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Proposed Supervision Rule Change Creates Controversy at Texas Medical Board Stakeholders Meeting

Posted By Administration, Wednesday, June 12, 2019

physician supervision

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

Last week, the Texas Medical Board held a meeting to solicit feedback from stakeholders on possible changes to medical board rules that are in development. Representatives from AmSpa attended this meeting and had conversations with stakeholders and interested parties. The meeting generated some lively discussion regarding the changes, one of which was for Rule 193.17. This rule provides protocols for physician delegation of “nonsurgical medical cosmetic procedures,” which encompass most of the treatments offered in medical spas.

It is important to understand that this meeting was to discuss rules “in development” that have not been formally proposed or begun the official process of adoption. These developmental rules may change before being officially proposed—if they are officially proposed at all.

The development committee offered two versions of proposed changes for Rule 193.17. The primary proposed change would require offices that provide nonsurgical medical procedures to post a notice in the treatment rooms and lobby that includes the name and license of the delegating physician, as well as information for making complaints to the Board of Medicine.  The specific details of this notice are contained in the current Medical Board Rule 178.

An alternative proposal was also discussed, and it would make three additional changes:

  • Physicians would no longer be able to delegate to unlicensed persons;
  • A physician or midlevel would need to provide onsite supervision whenever procedures are delegated; and
  • The rule would explicitly state that these nonsurgical cosmetic medical procedures constitute the practice of medicine, and facilities providing them would need to be owned by a Texas licensed physician.

The alternative proposed rules generated the most discussion from the stakeholders present. A number of different parties raised concerns and complaints over all three of the proposed amendments. In an email, the Texas Medical Board relayed that these alternative proposed rules would be held for further consideration and possible revision. It assured attendees that it would hold a future stakeholder meeting if these changes were considered again. At present, however, the board is not moving forward to the next stage of the revision process.

The Medical Board also informed attendees that the primary proposal regarding the notice requirements had not received any negative feedback; as such, this change will be presented to the full Medical Board for consideration. The board will consider this change at its June 14 meeting, and if they approve the change, a 30-day public comment period before formal adoption will begin.

Click here to view the present version of the changes that will be presented to the Board. AmSpa will continue to closely monitor these changes and will report any further developments.

Tags:  Med Spa Law  Med Spa Trends 

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Introducing QP

Posted By Administration, Tuesday, June 11, 2019

qp first issue

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

When we first started AmSpa in 2013, we knew that, ultimately, we would start a magazine. It was a natural evolution and was always in our plans; however, we always wanted it to be different. We didn’t want to simply put out another trade publication or industry magazine. Don’t get me wrong—there is a place for those publications in the world, and they bring great value to the industry.

But, as we looked at the landscape of aesthetics, there was nothing that truly spoke to medical spas. The medical spa industry is like nothing else in aesthetics. It’s its own unique industry, with its own characteristics and unique traits. These aren’t dermatology practices and they’re not surgery centers. They are definitely not traditional spas, either.

When we thought about how to capture the medical spa industry in print, we immediately discarded the traditional characterizations. We didn’t want doctors in lab coats or slick suits, and we didn’t want stock images of syringes or cookie-cutter offices, either. We also didn’t want extensive treatises on treatments or tactics. We wanted to capture the true essence of the industry—the spirit and underlying vibe that makes the industry go.

At its core, this industry is about people. Medical spas help people feel empowered. They help people recognize their true beauty. They inspire confidence, pride and hope. They make people look better, to be sure, but they also restore people from within. And they do this while making money and having fun. There is a sexiness and glamour to this industry that you won’t find anywhere else, and there is community and strength in the industry, as well.

It is our goal to capture this essence in a publication while ensuring that we stick to our core values of compliance and safety. After all, none of the allure and glamour is possible if we don’t provide impeccable patient care and adhere to strict medical standards. As I’ve often said in talks throughout the country, there is only one thing that can stop this industry from continuing its incredible growth trajectory—us. It’s us tolerating bad outcomes, receiving negative press and failing to follow the rules of the road. So long as we are compliant, professional and safe, the sky is the limit for this industry.

With that said, it is with great pleasure that I present the premier issue of AmSpa’s new quarterly publication, QP. It is an exploration—and a celebration—of the industry through the eyes of the people who have built it: you. In its pages you’ll find color, insight, advice and perspective that you may not have considered before. You’ll get to go inside the top medical spas in the country, read about the entrepreneurs who built the industry and share in their experiences.

In our first issue, we present the top med spas in the country. Inside you’ll find exclusive photos and insight from some of the most successful medical spas owners in the world. What are their secrets? What drives them? And to what do they attribute their success? In future issues, we'll highlight influencers, innovators, technology, data, and, of course, regulation (it is AmSpa, after all). But through it all, we will focus on people.

And of course, we invite you to let us know what you think and what you want to see. This publication is for you, and it’s important to us that you’re proud of what you see. This has been a long time coming, and we hope to be around for many years to come.

AmSpa members should receive the premier issue of QP in late June.

(Please note that if you became an AmSpa Member prior to May 31, you'll receive the first issue in the mail. If you have become a Member since May 31, the second issue will be your first. If you want to receive QP—among many other benefits—become an AmSpa Member today.)

Tags:  AmSpa  Med Spa Trends  QP 

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How Core Doctors Can Overcome Generational Differences in Marketing, Advertising and Ethics, Part 2

Posted By Administration, Monday, June 10, 2019

vlog doctor

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

(Click here to read part 1)

Streaming video of procedures has helped many core doctors make names for themselves on social media and the internet, but this practice is understandably the source of a great deal of controversy. Recently, some prominent plastic surgery societies have begun to consider the ethical questions surrounding plastic surgeons broadcasting the procedures they perform on social media services, such as YouTube and Facebook. The doctors who stream these surgeries often say that they do this for its educational value, but these shows are also designed to raise the surgeon’s profile. If the event is properly publicized, several thousand people will tune in, and sometimes a staff member will even be in the operating room with the surgeon answering questions from the video’s chat function on a computer. This can lead to a great deal of income for the surgeon.

There is nothing illegal or even necessarily unethical about this but, on occasion, these videos make the surgeons and their staff members look unprofessional, especially depending on how they act during the procedure. While acting silly is almost expected from those engaging in social media today, it can be argued that medical professionals should hold themselves to a higher standard. If the purpose of the video truly is to educate rather than raise the surgeon’s profile, this sort of behavior should not be highlighted.

At the same time, it is undeniable that live streaming is an effective way for a surgeon to get his or her practice’s name on people’s lips. It also makes prospective patients comfortable with the surgeon, provides answers to questions that many patients have, and promotes plastic surgery as a whole. And if you ask the surgeons themselves, many who live-stream can point to a direct correlation between their marketing efforts and a sharp increase in revenue.

However, while it’s understandable that medical aesthetic doctors engage in marketing techniques such as these, those who make videos must make sure that they’re still representing medicine in a professional manner. This is still the practice of medicine, after all. They also need to make sure that they’re acting in a manner that is respectful to their patients, who often are unconscious on the operating table—it looks bad when doctors are dancing and joking while the patient is prone (yes, this has actually happened). It’s easy for a surgeon to lose sight of this when he or she is performing (because a live broadcast of a surgical procedure realistically is a performance), but it is something he or she should make a point to be mindful of. This is a competitive market in which many people are utilizing unorthodox sales techniques and, while medical aesthetic professionals have to ensure that a practice remains profitable, they are still dealing with medical patients.

Crossing Ts, Dotting Is

Although this should probably go without saying, it is critically important that any surgeon or medical spa planning on conducting a social media campaign receives written consent from featured patients that thoroughly cover all HIPAA and local patient privacy laws. The forms used for this must be very specifically drafted in order to address the legal minutiae of social media, so anyone planning to do this needs to be very careful to ensure that the patient understands exactly what is going to happen. This is not the sort of form that anyone can simply download off the internet—it will need to be vetted by an experienced health care attorney to guarantee that no legal entanglements result.

Again, it’s worth mentioning that when he or she signs such an agreement, the patient is consenting to having his or her likeness out there for the world to see for educational purposes, not to being a motionless prop while the surgeon or his staff members act foolish. It’s not hard to imagine a scenario in which a patient would be fine with participating in a social media campaign or educational live-stream, but then appalled when he or she sees the surgeon and staff members goofing around during the promotion. The end result may not be covered by the consent form the patient originally signed.

Direct Messages

So is it inherently bad for plastic surgeons to become social media celebrities? Isn’t that the goal of marketing and public relations? It probably doesn’t matter – the genie isn’t going back in the bottle and the industry is going to need to figure out how to deal with it. There are numerous questions that societies should be asking themselves, particularly given the number of non-core doctors entering the industry. Any physician can establish himself as an expert by virtue of social media and internet advertising, but it can be problematic when the physicians in question are young and perhaps doing work that they aren’t quite qualified to be doing. If patients are receiving misrepresentative information from these doctors—and if we’ve learned anything in this country in the past couple years—it’s that people tend to believe what they see on television and social media, and that can be extremely dangerous.

At this point, dealing with this issue seems to be about making the use of social media acceptable from an ethical standpoint. There really is no turning back—social media has become a key part of marketing for core doctors, no matter how badly some wish it weren’t true, and it isn’t going anywhere.

The bottom line is that the medical aesthetic industry needs to be careful—it shouldn’t get too brazen with its marketing, because medical societies have much louder voices in halls of government than the medical spa industry does. A group of Northwestern Medicine authors recently proposed a code of ethics for videos, for example, and I think this is a good idea. After all, if these campaigns truly are for educational purposes, they don’t need the theatrics. But at the same time, the ability of medical spas to market themselves aggressively is one thing that sets them apart and allows them to succeed in a very crowded marketplace. And the personalities of practitioners come through in social media campaigns, and often the providers become much more relatable than their surgeon counterparts. There is a delicate balance that must be struck and, if the industry is going to survive, it is imperative that we make this balancing act a priority.

To stay updated on this issue and learn about many others, become an AmSpa Member and schedule a complimentary initial consult with our partners at ByrdAdatto.

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

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How Core Doctors Can Overcome Generational Differences in Marketing, Advertising and Ethics, Part 1

Posted By Administration, Friday, June 7, 2019

doctor vlogger

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

Core doctors—plastic surgeons, facial plastic surgeons, oculoplastic surgeons, and dermatologists—are, as their moniker suggests, the center of the medical aesthetic industry. As physicians, they are allowed to own and operate medical spas, and their fields of expertise coincide with many of the procedures sought by those who frequent these businesses. Historically, core doctors have made a lot of money by operating medical spas along with their more traditional practices.

However, in recent years, younger core doctors, nurse injectors and medical spa owners have courted controversy by stepping outside the role of humble healer that physicians traditionally take on, and into another role—celebrity provider. These doctors do not hesitate to market themselves and their businesses in ways that some older physicians find gauche and undignified, and they have created a great deal of controversy in the medical community by doing so. This generation gap must be addressed, but the issues at the heart of the matter must first be understood by both sides.

Social Studies

Younger core doctors primarily market themselves with social media sites such as Twitter, Instagram, and Facebook. The use of social media is a very different form of promotion than what many core doctors are used to, and it can be difficult for more traditional doctors to wrap their heads around what it is and what it does.

Because medical aesthetics has become so lucrative, it has arguably moved away from more traditional medicine. While traditional rules and traditional ethos apply, aesthetic medicine is governed in many ways by a completely different dynamic—aesthetic treatments are all voluntary, they are all cash-based, and there is a great deal of competition. Doctors are taught the Hippocratic Oath and other ethical ideals that have governed the profession for millennia. But when people choose to undergo surgery for purely cosmetic purposes, medical providers are no longer healing a patient per se, but rather providing the patient with a service that is advertised and sold on the open market. So, how do you take medical ethics that are designed to help cure disease and apply them to a competitive industry where patients shop for—and doctors sell—treatments that address patients’ desire to change the way they look?

The medical aesthetics industry also intersects with technology and marketing in ways that traditional medicine does not, which has contributed to this discord. It’s not entirely generational—there certainly are younger doctors who believe that the actions of some core doctors are a bit over the top, and there are older doctors who have bought into social media—but there clearly is a generational line between some of the older plastic surgeons who were trained in a time where marketing their practice, and themselves, was not as important as it is now. For many, the medicine and science behind plastic surgery has been subverted by the need for views, shares and likes. These surgeons feel that many in plastic surgery are missing the point of what it means to be a surgeon, and that the need for celebrity has overtaken the need to practice medicine.

But in today’s world, particularly among younger surgeons who have been using social media for years, the idea of not marketing yourself is unthinkable. In their world, one must adapt or die, and failure to compete in the marketplace through use of social media, video and marketing is the easiest way to make your practice extinct. Although there have always been surgeons who are at least somewhat famous, with social media and reality television becoming ubiquitous in recent years, this has been taken to a whole new level. With social media especially, celebrity has become democratized, and physicians can become famous through sheer hustle. There are young surgeons who have become far more famous than their older counterparts purely by utilizing the social media tools at their disposal, and this has, to some extent, disrupted the established order and ruffled some feathers. So the question must be asked: Is this merely the competitive marketplace shaking itself out or has aesthetic surgery crossed the line into something more problematic that needs to be reined in? It depends on who you ask.

(Check back on Monday morning for part 2)...

To learn more about the legalities that govern medical aesthetics, sign up for an AmSpa Boot Camp. You will learn how to operate your medical spa compliantly and profitably.

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

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How to Stay Compliant When Using Social Media Influencers

Posted By Administration, Wednesday, June 5, 2019

influencer

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

As is the case in most industries, the use of social media influencers to promote medical aesthetics is extremely common. However, because medical spas offer medical treatments, the regulations that govern influencer marketing in this space are more stringent than with many large brands you might see represented on Instagram, YouTube or other social channels.

The power of social media influencers is undeniable. If an influencer goes to a medical spa for a treatment, he or she may film the entire visit and broadcast it throughout the world on his or her social media channels. If the influencer has a significant following, this can have a major impact on a medical spa’s business.

However, most of these visits are not spontaneous situations. More often than not, medical spas compensate influencers with cash and/or free treatments to get them to portray their practices in a positive light. If your medical spa is engaging in this sort of advertising, you need to understand the legal issues surrounding these matters, although in most cases, precedent has yet to be established, as these transactions are occurring in a new medium.

Written Agreements

If a medical spa uses an influencer to promote the practice, it must have a written agreement with the influencer in place. This agreement should dictate what the influencer’s responsibilities are—how many times he or she is going to post about the practice and what he or she is going to post. The medical spa should have as much editorial control over the posts as possible, since the influencer’s primary goal is to promote his or her brand—not yours—and the medical spa is responsible for keeping the influencer on message. The deal must meet the medical spa’s expectations to ensure that it’s getting its money’s worth. Even if you’re compensating the influencer with a treatment, you need to make this as clear as possible, and a written agreement will help both sides understand the nature of the deal. This also helps you to assign a value to the services you are providing.

Advertising Rules

As a medical provider, when you compensate someone to promote your brand, you are subject to medical advertising rules and regulations, which are much stricter and have much more dire consequences for violations than common advertising rules. Primarily, this means you cannot say anything that can be construed as misleading, untrue, aggrandizing or exaggerated—everything that’s said about your medical spa must be provably true. You can’t simply say that you’re the best injector in the world, for example, because you can’t prove that. That advertisement is asking for trouble.

When influencers are being paid—or given free treatments—to represent your medical spa, they are legally acting as a paid advertiser. As such, you’re responsible for everything they say, so if they say something hyperbolic, you are responsible for that message, and the situation can get very sticky if a medical board finds out about it. You will need to make sure that the influencer understands that the medical spa is subject to these restrictions and that he or she must be sensitive about precisely what is said in these videos or blog posts. With a written agreement, you can disclaim some of these factors, which allows you to exert some control over the message.

Disclosure Guidelines

Influencers also have their own set of guidelines to worry about. In 2017, the Federal Trade Commission (FTC) issued warnings to more than 90 social media influencers who failed to disclosure when they were being compensated in exchange for coverage, and reiterated its guidelines for compliance. These include:

  • Keep your disclosures unambiguous;
  • Make your disclosures highly visible; and
  • Avoid hard-to-read, buried disclosures in strings of hashtags that are skipped by readers.

Influencer marketing can be a very powerful promotional tool, but it must be wielded with some care in order for your medical aesthetics practice to remain compliant. As I mentioned earlier, the legal aspect of its use in a medical setting is still developing, so if you’re unsure about how to proceed, be sure to consult with an experienced health care attorney.

For more information about utilizing social media to build your practice and about the laws governing medical aesthetics, sign up for an AmSpa Medical Spa & Aesthetic Boot Camp.

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

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Lips Stay on the List

Posted By Administration, Monday, June 3, 2019

lips

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

Lips have always played a major role in the medical aesthetic industry, although lip treatments have not always been embraced by those who provide them. In recent years, some surgeons have shied away from operating practices where high volumes of fillers and toxins are administered, because they didn’t believe the margins for these treatments were high enough. Industry observers speculated that eyebrows would be the new lips, and that the recent rise of treatments such as vaginal rejuvenation and CoolSculpting might change the business permanently. However, a large percentage of medical spa revenue still comes from lip treatments, and this is expected to continue to be the case for years to come.

Through marketing and the use of mid-level practitioners (rather than physicians) to administer these procedures, practices are beginning to focus on providing specialized treatments on lips with fillers and Botox, and they’re making a lot of money doing it. Although devices such as lasers and CoolSculpting will definitely continue to play significant roles in medical spas, many practices are going to go back to focusing on fillers and other injections. Quite simply, they are inexpensive, effective, low-risk treatments that get people through the door.

As silly as this may sound, the “selfie” phenomenon has a lot to do with this. People, particularly millennials, are constantly taking photos of themselves, and their lips are front and center in all these shots. When young people see the Kardashians, for example, in countless selfies with “duck lips” and pouty faces on social media, it makes them want to do the same, and they want to ensure that their lips look good in these images.

The ways lips are treated has become more refined in recent years. Some medical spas offer combination lip treatments that include fillers combined with botulinum toxin. In these treatments, the botulinum toxin is applied above lip in order to free the muscle so that the lip is drawn up in such a way as to make the lip appear fuller. The botulinum toxin also can be applied to the sides of the mouth in order to achieve the same effect.

Additionally, mid-level practitioners—typically registered nurses and nurse practitioners—have become exceptionally good at administering filler and botulinum toxin injections. This is because they perform a lot of injections—physicians typically delegate these procedures to nurses because the physicians tend to have more lucrative procedures to attend to. As a result, nurses have become experts at creating lips. As nurses have begun to gain more agency in the medical aesthetic industry through changes to nurse practice acts, their expertise in this area may create new opportunities in the near future.

Lip treatments aren’t necessarily the most sensational or lucrative treatment that a medical spa can provide, but they are a foundation of the industry. If your medical spa does not offer fillers, it’s definitely worth exploring what they can offer for your patients. After all, selfies aren’t going anywhere, and as long as people pucker their lips trying to look like a celebrity, there will be money to be made from lip treatments.

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

Tags:  Med Spa Trends 

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How to Find Legal Answers for Your Medical Spa

Posted By Administration, Wednesday, May 29, 2019

lawyer and statue

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

At AmSpa and ByrdAdatto, we are asked every day about the legalities of the medical aesthetic industry. We constantly hear from professionals wondering, for example, if an aesthetician can perform a particular procedure, or whether a licensed vocational nurse can inject a certain product, among many others. The number and types of questions we receive speak to the complexities of the industry.

Providing information such as this to medical aesthetic professionals is the reason why AmSpa was started in the first place, but people often question our conclusions or wonder why, if the law is what we say it is, no one is following it. As it turns out, finding legal answers in the medical aesthetic industry is not easy, and the answers themselves are not simple, and there are numerous reasons why.

Some conversations about the legalities of the industry repeatedly occur. For example, I will explain the requirement that a physician, physician assistant or nurse practitioner perform a face-to-face examination of a patient before a laser treatment or filler injection, and the person with whom I’m speaking will say that can’t be true—nobody does that. If that is what’s required, they say, you could shut down every medical spa in the state for violating this law. But it is true, it is the law, and yes, a regulatory agency probably could shut down most medical spas in a given state if it had the manpower to investigate them all.

The medical aesthetic industry is unique in many ways. First of all, its procedures are all elective, so medical spas must market to people who choose to undergo their procedures rather than require it. Also, medical spas do not deal with insurance—the industry is entirely cash-based. Because of these factors, medical spas have to market themselves to a degree that traditional medical outlets do not.

As a result of this need for effective marketing, non-physicians play key roles in the health of these businesses. For example, a registered nurse who is a skilled injector can be the person patients come to see, as opposed to the physician. This is a much different dynamic than can be found anywhere else in the world of medicine.

Additionally, medical aesthetic practices typically have to deal with multiple practice groups, including medical boards, nursing boards and boards of cosmetology. And because the medical aesthetics industry is so young, many of these agencies are dealing with questions that are being raised for the first time. Essentially, the industry is governed by laws that are not designed to govern it and people who are more concerned with other issues.

For example, nursing boards probably won’t have too much to say about CoolSculpting, since much of their time is spent dealing with pressing matters such as opioids. They have so much to deal with that they can’t reasonably be expected to understand the nuances of the medical aesthetics industry.

When AmSpa researches the laws that apply to medical aesthetics practices in a particular state, we start by finding what we can in the state’s legislation, but most of the time, these laws’ use in relation to medical aesthetic situations is tangential; they’re typically written to deal with other areas of medicine and nursing. Therefore, regulatory interpretation of these laws with regard to medical aesthetics is vital. If a board has not published an opinion on a matter, that does not necessarily mean it does not actually have an opinion—it means that it has not yet presided over an incident that has caused it to issue an opinion. When you’re dealing with multiple boards with multiple opinions, the situation is further complicated.

All this makes AmSpa’s job very challenging. Usually, we have to take what we know about the laws and the boards and try to determine what a ruling would be. When we say, “This is what we believe the rule is in this particular state,” it’s unlikely that it is taken directly from legislation, because there’s a good chance that specific legislation doesn’t exist. We can, however, combine precedents with our legal knowledge to give you the most complete possible interpretation of the situation.

Our attorneys have been researching these regulations for years. They have appeared before nursing and medical boards to argue cases, and they have spoken with officials about these issues. This is how we learn about these issues. It’s very difficult work, but we’re confident that our attorneys provide our members the best possible information.

For more information about med spa laws, become an AmSpa Member to schedule a complimentary initial consult with our partners at ByrdAdatto.

Tags:  ByrdAdatto  Med Spa Law  Med Spa Trends 

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Join AmSpa at the Asheville Medical Spa & Aesthetic Boot Camp EXTRA

Posted By Administration, Friday, May 24, 2019

asheville omni hotel

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

Starting next Saturday, June 1, AmSpa will host its Asheville Medical Spa & Aesthetic Boot Camp EXTRA at the Omni Grove Park Inn. We’re extremely excited for the opportunity to help medical aesthetic professionals develop their practices in this beautiful setting. 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 1

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 – 11:30 a.m.: The Marketing Plan, presented by Terri Ross (Terri Ross Consulting)—Renowned medical spa consultant Terri Ross shows you how to most effectively market your practice using market research and defining your objectives.
  • 11:30 a.m. – 12:30 p.m. The Social Media Plan, presented by Danielle Smith (Smith & Popov)—This session will help you determine how to promote your medical aesthetic practice using cutting-edge social media techniques.
  • 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 – 5 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.
  • 5 – 6 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.

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

Sunday, June 2

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 Digital Marketing Ecosystem, presented by Audrey Neff (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.
  • 11:30 a.m. – 12:15 p.m.: Medical Aesthetic Hot Topics Panel, featuring Page Piland (Galderma), Audrey Neff (Crystal Clear Digital Marketing), Terri Ross (Terri Ross Consulting) 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 – 1:45 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.
  • 1:45 – 2:45 p.m.: The Long-term Revenue, presented by Bryan Durocher (Durocher Enterprises)—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, Bryan will show you how to build patient loyalty and move your business forward.

Monday, June 3

The Boot Camp begins at 8:30 a.m. with a continental breakfast.

  • 9 a.m. – 12 p.m.: Making Money in Your Medical Spa, presented by Terri Ross (Terri Ross Consulting)—Learn about the most profitable and popular treatments available to your practice, and get a preview of The Roadmap to a 7-figure Medical Spa—Terri’s sales training course—which will show you how to convert web leads and develop phone skills, both of which are vital to medical spa success.

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

We hope you can join us in Asheville next 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 Trends 

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Understanding the Legalities of Off-Label Use

Posted By Administration, Monday, May 20, 2019

drugs

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

The use of pharmaceuticals for treatments that are not specified by the U.S. Food and Drug Administration (FDA) is known as off-label use. This is a somewhat controversial practice, and many in the medical aesthetic industry may not fully understand why this is the case. However, if physicians use common sense and the medical information that is available, they can avoid legal entanglements. Here are a few things to keep in mind when considering off-label use in a medical spa setting.

Considering Use

In most cases, it is legal for a doctor to use FDA-approved medications in ways that are different from what the label specifically mentions. For example, Botox originally was specified by the FDA for use in the treatment of incontinence caused by spinal cord injuries or multiple sclerosis, migraines, upper limb spasticity, pain caused by cervical dystonia, axillary hyperhidrosis (sweating), blepharospasm (eye spasms) in children with dystonia, and strabismus (crossed eyes) in children. The reduction of facial wrinkles is not on that list, but it became by far the most prevalent use of the drug, and over the past 15 years, Botox has received three indications for cosmetic use. It is typically up a doctor’s own medical judgment to determine if a medication can be used for other treatments.

Also, it’s worth keeping in mind that the FDA does not govern the practice of medicine; it governs drugs. State medical boards govern the practice of medicine. Therefore, a board-certified doctor can determine how to use a particular drug.

“To be very, very clear, the FDA has no ability—zero ability—to have any control over how a physician practices,” said Bradford Adatto, partner for ByrdAdatto, a Dallas-based healthcare and business law firm. “They are not in the business of regulating physicians. If you as a physician want to do something that’s off-label, it doesn’t affect you at all.”

In fact, off-label use has led to medical breakthroughs in the past. Aspirin, for example, was originally specified only to treat headaches—after it was introduced, doctors discovered that it thins the blood, and they began using it to treat heart congestion. (It has since been specified by the FDA for use in heart patients.) In the medical aesthetic industry, doctors have been known to try to use fillers and Botox in innovative ways to try to solve unusual problems presented to them by patients.

Regulatory Issues

Should patients and medical spa staff members worry about their doctor conducting off-label treatment? Generally, the answer is no, as it is up to the doctor’s judgment, and one can reasonably assume that judgment is informed by thoughtful research and years of experience.

“The physician has the ability to treat the patients based on their own medical knowledge, what other peers are doing, what is documented in medical journals that are out there or experiments they’ve done,” Adatto said.

However, doctors also have been known to use drugs on patients for more experimental purposes, and when that happens, state medical boards can intervene.

“If I, as a physician, am doing something that no one else is doing, and my medical board wouldn’t approve of it—there’s no medical journals on it, and I’m way off the skis of where everybody else is going, and I am just sailing in a direction where I’m all by myself—I could then be in trouble with my medical board for experimental use that’s outside the community of care of that particular specialty,” Adatto said. “You don’t want to be going in a situation where a medical board does not approve of that or believes it is too experimental or is not within the typical standard of care for a patient.”

If a physician is found to be using pharmaceuticals irresponsibly, he or she could be censured by the medical board and lose his or her medical license. In addition, he or she will need to explain his or her actions to the board.

Reckless Endangerment

In addition to facing sanctions from his or her state’s medical board, a physician who engages in reckless off-label drug use may be subject to legal liability issues. If a physician is found to have harmed a patient with his or her off-label pharmaceutical treatments, he or she could be sued for malpractice. If the off-label use resulted in serious injury death, a doctor can even be subject to criminal prosecution.

You may remember the case of Dr. Conrad Murray, the personal physician for music legend Michael Jackson. Murray was found complicit in the Jackson’s death because he improperly administered propofol—a drug specified for use as an anesthetic—in order to help the “King of Pop” sleep. He was found guilty of involuntary manslaughter and sentenced to four years in prison.

“Those drugs are usually only used for surgery, but there are other physicians who have used it to help calm individuals,” Adatto said. “It just then goes back to, not that many doctors were using it—it was a very small community that was using it—hence the malpractice, and then the liability of jeopardizing your license for being so far off-label.”

A doctor who is administering pharmaceuticals off-label also must be completely forthcoming with the patients being treated and obtain their express consent prior to providing these treatments. Misleading patients as to the specified use of the drugs being administered is another excellent way for a doctor to attract the attention of a state medical board.

“If you’re saying that this drug has been approved for this, and the medical board considers that what you’re providing is false or misleading information, that’s another potential issue,” Adatto said. “When you’re treating a patient on the front end, you must get that consent in order and make sure that the patient understands that the drug has not been approved for this type of use.”

In order to prove he or she has properly acquired consent for these treatments, the physician should be sure to get it in writing.

“We would always recommend to physicians that if you are going to be using a drug often for off-label, make sure you have a written consent that then describes that, so that a patient can also sign off on it, knowing that they received it both orally and in writing,” Adatto said. “That’s going to protect the physician, showing that they did tell this particular patient that they were using this drug for an off-label use, and the patient understood that and assumed some of those risks.”

Sensible Solutions

Off-label use can be a particularly tricky issue in medical spas, since non-doctors are sometimes the ones administering these treatments. Everyone in a medical aesthetic practice must understand that off-label use is a medical decision that is to be made only by a doctor. For example, a nurse administering an off-label pharmaceutical must be following a doctor’s order, and the decision needs to be established following proper delegation protocols.

If a doctor uses good judgment backed by research and is forthcoming with patients about why he or she wants to administer that drug in a manner that is not directly approved by the FDA, off-label use should result in no legal issues. However, obtaining patient consent is vitally important in cases such as these, so doctors should consult with their healthcare attorneys to verify that the consent they obtain will shield them from potential action.

In many cases, doctors who provide off-label treatments are simply attempting to help their patients. Providing them the leeway to do so has led to important medical breakthroughs and changed countless lives for the better. As long as doctors take the proper precautions, off-label use is perfectly acceptable from a legal standpoint.

Tags:  Med Spa Law  Med Spa Trends 

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Differentiating Your Practice: Choosing the Right Aesthetic Treatments to Set Your Practice Apart and Meet Client Needs

Posted By Administration, Thursday, May 16, 2019

cynosure

More than ever before, consumers are seeking out aesthetic treatments to help them feel and look their best—even if it means paying out of pocket. This means profit and growth opportunities for medical spas and medical aesthetic practices, but also comes with the pressure of keeping up with high demand, evolving industry trends and the latest technology.

With hundreds of treatment options available to address a myriad of patient concerns, it can be a challenge to determine what investments will bring the greatest returns to a practice and enhance its competitive edge.

This process of selecting and investing in new technology involves careful evaluation across many factors, including the practice’s current and prospective client base, the versatility of the technology on the table, and the technology provider’s capabilities to serve as a true partner to the practice.

Evaluating Current and Prospective Clients

It’s no secret that the demographics of those seeking out medical aesthetic treatments have changed and continue to evolve. Gone are the days when older women looking to slow the effects of aging were the only target market for medical spas and medical aesthetic practices.

Instead, today’s Millennials and men represent strong and growing populations of those receiving aesthetic treatments. Yet, each group approaches aesthetic treatments differently and are looking to address diverse present—and even future—concerns. This means medical spas and aesthetic practices could miss out on key growth potential if they do not look beyond the needs of their traditional client base to target new customers, with proven technology designed to address those specific concerns.

Radiofrequency (RF). Millennials are becoming increasingly interested in non-invasive skin treatments and are turning to radiofrequency (RF) technology in numbers never-before-seen. Although there are many RF devices on the market, those that offer differentiators in the realm of anti-aging and preventive maintenance are in highest demand. Dr. Dianne Quibell of MD TLC in Wellesley, MA, says, “My Millennial patients are requesting treatments using RF technology, including Cynosure’s TempSure Envi treatment, to tighten skin through soft tissue coagulation, minimizing facial fine lines and wrinkles, and temporarily improving the appearance of cellulite. Millennial patients love that they can incorporate these treatments into their beauty routines without downtime to address current concerns and future signs of aging.”

In addition to addressing active skin problems, RF technology is becoming increasingly popular for preventive skin maintenance, with Millennials thwarting the signs of aging before they even appear. With an increase in active—instead of reactive—beauty maintenance, practices could expect to see RF technology increase in popularity, particularly with this age group.

Non-invasive body contouring. Although women have historically been more accepting of—and forthcoming with—their cosmetic procedures, more men than ever are receiving cosmetic procedures. In particular, advancements in non-invasive body contouring procedures have helped men become more comfortable with receiving treatments, because they can now return to work immediately following the procedure with no downtime required.

Dr. Quibell continues, “Although many of the men I treat lead healthy, active lifestyles, most people have stubborn pockets of fat that seem impossible to lose, even with diet and exercise. The ability to undergo a 25-minute procedure, like SculpSure treatments in my office, that reduces up to 24% of treated fat cells without surgery, has captured the attention of men nationwide.”

As the audience for medical aesthetic treatments grows and diversifies, practices must target new prospective clients by identifying the technology best suited to address their concerns. Millennials and men continue to invest in treatments, meaning that both RF technology and non-invasive body contouring procedures are here to stay, because they provide real results with no surgery or downtime required.

Selecting Versatile Technology Options

When selecting new technology, practices can maximize their return and make major impact on their treatment offering by investing in technology with versatile functionality.

New technology innovations can perform multiple treatments or applications with one piece of equipment. This means that practices can benefit from multiple revenue streams from just one investment.

For example, the Icon platform is a flexible and versatile system that leverages IPL  and laser technologies. Through one piece of technology, Icon addresses several client concerns, ranging from hair removal to procedures for pigmentation, vessels, wrinkles, scars, and stretch marks, while offering a cost-effective, impactful way for practices to expand their offerings.

With other dynamic, multi-application systems hitting the market, practices can maximize their spend while also enhancing their portfolio of treatment options—all with a single investment.

Choosing a Partner, Not Just a Provider

Selecting new technology for your practice is an important decision that impacts your business’s bottom line and growth potential, as well as client satisfaction. It’s important that the company you purchase from will serve as a partner with your business, and not just a provider.

Providers become partners when they value a customer’s practice as an extension of their own business and offer turnkey solutions and dedicated support to ensure success. The value of a company’s overall commitment to improvement through innovation and client service, as well as their longevity in the space, are key factors when comparing their promises and evaluating their impact on a practice.

Practices should carefully select manufacturers based not only on the equipment they sell, but on the on-going support they provide by asking key questions, including: “Will this company support my facility through service and technology upgrades that will help serve our needs and the needs of our clients?”

With constant advancements in treatment technologies, it can sometimes be difficult to hone in on the options that will offer the most to both the practice and its clients, while also differentiating the practice in a competitive market. When investing in new aesthetic technology, balancing the needs of clients with the goals of the practice will ultimately result in sustainable success and satisfaction.

Cynosure, A Hologic Company (Westford, Mass.) is a global leader in advancing and innovating medical devices for aesthetic procedures and precise surgical applications. Its non-invasive and minimally invasive technologies enable plastic surgeons, dermatologists and other medical professionals to address skin revitalization, body contouring, fat removal, cellulite, scarring, tattoo removal, gynecologic health, unwanted hair, excessive sweating, and vascular and pigmented lesions. Cynosure also markets radiofrequency technologies for facial plastic and general surgery, gynecology; ear, nose and throat procedures; ophthalmology; oral and maxillofacial surgery; podiatry; and proctology. Established in 1991, Cynosure sells its products globally under the Cynosure, Palomar, ConBio and Ellman brand names.

Tags:  Guest Post  Med Spa Trends 

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