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How the Texas Corporate Practice of Medicine Relates to Medical Spa Ownership

Posted By Administration, Tuesday, September 10, 2019

medical law

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

Recently, AmSpa has been getting a lot of emails and calls telling us they have been informed that in Texas, unlicensed people can own a medical spa and simply hire a medical director. This contradicts our information, as well as ByrdAdatto’s research on the subject: Texas’ corporate practice of medicine (CPOM) policy generally prohibits non-physicians, lay corporations and other entities from employing a physician to practice medicine. We understand how there can be some confusion, as the various authority and elements that make up the legal basis for Texas’s CPOM policy are scattered in a number of places. However, we wanted to provide our Texas members with some additional information on this, because it is important to stay in compliance with the policy; failing to do so can open the physician up to discipline for abetting the unlicensed practice of medicine, and can subject the non-physician owners to fines and penalties as well. You only need to look to the Texas Medical Board’s June 27, 2019 press release for examples of the board taking action. In one instance, a physician was prohibited from performing, supervising or delegating medical spa procedures for five years for aiding the unlicensed practice of medicine and lending his license to a medical spa. In two other cases, unlicensed medical spa owners entered into agreed cease-and-desist orders with the board; they had been engaging in the unlicensed practice of medicine by advertising and providing medical cosmetic procedures. This article will explore some of the main sources of this policy and attempt to dispel some of the confusion.

A discussion of this topic should begin with the Texas Occupations Code Chapter 3 Subtitle B, collectively referred to as the “Medical Practice Act.” Section 155.001 requires that a person must hold a license to practice medicine. Section 155.003 make it clear that only a person who has completed the required educational steps may hold a license to practice medicine. Section 165.152 make it a violation subject to penalties for a person to practice medicine in violation of the Medical Practice Act. Section 165.156 also make it a violation for a “person, partnership, trust, association or corporation” to use any letters, words or terms in any manner that indicate it is licensed to practice medicine if it is not, in fact, licensed to practice medicine. In Section 164.052, the code states that a physician is subject to discipline if he or she “directly or indirectly aids or abets the practice of medicine by a person, partnership, association or corporation that is not licensed to practice medicine by the board.” Section 165.155 prohibits a physician from paying or rewarding any person or entity for soliciting or securing patients. Taken together, it is clear that an unlicensed person, corporation or other entity cannot advertise that they practice medicine or offer medical services, and they cannot simply hire a physician to lend a license to their business.

Now, there are a number of exceptions to this general prohibition on employing physicians. The Texas Medical Board has adopted Rule §177.17 and provided a FAQ article on CPOM that provides a helpful summary of the information and possible exemptions. Rule §177.17 lists various exempt hospitals, non-profits and institutions. However, those entities are not applicable to a privately owned medical spa. Corporations and other entities properly formed and owned under Title 7 (Professional Entities) of the Texas Business Organizations Code are also exempt. A properly owned professional medical corporation may hire physicians and offer medical services.

The Texas Medical Board’s FAQ also mentions that physicians may enter into an independent contractor relationship, though it is a question of law and facts whether it is a permitted independent contractor or a prohibited employment relationship. Under 151.055, hospitals may enter into independent contractor agreements with physicians. However, for other physician and non-physician relationships the navigation can be incredibly tricky. Any independent contractor arrangement must still comply fully with the Medical Practices Act, as well as not fall into any aspects that would make it a prohibited employment relationship. Each of the listed court cases and attorney general opinions addresses different aspects used in determining independent contractor status from employment relationships. Some of the issues examined are the flow of funds, setting of fees, ownership, control over medical decisions, control over services or employees, and advertising. This means that even if your agreement says “independent contractor,” it may still be a prohibited employer/employee relationship if it does not satisfy all these elements.

For example, in the case of F.W.B. Rockett v. Texas State Board of Medical Examiners, the physician saw patients and reviewed X-rays for a non-physician-owned clinic; for his services, he was paid a flat monthly fee. In this case, the physician lost his license because he was permitting an unlicensed person to practice medicine. Similarly, in Flynn Brothers, Inc. v. First Medical Associates, the physician claimed to be an independent contractor, but the court found him to be an employee because, among other reasons, the non-professional entity retained two thirds of the physician’s collected fees.

Taken all together, the case law and statutes form a complex balancing act. The Texas Medical Association recently published a white paper detailing its explanation of the doctrine, and it largely reflects the views of AmSpa on the matter. Additionally, the medical service organization (MSO) model allows medical spas in Texas a way to navigate these situations. If you are not familiar with the MSO model, see articles about it here and here, and the concept will be covered by an attorney from ByrdAdatto at the upcoming AmSpa Medical Spa & Aesthetic Boot Camp in Dallas. Because of the highly technical nature of the CPOM, the board’s FAQ recommends that you consult an attorney before entering any actual arrangement. Also, do not base your business plan on any article, even—and especially—this one. You need specific and tailored advice from an attorney who is intimately familiar with the Texas CPOM, professional organizations law and medical spas.

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

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Can I Reward My Medical Spa Patients for Referring a Friend?

Posted By Administration, Monday, September 9, 2019

gift card exchange

By Robert J. Fisher, JD, ByrdAdatto

We at ByrdAdatto receive numerous questions each week from providers, medical spas, wellness counselors and other businesses in the aesthetic space. These questions range from entity structuring to employee disputes to lease negotiations, but questions relating to patient reward programs for referring friends are among the most frequently asked.

Patient referral rewards come with multiple overlapping layers of laws and regulations. In order to understand the risk you might incur by using these referral programs, it is critical to seek advice from a health care attorney before implementing a rewards system or referral incentive initiative.

The federal Anti-Kickback Statute is the starting point for understanding the implications for rewarding a patient for referring a friend. This law states that providers cannot offer remuneration in cash or in kind to induce the referral of a business or service covered by a federal health care program. Stated another way, a provider cannot give a person gift cards, cash, discounted services or anything else of value in exchange for referrals when federal insurance programs, such as Medicare and Medicaid, are involved. The federal Anti-Kickback Statute likely does not apply to your aesthetic practice, since such aesthetic practices are typically cash-based, but it serves as an important building block.

Most states have their own version of an anti-kickback law that uses the federal language as a base, but broadens the restrictions to varying degrees. For example, Texas, New York, Florida and California all have laws that prohibit providing remuneration to a person for referrals, regardless of whether patients are paying with cash or insurance. In these states, giving a patient cash, gift cards or generally anything of value for referring a friend will create the risk of violating the state anti-kickback law. On the other hand, Illinois law only prohibits remuneration for referrals when insurance is involved and does not regulate paying for referrals where the practice is cash-based.

Finally, the regulatory boards—medical boards, nursing boards, etc.—can issue their own rules and regulations that tighten or otherwise modify state anti-kickback laws. Continuing the Illinois example, while its state law does not prohibit providing remuneration for referrals when cash payors are involved, the medical board has opined that it views this practice as unprofessional and unethical. This can result in a medical provider being at risk for loss of license, reprimands, fines and more from the medical board if he or she pays for referrals.

The complexity of health care laws and the importance of identifying the laws applicable to your practice make the risk of creating a patient referral program without talking to a health care attorney too great. There also may be alternative solutions to boost patient numbers, such as installing membership discount systems, that avoid creating a regulatory headache.

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 become the next med spa success story.

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

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QP Extra: Q&A with Chris Bailey of Ovation Med Spa

Posted By Administration, Friday, September 6, 2019

chis bailey

When Chris Bailey founded his medical spa in 2006, he was new to the industry. The practice was a franchise, though, so he felt he could count on the support of the franchisor. Six months after the practice opened, however, the franchisor went out of business, so Bailey picked up the phone and called every medical aesthetics professional he could track down, asking those who would talk to him about every aspect of the business. He developed a number of long-term relationships with highly respected members of the industry and, before long, his practice—renamed Ovation Med Spa—was thriving. Bailey spoke with AmSpa Content Writer/Editor Michael Meyer about how he and his practice rebounded from a rocky start to become one of the most successful medical spas in the Houston area.

Michael Meyer: What inspired you to open your practice?

Chris Bailey: I spent 15 or 16 years in corporate America and I was getting burned out. I was bored. Fourteen or 15 years ago, I was in LaGuardia Airport a couple of weeks before Christmas, coming home from a client meeting. I'm looking around the airport, and there are people 10 or 20 years older than me, and I'm just sitting there thinking, “I can't be doing the same thing in 10 years or 20 years.” And I remember standing at the magazine rack and flipping through Entrepreneur magazine—the Franchise 500 edition—thinking, “I don't want to make sandwiches, I don't want to be a janitor and I probably don't want to own a daycare.” And then I saw some medical spa franchises, and I'm like, “Huh—that's interesting. People are getting older, and they don't want to look older. Maybe I should look into this.” I started doing a bunch of research, and a year and all my money later, I opened our business. That's where it started.

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

CB: We opened about 13 years ago, and at the time, you could categorize what we did as skin rejuvenation. We did injectables, we did IPL and different things for skin rejuvenation. Body contouring wasn't really even a category yet, because there were no devices that really did it. Today, we do everything from skin rejuvenation, body contouring, vaginal rejuvenation, erectile dysfunction, hormone replacement—it's really the gamut of anything you can do nonsurgically to someone to make them look or feel better.

MM: What is your most popular treatment, and what brings in the most revenue?

CB: The most popular treatment can vary by season. Certain times of the year, our Sciton Halo is very popular for skin rejuvenation; we get to the summer and that's not quite as popular. We do a lot of CoolSculpting. We do a lot of Emsculpt treatments—the new body contouring device. One of the fastest-growing segments has been vaginal rejuvenation, which has been kind of surprising to all of us.

What brings in the most revenue? We're pretty balanced. It's probably a fairly even mix between skin rejuvenation and body contouring. And things like vaginal rejuvenation and hormone replacement are smaller percentages but growing.

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

CB: I think some of it is that we've continued to innovate. We have close to 40 different FDA-approved devices; I think the average medical spa might have three or four. We have always stayed on top of technology, and we have multiple options to do similar things. We've never wanted to be in the position where someone comes in and we have to tell them, “You need x, and y happens to be the only thing we have.” We're in a unique position where we can truly customize treatment plans for people based on their needs because we've got all kinds of different technology to accomplish that.

MM: What sets your medical spa apart from others?

CB: I think some of it is what I was just talking about—the continuous innovation and the technology that we have. No one has the technology we have, I don't think, anywhere in the country. And then you marry that with our outstanding service providers—we've got employees who've been with us since day one, for 13 years, and we've got very low turnover. Our staff is excellent. They get great training, and they do great treatments, and they provide great customer service. We have customers that we've literally had for 13 years, since we opened our doors. Our unique selling proposition is that we don't sell a one-size-fits-all solution—we can truly customize treatment plans for what people actually need.

MM: Who inspires you?

CB: My father has always inspired me. He is probably the person, from when I was a young child, who taught me to dream bigger dreams, think big and believe we can do things beyond what we are doing today. He's always been an inspiration my life.

MM: What do you love most about aesthetics?

CB: I think some of it is the opportunity—and this is always hard to say without offending someone—to help people become what they believe are better versions of themselves. It's just fun to have someone come in, unhappy with some aspect of how they feel or how they look, and be able to make a positive change and have them be happy that they were able to accomplish that. That's one of the most fun things about it.

MM: What do you love about being an entrepreneur?

CB: Some of it is the constant challenge and the constant change and the constant need to be creative and innovate. If we think about how the aesthetics market has changed in the 13 years we've been in it, it's so amazing. It's different this year than it was last year. It changes so rapidly, and it continues to change. That constant challenge is what keeps me engaged.

ovation med spa

MM: What was the goal with the spa design you chose?

CB: We don't want to look like a medical office, and, and we don't necessarily look like a real frou-frou spa. Our design is clean and efficient. We're not trying to look like the Taj Mahal, but we want an efficient, clean, visually appealing space. But we don't want you to think you're in your family practice doctor's office either.

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

CB: Keep your overhead low—as low as possible—and network with as many different people around the country as you can who do similar things as you. When I started this company, we actually had purchased a franchise. I spent all the money I had and borrowed more money than anyone should have let me, and we started this franchise. Six months after we opened our doors, the franchisor went out of business. And so here I am—I paid all this money for all this help, training and assistance I was promised, and it's now vanished. But I have no other choice—I have to make this work because I'm deeply in debt at that point and have no job. So, I literally got on the phone and called anyone in the country who would talk to me just to ask questions. Because of that, I've developed some great long-term relationships with some very top-end doctors in the aesthetics world that have really been beneficial to me.

What's interesting about that story is no one in Houston would talk to me, and I still find that fascinating—in the business world, we talked to our competitors, and we understood they're competitors, but we would talk and share ideas. Entering this medical space, it was, at least on a local level, a very closed community, especially to someone who wasn't a medical provider coming into it.

Because of all that pain and suffering I had to go through in the beginning to survive and make relationships, we've had some opportunities that just never would have come along otherwise. As an example, as a non-doctor, I was the first person in the country to have the Emsculpt device. I had developed a relationship with the people at BTL, and they knew we were innovative, and they loaned us one in the very beginning to try to help figure out what it did. And so, I'm the only non-medical person listed on some of these published studies for the Emsculpt. Those kinds of opportunities really stem back to those early days of networking with people around the country and building our reputation through asking for and sharing ideas with people. My business wouldn't exist had I not been able to network and do those things early on.

I get calls all the time, and I'm always willing to talk to anyone who wants to call and ask questions, because I did the same thing. It's surprising to me how many people either are afraid to reach out and ask questions or assume that they won't help you because you’re a competitor. I laugh at that. I'm in Houston, Texas, right? If every aesthetic facility in the city was running at full capacity, we couldn't serve everyone who wants treatment. It's just not even possible. It's millions of people, and I just laugh sometimes when people are so worried about competition. Just do a better job. If you do a great job, there's plenty of business for everyone. As an industry, we can make the entire industry better if we actually talk to each other and help each other.

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 Ownership  Med Spa Trends  QP 

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Join AmSpa at the Dallas Medical Spa & Aesthetic Boot Camp

Posted By Administration, Wednesday, September 4, 2019

dallas texas

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

Starting next Saturday, September 14, AmSpa will host its Dallas Medical Spa & Aesthetic Boot Camp at the Doubletree Dallas Campbell Centre. We’re extremely excited for the opportunity to help medical aesthetic professionals in the Lone Star State develop their practices, and we can’t wait to once again visit Big D. There’s still time to register for the event—just click here to sign up.

Here is a quick overview of the program:

Saturday, September 14

The Boot Camp begins at 8 a.m. with a continental breakfast, followed at 8:30 a.m. with my opening keynote. From there, we will move into the main program:

  • 9 – 10:30 a.m.: The Plan, presented by Bryan Durocher (Durocher Enterprises)—What are the most effective ways to develop a business plan for your medical spa? Medical Spa Consultant Bryan Durocher discusses the ins and outs of the planning process and helps determine how long it realistically takes to open a practice.
  • 10:45 – 11:45 a.m.: The Lessons, presented by Louis Frisina—Every medical spa is different, but the successful ones share several common traits. In this session, Business Strategy Consultant Louis Frisina discusses the qualities that are typically found in practices that bring in a significant amount of revenue.
  • 12:45 – 1:30 p.m.: Medical Aesthetic Hot Topics Panel, featuring Tim Sawyer (Crystal Clear Digital Marketing), Bobby Calhoun (Environ Skincare), and Jamie Bergeron (Bellus Medical) and Page Piland (Galderma)—This panel, moderated by yours truly, will feature a spirited discussion of the current issues and events that concern medical spa owners and operators.
  • 1:30 – 3:30 p.m.: The Law, presented by Alex Thiersch (AmSpa) and Bradford Adatto (ByrdAdatto)—In this presentation, we’ll discuss the long-standing and emerging legal issues that every medical spa owner needs to know about. As you can imagine, there is a lot to cover here, since new concerns seem to be arising daily lately.
  • 4:15 – 5 p.m.: The Treatments, presented by Terri Ross (Terri Ross Consulting)—Learn about the most profitable and popular treatments available to your practice, and find out how to best determine which treatments are right for you based on the state of your practice.
  • 5 – 6 p.m.: The Digital Marketing Ecosystem, presented by Tim Sawyer (Crystal Clear Digital Marketing)—Find out how to effectively spread the word about your medical aesthetic practice and how best to determine what’s working and what’s not. Your practice’s digital presence is more important than ever before, and curating it should be a top priority.

Saturday will wrap up with a cocktail reception from 6 – 7:30 p.m.

Sunday, September 15

Once again, the Boot Camp begins at 8 a.m. with a continental breakfast.

  • 8:30 – 9 a.m.: Anatomy of a $5-Million Med Spa, presented by Alex Thiersch (AmSpa)—Have you ever wondered what the difference is between your medical spa and one that’s mega-successful? It might be less significant than you think. This presentation will show what a $5-million med spa is doing right—and what you might be doing wrong.
  • 9 – 10 a.m.: The Financials, presented by Bryan Durocher (Durocher Enterprises)—At the end of the day, the money you’re bringing in is the most important measure of your practice’s success. This presentation will, among other things, demonstrate how to properly develop a budget and use metrics to determine your med spa’s strengths and weaknesses.
  • 10:30 – 11:30 a.m.: The Long-term Revenue, presented by Brandon and Jenny Robinson (Skin Body Soul MedSpa)—Simply being successful isn’t enough for a medical aesthetic practice; you have to know how to maintain and grow your success. In this session, Brandon and Jenny will show you how to build patient loyalty and move your business forward.
  • 11:30 a.m. – 12:15 p.m.: The Consultation, presented by Terri Ross (Terri Ross Consulting)—As the old saying goes, you never get a second chance to make a first impression. Learn how to put your best foot forward with effective patient consultations—and how to turn them into consistent business.
  • 1 – 2 p.m.: The Marketing Plan and Social Media, presented by Brandon and Jenny Robinson (Skin Body Soul MedSpa)—This session will help you determine how to most effectively market your medical aesthetic practice using both traditional methods and cutting-edge techniques.
  • 2 – 3 p.m.: The Team, presented by Bryan Durocher (Durocher Enterprises)—A medical spa is only as good as its personnel, so it’s important to make sure that you hire a staff that can do everything you want it to—and more. In this session, you’ll learn about recruiting, hiring and retaining employees who can make your medical spa dreams come true.

Also, you’ll have the chance to visit with a number of exceptional vendors during this event. Attend the Seattle Medical Spa & Aesthetic Boot Camp to check out the latest and greatest from the following companies:

We hope you can join us in Dallas next weekend. This Boot Camp is a tremendous opportunity to get a medical aesthetic business started off on the right foot, as well as learn how to take an already successful business to the next level. Click here to register!

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

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AmSpa Member Spotlight: Lily and Sami Nizam of Alabama Surgical Arts

Posted By Administration, Tuesday, September 3, 2019

Watch this video to learn about Lily Nizam, PA-C, CPCP, and Sami Nizam II, MD, DMD, of Alabama Surgical Arts in Montgomery, Alabama—a vibrant year-old practice where a medical spa coexists alongside oral surgery and facial cosmetic surgery practices.

Lily joined the American Med Spa Assocation (AmSpa) before Alabama Surgical Arts opened in order to learn about the industry. In addition to taking advantage of the many material perks offered with AmSpa membership—including discounts from vendors and access to legal updates—Lily has become a regular attendee of AmSpa events, where she has found new inspiration.

To learn more about Alabama Surgical Arts, click here to visit its website.

AmSpa’s Medical Spa & Aesthetic Boot Camps are intensive two-day seminars covering legal and business best practices in the medical spa industry. These events are designed for all medical spa professionals looking to run efficient, compliant and profitable aesthetic practices. Click here to learn more about upcoming Boot Camps, and click here for information about The Medical Spa Show 2020, the premier conference and trade show for non-invasive medical aesthetics.

Tags:  AmSpa's Med Spa & Aesthetic Boot Camps  Med Spa Trends  Member Spotlight  The Medical Spa Show 2020 

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QP Extra: Q&A with Terri Ross of Lasky Aesthetics and Laser Center

Posted By Administration, Friday, August 30, 2019

terri ross

When Lasky Aesthetics and Laser Center opened in 2010, it was a much different business than the $3-million-per-year Beverly Hills fixture it has become. In fact, it struggled mightily until medical spa professional Terri Ross joined the practice as managing partner. AmSpa Content Writer/Editor Michael Meyer spoke with Ross—who now operates Terri Ross Consulting—about her role in turning Lasky Aesthetics into one of the most successful medical aesthetic practices in this beauty-obsessed city.

Michael Meyer: What's different about the practice now versus when you started working there?

Terri Ross: All of the owners are physicians who practice offsite and in different specialties—cosmetic dermatology to facial plastic surgeons and a general plastic. They opened the business in 2010 to keep everything in house and refer their patients to the nonsurgical aspect of the business, but it was poorly run. It was a grassroots operation at the time with two employees, no website, no system, no infrastructure—no nothing, which was why they hired me. They invested a lot of money, and at the time it was only generating under a half a million. So, I basically came in and treated it like a startup. I think the takeaway is that there's so much opportunity to grow, but you have to have the proper structure internally to do that.

MM: What do you think is the most important factor to your success?

TR: I think you need to have an operational savvy business. You have to train your providers, train your staff, which is an investment, and which is what I see not happening. You have to have the proper software to track and measure your data. You have to have a high-performing website—it’s your virtual brochure on the outside. And then when patients come in the door, you really need five-star customer service to be different.

MM: What is your unique service proposition?

TR: Aside from the physicians and their pedigree and their background, which has credibility, I would say it's our protocols. You can't come into our center without a consultation. We charge for the consultation. You can't get a treatment without prepping beforehand. We have a very systematic approach, which ultimately retains the patients, and they have better outcomes.

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

TR: We look at the number of new leads coming in. We measure conversion ratios. We measure revenue per hour per provider. We measure no-show rates. We measure retention. Those are the top KPIs.

MM: What's the metric that you look at more than any other?

TR: At the end of the day, revenue. I look at what our goals are for the month, and I look at revenue, new patient acquisition and conversion.

MM: Who Inspires you and why?

TR: Brené Brown. Tony Robbins. I think that it's all about gratitude. It's all about living your best life. It's all about determination. It's all about how failing is okay. Making mistakes is how you grow. And this is a very competitive environment. It's a very commoditized environment, especially where I'm located in Beverly Hills, and it's the ability to seize opportunity.

MM: What do you love most about aesthetics?

TR: I love that it's an area of medicine that can be looked at two ways. It can be looked at as superficial, and it can be looked at as people want to stay youthful and invest in looking healthy. And if we're able to provide such services with quality care and make a person feel better about themselves, that's what inspires me. And that's what makes me feel good about wanting to run a successful operation.

MM: What do you love most about being an entrepreneur?

TR: I love that I can make an impact. I spent 20 years in corporate, and I think it's the ability to make change and to make a difference. I'm humbled that I've had an opportunity to be in corporate, and I've had an opportunity to run a practice and have a case study that's successful, and now I want to be able to give back the things that I've learned and the successes I've had to other practices.

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

TR: I would say that if you don't know something, it's imperative that you ask or seek professionals to help you so you are not making costly mistakes, and do not try to pinch pennies. And you really need to have the proper infrastructure and the proper team in place to have a successful business and to be different and stand out.

MM: What was the goal of the design that you chose?

TR: I think Beverly Hills is the Mecca of beauty, so it's very contemporary. It's very white, very open, very airy. People who are spending their own disposable income don't want to come and have it feel like a doctor's office, so it's very warm. It's very warm and welcoming—not cold. I think it’s important to have a place where they feel very comfortable and that’s aesthetically pleasing since, this is the environment that we're in.

MM: What was your inspiration for that design?

TR: I don't know that I had an inspiration. I hired a phenomenal designer and I had been around other practices to see what that was all about. The inspiration was to make people feel like they’re walking into this warm and inviting place, but yet kind of having that feeling of, “Wow,” right? This is a really, really well-designed, beautiful place. It makes them feel like that's going to equate to the kind of service that we provide.

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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Building a Marketing Program

Posted By Administration, Wednesday, August 28, 2019

marketing meeting

By Terri Ross, Terri Ross Consulting

As the number of new medical aesthetic offices is steadily increasing, it is essential that you build and sustain an effective marketing program. The goal of this program is simple and two-fold:

  1. Attract new patients; and 
  2. Retain current patients.

To achieve this goal, you first need to establish your presence in the market. This can be achieved by branding your office, services and programs, and by creating and sustaining a successful marketing outreach plan. Both a strong physical presence and a successful media presence are critical components of this plan.

Once you have attracted the attention of a prospective patient, your job is to communicate your expertise. Because the front office staff often is a patient’s first contact with the office, it is critical that members of your staff are knowledgeable and engaging. They inform potential patients of the technology, treatments and individualized programs your office offers. Click here to read about the LAER model I developed for training front office staff.

As you implement new marketing strategies, keep track of the numbers—find out how patients first heard about your office—which marketing materials worked—and why they return (e.g. state-of-the-art technology). Know your marketing return on investment (ROI) and incorporate the most successful strategies into your business plan moving forward.

Here are some ways you can build an effective marketing program in the medical aesthetic office world.

Define Your Target Population

The first step in building an effective marketing program is to define and characterize your target patient population. You don’t necessarily want or need to attract everyone to your office—you only need to attract a certain population well. What type of clientele do you want to attract? What services are they looking for? You’ll need to know where these patients live, what services they have access to and how regularly they will visit your office. Once you have defined this population, create your marketing program to target them. Find your patient niche and commit to it.

Establish Your Presence in the Market

Physical: The physical structure of your office—both the exterior and interior—helps to define your presence in the market. An ideal location, updated sign and well-groomed exterior will attract the interest of potential patients and keep current patients returning. The interior of the office is equally, if not more important. Invest in well-appointed furniture and décor. The main waiting room and each treatment room should be clean, inviting and well-decorated. Offer pamphlets and relevant literature on the treatments you provide so patients are informed of your services in advance of their appointment. You also may want to offer refreshments and/or a hot beverage station to make patients feel more comfortable as they wait.

Media: The most successful medical aesthetic offices market themselves through a variety of media. Create brief and targeted marketing advertisements and publish them where your target patient population will see them. Consider local and regional magazines and newsletters. In the current day and age, it also is essential to create and maintain a positive presence on social media, whether through Facebook, Instagram or a similar avenue. Keep in mind that building your social media presence takes time. You won’t see an immediate return on your investment, but with careful branding, engaging posts and consistency, you will build a successful, long-lasting presence.

Communicate Your Expertise

Communicating your expertise goes hand in hand with establishing your presence in the market. It’s important to clearly communicate the services and treatments you offer, as well as how your office excels over the competition. Do you offer state-of-the-art technology? Individualized treatment plans? Top-notch staff? Market this to prospective patients. You can do this in a variety of ways, including quarterly newsletters, professional pamphlets, informational booths at conferences and more. You also can host informational sessions at your office annually or biannually. This gives you a chance to connect with your patients and present information about existing or new treatments or services in your office.

Targeted e-mails are key components of communicating your expertise. Make sure you have current and prospective patient emails, and send them personalized information monthly or quarterly. The key here is personalization, reach and frequency. You want to make your patients feel important. Send out any new information regarding technology and/or treatments they previously have received or expressed interest in.

Keep Track of the Numbers

There are several important numbers you need to know to track the progress of your marketing program. Know your marketing ROI—the projected and actual ROI for each marketing avenue (social media, e-mail promotions, informational sessions, etc.) and track them quarterly. You’ll want to invest more money and/or personnel in the marketing programs that are working and find ways to improve the programs that aren’t. It also is important to know your current patient conversion and patient retention rates. How many prospective patients come in for their first consultation appointment? How many current patients are satisfied with their experience and return? These rates are directly tied to the success of your marketing program.

Plan for the Future

Implement an informed and guided plan for the future. Assess the numbers and consider patient feedback. Have your patient conversion rates increased due to a positive, established social media platform? Do your patients give positive feedback—verbal or written—on quarterly newsletters and individualized emails? Make concrete goals for the future and implement strategies and procedures to get there. If your goal is to increase patient conversion by 50%, invest in training your front office staff and developing the right materials to educate prospective patients on the high-quality service and care you provide. This will lead to increased consultation and service appointments in the future, expanding your patient base and increasing the profitability and success of your office.

Click here to learn more about training with Terri Ross.

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  Guest Post  Med Spa Trends 

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UPDATED—The Hyaluron Injection Pen: Is It Legal? Who Can Use It?

Posted By Administration, Monday, August 26, 2019
Updated: Monday, August 26, 2019

medicine

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

ORIGINAL STORY [7/1/2019]: The Hyaluron Pen is a new injection device that is gaining a lot of buzz overseas. It claims to deliver injections of fillers—typically hyaluronic acid—in a less invasive and painful way than typical needles and syringes. As these products make their way to the U.S., it must be noted that currently, no device is U.S. Food and Drug Administration (FDA)-approved for injecting hyaluronic acid and other fillers in this way. We have seen several ads and notices that offer to sell these devices and provide training for them. Before you make a purchase, you may want to know: Is it legal? And can you legally perform this procedure?

When a medical device gains FDA approval, it can legally be marketed for that specific approved use. We have discussed issues with using approved devices in unapproved ways—so-called “off-label use.” In this case, we were unable to locate an FDA marketing application for a hyaluronic acid injector. According to an FDA guidance document on needle-free injectors, this type of device would likely by regulated by FDA’s Center for Biologics Evaluation and Research or Center for Drug Evaluation and Research as a “combination product.” General-use needle-less or jet injectors are regulated as Class II medical devices. In general, without an FDA marketing or premarket approval, a product manufacturer cannot legally sell or advertise a device for unapproved use; this marketing prohibition extends to purchasers of the product as well.

Since this product is so new, there are no specific laws that directly address who may use it. Instead we must look at how similar procedures and technologies are treated. Unlike a traditional filler injection that uses a hypodermic needle and syringe, this device uses a high-pressure jet to inject the fillers through the skin without the use of a needle. This makes the device similar to other needle-less and jet injection systems that sometimes are used to deliver vaccines and other medications.

While the injection technology is novel, the treatment is fundamentally the same as traditional filler injections. Although there is no needle being used, the skin is still being “pierced” by the jet of hyaluronic acid. As such, we believe these pens will follow the same or similar rules as injecting filler using traditional syringes. Therefore, the use of these devices is a medical treatment, so a good-faith exam must be performed before the procedure, and if the physician is not administering the treatment him- or herself, it must be properly delegated. Unfortunately for practices that would like to use unlicensed practitioners to use pen injectors for fillers, this takes the procedure out of the scopes of practice for aestheticians and most LVNs.

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 become the next med spa success story.

UPDATE [8/26/2019]: AmSpa has become aware that the Texas Medical Board (TMB) has issued at least one and possibly more compliance letters regarding Hyaluron Pens. We don’t have all of the details on this issue, but it appears to have stemmed from health inspectors noticing a Hyaluron Pen at an aesthetician’s station during a salon inspection.

In the article below, we noted that even though these pens do not use needles, their use is considered the practice of medicine, and these procedures need to be performed by appropriate persons under medical supervision. This TMB letter, at least for Texas, confirms that belief, and we see no reason other states would take a different view.

It is our understanding that Hyaluron Pens are being promoted through seminars and trainings; these trainings seem to be marketed primarily to aestheticians and cosmetologists. Remember, before you spend any money or time on any training, it is important to verify that you will be legally able to perform the procedure. (See here for more information.)

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

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QP Extra: Q&A with David Prokupek of Ideal Image MedSpa

Posted By Administration, Friday, August 23, 2019

david prokupek

Prior to the economic downturn of 2008, medical aesthetic franchises were common; however, ever since the Great Recession, the industry has been dominated by independent practices. Today, large chains are beginning to re-emerge, led by Ideal Image MedSpa, a Tampa, Florida-based company that boasts 137 locations in the United States and Canada. AmSpa Content Writer/Editor Michael Meyer recently spoke with Ideal Image CEO David Prokupek about the company’s ability to offer patients convenience and high-quality care.

Michael Meyer: How did you first get into the medical aesthetic business?

David Prokupek: I got into medical aesthetics in a couple of ways. My brother is a doctor out in Los Angeles, and he's a little bit in this business; I was helping him look at the category. And then I got a call from the L Catterton guys, our private equity firm, who I'd known for the last 15 years, and they told me about this great opportunity and investment that they had in Ideal Image. Over about a 60- to 90-day period, I looked at the business and finished out all the industry work, and here I am.

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

DP: There are a number of factors to our success, but one of the main ones is that the leadership position that we hold in the industry gives us a tremendous amount of resources to really provide every client with a team of medical experts, and skin, face and body specialists. It's a unique position in the industry. A lot of people are very curious about how this noninvasive world works, so we're able to give them a counselor to help guide them through that and a medical professional, nurses and the like to do the treatments. That's been a big part of our secret sauce. Our consumers and clients really like the fact that we are a one-stop shop for everything—skin, face and body. We’re doing a tremendous amount of injectables, laser hair removal and body-sculpting. And we’re surprisingly affordable. Our average client is an average American, and we’ve figured out through our scale how to make the services surprisingly affordable. That’s added up to a lot of success for us.

MM: What makes your med spa different from others?

DP: I do think that our medically driven model is different. We are very much on trend about what's working and evaluating a lot of new services that are in the marketplace. And convenience has become an increasingly important part of our success. This last year, we've gone to same-day treatments for Botox and injectables, and almost half our business is happening that way right now. We're open late in the evening. And we've just put in all these 3-D skin Reveal cameras to really start to provide personalized analysis, especially around the face and skin. I think people really appreciate that personalized approach to the business.

MM: What is your most popular treatment? Which one brings in the most revenue?

DP: It's been changing. This past year, from a popularity perspective, Botox, facial fillers and injectables have become among the most popular things that we do. That business has been more than doubling this last year, and is really fueled by a broad interest from young women in their twenties to folks my vintage. There is a high, high level of interest amongst Americans as to what role injectables can play.

In terms of total revenue, our laser hair business still brings in the most money every year, but it's getting very balanced across body-contouring, injectables and laser hair at this point.

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

DP: As a leader of business of our size, I look at a balanced scorecard in terms of measuring our business. We spend a lot of time on consumer metrics, around net promoter score, satisfaction and ratings, as well as people's likelihood to recommend us. I look a lot at what our traffic looks like, from new clients to existing clients coming in and their purchase patterns with us. I think it's important for us to build a balanced approach to the business, so I’m really focused on the growth in the various modalities, including laser, hair, injectables, skin resurfacing and the like. The last thing is around our people, in terms of tenure and productivity and those kinds of metrics.

MM: What do you love most about aesthetics?

DP: I love that we really can help people look and feel their best naturally. People just feel good after they leave one of their clinics, and it's just a really uplifting industry to be in.

MM: What do you love most about being an entrepreneur?

DP: It really lets you create a platform to be transformational, to take risks and to try new things without a lot of constraints. That's really played to my skillset. I think, personally and professionally, it's very rewarding to be able to try those new things and be very creative. My style of being an entrepreneur has been to partner with private equity firms—in this case, L Catterton, the leading consumer private equity group. It helps me get the best consumer thinking and capital to be able to grow, and it's really energizing.

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

DP: I think it's really important, as an industry, that we really are transparent to what the client wants and needs regarding how our services work, and that we listen. I think it's really important that we focus on delivering results that are natural. And I think, personally, that focusing on the consumer, around convenience and service hours and services, is really something that's going to be important as the med spa category takes market share from other traditional places. I think if we focus broadly as an industry on those things, we're going to all do very well.

ideal image

MM: What is the goal with the clinic design that you incorporate into your facilities?

DP: We're continually working on our design, but I think one of the most important aspects of our design is to be warm and to be welcoming. I think that's critical. But patients should also have a sense of privacy. More and more people are talking about the procedures they're having, but there's also still an innate sense of privacy, confidence and intimacy that people want to have. The design, both in the consultation rooms and the treatment rooms, needs to be set up well for that. I would also say location—we’re trying to be more ‘Main on Main’ and in the flow of where our consumers live and work every day, versus being hidden away, and build the brand through visibility and convenience.

MM: What do you think is the benefit of your many locations? How does that affect your business?

DP: We have the benefit of having about 140 locations in a lot of states and in Canada. I think there are a couple of things that gets us. In terms of purchasing scale, we're almost everyone's biggest customer in the aesthetics business. It affords us a level of scale that we get to pass onto the consumer. One of the reasons I stepped into this role is that I really believe that building and having a brand that people see in the neighborhood around the United States inspires confidence. I think that gives us a lot of benefit to customers who start their treatments at one clinic and ultimately transfer to others along the way. I believe that as the leader with the locations, we have the ability to help set the standard for what a great business model from a consumer perspective and business model can look like, and that scale is going to bear fruit for us.

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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How Practices Can Effectively Use Social Media

Posted By Administration, Thursday, August 22, 2019

filming surgery

By Renee E. Coover, JD, ByrdAdatto

Social media in plastic surgery practice continues to explode, driven by the marketing opportunities created by the public’s unabashed desire for before-and-after photos and live patient surgeries. But with this reliance on social media to market and advertise, a plastic surgeon’s practice assumes often unknown risks. In a recent Los Angeles Magazine article, Beverly Hills Plastic Surgeon Ashkam Ghavami, MD, who has almost 400,000 Instagram followers to his practice, acknowledged the challenges in balancing ethics with entertainment. According to Ghavami, “Because social media is the most valuable marketing tool of our trade, some surgeons post deceptive before-and-after photos of patients on social media. This creates an uneven playing field and, worse, harms the potential patients who are trying to choose their surgeon.”

Questions arise as to what is appropriate or legal for a physician to advertise on social media: Does it require patient consent? Who ultimately owns the content that is posted to social media?

Here are some key compliance considerations for social media in your plastic surgery practice:

  1. Obtaining patient consent. Patient consent for social media use should be separate from other consents. Consent must deal with the circumstances of the social media use. A wide range of circumstances that can impact consent. Before you ever post before-and-after photos of a patient’s Brazilian butt lift, you must obtain written consent from your patient. Likewise, if your patient brings in a friend or relative to live-stream a video of his or her medical procedure, it still requires direct consent from the patient. Without patient consent, a plastic surgeon puts his or her license at risk by posting patient photos or videos to social media.
  2. Physician advertising rules. Physicians are subject to specific state medical board advertising rules that control the messages they advertise so as not to be deceptive or misleading to the public. The Federal Trade Commission (FTC) also regulates physician advertising. (For more on this, read Michael Byrd’s recent article “FTC Focuses on Social Media for Truth in Advertising.”) The American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) also regulate physician advertising; for example, check out this article, which discusses the first code of ethical behavior for sharing videos of plastic surgery on social media, published by Northwestern plastic surgeon Clark Schierle, MD, and presented at the ASPS annual meeting. Using “enhanced” before-and-after photos or stock image photos, using models, allowing staff to post their personal beliefs and opinions on your social media accounts, and communicating directly with patients via social media are just a few ways plastic surgeons get in deep trouble with physician advertising laws.
  3. Ownership of social media. The ownership of content posted by employees often is unaddressed. For example, physicians and nurses often post before-and-after photos to their personal social media accounts. This creates both potential infringement issues and patient privacy issues. As attorney Bradford Adatto noted in his recent article, “5 Key Details Every Plastic Surgeon Should Know About Their Employment Agreement,” relating to plastic surgeon’s employment agreements, there are a substantial number of patient privacy laws to understand before posting patient photos to social media. Further, if the practice intends to keep all social media content as its property, whether it is posted to a practice account or an employee’s personal account, this needs to be addressed in a social media policy.
  4. Social media policy. A variety of issues arise when using social media to advertise medical services; thus, it is crucial for every plastic surgery practice to develop a social media policy to address issues such as employees’ use of social media and ownership of the content. The social media policy also should be mentioned in your employee handbook. Simply having a social media policy is not effective unless all staff have been informed of the policy and management is trained to implement and enforce the policy.

All this information also applies to medical spas. To learn more about how to effectively use social media in a medical aesthetic setting, consider attending an AmSpa Medical Spa & Aesthetic Boot Camp. Each Boot Camp features a session on social media, as well as useful information about all aspects of running an effective medical aesthetic practice. AmSpa Members save when registering for Boot Camps—click here to learn how to join.

Tags:  ByrdAdatto  Med Spa Law  Med Spa Trends 

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