MedSpa Business Can Be Quicksand for Physicians

Many physicians have come to realize the synergy and profitability of establishing a medspa business for their patients.  Done right, it can be the perfect compliment.  And being “off insurance” is a nice pivot for many physicians, especially those in the cosmetic space (or even many OB/GYNs).  While most physicians starting a medspa already understand about the scope of practice and physician supervision issues for mid-level practitioners, most don’t seriously consider the issue of structure.   In short, care has to be taken when structing these businesses. 

Focus needs to be paid to the Florida Patient Self-Referral Act of 1992, which contains a number of “Stark-like” provisions, including those that impact the ability of a practicing physician to own and refer to the business.  Many physicians may think (wrongly) that cash based businesses aren’t impacted by the PSRA or the Patient Brokering Act (PBA).  Wrong! There is no such demarcation in those laws. 

If the physician is retired or not practicing medicine, the structure issues are mitigated.  But for physicians in practice who own a med spa, they need to understand the PSRA provisions that speak to ownership interest limitations and also to ownership interest disclosure requirements.  While these issues are not insurmountable (and not nearly so daunting as supervising physician qualifications), they are not mere details.  They’re important ones!

Medspa owners often think that the usual (and harsh) healthcare laws, like the Anti-Kickback Statute (AKS), the safe harbors and the Florida Patient Brokering Act (and other state based laws like those related to fee splitting) don’t apply to cash based med spas.  That’s flat out wrong!  There is no such cash v. insurance delineation with these laws.  And while it’s true that the AKS applies only when state or federal healthcare program monies are at play, it’s also true that he PBA requires safe harbor compliance, thus expanding the AKS and safe harbor reach well beyond state and federal healthcare program based businesses. 

Where will medspas see these laws most likely coming to bear?  In healthcare professional and marketing compensation arrangements.  This is where issues like percentage based compensation arrangements, for instance, are specially tricky.  Medspa owners must be tutored on the meaning and application of all the laws mentioned above.  And since the navigation and application of those laws necessarily requires (1) education about the laws, (2) exploration of the options, and (3) a risk assessment for each such option, it’s easy to understand why one size fits none!  If anyone is selling the one size option, run!  They’re (unknowingly) walking right into quick sand.    

IV Therapy Clinics: Take Note of IV Supervision Requirements

As IV therapy clinics become more and more popular, the question to follow is, who can place the IV line and under what supervision? You would expect that first responders like Emergency Medical Technicians (EMT) would be able to start lifesaving IV lines on their own since they are the life support in between an incident and the emergency room. Contrary to what one might think is an “appropriate” ability or function of emergency personnel, under Florida law, EMTs are actually not permitted to place their IV lines on their own outside of an emergency situation. While there might be some very narrow exceptions, the general rule is clear in its prohibition.Continue reading

Medical Spa Industry Is Booming But is Regulation Keeping Up?

medical spa law

medical spa lawMedical Spas nationwide, but specifically in Florida, have been opening up at a staggering pace. For many reasons, including new services, technological advances, and lax regulations, the opportunities for medical spa businesses are endless.

In 2010, there were about 1,600 medspas operating in the United States generating about $1.1 billion in revenue (about $700,000 per medspa on average). By 2018, these numbers increased to over 5,000 medspas generating about $7 billion-$8 billion in revenue (about $1.4 million per medspa on average). The number is expected to grow to over 10,000 medspas by 2023 with about $18 billion-$20.7 billion in revenue.

While medical spa owners have taken advantage of these opportunities, state authorities have yet to keep up. The medical spa industry is largely unregulated, whether that be due to the nature of the services provided, or the explosive growth in this alternative type of medical clinic. On top of that, there’s been a expansion in scope of practice and supervision requirements for certain providers, including nurse practitioners.Continue reading

Aesthetic Clinics and Regulation – What’s Happening?

supervision requirements for medspa

supervision requirements for medspaBy: Chase Howard

Over the last few months, there has been a significant uptick in investigations in the “medical spa” space. The biggest points of enforcement have been in regards to supervision and scope of practice.

The various governing bodies have taken a more active role in ensuring that providers are providing services within their scope of practice as wells as enforcing the various supervision statutes.Continue reading

How to Add Aesthetics to Your Dental Practice

aesthetics dental inject botox

aesthetics dental inject botoxBy: Chase Howard

Botox. Fillers. Lasers. The aesthetic options for patients today are endless with more and more treatments available all the time. The “MedSpa” world is booming, and anyone can get in on the expected growth, including dentists. If you’re a dentist and you’re thinking about adding aesthetic treatments to your practice, you should first consider the following:

  1. Scope of Practice. While most medspas provide full body aesthetic treatments, Dentists are limited to providing treatments that are with her or his scope of practice. For example, Botulinum Toxin-A may be prescribed by a dentist, but is limited to the face and neck of patients. This also means that for nurse practitioners working under the supervision of a dentist, they too are limited in practice. While certain other treatments don’t require any specific medical license or training, dentists should evaluate the type of treatments they wish to provide or supervise to ensure it is within their scope of practice.
  2. Ownership. While medspas may be owned by anyone, including non-licensed providers, Dentists must be careful if taking on business partners due to corporate practice of dentistry. Under Florida law, no person other than a Florida licensed dentist, nor any entity other than a professional corporation or limited liability company composed of dentists may employ a dentist in the operation of a dental office. While most aesthetic services are not dental services, a non-dentist may not directly employ a dentist. Violation of these laws will subject the dentist to disciplinary action. If you’re a dentist in Florida, you can legally add limited aesthetic treatments to your practice. If you’re opening a new business with non-dentist partners, however, you will need to be cautious of these laws.
  3. Keeping Things Separate. Adding aesthetics to your practice carries not only financial risk, but also professional risk. It’s recommended that rather than operate and bill for aesthetic services under your dental practice entity, incorporate a new entity to keep your new business separate from traditional practice.
  4. Regulatory Compliance. Although aesthetic treatments are primarily elective and paid in cash, certain Florida laws still apply to dentists, patients, and marketing and referral arrangements. Dentists must maintain compliance with the Florida Patient Brokering Act when it comes to marketing or referral arrangements. Understanding these laws and exceptions is significant when it comes to avoiding scrutiny.
  5. HIPAA. While it may seem obvious, many believe that because aesthetic services are elective, patient confidentiality does not apply. That is simply not true and providers must maintain compliance with HIPAA, even for such elective treatments.
  6. Training. Anytime a medical business is expanded with the addition of new services, it is vitally important to be well-trained and educated in delivering such treatments. Even if you are not individually performing a treatment that you supervise, it is highly recommended that you be trained in such procedures. Aesthetic and elective services are just as highly litigated by unhappy patients and patients that feel as though a treatment resulted in negative outcomes. Even as a supervising providing, your license is at risk.

While there are many more considerations to adding aesthetic services to your dental practice, the above stated would be sufficient to get a dentist in Florida started on the path to adding a new line of business to their traditional practice.