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Inc.com Article Outlines Business Concepts Vital to Medical Spa Success

Posted By Administration, Tuesday, November 14, 2017

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

In this space, I often discuss the legal peculiarities of running medical aesthetic practices from a viewpoint that generally deals with medical issues. However, while it is critical that medical spa owners and operators understand what’s expected from them in terms of rules and regulations, they must be equally adept at managing the business side of the aesthetics equation.

To that end, I highly recommend reading “6 Business and Financial Terms Every New Entrepreneur Needs to Know” by Jeff Haden on Inc.com. In general, Inc.com is an extremely useful resource for people who wish to develop a better understanding of the ways business works. It has given me some really valuable, practical tidbits over the years, and I would highly encourage anyone who is serious about developing their business savvy to follow Inc.’s Facebook page or regularly visit its website.

In this article, Haden gives basic but very informative explanations of these six metrics:

  • Customer acquisition cost,
  • Customer lifetime value,
  • Customer retention rate,
  • Repeat purchase rate,
  • Redemption rate, and
  • Revenue percentages.

This piece is extremely applicable to medical spas. Practice owners who take the time to learn the specific metrics that are referenced in this article tend to be the ones who are the most successful—the ones whose practices bring in millions of dollars in revenue every year.

You can spot a dedicated business owner from the types of metrics that they look at, and the ones mentioned in Haden’s piece are the ones that AmSpa’s industry experts discuss in our Medical Spa & Aesthetic Boot Camps. They are all vital when it comes to managing your medical spa, because a medical spa is much more akin to a retail store than it is to a doctor’s office, even though you have to follow the same rules and regulations concerning the administration of medical procedures that a doctor’s office would.

If a medical spa owner truly wants to be successful, he or she needs to realistically understand the dual nature of the business. If you are a nurse or a doctor, you need expand your horizons to better understand the ins and outs of the retail business. Sometimes, that means taking a 30,000-foot view of what your data shows you. Any initiative that you’re taking must be measured, tracked, and eventually evaluated.

The decisions you make should be based on the data you’ve compiled. The metrics mentioned in “6 Business and Financial Terms Every New Entrepreneur Needs to Know” are vital to helping you develop a more thorough understanding of the way your business functions. I think it explains these concepts very well.

At the end of the day, a medical aesthetic practice must make money. This might seem to go without saying, but when you’re in the process of starting up a medical spa, several other aspects of the business might seem to take precedent, especially if you’re coming to the medical aesthetic business from a medical background. And yes, it’s vitally important to set up a compliant practice and make sure that you’re following all applicable state and local regulations to the letter, but if you’re not doing everything you can to understand and utilize business concepts such as these, you’re not giving your medical spa a fair chance to succeed.

Tags:  business and financial terms 

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FDA Guidance Offers Clarity on Microneedling Issues

Posted By Administration, Tuesday, November 7, 2017

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

The question of who can perform microneedling has been a hot-button one in spas and medical spas in recent years. On September 15, 2017, The U.S. Food and Drug Administration (FDA) issued a draft guidance to employees and industry professionals concerning its position on controversies concerning microneedling devices. The document, titled “Regulatory Considerations for Microneedling Devices,” clarifies the rules and offers definitions for a variety of microneedling products. It can be read and downloaded here.

Microneedling—also known as collagen induction therapy—is a skin treatment in which tiny needles are introduced to the skin, penetrating it in order to stimulate the production of collagen and other growth factors. It is relatively inexpensive, usually produces visible results without complications, and is easy to perform, so it has appeal both to medical aesthetic professionals and patients. (See AmSpa’s Treatment Directory for more information on microneedling.)

However, while this treatment is simple, the legal issues surrounding it are not, so it is important to understand why microneedling is such a controversial topic and why this document from the FDA is an important step toward clarity.

The controversy


Treatments that break the outer layer of a patient’s skin typically are considered to be medical in nature. This might seem to intrinsically make microneedling a medical procedure but, in fact, it is very difficult to judge whether or not the skin is being broken when you are dealing with tiny needles that can be as small as fractions of a millimeter long. Skin layer depth varies from patient to patient and depends on the part of the body being treated, as well as the amount of pressure being applied. 

Hypothetically, if microneedling is not a medical procedure, it could be performed by an aesthetician without an exam. However, if it is medical, a patient history must be taken, a licensed medical professional must administer an exam prior to treatment, and proper supervision and/or delegation procedures must be observed during the treatment. Put simply, if microneedling is treated as a medical procedure, it is far less profitable for the medical spa and far less convenient for the patient.

Getting to the point


This draft guidance is a big deal for the medical aesthetic industry. It offers some clarity regarding whether or not the manufacturers of certain microneedling devices need to be compliant with FDA standards, which gives some insight into the current attitudes of the agency and its partners regarding the nature of these treatments.

“Depending on the applicable state laws for scope of practice, delegation and supervision, this could result in medical spas having to reorganize their staffing for the performance of microneedling using newly classified devices,” says Jay D. Reyero, JD, partner at ByrdAdatto. “It could also result in transforming more traditional spas that feature microneedling into what we think of as medical spas.”

We advise everyone who is using microneedling devices at their medical spas to proceed with some caution, because there are FDA issues that are being worked through with regard to compliance. 

“We could see a clear distinction of what constitutes the practice of medicine for purposes of microneedling develop, giving medical spas more clarity on the issue,” Reyero says. “We could envision state licensing boards adopting a position to rely on the FDA’s determination and base a determination of the practice of medicine simply on the type of microneedling product used rather than the particular effects on the human skin or the lengths of needles.”

We anticipate that in the next month or two, the FDA will provide some clarification regarding these issues, but for now, it likely is best to proceed as if these treatments are explicitly medical in nature.

For other medical aesthetic legal questions be sure to seek legal advice from an attorney familiar with aesthetic laws in your state. AmSpaBasic members have access to a 60-question legal summary of regulations in their state, while AmSpaPlus members have access to these answers plus 25 additional questions. Become a member today to get answers to your aesthetic legal questions.

 

 

Tags:  med spa law  microneedling 

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Illinois Nurse Practice Act Update

Posted By Administration, Friday, November 3, 2017

 

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

UPDATE: Gov. Rauner signed the revised Illinois Nurse Practice Act on Sept. 20. As stated in this post, it will take effect on Jan. 1, 2018. AmSpa will be conducting a webinar discussing the implications of this development on November 15, 2017 from 11:30am - 12:30 pm CST. If you own or operate a medical spa in Illinois, or if you live elsewhere and want to know how similar legislation might affect the industry in your state, register for the webinar today.

Tags:  Illinois Nurse Practice Act  Med Spa Law 

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Scary Patients Can Haunt Your Practice

Posted By Aly Boeckh, Tuesday, October 31, 2017

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

Most of the people you encounter while working at a medical spa are perfectly pleasant, have reasonable expectations of their treatment, and are happy to discuss their options with you. However, at some point you will likely encounter a patient who asks too much of you or your business. Unfortunately, it is within that person’s power to make your life extremely complicated. It is important that you understand how to manage problematic patients to maintain your practice’s good reputation and prevent potential legal headaches.

A peculiar problem


Medical spa owners and operators face many challenges due to the nature of the medical aesthetic business.

Patients often may feel extremely entitled because they are paying out of their own pockets for their services instead of using insurance. Due to this entitlement, patients are often more demanding that in a managed care or traditional health care setting and there is a greater risk of the relationship ending badly. If a facility feels the need to initiate the termination of the relationship, some patients may be offended and may make legal complaints or turn to the state medical board.

This is unfortunate, but it is the nature of the industry. Sadly, some of these difficult patients simply cannot be reasoned with.

Oftentimes, because medical aesthetic services have to do with the physical appearance of patients, you may encourage patients with serious mental health issues related to their appearance, making them fundamentally unhappy with unrealistic expectations. 

Patient complaints to medical boards are no joke. Even if a claim such as this is eventually dismissed, a physician still must take the time and spend the money to defend him- or herself against it. And even if a physician is cleared of professional misconduct, his or her business still can be harmed by that former patient.
Medical aesthetic patients with mental instability also may be more likely to vent online in ways that can be professionally damaging on a number of social media sites, including doctor-rating websites. 

Combating complications


The best way to avoid having to confront issues concerning problematic patients is to make sure that you don’t associate with them in the first place.

Try to identify potential problem patients early on and figure out the best ways to encourage them to avoid your practice without offending them. This is where hiring the best front desk and customer care employees come in. They need to be trained on responses to handle and screen for potentially problematic patients, identifying red flags. These include patients who vent frustrations about previous doctors and patients who have unrealistic expectations about appearance changes they desire. Often, if you just listen to your patients, they will tell you everything you need to know.

It also is important that medical spas explain their policies as clearly as possible. A medical spa should team with an attorney to produce a contract for patients to sign prior to the administration of any procedures; this document should clearly present the conditions under which a medical spa will provide the prospective patient the service.

It is crucial that patients understand the expectations of the medical spa as clearly as the medical spa team understands the expectations of the patients. Patients needs to understand that they will not be allowed to disrespect medical spa procedure, such as not showing up for appointments, not adhering to instructions for preoperative treatments, making threats or are disruptive in the office environment and not paying for their treatment in a timely manner. Clarity and enforcement are critical to successful patient relationships.

Medical spas also can prepare themselves for the problem patients by making sure that their malpractice insurance contains language that protects them from spurious legal action.

“If a complaint is filed against a person and a governmental body comes in and decides to investigate, there’s a provision within a malpractice policy that is referred to as administrative defense coverage,” said David Shaffer, vice president of Professional Medical, the health care division of Insurance Office of America. “It basically provides the insured with reimbursement coverage for the cost of the investigation itself.”

Targeted coverage that can help to protect against unwarranted social media attacks is also available.

“One of the perks that’s built into the AmSpa [Medical Spa Insurance] Program is reputational harm coverage,” Shaffer said. “A consultant is made available when coverage is triggered to help them go out and perform whatever services are necessary to rebuild that reputation or correct whatever wrongs may have been put out there by a disgruntled patient.”

However, this coverage is only triggered if a claim is associated with the perceived damage—little can actually be done if an irrational patient smears a physician or spa via social media without filing a complaint. Again, your best defense is to avoid treating people patients such as these.

It is also worth noting that, in my experience, many problem patients come to med spas via deal sites such as Groupon. If you are considering partnering with a site such as Groupon to get the word out about your med spa, you may want to consider the quality of client these promotions sometimes attract. 

Being human


Even if you implement strict upfront screening practices and provide explicit terms and conditions for your services, you may still encounter patients with whom you feel you need to part ways. If this happens, talk to the patient with empathy and make sure he or she understands that you feel you are working in his or her best interests.
 

Tags:  Bad Patients  Med Spa Law 

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Streaming Surgeries Raise Issues for Medical Spas

Posted By Administration, Thursday, October 26, 2017

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

 

Can you­–and should you–live-stream medical procedures on social media? Recently, some of the most prominent plastic surgery societies—most notably the American Society of Plastic Surgeons (ASPS)—have begun to take a look at some of the ethical questions surrounding plastic surgeons broadcasting live video of the procedures they conduct on social media services such as YouTube and Facebook. The surgeons who stream these surgeries typically say that they do this for its educational value, but clearly these shows are also designed to raise the surgeon’s profile. If the doctor successfully publicizes the event, several thousand people will tune in, and sometimes a staff member will even be in the operating room with the surgeon answering questions from the video’s chat function on a computer.

 

There is nothing illegal or even necessarily unethical about this but, on occasion, these videos make the surgeon and his or her staff look unprofessional, especially if they are joking around or goofing off during the procedure. And while gimmickry such as this is almost expected from those posting to social media today, it certainly can be argued that medical professionals should hold themselves to a higher standard. If the purpose of the video truly is to educate rather than make the surgeon a social media superstar, this sort of behavior should not be highlighted.

 

A matter of respect

 

At AmSpa’s Boot Camps, we often point out that in the medical aesthetic field, it is very important to incorporate sales and marketing techniques into the every day operation of a practice—certainly moreso than one would in a traditional medical setting, such as a doctor’s office or a hospital. After all, medical aesthetics is a retail business, and if those in a retail business do not pay attention to this aspect of the operation, they are not likely to be in business for very long.

 

To that end, live streaming is an effective way for surgeons to get their practice’s name on peoples’ lips. But while we typically encourage medical spa owners and operators to engage in marketing techniques such as these, we feel that those who act foolishly in videos need to take stock of just how far they’re going and make sure that they’re still representing medicine in a professional manner. They also need to make sure that they’re acting in a manner that is respectful to their patients, who often are unconscious on the operating table—it just looks bad when doctors are dancing, joking, and saying silly things to the camera while the patient is prone. It’s easy for surgeons to lose sight of this when they are performing (because a live broadcast of a surgical procedure realistically is a performance), but it is something they should make a point to be mindful of. This is a competitive market in which many people are utilizing unorthodox sales techniques and, although medical aesthetic professionals have to ensure that a practice remains profitable, they are still dealing with medical patients.

 

Contracting trouble

 

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

 

Again, it’s worth mentioning that when patients sign such an agreement, they are consenting to the doctor streaming video of the procedure and to having their likenesses out there for the world to see for educational purposes, not to being a motionless prop while the surgeon acts foolish. It’s not hard to imagine a scenario in which a patient would be fine with participating in an educational live-stream, but then appalled when he or she sees the surgeon and staff members messing around during the actual video.

 

Living with a low profile

 

There is a very strong division in the realm of plastic surgery between those with the old-school mentality that any sort of self-promotion is gauche and those who have no problem with marketing themselves. Medical spas are caught in the middle—they are mostly run by non-core doctors and, in order to compete, they often are forced to engage in promotional techniques that some medical professionals might find unsavory.

 

I think it is important for medical spas to be a responsible party and to not promote stunts that are too overblown, because if they do, there will be blowback if something goes wrong or a patient files suit because he or she feels misled. Those doctors with anti-promotional mind-sets will use the opportunity to try to take certain procedures out of medical spas’ hands. The medical spa industry needs to be careful—it shouldn’t get too brazen or overt with its marketing, because medical societies have much louder voices in halls of government than the medical spa industry does. A group of Northwestern Medicine authors recently proposed a code of ethics for videos, and I think this is a good idea. After all, if these videos truly are for educational purposes, they don’t need the theatrics.

Tags:  Live Streaming  Med Spa Law  Plastic Surgery 

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Corporate Practice of Medicine Issues in Illinois Medical Spas

Posted By Administration, Tuesday, October 24, 2017

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

 

The laws about owning a medical spa in Illinois are not necessarily straightforward, but are increasing in importance because the state is a hotbed for the medical aesthetic industry. If you travel in and around the bustling city of Chicago, you may find yourself overwhelmed by the number and variety of medical spas in the area. However, likely due to the size of the industry in the state, Illinois has become known as one of the most active states in the nation in terms of regulatory investigation of medical aesthetic practices.

 

Ownership is one of the key factors that Illinois regulators look at continuously—they are very concerned with who owns and collects revenue from the state’s medical spas, and they are quick to punish those whose ownership structures are found to not meet the requirements of Illinois law. Therefore, it is important for Illinois medical spa owners—and prospective Illinois medical spa owners—to know what constitutes a legal ownership structure in the Land of Lincoln, since laws can vary greatly state-to-state. (AmSpa Members: Consult your legal summary to find answers to Illinois medical spa ownership questions.)

 

Corporate practice of medicine

 

Illinois observes a legal doctrine known as the “corporate practice of medicine,” which dictates that a physician or a physician-owned corporation must be the sole owner of a medical facility in the state. Since medical aesthetic practices are medical facilities—unorthodox medical facilities, but still—they are required to adhere to this standard. Additionally, only physicians or physician-owned corporations can collect revenue from medical procedures administered, and non-doctors—including nurses, estheticians, and entrepreneurs—cannot employ or contract with doctors to serve as their medical director and then collect revenue from medical spa services. This is designed to ensure that physicians are in complete control of all medical treatment; this extends to the pricing of procedures and the purchase of medical supplies and drugs. In the eyes of the state, a doctor should always have control of these factors and, if one is not, the pursuit of profit will win out over the welfare of the patients.

 

The arrangement that tends to get people in trouble in Illinois is when an entrepreneur, a nurse, or an esthetician opens a medical spa and enters into a medical director contract with a doctor. If a non-doctor accepts payment for medical services, it is a violation of the corporate practice of medicine, even if the doctor is heavily involved in the day-to-day operation of the facility (which is not always the case with medical directors). In such a case, the revenue—and, therefore, a degree of control over medical treatment—flows to a non-doctor, which is prohibited.

 

A solution

 

If an entrepreneur or a nurse wants to become a part of the medical aesthetics industry on an ownership level in Illinois, he or she can look into setting up a management services organization (MSO). An MSO partners with a physician, for whom a separate company is created; this company only provides medical services. This arrangement is known as a management service agreement (MSA) and essentially allows a non-physician to supervise almost every aspect of a medical aesthetics business, including branding, marketing, owning the real estate, payroll, human resources, accounting, and billing—everything except the actual administration of medical services, for which the physician remains solely responsible.

 

Essentially, this is best thought of as a lessor/lessee situation. The physician pays the MSO “rent” for the right to occupy the space, and the MSO as a landlord, maintaining the facility and keeping the physician as comfortable as possible. However, the amount paid to the MSO fluctuates according to the amount of business conducted by the physician. If the medical organization conducts more treatments in a month or quarter (depending on the terms of the agreement) than it did the previous term, the MSO also will make more money. This helps to create a bond between the physician and the MSO—if one succeeds, they both succeed. 

 

Words of warning

 

Often, AmSpa consults with nurses and entrepreneurs regarding the corporate practice of medicine issues in Illinois, but it is equally as important for non-core doctors—surgeons and general practitioners, for example—who are becoming medical directors to watch out for this. Ultimately, they can have their licenses investigated because of this doctrine. In this space in the future, we will discuss some recent court cases in states such as Michigan and New Jersey, in which there have been severe consequences for violating the corporate practice of medicine—contracts have been invalidated, insurance payments have been recouped, and coverage has been denied. This is a real issue that medical aesthetic professionals need to be aware of. To be sure you are on the right side of medical spa law consult an attorney familiar with medical aesthetic regulations in your state.

Tags:  Illinois Corporate Practice of Medicine  Med Spa Law 

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How Environ Skin Care is Dominating the Medical Spa and Aesthetics Industry

Posted By Aly Boeckh, Saturday, October 14, 2017

By: Aly Boeckh, Marketing and Sales Coordinator for the American Med Spa Association

The Medical Spa Industry is growing so rapidly, nearly $4 billion in sales in the 4,200 locations in the U.S., and it's becoming an extremely competitive market for skin care products to stand out, dominate, and sell within a medical spa space.

With so many consumers uneducated on key ingredients and medical spa professionals lacking the sales talk techniques to engage consumers, most medical spas don't see the profit value in selling retail.

But because we know the top med spas in the nation are making a killing off their retail sales, we're letting you in on the secrets to retail success - and that's exactly what led us to Dr. Des Fernandes, Environ Skin Care Founder and Scientific Director. 

Fernandes is the pioneer and globally recognized expert in vitamin A skin care, Cosmetic and Medical Needling, Cool Peel Technology and state-of-the-art skin care ingredients and formulations.

As expected, Fernandes is as intelligent as they come - and built Environ Skin Care out of the very desire that every physician who's ever struggled with the question of what skincare line you should be using can relate to. 

Why Environ Skin Care was Born out of Necessity:

“Medical Spas are moving away from the simple visit once a year to actually trying to put people on the road to good skincare. I think we now open the opportunity for them to make substantial differences to skin, to make skin healthy, instead of just being pampered.” 

“In a medical spa, this is their natural type of function. The most interesting thing is the return business. We’ve got the big spas like Canyon Ranch, which is not a medical spa but it’s becoming a medical type of spa as well, that is opening up a tremendous future for medical spas to start doing work with patients that get hooked on the beautiful skin.”

Discovering the Secret to Vitamin A in High Doses:

“As we’re sitting here and as the sun is coming through the windows, UVA comes through, so I’m getting a bit of UVA that’s destroying my vitamin A on my skin and it will destroy the Vitamin A quite significantly."

"You know the photograph that they typically show of the truck driver that’s terribly damaged on the left side? That is photo-damage. But nobody takes you to that next step…What went wrong from the photo damage? What happened when the sunlight came into the skin? It damaged his vitamin A. When you see wrinkled skin or pigmented damage thick skin, you’re seeing vitamin A deficiency.” 

“Progressively, when we’re young we have excellent levels of vitamin A in our skin, because we have excellent receptors on the skin surface, but with time as we expose ourselves to sunlight just through the window, we get those damaging rays.”   

"As we get older we lose our vitamin A receptors core cells. Now you don’t notice it, and you don’t know that you have vitamin A deficiency. But as you get older, you start to see that your smoother skin is now on the bottom, which is generally not receiving the sunlight. That’s the crime of vitamin A deficiency that we suffer from." 

How Vitamin A Reverses Signs of Aging:

"First, we have to make the cells able to use the normal amount of vitamin A, but the cells can’t use the normal amount of vitamin A."

"Say a blonde person like you, give them vitamin A and they’ll say 'This is dry, it makes my skin pink, acne spots, this stuff is terrible' and it’s just because you don’t have the receptors from subtle damage to the skin that we are totally unaware of. It takes a bit of time for us to adapt to the skin to take in normal doses of vitamin A."

"That’s why I created the step up system. For some people, even the step up system is too drastic for them and they start with vitamin A once a week. Then I advise these people to eat vitamin A, because when you take it by mouth you will build up more vitamin A in the skin cells as well."

Complimenting Cosmetic Treatments

“That is why I created it. When I started a private practice I was very lucky. Rapidly, I became very busy doing lots of facelifts, and what I realized is that if you’ve got bad skin and very wrinkled skin, I can do a facelift at my upmost best, but you don’t look young enough. You don’t look really young." 

“One of the things that you sometimes see is somebody looking very old, very tired, but they look odd. They look odd because they have old skin and a tight young face but it doesn’t look young. We’ve all seen that as we walk down the street and so on, and when I was in Canyon Ranch I saw a few examples of that." 

“What I realized in the early 80s, is if I wanted to get good results, I had to do this. That’s why I made the initial product. Only for my patients. Then I suggested to a number of my colleagues that they too should buy these products for their patients, and they just thought I was crazy!” 

“But the main reason was for medical reasons. Then as a plastic surgeon in South Africa, we treat a lot of skin cancer cases. When patients come in with skin cancer again and again, 2 to 3 times a year, we feel that we have to do something here. As I got more people to use vitamin A on their skin, I  started noticing that they were coming in for check ups. People that were operated on 3 times a year, were now coming in for a check up annually and they didn’t have the skin cancer. Then I realized that actually this cosmetic level of vitamin A was managing to reduce the risk of skin cancer."

The Medical Spa Landscape in South Africa:

"In my own practice we don’t sell any cosmetic products. You have to have very separate esthetician offices, and that is pretty true for United Kingdom and most of Europe. There are very few medical spas. You must not forget that lucky for South Africa, an esthetician goes to study 2-3 years at a college before they come in."

"For example, if you go to Ireland they have to go to a university to get a degree before they can become a skin care therapist. So there is a vast difference. In America, true esthetic work is a relatively new concept. Estheticians here are being trained with 300 hours to do things and the equivalent person in Europe and Australia, are going for more or less university courses." 

"I think the American model of the medical spa will come. But it’s not there now. Not significantly. It’s beginning, it’s in its early phases.“

To learn more about Dr. Des Fernandes, please visit his page here

Tags:  Dr Des Fernandes  Environ Skin Care  Med Spa Retail 

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Who Can Legally Fire a Laser In Georgia?

Posted By Aly Boeckh, Tuesday, October 10, 2017

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

The issue of who can and cannot legally operate cosmetic lasers troubles many medical spa and medical aesthetic facility owners and operators. After all, there is no universally accepted licensing procedure for cosmetic laser technicians, and most state medical boards have not taken the time to rule on the subject. However, the Georgia Composite Medical Board has been proactive in addressing the idea that cosmetic lasers are something of a hybrid of medical and non-medical treatment, and it offers cosmetic laser practitioner licenses that permit estheticians, registered nurses, and cosmetologists to legally fire lasers under certain circumstances.

Peachy keen

It is difficult for some medical spa owners and operators to come to terms with the fact that some non-invasive laser treatments are considered medical treatments, and therefore require a physician, nurse practitioner (APRN), or physician assistant (PA) to not only perform an initial consultation, but also fire or supervise the firing of the laser. To many, this seems like an unnecessary use of these medical professionals’ time and resources.

The Georgia Composite Medical Board decided to address this issue by creating a state licensure procedure to clarify who can legally fire certain types of cosmetic lasers, and what procedures need to occur in advance of these treatments. 

First of all, it is important to clarify that this licensure covers only a few types of cosmetic laser treatments: laser hair removal, intense pulsed-light devices, and non-ablative light-based devices. All other cosmetic laser treatments are beyond the scope of this licensure and must be treated as medical procedures, with accompanying initial exams and proper supervision. However, the simple, relatively inexpensive cosmetic treatments this licensure does cover account for a large percentage of the laser treatments administered in the U.S., so the impact of this licensure can be significant.

Georgia’s law creates two levels of cosmetic laser practitioner licenses:
Assistant laser practitioner: This license allows people who hold licenses as PAs, licensed practical nurses (LPNs), APRNs, registered nurses (RNs), estheticians, and master cosmetologists to conduct the cosmetic laser treatments mentioned above without a doctor seeing the patient first or a even being on site. In order to earn this license, a candidate must complete certain courses from accredited laser training schools and meet certain requirements from the state.

A licensed assistant laser practitioner does not require any supervision when performing the treatments covered in this license, which helps improve a medical spa’s flexibility. Having a physician onsite to supervise basic treatments such as these is a major hurdle that these businesses have to clear in order to improve their profitability, and Georgia has provided the mechanism to make that possible. 

Senior laser practitioner: This license permits PAs, RNs, and APRNs to supervise unlicensed individuals who are firing lasers. If an LPN or esthetician, say, does not have an assistant laser practitioner license and a physician is not onsite to supervise, an RN with a senior laser practitioner license does provide sufficient supervision from a legal standpoint, thanks to this aspect of Georgia law. Again, this gives the practice the ability to treat a patient without needing a doctor to see him or her, which could potentially save it a great deal of money. 

As with the assistant laser practitioner license, someone seeking a senior laser practitioner license must complete training courses from state-approved laser training schools. In addition, he or she must have at least three years of experience, as well as three years of clinical or medical technological experience.

The laser’s edge

From AmSpa’s perspective, the availability of these licenses is a major positive, because it provides some clarity in an area of medical aesthetics where, often, there is none. It’s something we in the legal profession always seek—a definitive statement that illustrates exactly what one must do to be compliant. We’re always supportive of efforts by a legislature or medical board to clarify things that need it.

Also, this law creates the potential for medical spas and laser centers in Georgia to see more patients, as well as potentially open more locations with a higher patient flow, because they don’t need to circulate the patients in to see a doctor or NP. However, this still only addresses a small number of laser services, so if you operate in Georgia and have questions about remaining compliant while administering other laser treatments, consult your local health care attorney or work with AmSpa’s national law firm, ByrdAdatto. AmSpa members can view the Georgia legal summary to get an overview on the state’s medical aesthetic laws.

To learn more about this law and others that affect medical spas in the Peach State, sign up to attend AmSpa’s Boot Camp in Atlanta on November 6 and 7. Click here for more information and to register for the Boot Camp. We hope to see you there!
 

Tags:  Georgia Laws  Lasers  Med Spa Law 

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

Posted By Aly Boeckh, Thursday, October 5, 2017

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

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

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

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

Tags:  Med Spa Employee Types  Med Spa Stats 

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FTC Reiterates Social Media Influencer Guidelines

Posted By Aly Boeckh, Tuesday, October 3, 2017

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

Social media influencer marketing isn’t heavily used in medical spas yet. According to AmSpa’s 2017 Medical Spa State of the Industry Report medical aesthetic practices rely most heavily on their website, email marketing, and their own free social media channels to reach new patients. In many other industries, however, online influencers are gaining a lot of attention from marketers looking for effective ways to reach certain demographics.

If you ask a Millennial who his or her favorite entertainers are, you very likely will be introduced to a world beyond movie stars, rock stars, and comedians—the world of social media stars. These enterprising individuals create their own content and broadcast it over social media for the world to see. Although this form of celebrity might seem unusual to some, the potential reach of social media networks is undeniable. YouTube, the ubiquitous video site, claims to have more than 1.5 billion active visitors each month, and Twitter has 328 million active users per month. Some social media celebrities have garnered enormous followings—for example, more than 57 million YouTube accounts subscribe to the channel of controversial video game vlogger PewDiePie (aka Felix Kjellberg).

In marketing terms, these social media celebrities are known as influencers. And because these influencers’ audiences are huge and extremely dedicated, marketing professionals have begun to dedicate a great deal of time and effort to reaching them. This has led to the rise of this new type of marketing known as “influencer marketing,” whereby the influencers are paid to tacitly endorse a product rather than overtly promote it. This is seen by marketers as a way to establish credibility with the influencer’s followers without engaging in the bald consumerism of conventional advertising. What’s more, it has proven to be extremely effective, with advertisers reporting immediate upticks in activity on their social media sites and websites, which translates directly into sales. This is considered to be among the best ways to reach Millennials, a demographic that is known to be notoriously difficult to market to.

Medical spas have not yet engaged in a great deal of influencer marketing, but given the growth of this type of advertising, it likely is only a matter of time before it becomes a part of medical spas’ marketing strategies.

However, the Federal Trade Commission (FTC), which regulates advertising on the airwaves, has issued a statement that warns influencers to be very careful when they engage in this type of marketing, because truth-in-advertising requirements mandate that they very clearly disclose when they are being paid to promote a particular product or service. When you see an advertisement on television or in a magazine, it is very obvious that it is a paid marketing unit; this is because the FTC wants to ensure that the public is fully informed when it is being sold to, because otherwise the ad can be viewed as misrepresentation.

The problem with influencers mentioning products is that often, they do not disclose that they are being compensated. The FTC considers this a problem. Influencers have a great deal of selling power, even though they might not necessarily realize it.

In April 2017, the FTC revealed that it issued warning letters to more than 90 social media influencers. These letters explain very explicitly that the influencers need to be careful, and that they need to disclose very specifically if they are being paid to talk about a product. In a blog post explaining the letters, the FTC offered the following advice:

Keep your disclosures unambiguous. Vague terms like “Thank you,” “#partner,” and “#sp” aren’t likely to explain to people the nature of the relationship between an influencer and the brand. There’s no one-size-fits-all way to make that disclosure, but an unfamiliar abbreviation or cryptic word subject to multiple interpretations probably won’t do the trick. Approach the issue by asking yourself “In the context of this post, how can I make the connection clear?”


Make your disclosures hard to miss. In addition to what you say, consider where you say it and how it will look to consumers on the devices they’re using. People should be able to spot the disclosure easily. But if they check their Instagram stream on a mobile device, they typically see only the first three lines of a longer post unless they click “more.” And let’s face it: Many people don’t click “more.” Therefore, disclose any material connection above the “more” button.


Avoid #HardtoRead #BuriedDisclosures #inStringofHashtags #SkippedByReaders. When posts end with a jumble of hashtags, how likely is it that people really read them? That’s why a “disclosure” placed in a string of other hashtags isn’t likely to be effective.

If your medical spa is using an influencer marketing program or is interested in exploring this type of campaign, make sure the influencers with whom you’re working know the rules governing this type of advertising. If not, they could be subject to severe penalties from the FTC. 

Tags:  Med Spa Law  Social Media Influencers  Social Media Marketing 

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