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Keys to Keeping Medical Records in a Medical Spa

Posted By Administration, Monday, October 8, 2018

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

Medical spa medical records are a piece of your compliance plan that cannot be overlooked. It’s easy to look past them when considering other parts of building your business, but they are vital to your practice. According to our 2017 State of the Industry Report med spas indicated that 70% of their clients are repeat customers. This is a wonderful statistic to read because loyal customers are happy/satisfied customers and they can and will generate great recommendations and buzz for new customers. But these loyal clients and customers are much more than that; they are also patients. Because most of the procedures offered in med spas are medical procedures the practice must retain appropriate records just as any other clinic or doctor’s office would. 

The content and retention requirements for medical records are set by each state and their respective medical boards. In general the records should include, among other things, medical histories, exam notes, details of procedures and treatments. Typically these should be kept for several years after seeing the patient with the two years that New Mexico requires being the shorter side and 10 years as in Tennessee and South Carolina being on the longer side. Physicians may be subject to Board discipline for failing to properly maintain and keep patient records, so you will want to review your own state statutes and advice of your medical board to determine what information should be kept in the medical records and how long you should keep them. 

Watch AmSpa’s webinar on patient charting for more information on the topic.

The 2017 industry survey also uncovered this interesting stat: half of med spas we heard from see more than 50 patients a week. This is great from a business perspective, but daunting from a record keeping perspective. Every one of those visits will need an entry made in that patient’s records, and the med spa’s records system, in addition to being able to keep up with the volume of updates, will also need to comply with Federal and State privacy laws. 

The big one is the federal Health Insurance Portability and Accountability Act (HIPAA). I’m sure you’ve heard more about HIPAA than you ever cared to so I won’t bore you with too much detail other than to say patient medical information needs to be securely stored and accessible only to authorized individuals. Most states also have a version of a patient information privacy law with similar concepts. 

While the general gist of the laws are “protect patient information” you’ll need to check your jurisdiction for specific implementation requirements. For instance California has the Confidentiality of Medical Information Act which has stricter requirements on when and who you can disclose confidential health information. AmSpa members can check their state’s medical aesthetic legal summary, or utilize their annual 15-20 minute complimentary compliance call with ByrdAdatto for more specific information.

It takes a lot to build a successful med spa and the more successful it becomes the more important it is to have a streamlined and secure medical record system and policy. Don’t let paperwork be a limitation on your Spa’s success. If you want to learn more about record retention policies and systems consider attending one of AmSpa’s Medical Spa & Aesthetic Boot Camps to learn medical spa legal and business best-practices.
 
If you liked reading through our 2017 State of the Industry Report we will be gathering data for 2019 survey soon. Did your spa see more customers this year? Did you add new service lines? Or bring on more staff? We hope to hear from you so together we can define data in the medical spa industry.

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

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What Does Certification Mean in a Medical Spa?

Posted By Administration, Tuesday, October 2, 2018

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

Certifications are common in medical spas, but some of them mean more than others. In some cases, for instance, a certification doesn’t necessarily even mean you can perform the treatment in your state. Understand the difference between Board Certification, training programs that offer certificates, and state licenses so you don’t end up purchasing equipment you can’t legally use or worse, on the wrong side of an investigation.

Board Certified

In many fields of medicine, board certification can inform patients of a doctor’s specialization and help them choose which doctor is right for them. In the medical aesthetic and medical spa space, however, there are multiple types of certification to consider, and determining which are meaningful and which should be looked at with some trepidation is a dilemma for both consumers and medical spa operators.

“Board certification” is a state or nationally recognized certification by a board that has been created to keep certain standards in a particular profession. For example, in order for a plastic surgeon to achieve board certification, he or she must go to school, train for a certain amount of time under another surgeon, and take a board exam, among other requirements. There are numerous specialties in which a doctor can achieve board certification, including obstetrician/gynecologist, family practice, neurology, and general surgery. 

These certifications are extremely precise, and they help inform consumers who are searching for a very specific type of doctor. If you need surgery, for instance, you are going to look for a board-certified surgeon, because this guarantees that the surgeon in question has met a governing body’s standard, and it can be presumed that standard is reasonably high.

Certification Classes

However, in medical spas, you’re much more likely to come across people who claim to be certified in areas such as laser use and injectables. This is a whole different world of certifications—these are not based on state or national standards, since those standards don’t yet exist, generally speaking. (Some states—including Georgia, New York, and Texas—have enacted laser certification laws that provide for a certain level of training, but the focuses of these certifications is very narrow and typically are relegated to laser hair removal. See AmSpa’s medical aesthetic legal summary to see if there are aesthetic certifications in your state.)

The “certified” laser technician is the most common of these types of professionals, but being certified in laser use typically means that a person passed a course administered by the manufacturer of a laser he or she is using. In most cases, this does not, in any way, mean that a state medical board or state licensing board recognizes that training as being substantial enough to warrant certification. Any private company can train someone and provide a certificate that states the person completed that training. In fact, many people who complete these courses declare themselves to be “certified,” but this is not the same thing as being board-certified.

In the medical aesthetics industry, many of these certifications are available, but none should provide the public with the same level of confidence that a doctor’s board certification does. It is up to the medical spa industry and the providers of the services to ensure that the public is not misled. 

Additionally, these certification classes may offer some level of training in the procedure but generally do necessarily allow a practitioner to perform the treatment in their state with or without supervision or delegation of a doctor. Check with your state boards, the AmSpa legal summary, or an attorney familiar with aesthetics before offering a new procedure. 

Truth in Advertising

Medical providers are bound to very specific requirements when it comes to advertising. If you say you are certified in something, you need to be able to prove that’s true. If a laser tech is certified by a laser manufacturer rather than an actual medical board, this must be made clear in any public-facing material. And though this should go without saying, a certification to fire a laser in a particular state is very different than a license to practice medicine, so saying that anyone other than a doctor is “board certified” likely is a good way to get a practice investigated.

(Note: Physician assistants can be certified through the National Commission on Certification of Physician Assistants, but this also does not imply a focus on aesthetics. The NCCPA provides an online tool to check if someone with a PA-C has actually been certified by the organization.)

All practitioners need to be careful about how they represent themselves to the public, and they need to be somewhat wary when a laser company says it can certify someone for a particular procedure, because that does not necessarily mean that the state recognizes their ability to perform it. Ultimately, responsibility and accountability lies with the on-site doctor to determine if a person is able to perform a procedure, regardless of whether or not he or she has been certified by a manufacturer.

Attend an AmSpa Medical Spa & Aesthetic Boot Camp to learn what you can and can’t do in a med spa, and to find ways to build an efficient and profitable medical spa practice.

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

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FTC Announces Enforcement Action Against IV Therapy Clinic for Misleading Advertising

Posted By Administration, Monday, October 1, 2018

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

The Federal Trade Commission (FTC) recently announced their first ever enforcement action against a provider of intravenous therapy (IV therapy) for making unsupported claims about the health benefits of their IV treatments. You can read the complaint and press release by clicking here. But in brief the FTC alleges that iV Bar’s website contained multiple false, and unsubstantiated representations as to the clinical or scientific effectiveness of the treatments. Setting aside the merit of the FTC’s claims, this case does highlight a hidden danger of medical spa and IV bar ownership: advertising.

Advertising is a critical part of a successful med spa or IV therapy clinic. Effective advertising is vitally important in attracting new patients and informing existing patients of other services you offer. You want to let consumers know of your expertise, the benefits you can provide, and to distinguish your practice above your competitors. However, med spa and IV therapy clinic advertisements, as with other medical practices, fall under several layers of rules and regulations. Since advertising by its very nature is easily accessible out in the public sphere it makes it a simple matter for regulatory bodies to locate advertisements that violate the laws. Therefore it is beneficial for med spa and IV bar owners to have at least some familiarity with the limitations of what they can say in ads.

Read more about legal issues in medical spa advertising here.

Deceptive Practices Acts

In addition to the Federal Trade Commission Act, many states have adopted some form of a deceptive trade practices act designed to protect consumers from fraudulent and deceptive advertising and statements. These are usually enforced by the State’s attorney general and many provide private rights of action allowing the consumer to sue the business directly. For example the Texas Deceptive Trade Practices Act makes it a deceptive practice to represent that goods or services have approval, uses, benefits which they do not. Damages in the Texas statute can include compensation for economic and mental anguish and if the court finds that the conduct was “knowing” and “intentional” it can result in three times the economic and mental anguish damages being awarded to the consumer. 

Medical Licensing Boards

Med spas and IV therapy clinics are medical practices and as such will fall under their state’s rules for physician advertising and professional conduct. Many state Medical Practice Acts, including Florida’s, prohibit physicians from using false, deceptive, or misleading advertising or as is the case in New Hampshire claiming professional superiority. Even if not explicitly in the statutes, state medical board’s ethics rules and opinions often contain similar prohibitions. For a good general overview there are the American Medical Association’s ethics opinions such as this one which states, in part:

Because the public can sometimes be deceived by the use of medical terms or illustrations that are difficult to understand, physicians should design the form of communication to communicate the information contained therein to the public in a readily comprehensible manner. Aggressive, high pressure advertising and publicity should be avoided if they create unjustified medical expectations or are accompanied by deceptive claims. The key issue, however, is whether advertising or publicity, regardless of format or content, is true and not materially misleading.

Often, state medical disciplinary boards are influenced or adopt guidelines similar to the AMA’s.  
The business name you advertise under can also be subject to various rules. Several states, one such being California, prohibit a physician from doing business under a name different than their own unless they obtain a fictitious or assumed name registration. Still other states limit the use of words such as “spa”, “clinic”, or “medical” unless certain requirements are met or procedures offered.

AmSpa members can utilize their annual compliance consultation call with the law firm of ByrdAdatto to understand the medical advertising requirements in their particular state.

Conclusion

False, misleading, and deceptive. If you feel like you are seeing a trend you are right. Generally these laws and boards use similar language to protect consumers and patients. However the specific interpretation and implementation of these terms is not identical and one type of ad or commercial may be acceptable in one state and not in another. So before you launch a “too good to be true” campaign you would do well have it reviewed by your counsel or to read up on your jurisdiction’s advertising rules.  

Attend an AmSpa Medical Spa & Aesthetic Boot Camp to learn how to build and run a profitable, efficient, and legally compliant medical spa practice.

Patrick O'Brien grew up in west Texas loving the outdoors and Scouting, earning the rank of Eagle Scout. After attending Southwestern University, he worked in Margin trading with a major investment brokerage. There, he saw how yesterday’s decisions affect tomorrow, and learned how to proactively navigate situations to give clients the best possible outcome. This problem solving inspired his return to school and pursuit of a law degree from Southern Methodist University. He brings his legal training and business acumen to AmSpa to get ahead of legislative changes which affect our members. When he is not in the office he enjoys reading the same book to his toddler for literally the twentieth time today. But he laughs every time so it is worth it. He also loves cooking and spending time outdoors with his wife, son, and loyal hound.

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

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When Do You Need a Medical Spa Business Attorney?

Posted By Administration, Friday, September 21, 2018

By Michael S. Byrd, Partner, ByrdAdatto

Compliance is cool, but do you have a compliance plan? Are you aware of any state laws that could affect your med spa ownership structure? A common problem among clients is the struggle with this common question: When do you need to hire a business attorney? Consistent with the adage “an ounce of prevention,” our most successful business clients follow the 5/50 rule.

The 5/50 rule is actually a choice we present to our clients when this very question is posed. The choice is whether the client would like to pay $5 now to proactively structure their business, set up compliance protocols, or address legal issues in their business. The alternative choice is to do nothing now and pay $50 to clean up the mess later. Though admittedly we should adjust the rule to realistic dollar comparisons, the 5/50 ratio is realistic. In making the choice more personal by drawing an analogy to one’s personal health, we ask our clients whether they would rather stick to an annual wellness treatment plan and pay the associated costs or go to the doctor and react to a stage 4 cancer diagnosis.

Our clients often then ask how to know whether they are properly using legal counsel to guide their business. A great litmus test is to look at budget and spending for legal counsel for the business. If a business has budgeted or spent under $12,000 in an uneventful year for legal fees, the business is not utilizing legal counsel proactively. Most on-going businesses spend between $18,000-$30,000 per year when using counsel to advise and proactively address the legal needs of the business. Smaller businesses or single-owner physician practices may spend less, but still be in the $12,000 range on the low end.

The first step to change how and when legal counsel is used is to shift thinking in budgeting and shift thinking on utilization. Good attorneys think strategically and creatively and can be a great confidante for new business ideas or issues.  Start calling your business attorney as a sounding board to work through these ideas and issues.  It does not have to be lonely at the top.

ByrdAdatto has created a platform to ease this transition. Specifically, our Access+ monthly retainer program creates a set monthly fee for a defined scope of work suitable for the typical needs of a business. The key to this program is unlimited access by phone and email to the attorneys at ByrdAdatto. The hope is that this will incentivize proactive communication with us to help keep the business on the 5 side of the 5/50 rule.

For more ways to build and run your medical spa practice legally and profitably attend an AmSpa Medical Spa & Aesthetic Boot Camp and be the next med spa success story.

Michael S. Byrd , JD, is a partner with the law firm of ByrdAdatto. With his background as both a litigator and transactional attorney, Michael brings a comprehensive perspective to business and health care issues. He has been named to Texas Rising Stars and Texas Super Lawyers, published by Thompson Reuters, for multiple years (2009-2016) and recognized as a Best Lawyer in Dallas by D Magazine (2013, 2016).

 

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

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Physician Liability in Med Spas

Posted By Administration, Thursday, September 20, 2018

By Renee Elise Coover, JD, ByrdAdatto

Physicians in the medical spa industry are lured by the lucrative income and flexible nature of med spa ownership but as the popularity of this business model increases, so does the risk for liability. 

The number of med spas in this country is at a record high. Dermatologists, plastic and cosmetic surgeons are opening med spas or adding med spa services to existing practices as the demand for non-invasive cosmetic procedures rapidly grows. Additionally, non-core physicians, mid-level practitioners, and entrepreneurs are beginning to outpace core doctors in the medical spa space, according to the 2017 Medical Spa State of the Industry Report

Though med spas offer non-invasive and fairly simple medical treatments like Botox and laser hair removal, these procedures carry the same risk of litigation as any other medical procedure. Due to the aesthetic nature of the treatments and spa-like setting where most treatments are performed, there is a public perception that med spa procedures are risk-free. This misconception has contributed, in part, to the recent rise in litigation, putting med spas in the spotlight for all the wrong reasons. 

Physicians now must be especially cautious when signing on as a “medical director” of a med spa, offering med spa-like treatments or opening a med spa of their own. As the saying goes, ignorance is not an excuse; but for many physicians, ignorance of the law can also cost them their license.

There are several common patient allegations that put physicians at risk of losing their medical license. Lawsuits are often filed by patients due to allegations of lack of supervision of medical treatments, inadequately trained med spa personnel, less than optimal results, and lack of informed patient consent. 

For more information about medical malpractice lawsuits listen to the recent episode of AmSpa’s Medical Spa Insider podcast with patient advocate law firm Sukhman|Yagoda.

 

Perhaps the most problematic issue that most patients are not even aware of is improper ownership of the med spa. In many states med spas must be physician-owned in accordance with that state’s medical practice rules, but many physicians either do not know the laws or they are trying to get around them. If a physician signs on as a “medical director” of a medical spa but has no ownership and no supervision of the medical procedures, the med spa will be charged with the unauthorized practice of medicine in several states and the physician could lose his or her license.

Non-physicians interested in participating in medical spa ownership should click here to learn about MSO ownership structures.

In Illinois, the Department of Professional Regulation has put med spas on their radar and in the past few years, hundreds of physicians have been fined, suspended or lost their licenses due to allegations of improper ownership or lack of supervision in the med spa setting. 

Physicians must be very cautious when opening a med spa or offering med spa services as part of an existing practice.  To reduce the risk of liability, physicians should educate themselves and their staff regarding written protocols, relevant laws and regulations for their particular state, legal and regulatory issues associated with med spas, adequate supervision and proper delegation of medical procedures, and risk management

AmSpa members can view the legal summary of medical aesthetic regulations or schedule their complimentary annual 20-minute consultation call with an attorney from ByrdAdatto.

For more guidelines on how to open and run a legally compliant and sustainably profitable medical spa practice attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps

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

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Tennessee Law Aims to Make Medical Spas Transparent

Posted By Administration, Tuesday, September 18, 2018

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

Tennessee medical spas are, for the most part, governed by laws that are very similar to the laws that regulate such practices in other states. (AmSpa members can check their medical aesthetic legal summary to find the laws governing their practice.) However, as part of a bill that was passed in 2015, Tennessee has taken the extremely unusual added step of defining “medical spa”. 

The Definition

According to the law, which can be read here, a medical spa is “any entity, however named or organized, which offers or performs ‘cosmetic medical services.’” The law also requires all medical spas, and medical spa medical directors, to register with the state’s health professional boards. Lawmakers hope that this regulation will help practitioners in the Volunteer State become more transparent.

Registration

For example, if you are the medical director or supervising physician of a medical spa in Tennessee, you are required to fill out a form to register with the state. Likewise, if you are running a medical facility that offers cosmetic medical services primarily, you must register with the state of Tennessee.

Other requirements in the law lay out what must be disclosed in this registration, and in the practice’s advertising. For example, if the medical director is not board-certified as a plastic surgeon or a dermatologist, that fact must be divulged. This is a laudable step, as it ensures the public has a significant amount of information available to it. It tells consumers right up front that a practice is a medical spa, and it allows them to know, in no uncertain terms, which doctors are affiliated with the practice. Click here to read about general best practices to make sure your medical spa advertising is legally compliant.

Treatments

Aside from the registry, Tennessee’s regulations are fairly similar to those of other states, in that some are very specific and can be defined narrowly, while others are more vague and present some grey areas. Generally speaking, though, all treatments that are offered at a typical medical spa—light-emitting devices, laser treatments, Botox, etc.—are considered to be medical treatments. Click here to read more about medical vs non-medical treatments in med spas.

Delegation

Tennessee has a fairly broad, yet restrictive delegation statute, which appears to say that a physician is authorized to delegate treatments only to LPNs, RNs, NPs, PAs, and, oddly enough, pharmacists. However, this statute does not provide any direction when it comes to delegation to unlicensed individuals. Therefore, it must be assumed that in Tennessee, you must be a licensed practitioner to fire a laser, for example. This is unlike similar delegation statutes in other states, such as Texas and Illinois, which allow physicians to essentially delegate to whoever they want, provided that person is operating within his or her scope of practice. Click here to see AmSpa’s webinar on the basics of medical spa delegation, free to AmSpa Plus members.

Ownership

Tennessee does not allow anyone other than a physician to own a medical spa, although in some instances, PAs and NPs can own practices and can enter into contracts with physicians. If you are a PA or NP who wishes to look into medical spa ownership, you should reach out to ByrdAdatto to discuss how to structure it. A consultation is free to AmSpa members. Of course, an MSO is a possible solution that permits a certain amount of ownership to a non-physician, but as we don’t want anyone to be a test case, the prudent and conservative approach in Tennessee is to make sure a physician owns the facility.

See the Tennessee medical aesthetic legal summary for more information about laws governing medical spa practices in the Volunteer State.

We’ll be discussing these regulations and many others at our Medical Spa & Aesthetic Boot Camp at the Doubletree Nashville Downtown in Nashville on Oct. 15 and 16. Join us there to learn all about how to run a compliant, successful medical spa in Tennessee and throughout the country. Click here to learn more and register, and click here to see the full schedule of Boot Camp dates.

 

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

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Physician Supervision: Keeping the “Medical” in Medical Spas

Posted By Administration, Thursday, September 13, 2018

By Renee E. Coover, JD, ByrdAdatto

Medical spa laws regarding physician supervision can be critical to a practice’s compliance plan, particularly if the practice utilizes nurse practitioners, physician assistants, nurse injectors, laser techs, or other non-physician providers to administer treatments.

Given the current economic landscape for medical practices, an increasing number of physicians are seeking alternative sources of revenue outside the traditional practice of medicine. Many physicians are turning to medical spas as an additional or alternative source of income, not wrought with the same Medicare/Medicaid and insurance issues currently plaguing the healthcare industry. But as physicians flock to medical spas in the hopes of making an easy income, many overlook the fact that a certain level of supervision is still required for all medical treatment. At the end of the day, the physician is responsible for every patient and if something goes awry, the physician’s license is on the line. 

Recently, our law firm has exploded with calls from physicians and med spa employees asking questions about physician supervision like: 

  • Does the doctor need to be present at all times? 
  • Does the doctor need to see every patient? 
  • What if the doctor consults with the patient over Skype- is that allowable? 

Of course, the answers to these questions, and many others, depend upon your particular state’s laws and regulations. AmSpa members can check their state’s medical aesthetic legal summary to find the answers to their med spa compliance questions.

The Practice of Medicine

First and foremost, it is crucial to know what med spa services require physician supervision in your particular state and what constitutes an adequate amount of supervision. In California, for example, all medical treatments – including Botox and laser hair removal – require physician supervision. Although a physician may delegate medical treatments and initial patient consults to nurse practitioners (NPs) and physician assistants (PAs), the physician must be involved and available to patients in the event of an emergency. 

Ultimately, the physician is responsible for each patient that walks through the door of a med spa. Some states have additional oversight requirements as well. In Illinois, a medical professional must be onsite at the med spa at all times when medical procedures are performed. This means that if a physician owner only has one other employee and that individual is a non-medical professional, the physician must be onsite at all times to supervise the medical procedures. 

Many physicians don’t realize, at least not right away, that treating patients in a med spa is just like any other practice. Most medical spa treatments by and large are still considered the practice of medicine, and the physician must assume ultimate responsibility for all of the patients that are seen and treated at the med spa. The physician must ensure that proper protocols are in place, oversee treatment plans, and safeguard patient confidentiality. While many of these tasks can be delegated, it is the physician, not the med spa owner or the employees, who is going to be held responsible if something goes wrong.

Experience and Training

One pitfall is the physicians’ notion that they can supervise medical tasks outside of their specialty practice, but in most states a physician in a med spa must specialize in, or at least have experience and training in, aesthetic medicine. In other words, the physician overseeing the medical spa and whose license is ultimately on the line, must actually practice aesthetic medicine.

Frequently, general practitioners, OB/GYN’s and emergency room physicians are quick to sign on as “medical directors” of med spas even though they have no experience or training in injectables, laser treatments, or any other aesthetic procedures, but this can get them in trouble fast. Even dermatologists and plastic surgeons should seek out training in these types of medical treatments in order to properly supervise the aesthetic treatments being offered at the med spa.

For more information on medical spa supervision and delegation requirements watch AmSpa’s medical spa webinar on the topic, presented by Michael Byrd, JD, partner at ByrdAdatto.

Telemedicine

With the advent of telemedicine, physicians frequently want to know if they can use real-time interactive communication on programs like Skype or Facetime to consult with and examine patients instead of meeting each new patient in-person, but this remains a gray area in the law. There is a fine line between giving generic health information over a smartphone and actually diagnosing or treating a patient.  Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face method of providing medical care and in some states it is being cautiously embraced. In Oklahoma, for instance, the state medical board recently passed telemedicine rules exempting physicians from face-to-face meetings with patients if certain criteria are met. Not every state is on board with this and only time will tell if telemedicine will be the future of medicine. Read more on telemedicine in medical spas here.

The bottom line is that physician supervision in the medical setting is a key component to running a successful and legally compliant med spa business. If you are unclear about the level of physician supervision required in your state, you should seek legal guidance from an experienced attorney immediately. AmSpa members can take advantage of their 20-30 minute annual compliance consultation with an attorney from ByrdAdatto.

For more ways to build and run your medical spa practice legally and profitably attend an AmSpa Medical Spa & Aesthetic Boot Camp and be the next med spa success story.

Renee E. Coover, JD, is an associate with ByrdAdatto, a law firm focusing on business, healthcare, and aesthetics. She has a unique background, blending litigation with healthcare law. A former litigator in high-stakes employment cases, Renee has extensive experience with counseling and representing businesses in employment matters, policies, and contract disputes, and defending business owners in state and federal trials. She has also served as General Counsel for the American Med Spa Association, advising health care professionals on regulatory and legal issues governing the medical spa industry.

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

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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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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.

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

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