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Concierge Medicine in a Time of Crisis

Posted By Administration, Friday, March 27, 2020

knocking on a door

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

Over the last several weeks, the coronavirus pandemic has rapidly evolved from an isolated outbreak in China to a national emergency in the U.S. with rising case totals in every state. In the face of this, emergency federal and state leaders have recommended that non-essential surgeries and procedures be postponed or canceled. AmSpa recommends that medical aesthetic practices should temporarily close. Increasingly, city and state authorities are instituting shelter-in-place rules that require the closure of non-essential businesses. As discussed here, health care is typically categorized as an essential business, but aesthetic medical procedures likely are prohibited for other reasons. In places that have yet to institute shelter-in-place orders, some practitioners are offering concierge services. However, if you are planning to offer aesthetic services at you patient’s home, here are some issues you will want to consider.

Before you start seeing patients at their homes, make sure your professional liability insurance covers these house calls. Many policies will cover them, but they may limit what types of services you can offer. It may include typical checkup or physical exam-type visits, but it may not protect you for filler or toxin injections or energy-based skin treatments. You also may want to check with your carrier on its policies for coverage during declared emergencies such as this one. Also remember that patient privacy applies not matter the location, so be sure to protect the patient’s health information the same way you would if they came to your office.

Whether medical procedures are performed in an office or a residence, they still need to meet the professional standard of care. Minimizing risk of complications and infections is part of this standard. You have much less control over the condition of your treatment room when it is in someone’s house. At your office, you can clean and sanitize the area to your requirements; at someone’s home, additional precautions will need to be taken. You may need to use additional personal protective equipment (PPE), spot-sanitize your working area and bring supplies for addressing emergencies or complications.

The coronavirus adds an additional wrinkle to this concern. While you can prescreen for symptoms, people can be contagious with COVID-19 prior to the onset of symptoms. Both you and your patient are potential vectors. When practicing in someone’s home, everyone else living there is a potential vector as well. These others would need to be accounted for and any concerns addressed prior to the appointment, especially if the patient lives with someone who is vulnerable to serious complications from COVID-19.

The general risks of person-to-person contact and the other issues with making house calls can all be mitigated by utilizing telecommunications technology. Telemedicine has made great strides in the last several years. While the rules and regulations supporting the practice are sometimes slow to catch up, most states are supportive of the practice, provided it meets the same standard of care as in-person visits. Obviously, you cannot provide treatments or perform procedures through the internet (yet), but you can provide examinations, make recommendations, prescribe treatments and generally support your patient’s health goals until you are able to see them in person again. We offer a number of resources (here is a recent one) on telemedicine, and this forthcoming webinar will speak directly to the challenges of maintaining a telehealth aesthetic business during this crisis.

Tags:  COVID-19  Med Spa Law  Med Spa Trends 

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5 Things We Can All Do Right Now to Make Things a Little Easier

Posted By Administration, Wednesday, March 25, 2020

mountain climbers

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

The last two weeks have been a rollercoaster of emotions, haven’t they? I really can’t remember a time with so many ups and downs for all of us. From alternately being nervous (read: terrified) about this virus to concerned about our business to laughing hysterically at the memes forwarded to me every few minutes, I can’t get a handle on my emotions. (Seriously, there are some really clever people in this country—some of the memes I’ve read had me belly-laughing like I haven’t for a long time.)

Every week feels different. This past week has felt a little more ominous. Last week, everything was kind of new—we were working from home, contained inside our little worlds with our loved ones, almost like a slumber party. Plus, the news was bad, but still not that bad. Now, reality is setting in. The news is getting worse, and, after a full week of exactly zero revenue for all of us, our business reality is creeping in. Folks are starting to snap at one another on conference calls. Patience is wearing thin. And it’s only week two!

But every now and then I get a moment of clarity and I refocus my attention to how lucky I really am. Over the last few days I’ve been taking notes on the things that happen that draw me back to this feeling, and I’d like to share them. I’d also love for all of you to share with us the things that make you feel happy and lucky during these turbulent times. Share them with us on social… we’re in this together!

  1. Take a deep breath and recognize that we’re going to get through this. AmSpa is made up of small business owners, and it’s easy to get freaked out over what’s going on. Our businesses are or livelihoods, and many of us have spent years building them. And all of it can be taken away by a virus? It’s kind of mindboggling, really. But here’s the thing—we’re going to be okay. We’re at the very beginning of this. Just today, our friends in Washington, D.C., managed to pass a stimulus bill that will provide much relief to all of us. The preliminary language of this bill is encouraging—all small businesses will be entitled to funds to cover payroll and rent, at a minimum. That will be a huge relief, as it will allow us to stay in business and pay our people. Taking that burden off of all our minds will be a huge relief and will allow all of us to focus on the good things that are going on around us.
  2. Be understanding and graceful towards your vendors. Look, we’re all in this together. None of us are making any money. We are all feeling the pain right now. So, let’s all give each other a break on money that is owed to us. Yes, all of need the money, but the businesses that owe you money also need the money, and the businesses that you owe money to also need the money. We all need cash, and it makes no sense for anyone to hold someone else’s feet to the fire over a bill at this point. Be gracious, be patient and recognize that the person who owes you money is in the same situation, as stressed and as worried about future as you are. If we take a moment and just breathe, and recognize that we’re all in this together, it’ll make you feel better. I promise. And I should note that I’ve seen nothing but graciousness to this point—every company I’ve dealt with is working with everyone else to get through this. Even the credit card companies! Keep it up, and don’t be the first one to be a di*k.
  3. Plan, organize and communicate. Studies have shown that most stress is directly related to a feeling of lack of control. We fear what we don’t know. And in these times, we don’t know anything, so the stress and fear is at an all-time high. But science also shows that if you make a plan and do what you can to get organized, you’ll feel as if you’re getting things under control, even as the outside world continues to spin uncontrollably. So, make a plan for your business, your personal life, even your day. Cash is king right now, so work through your burn rate, step by step. (Your burn rate is how fast you’re “burning” through cash and, ultimately, how long you have until you have no cash left—if you need a fillable spreadsheet that helps with this calculation, here it is, courtesy of our friends at Skytale Group.) Then, make a list of outstanding bills and get on the phone to call your vendors. I promise, your business partners will understand (see #2 above). Make a list of things you can cut and things you can’t. The process of going through your business will make you feel better, and it will inform you of things that you’re spending money on that you don’t really need. And make sure you communicate with your team—we’re all isolated, and it’s easy to forget that your team is also stressed and cannot read your mind. Now is the time for leadership, and that requires communication.
  4. Pick. Up. The. Phone. Seriously, call someone. Anyone. There are tons of people you can call—coworkers, family, friends, enemies… frenemies, even. Ask them how they’re doing, over the phone. We have such a digital society that it’s easy to fall into the habit of communicating by email or text. But hearing other peoples’ actual voices can be refreshing. To take this a step further, have video meetings with your team and FaceTime calls with your family. Seeing other people helps. Science says that humans need interaction with other humans, so it’s worth the effort to make that connection.
  5. Focus on the good that is happening. It’s difficult to do, but the best thing to do is turn off the stupid news. Check in to get informed, but the bulk of your day can’t be spent following the bad news of the day, or you’re likely to start tearing your hair out. Right now, the news is bad. Count on it. But you know what? There are also some really amazing, inspiring, selfless things that people are doing out there. Our incredible marketing team put together this post of positivity that is really inspiring. And you know what? It’s not just bad for you—it’s bad for everyone, and there’s always someone worse off than you. So instead of dwelling on the bad, focus on the good things and what you can do for everyone else. All it takes is a little switch and your mood changes, which changes your outlook, which changes your focus, which puts you in a better mood.

None of this is easy. None of us have ever dealt with anything like this before—not even close. And there will be tough times ahead. But if you focus, plan and, most importantly, be nice to one another, it’ll make things easier for everyone else. We’ll get through this. We’re all in this together!

Tags:  Business and Financials  COVID-19  Med Spa Trends 

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What to Do Right Now: Essential Business Strategy & Tactics During Challenging Times

Posted By Administration, Tuesday, March 24, 2020

gift card

By Bryan Durocher, Founder & President, Durocher Enterprises

Hearing about the slowing economy and uncertainty is topic #1 in recent days. Focus on what you have control over at this volatile time. As a leader, model being calm and transparent, and avoid emotional knee-jerk reactions. Here are some strategies that provide you a baseline of information for how you can stay in action when and if it is appropriate for you:

  • Look at your finances—determine your cash flow and prioritize what you have to and can skip paying.
  • Negotiate with vendors to extend your terms and get you through. We are all in this together.
  • For your team, offer transparency and training, and be a good source of information and a leader during a crisis.
  • Keep in contact with your patients using telemedicine and video conferencing. These systems allow you to see patients for consults, preoperative visits and postoperative visits. 
  • Train on technical, recommendation and selling skills during your possible closure.
  • Put together a virtual special sales event to create cash flow now.
  • Offer advanced gift card sales and package incentives online.
  • Consider a concierge travel service.

Cash Flow

Cash flow is always a critical factor in keeping your business healthy. Right now, here’s what needs to be done. Determine what bills for goods and expenses are due each month. Of that dollar total, payroll will usually be right on top. Negotiate terms with all your vendors to either skip payments for, say, 60-90 days or reduce your monthly payment amounts. Don’t be afraid to ask—your vendors want you to succeed and stay in business. Get on top of this right away and don’t delay.

Regarding payroll, this is a tough area. Look at what you can realistically do. Be transparent and up-front with your staff. Emphasize you are all in it together. Perhaps your staff can use their PTO during a shutdown. Some of your staff could take a voluntary leave and be rehired once you reopen. Use your financial advisor as a resource for information regarding unemployment insurance filing, find out if your state has programs for rent abatement and/or mortgage relief—find out anything and everything that can help your team. They could be afraid, and it is your time to have empathy and listen with the intent to reassure them of what is possible.

Whatever changes you make, document everything. The Society for Human Resource Management is a resource that can help you through the necessary steps; click here to visit their website.

Communicating with Your Patients/Clients

Keep communication with your clients open. Be a calm presence, stay relevant and be a wellness leader. Keep the flow of information open with your website, Google business listing and social media channels.

Put an announcement banner on your home page that stands out. Have it link to a landing page with information about the up-to-date status of your business. Don’t alter your home page, as it could affect your long-term SEO.

People will be looking. Adjust the hours on your Google business page and create a post on the status of your business.

Be a calm presence on social media. Offer wellness advice that is appropriate to your business. Stay relevant to the pulse of what is happening now. This is a great time for you and your team to post content. Video your service treatments with step-by-step explanations of their benefits. You could create a private Facebook group for VIP information and learning. Put up a how-to Instagram video. Facebook and YouTube allow up to four hours of recording, while Instagram will allow for 60 minutes. You call also use Zoom or WebEx as a tool to convey non-HIPAA-compliant information.

The services you offer your clients are a part of their wellness experience. Get them thinking that your services not only help them look and feel better, but also help them to reduce stress and be able to give more to their work and the important people in their lives. On average, during a downturn in the economy, the first things to be excluded from an individual’s budget are “perceived” luxury services and products such as massages and aesthetic treatments. We want most clients to consider our services a necessity—not a luxury. However, you must realize that clients are pushing appointments out further than normal, attempting to maximize their dollar. Instead of visiting every four to five weeks, we are seeing clients return every six to eight weeks, which translates to one fewer visit per year per client. When we do the math, this can add up to a considerable drop in profitability at the end of the year, not only for the overall business, but also for the practitioners and technicians. You can counteract this with the right type of training.

Everyone is affected by the economic slowdown, so it is everyone’s responsibility to come up with solutions. Do not fall into the trap of your staff chanting, “You need to do more.” The truth is that everyone needs to do more. Everyone needs to market more. Everyone needs to network more. It needs to be a collaborative effort working toward the common goal of procuring more business for everyone. There is no magic bus of clients that will drive into your parking lot for services.

Train While You’re Closed

The uncertainty will end. Don’t lose an opportunity to teach your staff. With virtual learning, opportunities abound everywhere. We can lead virtual trainings with programs such as Zoom or WebEx. If your business is closed, use this time to enhance your staff’s skills sets. Whether it’s technical training, working on their service skill sets, or practicing their dialogues on how to recommend series, pre-booking or ask for referrals, it is a good time to keep focused on something productive. Most medical spas completely underutilize their retail sales capabilities. Training for recommending retail is more important than ever.

Suggestive Selling: Train Staff on Selling Techniques

There is a huge difference between, “Do you need any retail today?” and, “These are the products I recommend, which of them would you like to take with you today?” Suggestive selling is one aspect of merchandising that is often overlooked, yet it can make a tremendous difference in the total retail sales of a medical spa. It is proven that close to 40% of clients will say yes when asked by staff members if they wish to upgrade in size or quantity. There is a fine line between being perceived as pushy and merely suggestive, though.

The creation of simple scripts is a good way to assist your staff with suggestive selling. Choose two to three products that you wish to feature. Write out key features and unique selling points of each of the products and ask your staff to get comfortable with the language you have chosen. If you find this step challenging, your product representative is a great resource to turn to for help with descriptions and sales techniques for the featured products. Require staff members to be sure that each client receives at least one mention per visit. When clients are scheduling their next appointment and paying for their service, it is a wonderful opportunity for your staff to suggest gift cards and your packages. The “every client gets one mention” technique is a great way to boost sales of gift cards. Offer prospects $25 in retail products for every $300 they spend with you. (Don’t discount services in your packages, as it takes away profits. Use retail, which has no labor cost, as the incentive.)

Ask your product representative for all press releases and endorsements the product line has. Suggestive selling also may be accomplished simply by featuring a “product of the month” in a high visibility area. This technique is great for seasonal specials and time-sensitive products.

Cross-merchandising is imperative for your staff members to learn and master. It is a technique that is used with tremendous success by top medical spas. It is simply the art of matching products that complement each other together. Try using merchandise from different parts of the medical spa, with the intent to introduce clients to ancillary services as well as products. Displays using this tactic present a wonderful opportunity to introduce clients to services the practice offers other than those for which they usually visit. Just like its counterpart cross-marketing, cross-merchandising creates opportunities to increase sales while creating loyalty to your medical spa. It is highly effective, and is the suggestive selling technique that can offer a significant reward to your business when applied consistently.

Plan a Virtual Spring Semi-Annual Sale 2020 Online

Plan a sale or promotion online where your clients can purchase value now and use it later, when they are more comfortable. Much has changed in the last few days. We want to continue to reward our most loyal clients. Clients look forward to this sale twice a year, and we want to still make sure we can offer some sense of normalcy during these stressful times. We also know that people will want to take their minds off the stress, and self-care always helps.

Offer your 10-15 best treatments of 2020, making sure to not discount too deeply to prevent having short-term cash flow and losing money long-term. Clients will learn of the sale from your outgoing marketing efforts. Post the link for your online store so clients can browse from the comfort of anywhere. Clients can find the link on Facebook, Instagram, your website and email blasts.

Any clients who purchase either three of the same item or any other combination of three sale items will receive 10% of the purchase price in free retail. This can be any product that the provider recommends or that the client is interested in trying. Any client who qualifies for this benefit will be scheduled with a skin care consultation, preferably before the first booked service. During this visit, the client will have a skin scope and discuss their goals, and you will recommend a skin care regimen. Recommend the client two to five products, based on their needs. They will have a predetermined credit based on 10% of semi-annual sale purchases that will be on checkout tickets. You will recommend the products and remind them of their free credit they can use towards any of the products. Clients will purchase anything above their complimentary voucher.

Checkout and rules: Checkout skin care to a rep, if possible. If there is no rep for the product, discount the credit amount. Any remaining balance would be owed by the client. Vouchers must all be used at one time. No store credits will be issued for any balances.

Goals of retail:

  • Recommend skin prep kits first.
  • Fill in their missing skin care regimen, which will help maintain their goals.
  • Increase retail sales.
  • Create loyalty through the gift-with-purchase promotion.
  • Encourage future repeat sales of retail.

For a second promotion, encourage customers to purchase gift cards now for later visits and get 10% of their gift card purchase back in the form of a retail redemption towards product. As a third promotion, the client can buy any package series of treatments and receive 10% of their series purchase back in the form of a retail redemption towards product.

Series-sell Everything Possible in a Bundle

Identifying services sold in packages—such as luxury facials, body treatments, medical-grade peels and massage services—is a great way stock up the dollars in the business coffers. Selling a series has a client come in with frequency to maintain the service, and they are more likely to be loyal to a service provider or business because of the consistent service and results. You have collected the money up front, so they are committed to your business. In addition, they will tend to spend more on products and other services in subsequent visits, as they are not paying for the service after the initial payment. Do not discount series, as doing so takes away all service profits. Instead, use retail as the incentive for a series purchase. It keeps the client loyal, maintaining their service results, and again has no labor cost associated with it. For example, purchase a series package for $1,000 and receive a retail gift package worth $100 at the time of purchase. Also, purchase gift cards right now and receive 10% of their value back in complimentary retail products.

Virtual Consultations

We are sensitive that clients may not feel comfortable in public right now. Create an
appointment called a virtual consultation for all providers.

  • Online store: Clients have the option to purchase from the store or fill out a virtual consultation request.
  • Online purchases: Forward purchases to the concierge for input into the software. When you know what the client purchased, contact the client to schedule their visit. If the client qualifies for a free retail skin care consultation by purchasing three items from the sale, please book before service.
  • Virtual consultation request: If the client fills out a virtual consultation request, reply to the client and get them booked with the provider that best matches the list of their concerns. If they have multiple concerns, please specifically ask the client about concerns and match them with the correct service and provider. Verify phone numbers and tell the client they will receive a phone call from the provider at their appointment time.
  • Providers virtual consultation: Call the client during the appointment time on your schedule. Our goal is to review the client’s concerns and recommend the best treatment plan to the client. To have the best outcomes for long term benefits, clients will receive free skin care with the purchase of any three sale items. There are options with companies like TouchMD or One Touch Telehealth for these services.

Virtual visits will help protect your staff and patients from the COVAD-19 virus and comply with rules for in-person contacts. Consider providing concierge treatments at the client’s home; create an “at home on demand” list of services you can take on location when the time is right. It is a collective effort of every member of the team, especially during economically tough times. Act now to protect everyone from a smaller paycheck at the end of year. Ensure the downturn the country is facing does not affect your business negatively. Be proactive. Get creative with marketing programs, team coaching programs and special events.

Bryan Durocher is the author of Wake Up … Live the Life You Love … in Beauty, and is the founder of Essentials Spa Consulting and Durocher Enterprises. Durocher was named one of the “Top 20 People to Know in the Beauty Industry” by Global Cosmetic Industry magazine, and provides coaching, consulting, global industry trends and marketing solutions for medical spa, spa and industry professionals internationally.

Tags:  Business and Financials  COVID-19  Med Spa Trends 

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New COVID-19 Relief Bill Introduced in the Senate

Posted By Administration, Friday, March 20, 2020

capitol building

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

A new aid package designed to provide relief for the disruptions cause by the ongoing coronavirus pandemic has been introduced in the U.S. Senate. Senate Bill 3548 (S 3548) is known as the “Coronavirus Aid, Relief and Economic Security Act,” or the “CARES Act.” It provides relief for small businesses, individuals and families, and seeks to address supply and shortages in medical products, devices and testing. It is broad in scope, so this post will only look at a few of the provisions as they pertain to small businesses. These bills have been moving quickly through the legislative process, often with substantial changes.

Small Business Interruption Loans

S 3548 would increase eligibility and relax some requirements for applying for business interruption loans. Businesses with fewer than 500 employees are eligible to apply for this special U.S. Small Business Administration (SBA) loan program during 2020. The maximum loan size is based on four times the average annual payroll, mortgage, rent and debt payments, up to $10 million. Loan funds can be used to meet operating, payroll and business expenses. Eligibility for such loans is based only on being in operation as of March 1, 2020, with employees for whom payroll taxes were paid. The SBA is directed to waive or reduce fees for these loans as much as possible, and will guarantee the lenders at 100% of the loan value. Additionally, payments for loans under this program would be deferred until at least January 2021 and up to a year.

Please note: Companies that have received SBA disaster loans under section 7(b) would be disqualified from participating in the loan program described by this bill.

Loan Forgiveness for Payroll

For loans issued under the above program, there will be a forgiveness period for maintaining payroll from March 1 to June 30, 2020. This includes paying for sick leave, family leave wages under the Families First Coronavirus Response Act and compensation up to $33,333 per employee. The forgiveness amounts are subject to some limits and reduction based on the average number of workers and total compensation.

Entrepreneurial Development

Grant money will be made available to resource partners to provide education, training and advising services to businesses that have been “substantially” affected by COVID-19.

Changes to the Emergency Family and Medical Leave Expansion Act

S 3548 adds some fixes and modifications to the emergency family leave provided by the Families First Coronavirus Response Act that was passed earlier this week. It would limit the amount of sick leave the employer would be required to pay to 10 at $511 per day (for a total of $5,110) if the employee is subject to a quarantine order, or $200 per day (for a total of $2,000) for employees who are caring for someone under quarantine or a son or daughter displaced from school.

Relief for Corporations

Under S 3548, a number of deadlines related to taxes for corporations are relaxed or postponed. Estimate tax payments that are normally due would now not be due before Oct 15, 2020; additional payments for payroll taxes will be deemed on time if made by October 15. There are a number of other modifications that apply in specific tax circumstances. You should consult your tax advisor for guidance, provided the bill becomes law.

Tags:  Business and Financials  COVID-19  Med Spa Trends 

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Letter from the CEO: It’s Time for All Medical Spas to Close

Posted By Administration, Thursday, March 19, 2020

business closing

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

Like all of you, the American Med Spa Association (AmSpa) team has been closely monitoring the developments surrounding the spread of COVID-19.

Although the lack of testing and complete information has made it difficult for governmental leaders to come to any sort of consensus, the scientific community has been very consistent in its position that drastic and immediate action is needed.

In order to contain this outbreak – and, more importantly, to shorten the timeline of economic hardship to all – nearly every epidemiologist, infection specialist, and researcher has made the same recommendation: all elective surgeries and non-essential medical procedures that can be delayed, should be delayed. It is the recommendation of the U.S. Surgeon General, the American College of Surgeons, and the White House Coronavirus Task Force that all non-essential medical procedures be postponed. Many cities and states are taking this stance, as well.

Accordingly, it is AmSpa’s strong recommendation that all medical spas close their doors and refrain from offering any elective procedures for at least the next 30 days, or until further notice. Although this will be a difficult time for us all, AmSpa strongly encourages its members and the industry at large to heed this advice.

These are difficult times for all of us, and unfortunately, difficult times result in leaders having to make difficult decisions. This is one of those times. Closing your business can have devastating consequences, even for a week, let alone 30 days. We at AmSpa understand that, and, as a small business, we’re living it, too. Our livelihoods are at stake here, and the decision to recommend that members shut down – let alone having to actually do it – is a painful one. We understand what this means for all of you, and the gravity of this recommendation for the entire industry is not lost on us.

I strongly believe, however, that the medical aesthetics industry will all pull through this, but not without help, both from others in the industry and from outside agencies. AmSpa is committed to providing as much support, influence, and information as we can to help each of you through this difficult time. To ensure our industry’s continuing viability, AmSpa has already begun doing the following:

  • I have personally reached out to the heads of the largest industry suppliers (Allergan, Galderma, Merz, etc.) and requested that they work with our members on outstanding invoices and expired product, including postponing current invoices by at least 30 days (with more extensions if needed). As many of you know, their response has been encouraging and I have no doubt all industry vendors will be flexible with their accounts receivable.
  • AmSpa is providing as much content, information, and guidance as possible to its members.
  • AmSpa is providing guidance on obtaining emergency capital and funding. (We have already reached out to the U.S. Small Business Administration (SBA) to learn the process for accessing their disaster relief fund, and we hope to have more information within a day or two).
  • AmSpa is encouraging our leaders at the federal level to allocate relief funds for aesthetic businesses impacted by the COVID-19 pandemic.

We understand how difficult and stressful this time is for you, and we want all professionals in the medical aesthetics industry to know that AmSpa is dedicated to ensuring the prosperity of this industry. Please let us know if you have any questions or ideas for how we can help. We are in this together, and we’ll get through it together.

Tags:  Business and Financials  COVID-19  Med Spa Law  Med Spa Trends 

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UPDATED: A Look at the Federal COVID-19 Relief Bills

Posted By Administration, Thursday, March 19, 2020
Updated: Thursday, March 19, 2020

capitol building

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

UPDATE: HR 6201 has been signed into law. The final version is available to read here. The general paid sick time mandate discussed in the original article has been replaced with an “emergency paid sick leave” requirement that applies only to the current crisis. Not mentioned in the original article, HR 6201 requires reimbursement or insurance coverage for testing for the coronavirus but does not change coverage for treatments. Because this is new law guidance and specific instructions are not yet available, regulatory agencies should provide more information in the coming days.

The major takeaways for medical spa owners and operators are:

Employees who have been on the job for at least 30 days are eligible to take a job-protected leave to quarantine, care for quarantined family or recover. The leave is unpaid and can be up to 12 weeks. the Department of Labor hasn’t yet updated its webpage, but you can find more information here when it does.

Employers must provide all employees with emergency paid sick leave, available for immediate use. Full-time employees are entitled to 80 hours of paid time, and part-time employees are entitled to the number of hours they work in a two-week period. The paid sick time may be used if the employee is unable to work or telework, because they are:

  • Subject to federal, state or local quarantine orders;
  • Advised by a health care provider to self-quarantine;
  • Experiencing symptoms of or seeking diagnosis for COVID-19;
  • Caring for an individual subject to quarantine;
  • Caring for a son or daughter due to school closure; or
  • Another similar circumstance.

Employers and self-employed individuals get a tax credit to offset the costs of the emergency paid sick leave. It is a quarterly credit against employment taxes for 100% of the wages paid up to $200 per day, or $511 per day if the reason is due to quarantine, ordered self-quarantine or the person experiencing COVID-19 symptoms. However, the credit can only account for 10 days per quarter.

ORIGINAL POST: The federal bills aimed at providing relief for COVID-19 would require employers provide paid sick time for employees and create a federal additional sick time for public health emergencies. The Senate version, known as S 3415, is currently with the Committee on Health, Education, Labor and Pensions for deliberation. The House’s bill, known as HR 6201, has passed the House vote; however, recent reports indicate there are some issues with adopting amendments on the specific terms and funding for some of these new benefits and to whom they apply that must be addressed before passage. We’ll briefly review some of the tenets of HR 6201, since it is the more expansive bill; however, bear in mind that they may change substantially once these measures are finally passed.

Paid Sick Time

Under HR 6201, all employers with one or more employees would need to provide a paid sick leave benefit. The sick leave may be used for a number of health related absences, such as when the employee is ill or caring for a parent, child or spouse, as well as when a place of employment is closed by a state or federal official, or by the employer’s discretion due to a public health emergency. The sick time must accrue at the rate of at least one hour for every 30 hours worked, up to 56 hours in a year; however, the employer has the option of choosing higher limits. Exempt employees also earn this time. The sick time would begin accruing following the 60th day of employment. However, in the event of a public health emergency—such as the one we’re currently experiencing—the employee may use a special emergency paid sick time (discussed below). This sick time benefit will carry over from year to year, but employers are not required to provide more than 56 hours at any one time. Terminated or resigned employees are not entitled to be paid for unused time.

Employees also are entitled to additional paid sick time in the event of a declared public health emergency in addition to any regular sick time they have accrued. Full-time salaried employees would receive the equivalent of 14 days of leave; part-time and hourly employees would receive the number of hours they would normally have worked in a 14-day period. In a public health emergency, this sick time is used up first, followed by the normally accrued time. Employers with 50 or fewer employees are able to request a reimbursement of these emergency leave wages from the Secretary of Labor by submitting an affidavit showing the periods and wages associated with this additional paid sick time. Funds will be paid by the Secretary of the Treasury after approval.

Health Emergency Leave

In addition to the paid sick leave mentioned above, HR 6201 includes a separate emergency paid leave for those affected by COVID-19 who are either diagnosed ill, under quarantine or caregiving due to illness or facility closure. This leave is paid by the Social Security Commissioner in 30-day increments, up to three increments (i.e. 90 days total). The leave is at the rate of two-thirds of the average monthly earnings, up to $4,000. However, there is a dollar-for-dollar reduction in this benefit for any state or private paid leave the individual receives during this period. In order to use this benefit, individuals would need to first use up their paid leave, wages paid that period or unemployment compensation for the week. These funds would not be subject to income tax for federal tax purposes.

Employers also would need to provide protected unpaid leave up to 12 weeks in public health emergencies. This would be under the Family and Medical Leave Act, which typically only applies to employers with 50 or more employees, but for “public health emergencies” applies to any employer with one or more employee. This unpaid leave may be taken intermittently or on a reduced schedule. The employee can choose to substitute accrued paid leave or vacation for the unpaid time. However, the employer cannot force them to do so.

Other Provisions

HR 6201 contains additional provisions not found in S 3415. HR 6201 would require the adoption of emergency standards for health care workers to protect them from COVID-19; these standards would be developed jointly by the Centers for Disease Control and the Occupational Health and Safety Administration. It also would make additional funds available for SNAP assistance, student lunches and child nutrition, and provide waivers on state certification periods and reporting requirements to facilitate rapid implementation. HR 6201 also would require the adoption of emergency standards to protect health care and elevated-risk workers.

These bills, HR 6201 in particular, are moving and changing rapidly, so any specific provisions may be changed by the time they are finally passed. As this is a rapidly evolving crisis, it is likely that one of these measures will be adopted in the coming days. AmSpa will endeavor to stay on top of developments in these bills and keep you informed.

Tags:  Business and Financials  COVID-19  Med Spa Law  Med Spa Trends 

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AmSpa Launches AmSpa Live Series to Address Current Medical Spa Issues

Posted By Administration, Tuesday, March 17, 2020


The world of medical aesthetics—and life in general in the United States—has changed a great deal in the past week. The COVID-19 pandemic has affected every person’s life and livelihood. Maintaining social distance and remaining at home are prudent decisions aimed at preventing a mass outbreak of a deadly disease, but they are also causing enormous problems for small businesses in all sectors, including medical aesthetics.

At AmSpa, we realize that this is a crucial time for your business, and we’re here to help you weather the storm. To that end, we’re launching AmSpa Live, a series of interactive online presentations designed to bring you the timely information you need to keep your medical aesthetic business running in these trying times.

AmSpa Live will be programmed from week to week, in order to provide viewers with the most useful, up-to-date information available. This week’s presentations are:

  • Tuesday, March 17, 11am Central—Coronavirus and Your Medical Spa: Medical and Business Perspectives: Recording coming soon!
    Dr. Robin Patel, the director of the Infectious Diseases Research Laboratory at the Mayo Clinic and the president of the American Society for Microbiology, and Kim Chambers, HR Generalist from Cognos HR, will help answer the questions you have regarding the virus itself, its spread and how it will affect your business.
  • Wednesday, March 18, 1pm Central—Paying for Productivity: Compensation Programs That Don’t Violate Fee-splitting Laws: In order to get the most out of their workforce and incentivize employees to give their all, employers often structure compensation programs that reward employees for productivity by giving them a piece of the pie. This standard concept can become complicated in the medical field, as many states have anti-kickback and fee-splitting laws that can restrict or prevent employers from providing certain personnel with a piece of the medical procedure fee. In this regularly scheduled webinar, Robert Fisher from ByrdAdatto, PLLC, will discuss these fee-splitting laws and how an employer can legally structure compensation programs to incentivize employees in a compliant way.
  • Thursday, March 19—How Do Small Businesses Handle Employment Issues During the COVID-19 Outbreak? In this webinar, Renee Coover, partner with ByrdAdatto, will address concerns that small businesses are facing across the country as the COVID-19 outbreak fundamentally changes the way we work and the economic landscape. Renee will provide guidance on wage and hour considerations; how to handle sick or potentially sick employees; employee travel restrictions; telecommuting and alternative means of providing services to clients; vacation, PTO and sick leave policies for small employers; employee leaves and the intersect of the ADA, FMLA and NLRA; and changes in working conditions in response to this global outbreak.
  • Friday March 20—COVID-19 and Your Medical Spa: Not Business as Usual: Learn how some of the industry’s leaders are handling the situation surrounding COVID-19 at their own businesses. Nicole Chiaramonte, owner of Synergy MedAesthetics, Kennewick, Washington; Marria Pooya, managing partner of Greenwich Medical Spa; and Ben Chew, owner/administrator of Illume Aesthetics, Ashland, Oregon, join us to discuss what they’re doing to address the issues that are emerging.

Each presentation is a webinar in function, so attendees will be able to interact with the presenters and have their questions answered in real time.

No one could have foreseen what has happened in the past week, but now that we’re here, AmSpa is dedicated to helping medical spas survive and thrive in the new world in which we’re living. There’s no telling what will happen next, but with AmSpa Live, we’re dedicated to addressing it.

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

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Community in a Time of Crisis

Posted By Administration, Monday, March 16, 2020


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

It is amazing to think about how quickly things move in today’s world. The AmSpa Team returned from Medical Spa Show 2020 (MSS) a little over a month ago, inspired by the spirit, community and excitement generated by the attendees, speakers and exhibitors who converged on the Aria Resort & Casino in Las Vegas. What makes this industry different—what makes it great—is its sense of community and support. I’ve been to dozens of conferences in this industry, and none of them engender the excitement and enthusiasm created by the people attending MSS. Those of you who made it to Las Vegas for MSS know what I mean. The support, willingness to share and sense of togetherness were truly uplifting—and the Opening Night Party was off the hook!

And yet, six weeks later, as I write this letter from my self-imposed “social isolation,” the reality is that it feels like we are totally separated from one another. The COVID-19 scare is at a fever pitch. These events have moved with a speed and intensity that I’m not sure we’ll see again in our lifetime. We at AmSpa went from the excitement of kicking off another Boot Camp season to the postponement of the first two Boot Camps in one day. Now, we’re working from home and hoping the economy recovers. It’s mind-boggling how quickly COVID-19 has altered our lives.

Still, in spite of our current circumstances, I find myself incredibly optimistic and excited about the future of this industry. It’s strange, in a sense—I see how isolation and quarantine will slow down our individual economies but, at the same time, I have no doubt that the medical spa industry will make it through this crisis and be stronger than ever. And the reason for that is the people. The same spirit and community that made MSS so special will be the tonic that calms our nerves, and, in the end, lifts the entire industry higher than it would have been before. The spirit of community and support needed to get through this time already exists in this industry, and I have no doubt we will all step up and meet the challenge.

We want you to know that AmSpa is here for you and will continue to provide the best education, resources and content for our members and the industry. Read a quick primer on the AmSpa Now blog for an overview on how this might affect your practice, and for information on how to prepare your employees, address regulatory concerns and create a viable plan of action, you can view this free webinar.

Additionally, we will be posting a podcast next week featuring Dr. Robin Patel, the director of the Infectious Diseases Research Laboratory at the Mayo Clinic and the president of the American Society for Microbiology, and Kim Chambers, HR Generalist from Cognos HR, to help answer the questions you have regarding the virus itself, its spread and how it will affect your business. Feel free to send questions you would like answered to by Monday at 5 pm CST. We’ll continue to research ways to assist you in preparing your practice to handle the current situation.

With all that said, I want to thank you for helping us create a community that lifts people up rather than tears them down—that builds rather than destroys. While we may not all be in the same room for a while, we are still committed to helping our members grow and prosper.

We’re a family, and we’re here for you.

Tags:  Business and Financials  Med Spa Trends 

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What Your Medical Spa Needs to Know About the Coronavirus, Part 2

Posted By Administration, Friday, March 13, 2020

coronavirus covid-19

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

Since part one of this article was originally posted, the outbreak of Coronavirus, which causes the disease COVID-19, has spread rapidly in the U.S., with cases in every state and hundreds of cases in our largest cities. The World Health Organization has labeled the outbreak a “global pandemic,” and nations, states and cities have declared emergencies. Many public events have been cancelled or postponed, and the Center for Disease Control (CDC) and other authorities are requesting that people take certain steps to help limit the spread of infection.  Many businesses are requesting that their employees work from home; unfortunately, medical spas are not in a position to do this.

In part one of this article, we discussed an employer’s duties in events like this, as well as the need to develop policies and response plans. Recently, the U.S. Occupational Safety and Health Administration (OSHA) published a guidebook about preparing workplaces for COVID-19 for employers. We recommend that you read it in full. In addition to that information, here are some ideas for the challenges unique to medical spas:

  • Increase the use of personal protective equipment (PPE): Because of the close, personal nature of medical spa services, the chances of transmission are elevated. You may want to consider increasing the levels of PPE for all patient encounters. If you currently only use gloves for consults, consider adding a mask and eye shield, as well as more thoroughly ventilating the rooms.
  • Sterilize or remove commonly touched items: your waiting room sees the most traffic of any part of your facility, but it probably receives the least frequent cleanings. Make it a point to sterilize doors, chairs and counters multiple times each day or after each use. If you have a pen cup, remove it and use one pen that is wiped between uses. If you use a tablet-based system, sterilize it between uses or have your front-desk person take verbal instructions.
  • Limit chances for contact: Your prescribing providers—physicians, physician assistants and nurse practitioners—are critical members of your team, and, to the extent state laws allow, may want to perform patient examinations via telemedicine, provided proper supervision of the facility is maintained. Before patients come in for appointments, they should be prescreened and asked to reschedule if they have any symptoms or prior exposure. Employees who can work remotely should be permitted to do so.
  • Broaden your providers’ scopes: Identify your core services and make sure that as many of your employees who are able to provide the services are trained to do so (staying within each person’s licensed scope of practice). By having a cross-trained team, you can minimize disruptions if a single member is forced to miss work for any reason.

It also is extremely important that you communicate these efforts to your patients. Not only will it build confidence in your services, it will also help patients assist in the efforts. You may want to include a sign on the door or at the front desk to this effect:

We take the threat of the Coronavirus/COVID-19 very seriously. To combat the spread of this disease and to protect our patients and employees, we have instituted protocols and strengthened our already thorough sterilization procedures.

If you have questions about these procedures, please ask.

To assist us today, please cover coughs and sneezes, and refrain from touching surfaces. We have provided tissues and hand sanitizer for your use. Thank you.

For legal updates and business best practices delivered straight to your inbox, subscribe to AmSpa’s email newsletter. For more information on how AmSpa can help your practice operate legally and profitably, contact us online or call us at 312-981-0993.

Tags:  Med Spa Trends 

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Starting a Revolution: Sheila Nazarian, MD, MMM

Posted By Administration, Monday, March 9, 2020

dr sheila nazarian

By Michael Meyer, Content Writer/Editor, American Med Spa Association

Today, it seems that practically everyone is determined to use social media to help make themselves stars. But it wasn’t that long ago that the list of people who became celebrities on social media was relatively short. Back then, those who managed to make names for themselves in this way did so primarily by presenting something that nobody else could offer. In the case of Sheila Nazarian, MD, MMM, straightforward and engaging looks at plastic surgery led her to become a social media sensation with more than 238,000 followers on Instagram (@drsheilanazarian). Today, she’s paying it forward by helping other medical aesthetic professionals find their paths to success.

Opening the Door

Dr. Nazarian has overcome challenges her entire life. She was born in New York to a Jewish family from Iran that wanted to obtain birthright citizenship for her in the U.S. due to Iran becoming an Islamic republic as a result of the 1979 Iranian Revolution. When they returned to Iran, however, the family was not permitted to leave. When Nazarian was six, she and her family were smuggled out of Iran into Pakistan in a truck filled with corn, and, shortly thereafter, emigrated to the U.S.

In college, she studied orthopedic surgery, but found that it did not offer her much of a chance to be creative, so she began to study plastic surgery, which she found to be “the perfect combination of science and art.” During this time, she began using Facebook to keep in touch with friends and family, and, before long, she began to see the benefits of using social media to do even more.

“People were kind of following my career, because there aren’t that many surgeons that are female in my community,” Nazarian says. “And then I started talking about aesthetic things and growing Facebook.”

After finishing her plastic surgery residency at the University of Southern California, Nazarian found herself with the time to take her social media engagement to another level. “I’d just graduated and I wasn’t so busy, so I started making tons of videos because I thought people would rather watch a video than read on my website,” Nazarian explains. “Little did I know that was going to help me grow very quickly in SEO [search engine optimization] organically. I was at a conference for residents—I was one of the faculty members—and somebody was talking about SEO on stage, and I said, “Let me search ‘Beverly Hills plastic surgeon’ and see where I rank.’ And I was on the first page, two years out of residency, because of the videos and social media.” Nazarian credits this success to her engaging content.

“When Google looks at your website and sees how relevant it is, they look at how long people stay on your website and, when you have videos, people stay on for a long time to watch the videos,” she says. “Since I was the only one who really had videos at that time, I grew in the ranking so quickly, without investing any money in Google AdWords or anything like that.”

Ready for Her Closeup

Because her content was so popular, and because she was creating videos rather than simply blog posts, for example, Nazarian soon became a go-to plastic surgery expert for all sort of content creators.

“When the journalists were looking for an expert, I showed up number one and, because I am on camera, it was kind of like a video résumé,” Nazarian explains. “When they saw I can speak in layman›s terms, really communicate procedures easily for people to understand and I’m not afraid of the camera, they chose me.”

Nazarian has appeared on programs such as The Doctors, The Real, Revenge Body With Khloé Kardashian, Inside Edition, The Insiders, among many others, as well as numerous local talk shows.

Meanwhile, Nazarian founded her private practice, Nazarian Plastic Surgery, in 2013 and, since then, it has become a fixture in the crowded aesthetics scene in Beverly Hills. She estimates that she spends half of her time performing surgical procedures and half of her time performing medical aesthetic procedures, and she feels that the things about her that are somewhat unusual in the field help set her apart as a practitioner.

“I’m female, so a lot of women feel more comfortable, especially when it comes to breast augmentation or labiaplasties, being with a woman instead of a male,” Nazarian says. “Also, I’m dark skinned, so I did get a lot of dark-skinned individuals coming in initially for issues with their skin because I focus on lasers and spa equipment that are safe for all skin types instead of just having one thing that is supposedly good for everybody. Also, being on TV a lot and doing speaking gigs and things like that where we focus on empowerment rather than telling people what they should look like—I think that’s a huge differentiator, as well.”

In addition to her work in aesthetics, Nazarian operates a nonprofit, the Nazarian Institute (@nazarianinstitute), that presents events that are designed to help medical aesthetic professionals build and grow their brands. Whether she’s acting as a physician or a teacher, she makes sure to take the time to make connections with the people with whom she works.

“I’m inspired by helping people and hearing other people’s stories,” Nazarian says. “I think we, as physicians, a lot of times, don’t take time to really accept a thank you—I think it’s just what we expect of ourselves, to give good results. And when people say, ‘Thank you,’ we’re like, ‘Oh great! So glad you’re happy!’ And we move on to the next patient. I’m inspired by changing people’s lives, and when they say, ‘Thank you,’ I really want to internalize that and take it in so that I don’t burn out.”

Welcome to the Party

Understanding the value of making positive connections is a key to the success of Nazarian’s social media, and she advises other medical aesthetic professionals to maintain their online presence in a similar way.

“Treat your social media like a cocktail party,” Nazarian says. “If you walked into a cocktail party and showed your before-and-afters to people, you probably wouldn’t make many friends. But if you walked in and you were wearing a cute outfit or talked about your kids or talked about the place you went on vacation, it’s probably a lot more interesting to people. I think the trap a lot of people fall into is just posting pictures of their practice, pictures of their patients and testimonials. I think it becomes really inauthentic and sales-oriented. I think the more you can let people into your life and inspire people, the more successful you’re going to be on social media.”

AmSpa members receive QP every quarter. Click here to learn how to become a member and make your med spa the next aesthetic success story.

Tags:  Med Spa Trends  QP  Social Media Influencers 

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

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