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QP Extra: Q&A with Shawna Chrisman of Destination Aesthetics

Posted By Administration, Friday, August 9, 2019

destination aesthetics

When Shawna Chrisman, acute care nurse practitioner, opened Destination Aesthetics in 2011, she hoped it would provide her with some flexibility and positivity, both of which were in short supply in her previous career in critical care medicine. Thankfully, medical aesthetics became her passion, and she recently spoke about her career and love of the industry with AmSpa Content Writer/Editor Michael Meyer.

Michael Meyer: What inspired you to open your practice?

Shawna Chrisman: I was working as a nurse practitioner in an acute care setting in critical care medicine in the hospital, and I was looking for something to do on the side. I was looking for something with a little bit more flexibility because of my kids and my family. I thought it would be something fun and positive instead of something sad—I was working in a hospital setting and taking care of dying patients. That is actually what inspired me. It really wasn't to build Destination Aesthetics into what it is now. That was never part of the business plan at all. It was really just something to do on the side—something fun and uplifting and something that I thought would bring some positivity with my licensure and professional degree.

MM: What's different about your practice now versus when you opened it?

SC: I started it just with myself as a solo provider and my medical director as my partner. I mean, I was the receptionist, I did chemical peels, I did my bookings, I was the janitor, I did my ordering—I did everything in one room, and now we have three locations and 27 employees, and we’re ranked number four in the nation with Allergan a little over seven years later.

MM: What's your most popular treatment?

SC: We focus on cosmetic injectables, so Botox, primarily, and fillers.

MM: What do you think is the most important factor to your success?

SC: Passion is the most important factor, because I'm not in it to make money. I'm not in it for the attention. I'm in it because I love it. I love what I do. I love my patients, I love my team, and it's just a positive feedback loop that keeps giving. That's what's empowered us to move forward and be successful in a short amount of time. It's all because of the passion for our industry and for our patients.

MM: What makes your med spa different from others?

SC: What sets us apart is, I would say, our level of patient satisfaction, and again, our passion and our pride in what we do. Really, it's our teamwork. We have a very strong, cohesive team. We hire from the inside out, with strong minds and powerful hearts who really care about the patient and about each other. I'd say that that is the primary integrity—the core of Destination Aesthetics. There's so many things that really set us apart, but primarily I'd say it’s the integrity and passion that we have for our patients. I mean, I think everyone would say that, but again, it's that positive feedback loop that we keep revving us up and empowering us to continue to do the best that we can do.

MM: What specific metrics do you use to determine success?

SC: We look at all of the benchmarks that, I'd say, everyone kind of pays attention to—the profit and loss, profitability and net income. We look at patient satisfaction rates, we look at patient retention, we look at first-time patient retention. We pay attention to the percentage of retail to overall revenue. We look at run rates on inventory. We look at return on investment from marketing. Those are kind of the metrics that we focus on.

MM: Who inspires you?

SC: I get a lot of my inspiration from my patients, because I see a lot of survivors of horrible tragedy. I see patients who survive terrible medical diagnoses. A lot of my patients' stories have inspired me, and there are a few that really come into play. One is a patient who was beaten in her own front yard when she was playing when she was seven years old. This guy got out of his car and just started beating her with a baseball bat, and it was a hate crime because of her race. Because of that, she had multiple facial fractures and had to literally have her face rebuilt. The power that we have with what we can do with our hands, making someone feel confident and beautiful, is really the driving factor and what keeps us moving forward and kind of paying it forward, but in a different way that no one else would understand unless you were part of our industry. When she says to me, “You're the only one who has ever made me feel this beautiful,” after she's had such traumatic experience, it's like, yes, this is what I'm supposed to do.

A lot of people think that our industry is about vanity, when it's really so much more than that. I've had elderly women come in and say, “I'm trying to maintain my position in my job market, and I'm trying to compete with 20-year-olds who are just out of college. I’m 70 and I really need this job to continue to live the lifestyle that I do and pay my bills. And the Botox that you gave me just made me feel so refreshed that I went into this interview really confident and I got the job.” Those are the kind of things that make you say, “Wow, that's amazing.” And there are so many more. I mean, I could go on and on. That's where I get inspired. That's what inspires me. It just keeps me wanting to continue to deliver that type of medicine to the heart and the mind with my hands.

Our industry has such a stigma from people who have never had any type of aesthetic procedure done. But when it makes people feel the way that they do, it's incredible. You have almost an instant gratification, positive feedback, and it's very rewarding. And then they continue to pay it forward, and it's the gift that keeps on giving.

destination aesthetics

MM: What do you love about, what do you love most about aesthetics?

SC: On so many levels, I feel like it brings people together because of the way it makes people feel. It's a positive form of self-love and self-care, and I think more people need to focus on that. As people continue to get busier and busier in their lives, and we move away from the personal touch—more towards everything technology-driven and hands-off—it’s great to deliver a personalized service to someone where you are catching them and you are speaking directly at them. It's great to continue to be able to provide a service that is so connected to one another, versus over the computer or iPhone. I love that. It's still kind of old school like that. You can go to the hospital now and be seen by a robot who's basically a doctor on a screen who could be 500 miles away from you. But we're still seeing patients face to face, interacting as we have for generations and not relying on technology to deliver our services. And I love that patient connection.

MM: What do you love about being an entrepreneur?

SC: I love having the flexibility and creativity to develop something that I feel is rewarding to not only myself, but also so many others. I love the freedom to create those ideas that come to your mind, and not have to rely on the corporate structure to make things happen. You can execute on your own terms, and I love that. I just love that freedom and that ability to create.

MM: What advice would you give to other medical spa owners?

SC: Only enter this field if you're truly passionate about aesthetics—don’t be financially driven. Also, nurture your team, yourself and your patients, and have those be the top three priorities, other than your family—obviously that’s number one—but really focus on team-building and personal self-care, and have your outcomes be completely patient-driven and satisfaction-driven.

MM: What would you say is the goal behind your medical spa's design?

SC: The goal is really just to create a well-oiled engine that focuses on patient satisfaction and patient outcomes, and to deliver a brand that is luxurious yet professional and maintain a high level of respect in the community.

The branding is very compatible. All of our interior design and social media and everything, it all encompasses our brand in that it's a luxury medical professional entity. We want it to be a place away from home that feels comfortable and upper-end, but still maintain that professionalism in our community. We're trying to take the medical spa connotation into the next level. It's not anything basic. We want to be everything but basic. We want to be next-level.

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:  Business and Financials  Med Spa Trends  QP 

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How Do You Name a Medical Spa in New York (And Elsewhere)?

Posted By Administration, Wednesday, August 7, 2019

new york city

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

Choosing a name for a new business is one of the more difficult decisions entrepreneurs have to make, and this is especially true in the medical aesthetic industry. A medical spa needs a unique and memorable name that conjures thoughts of vitality, health and beauty, but it also must follow the rules for naming medical and professional entities. As we’ve discussed in the past, most states consider medical spas to be medical practices, and every state has its own rules or standards when it comes to naming and advertising medical practices.

New York state has particularly stringent rules regulating physician advertising. Fortunately, the New York State Office of the Professions provides a useful resource for navigating the rules for naming a professional entity in the state. While these rules are specific to New York, the concepts are similar in many other states.

The requirement that the name of a professional entity must appropriately describe the profession and the professional service being offered is the first and largest hurdle to overcome. In the medical spa setting, the professional services being offered will be “medicine” or “medical”—or, for independent nurse practitioners, “nursing.” But these terms are very generic and don’t accurately convey the type of experience and services offered in most medical spas. To provide a better description, you might be tempted to use terms such as “aesthetic,” “esthetic” or “anti-aging” to describe medical spa services, but these terms fall under the “specialty area” naming rules in New York. Essentially, if you want to use a special branch of a profession—in this case medicine—the Office of the Professions requires that you submit proof of certification in that specialty practice. While physicians may obtain board certifications in dermatology and plastic surgery, practicing in the area of aesthetic medicine does not come with specialty board certifications.

Could you add “medical spa” to the end of the name for your professional entity? Using the term “medical spa” reflects the required “medical” professional practice area, and “spa” makes it clear to the public what types of aesthetics services you plan to offer. This seems like a good alternative, but, unfortunately, the term “spa” in connection with “medical” are among a list of words specifically prohibited as being misleading in New York. And it isn’t only “misleading” terms that are prohibited: Professional entity names cannot suggest an affiliation with another entity or imply professional superiority. Therefore, whether intentional or not, the chosen name can’t be too similar to the name of another entity, and it also can’t include ideas such as “best,” “advanced” or “expert.”

To add an additional twist, New York medical spas face the same restrictions when choosing an assumed name under which to practice, also known as a “doing business as” or “d/b/a” name. Many states have particular rules in naming the registered professional entity, but they often allow more flexibility in using assumed names. This is not the case in New York—the assumed names of professional entities must follow the same naming requirements.

While New York is particularly strict, each state has its own rules that govern business naming, especially for businesses that provide medical services. Before you spend valuable time and money on signage, web design, advertising and marketing, it is important make sure that you choose a name that complies with your local and state laws. If you want to learn more about effective medical spa marketing and business practices, attend one of AmSpa’s Medical Spa & Aesthetic Boot Camps.

Tags:  Business and Financials  Med Spa Law  Med Spa Trends 

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QP Extra: Q&A with Eliza Parker, MD, of Cadella Aesthetics and Wellness Center

Posted By Administration, Friday, August 2, 2019

Eliza Parker of Cadella Aesthetics

At Cadella Aesthetics and Wellness Center in Chicago, a medical aesthetic treatment is just part an overall experience that’s designed to help patients not only look better, but also feel better. Practice owner Eliza Parker, MD, recently spoke with AmSpa Content Writer/Editor Michael Meyer about how Cadella came to be and how its customer service helps sets it apart.

Michael Meyer: What inspired you to open your practice?

 Eliza Parker: I really love what I do. So there are a couple things. One, I love the artistic part of aesthetics. It's just so much fun to restore and rejuvenate how people look and feel. I think also, coming from intensive medicine, I love the wellness side of the approach. You're seeing people and you're making them feel good, and they're coming from a healthy place. It was a really nice change. And also, I just love people, and if you like people, this may be one of the best industries to be in, because throughout the day, you meet so many people from different walks of life who are doing different things. It never, ever gets boring. It's so fun.

MM: What would you say is different about your practice now versus when you opened it?

 EP: It's really evolved and developed and grown on all fronts. When you first start, you have a vision—I can keep this so simple, and I'm not going to have to do X, Y, and Z. And then you learn that you have to do X, Y, and Z, and it gets more complicated, but it also gets richer. Experience changes everything—not only with patients, but also with the business and with how you outreach, with how you manage goals and all these various parts of it. And the more people you meet and talk to any industry, the more you see things that you do and don't want to do—I think there are as many don'ts as there are dos. You think, “I don't think that's the way I want to go,” but you have to try. I feel like as you try different things, the business grows really fast. When I first started, I kept it very simple. I had a very straight idea of how I wanted to grow. Now it is at the place where I have this very mature, experienced staff. I have a very well-established business model, and it makes it so when we add something new, we have all this infrastructure to grow with. I think it's just very solid. It's awesome.

MM: What is your most popular treatment?

 EP: It's definitely my liquid facelift. If you just walk into a med spa off the street, you won't be able to get those kinds of long-lasting results. But to actually get a nonsurgical liquid facelift, it changes people's whole perspective of themselves. For me, it's just so much fun because I can take pictures of how they looked 20 or 30 years ago, and we can restore that. They're always so amazed that you can recreate what they were and keep that moving forward, and it definitely brings in the most revenue for sure. I think fillers are an amazing way to make transformational change, and the time it takes to do them is less exhaustive than some of the other procedures.

MM: What would you say is the most important factor to your success?

 EP: Loving what I do and finding staff who love what they do. I have had all of the ups and downs, but when you get people in different positions in your business who truly love to come into work every day, it just naturally grows exponentially. That's, I think, why it's gone in such a positive direction. We have a mission statement—we go through it every team meeting, we all are on the same page and I don't feel like everyone has different goals. We all are working with each other for the same goal, so it works well.

MM: What makes your medical spa different from others?

 EP: It's hard to say, because I don't personally go to a lot of other medical spas, but what I hear from my patients is that they feel like they're really well taken care of. We tend to really try to find out what the patient wants and needs. What is going to make their experience better? It may have to do with us changing their parking position, or it may mean we have to help them get to their next appointment and call ahead. How can we make their day better? We actively try to look at how we can improve not just their Botox experience, but also their life. We truly do care, and I think it comes across, and I think patients feel that way. It's very intimate, and we know everybody. Even though we are very big, we really work hard at making everything very personal.

MM: Who inspires you?

 EP: I'm constantly reading books, and I get them from different people who I'm working with, or one book leads to the next. I think being well informed is always key, but I would have to say the thing that really keeps propelling me is my patients. There's so much information you get every day from every encounter that propels this business, and it is inspirational. You meet people and hear their different stories, and if you really analyze every single one, it can also make you crazy, because if you have a lot of bad experiences you may not feel inspired. But at least for me, most of the time I find my patients extremely inspiring.

It's also my kids. I created this business and used their names—Cadella is a combination of my daughters’ names—and I know this whole business was forged with them in mind; that always inspires me. And working with people who I enjoy working with inspires me. I think it's definitely a lot of factors.

MM: What do you love most about aesthetics?

 EP: A couple things. One, the field is growing daily, so it's very, very fun. There's so much innovation. It's not stagnant or boring. Every couple of months, somebody's got some new product, some new device or some new way of trying to improve the aging process, so it's never boring. I think that every single person you treat reacts or responds slightly differently, so you're applying new algorithms for each person, so it's not boring. Also, you're making people really happy. What's not to love about that?

MM: What do you love about being an entrepreneur?

 EP: It's the best, because you come up with ideas and then you try them out, and you constantly are going for it. When I started, I was so frightened because there are so many big financial risks you take in this field. It's kind of hard to believe that I did it. But you take these financial risks, and then you don't think that failure is an option, and then it doesn't become an option and you just make it work. I think that once you've learned that you can do that, you start applying it to all parts of your life. I think that's one of the best parts, for sure. I love it.

MM: What was your goal with the interior design that you chose?

 EP: It’s just my taste. I love it. I wanted to make it very relaxed and refined for my patients, so when they come here, they feel like it’s private and they can feel safe. I also wanted to make sure they feel that they are not stuck in some random waiting room. I wanted them to feel fairly relaxed, like this is a place that they're welcome to come any time. I wanted to make them feel like it was more than just a medical office—it’s a very safe space and a really pleasant space to be in.

interior design

MM: What advice would you give to other med spa owners?

 EP: If you think it's a get-rich-quick scheme, you are wrong. It is not. You can do very well financially, but it costs a lot. Your motivations for doing it have to be aligned with loving it. If you're doing it because you want to make a lot of money, I just don't think that's a great approach and I haven't seen people who have that attitude do very well. I've seen a lot of people fail at this business and I’ve seen a lot of people succeed, but I've seen more failures than success. So I think you should know, right from the get-go, that this is not a cookie-cutter, easy business to jump into. The patients, the consumers, are extremely savvy. They have a lot of choices. You have to be really good at what you do if you want to be successful, and it's going to take as much time as any other profession to get good at it. It's not easy to find an injector and make a ton of money off Botox—you have to find an amazing injector, and then, over time, you will make money.

Also, talk to colleagues—it needs to happen so much more than it does. I've had the privilege of being in a group of medical spa owners—we meet and talk about our failures and our successes, and it really expedites growth. I think people tend to stay quiet and think that they are coming up with the only solution, and they don't want to share because they want to be the only one to have it. I think that's a really sad approach. I feel like if we're all talking together, everyone moves faster, and patients are going to choose who they want, no matter what you do in your business. There are enough patients for everybody. There's plenty of business out there. It would be so nice if people were more open.

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:  Business and Financials  Med Spa Trends  QP 

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Front Office Training: 7 Steps to a Positive First Impression

Posted By Administration, Wednesday, July 31, 2019

By Terri Ross, Terri Ross Consulting

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Microneedling Joins Toxins and Fillers as a Leading Medical Spa Treatment

Posted By Administration, Monday, July 29, 2019

procedures

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

It should come as no surprise that injections of botulinum toxin and hyaluronic acid fillers are the treatments most commonly offered by medical aesthetic practices. After all, they provide good return-on-investment (ROI) and are constantly in demand. According to the 2019 Medical Spa State of the Industry Report, 88% of respondents’ medical spas offer botulinum toxin. Furthermore, 73% of respondents’ medical spas cite it as being among their top three most frequently performed treatments, and 56% state that it is the most common treatment for first-time patients.

Hyaluronic acid filler injections are similarly widely available—they are offered by 88% of medical spas—but are not quite as widely administered, appearing in 58% of med spas’ top three most frequently performed treatments.

In the 2017 version of this report, botulinum toxin and fillers were combined as one option, and they were found to be available at 82% of medical aesthetic practices, so their availability is still growing.

And while it finished fourth in terms of availability, microneedling’s ascent into the pantheon of medical aesthetic treatments is perhaps the biggest story of this report. In the 2017 survey, microneedling was mentioned on only a handful of responses; today, it is available at 84% of responding medical spas and is among the top three most popular treatments at 20% of them. 

AmSpa Basic Members receive an executive summary of the 2019 Medical Spa State of the Industry Report, while AmSpa Plus Members receive the entire report. Click here to learn about this and all the other great benefits of becoming an AmSpa Member, and sign up today.

Tags:  AmSpa's 2019 Medical Spa Statistical Survey  Med Spa Law  Med Spa Trends 

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QP Extra: Q&A with Vic Owoc of Ageless Medical

Posted By Administration, Friday, July 26, 2019

ageless medical

“You can't manage what you can't measure,” says Vic Owoc, MBA, co-owner of Ageless Medical in suburban Fort Lauderdale, Florida. Since the practice opened in 2006, he has used his expertise in metrics to make it exceptionally successful. Owoc recently spoke with AmSpa Content Writer/Editor Michael Meyer about his history in the medical aesthetics industry and how he maintains his practice’s success.

Michael Meyer: What inspired you to open your practice?

Vic Owoc: Before opening up this business, I was involved in a health and supplementation business called Vital Pharmaceuticals. The business has really grown quite a bit now. I don't know if you've ever heard of a product called Bang energy drink or Redline—they just surpassed Rockstar as the number-three energy drink. So prior to this I was involved in that business, and we had some anti-aging products, as well as a lot of health and fitness-related products. So when I met Erin (Owoc, ARNP)—she's my partner in this and she's a nurse practitioner—it was a very natural progression, once I sold off that business, to the whole idea of health and making people look their very best. Moving over to a medical aesthetics practice was fairly logical for us. Erin had been doing procedures—Botox and hair removal and tattoo removal and all that—for a dermatologist for quite some years, and me being more the entrepreneur, I had several small businesses before we opened up this. We thought it was such a great fit. I had the business background and the entrepreneurial risk, and she doesn't have a lot of that, but she had a great following and a lot of knowledge in this area. So together we thought it just was a wonderful fit for this type of business.

MM: What would you say is different about your practice now versus when you opened it?

VO: The size of the business, certainly the number of patients and our location. We ended up buying our building, as well—one thing that I think is very important in this business is to own the real estate. Part of it was moving out of an area that was a smaller strip mall area to something that was bigger and had much more of a professional look and feel to it.

MM: What is your most popular treatment?

VO: We've got eight areas of business here, and I run this almost like eight different businesses. We've got our medical-grade products business. We've got a Botox, Dysport and Xeomin business. We've got our dermal filler Sculptra business. We've got a laser hair removal business. We’ve got a tattoo removal business. We've got a fat reduction business. We've got an aesthetics business, which is your facials, Hydroderm and SkinPen. And then we've got a medical aesthetics business, and that's where we have the more advanced stuff, including CO2 and Vivace and IPL and laser resurfacing—things typically an aesthetician can't do. I've always run this business as multiple businesses, so I can tell how this particular business is doing, what kind of marketing we're doing for this particular business, etc. I always say that our business is doing the best when all eight cylinders are running. 

But to answer your question, as far as revenue, it's fairly well balanced. The top three would be, the injectable businesses—your Botox, Dysport and all that, and then your dermal fillers. That is probably 30 – 40% of our business. And then from there, it's pretty much all balanced out. Our aesthetics business, 15%; hair removal, 15%; medical aesthetics, 15%; fat reduction, 15%. I've tried to get everything balanced together because you don't want a business—at least I don't want a business—where you've got all your eggs in one basket. Then, all of a sudden, a product comes out—for example, it could be topical Botox, which a lot of people are talking about. If you had 70% of your money in injectables, you're like, “Wow, I'm taking a big hit.”

So I believe in running a balanced business, like all eight cylinders in a car. But today, the injectable business is still the most profitable, if you had to break that out.

MM: What do you think makes your spa different from others?

VO: If I look at the competition, the biggest thing that I see is the discounting—trying to get patients by lowering price. It's a different type of patient. Yes, we'll have promotions here and there—not that often—but we're not going to discount lower than the next guy to get business. We don't want that type of patient. I hear it from some from some of the patients when I do a survey—your prices are a teeny bit higher, but I go there because of Lisa. I go there because of Erin. I go there because of how great the front desk makes me feel. When you start discounting, you train people to look for that. When I look at other practices that are continually having promotions and trying to bring people in through pricing, that's not what we do.

MM: What specific metrics do you use to determine success?

VO: I'm kind of a metric maniac. I start with daily metrics—how many leads have come in and how much revenue is coming in. Those are metrics that we manage by. And then how many of those leads that have come in—and this starts going on more of a monthly basis—come in for consults? How many of those leads as consults come for business? That's a very important metric for me because it allows me to say I'm spending this amount of money on this particular type of marketing, and who's coming in, how many are coming in, the percentage that is coming in for consults and how many who are coming in for consults are coming in for procedures. So that's a big metric area that I look at.

As far as other financial metrics, at the end of each month, we look at every single service that we do compared to how that service did last year and the percentage of business—like I said, the injectables being around 35%—that particular service brings in. I have this sheet that we look at during our team meetings and say, okay, our medical aesthetics business is down 2%, and within that business you notice that a laser, IPL or something else is what’s that's dragging that along. I always say, you can't manage what you can't measure.

It's very clear every month where our money's coming in, what services are bringing people in, and what is growing year over year. Knowing that is very important for each business. And then I jump into that in a little bit more detail, and that is, what's the profitability? I run the metrics on the profitability of each of those services so I can get a gross margin so I can say, okay, this particular service I'm emphasizing a lot, it's not growing, but here's what it's really doing to my bottom line. And then I do the same thing for the providers. What is the profitability of each provider that I have?

To really understand your business, and it's real clear, you have to know which services you’re making money on. Here's where I'm going with them, here are the providers I have, here's how much I'm paying them, here's the gross margin on each of them. When you do that, you really understand the health of your business. You understand where your marketing dollars are going and what's bringing you the most return, and for the providers you have, which ones are doing the best and bring in most of the bottom line, and the same thing with services.

There's one that I do on a daily basis looking at the revenue coming into leads. There's a monthly-basis one that's profitability on each of the services and how the services grew year over year. And then there's more that I run every quarter to six months. But there's a lot of them, and I do run this business on a metric base, because I just can't say this money I'm spending here on marketing, I think it's doing well; it looks like I'm a little busier. Or I want to get into vaginal rejuvenation but I'm not really sure. You have to measure it, and you have to be ready to drop a service or change out a provider, because once you have this data, what do you do with it? You can try to change the costs associated with those services, and the same thing with the providers. You have to be ready to make changes.

vic owoc

MM: What do you love most about the aesthetics business?

VO: I love that we're helping people. Our slogan is, ‘We make people look as young as they feel.’ Especially here in South Florida, people don't want to look like they've aged. When people come in here, they feel good. I can't tell you how many times my wife has told me, and I've seen it on occasion, that the patients cry. They've done dermal fillers on their face because that's something immediately you can see, and they look at themselves and they cry, and that's how much this bothered them. It's just amazing what you can do with some treatments of IPL to take the pigmentation off their face, some fillers for if they have folds on their face, and treating wrinkles around the forehead with Botox, you can make them look 10 years younger. It's just beautiful.

MM: What do you love about being an entrepreneur?

VO: Being able to call my own shots. I worked for large corporations for years. Reporting to someone else and being responsible—if you're a real mover and shaker and you want to change things, it’s very difficult to do in a corporation. But as an entrepreneur, if you can handle the risk, and you may make some mistakes and you may have some issues with that, but the ability to create your own success, to manifest your own destiny to me is exciting. I really love being able to take an educated risk, and of course the benefits from that. All the positives of being your own boss and running a successful business that helps people. I couldn't see it any other way.

MM: Who inspires you?

VO: My wife. She's the lead provider at Ageless Medical. She's just a very smart person. The patients come in so often to see Erin, it's almost a problem for the other nurse practitioners that have to go against her. Not only is she well credentialed, being a national trainer, she's just awesome.

MM: What advice would you give to other medical spa owners?

VO: Create a high-end brand. If you start your medical spa business and your brand is just okay, it's hard to go up, so start off with a great customer-centric brand. Also, you need to have the right people. When we bring someone on board and they know that we pay more than the other medical spas, they know we expect more. The people are so important. Hire the very best people. Pay them more. Because I will tell you, this is a business about people. A lot of people have the same technology that we have, but not everybody has our people. Attracting, training and retaining the right people are, by far, the most important things.

MM: What would you say is one word to describe your med spa journey?

VO: It's been exciting. You have to love this business. When I say exciting, it's all the changes that go on—you have to be excited about them. There are changes in technology, sometimes changes in policy, changes in your types of patients—now it’s becoming more and more millennial-based, for example. I'm excited about the changes. The business itself has been changing, but my feeling about the whole thing has just been excitement.

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:  Business and Financials  Med Spa Trends  QP 

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5 Tips for Managing Patient Photos to Keep Your Medical Spa HIPAA Compliant

Posted By Administration, Thursday, July 25, 2019

doctor photographer

By Emily Alten, on behalf of RxPhoto

Before-and-after photos and photos used to document patient procedures are considered protected health information (PHI) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), regardless of whether or not clients are using health insurance to pay for their services. Therefore, it is essential that your practice properly secures patient photos to avoid potential fees for improper PHI handling. Here are five things to keep in mind to ensure that your patient photos remain HIPAA compliant.

Storage

Do not leave photos stored on devices indefinitely, and no photography equipment should ever leave the practice unless it has been wiped of photos. Remote-wipe technologies exist, but if you have set up this capability, make sure you are up to date on the most recent Health Information Technology for Economic and Clinical Health Act (HITECH) regulations. (Click here to learn more.) If using a DSLR camera, photos must be uploaded to a computer regularly and the SD card must be wiped clean so that photos cannot be accessed outside the practice or by anyone other than a trained staff member. If using a mobile device, the simplest way to remain HIPAA compliant is to use a service that stores photos in a HIPAA-compliant cloud server for you. That way, when photos are taken, they are automatically stored on the cloud and never stored on the device itself.

Communication

Sending or receiving photos of clients is an easy way to fall into HIPAA non-compliance. Emails are a big no-no. HIPAA requires that electronic communications with any PHI—including photos, names, any medical information or anything that can be used to identify a patient—be properly encrypted to ensure privacy. Also, be aware that sharing information with another party requires a consent form from the client to acknowledge that he or she is aware of what information being shared and with whom. HIPAA also states that communication between two parties should only include the minimum necessary information to properly care for the patient; however, if the client is a mutual patient of the two parties sharing health information, it can be freely shared.

Marketing

It may be obvious that consent forms are required to use any client’s information or likeness in order to market your product, but you should be aware that blacking out a subject’s eyes or even face is not enough to remove all possible identifying features or information. Getting consent forms and being transparent with clients about how their information might be used by the practice is the most prudent move.

Social Media

Social media is an excellent way to market to and communicate with present and potential clients. However, it is easy to slip into HIPAA-violating familiarities online. Even confirmation that an online persona is a client violates HIPAA rules. Make sure that any online communication from the practice does not include any of the following information:

  • Recognition that someone is a client—“It was nice to see you the other day,” or, “Glad you enjoyed your visit”;
  • Discussion or comment on a treatment—“We’re glad you’re happy with your Botox”; or
  • Recommendations for treatments, which could be considered medical advice from a non-MD source—or, worse, public medical advice violating patient confidentiality.

Educate Your Staff

Your staff should be educated on HIPAA and HIPAA compliance to ensure that your practice is doing everything it can to remain above-board. There are numerous resources, including online courses, that offer HIPAA training for medical staff; pricing averages approximately $25 per employee. (HHS.gov, HIPAAExams.com and MyHIPAATraining.com are among the sites that offer these training opportunities). This will not only keep your practice HIPAA compliant, but also help keep any staff/client communication professional and courteous.

Writing enthusiast and biology nerd, Emily Alten specializes in educational health care and medicine content. She is a Magna Cum Laude graduate from Columbia University with a degree in biological sciences/pre-medical studies.

Tags:  Guest Post  Med Spa Law  Med Spa Trends 

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The Legalities Behind HIPAA and Social Media

Posted By Administration, Monday, July 22, 2019

social media

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

A well-executed social media campaign can be extremely beneficial to a medical aesthetics practice. Millions of businesses use social media channels—such as Twitter, Facebook and Instagram—to increase their brand awareness, and successful social media campaigns can help build strong bonds between practices and their patients.

Unfortunately, medical aesthetic practices and medical spas are particularly susceptible to certain types of social media violations that can attract the attention of the federal government, and investigators will not care whether or not you were aware of these transgressions. You must educate yourself about what you can and can’t post on social media channels to stay on the right side of health care privacy laws.

Understanding Your Identity

It’s important that medical aesthetic and medical spa physicians, owners and operators understand that these practices are, in fact, medical institutions—unorthodox medical institutions, certainly, but medical institutions nonetheless. However, they exist in an unusual market. The services they offer are elective, so they typically market themselves in ways that traditional health care outlets do not. They often present their services as commodities, in much the same way as outlets such as traditional spas and salons do. And because the medical aesthetics market is expanding, there is a great deal of competition for a prospective client’s attention, so marketing campaigns need to be cost-efficient and effective.

This is why many medical aesthetic practices and medical spas turn to social media to help publicize their businesses. However, it is shockingly easy for such a practice to expose itself to patient privacy issues with even the most harmless-seeming social media activity.

An Introduction to HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a piece of legislation that regulates the many ways in which the business of health care is conducted in the United States. Since its adoption, however, it has become virtually synonymous with the issue of patient privacy. HIPAA’s Privacy Rule prohibits medical institutions from sharing protected health information, which it defines as anything that can be used to identify a patient. This includes any information at all that could possibly reveal the identity of the patient—his or her e-mail address, street address, name, birth date, Social Security number, etc. All this must be kept completely confidential.

If a medical institution is found to have violated HIPAA, it may be subject to very substantial fines—sometimes hundreds of thousands of dollars per violation. Additionally, many states enforce even stricter patient privacy statutes, so medical institutions must go to great lengths to ensure that absolute patient privacy is observed at all times.

See No Evil

There are three major ways that medical aesthetic facilities and medical spas often violate patient privacy laws on social media without even being aware of it.

1. Publicly reaching out to a patient. If you are connected with clients via a social media channel, such as Facebook or Twitter, it might seem like a good idea to reach out to them after a visit to publicly thank them for coming in. Ideally, this could build a relationship with these clients and entice their friends to follow suit. Unfortunately, this seemingly innocuous act may constitute a violation of HIPAA (and possibly a gaggle of state laws), because you’re revealing that person is one of your patients.

You can still thank your patients via social media; however, you just need to be very careful about how you go about doing it. Consider reaching out to your patients using the private messaging feature of whichever social media platform you are using. You will not be able to reach your client’s friends, but you’ll still strengthen your relationship with your client. However, as any number of disgraced celebrities will tell you, it’s very easy to post something to the public that you intended to keep private. Use extreme caution if you decide you want to attempt this.

Also, if you’re starting a Facebook campaign, establish a fan page rather than a standard user page. That way, your facility’s followers won’t be visible to users.

2. Publicly responding to a positive comment from a patient. Let’s say that one of your clients posts the following on your practice’s Facebook wall: “Had a great Botox treatment here today!” You may be inclined to post a response, such as: “Thanks! We hope to see you again soon!” However, it is important to understand that even this can represent a breach of a patient’s privacy, since you’re confirming that your practice provided the customer with treatment.

This is an emerging legal issue that has yet to be put to the test by litigation, and it could be argued that, by publicly posting that message, the patient is tacitly waiving his or her HIPAA protection. Unfortunately, HIPAA and other state-based privacy laws are very strict, so it’s probably not a good idea to test them.

You can attempt to avoid falling into this trap by stating on your social media channels that, although you appreciate all comments, the best way to deliver them is via e-mail or to call the practice directly. If you do this, you can avoid appearing unappreciative and reduce your potential exposure to patient privacy violations. Alternatively, you can try to draft a form that acknowledges that a patient who signs it wishes to waive his or her HIPAA protection for social media; however, this form would need to be very complex in order to stand up to legal scrutiny.

3. Responding to negative reviews. Yelp is a social media service that allows users to rate the experiences they have with businesses. As of the fourth quarter of 2015, more than 86 million unique visitors per month use mobile devices and 75 million unique visitors per month use desktop computers to refer to Yelp’s more than 95 million user-generated reviews, so make no mistake: This service is immensely powerful. The success or failure of businesses can be determined by their Yelp reviews alone.

This can empower ordinary people and, ideally, lead businesses to provide exceptional service to everyone. Yelp even encourages the businesses that are critiqued to become part of conversation, allowing owners and operators to respond to reviews and engage with users.

Unfortunately, Yelp’s enforcement of its user content guidelines is spotty, so it can have a dark side for businesses. Some reviews are unfair, made by people who have ridiculous expectations or axes to grind. Additionally, some Yelp users post negative reviews if they aren’t allowed to pay the prices they want to pay for products and services, regardless of whether those prices are reasonable. And those negative reviews can impact prospective customers—even if a business has a preponderance of four- and five-star reviews, readers are often compelled to peruse the handful of one-star reviews for entertainment purposes or to familiarize themselves with the worst-case scenarios.

Most businesses have recourse for dealing with problematic Yelp reviews—they can openly engage critical users using the service and attempt to demonstrate that they’ve done nothing wrong. The owners and operators of medical aesthetic practices, however, absolutely cannot respond to these posts, because if they do, they could identify unhappy users as patients, thereby violating patient privacy statutes.

The best way for medical spas to combat bad Yelp reviews—the only way, really—is to encourage satisfied customers to post positive reviews. Unfortunately, this means that you’re essentially asking customers to work to promote your business for free, but there is little else that can be done to address the situation without violating patient privacy laws.

Given the importance of Yelp and the lack of a level playing field regarding its reviews, the owners and operators of medical aesthetic facilities may be tempted to engage in what is known as “astroturfing”—using employees or associates to post fake positive reviews in order to bolster ratings. However, they must resist that urge, as astroturfing can be interpreted as consumer fraud. New York state regulators recently issued enormous fines to several facilities for astroturfing.

The Final Word

Social media can be a valuable tool in the promotion of a medical aesthetic practice, but its use can also be fraught with peril. Owners and operators of these practices should make sure that everyone involved in their social media campaigns—as few people as possible, ideally—understands that it is critically important that patient privacy be respected at all times. Few practices can survive the penalties associated with these violations, so they must be avoided at all costs.

Tags:  Business and Financials  Med Spa Law  Med Spa Trends 

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QP Extra: Q&A with Matt & Kathy Taranto of AesthetiCare Medspa

Posted By Administration, Friday, July 19, 2019

matt kathy taranto

AesthetiCare Medspa is among the more successful medical aesthetic practices in the Midwest—it is so successful, in fact, that owners Matt and Kathy Taranto also operate an aesthetic medicine consulting business, MINT Aesthetics. The Tarantos their staff have been providing a wide variety of aesthetic treatments to the residents of eastern Kansas for over 18 years, and they recently spoke about their history in the industry and keys to success with AmSpa Content Writer/Editor Michael Meyer for the inaugural issue of QP.

Michael Meyer: What inspired you to open your practice?

Matt Taranto: I had been in the industry for about six years, starting in the mid '90s, and back then, all the equipment companies used independent reps—they didn't use employees. I was an independent rep, and I sold a variety of lasers, microdermabraders and skin-care products in a six-state region in the Midwest. After doing that for a while, in 2001, I decided to open AesthetiCare. At that time, the main reason was I realized that every equipment company sells the best of everything and all the reps base their sales pitches on what the company tells them. And I thought, man, I'd have a lot more credibility I actually used if the things I was selling every day in a clinic and I could tell my equipment clients, “I'm not just telling you what the company tells me to say. I'm telling you what we see in our clinic every day.” So I really opened it up to be a model for my equipment. But what ended up happening was I really liked the clinic a lot and started focusing more and more time on it. So instead of just turning out to be a small little model where we used equipment, I decided to really focus on it and make it something special.

MM: What is different about your practice now versus when you opened it?

MT: Everything. I opened at 1,000 square feet and we now have 11,000 square feet. I opened with three treatment rooms and we now have 18 treatment rooms. I opened with two employees and we now have 26 employees. What happened is once we saw that we were able to make it grow, we decided to kind of pivot from what we were doing with the equipment sales and really focus more on utilizing our experience in growing a successful clinic to helping clinics all over North America realize their potential, and so we started doing a lot more business consulting using AesthetiCare as a model. We are now on our fourth physical location—we started in 1,000 square feet, we expanded to 2,200, then we expanded to 4,000, then we expanded to 6,000, and now in the same 6,000-square-foot space, we've added another 5,000, so we're up to 11,000 square feet. It's been 18 years now, and we've actually never had a year where we have not grown by at least double digits. The thing we're most proud of is we've always had this steady increase, and hopefully we'll continue to do that.

MM: What's one word you would use to describe your medical spa journey?

MT: I would say “educational.” I've learned a ton.

Kathy Taranto: I would say “passion.” It's something that I've found joy in every single day. It's one of those things where you continue to love it. Why wouldn't you continue to grow and enjoy it?

MM: What is your most popular treatment? Which is the one that brings in the most revenue?

MT: There are basically three treatments that we look at that make up about 65% of the revenue, and they're all pretty equal. CoolSculpting is one of them. Forever Young BBL and Halo, which we do a lot in combination, is another one. And then neurotoxins and fillers. Each one of those three brings in $1 million or so a year in revenue. The other 40% of revenue is made up from a ton of different things that we do. We have a very large menu. But those three are pretty equal as far as revenue goes.

MM: What do you think is the most important factor in your success?

KT: I really feel like it's the culture. I feel like when you create an environment that your team wants to thrive in, they want to build their own careers within your practice. Matt started the clinic before we were together, and so that was already created when I came on board. It's something that we really strive to continue with every single day, having a space that our team loves, and then that just feeds out into our patients or our client base.

MT: Right. Without a doubt, it's your team and staff. Like Kathy said, we want our staff to love their job. And the way that we do that is we pay them more than anybody else pays them. We spend more money on advanced training than any clinic I've ever seen. And we try to remind ourselves, you know, we're not curing cancer here. This is not a life-or-death situation. We should have fun. We laugh a lot and hug each other a lot and just create this environment where we just don't have turnover. Turnover is so expensive, and so many clinics don't realize that. When you lose a good provider, you don't replace that provider the next day. It takes probably a good two years to replace a really good provider. So Kathy and I both just focused on making sure that we treat our staff incredibly well. We treat them like family—like we would want to be treated. And the result is they just don't leave. We create these wonderful long-term relationships with them, and them with our clients.

KT: Because we not only have our clinic, but also have an aesthetic consulting business, we're exposed to so many other clinics and their culture, or lack thereof. One of the things that I can instantly tell is when they're afraid of the owner or afraid of the doctor or they're really not friends. It's like they just go to work. It's just this constant reminder of how important that is—this fun culture that you create at work.

MM: What makes your medical spa different from others?

MT: We have 55 aesthetic centers in a 15-mile radius of us, and we have a staff meeting every other week and we talk about that—how can we be different? What can we do? Because we're not going to be different because we offer Botox or CoolSculpting. Everyone and their sister offer that. So what makes us different? I think it's the focus that we put on customer service. We want people bragging about AesthetiCare they way they brag about Nordstrom or Disney or Ritz Carlton. But the biggest thing, as she said, is that we've trained and consulted with over 1,200 clinics, and we invest more money into advanced training for our staff than any clinic we've ever seen, because to us, it's common sense. The more we invest in them, the better they get at their treatments; the better treatments they give, the happier clients they have and the more referrals they get. I really think that focusing on an extraordinary level of customer service and making sure our staff is better trained than any of our competitors are so important to us.

aestheticare

MM: What specific metrics do you use to determine success?

MT: We can look at our financial statements and see what percentage of every dollar goes to payroll, cost of goods sold, marketing, benefits, insurance, things like that, and really making sure those things stay in the zone that makes us profitable. But the other thing is really measuring your staff. For each of your providers, you should look, at every month, how much revenue are they producing, how much revenue they're producing per hour, and where that revenue coming from. It's a combination of treatments and products, and what is that ratio? We really strive to do 15 to 20% of our gross revenue in retail products.

We also look at price integrity. We work with a lot of clinics who say, “We charge $13 per unit for Botox.” Then, when we do the math of what they've actually taken, we realize they charge $13, but they're only getting $10.50 because they put it on sale all the time or they're giving freebies. We really try to make sure that we have price integrity. Every month, we give all our providers a sheet showing what they produced, how that compares to the year before during the same time period, and how that stacks up against their peers. Why is the top nurse doing better than the bottom nurse? Why is the top aesthetician doing better than the bottom aesthetician? What can we learn from that?

KT: I think too, it comes down to not just the money side, but back to the fulfillment side, in terms of success—what fulfills each one of our providers? What kind of personality do they have? What fulfills us on a regular basis? It's looking at that joy you find at work—is our team happy? Do they stay with us? And looking at our turnover, or the lack thereof, I think really helps to speak to that as well.

MM: What do you love most about aesthetics?

MT: I think it's so amazing to have a career where, when you tell people what you do, they want to talk about it in detail. If I sold life insurance, nobody's going to really want to talk to me about my career that much. And nothing's wrong with that job—it's just not the most fascinating job. When I tell somebody I'm in aesthetics, man, they want to talk about it. And I love the fact that I work in a field that people find intriguing.

KT: I think for me, it is the interaction with our clients. I understand we're not curing diseases, and you don't need the treatments we offer, but these improvements you make in their skin build their confidence, and you get to know them over months and years, and you get to know their families. The connection with people is something that I've always loved within the industry. Whether it's with our patients at AesthetiCare or our clients at MINT, having that personal relationship with them is always something that I've loved.

MM: What advice would you give to other medical spa owners?

MT: The best book I ever read about business is The Customer Comes Second [by Hal F. Rosenbluth and Diane McFerrin Peters], and that book is all about how you make your staff your number-one priority. If you're going to own a business, with the financial risk and time commitment, your goal is to develop something that isn't dependent on you. The whole idea of creating a great team is that this place can run when Kathy and I are gone. And so I would say my number-one tip is make your staff your number-one priority. Number two sounds silly, but it is do everything you can to make it fun. Enjoy it. We spend too much time at work to look at it as a chore. We have a choice every day when we walk through the door—what type of attitude are we going to bring to the workplace? And if we're going to put in our 40, 50, 60, 70 hours a week, man, let's laugh a lot. Let's joke around a lot. Let's have some fun. I think when you combine those two things, it's a good recipe for business.

KT: I definitely agree. I think the other thing that I commonly see that I feel like we're always helping our consulting clients with is just looking at their numbers. For me personally, the team and the fun and all that comes more naturally. The numbers, for me personally, don't come as naturally, which is great because it does for Matt. But most people don't have a Matt and Kat—they have just one person who owns the clinic, and maybe they have a manager and maybe they don't. And so they just tend not to really look at their numbers. They don't have anybody to help them with their numbers. And then they come in here and they're shocked to see they're not making money. Take a look at your numbers. Find somebody that can help you or pay somebody to do it for you, but really take a close look and understand where you are with that.

MT: I think Kathy has a good point—understand your business. I think one thing we see, to that point, is that so many of these clinics are owned by a doctor who also has a medical practice. It might be a derm or plastic or whatever, and their medical practice may be doing very well. They lump all those numbers together and say, “Oh yeah—we're doing pretty well.” Then, when you break out the aesthetic number that the medical practice is supporting, your aesthetic practice is actually losing money, and it's eye-opening.

Also, one thing we get a lot in this day and age is people saying, “Oh man, there's so much competition. So many people are doing it, I don't know if I should do it. Is there enough business?” Never worry about competition. We've worked with over 1,200 clinics; I would tell you 80% are never going to get the right way to do this business. It'd be great to have a goal to be the greatest med spa in the world, but be the greatest one in your geographic area—maybe a 10- to 15-mile radius of you—and that's doable. When the number one procedure in the United States is Botox and only 3% of Americans have ever tried Botox, there's a lot of room for growth.

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:  Business and Financials  Med Spa Trends  QP 

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Are You Lost in the Scope of Practice Decision Tree?

Posted By Administration, Wednesday, July 17, 2019

nurse consultation

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

In many states, it can be a challenge to determine what specific interventions and tasks are within the scope of advanced practice registered nurses, registered nurses and licensed practical nurses. Often, the statutory scope of practice on which the nursing board relies is written in vague and general terms, such as “promoting health,” “providing care and support” and “acquired through educational preparation in nursing.” To provide additional guidance, many nursing boards have adopted the Decision-Making Framework promoted by the National Council of State Boards of Nursing (available here). However, when you reach out to these boards seeking additional guidance, they will ask you to work through the framework to answer your own question.

While the decision tree can be helpful in reasoning through a nurse’s scope of practice, it often raises more questions than it answers. This is especially true for nurses who practice in medical spas and the aesthetic industry, since the procedures they are asked to administer are often very different from what is considered the “traditional” practice of nursing. For example, in the second question the framework asks if the task is “consistent with evidence-based nursing and health care literature,” but it does not provide information about how much evidence is needed or which publications are acceptable sources. Similarly, the fourth question asks about “necessary education to safely perform the activity,” but again, how do you know if you have enough education about the procedure? Is a weekend course enough, or do you need something that lasts a week or semester?

Fortunately, the Oregon State Board of Nursing recently provided a very helpful interpretive statement on cosmetic procedures. Interpretive statements in general aren’t unusual, but what makes this one unique is that the board walks through and discusses the issues and reasoning for each question in the decision framework as it pertains to procedures a nurse could perform in a medical spa. We won’t review the whole statement here, but we want to point out some of the more interesting points in the board’s analysis.

  • Is the role, intervention or activity prohibited by the Nurse Practice Act (NPA) and Rules/Regulations or any other applicable laws, rules/regulations or accreditation standards? In addressing the first question, the board makes it clear that nurses don’t operate on their own and can only accept procedures when they are ordered by licensed independent prescribers. The board also looks not only at the NPA, but also at the medical practice act and health authority laws, as well as the interpretive guidance from those organizations in answering this step.
  • Is performing the role, intervention or activity consistent with professional nursing standards, evidence-based nursing and health care literature? Here, the board gives some qualification to what sort of literature is acceptable. They point to guidelines from specialty nursing associations as well as peer-reviewed publications. Therefore, information in newsletters and trade publications likely is not going to be sufficient.
  • Are there practice setting policies and procedures in place to support performing the role, intervention or activity? For this question, Oregon discusses additional aspects of what constitute appropriate policies and procedures. Its main points are that the nurse has a professional responsibility to practice according to the board’s standards, and the facility policies and protocols cannot force them to practice outside of those standards. This includes refusing to accept a delegated procedure that the nurse deems unsafe.
  • Has the nurse completed the necessary education to safely perform the role, intervention or activity? The board agrees that there is rarely an identified educational standard for medical spa procedures. However, the burden falls on the nurse to show that the education he or she has received is sufficient. For non-ablative procedures, the Oregon board sets a minimum of 40 hours of laser education from the American National Standards Laser Safety Education Program.
  • Is there documented evidence of the nurse’s current competence (knowledge, skills, abilities and judgment) to safely perform the role, intervention or activity? The board stresses the need for nurses to maintain records of all their education and other methods they used to acquire competency in a procedure. While it may seem like a tedious requirement, these records will be critical information if the nurse ever needs to respond to a complaint.
  • Would a reasonable and prudent nurse perform the role, intervention or activity in this setting? This is the most uncertain question. After all, what constitutes a reasonable and prudent nurse? Here, the board interprets this question to mean a prudent nurse would be one who can answer “yes” to questions 1 – 5.
  • Is the nurse prepared to accept accountability for the role, intervention or activity for the related outcome? The final step in this framework is simply reminding the nurse that he or she has accountability for performing the procedure and its outcome. The nurse’s willingness to accept the responsibility is not a scope of practice issue, but it does serve as a final check in determining answers to scope of practice questions. If the nurse chooses to decline, it probably means that one of the previous questions was not answered clearly in the affirmative.

Now, obviously, this analysis is specific to Oregon and won’t apply completely to your state. It does, however, provide insight into how your own state’s board might navigate this decision framework. Finding answers about the legal aspects of the medical aesthetics industry and educational issues can be daunting. AmSpa members can check their states’ legal summaries to determine if a procedure falls within their statutory scope of practice. However, nurses still will need to examine their own educational backgrounds and the practice setting to determine if the procedure is within their personal scope of practice.

Tags:  Compliance is Cool  Med Spa Trends 

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