Medical spas have exploded across the country in the last few years. States have rushed to pass legislation and create regulations to keep up with this industry growth in order to ensure patient safety and maintain proper medical standards. Some states have cracked down hard to control ownership and operations of med spas, while others remain fairly unrestricted.
What is a Med Spa?
A med spa is exactly what the name describes: medical treatments targeted to the spa crowd. In other words, treatments that would ordinarily be given in a spa but that require a medical license to supervise or perform. Examples of these treatments include:
- IV hydration
- Intramuscular injection of nutrients
- Skin treatments using medical-grade lasers
- Botox and other medical injectables
- Removal of skin tags and other growths using a scalpel or liquid nitrogen
- Microneedling deeper than 0.3 mm.
- Medical weight loss.
Any cosmetic/spa-like treatment or procedure that requires a licensed medical provider to prescribe or administer is considered a med spa.
Ownership
A med spa is considered a medical practice. The name designation does not change this. And as with any medical practice, ownership is governed by the Corporate Practice of Medicine (CPOM) restrictions of each state; see Corporate Practice of Medicine in these articles. For example, states like New York only permit MDs or DOs to own a med spa. California requires that these professionals own at least 51% but restricts minority ownership to only certain licensed healthcare professionals. In fact, California has several restrictions on med spa ownership that are extremely involved and often difficult to understand. By the same token, Texas requires ownership by a physician but does not require a particular amount. However, it will not allow nurses to have any ownership whatsoever in a med spa.
Providers and Supervision
Who may perform or supervise a particular procedure depends on the procedure. For example, an RN may administer an IV but cannot inject Botox. The licensed provider acting as the medical director must be specifically trained in the procedures he or she is supervising, even if the supervised personnel have appropriate licenses, training, and experience. In addition, in many states a supervising provider must be available in person to evaluate and initiate care for a patient with a suspected adverse reaction or complication and must be physically located within a certain radius of the facility. In some states, a med spa must have at least one physician or nurse practitioner on premises while procedures are being performed. |
Good Faith Exams
A good faith exam (GFE) is a fancy term for an initial patient visit. During this visit, a provider with a proper license performs an examination of the patient and creates a treatment plan. While RNs are allowed to take patient history, only a physician assistant, nurse practitioner, or physician may perform a GFE and create a treatment plan. In most cases, the GFE can be performed via telehealth, and the provider does not usually need to personally speak or interact with the patient to create a treatment plan. The provider only needs a direct telephone or video encounter when it is necessary to determine something essential to the treatment plan or otherwise maintain the proper standard of care. However, some states require an interaction by at least telephone to satisfy a proper GFE. Standing orders may not be used for a new patient or a patient seeking a new treatment.
Non-Medical Procedures
Some cosmetic procedures do not qualify as medical. Generally, these are not governed under state med spa laws. However, some med spas offer these in their menu of treatments, and a medical provider can supervise most of them. Either way, these non-medical procedures are still governed by the laws and regulations pertaining to the cosmetology profession.
Management Services Organizations
Many people who want to have ownership in a med spa but are prohibited because of corporate practice of medicine restrictions in their states opt to create a Management Services Organization (MSO). This allows the owner to work with a medical practice and make money by performing the business and management services for the practice. It is in essence a form of profit sharing without actual ownership in the practice. Nevertheless, if an MSO owner is a licensed healthcare professional, he or she might also be eligible for minority ownership in the practice. MSO arrangements must be set up on a state-by-state basis, carefully navigating all the laws and regulations of that particular state. See MSOs in these articles.
Important Considerations
Med spa owners need to consider several important aspects of operating a med spa and making key decisions such as:
- Who will act as the medical director
- What license is required for a medical director in the state
- Which procedures require a medical director to supervise
- Which procedures require a licensed supervisor to be physically on-site
- Who can perform certain procedures with what license
- Does the med spa need a certain facility license from the state
- What type of business entity does the med spa need to be filed as
- Medical waste disposal
- OSHA and HIPAA requirements
- Other state filings or requirements
- Employment agreements
- Patient consent forms and other legal protections
- Supplier contracts and other third-party agreements.
Let us help guide you in making these decisions and launching your med spa!