Posted By Administration,
Thursday, November 15, 2018
By Alex R. Thiersch, CEO of the American Med Spa Association (AmSpa)
As many have seen in the news recently, a Texas LVN named Michelle Bogle from Savvy Chic Medical Spa was arrested under the claim that she was practicing medicine without a license.; specifically, she was offering Botox injections. Although all of the facts about the case are not known, AmSpa wanted to take this time to review the rules in relation to delegating cosmetic medical procedures in Texas. The state of Texas is fairly liberal in who it allows to physically perform Botox and other injectable procedures. Anyone with proper training may inject Botox and other cosmetic injectable as long as it is under the protocols, supervision, and delegation of a physician. The Texas Medical Board has adopted Rule §193.17 (available here) to provide guidance to physicians who delegate these nonsurgical cosmetic procedures. The rule applies to nonsurgical cosmetic procedures, including injecting or using a prescription medical device performed by someone who is not otherwise licensed to perform the procedure and not a physician, PA, or NP. The rule includes 13 points that physicians must adhere to in properly supervising and delegating such a procedure to anyone other than a physician assistant or a nurse practitioner. These include the following.
A physician is responsible for being properly and appropriately trained in the specific procedure, and keep records documenting their training.
Before the procedure is performed, the physician or a PA or NP acting under their delegation must perform an initial examination. This examination must include: taking a history, performing a physical exam, making a diagnosis, recommending treatment, developing a treatment plan, obtaining a patient’s informed consent, and providing emergency and follow-up care instructions. They must also maintain medical records, and have signed and dated written protocols and standing orders for the procedure
Following the above examination and diagnosis, the procedure can be delegated to another person as long as a PA, NP, or physician is on-site, or the delegating physician is available for emergency consultation and able to conduct an emergency appointment if necessary.
The physician, regardless of who they delegate to, maintains ultimate responsibility for patient safety.
The physician is also responsible for documenting and maintaining the patient records.
The facility must have a quality assurance program in place, including mechanisms to identify complications, adhere to protocols, monitor the quality of treatments, a review and improvement mechanism for protocols, and ongoing training.
Physicians can delegate procedures only at a facility where they have either approved of that facility’s written protocols for the procedure or they have developed their own protocols.
The physician must also make sure that the delegated person has appropriate training in several areas related to performing procedures (see the rule for details).
The physician must have in place a written office protocol for the delegated person to follow in performing the procedure. his protocol must identify the delegating physician, criteria for the physician, PA, or NP to screen the patients, and description of appropriate follow-up care including for complications, injury, and emergencies.
The physician must make sure that the delegated person follows that written office protocol.
Patients must sign consent forms before receiving any treatment. The form must identify potential side effects, complications, and identity of who will perform the procedure.
The delegated person who performs the procedure must have a name tag which discloses their name and their credentials.
The facility must have at least one person on-site who is trained in basic life support whenever a procedure is performed.
Each of these above points are necessary to be in compliance with the rule. However, this article is not meant to be an exhaustive compliance check rather to give more of an overview. So, if you are a physician planning on delegating such procedures to anyone other than a PA or NP, please carefully review the rule in total or consult with an attorney to ensure that you develop policies and procedures that are compliant with its requirements.
The implications of this story are far-reaching. This is the second instance of an LVN being charged with the unauthorized practice of medicine in recent months as a result of an undercover sting operation (the other occurred in California). AmSpa encourages all of its members—particularly those in Texas—to ensure that they strictly comply with every step of the Texas delegation and supervision rules governing cosmetic procedures. Following each step specifically is critical, and practitioners must take care to pay very close attention to the specifics of the rule and follow it exactly. As now has been seen, failure to do so may result in criminal prosecution, not to mention action by the medical and/or nursing boards.
Posted By Administration,
Tuesday, November 13, 2018
Sponsored by CareCredit
Spa and med spa businesses are always looking to strengthen relationships with clients. How you connect with clients, solidifies credibility and trust that translates into continued financial success. However, a major challenge many businesses face is identifying the right strategies to help build long lasting relationships and overall reputation. One effective action plan can be to offer your clients payment options, like the CareCredit credit card.
1.Provide transparency and build trust with your clients
Offer your clients payment options that include special financing options like the CareCredit credit card, with no interest if paid in full within the promotional period*. This helps them identify how to pay, with a selected option that best fits their needs. With budget-friendly monthly payments, spa owners can also help clients choose service enhancements and add-ons without cutting the price of the service to show value. With a dedicated way to pay, clients will understand the pricing for their treatments, and trust their spa or med spa providers. This may also entice clients to elevate or increase services and return for follow up treatments.
2.Offer payment options that help clients get the treatments and services they want, when they want them
Most spa clients may not have a fixed budget for covering the costs of the beauty, spa and wellness treatments that they want or need. The CareCredit credit card offers spa clients a convenient payment option so they can fit more spa services into their budget. Promotional financing options are available for purchases of $200 or more. CareCredit offers cardholders access to a calculator tool so they can easily review average monthly costs. In turn, clients will feel valued knowing their spa and med spa provider has their best interest in mind.
3.Leverage payment options to promote your spa or med spa specials and exclusive offers
Give your marketing materials an overhaul. Update exclusive offers and eblasts touting the latest and greatest offerings or promotional specials; and make them even more exciting by noting that the CareCredit credit card is a payment option for them. By offering value and information about a payment option with promotional financing options, clients will feel like they are receiving a special offer. As a result, they may schedule services and return visits.
CareCredit works with more than 210,000 providers across a broad range of specialties including medical care, beauty, dental, optometry, hearing and veterinary services. With CareCredit’s 11 million cardholders, spa and med spa businesses can get connected to a new client base, while providing optimal service for current clients.
*Subject to approval. Minimum monthly payments required. See carecredit.com for details.
**No interest will be charged on the promotional purchase if you pay the promotional purchase amount in full within the 6, 12, 18, or 24 month promotional period. If you do not, interest will be charged on the promotional purchase from the purchase date. If your purchase qualifies for a 24-month promotional offer, fixed monthly payments are required equal to 4.1667% of initial promotional purchase amount until promotion is paid in full. The fixed monthly payment will be rounded up to the next highest whole dollar and may be higher than the minimum payment that would be required if the purchase was a non-promotional purchase. For all other promotional offers, the regular minimum monthly payment terms of the account will apply. Regular account terms apply to non-promotional purchases and, after promotion ends, to promotional balance, except the fixed monthly payment will apply until the promotion is paid in full. For new accounts, Purchase APR (interest rate) is 26.99%. Minimum Interest Charge is $2. Existing cardholders should see their credit card agreements for their applicable terms. Subject to credit approval.
Posted By Administration,
Thursday, November 8, 2018
By Alex R. Thiersch, CEO of the American Med Spa Association (AmSpa)
The most effective and marketable services offered by a medical spa will almost always be the treatments provided, running the gamut from microneedling, to laser skin resurfacing, to anti-aging treatments, such as Botox. Although these procedures draw patients in, offering skin care products can put your patients on the path to the best long-term results.
Skin Care Supporting Treatments
It should be no surprise that medical spa treatments designed to revitalize the skin can benefit from proper after-care.
“You’re doing your practice an injustice if you’re not sending the clients home with a product that’s going augment the results of the treatments they just came in for,” said Candace Noonan of Environ Skin Care.
After laser skin resurfacing, for example, doctors on RealSelf.com universally recommend emollients for the days immediately following treatment, with some also suggesting home-care treatments containing retinoids to aid in skin healing. After microneedling, RealSelf.com doctors recommend topicals that include a growth factor for improved results and faster healing.
Do your research and ask your skin care sales representatives what home care products will work best with your menu of services.
Skin Care as an Anti-Aging Treatment
Medical spa-based skin care is not limited to after-care. For patients concerned with procedures relating to skin health and/or anti-aging, medical-grade skin care products can be a treatment on their own. Although moisturizers and other skin products are widely available from drug stores and retail boutiques, these products are often very different than what medical spas are able to offer.
According to the FDA, with retail products, patients should be able to select and safely use the product using only the information available on the label. This means that off-the-shelf products need to be safe enough for a customer to self-diagnose and administer without the advice of a trained professional. As a result—although retail products may say they include similar ingredients the concentration of active ingredients—the ingredient concentration is often far lower, in order to ensure it can serve the widest population of people.
“Generally, brands that are sold in drugstores and department stores contain lower amounts of active ingredients so they’re irritation-free for a broad consumer base,” said Lucy Papa, executive vice-president of Canderm Pharma Inc., which sells both medical-grade and retail-grade skin care products.
Since a medical spa will select products specifically based on a patient’s unique needs and train the patient on proper use, these products will contain a higher concentration of active ingredients with clinically tested formulations that can deliver faster and better results.
“We have to look at things like bioavailability, how is it delivered to the skin, is the skin even able to absorb these ingredients,” said Noonan. “When choosing a skin care line … you have to be able to back it up with science as far as what’s actually going to work.”
The onus is on medical spa professionals to educate patients on the benefits of medical-grade skin care, not only with respect to supplementing procedures, but also as a treatment in itself. Selling skin care in your medical spa will not only lead to better results for your patients, but also for your business, as well.
Take a tour through one of Boston's top med spas, LexRx, located in the Beacon Hill neighborhood of Boston.
Co-Founders and Nurse Practitioners, Alexa Nicholls Costa and Alexandra Rogers share the success of running an injectables-only business in this member spotlight feature.
LexRx is a hyper-focused dermatology practice offering only injectable services, botox and dermal fillers. They are breaking the myth that you can't make money on injectables.
Check out the video playlist on Youtube to get the full walk through tour of their practice and learn about their secrets to success!
Alexa and Alex attended the Boston AmSpa Boot Camp in September 2018 to speak on the social media panel. They will also be speaking at The Medical Spa Show February 8-10, 2019 at the Aria Resort & Casino. Visit LexRx's Instagram account to view the available promo codes for attendance to The Medical Spa Show 2019 and AmSpa memberships.
Posted By Administration,
Wednesday, November 7, 2018
By Dori Soukup, CEO and Founder of InSPAration Management
In the early 1980s, American Airlines’ goal was to increase retention and provide their clients with something extra special. The airline created the first frequent flyer program that allowed travelers to accrue miles and gain benefits when they flew with American.
American Airlines was one of the first companies in the country to offer a customer loyalty program. It set the standards for the entire industry. Since then, loyalty programs have gained significant popularity. According to a recent study, companies spend more than $2 billion on loyalty programs every year. Statistics show that the average American household belongs to about 14 different rewards programs.
If you want to increase your retention rate, it is a great idea to offer your clients a loyalty program that will keep them coming back.
What type of loyalty program should you offer?
There are several types of programs to offer consumers, and no matter which one you choose, it is important to keep it simple. Below are two of the most effective loyalty programs:
A. Charge a fee to join the loyalty program.
For example, Barnes & Noble charges its clients $25 to join their loyalty program. Then, its members can save 10 percent on their purchases for an entire year. For a person who frequents Barnes & Noble weekly, this type of program provides great benefits. The end-of-year savings are significant. This program keeps me loyal to Barnes & Noble, and the $25 fee to join is well worth it. You can do the same, but I recommend you charge more. For example, you can charge a fee of $150 to join and offer them the following:
Two $25 gift cards—to be utilized one at a time
A complimentary consultation valued at $50
A complimentary makeover valued at $50
A loyalty program welcome kit
A discount of five to ten percent on every spa visit or retail purchase
You are giving them the $150 enrollment back in value. This allows you to raise cash flow, and encourages the new member to visit the spa on a regular basis. As part of the loyalty program, the client will benefit by receiving a small discount with each spa visit.
B. The second plan offers clients a chance to join for free and earn points with every visit. You can reward them by letting them earn one point for every dollar they spend. Once they reach a certain number of points, they can use them toward gifts, services or products.
You will need to determine the amount of rewards you are willing to offer. For example, if someone spends $500, they will earn 500 points. If you wish to offer them a 10 percent reward, you will need to select a $50 prize that they can have once they reach 500 points. This represents a 10 percent reward. If you are offering this type of loyalty program, I recommend you offer merchandise as a reward because your cost will be $25, but the client will receive a value of $50. This practice allows you to decrease your loyalty cost to a five percent reward instead of 10 percent.
Select gift items that you can brand with your logo. This includes robes, T-shirts, hats and water bottles, all displaying your logo. This method has many benefits:
Provides your loyal clients with desirable, quality gifts
Gifts are a great way to promote your business
Shows a higher perceived retail value while reducing your loyalty cost
Saves money and increases retention
The point system can also be used as a marketing tool. If you have some slow slots within your schedule, you can reward your clients with double points on slow days or hours. Instead of offering discounts, offer double points for promotions. You can ask your clients to write reviews to earn points. Or, let them earn points when they “like” your page on Facebook, and so on.
Keep in mind that no matter which program you offer, you have to market it, track it and deliver a great guest experience.
Offering a loyalty program is a great opportunity to promote your business and recognize your VIP clients with special value while motivating your clients to keep doing business with you. Implement a loyalty program and increase your retention!
Dori Soukup is the Founder and CEO of InSPAration Management, a firm specializing in medical spa and salon business development, advanced education, and business tools. Throughout the past 15 years, Soukup has contributed to the success of spa companies worldwide. Her passion is developing innovative, effective educational programs and business strategies leading to exponential growth and profits. She is the recipient of the American Spa Preferred Educator award and is a sought-after global speaker within the spa and medical spa industries.
Posted By Administration,
Friday, November 2, 2018
By Brad Adatto, JD, Partner, ByrdAdatto
Do you own or work for a med spa in California? If so, this is important news. Just two months after California passed their new sweeping consumer privacy law, the California Legislature has passed an amendment to the act that was submitted to the Governor on September 12th for signature. The original bill, the California Consumer Privacy Act of 2018 (“Privacy Act”), was signed into law on June the 28, 2018, creating the strongest protections in the nation on collecting and using consumer’s information (please see our previous article here for more details on the Privacy Act). As written, the Privacy Act would require substantial compliance efforts for businesses working with California residents. The amendment makes many changes and clarifications to the Privacy Act, and several will be beneficial to medical practices.
The most beneficial change for medical practices is the Privacy Act now does not apply to health care providers to whom the rules of HIPAA or California’s Confidentiality of Medical Information Act apply, so long as the practices maintain patient information in the same manner as they are required to maintain protected health and medical information. Protected health information and medical information covered under those laws were already exempted in the original law.
A second helpful change for medical practices is that the disclosure to consumers of their rights of deletion no longer needs to be on the website or in the privacy policies. Rather, it now only needs to be “reasonably accessible to consumers.” Previously, this would have necessitated medical practices making major updates to their websites to be compliant.
The amendment also narrows the broad definition of personal information covered by the law. Previously “personal information” included a laundry list of types of information, ranging from biometric data to employment information. Unfortunately, the laundry list still remains, but is limited only to data that is capable of being associated or linked with a particular consumer or household. This is helpful as it exempts aggregated demographic and trend data.
While the Amendment may have eased the burden of compliance for medical practices, it has not removed it. We are hopeful that most of the nuts and bolts compliance concerns will be fully addressed in the Attorney General’s forthcoming rule interpretation. Consistent with the amendment, the AG must release its rule interpretation by July 1, 2020. However, since the Privacy Act itself becomes effective January 1, 2019, medical practices will need to be mindful of how they are treating consumer information before the Privacy Act takes effect. Substantial processes and changes may still needed by medical practices to be compliant.
Brad Adatto, JD, is a partner at ByrdAdatto, a business, healthcare, and aesthetic law firm that practices across the country. He has worked with physicians, physician groups, and other medical service providers in developing ambulatory surgical centers, in-office and freestanding ancillary service facilities, and other medical joint ventures. He regularly counsels clients with respect to federal and state health care regulations that impact investments, transactions, and contract terms, including Medicare fraud and abuse, anti-trust, anti-kickback, anti-referral, and private securities laws.
Posted By Administration,
Thursday, November 1, 2018
By Alex Thiersch, CEO of the American Med Spa Association
Bad outcomes and patient injuries in medical spas are appearing in more and more headlines across the country. It is evident to many who work in the medical spa industry that there are a number of grey areas in the rules and regulations that govern it, and that certain unscrupulous medical spa owners and operators exploit these inconsistencies while sacrificing quality patient care to make money. Media pieces highlighting these bad actors in the industry are appearing with increasing regularity, and even the Doctor Oz show recently highlighted “Rogue Med Spas” that endanger patient safety. These reports express the industry’s problems to the public and, when the public catches wind of a health issue, you can bet that local, state and federal regulators will need to address it sooner or later.
The days of the medical spa industry being the “wild west” are likely coming to an end. So if your practice is not entirely compliant with your state’s medical statutes, it is certainly in your best interest to identify the ways in which it falls short and address them as soon as possible.
Stories such as the Doctor Oz report are not positive for the medical spa industry, but they’re not necessarily hatchet jobs, either—many medical spas are, in fact, operating illegally, and untrained, unqualified employees are burning patients with lasers, among other potentially serious violations.
Medical spas and laser centers have become so popular—and so profitable—that some owners and operators rush to open them and, as a result, they are often not properly formed and not compliant with state and local statutes. Traditionally, there has not been a great deal of enforcement of these violations, but this is changing.
Medical spas have become so prevalent that state regulatory agencies simply cannot ignore them anymore. As is seen in the rise of media coverage of these issues, patients who suffer unforeseen outcomes will not hesitate to complain to the media. Personal injury attorneys have also picked up on the trend—you may have noticed television commercials and print ads calling for clients to sue medical spas and laser centers. The story is out there, and it only takes one aggrieved patient to cause a medical spa’s world to come crashing down.
Although it is undeniable that there is a certain level of non-compliance that exists in the medical spa industry, medical spa owners and operators need to be asking themselves how they can start becoming an industry that regulates itself, so that they don’t have these types of continuing issues with state regulators.
To start on the road to compliance, medical spa owners and operators should take the following steps.
Know the law. While there are grey areas, many answers can be found in state’s practice acts with just a little bit of searching.
Reach out to local health care attorneys for evaluation. Most medical spas only contact a lawyer when they’re already in trouble, not at the front end where the lawyer can help prevent trouble down the road.
Work toward understanding. You goal should be to understand the basic core principles regarding medical practice and realize that, while this is a lucrative industry that is often quite safe, there is still some level of danger.
AmSpa pledges to continue its efforts to educate medical spa owners and operators to make sure that they are operating in compliance with the law. It also aspires to educate the public in order for them to understand the difference between a medical spa that is compliant and one that is not, as well as inform them about what the treatments offered by medical spas actually entail. AmSpa is also pushing for standardization of laser training across the industry—in some states, there are no training requirements, and a lack of proper training can lead to outcomes such as the ones that Doctor Oz aired to the general public.
The industry needs to come together to discuss how it should be regulated, as it is clearly growing and is not going away. There is some guidance in the laws as they are written, but the states do not do a particularly good job in educating the public about what they say and mean. Still, enforcement is ramping up, and medical spa owners and operators must be properly prepared in order to comply and avoid more negative media coverage in the future.
Posted By Administration,
Wednesday, October 31, 2018
By James M. Stanford, JD, Partner, ByrdAdatto
Negotiating for any business, including a med spa, is not easy. Most prefer to avoid confrontation and that preference has its virtues. At the same time, however, that general mindset can result in a tendency to cave during negotiations. It does not mean that one should be provocative and confrontational during negotiations as such a stance may have adverse results. However, holding your position, even when you believe you may not have the bargaining power, can yield surprising results.
Time after time, I see parties give in far too easily on a particular term or position when it’s not in their best interest. This often occurs after discussing the matter informally with the other side (i.e., no legal counsel present for either side) and accepting verbal assurances that in reality mean very little when the language of the contract will be controlling.
Bargaining power is established by many variables, including the size of the respective parties, norms of the industry to which the contract relates, the alternatives available if negations fail, and current market forces in terms of supply and demand for the goods or services being negotiated. One thing is clear though, you can obtain more bargaining power than you think by being willing to walk and find an alternative if the other party is unreasonable in demanding one-sided, onerous terms. I have been pleasantly surprised on occasion when a client holds their ground on certain positions and we ultimately obtain better terms than expected. The only downside is that you may actually have to walk and find another vendor, lender, or location to lease. Nevertheless, this may result in a better deal provided you are seeking terms that are generally reasonable.
Without getting into the specific nuances and art of negotiating, the primary factors for strengthening your position that should be in place before you even start negotiating are as follows:
try to have alternative vendors, lenders, locations, etc. in case your first choice is unreasonable;
engage legal counsel who is experienced in the industry and subject matter of the deal; and
start with the mindset that you will walk if you cannot obtain reasonable terms.
Of course, this will not apply in situations where you don’t have an alternative and you must consummate the particular transaction. For the most part, however, you will gain substantial bargaining power when you are as willing to walk away from the table as you are to consummate the transaction.
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.
Posted By Administration,
Tuesday, October 30, 2018
By Alex Thiersch, CEO of the American Med Spa Association
In this space a couple of weeks ago, I wrote about the need for self-regulation in the medical aesthetic industry. In that piece, I mostly focused on how medical spa owners and operators can help the industry by observing certain standards that AmSpa is helping to develop. However, the need for self-regulation is not limited to practitioners—it extends to equipment and device manufacturers, as well as clinical training facilities.
After an AmSpa Boot Camp or a consultation where I detail the legalities of laser use, for example, I’m often approached by attendees who say, “I was trained by a laser manufacturer, and they didn’t tell me any of this stuff.” What I’ve found is that there are a lot of people out there who give a lot of disparate information and, oftentimes, it’s not accurate and it leads people to believe that they can do things that legally they cannot do.
We at AmSpa have been working very hard since the organization’s inception to educate not only medical spa owners and practitioners, but also the industry as a whole. If everyone knows the laws under which they operate, everyone can be on the same page.
AmSpa works with many laser manufacturers that have listened to us and acted in very responsible ways. However, I’ve also heard countless stories from people who were told by manufacturers or training facilities that they can do something that they plainly cannot, and they feel like that is unfair.
This is not just an AmSpa problem or a medical aesthetic practitioner problem—it is an industry problem. The entire industry need to be on the same page. Every member of the industry needs to buy into the same set of standards, and we all need to be teaching the people who work in the industry the same thing. It makes no sense and does nobody any good to, say, take a long laser course and learn to perform treatments if a practitioner cannot legally administer them.
Therefore, AmSpa is calling on the entire industry—not just medical spa owners and practitioners, but also device manufacturers, drug manufacturers, and training facilities—to start taking compliance seriously, because it’s the only way for the industry to evolve in a positive direction. Everyone wants to succeed and make money, but if the industry is overly regulated due to negative outcomes and people acting in bad faith, it will be extremely difficult for the industry to become better and larger than it already is.
I’m looking forward to discussing self-regulation with everyone at forthcoming AmSpa Boot Camps. We will be in Orlando next week for our final Boot Camp of 2018, and our just-announced 2019 itinerary includes stops in Los Angeles, Chicago, Atlanta, Seattle, Dallas, New York and Orlando. Click here for more information and to sign up for a Boot Camp near you. We’ll also be discussing this matter at the Medical Spa Show in Las Vegas in February 2019. Click here to learn more about this year’s agenda and event … it shouldn’t be missed!
Posted By Administration,
Monday, October 29, 2018
By Patrick Armstrong O’Brien, Legal Coordinator, AmSpa
Many states prohibit non-physicians from owning medical practices either directly or through a business entity. This is known as the Corporate Practice of Medicine doctrine, which AmSpa has previously discussed here. The concern these states have with corporate practice of medicine is that the non-physician control will interfere with the physician’s professional judgement in the physician-patient relationship. Whether or not that fear is founded, it has resulted historically in many states forbidding the practice. AmSpa members: To see what your state’s policy is please your state legal summary.
Over time, the practice of medicine has evolved and become more complex and interconnected. Physicians no longer practice with just a bag and a stethoscope. They render medical services through a team of professionals and specialists who utilize an array of advanced machines. This complexity and interconnectedness has weakened much of the original motivation for the prohibition against medical services being delivered in a corporate structure. Often, these prohibitions are seen more as a hindrance than an aid to effective care. There has been a general trend to move away from or weaken this prohibition. This has taken the form of passing statutes that affirmatively allow corporate practice or remove the restrictions.
On one end of the spectrum, you have states similar to Alabama, which does not prohibit physicians from being employed by a corporation as long as the physician is free to use his professional judgment in making medical decisions. This is evidenced in their statutes and opinion letters from the attorney general’s office. You also have states such as Idaho where the board of medicine previously adhered to the doctrine. However, in 2016, they affirmatively rejected the doctrine and would no longer discipline their licensees for practicing in a corporate structure.
On the other end of the spectrum, you have states such as California. The state statutes clearly prohibit the practice of medicine by corporations and the California Medical Board actively polices and enforces it. The California Medical Board even offers a resource page of their website to address the subject. These states and others like them provide medical spas with clear information on the types of business structures permitted.
Other states may have lax or infrequent enforcement of their prohibition. Wisconsin is an example: the state laws clearly prohibits laypersons from employing physicians to provide medical services as outlined in a Wisconsin Attorney General letter available here. However, there appears to be no recent history of enforcement actions for violating this rule. Wisconsin isn’t alone; many other states have infrequent enforcement of their corporate practice rules. This can create a lurking issue for people wanting to open a medical spa.
Those preparing to enter the medical spa field may look around and see examples in their state of non-physicians hiring on medical directors or partnerships between doctors and non-doctors. Depending on the state, these arrangements may be completely fine or they may be in violation of that state’s laws. Where there is lax or infrequent enforcement by the state’s attorney general or the medical board, a medical spa may go years without issue. However, the risks still remain. Future attorney generals or medical board members may change their policies and begin aggressively bringing enforcement actions. Or, if the medical spa or physician is brought to their attention for other reasons, the corporate structure may result in additional penalties or discipline. The improper business structure could be used as a challenge to contracts in disputes among business partners.
Just like you still wear your seatbelt even though you don’t plan to be in a car accident, having the proper corporate structure for a medical spa is important, even if no one has recently gotten in trouble over it. As the aphorism on ounces of prevention goes, taking time to structure your medical spa correctly at the beginning can be good insurance against possible future issues. If you would like to learn more about medical spas business structures and other legal issues please consider attending an upcoming AmSpa Boot Camp or the 2019 Medical Spa Show.