others in your organization.

The more information you have, the better decisions you’ll make. By participating in AmSpa’s 2019 Medical Spa State of the Industry survey, you’ll help yourself and others to become better informed about the trends and topics that are currently driving the medical aesthetics industry, which can, in turn, help the industry can become even healthier as a whole.

Tags:  AmSpa's 2019 Medical Spa Statistical Survey  AmSpa's Med Spa & Aesthetic Boot Camps 

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Medical Spas Face the Challenges of Private Equity-Backed Health Care

Posted By Administration, Thursday, March 14, 2019

By James M. Stanford, JD, Partner, ByrdAdatto

Over the last several years, private equity activity progressively made its entrance into the market of dental support and management service organizations. Now, the trend has made its way into the practice of dermatology, and the field is divided over the rise of private equity—not only in dermatology, but in other areas of medicine as well, including plastic surgery, aesthetics, and the medical spa space. The competing schools of thought on private equity in medicine are highlighted in an article recently published by The New York Times entitled, “Why Private Equity is Furious Over a Paper in a Dermatology Journal.”

The article details the backlash a medical research paper received after its data supported a conclusion that private equity firms tend to acquire practices “that perform an unusually high number of well-reimbursed procedures and bill high amounts to Medicare.” The article also highlights the criticisms over the paper’s factual accuracy, its sudden removal from the medical journal’s website, and the questions raised about private equity firms’ growing presence and influence in the practice of dermatology at the expense of patient care.

While the corporatization of healthcare is not a new debate, the research paper’s conclusion is the most recent example to illustrate the challenges that arise in maximizing profits without diminishing patient care. This is because the ability of a practice to effectively align its healthcare and business issues can be the differentiating factor between the success and failure of the practice. On one side of the equation, you have the traditional healthcare practice structure where business innovation and creativity is extremely limited, and the primary focuses are patient care, efficiency in billing and operations, and payer reimbursements. On the other side, you have the retail business structure where there is a limited understanding with healthcare laws and regulations and the correlated risks of excessive monetary penalties and lawsuits, but its experts are skilled in innovative marketing and branding.

Like it or not, private equity has made its way into the dermatology market and other health care spaces. If you have a management service organization and need help navigating the challenges of raising private funds, or if you are currently operating with private equity backers and need guidance, consider attending one of AmSpa's upcoming Boot Camps, where industry leaders can answer your questions and show you how to move your business forward.

James M. Stanford is an attorney and partner at the ByrdAdatto law firm. From transitions, mergers, and acquisitions to structuring complex ownership arrangements, James enjoys the personal reward that comes from bringing parties together and making deals happen. James practices primarily in the areas of health care and corporate law with a focus on intellectual property. A proud father, Jim served in the U.S. Army and is fluent in Russian. In his spare time, he enjoys hunting, fishing, and spending time outdoors.

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

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Fibroblast Plasma Therapy, Who Can Do It?

Posted By Administration, Tuesday, March 5, 2019

By Patrick O’Brien, J.D., Legal Coordinator for the American Med Spa Association

Fibroblast Plasma Therapy is a new skin tightening procedure that is generating a lot of buzz in the medical aesthetics industry. It delivers tiny arcs of plasma created by an electrical discharge via a “plasma pen” to the skin, singeing the surface and tightening the underlying tissue. Unlike a typical light or other energy based skin tightening treatment where a large area of skin is treated with each firing, a Fibroblast Plasma Therapy treatment only effects a tiny pin-point of tissue with each firing. The whole treatment is then performed by repeatedly applying the pen in grid pattern over the treatment area. It appears that, in general, there are few risks of complications with this treatment. However, there is risk of burning through part of the skin if the plasma is applied for too long or too deep.
As is typically the case when such a product emerges, we at AmSpa are getting a number of questions about who can actually perform Fibroblast Plasma Therapy procedures. The treatment appears to be very straightforward—a provider applies the device in a grid pattern to the area of the skin to the skin. Its simplicity raises an obvious question: can an esthetician or licensed vocational nurse (LVN) perform this procedure?
It’s great that we get these questions because it shows that medical spa owners and operators care about remaining compliant, but because innovation moves faster than the regulation, it’s sometimes difficult to determine what the answers are when new treatment emerges. However, we can use what we know about similar treatments and technologies to determine the most prudent course of action until government agencies make their rulings.

Find answers to your med spa law questions with AmSpa's State Legal Summaries.
Click Here

Simply put, the Fibroblast Plasma Therapy is essentially an energy device similar to other IPL, electricity, and radio frequency devices. A lot of the issues we’ve addressed in recent years regarding other energy skin tightening devices are likely also going to apply to it. Every state that has looked into these other energy devices that tighten the skin has found it to be a medical treatment, so a good-faith exam must be performed before the procedure, and if a doctor is not administering the treatment him- or herself, it must be properly delegated. Unfortunately, for practices that would like to use unlicensed practitioners to perform Fibroblast Plasma Therapy procedures, this takes them out of the scopes of practice for estheticians and most LVNs.
The only conjecture we can make is that Fibroblast Plasma Therapy will likely be regulated in much the same way as other energy based skin tightening, both in terms of medical board rulings and FDA approval.
Unfortunately, since it is so new, we don’t have all the answers yet, however we will stay on top of this as more states weigh in on the procedure and news develops. Look to AmSpa for more about Fibroblast Plasma Therapy treatments. Thus far, it has been safe and well received, but the industry needs to have a firmer grasp on the regulatory issues surrounding it.


To learn about legal and business best-practices to keep your med spa compliant and profitable, attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps and be the next med spa success story.

For legal updates and business best practices delivered straight to your inbox, subscribe to AmSpa’s email newsletter. For more information on how AmSpa can help your practice operate legally and profitably, Contact Us online or call us at 312-981-0993.

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

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Texas Nursing Board Reiterates That Nurses May Only Use Non-Ablative Lasers

Posted By Administration, Monday, March 4, 2019

By Patrick O’Brien, J.D., Legal Coordinator for the American Med Spa Association

Unlike many other professional licensing boards, the Texas Nursing Board provides a volume of guidance and answers on their website for nurses wanting to practice in a medical spa. In general, this guidance recognizes that that registered nurses (RNs) and licensed vocational nurses (LVNs) have a scope of practice that is defined partially by their educational background, level of competence, and knowledge. This flexibility seems to carry over to the Board’s position statement 15.9 on Laser Therapy.
Position statement 15.9 (available here), begins by acknowledging that the “use of laser therapy and the technology of laser use have changed rapidly” over the years. It goes further on to state that nurses play many important roles in laser therapy and that it may be within their scope of practice to administer such treatments. The statement lays out the basic requirements that the nurse needs to have the education, experience, and knowledge to perform the treatment and must perform it subject to a valid medical order and under appropriate supervision. All through this section references are made to lasers, laser therapy, or laser energy. However, the seeming broadness of this position is quickly undermined by the single use of one term: non-ablative. Non-ablative is used only once in the statement and by its inclusion it excludes many laser skin resurfacing treatments from RNs and LVN’s potential scope of practice.
Recently, Sam Pondrom an attorney with the law firm ByrdAdatto, spoke with the Board of Nursing regarding this language in 15.9 he says “The Nursing Board was very clear: that there are no plans to remove the (non-ablative) language from the statement and that they don’t feel a (RN or LVN)’s educational background prepares them to accept these assignments.”
This limitation to non-ablative lasers in the position statement appears to be in response to an older practice guideline from the Texas Medical Board (TMB). This TMB guideline was adopted in 2003 but has since been withdrawn and at the time it prohibited physicians from delegating any ablative laser procedures to others. However, the Nursing Board’s statement retains the restriction and in 2013 only removed reference to the withdrawn TMB rules (see here for a discussion of the 2013 amendments). Currently, no other rule or law prohibits a physician from delegating an ablative laser procedure to a nurse.  However, position statement 15.9 makes it clear that it is not within the scope of practice for an RN or LVN to accept such a delegation. It remains to be seen when The Board of Nursing will again recognize that “the use of laser therapy and the technology of laser use have changed rapidly” as they had previously stated in the opening line of 15.9. 

To learn about legal and business best-practices to keep your med spa compliant and profitable, attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps and be the next med spa success story.

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

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The Incredible Takeaways from the 2019 Medical Spa Show

Posted By Administration, Thursday, February 28, 2019

By: Tim Sawyer, President & Co-Founder, Crystal Clear Digital Marketing

If you were fortunate enough to be in Las Vegas at the Medical Spa Show, then you saw firsthand the explosion in popularity of this emerging event. With almost 1,000 attendees, a vibrant, sold-out vendor floor and the gathering of many of the leading industry experts, the 2019 Medical Spa Show was an event for the ages. As an exhibitor, sponsor, speaker and long-time friend of AmSpa, I was particularly impressed with the diversity among attendees. By that, I mean the attendance and participation of Beverly Hills plastic surgeon Dr. Sheila Nazarian, world-renowned plastic surgeon Dr. Jay Burns as well as many other surgeons, dermatologists, anti-aging doctors and entrepreneurial-minded business folks looking to find their way into the fast-growing aesthetic market. Clearly, this was more than a gathering of newly-formed med spa owners, although there were many. This was the widespread recognition and cultural acceptance of the proliferation of non-invasive technology and treatments to not only treat but also prevent the effects of aging across all age groups. It was great to see this evolution on full display, and I was grateful to be a part of it. From my perspective, there were some important takeaways that will have a significant impact on the industry in 2019 and beyond.

One – why would a plastic surgeon attend a medical spa event? Isn’t that a conflict?

Absolutely not! Historically, there has been some healthy tension between med spa owners and the surgeons who have dominated this market for decades. Now, however, we see that many of these surgeons/doctors have either incorporated non-invasive treatments into their practice, or more often than not, they are opening up standalone med spas as a complement to their existing practice. This trend will continue as better, cheaper devices can get a similar result without the need for costly and painful surgery. What I discovered (the big takeaway) from sitting on the panel with Dr. Nazarian and Dr. Burns was not resistance to the inclusion and growth of the med spa market, but more of a concern related to the lack of uniform protocols and governance in the med spa community. This is a real issue. Med spa owners and operators should share their concerns because non-compliant facilities can cause real problems for EVERYONE, not the least of which would include unnecessary and expensive regulations. The biggest opportunity to continue the growth trajectory is self-policing and adherence to accepted best practices. Net result, well-run, compliant med spas will lead to increased collaboration and support of surgeons and doctors nationwide.

Two – EVERYBODY is trying to solve the social media puzzle. At the 2019 MSS, there were many sessions and panel discussions speaking to this complicated issue. While there were some obvious well-established best practices shared for popular platforms such as Instagram, Facebook, Snapchat, etc., the big takeaway for me from listening to the experts is there is no one-size-fits-all solution. Every practice is unique with varying degrees of resources and different business goals. This is where YOUR discussion with social media needs to start. What are YOUR business goals related to your social media efforts? In other words, what is the problem you are trying to solve? Is it exposure, education, local fame OR how to create more paying patients for your practice? Once you have established some basic business goals, along with established procedures to track your results, the social media puzzle will begin to take shape for you. One cautionary tale – some of the attendees at the 2019 MSS meeting have tens or even hundreds of thousands of followers. We must resist the temptation of comparative living. Meaning, obsessing over the few practitioners who have solved the puzzle might lead to frustration and disappointment. You have to start somewhere and create realistic expectations along the way. Here’s what I know for sure: Everyone had to start with one follower and grow their universe from there.  

Three – and this is the big one – you can drive all the traffic in the world to your practice from Google, social media, email marketing, billboards or wherever, but that alone will not result in sustainable growth. One of the themes that kept emerging was the frustration associated with low conversion rates from these established mediums. The question that needs to be asked is, why do some med spas flourish in the area of conversion while others remain stuck on first base year after year? 

The answer lies in leadership, priorities, people, process and tools. Let’s start with leadership, as it sets the tone for everything else that follows. Leaders must be principle-based. In other words, what do you and the practice stand for? What principles set you apart from everyone else? Leaders must have a plan and commitment to specific goals and strategies to hit those goals for 2019. As the old saying goes, you stand for something or you stand for nothing. What do you stand for?

Your conversion rate is always heavily influenced by your people. Typically, the team should mirror the principles and values set by the leader. Are your people committed to providing a consistent, world-class patient experience each and every time someone visits the facility? Are they enthusiastic? Do they take ownership and accountability for their part in the practice? Most importantly, are you listening to phone calls and training and practicing TOGETHER? Could your people sit down right now and write a similar 30-second corporate commercial that clearly defines your unique selling proposition? I hope so. If not, the marketplace and your competition will define you!

In terms of process, have you sat down to create a sales and marketing blueprint that includes: phone scripts, FAQs, most common objections, price responses, staff credentials, consultation best practices, etc.? From my experience, if you don’t develop this process in painstaking detail, your team will be left to make it up for themselves. And when that happens, the result is generally not consistent with the vision of the owners.

Lastly, does your team have the right tools to optimize the conversion funnel? This must include some way to capture, track and automate communication; nurture and convert opportunities into paying patients; and manage loyalty programs, specials promotions, social media, SEO, emails and beyond. Then, does your team have the right tools to continue the patient relationship to increase per patient revenue, and most importantly of all, RETAIN the patients? And if you have these tools, has your team been properly trained on how to use them? Or, as can often be the case, are your team members trying to brush their teeth with a hammer? Ouch! Painful and expensive.

At the end of the day, whether it’s employing best practices, trying to effectively leverage social media or making the most out of your sales and marketing efforts, there has never been a better time to run a successful medical spa. My biggest takeaway was the positive state of the med spa industry and my belief that the biggest threat to sustained growth is an internal one, which is the non-compliance and lack of willingness to adhere to a uniform set of best practices surrounding the treatment, health and safety of the patient. At the end of the day, this is what we all want, and that is why the 2019 MSS attracted the greatest minds in the industry. Until next year, congratulations to AmSpa on the success of the 2019 MSS!

Visit to discover why hundreds of medical spa owners just like you have chosen to implement their fully integrated software, marketing and consulting platform.

Tags:  Business and Financials  The Medical Spa Show 2019 

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Highlights from the SOLD OUT Medical Spa Show 2019

Posted By Administration, Wednesday, February 27, 2019

Did you make it to Las Vegas for The Medical Spa Show 2019? We had a great time and whether you made it or not, we hope to see you at MSS 2020!

See some highlights from the show below, and if you have pictures you want to share, post them on social with the hashtag #MedSpaShow2019!

AmSpa’s CEO, Alex Thiersch, presented to over 900 medical spa professionals about the current state and legal landscape of the medical spa industry.

According to AmSpa's 2018 State of the Industry Report, 82% of industry professionals have been in the industry for less than 10 years! The industry is young and people are flooding into the market.

80% of med spa facilities are a single location, and of the remaining 20%, most have no more than 2-3 locations. This is an industry of mom-and-pop stores where you can open up and make a difference, and it's one of few industries that you can succeed and flourish just on your own!

Allergan sponsored the Members-Only reception, where AmSpa members networked and traded notes about their experience in the industry. AmSpa’s membership network has grown to over 2,000 members, and we were very excited to meet new members and our super fans!

AmSpa’s Glam Celeb Duo, Dr. Sheila Nazarian and Glam RN, greeted guests on the red carpet at The Opening Night Party. 

AmSpa attendees fiercely competed in the app game for a chance to win luxurious prizes including 2 Gucci Bags, a Luis Vuitton bag, an iWatch, an all expenses paid trip MSS20 and an all expenses paid trip to the Next Level! event – courtesy of AmSpa.

The Social Media Glam Stars met their super fans after the Social Media panel, “How to Gain Thousands of Social Media Followers and Why It’s Important”

What Happens in Vegas, Doesn’t Always Stay in Vegas … and some attendees have the AmSpa tats to prove it!

We loved having you, and we'll see you again next year at #MedSpaShow2020, Jan 31-Feb 2, 2020!

Tags:  The Medical Spa Show 2019 

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Suit from Laser Hair Removal Injuries Highlights Need for Training and Oversight

Posted By Administration, Monday, February 25, 2019

By Patrick O’Brien, J.D., Legal Coordinator for the American Med Spa Association

If you are thinking there is a lot of Medical Spa related news coming from Houston, TX, you would be right. We’ve previously commented on some criminal medical spa issues here. And, today, I want to draw your attention to a recent civil suit filed in Harris County District Court by a man who received multiple painful and sensitive burns on his legs and trunk as a result of an improper laser hair removal procedure. According to the article the specific laser machine was new to the medical spa and during the procedure the plaintiff recalls hearing the employee say “uh-oh.” 

“Uh-oh” is something you never want to hear during a haircut let alone a medical procedure. This highlights a topic we have touched on several times: while laser hair removal (LHR) and other procedures can be very safe, they are not without risk of injury or complication. It is critical that individuals who perform these procedures have proper training and skill not only in the device itself but the underlying human physiology at play. Often this medical knowledge will be gain in acquiring a professional health care license or it may be provided under the supervision of a physician or other qualified health care professional. 

Most states recognize the importance of having this medical oversight of these procedures. Whether it is, as most states do, by treating laser hair removal as a medical procedure or, as in states such as Texas or Florida, by having licensed laser technicians who practice under a consulting physician, a medical professional is involved at some stage in the process. (AmSpa members may review their state summary for details on their state’s laser laws.)

The major exception to this is New York where laser hair removal is not regulated by any organization. We’ve previously discussed the efforts to pass legislation and this year’s Assembly Bill 821 that seek to bring the LHR industry under regulation. AB821 would create training requirements for LHR technicians and require that they practice in facilities overseen by a consulting physician. 

However, 2019 could also see Arizona replace New York as being the wild west of LHR laws. A Bill introduced in Arizona’s Senate this year would reduce oversight of their laser technicians allowing them to practice under a “laser safety officer” who does not require any sort of medical background. Even more notable is that laser technicians in AZ are not limited to LHR but may also perform other laser and light based skin procedures. Procedures that carry a much greater risk of complication or adverse outcome all without any medical professional oversight or supervision.

As covered before, in order for the Medical Aesthetic Industry to continue to grow and thrive it needs to have practical rules. Part of insuring this is operating in a way that maximizes patient outcomes, minimizes complications, and avoids drawing negative attention. Having properly trained and supervised people to perform the procedures is a huge part of this. State Legislatures pass legislation reactively and overly restrictive laws get passed in reaction to shocking news. For instance, Virginia enacted their LHR regulations in the wake of a lurid news story where a patient was burned after receiving treatment performed by the clinic’s janitor.

Again, we don’t have any details on the training or supervision involved in the above LHR lawsuit from Houston. In general, a person with better training, education, and skill in the procedure, the device, and with medical supervision is going to have fewer “uh-oh”  moments than a person who only has the minimum training. Eliminating “uh-oh” moments is a critical step to long term success for both your Medical Spa and the Industry at large.  

Tags:  Med Spa Law 

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Rethink Your Math: Discover How Offering Payment Options Can Build Longer, Stronger Client Relationships Than Discounting

Posted By Administration, Wednesday, February 20, 2019

By: Karen Zupko, on behalf of CareCredit

I'd like to dispel a common myth our team hears from clients, which is that they can build a loyal customer base by offering rash and random discounts. 

Such discounts appeal to what researcher Paul Wang, PhD defines as transaction buyers, whose psychology is: "I want to get the best deal." They come for the price, and they’ll leave for the price. 

Think about your price conscious guests, who may ask if you are able to price match another spa. While your goal is to ensure they have an unsurpassed spa experience, at the end of the day, their main focus will always be the cost of the service not the quality of their experience. [1] That’s why it’s best to maintain the value of your services and avoid offering continuous discounts. As an alternative, here are some ways to leverage your spa’s payment options to optimize your client’s experience. 

1. Train your team to identify whether guest hesitation is a budget or cash flow issue.

This answer will help you tailor the message. If the guest truly can't afford the treatment, it's a budget issue. Offer a less expensive service or product. If they can afford it, they may be uncomfortable paying for the whole treatment at once. Resist the urge to discount! Instead, let them know you accept the CareCredit health, wellness and beauty credit card as a payment option. CareCredit's online calculator allows your team to run payment scenarios in seconds.

Example:" I realize that $1,200 is a lot all at once. We offer a 6-month promotional financing option with the CareCredit credit card. Let’s look at what your monthly payment could be." 

2. Combine promotional financing with a special offer that addresses a specific issue. 

For example, to introduce a new aesthetician or drive volume to pay for a new laser, think strategically. Who would like to know you are offering a new treatment or service? Existing guests, of course. 

Create an email or mailing to all guests seen over the last two years. Announce the new staff or service available and offer a special limited time price for a select service. A simple sentence explaining that special financing options are available with the CareCredit credit card completes the message.

3. Generate the unconverted quote report and create a "schedule filler." 

For example, in summer months that are often slow, contact guests who left the spa with a quote for laser hair removal, or fillers, but have not yet scheduled. Send them a personalized note such as the sample below.

"When we last spoke about laser hair removal, you were exploring your options and cost seemed to concern you. If you've not yet scheduled with another spa, and your schedule is flexible, we'd like to offer you a reduced fee if you schedule in June or July. I know you'll be buying back to school clothes and supplies for your two kids at that time, so you might want to use our 6-month special financing options through the CareCredit credit card to pay over time*! 

4. Think "velvet rope."

"Exclusives" work better than giving discounts to everyone. Don't blast out special offers to everyone in the email database or post them to Facebook. Make it feel personal and exclusive.  

For instance, mine your database for guests who are regular skincare product purchasers. Send invitations for a special event that discusses CoolSculpting or laser treatment and encourage them to invite a friend. Explain payment options as part of your presentation and have an iPad on hand for people to easily apply for the CareCredit credit card . All attendees leave with a goodie bag that includes information about the CareCredit credit card and a special treatment pricing offer valid if scheduled within one month.

5. Combine CareCredit's Available Credit report with a targeted offer.

This highly useful report is available in the CareCredit provider portal. It displays people who have been approved for CareCredit, along with the amount of available credit on their account. Develop several, limited time specials at different price points and contact people whose available credit amount is a match.

Whether you contact them by phone or email, nuance and word choice are important. Here are a few helpful conversation starters and things to avoid:

 Don't Say Instead Try
"I noticed that you have $800 to spend using your CareCredit credit card."

"We're contacting you about our THERMI special offer. For those who use CareCredit's 6-month or 12-month special financing option, we are extending a special price of $____ and our records show that you are the perfect candidate for this limited time offer."

Subject to credit approval. Minimum monthly payments required. See for details.

“You have $700 left to spend on your CareCredit credit card, would you like to rebook now?” “We noticed that last time you visited us, you received a laser treatment with one of our technicians. So, we thought you might be interested in learning about some of our similar treatment options. We would love to book a consultation for you with one of our estheticians. Right now we are offering an exclusive price if you were to use your CareCredit credit card for payment. 

Try these 5 tips to in your spa today and see how using CareCredit can help build strong client relations without having to discount services. If you don’t accept CareCredit there is no cost to enroll. Get started today! Visit 

[1] This service cannot be utilized in Day Spas, Med Spas only.
*Subject to credit approval. Minimum monthly payments required. See for details.

These simple tips have been provided by Karen Zupko on behalf of CareCredit. Karen is president of KarenZupko & Associates, Inc., She has been advising aesthetic practices about marketing and management for more than 30 years.

About CareCredit: CareCredit is a health, wellness and personal care credit card dedicated to helping people get the care and treatments they want and need. For more than 30 years, CareCredit has helped millions of people by offering special financing options with convenient monthly payments. CareCredit is accepted at more than 200,000 locations for a wide variety of health and wellness procedures, treatments, products and services. CareCredit is a Synchrony solution. Synchrony is the largest issuer of private label credit cards in the U.S. based on purchase volume and receivables. Visit to learn more.

This content is subject to change without notice and offered for informational use only. You are urged to consult with your individual business, financial, legal, tax and/or other advisors with respect to any information presented. Synchrony and any of its affiliates, including CareCredit, (collectively, “Synchrony”) makes no representations or warranties regarding this content and accept no liability for any loss or harm arising from the use of the information provided. All statements and opinions are the sole opinions of Karen Zupko. Your receipt of this material constitutes your acceptance of these terms and conditions.

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