Is Private Equity Coming For MedSpas?

Over the last 12 months, one of the top trends we’ve seen in the Medical Spa industry is private equity coming to town and buying single and multi-location medical spas. Private equity comes in all shapes and sizes but after years of growth, the industry is ripe for consolidation and roll ups of smaller clinics. Much like the influx of private equity into dermatology clinics, we’re seeing a similar trend in medical spas. So what does this mean for you? Opportunity! Whether that means selling and fulfilling an exit plan or branding your medical as the alternative to a larger group. Either way, the time is now to prepare for what is coming to this industry.

Good Faith Estimates Are A Go

Prepared by: Carlos Arce, Esq.

Florida Healthcare Law Firm

The United States Department of Health and Human Services (“HHS”) released that more than 90,000 claims were filed in April 2022 through the independent dispute resolution portal via CMS’s website.[1] This has caused an overload in submissions which CMS was not prepared to address.

CMS has opened a rulemaking style “frequently asked questions” portal where providers can submit questions for answers. A few of these questions include the following: 1) Are providers or facilities required to provide a Good Faith Estimate (“GFE”) to individuals who schedule a same-day appointment or are walk-ins? CMS answered, “No. The requirement to provide a GFE to an uninsured (or self-pay) individual under 45 CFR 149.610 is not triggered upon scheduling an item or service if the item or service is being scheduled fewer than 3 business days before the date the item or service is expected to be furnished. For example, if an uninsured (or self-pay) individual arrives to schedule same-day laboratory testing services, the laboratory testing provider or facility is not required to provide the individual with a GFE; and 2) How do providers and facilities address situations where unforeseen items or services that were not otherwise scheduled in advance are furnished during a visit? CMS answered, “The interim final rules do not require the GFE to include charges for items or services that could not have been reasonably expected. A GFE provided to uninsured (or self-pay) individuals must include an itemized list of items or services that are reasonably expected to be furnished, grouped by each provider or facility, for that period of care.

As noted above the GFE is effective and operating under its interim final rules, which mean that the law is in effect, but changes are being done to it as we speak. There is lawsuit pending in  Texas, where the validity of the independent dispute resolution is being questioned. We expect to see changes in 2023.

For now these are the top codes which are being disputed per the data CMS released: Emergency department services (CPT codes 99281-99288), Radiology (70010-79999), Anesthesia (00100-01999), Surgery (10004-69990), Pathology and lab (80047-89398), Neurology and neuromuscular procedures (95700-96020), Critical care services (99291-99292), and Cardiovascular procedures (92920-93799), Hydration, therapeutic, prophylactic, diagnostic injections and infusions, and chemotherapy and other highly complex drug or highly complex biologic agent administration (96360-96549).

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Attorney Carlos Arce works with the Florida Healthcare Law Firm in Delray Beach, FL. He has deep experience with bodily injury trial work and in health law. Carlos has handled multi-million-dollar healthcare transactions and serves as out-of-house counsel to various small to large types of healthcare entities. He can be reached via email at [email protected] or by calling 561-455-7700.

[1] Top No Surprise Act CPT Code Disputes, Patsy Newitt, Becker’s ASC Review: https://www.beckersasc.com/asc-news/top-no-surprises-act-cpt-code-disputes.html?utm_campaign=asc&utm_source=website&utm_content=latestarticles

What are biggest trends in the Medspa industry?

Over the last 12 months, I’ve seen a consistent trend in the “MedSpa” industry. Three services have become more popular amongst Medspas either as a stand alone service or add-on to existing services.

  1. Hormone/Vitamin Therapy
    1. Patients are looking for the next best thing to them an edge in performance and vitality. Hormone and vitamin therapy has become increasingly more popular and available.
  2. IV Hydration Therapy
    1. Possibly the hottest trend in healthcare are IV hydration therapy clinics. Whether they be brick and mortar or mobile, IV services have seen a large increase in demand. With relatively low barrier for entry and overhead, IV hydration has become a main focus of Medspa operators over the past year.
  3. Lasers
    1. With advancements in technology and possibilities, laser services for skin treatments have become more available and affordable. While there are many device manufacturers on the market, some are able to assist their clients with turning the use of those lasers into serious financial drivers of Medspa revenue.

Do you need a medical director if you’re autonomous?

Autonomous practice for advanced practice registered nurses (“NP”) was a monumental change in law in 2021. Since then, NPs that qualify for autonomous practice have jumped at the opportunity to expand their offerings and create opportunities for themselves through a self-owned clinic, including Medspas and IV clinics. But where is the line for when an NP needs a medical director, or supervising physician, and when they don’t?

 

Florida’s autonomous practice law allows qualified nurse practitioners (2 years or 3000 hours supervised practice) to practice only in primary care practice, including family medicine, general pediatrics, and general internal medicine. The Florida Board of Nursing last updated its definition of “primary care practice” in February 2021 to include: “physical and mental health promotion, assessment, evaluation, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses, inclusive of behavioral and mental health conditions.” This would allow autonomous NPs to provide wellness services without supervision but not aesthetic services.

In Florida, when a physician supervises an NP that is at a location other than the physicians primary practice location and the NP is performing primarily dermatologic or aesthetic skin care services, the physician must be board certified dermatologist or plastic surgeon, within 25 miles of the physician’s primary practice location. The physician is limited to supervision of only one additional office location. If you are not primarily offering these services, then the specialty is not addressed under Florida law.  

The requirement of having a medical director, or supervising physician, is primarily dependent upon the services that you provide.