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Front Office Training: 7 Steps to a Positive First Impression

Posted By Administration, Wednesday, July 31, 2019

By Terri Ross, Terri Ross Consulting

When you first walk into a medical office for an appointment, what are your expectations? How do you want the staff to greet you, and what are some of the things that make you say, “I’m never coming back here again”? As a business owner, do you meet those expectations? The front office is often a patient’s first glimpse into the workings of a practice, and if a patient has a positive experience with your front office staff, it sets the stage for a positive experience overall.

As with any business, effective communication in the medical aesthetic office is key. The first interaction you have with potential patients is often a phone call. Office staff should be trained on how to begin and execute a productive and engaging phone call. In their interactions with patients, front office staff should strive to be enthusiastic, knowledgeable and engaging.

1. Be enthusiastic, engaging and confident: A positive attitude is infectious and an important element of success in any business. This article from the Huffington Post explains the importance of a positive attitude in business. Convey a positive attitude, speak and articulate information with confidence, and engage the patient in dialogue to ensure you have gathered all of the facts about them and what they are requesting. This will set you apart significantly from others practices that don’t invest in training their staff. 

2. Listen first: Listen to prospective patients—assess their needs and desires before pitching a service or treatment. Strive to make a genuine connection with each patient. You want to “land the patient.” See TSIA’s explanation of the Land, Adopt, Renew, Expand (LAER) model here. The LAER model I teach is Listen, Acknowledge, Explore, Respond. Most often, people tend to listen and respond without really understanding  patient needs. Explore more details, show empathy and acknowledge that you fully understand what the patient is telling you.

3. Ask questions: Your ability to connect, ask questions, and engage with potential patients is critical. The medical aesthetics space is very competitive, and the consumers are very educated and have numerous resources to explore. They also have many choices, so your ability to articulate with conviction by credentialing the business and providers, as well as knowing the products and treatments you offer over the competition is paramount to a prospective patient wanting to schedule with you over another office.  

4. Never say no: If a patient asks if you offer Ulthera and you don’t, do not say no, or you’ve lost them. Instead, say, “May I ask who is calling? Hi [patient name]—so you are interested in skin tightening, is that correct?” This means you must know your technology and your competition and be able to effectively convince them that what you offer is equally as good if not better than another option. More importantly, your knowledge and skill set will make them want to schedule with you. If that doesn’t work, ask if you can follow up with them.

5. Respond to patient needs in a timely fashion: If a patient calls or emails with a question or need, make it a point to respond immediately—usually within 1 ¬– 3 hours, or 24 hours at the very latest. There are several different types of patient inquiries, and one of them is new leads. This is critical, as they are shopping but haven’t yet decided on your practice. Current patients are the ones who know you, trust you, and already have a relationship with you. However, communication with current patients is equally as important, as this helps to establish patient retention. If a patient asks a question to which you don’t immediately know the answer, say that you are searching for the answer and will respond as soon as possible. This lets them know that they are important.

6. Be the expert: It is essential for you to know every product and service offered in your office. Do your homework. You need to know every treatment: What it does, what it’s used for and how it can be incorporated into a personalized treatment plan. By knowing your services and how they compare to your competitors’, you engage patients and make them feel they have landed at the right office.

7. Go beyond what is expected: In attitude, knowledge and service, go beyond the patient’s general expectations. Make sure the patient has a positive experience from start to finish. Are you the Four Seasons or the Marriott?

Now that you’ve read these seven steps, picture yourself as a patient walking into your office, and ask yourself if you’d return for a next visit. Even if you’ve answered yes, there might be some room for improvement in certain aspects, and I want to make sure you have reached the point of a perfect first impression. Please download the complimentary checklist to evaluate where the holes in your staff training might be.

Is your office running at maximum capacity? Have you invested in staff training or sales consulting? Click here to download Terri’s 10-point checklist

Terri Ross brings more than 20 years of sales and management experience to the field, having worked with leading-edge medical device companies such as Zeltiq, Medicis, EMD Serono, Merck Schering Plough and Indigo Medical; a surgical division of Johnson.

Ross’ vast knowledge and experience as a sales director managing upwards of $20M in revenue and successful teams has allowed her to become a renowned plastic surgery management consultant helping aesthetic practices thrive.

To optimize revenues and business performance, Ross’ practice management consulting services help physicians evaluate practice processes including, but not limited to, overall-operating efficiencies, staff skill assessment, customer service and operating efficiency strategies. The goal is to develop a comprehensive plan of action to improve productivity, quality, efficiency and return on investment.

Tags:  Business and Financials  Compliance is Cool  Med Spa Ownership  Med Spa Trends 

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Join AmSpa at the Seattle Medical Spa & Aesthetic Boot Camp

Posted By Administration, Thursday, July 11, 2019

motif seattle hotel

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

Starting next Saturday, July 20, AmSpa will host its Seattle Medical Spa & Aesthetic Boot Camp at the Motif Seattle Hotel. We’re extremely excited for the opportunity to help medical aesthetic professionals in the Pacific Northwest develop their practices, and we can’t wait to visit the Emerald City for the first time. There’s still time to register for the event—just click here to sign up.

Here is a quick overview of the program:

Saturday, July 20

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

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

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

Sunday, July 21

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

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

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

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

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

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How to Partner with a Medical Professional

Posted By Administration, Wednesday, July 10, 2019

partnership handshake

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

Creating a partnership with a medical professional can be a lucrative—and often legally necessary—step for traditional spa owners, salon owners, and entrepreneurs who want to get a piece of the ever-growing medical spa pie. Here is what you need to know in order to effectively and compliantly partner with a medical professional.

Staking Your Claim

Most states observe a doctrine known as the corporate practice of medicine, which requires a physician or physician-owned corporation to receive payment for medical services. Since many of the treatments offered at medical spas are medical in nature, these practices are governed by this doctrine where it applies.

So, creating a medical spa is not as simple as contracting with a doctor or a nurse to administer medical treatments, or listing the medical professional as a “medical director” without having him or her available for consultations. Often, arrangements such as these are illegal, so medical spa owners should consult with a local health care attorney and the American Medical Spa Association (AmSpa) to make sure they are operating on the up-and-up.

If an entrepreneur wants to become a part of the medical aesthetic industry on an ownership level where the corporate practice of medicine is observed, he or she can set up a management services organization (MSO), which partners with a physician, for whom a separate company is created; this company strictly provides medical services. This arrangement is known as a management service agreement (MSA), and it allows a non-physician to supervise most aspects of a medical aesthetic business aside from the administration of medical services.

Playing by the Rules

Regardless of the ownership structure, the medical side of the practice must remain the domain of medical professionals. It is their responsibility to make sure all medical procedures are administered by employees who are properly trained and supervised.

It is perfectly legal and quite common for physicians to delegate regular medical procedures at a medical spa to licensed practitioners, such as nurse practitioners and physician assistants. Those practitioners can, in turn, delegate tasks to non-medical staffers, such as registered nurses and laser technicians, as long as the tasks they are assigned fall within the scope of their training and they are properly supervised. Additionally, physicians do not even necessarily need to be at the medical spa, as long as they are reachable and a licensed practitioner is present while treatments are being administered.

Physicians are accountable for everything that occurs at the medical spa, so it is important for them to make sure that the staff is properly trained. A medical professional who does not wish to actually be involved in this aspect of the business is probably trying to get involved for the wrong reasons.

Splitting Headaches

Because physicians may not be conducting treatments, they might wish to reward the people who are actually dealing with the patients by giving them a percentage of the business they bring in—commission, in other words. Unfortunately, this is probably illegal if the practice is governed by the corporate practice of medicine, because it constitutes fee-splitting.

As mentioned previously, under the corporate practice of medicine, all payments for medical treatments must be made in full to a physician or physician-owned corporation. If a percentage of that payment is directed instead to an employee, fee-splitting is said to have occurred. If a medical spa is found to have done this, all involved could face significant sanctions.

To learn more about this and many other topics that concern medical spa owners and operators, attend an AmSpa Medical Spa & Aesthetic Boot Camp. The next success story could be your own!

Tags:  Business and Financials  Med Spa Law  Med Spa Ownership  Med Spa Trends 

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MSOs: Your Path to Profit Optimization

Posted By Administration, Friday, June 28, 2019

doctor businessperson partnership

By Nicole Chiaramonte, CEO, TWG Consulting Corp.; founder, Synergy MedAesthetics; and aesthetic industry investor

The skyrocketing demand for aesthetic services in the U.S. has created a tremendous opportunity for business experts, entrepreneurs and investors. In an industry that until recently was run exclusively by physicians, the mainstreaming of management service organization (MSO) partnerships allows doctors to partner with entrepreneurs and benefit from their business expertise while they focus on the medicine.

With the advent of selfies, the Kardashian phenomenon and social media, women and men of all ages are flocking to spend money to look their best. The current medical establishment is not necessarily ready to handle this in a way that is beneficial for them, their employees and their patients. This is where MSO partnerships have allowed for a win-win-win in the aesthetic world.

An MSO allows investors and business experts to partner with a physician in a legal manner, thus not violating the corporate practice of medicine. These partnerships have proven to be profitable for all involved when properly executed. To understand the benefits of MSO partnerships for all parties, one must first understand the unique benefits and skillset everyone brings to the table and, just as important, what their responsibilities are in such arrangements.

Entrepreneurs

As an investor in the aesthetic industry, you will provide your time, investment capital and business expertise to the partnership. This may include a love for spreadsheets and a “Beautiful Mind” ability to read into the deeper layers of a profit and loss statement, balance sheet or statement of cash flow to identify unnecessary losses and quickly increase profit margins. These skills are what you bring to the table and why you are needed in this industry.

But your education has just begun. To be truly successful in this venture, you will need to gain a comprehensive understanding of aesthetic procedures—not only what they are and what they do, but also why they work. You will learn more than you ever thought you would know about the body’s healing systems, skin health, facial anatomy and more. Attend every practitioner training you are allowed to audit, conduct research online, and understand the competitive products, technologies and services. You will need to know them all this well enough to effectively market the practice, train administrative staff and answer patient questions.

When negotiating percentages of ownership in an MSO with a physician, remember to honor the dedicated time and expense required of your partner’s medical degree, as well as the responsibility he or she takes on with every treatment performed. Your active hours contributed to the operation may be significantly more when compared in the short-term, but his or her ongoing risk is real.

Physicians

It is common for doctors to feel the risk to their license is too great to enter into an MSO—they resist the idea of relinquishing a percentage of profit or determine they can best run a practice on their own. In my experience, 100% of the time, a physician enjoys more income from a partnership than he or she did prior to partnering into an MSO. In addition, physicians experience considerably less stress, aggravation and demands on their time when their partners are able to assume responsibility and management of staffing, human resources, inventory, accounting, payroll, patient management, and advertising and marketing.

Partnering with someone who has gone to the lengths necessary to know your industry, proper protocols, SOPs and standing orders is key for physicians considering MSO partnerships or medical directorships. Your partner should put the safety of your license above all else. If you have the right business partner, he or she may inform you about new clinical studies, FDA approvals and technique developments before you hear about them. This is especially necessary in an environment where you are a non-practicing aesthetic medical director who has delegated to onsite mid-levels (nurse practitioners and/or physician assistants).

Once a partnership is in place and responsibilities and parameters are set, it is time to get to work on profit optimization. In my experience of owning 20% to 85% interest in 12 MSOs, the following areas are the first places I audit, whether the practice is in operation or brand new.

  1. Back bar/treatment room materials. This includes everything from Hydrafacial MD products to Botox and machine consumables. How often are you checking for inventory loss or overuse of product that throws your margins off by up to 70%?
  2. Capital purchases. If you are paying list price for new machines, this can take a huge bite out of your profits, benefiting no one but your sales rep.
  3. Staffing. You must make sure you have proper hours, compensation levels and adequate coverage with the necessary practitioners.
  4. Advertising and marketing. From website development to ongoing social media marketing, is your practice paying a premium because you are deemed “medical?”

In short, aesthetic practice profitability is illusive to some and an exact science to others. MSO partnerships are legal, profitable ways to operate an aesthetic practice to the benefit and delight of all involved.

Tags:  Business and Financials  Guest Post  Med Spa Law  Med Spa Ownership  Med Spa Trends 

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Join AmSpa at the Atlanta Medical Spa & Aesthetic Boot Camp

Posted By Administration, Friday, June 21, 2019

loews atlanta

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

Starting next Saturday, June 29, AmSpa will host its Atlanta Medical Spa & Aesthetic Boot Camp at the Loews Atlanta Hotel. We’re extremely excited for the opportunity to help medical aesthetic professionals develop their practices, and we can’t wait to visit Atlanta again. There’s still time to register for the event—just click here to sign up. Here is a quick overview of the program:

Saturday, June 29

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

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

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

Sunday, June 30

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

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

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

We hope you can join us in Atlanta next weekend. This Boot Camp is a tremendous opportunity to get your medical aesthetic business headed in the right direction and learn some tips and tricks that can take it to the next level. Click here to register!

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

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How Core Doctors Can Cash In on Medical Spas

Posted By Administration, Wednesday, May 15, 2019

core doctors

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

The medical aesthetic industry continues to boom, and core doctors—plastic surgeons, facial plastic surgeons, oculoplastic surgeons, and cosmetic dermatologists—would seem to be set to profit in this space. As physicians, they are allowed to own medical spas, and they can ideally not only profit from the medical spas themselves, but also use them to direct business to their surgical practices. After all, medical spas tend to offer non-invasive procedures that are similar to some things core doctors do, and it does stand to reason that if patients go to a medical spa looking for a Botox injection, they might eventually want a nose job or a face-lift. That being the case, the core doctor who owns the medical spa should be uniquely positioned to offer his or her services.

However, that’s not necessarily the case. I chat with core doctors all the time, and those who open medical spas intending to use them primarily as feeders for their practices tend to view them as poor investments. Their medical spas tend to fail, and the amount of business they drive to their surgical practices is insignificant.

In truth, medical spas that are designed primarily to act as feeders for surgical practices are set up to fail, and most core doctors tend to be very bad medical spa owners. They typically don’t understand the medical spa business, how much work it takes, the profit margins, the necessary volume, and numerous other factors vital to maintaining a successful medical spa. But that doesn’t mean that a medical spa can’t still be a successful business for a core doctor or help to generate surgical business—it simply means that a core doctor needs to understand the realities of the medical spa industry before he or she decides to dive headlong into it.

A Singular Paradigm

The business model core doctors typically understand is very different from the one under which medical spas operate. Surgical practices offer big-ticket procedures, such as breast augmentations and face-lifts; they do not need to deal with a large volume of patients, and they do not need to market themselves like a retail outlet—by the nature of their business, they tend to generate sufficient revenue to get by.

While medical spas must follow the same rules and regulations to which more traditional medical facilities adhere, they are unique in that their services are entirely elective and entirely cash-based. People who use medical spas do so because they want to, and treatments at medical spas are much less expensive than those available from core doctors’ surgical practices. Therefore, for a medical spa to succeed, it must have a lot of patients, its employees must master the art of selling, and it must entice patients to return. In other words, it must operate like a retail center rather than a medical office.

For this reason, medical spas need to be run with a totally different mind-set than core doctors are typically used to. Medical spas owned by core doctors who do not adapt to a more retail-oriented emphasis often end up failing. When I tell core doctors that I have medical spa clients who generate up to $6 million annually, many of them cannot wrap their minds around how that is possible.

A New Perspective

In order for a medical spa to create business for a surgical practice, it must first succeed on its own terms. To facilitate that, core doctors typically need to let others run their medical spas. Core doctors need to understand that the medical spa business is much, much different than the ones they are used to, and they need to partner with people who are experienced with marketing and sales in a retail environment.

A core doctor’s time is better spent performing highly profitable surgical procedures, which medical spas cannot do. If a core doctor can get an experienced businessperson to operate the med spa, they will have a much better chance to succeed. Giving up this control can be difficult for core doctors, since a lifetime of academic and financial success tends to make them think they can achieve anything. However, most doctors don’t go to business school—they don’t know retail and they don’t understand sales. These qualities—rather than medical knowledge or surgical skill—tend to lead to medical spa success.

In addition, medical spa team members must be provided the tools and processes to sell. A medical spa receptionist, for example, should not be someone being paid $12 an hour with no experience; he or she should be one of the highest-paid people on an administrative staff, because he or she needs to be able to sell.

A medical spa also should provide talk tracks for nurses and aestheticians so they understand that their jobs are about selling themselves and the doctor. Employees at medical spas also need to understand that selling retail products is extremely important to maintaining a healthy business. These characteristics of successful medical spas may seem distasteful to doctors, who are used to professional environments that are less aggressive, but this is the reality of the medical spa industry, and every day more and more physicians discover this to be true.

The businesspeople who enter the medical spa industry are willing to do whatever it takes to be successful. A core doctor might believe he or she doesn’t need the help, but chances are the opposite is true.

There are several resources in the AmSpa store to help you build your business and train your team to put your medical spa practice in an excellent position to succeed.

The Practice of Medicine

A medical aesthetic practice must be focused on sales, but it also is required to follow the medical rules and regulations of the state in which it is located. These laws can vary significantly depending on the state, so a med spa operator should consult an attorney familiar with the industry when setting up the practice and procedures. AmSpa members can check their state’s medical aesthetic legal summary to learn about the rules and regulations governing their practice.

Most states observe a doctrine known as the corporate practice of medicine, which decrees that a medical practice must be owned by a physician or a physician-owned corporation. As previously established, medical spas are retail outlets, but they also are unquestionably medical practices, so medical spas must be entirely owned by a doctor or his or her corporation in states where the corporate practice of medicine is observed.

This can present problems for a core doctor who wishes to partner with a businessperson to run a medical spa, because the businessperson likely is going to want some equity in the practice. However, giving any ownership stake to a non-physician is illegal if the state where the medical spa is located observes the corporate practice of medicine.

Opportunities for Ownership

There are solutions, however. If a core doctor wishes to partner with an entrepreneur to open a medical spa in a corporate-practice-of-medicine state, he or she can set up a management services organization (MSO). An MSO provides practice management services, while the doctor, for whom a separate company is created, exclusively provides medical services.

This arrangement, known as a management service agreement (MSA), allows the non-physician who owns and/or operates the MSO to supervise almost every aspect of a medical aesthetic business, including branding, marketing, owning the real estate, payroll, human resources, accounting and billing—everything except the administration of medical services.

This is akin to a lessor/lessee situation. Generally, the MSO owns and maintains the facility, while the doctor inhabits the space. The doctor pays the MSO for the right to occupy the space, and the MSO acts as a landlord, maintaining the facility and keeping the doctor as comfortable as possible.

However, unlike a rental agreement that is managed by a lease that dictates the occupant pay a set amount of money for a certain term, the amount paid to the MSO fluctuates according to the amount of money the physician is paid by patients. If the medical organization treats more patients in a term than it did the previous term, the MSO will also make more money. This represents a sort of equity—in function, if not form. Read more about MSOs here.

The corporate practice of medicine also dictates the ways medical spa employees can be incentivized. In retail, salespeople are often offered commission—a percentage of the sales they make that meet certain conditions set by their employers. However, under the corporate practice of medicine, all payments for medical services must be made in full to a physician or physician-owned corporation. In these states, if a medical spa owner pays employees commission, he or she is engaging in fee-splitting, which is illegal.

This is somewhat common at medical spas. The people who own and operate these establishments generally only wish to reward the people who bring business to the practice, but if a medical spa is found to have engaged in fee-splitting in a state where it is illegal, the doctor who owns the practice could face the suspension or revocation of his or her license, as well as a significant fine. Additionally, the provider who receives the commission payment is subject to a fine. A performance-based bonus structure should be offered instead of commission. Read more about med spa compensation here.

Medical spa owners and operators who need to learn about the ownership requirements in their states should contact an experienced health care attorney to find out what is legal in their state.

Becoming a medical director for an existing medical spa, rather than opening a new practice, is another option for a core doctor. Several core doctors I have represented are doing this very successfully. They don’t need to deal with actual day-to-day operation of a retail store—they can simply lend their name to a medical spa, perform some consultations, oversee the practice’s other medical professionals, and then head back to their own practice rather than worrying about the intricacies of the business. This offers a core doctor a look at the industry without requiring him or her to make an enormous ownership commitment. It’s important, however, to understand the risks and responsibilities of med spa medical directors before committing to this course of action.

A Path to Success

The core doctors who oversee a compliant, well-run medical spa stand to gain a great deal from the arrangement. A successful medical aesthetic practice can earn a lot of money by itself, and if a med spa has a lot of patients, it makes sense that the number of referrals to an affiliated surgical practice will be higher than if it is struggling.

If a core doctor wants to enter the medical aesthetic industry, he or she cannot do it halfway. A medical spa that is created to function primarily as a compliment to a surgical practice is unlikely to find a great deal of success; one that is designed to succeed on its own terms, however, offers numerous benefits to its owners, including the possibility of increased surgical business.

Attend an AmSpa Medical Spa & Aesthetic Boot Camp to learn the legal and business best-practices you can employ to build and run a successful medical spa practice.

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

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MSOs Help Non-Physicians Own Medical Spas

Posted By Administration, Monday, May 13, 2019

contract

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

For many of the people who work in the medical aesthetics industry, the goal of owning a med spa is difficult to realize. After all, most states observe a doctrine known as the corporate practice of medicine, which dictates that only a physician or physician-owned corporation can receive payment for medical services. Since many of the treatments offered at med spas are medical in nature, this means that the ownership of such facilities is governed by this doctrine.

However, there is a path to med spa ownership that doesn’t involve you attending medical school for four years and then working as a resident for several more. It is called a management services organization (MSO), and while it still requires the participation of a physician, it allows non-physicians to play a very significant role in the day-to-day operations of a medical aesthetics business.

As its name suggests, an MSO provides management services. It partners with a physician, for whom a separate company that only provides medical services is created. This arrangement, known as a management service agreement (MSA), essentially allows a non-physician to supervise most aspects of a medical aesthetics business, including branding, marketing, owning the real estate, payroll, human resources, accounting, and billing—everything except the administration of medical services.

This can be thought of as a lessor/lessee situation. The MSO typically owns and maintains the facility, and the physician occupies the space. The physician pays the MSO for the right to occupy the space, and the MSO functions in much the same way as a landlord, maintaining the facility and keeping the physician as comfortable as possible. However, unlike an apartment rental that is governed by a lease that dictates the occupant pay a set amount of money for a certain term, the amount paid to the MSO is determined by the amount of business conducted by the physician. If the medical organization treats more patients in a period of time than it did the previous period, the MSO will also make more money. This helps to create a bond between the physician and the MSO—if one side of the business succeeds, they both succeed.

The contractual separation of the two entities also provides benefits to both parties. For example, the physician incurs very little risk when it comes to setting up the business. If the practice fails, he or she is not on the hook for the facility, its contents, and the land on which it is located—that is on the MSO. Additionally, the creation of a separate company for the physician helps to prevent any liability issue incurred at the medical spa from affecting any of the physician’s other medical pursuits. The MSO also typically covers the physician’s liability insurance. This arrangement might seem to favor the physician, but that’s why he or she pays the MSO. And should the physician incur any sort of liability claim, the MSO is in the clear. 

It is important to note that while it may seem that a properly set up MSO is in charge of its medical spa, in order for the practice to be compliant, the doctor must be in charge of medical and clinical decisions. The easiest way for an MSO to get in trouble is for it to not actually treat the practice as a medical company. The doctor must manage the medical aspects of the med spa; if he or she does not do this, they are subject to severe punishments, including license forfeiture and large fines. Furthermore, the MSO is subject to repercussions for practicing medicine without a license. As such, it is vital that all parties must understand their roles and obligations.

MSOs have been used by entrepreneurs to form management companies for medical organizations as large as hospitals and managed care facilities, so it stands to reason that creating an MSO for a medical spa would be comparatively simple. However, this is not the sort of thing that can be properly executed using forms you can download off the internet, so you should consult an attorney who has experience successfully setting up MSOs if you are considering entering into this sort of arrangement. This is especially important if a business wants to sell to a large entrepreneur or expand across state lines.

If you want to learn more about MSOs, they are covered in depth at AmSpa’s Boot Camps. Click here to find out when we will be coming to a city near you and register to take part in the course.

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

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Why Your Medical Spa Will Be Investigated

Posted By Administration, Monday, May 6, 2019

sad doctor

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

Medical spa owners and operators typically don’t think their businesses are going to be investigated by the regulatory agencies in their state, and historically, this is often the case. Agencies simply can’t keep an eye on every practice under their jurisdiction, after all. However, the recent growth of the medical esthetics industry has increased the amount of scrutiny it receives from these agencies, so the odds that your medical spa is going to be investigated are improving all the time.

If you practice is investigated, the consequences can be severe. Depending on what the agency finds, the practice’s physician’s license could be suspended, which could cause the practice to be unable to operate, and heavy fines may be levied. Severe infractions can even result in criminal prosecution. Understanding why these investigations are triggered will help you avoid them, so here are the top reasons why medical spas are investigated.

Intake Procedures

Most of the procedures performed at medical spas are considered to be medical in nature by regulatory authorities. Before these treatments are administered, a physician generally must conduct a face-to-face examination, wherein he or she determines the patient’s overall health and the extent of the patient’s issue. After this exam, the physician suggests a course of treatment. However, regulatory agencies have disciplined many medical esthetics practices because they do not properly administer these exams; in fact, this is the most common reason why these investigations are initiated.

Uncertainty over the status of minimally invasive treatments, such as Botox and filler injections, tends to lead to these violations. Many seasoned nurses have been cited for administering these treatments without an exam because they think an exam is not required, since for many of them, that’s the way it has always been.

In most states, the initial exam can be delegated to certain licensed practitioners, such as a nurse practitioner or a physician assistant, but the physician still must be involved with establishing this protocol and make sure it is always followed. Medical spa employees must understand that doctors are entirely in charge of medical treatments at their practices—only they can set the protocols, only they can set the treatment plan, and only they can prescribe and delegate others to perform that treatment plan.

Physician Oversight

Along the same lines, because medical spas are medical practices, a medical professional must always be on site. While a physician can delegate most of the practice’s medical treatments to others, including non-licensed individuals, a licensed professional—a physician, nurse practitioner, physician assistant or registered nurse—should be at the practice at all times to oversee these procedures. The type of treatment provided, as well as the type of practitioner performing the treatment, are important considerations, so if you’re not sure how your state defines certain treatments, check with your local health care attorney for more information.

Some procedures, such as microneedling and dermaplaning, traditionally have not been viewed as medical treatments, but now typically are. This complicates matters at medical esthetics practices where estheticians have been performing these procedures for years. Additionally, most states require a tattooing or permanent makeup license to administer microblading, which complicates matters further.

At some medical spas, physicians don’t pay much attention to what is going on and essentially serve as medical directors in name only. Some physicians oversee more than a dozen medical spas, which should tell you that they spend very little, if any time actually working at these practices. These practices probably do not have proper oversight, unless they have a large number of nurse practitioners or physician assistants on their payroll. Regulators can easily see if a physician appears to have too much going on and use that as a reason to investigate what’s happening at his or her medical spas.

Marketing

Regulatory agents tend to spend a lot of time searching the internet for potential violations, due to the lack of funding their agencies receive. If they search for terms such as “medical aesthetician,” for example, it’s not terribly difficult for them to find violations. Additionally, they typically can get an idea of the practice’s ownership structure and if it is in contravention of the agency’s regulations. If an agent finds that a practice’s website indicates that, say, an aesthetician or nurse owns the practice—in most states, only a physician or physician-owned corporation can own a medical practice—he or she likely will not hesitate to open an investigation of it.

Additionally, Medical spa owners and operators should not present testimonials that are hyperbolic or suggest that the practice offers services it cannot actually provide. Medical advertising regulations dictate that practices must only cite skills and accomplishments that can be proven. For example, if your practice advertises “the best Botox in Boston,” it is likely to draw attention from regulators, since that is not a fact that can be verified.

Regulators also search for indications that a practice has violated patient privacy laws, such as HIPAA, on social media. Anything that can identify someone as your patient—down to simply responding to a patient’s Facebook post—can be interpreted as a violation, provided you have not obtained the patient’s consent in advance. If you’re not sure if your social media activity is violating patient privacy laws, consult with an experienced health care attorney as soon as possible. (Author’s note: AmSpa works with national law firm ByrdAdatto, which focuses on medical aesthetic legalities, and as a member, you receive a discount off of your initial consultation, along with a number of other great benefits. To learn more about the benefits of an AmSpa membership, click here.)

Drugs & Equipment

Regulators are likely to initiate an investigation if a practice is found to have purchased pharmaceuticals that claim to be cleared by the FDA—but are not—from overseas sources. Only drugs and equipment that have been totally approved can be purchased legally in the United States; importantly, this means that in addition to the actual product, the FDA has approved all packaging and inserts.

There are two aspects of this issue. On one hand are potentially dangerous counterfeit drugs—typically Botox and fillers—that typically are manufactured in and purchased from China; these should be avoided at all costs. The prevalence of these products has declined in recent years as more owners and operators have learned about how dangerous they are, but they’re still out there.

On the other hand, “parallel importation” is a practice in which legitimate products sold in countries where price controls keep the cost of prescription pharmaceuticals low are resold to practices in the U.S. for far less than they would cost if purchased domestically. Parallel importation is broadly legal for most products, but it is understood to be illegal with pharmaceuticals, and the FDA has indicated a willingness to prosecute the practice. If your medical spa is found to be engaging in parallel importation, it very well might trigger an investigation.

Filing with the State Board of Cosmetology

Medical spas have to spend a lot of time and effort complying with regulations involving the administration of medical treatments, but they also must follow the rules related to purely aesthetic offerings. Most state boards of cosmetology require businesses that provide such services to apply for a cosmetology “establishment license”; this is called different things by different states, but essentially it is a registration with the board of cosmetology declaring that aesthetic services such as facials are being performed. Medical spas understandably tend to be much more concerned with maintaining medical compliance, so they often neglect to obtain this license.

Boards of cosmetology seem to be less formidable adversaries than medical boards, but they will cause significant problems for medical spas that ignore them. If your practice offers esthetic services, make sure it is in full compliance with the state board of cosmetology.

Straight & Narrow

Ninety-nine times out of 100, an investigation into a medical spa is triggered by a report to a regulatory body, and this is more likely to happen as a practice become more successful. Competitors might report a medical spa, sometimes for good reasons and sometimes out of professional jealousy.

Also, patients who are disappointed with the way they’ve been treated—whether they’ve actually been mistreated or not—may report a practice to a regulatory agency. A patient is unlikely to grumble if they he or she has a good experience, regardless of the outcome, but medical spas should always strive to provide patients with exceptional service so that they don’t do something irrational—after all, as all medical esthetics practitioners know, medical spa patients are, let’s say… a passionate bunch.

Finally, it’s not unusual for former employees to report medical spas to regulators if their departures were not amicable. Upon hiring new employees, a medical spa should set realistic expectations, provide proper job descriptions, and make sure they understand procedures, so that if they are terminated, it won’t be seen as a surprise or viewed as unfair in any way.

Tags:  Med Spa Law  Med Spa Ownership 

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Join AmSpa at the Chicago Medical Spa & Aesthetic Boot Camp

Posted By Administration, Friday, May 3, 2019

chicago boot camp

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

Starting tomorrow, AmSpa will host its Chicago Medical Spa & Aesthetic Boot Camp at the Chicago Marriott Southwest at Burr Ridge, and we’re extremely excited for the opportunity to help medical aesthetic professionals develop their practices. There's still time to register for the event—just click here to sign up. Here’s a quick overview of the program:

Saturday, May 4

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

  • 9 – 10:30 a.m.: The Plan, presented by Bryan Durocher (Durocher Enterprises)—What are the most effective ways to develop a business plan for your medical spa? Medical Spa Consultant Bryan Durocher discusses the ins and outs of the planning process and helps determine how long it realistically takes to open a practice.
  • 11 a.m. – 12 p.m.: The Marketing Plan and Social Media, presented by Brandon and Jenny Robinson (Skin Body Soul MedSpa)—This session will help you determine how to most effectively market your medical aesthetic practice using both traditional methods and cutting-edge techniques.
  • 1 – 1:30 p.m.: Medical Aesthetic Hot Topics Panel, featuring Tim Sawyer (Crystal Clear Digital Marketing) and Nealy Skeldon (Environ Skincare)—This panel, moderated by yours truly, will feature a spirited discussion of the current issues and events that concern medical spa owners and operators.
  • 1:30 – 3:30 p.m.: The Law, presented by Alex Thiersch (AmSpa) and Renee E. Coover (ByrdAdatto)—In this presentation, we’ll discuss the long-standing and emerging legal issues that every medical spa owner needs to know about. As you can imagine, there is a lot to cover here, since new concerns seem to be arising daily lately.
  • 4:15 – 5 p.m.: The Treatments, presented by Terri Ross (Terri Ross Consulting)—Learn about the most profitable and popular treatments available to your practice, and find out how to best determine which treatments are right for you based on the state of your practice.
  • 5 – 6 p.m.: The Digital Marketing Ecosystem, presented by Tim Sawyer (Crystal Clear Digital Marketing)—Find out how to effectively spread the word about your medical aesthetic practice and how best to determine what’s working and what’s not. Your practice’s digital presence is more important than ever before, and curating it should be a top priority.

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

Sunday, May 5

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

  • 8:30 – 9 a.m.: Anatomy of a $5-Million Med Spa, presented by Alex Thiersch (AmSpa)—Have you ever wondered what the difference is between your medical spa and one that’s mega-successful? It might be less significant than you think. This presentation will show what a $5-million med spa is doing right—and what you might be doing wrong.
  • 9 – 10 a.m.: The Financials, presented by Bryan Durocher (Durocher Enterprises)—At the end of the day, the money you’re bringing in is the most important measure of your practice’s success. This presentation will, among other things, demonstrate how to properly develop a budget and use metrics to determine your med spa’s strengths and weaknesses.
  • 10:45 – 11:15 a.m.: The Long-term Revenue, presented by Brandon and Jenny Robinson (Skin Body Soul MedSpa)—Simply being successful isn’t enough for a medical aesthetic practice; you have to know how to maintain and grow your success. In this session, the Robinsons will show you how to build patient loyalty and move your business forward.
  • 11:30 a.m. – 12:15 p.m.: The Consultation, presented by Terri Ross (Terri Ross Consulting)—As the old saying goes, you never get a second chance to make a first impression. Learn how to put your best foot forward with effective patient consultations—and how to turn them into consistent business.
  • 1 – 2 p.m.: The Lessons, presented by Louis Frisina—Every medical spa is different, but the successful ones share several common traits. In this session, Business Strategy Consultant Louis Frisina discusses the qualities that are typically found in practices that bring in a significant amount of revenue.
  • 2 – 3 p.m.: The Team, presented by Bryan Durocher (Durocher Enterprises)—A medical spa is only as good as its personnel, so it’s important to make sure that you hire a staff that can do everything you want it to—and more. In this session, you’ll learn about recruiting, hiring and retaining employees who can make your medical spa dreams come true.

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

We hope you can join us in Chicago this weekend. This AmSpa Boot Camp is a tremendous opportunity to get your medical aesthetic business headed in the right direction and learn some tips and tricks that can take it to the next level. Click here to register!

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

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Unsafe Practices by New Mexico Aesthetician Lead to Second HIV Infection

Posted By Administration, Wednesday, May 1, 2019

needle

By Alex R. Thiersch, JD, CEO of the American Med Spa Association (AmSpa), and Patrick O’Brien, JD, legal coordinator for the American Med Spa Association

According to the New Mexico Department of Health (NMDOH), vampire facials administered at VIP Spa in Albuquerque have caused the transmission of the HIV virus to at least two customers. The spa, which was operated by an aesthetician, was shut down in September 2018 after an inspection found that needles were being improperly handled and disposed of, creating the possibility of the transmission of bloodborne diseases. NMDOH is offering free blood testing services and counseling to the spa’s former clients.

Vampire facials involve the extraction of the patient’s blood, the centrifugal separation of plasma from the blood, and then the reinjection of the plasma into the face with microneedling equipment in order to stimulate collagen production. The procedure has gained popularity in recent years thanks to the influence of Kim Kardashian, who posted images of herself experiencing the treatment to her Instagram in 2013, but later stated that she regretted undergoing it and that it was extremely painful.

Obviously, this sort of procedure presents numerous avenues through which contamination can occur. In New Mexico, drawing blood and performing microneedling are both considered to be medical procedures and must be performed by an appropriately trained and skilled person under the supervision of a physician or nurse practitioner, including physician assistants either in collaboration with or under supervision of a physician, registered nurses, licensed practical nurses and trained medical assistants. Aestheticians, such as the person who operated VIP Spa, are not licensed to perform or provide oversight for these procedures.

The medical aesthetics industry is thriving, but this is exactly the sort of thing that could kill it. All over the country, unqualified people are doing things they shouldn't be doing, not following the rules or being safe, and potentially causing incredibly serious health issues and even deaths, such as in this recently publicized case of plastic surgery practices in South Florida that have caused the deaths of at least 13 people. Situations such as these are exposing the seamy underbelly of the industry, and while legislators struggle to catch up with the issues that are emerging, compliant providers may well get caught up in any kind of blowback that results from incidents such as these.

As we’ve discussed here before, we have to do better. AmSpa is currently working to develop a set of standards that will help the medical aesthetic industry govern itself and provide patients with reliably safe, satisfying treatment experiences. Stay tuned to this space to learn more about this effort and what you can do to participate.

Medical spa clients shouldn’t have to worry about contracting life-shortening illnesses or even dying as a result of their aesthetic treatments, but if stories such as these continue to emerge, that’s exactly what will happen. People may decide that they are more afraid of running into bad actors than they are desirous of looking and feeling their best, and if that happens, it’s the death knell of the industry. We have to prevent this at all costs, and we hope widespread adoption of these standards can help accomplish this.

Tags:  Compliance is Cool  Med Spa Law  Med Spa Ownership  Med Spa Trends 

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

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