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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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Nurse Practitioners and Physician Assistants in Medical Spas: An Overview

Posted By Administration, Friday, July 27, 2018
Updated: Thursday, July 26, 2018

By: Sam Pondrom, Attorney at ByrdAdatto

Medical spas utilizing mid-level practitioners like nurse practitioners (“NPs”) and physician assistants (“PAs”) is on the rise in the U.S. Merritt Hawkins, a national healthcare search and consulting firm specializing in recruitment, recently released the results of their annual review of physician and advanced practitioner recruiting.  In it, Merritt Hawkins found that NPs were the third most requested recruitment search, trailing only family physicians (#1) and psychiatrists (#2).  PAs also cracked the top 20 for requested recruitment searches, coming in at #20.

This recent expansion largely can be traced back to two key reasons.  First, NPs and PAs have broad scopes of practice and cost less to employ than physicians.  Second, NPs and PAs have less onerous education requirements, so a person can become a mid-level practitioner faster than they could a licensed doctor.  Accordingly, mid-level practitioners can perform many of the functions of unlimited licensees while reducing the cost of providing a healthcare service.  Moreover, because experts anticipate shortages in the supply of physicians, the use of mid-level practitioners likely will continue to expand because they can bring their services to market faster than physicians.

NPs specifically have been granted full practice authority in several states, and the Medical Group Management Association recently reported that practices employing APRNs/NPs were more efficient and profitable.

One important downside to the increased demand for NPs and PAs is the patchwork of statutes and regulations governing their practice.  NP and PA scopes of practice are set by state law, as are the requirements for supervising and delegating to mid-levels.  This means it is crucially important to understand the type of relationship (e.g., collaborative, supervisory, or independent) that a state requires an unlimited licensee to have with a NP or PA.  It is likewise important to know the limitations a state places on the medical tasks that mid-levels can perform and what tasks, if any, an unlimited licensee must perform to ensure the mid-level is maintaining the community’s standard of care (i.e. countersignature, chart review, meetings with the mid-level, etc.).

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 the legal requirements for mid-level practitioners in medical spas.

If you have any questions about the use of NPs or PAs in your medical practice, please contact Jay Reyero at jreyero@byrdadatto.com or Sam Pondrom at spondrom@byrdadatto.com.

Tags:  Med Spa Employee Types  Med Spa Law 

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Medical Aesthetician and Certified Laser Tech: The Risks of Misleading Medical Spa Titles

Posted By Administration, Thursday, July 5, 2018

By: Alex R. Thiersch, JD, Founder/Director of the American Med Spa Association (AmSpa)

“Medical aesthetician” and “certified laser technician” are common titles to see in medical spas, but these are among job titles that come with certain risks in medical practices. They are examples of a handful of titles for professionals in the medical aesthetic industry have become prominent over the years even though they are inherently misleading. Despite the fact that they are used constantly in and around the industry, they should be phased out since legal compliance is more important than ever due to increased appetite for enforcement by regulators.

Medical Aesthetician


The most prominent example of this problem involves so-called “medical aestheticians.” People who refer to themselves as medical aestheticians typically have some sort of training in a medical spa setting and want to separate themselves from other aestheticians who do not. They’ve usually completed a course or two in microneedling or laser use, and they wish to distinguish themselves by calling themselves medical aestheticians. This is very common—if you search for “medical spas” on the Internet, you will undoubtedly run across the term.

However, it is very dangerous for an aesthetician to use this title, because he or she risks disciplinary action by his or her board. Medical spas and other, more traditional medical practices are subject to very strict advertising rules and regulations, and practices need to zealously guard against any kind of misrepresentation or exaggeration relative to their services. Everything has to be very clear and on the up-and-up. The problem with the term “medical aesthetician” is that the person or practice using it can be seen to be suggesting that the person in question can perform medical treatments. Of course, according to their practice acts, aestheticians are explicitly prohibited from performing any sort of medical treatments, and even suggesting that they can is a significant misrepresentation of their abilities.

Several state medical and cosmetology boards—including California, Colorado, and Illinois—have explicitly stated that people cannot use the term “medical aesthetician,” and that if they do, they are subject to discipline. I see so many people use this term that it makes me think they simply don’t know any better and are getting bad advice from schools or co-workers. 

A few states offer “master aesthetician” licenses, and these allow aestheticians to perform more complex treatments than an aesthetician normally would. However, even in this case, using the term “medical aesthetician” is a bad idea.

Certified Laser Technician


It is not uncommon for people to take courses at laser training centers and, upon graduation, the school will tell them that they are “certified laser technicians.” The graduates will typically take that certificate back to their medical spa, hang it on their wall, and claim that they are certified to perform laser services in their states. However, this is not the case—they are certified by the private company that provided the training, not the state—and this is a significant distinction.

There are very few states that recognize any kind of certification for any type of laser treatment, and there’s a major difference between a state-sanctioned certification and a private company’s certification. People can run into real danger if they claim that they are certified by virtue of the fact that they have taken a course from a private company. Only a state can truly certify a laser technician. And again, if a person or their medical spa advertises that he or she is certified when that is not the case, they could be seen to be misrepresenting themselves.

It is crucial in medical advertising that professionals are fastidiously honest about where they got their certification and what it means, in every case. If you suspect that you or your practice is in violation of these rules, consult your health care attorney to find out what you can do to correct course as quickly as possible. (Reminder: AmSpa members receive a complimentary compliance consultation once per year with AmSpa’s partner law firm, ByrdAdatto.)

For more information on medical spa legal best-practices attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps.

Tags:  Business and Financials  Med Spa Employee Types  Med Spa Law 

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Who Are the Most Commonly Employed Team Members in a Med Spa?

Posted By Aly Boeckh, Thursday, October 5, 2017

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

According to AmSpa's 2017 State of the Industry Survey, physicians, nurses and aestheticians are among the most commonly employed staff at
medical spas. 

Nearly 77% of all medical spas are in some way affiliated with a physician. However, only 48.4% of physicians have complete ownership.     

The full report is available for purchase for $995 here. AmSpa members can request a complimentary copy of the executive summary by emailing Morgan at morgan@americanmedspa.org.

Tags:  AmSpa's 2017 Med Spa Statistical Survey  Med Spa Employee Types 

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