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Getting a Loan for Your Medical Spa Practice: Q&A With Wells Fargo

Posted By Administration, Wednesday, September 12, 2018

Sponsored Content: Wells Fargo

Being approved for a business loan for a medical spa practice isn’t a process that many are familiar with, and the thought of it can seem daunting. AmSpa recently recorded an episode of the Medical Spa Insider podcast with Jeremiah Johnson and Chris Maiwald of Wells Fargo. Check out the quick Q&A below and listen to the episode to get answers to your medical spa lending questions.

 
1. People tend to either be unfamiliar with commercial lending or intimidated by it. Can you describe how you, as a lender, approach the lending process with a new entrepreneur? Is it a difficult process or relatively painless?

Each lending scenario is different. However, I find the lending process to be relatively painless when the borrower/entrepreneur is responsive. My approach to lending is to offer financial expertise to my clients based on their business’ unique needs. My team and I work with our customers to offer them a range of financial services, including credit and cash management. 

 
2. Getting a commercial loan has been difficult, at least historically, in this industry. Are startup loans for med spas available? How hard are they to get?

Yes, start up loans for med spas are available. While each scenario and loan application is different, it is important to work with your banker to determine your best loan options. 

 
3. How does the overall process work? How long does it take? What information does the borrower need?

Although we have a standard process that all loans will follow, each customers’ business scenario and needs are different. Therefore, the timing will vary from customer to customer.

Most loan applications can take between 45 – 60 days depending on the complexity of the project. Projects that include real estate can take up to 60 days, due to the time it takes to obtain appraisals and environmental assessments. A start-up loan without real estate generally takes less time.

Equipment-only loans generally can take anywhere from 3-21 days depending on the documents needed and how fast the entrepreneur submits them.

Typically, we need a copy of an application, personal financial statement, 3 years of business and/or personal tax returns, and a resume.

 
4. How detailed a business plan should the entrepreneur have? Should they have pro formas for 1 year, 3 years, 5 years? How specific/detailed should it be?

Your business plan should serve as a road map to the success of your business. A detailed plan is great, but from a bank’s perspective, we look at a range of different numbers, what type of project you are taking on and the associated risk. 

 
5. Typically how much of a down payment does the entrepreneur have to come up with? Any rule of thumb?

Every loan transaction and customer is different and evaluated on their own merits. Generally, down payment requirements are up to 30% of the total project cost.

I always encourage our customers to call their banker to discuss the project they have in mind. This allows our team to get a better understanding of the customer’s needs and develop a plan for their specific business scenario. 

 
6. Are these loans typically personally guaranteed?

Not all business loans require a guarantee, but all SBA loans do require a personal guarantee. Talk with your banker to learn more about guarantees required by the lender. 

 
7. Why is it important to use a lender familiar with health care? Medical aesthetics specifically?

Lenders who fully understand the healthcare and medical aesthetics industry can speak the language that can help get borrowers through the application process and, if eligible and approved, get the project funded. Our team knows the industry thoroughly, so we are able to help our customers choose the right loan program that fits their needs and ultimately help to achieve their long-term plan. We understand all aspects of a business plan from the complete start-up cost to marketing. We also understand what it takes to be a fee for service business and how to approach cash flow needs from that perspective.

 
8. What about lending for capital equipment purchases, like a laser – do you handle that and how difficult is it to obtain this type of loan?

We have a healthcare equipment lending group that we will engage to help you evaluate potential options to finance this type of request. Our equipment lending group only lends on equipment and offers highly specialized expertise in this area.

Ultimately I would recommend reaching out to your banker who can make suggestions based on your unique situation.

 

For more information reach out to:

 Jeremiah Johnson
Vice-President–Healthcare Specialist
817-505-3641
jeremiah.a.johnson@wellsfargo.com

Chris Maiwald
Vice President¬–Business Banking
682-213-0711
chris.maiwald@wellsfargo.com

Tags:  Business and Financials  Medical Spa Insider Podcast  Sponsored Content 

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The Importance of Reading Contracts for Medical Spa Owners and Physicians

Posted By Administration, Tuesday, September 11, 2018

By Alex Thiersch, JD, Founder and Director of the American Med Spa Association

An employment contract between a medical practice and a physician must benefit both the employer and employee; otherwise, it likely will be unsatisfactory for one or both sides. If one or both sides don’t take the time to read the contract, they could find themselves disappointed with the outcome. Here are a few things that physicians and practices should find within a mutually beneficial contract.

For more information on medical spa employment contracts, view AmSpa’s webinar on the topic (free to AmSpa Plus members.) 

A Clearly Articulated Goal

Before a contract with a physician is finalized, the practice should consider what it wants to accomplish. Does it want to fill a need? Does it want to service more patients? Does it want to transition ownership to this individual? The answer to this can affect the way an employment agreement is designed and the type of person the practice wants to recruit (i.e., a younger doctor versus a more experienced one). If a practice hires a physician who has entrepreneurial aspirations to simply tend to patients, for example, neither side is likely to be particularly happy, and the relationship likely will not last very long.

The practice must clearly communicate its intentions during the recruitment process and make sure that the contract is built around that philosophy.

From the other perspective, a physician must honestly evaluate his or her goals when negotiating a contract. Physician contracts typically last for one to two years, but both sides typically expect that the relationship between the practice and the physician will continue thereafter, so a physician must consider his or her long-term plan. Is this where he or she wants to build a career? This can influence how the contract is negotiated.

The physician also needs to consider his or her “plan B”—if this arrangement does not work out, what’s next? The answer to this question heavily influences how he or she evaluates the contract. For example, if the physician wants to live in the city where the practice is located but the contract has a restrictive non-compete clause, that clause will need to be negotiated, as it severely restricts his or her options if it the relationship with the medical spa does not work out. Click here to read more on non-compete and non-solicitation clauses

A Fair Wage

A medical spa should balance the economics of the practice, the risk tolerance of the owners, and the realities of the market in terms of salary when negotiating a contract. A competitive guaranteed base salary with some form of incentive-based bonus system can make a difference when it comes to obtaining top talent who might be considering other options. There are multiple ways this can be arranged depending on what suits the physician.

The prospective employee, on the other hand, must come to terms with his or her risk tolerance. While a high base/low bonus structure might appeal to some, others might want to bet on themselves with a low base/high bonus structure. It is up to the physician to determine his or her comfort level with the contract’s salary structure and negotiate if it is not optimal.

The physician also must be sensible when determining his or her actual earning power. If there is not enough potential business in the market to justify taking a low base/high bonus salary, the physician should negotiate a different deal.

Ownership Considerations

The practice must determine what it wants to accomplish in terms of ownership with the hire, since it will affect everything from scheduling and coordination to top-level decision-making. The owner(s) of the practice also must consider if this transaction constitutes part of their exit strategy; if so, the contract must be structured with that in mind.

The physician, meanwhile, must determine his or her goals in building the practice and figure out how the ancillary revenue streams offered by the practice compare to those offered by others. Ownership has different appearances for different entities, so the physician must think about what he or wants and what the practice can provide. What is the cost of the investment? What is the potential return? What is the risk? All these questions should be answered in the contract.

A contract is a complicated matter. Both sides must assess the value of the risks and rewards, and they must be willing to compromise on matters that may not be as important. A careful reading of a contract is absolutely imperative, however—if a physician or practice doesn’t thoroughly read the contract, they have nobody to blame for their unhappiness but themselves.

For more information on structuring your medical spa profitably and compliantly, attend an AmSpa Medical Spa & Aesthetic Boot Camp and be the next med spa success story.

 

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

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SkinPen® Remains the Only FDA-Cleared Device for Microneedling

Posted By Administration, Monday, September 10, 2018
Sponsored Content: Bellus Medical

Aesthetic medical providers beware: The FDA codified its classification order for microneedling, likely putting practices using non-cleared devices at greater risk.

“In many medical device liability cases, a doctor is shielded from liability when properly using a cleared and compliant device, since the FDA review and clearance would ensure all likely hazards are controlled,” said Marc C. Sanchez, an FDA attorney who worked on Bellus Medical’s microneedling De Novo submission. “That defense is totally washed away when using an unapproved medical device.”

As of March 1, there is only one FDA-cleared microneedling device: SkinPen® by Bellus Medical. According to Sanchez, the classification order makes all non-cleared microneedling devices of any kind subject to enforcement actions, such as refusing entry for imported derma rollers and pens as well as issuing warning letters to non-compliant manufacturers.

Read Sanchez’s post on FDA Atty to learn more about the classification order and the new risks for doctors and aestheticians.

Click here for more information on Bellus Medical, and click here to read more about the SkinPen® in AmSpa’s medical spa treatment directory.
 

Tags:  Med Spa Trends  Sponsored Content 

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Social Media Advertising: Are You Legally Compliant?

Posted By Administration, Friday, September 7, 2018

By: Sam Pondrom, JD, Associate at ByrdAdatto

When it comes to advertising, social media is the hot new trend. It’s cheap, has a far reach and the potential to lure in many new customers. But it can also cost you if you aren’t advertising yourself and your business accurately. (AmSpa members can check their state legal summary, or utilize their annual compliance consultation with the business, healthcare, and aesthetic law firm of ByrdAdatto for more information on medical spa law.)

Social media marketing is being embraced across industries because of its cost-effective, direct-access marketing to potential consumers.  An additional bonus to social media marketing is its self-selecting nature, which allows social media users to seek out the advertising themselves, making them more receptive to the messages.  But when it comes to using social media marketing to select a plastic surgeon for treatment, it is important that social media users still perform their due diligence to ensure the advertisements are posted by board-certified, credentialed plastic surgeons.

A report recently published by the Aesthetic Surgery Journal examined all of the plastic surgery related advertisements posted to Instagram on a single day—January 9, 2017—to assess who was publishing the social media content.  The Journal found that there were about 1.79 million Instagram posts on that day that included at least one plastic surgery-related hashtag, like #plasticsurgery, #plasticsurgeon, #breastlift, #liposuction, or #brazilianbuttlift (hashtags categorize content and clicking on a hashtag retrieves similar content; they are functionally a search for similar content).  The Journal then evaluated the content of the top nine posts (top posts are those with the most engagement) in 21 plastic surgery related hashtags

The Journal also found that only 17.8% of the top posts for these hashtags came from board-certified plastic surgeons.  Another 26.4% came from physicians that did not have specialized plastic surgery training, and another 5.5% of the top posts came from persons who were not physicians at all, including dentists, medical spas with no physician/medical director, and even one hair salon.  The Journal also found that the majority of the posts were self-promotional (67.1%), rather than educational (32.9%), and that board-certified plastic surgeons were much more likely to post educational content than non-plastic surgeons (62.1% versus 38.1%, respectively).

This is particularly troubling because of social media’s reach and influence on young people, who now make up a large sector of the plastic surgery population in our country. The American Society of Plastic Surgeons reported that in 2014, nearly 64,000 cosmetic surgery patients were aged 13 – 19 and industry experts believe this number increases every year.  Moreover, in 2016, the American Academy of Facial Plastic and Reconstructive Surgery polled its members and more than half of the respondents reported an increase in cosmetic procedures in patients under age 30 in 2016. 42% of respondents also reported that their clients were at least partially motivated to seek plastic surgery because of a desire to look better in selfies posted to Instagram, Snapchat, and other social media platforms.

This means that social media users should research potential surgeons beyond their social media presence, and users wanting plastic surgery should seek out a board-certified plastic surgeon.  Board-certified plastic surgeons are doctors with more than six years of surgical training and experience, at least three of which are specifically in plastic surgery.  Moreover, social media users should move beyond Instagram and meet with the surgeon in person to obtain information like how many surgeries the surgeon has performed, what recover times are, and whether the patient is a good candidate for the surgery.

There are many resources to verify whether a physician is a board-certified plastic surgeon, including the American Board of Plastic Surgery’s website that lists physicians’ credentials, the American Society for Aesthetic Plastic Surgery that maintains a searchable database of board-certified physicians, and the America Society of Plastic Surgeons that allows a person to search for board-certified plastic surgeons by location.

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

For more medical spa legal and business tips sign up for our email newsletter to receive business strategies, news and med spa law directly in your inbox.

As the youngest of three brothers, Sam Pondrom learned early on how to work effectively as part of a team.  After graduating from Oklahoma State, an intrinsic sense of curiosity and a keen eye for details led Sam to work as an accountant for two Engineering-News Record top 40 construction firms.  It was here where he honed his ability to analyze complex issues and craft clear, concise answers.  Sam utilizes these skills to work in partnership with our clients to resolve their complex business and regulatory concerns in the most simple, straightforward way.

 

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

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Non-competes, Non-solicitations, and Medical Spa Employment Contracts

Posted By Administration, Thursday, September 6, 2018

By Alex R. Thiersch, JD, Founder and Director of the American Med Spa Association

Excellent medical spas require a commitment to building an excellent team, and once that team is in place many medical spa owners look to non-compete and non-solicitation clauses to protect their investment in time and training. Conscientious medical spa owners invest a great deal of time, effort and money toward making their employees the best they can be, and these contractual clauses, known as restrictive covenants, can prevent former employees from working for a competing medical spa and taking its clients and/or employees for a certain period of time. Implementing these clauses and enforcing them, however, are two very different things, so medical spa owners and operators must understand what they’re all about before attempting to utilize them.

Non-competition Agreements

A non-competition agreement is a part of a contract that is designed to bar an individual from working for a competing medical spa for a set period of time in a designated geographic area. If employees with non-competition clauses in their contracts choose to leave your medical spa, they would theoretically be subject to legal action if they went to work for another medical spa within the agreed-upon time span and geographic area.

This seems fairly straightforward; however, in reality, non-competition agreements are somewhat difficult to enforce to their fullest extent because American courts tend to be very reluctant to prevent people from working where they want. 

As with many things in this industry, the laws governing these arrangements vary from state to state. California, for example, has essentially established a ban on non-competition agreements. In Illinois, according to Renee Coover, JD, attorney with the law firm ByrdAdatto, “In a 2015 decision, the Third District of the Illinois Appellate Court readily followed and applied a rule established by a ground-breaking 2013 First District Appellate Court ruling. In Prairie Rheumatology Associates, S.C. v. Francis, the court reiterated that continued employment is sufficient consideration for a non-compete only where the employment is for a substantial period of time.  Citing the 2013 Fifield v. Premier Dealer Services, Inc. opinion, the court held that two or more years of continued employment amounts to adequate consideration. This means that the employee must be employed, under the terms of the non-compete agreement, for two years before the non-compete is enforceable against the employee.”

Non-solicitation Agreements

A non-solicitation agreement is a part of a contract that is designed to prevent a former employee from soliciting clients and/or other employees from your practice for a specified amount of time. In the medical spa setting, it’s not unusual for patients to become attached to the nurse practitioners, laser technicians and nurse injectors to whom physicians commonly delegate treatment. 

When one of these people decides to leave a practice, that practice needs to make sure that no effort is made to take said patients along—those are the practice’s patients, not the individual’s. If former employees make any effort to reach out to those patients and entice them to follow the employees to another practice, it is a clear violation of any non-solicitation agreement has been accepted.

Unlike non-competition agreements, non-solicitation agreements are commonly enforced, as courts are consistently willing to punish the misappropriation of a company’s assets—in this case, patients and employees. And with good cause—imagine the financial hit a medical spa could take if nurse injectors or laser techs were simply allowed to take the clients they’ve treated when they leave. However, like with non-compete agreements, you must be sure that any non-solicitation agreement you employ is carefully crafted to best protect your interests. 

Keys to Enforceable Contracts

Simply writing a non-competition or non-solicitation agreement into your employment contracts does not guarantee that they will be enforced when push comes to shove. But if these clauses adhere to the following guidelines, a medical spa’s chances of collecting damages if they are violated improve dramatically.

Adequate Consideration: In order to get something—in this case, protection for your medical spa should an employee leave—you must give something. This is known as adequate consideration, and every contract must include it in order for it to be enforceable. If you include a non-competition or non-solicitation clause in employees’ initial contract when they are hired, it is understood that employment is the consideration they are receiving in return for signing the contract.

“In the employment context, when an employee is at will, meaning he or she can be terminated at any time without cause, the employment itself constitutes adequate consideration,” says Coover. “Similarly, if a new employee signs a non-compete agreement as a condition of employment, the employment itself is also adequate consideration.”

However, if you wish to incorporate one of these restrictive covenants into an existing contract, some states require that you provide your employee with something extra in return for it—typically a pay raise or a promotion These states do not consider continued employment to be adequate consideration. If an employee does not receive something in return for this newly incorporated restriction, it is unlikely that a court will view the contract as enforceable. 

Coover adds, “For continued employment to be adequate to enforce a non-compete agreement on the existing employee, the employment must last a sufficient amount of time. For example, if a new employee signs a non-compete and the employer fires the individual the next day, it would not be fair to restrict the employee from competing for years in the future.”

Legitimate business interests: Courts typically permit the enforcement of restrictive covenants when they are utilized in the protection of confidential information, investment in specialized training and patient/client relationships. Make sure that any restrictive clause you wish to employ addresses these issues in some fashion—reach for anything more and you risk its enforceability.

Reasonableness: A restrictive covenant should not be excessively long in duration or cover a geographic area any larger than need be. Of course, both of these factors are case-specific—if a medical spa is in an urban area with a great deal of nearby competition, for example, it makes sense that the geographic restriction should cover a smaller area than if it were in a small rural community with one other medical spa in a 20-mile radius.

AmSpa members can utilize their annual complimentary compliance consultation with ByrdAdatto for any further questions regarding restrictive covenants in employment contracts.

A Crucial Decision

When delving into the world of restrictive covenants, it’s crucial to make sure that any non-competition or non-solicitation contract provided to employees be legal and binding. After all, a medical spa’s employees and clients are its lifeblood, and need to be protected. If you have existing contracts, make it a point to have a local health care attorney review them for viability. If you don’t have them in place and want to include them in your employment packet, make sure to work with a health care attorney to craft them correctly the first time.

To learn more legal and business best-practices attend a Medical Spa & Aesthetic Boot Camp and be the next med spa success story.

Subscribe to AmSpa’s email newsletter for medical spa news and legal and business tips delivered directly to your inbox.

 

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

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5 Principles For Recruiting and Hiring Medical Spa Employees

Posted By Administration, Wednesday, September 5, 2018

By Dori Soukup, Founder and CEO of InSPAration Management

Recruiting, and hiring medical spa employees (including physician assistants, nurse practitioners, nurses, and aestheticians) and building them into a high performing team can be difficult. Finding talented team members, training them, and keeping them is essential to success! In this article, you will discover five effective principles to help build your team and elevate your performance.  

PRINCIPLE 1: Always Be Recruiting 

You should always be on the lookout for talent. Avoid waiting until you need people to start interviewing. You want to hire people who have a position already. In sports, teams have recruiters who are always scouting and looking for talent. Your business should follow the same practice. You need to always be searching for “A Players”. If you wait until you need someone, you end up hiring out of desperation and you will most likely hire the wrong person. 

PRINCIPLE 2: In-Depth Interview Process

It all starts with the interview. Do you have a system for the interview process? If not, you must in order to avoid faux pas. The most common mistake spa and medi spa professionals make when hiring individuals is the lack of clarity in regard to expectations. 

Often, a detailed position description and a commitment agreement are missing. Both are essentials components of the CLARITI Hiring System where you write down all the expectations you want the employee to do. 

For example, if recommending retail products is mandatory, it needs to be clarified in the interview process. Or if attending training and team meetings is something you do on weekly and monthly basis. Or if doing laundry and maintaining inventory, etc. All expectations should be disclosed, clarified, agreed upon in the interview process, put in writing and signed off by both you and the new employee. This will help you avoid making costly mistakes and assist you in hiring A and B players instead of C and D players. 

The cost of team turnover and hiring mistakes is enormous. Always hire slow. Take your time and make sure everything is crystal clear prior to offering the position.  

Find the keys to implementing CLARITI in your practice in the AmSpa Store.

PRINCIPLE 3: Orientation 

Once you’ve hired the new employee, your goal is to position them for success. Begin with a professional Orientation. Your orientation manual should contain your operating guidelines, your organizational structure, your culture, your policies, procedures, your systems along with your employee manual. This can be a mini seminar they attend or it can be a video they sit and watch. Post-orientation, they should be tested to ensure they understand everything. This will provide clarity on what it means to be part of your team.  

PRINCIPLE 4: Spa & Medi Spa Training Manuals

No one is going to come to you completely trained. It’s essential to have training manuals to help you train your team. One thing I learned long ago is that for a business to succeed, you need to have effective systems in place, then keep training those systems until they are perfected. 

As a business consultant, I have the opportunity to speak to many medi spa owners and directors. The one thing I notice over and over is the lack of training structure within spas. Spa leaders must put on the trainer and coach hat more often if they want to build a dream team and reach new levels of success. 

I like to use sports analogies because they have a lot in common with business. Sports teams spend a lot of time training and sharpening their skills. Coaches are always on the floor watching and coaching  their teams. They take time-outs, watch videos, create plays and map-out game strategies. You have a TEAM and if you want to win, you need to spend time coaching and training. 

A. Business Training

Business training is almost non-existent within the industry. BIG MISTAKE! 

As leaders, it’s essential to train the team. Having training manuals by department will make your life a lot easier. Your manuals should include systems, strategies, processes, tools, forms, scripts, an approach on how to perform and deliver a great guest experience. 

Business training should include:

  • Revenue generation – Training the team on how to increase service and retail revenue (Click for more information on recommending treatment upgrades, series sales, or retail products)
  • Marketing – self and cross promoting to increase awareness  (Click for more information on building a medi spa marketing plan)
  • Guest experience – increasing retention rate
  • Promoting spa and medi spa memberships (Click for more information on developing your membership program)
  • Overall revenue generation – Increasing revenue per guest (Click for more information on compensation based on Volume Per Guest)

B. Technical Training 

Delivering a great experience is essential to your success. Your team must wow your guests with their skills, techniques and knowledge.

Technical training should include:

  • Treatment protocols
  • Product knowledge – services and retail
  • Contraindications
  • Ingredients and their benefits 
  • The spa and medi spa menu
  • Treatment room up keep
  • Inventory management
  • Monitoring product cost per treatment

C. Guest Relations Training – Reception Team 

Your client relations department can make you or break you.

Training manual should include:

  • Call management
  • Check-In
  • Check-Out
  • Retail sales
  • Future appointments
  • Membership sales
  • Scripts and strategies
  • Targets and goals

Click here to learn how to transform your guest relations department.

To be successful, a big emphasis must be placed on initial training and continual training.

PRINCIPLE 5: Develop Healthy Training Habits 

Training Schedule

Develop a training calendar and publish it. A training session can be as short as 30 minutes. Getting the team into a training habit is essential to your success. Schedule training sessions for the same day and time on a regular basis.

Training Agenda

Be prepared with an agenda and a purpose. Portray a professional image to your team and keep them engaged.

Evaluating Your Training

It is wise to evaluate your training to ensure productive sessions and obtain valuable feedback.

Assistant Coach

As in sports, the head coach has assistant coaches to assist them. Who are your assistant coaches? If you don’t have them, it’s time for you to develop some key players to assist you.

Setting Goals

Establish targets and goals for each department. Break them down into daily goals.

Measuring Results

Not measuring results is like getting on the playing field with a bunch of people running around and not keeping score of the game. Setting goals and measuring results is the only way to run a successful business.

Success requires planning, self-discipline, motivation, dedication and consistency. When you invest in your team’s technical/business training and development, your spa business will thrive and produce great results. 

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.

 

Tags:  Business and Financials  Med Spa Ownership 

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HIPAA Breaches: How to Protect Patient Privacy in Your Med Spa

Posted By Administration, Friday, August 31, 2018

By Jay Reyero, JD, Partner, ByrdAdatto

Patient privacy and HIPAA go hand-in-hand in any medical setting, including your med spa. While cyberattacks, whether on large hospital systems or small clinics, make for splashy headlines, healthcare providers should not forget to look within when it comes to vulnerabilities.

A recent examination by Verizon of security incidents across 27 countries found that the majority (58%) of healthcare protected health information (“PHI”) data breaches were due to insider threats. (For more information on patient privacy, sign up for our upcoming live webinar. It is free for all AmSpa members.)

The report highlighted several areas that healthcare providers encounter on a frequent basis where risks could arise internally, such as the potential for privilege abuse. Personnel require access to specific PHI to perform their duties but providing such access puts them in position to easily use or access the PHI for other, malicious purposes. This can be especially problematic with disgruntled or recently fired employees. The three steps a healthcare provider should take to protect itself are: (1) Identify; (2) Address; and (3) Audit.

Identification requires healthcare providers to identify all of the vulnerabilities to PHI; not only those risks from the outside, but just as important, those risks from within the organization. 

Once a healthcare provider identifies its vulnerabilities, steps should be taken to address each by implementing the appropriate safeguards necessary to protect the PHI, both in terms of technology and internal policies and procedures. Many may recognize this as the first step of any HIPAA compliance plan, which is the Risk Analysis and Management required under the Security Rule. 

Finally, healthcare providers must continue to be vigilant against the ever-present threat to extremely valuable data through regular audits of the systems and policies in place to find new vulnerabilities or current vulnerabilities being exploited.

Healthcare providers would be wise to conduct an updated (or first) risk analysis and understand where they stand in the fight against threats to PHI.

For more information on ways to build and run a successful, profitable, and legally compliant medical spa attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps and be the next med spa success story.

ByrdAdatto represents physician practices, dental practices, law firms, medical spas, and other professional services companies throughout the United States. AmSpa members can take advantage of an annual compliance consultation call with the firm.

Jay Reyero, JD, is a partner at the business, healthcare, and aesthetic law firm of ByrdAdatto. He has a background as both a litigator and transactional attorney, bringing a unique and balanced perspective to the firm’s clients. His health care and regulatory expertise involves the counseling and advising of physicians, physician groups, other medical service providers and non-professionals. Specific areas of expertise include Federal and State health care regulations and how they impact investments, transactions and various contractual arrangements, particularly in the areas of Federal and State anti-referral, anti-kickback and HIPAA compliance.

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

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Which Procedures Count As the Practice of Medicine in a Medical Spa?

Posted By Administration, Thursday, August 30, 2018

By Alex R. Thiersch, Founder and Director of the American Med Spa Association

Determining the distinction between medical and non-medical treatments is perhaps the defining issue of the medical aesthetic industry and, in many cases, that distinction is not as clear-cut as all involved would like it to be—what’s legal in one state might not be in another, for example. (AmSpa members can check their medical aesthetic legal summary to find this information.)

Medical spas, unlike most plastic surgeons’ offices and traditional doctors’ offices, make a lot of their money from offering non-medical treatments—such as facials, chemical peels, and aesthetician services—in addition to medical services. In fact, aesthetician services typically are among the top three treatments offered by most medical spas according to the AmSpa 2017 Medical Spa State of the Industry Survey. Many people begin their experience with a medical spa by partaking of these non-medical treatments before moving on to more invasive solutions so, needless to say, these services can be extremely valuable to a medical aesthetic business.

It is extremely important for employees of a medical spa to understand which procedures they perform are medical in nature so that they can approach them accordingly. If an aesthetician can perform a procedure by him- or herself, costs are much lower and margins are likely much higher; when you move into the medical realm, however, you must involve a physician, nurse practitioner, or physician assistant, and you must follow medical protocol and regulations. Costs go up, record-keeping requirements are far greater, patient privacy becomes an issue, and on and on.

For more information on proper medical spa procedures see AmSpa’s webinars on supervision and delegation, patient-charting requirements, and much more.

Some general guidelines can help determine what is and is not a medical procedure.

Baseline Rule

The baseline rule is that anything that impacts living tissue is considered medical. Generally speaking, if you’re doing something that goes beneath the outer dead layers of skin—known as the stratum corneum—you can assume that you are engaging in the practice of medicine. 

Exceptions

However, there are some exceptions to this rule. In several states, laser hair removal is the subject of certifications and rules that place it at least adjacent to the medical realm, despite the fact that it does not penetrate the skin. 

Additionally, microneedling, one of the trendiest procedures in the business, has been determined to be medical in nature by all the regulatory agencies that have looked at it, despite the fact that in many cases, the needles are set to a depth that does not actually penetrate the stratum corneum. Regardless, the fact that metal needles are the tools being used makes this a medical procedure in the eyes of the law in many cases.

Finally, subdermal fat-removing treatments, such as SculpSure and CoolSculpting, which don’t involve any sort of conventional laser use or invasiveness, still should be considered medical, even though the matter hasn’t as yet been widely investigated by state boards. There is very little doubt in my mind that as soon as an influential state board looks at them, it will determine these treatments to be medical in nature because they affect living tissue; therefore, you must observe medical protocol when performing them.

Beyond these general guidelines, AmSpa can help you determine what is and is not considered a medical procedure in your state. Use our website to keep up with the latest regulatory updates and, join us for an upcoming Medical Spa & Aesthetic Boot Camp (Boston in September, Nashville in October, and Orlando in November), to learn everything you need to know to keep your medical spa compliant and successful.

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

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Fillers For Your Other Lips?

Posted By Administration, Wednesday, August 29, 2018

By Emerald Gutierrez, RN, Certified First Assist in Cosmetic Surgery & Aesthetics

What may surprise you is that more women have problems when it comes to sex than men. Some 43% of women say they’ve experienced sexual dysfunction at some stage of their lives compared to 31% of men.

Sexual dysfunction in both men and women can result in a reduction in sexual intimacy in a relationship, which may then negatively affect family life and self-esteem. We need to keep in mind that female sexual arousal is multifactorial, often with psychological and emotional as well as physical factors, so there is no one ‘magic bullet’ treatment.

When sex becomes more painful than pleasure, don’t lose hope. Explore the below treatments and turn up the heat between the sheets.

The Challenge: Vaginal thinning & dryness; painful sex
The Treatment: Filler or PRP Injection
(Plasma-rich Protein) also nicknamed as the “O” or “O-Shot”

Recommended Treatments: Three every 4 weeks
Down time: None
Pain: None


Regeneration of this area leads to increased sensitivity and better orgasms. It is very safe as we use your own body products with minimal risks of bruising and infection.
-Emerald Gutierrez, R.N
Certified First Assist in Cosmetic Surgery & Aesthetics.

Platelet-rich plasma (PRP), where your platelets are separated from blood and then injected back into the body is traditionally given to stimulate collagen in the face but in recent years this treatment has been found to have benefits for genital areas too. It’s been nicknamed the ‘O shot’ as it’s said to improve sensitivity and the ability to orgasm. PRP tricks the body into believing it has been injured so it releases stem cells which regenerate tissue and we find it can help with everything from the skin condition sclerosis to stress incontinence and sexual dysfunction such as inability to climax.





The Challenge: Vaginal looseness
The Treatment: The Votiva, Radio Frequency by InMode

Recommended Treatments: Three every 4 weeks
Down time: None
Pain: None



Votiva is beneficial for therapeutic use in the treatment of sexual dysfunction or as an adjunct to Kegel exercises (tightening of the muscles of the pelvic floor to increase muscle tone). This treatment delivers gentle, thermal internal tissue remodeling of the genitals that is safe, effective, and in-demand. This is a comfortable treatment that provides uniform radio frequency heating of the internal vaginal tissue and external vulvar laxity or labial hypertrophy.

Labiaplasty
If time, genetics or childbirth has resulted in embarrassment, discomfort or intimacy issues due to the size and shape of your labia, labiaplasty procedure may be a good option for you.

Labiaplasty is a one to two hour surgical procedure designed to sculpt the external vaginal structures by reducing and/or reshaping long or uneven labia. Childbirth, the aging process and the effects of gravity may all erode the beauty of the female genitalia including the labia minora, labia majora, clitoral hood and perineum.
  • Experience a more youthful look in the vaginal area
  • Feel Improved sexual gratification and Increased friction during intercourse
  • Enhance vaginal muscle tone, strength, and control
  • Quick recovery- risks in surgery are extremely rare, and are seen in less than 1% of cases

Emerald Gutierrez has been a Registered Nurse for 18 years. Her experience includes Emergency Dept., In-and Out-Patient Operating Room/Recovery Room, Plastics, Oncology, Women’s Health, GI, Nurse Educator, and Director of Nursing. She began her role as a Beverly Hills Cosmetic Nurse/Nurse consultant when she moved to Los Angeles to obtain her RNFA degree (Registered Nurse First Assist), and her CNOR (Certified Nurse Operating Room) from UCLA. Since then, she has received training from some of the top prestigious and world renowned Cosmetic Surgeons, with most of them appearing on “Dr. Oz”, “The Doctor’s,” “Botched”, and “E Entertainment”.

Tags:  Glam RN Beverly Hills  Med Spa Trends 

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Your Medical Spa Show is Returning in 2019 and Early Bird Pricing is Almost Over

Posted By Administration, Tuesday, August 28, 2018

By Alex Thiersch, Founder and Director of the American Med Spa Association

At the beginning of this year the American Med Spa Association launched our first national trade event: The Medical Spa Show. The event was a long time coming, and we brought together more than 450 medical spa professionals from more than 220 practices across the country to provide something that the medical aesthetics profession truly needs and has been sorely lacking: a conference exclusively for medical spas, by medical spas.

 

Our first show was a success beyond anything we were expecting, and we’re proud and excited to follow that up with a Medical Spa Show that’s even bigger and better in 2019. Early bird pricing ends at the end of this month, so be sure to sign up this week to take advantage of these savings. 

We’re expanding with an additional half day of education for a total of over 100 sessions to choose from, and a 60% increase in booths in the exhibit hall giving you even more opportunities to find your next great technology, treatment, or service provider.

As many of you know, here at AmSpa we like to do things a little differently. Our goal has always been–and will always be–to advance the industry through business-building and legal compliance. We want everyone to be profitable, so we’ve brought together some of the top medical spas and aesthetic centers in the country to offer their secrets on how to build a successful practice. 

Along with that, and equally important, we want the industry to be safe. Because of this we provide extensive coverage of the laws, the emerging legislation that will impact the industry, and best-practices to keep the industry growing at its current pace.

In developing the course schedule the goal was for it to be a truly beneficial tool for you. I’ve been to far too many conferences where attendees have been underwhelmed by the content–where they left with only one or two pieces of new information to implement into their practices. AmSpa believes that a conference should be full of great material, and that every class should have value–not just one or two, so we conferred with many of the top medical spas and aesthetic centers in the country to determine what they wanted to learn.

And please don’t forget that one of the primary reasons we’re putting this conference on is to bring the industry together, because make no mistake about it–this is your conference. I’ve found that the best education can often come from the exchange of information, so plenty of time for networking and socializing (and partying! It’s Vegas, baby) has been built in.

Please reach out to us if any of you have any comments or questions. Our hope is that this conference will be on your calendar every year from this day forward, and just as a last reminder early bird pricing ends this week for the 2019 show, so click here to sign up today

AmSpa members save an additional $75, and if you’re not an AmSpa member you can save $100 on AmSpa Basic membership by signing up along with a ticket to The Medical Spa Show. I can’t wait to see you all in February when the medical spa industry comes together.

Tags:  The Medica Spa Show 2019 

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AmSpa provides legal, compliance, and business resources for medical spas and medical aesthetic practices.

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