Why Medical Spas Fail Reason #7: Lack of Systems in Your Practice

June 16, 2011 3 comments

In the book, “The E-Myth Physician”, Michael Gerber teaches us that unless your practice can be duplicated, it will never run without you.  According to Gerber, if you don’t have systems, then your aesthetic business will ultimately fail because you as the owner must keep all of the plates spinning in order to keep everything functioning.  Unless you train your employees to operate your clinic without you always having to be looking over their shoulder, you and your business will suffer from burn-out.  Systems and procedures are necessary for the long-term success of any business.

Perhaps the hardest area for doctors to address in their aesthetic practices is daily operations.  In each practice there are hundreds of daily routines and processes that take place. These processes are the methods in which things get done by our team members (support staff, laser technicians and consultants). This includes how the phone is answered, how consultations are scheduled, who is responsible for what services, how payments are collected, what paperwork clients fill out, how clients are greeted when entering the office, how clients are placed into the treatment room, how aesthetic treatments are performed, how consultations are conducted and measured, how charts are pulled and organized, and who is ultimately responsible for what.

Each of these areas can have a significant effect on the experience a patient has in your clinic and the profitability of your practice.  The importance of these areas should not be under -estimated.  If you find yourself working longer hours, getting paid less, feeling less in control and not having fun, then you need to develop an E-Myth practice.

Below is a list of the areas that should be systemized within your aesthetic practice:

Operational Procedures

A. Pre-Opening Procedures
Business Opening Checklist & Timeline
Establishment of Business Guidelines
Securing a Location
Building Out Your Site
Setting Up Bank Accounts
Getting Insurance
Meeting Your Tax Obligations
Required List of Equipment
Initial Inventory
Conducting a Grand Opening

B. Human Resources
EEOC Guidelines
Laws Regarding Harassment
Immigration Reform Act
Wage & Labor Laws
Job Descriptions
Employee Profile
Recruitment
The Employment Application
The Interview Process
Introductory Period
Developing Personnel Policies
Employee Orientation
Training
Time Reporting
Compensating Staff
Uniform / Dress Code
Performance Evaluations

C. Office Procedures
Suggested Office Hours
Customer Service
Client Retention
Daily Activities
Confirming Appointments
Checking Out First Time Clients
Checking Out Regular Clients
Accepting Payment
Processing Auto Debit Payments
Merchandising Retail Products
Inventory Management
Generating Business Reports
Maintaining the Office
Safety and Security

D. Sales
Scheduling New Client Appointments
Established Client Appointments
Greeting Clients
Conducting Consultations

D. Clinical Procedures
Clinical Certification
Treatment Programs
Greeting Regular Clients
Taking Clinical Photographs
Clinical Chart Documentation
Clinical Follow Up Calls
Laser Safety
Clinical Equipment Maintenance

F. Advertising
Calculating Advertising ROI
Internal Advertising Strategies
External Advertising Strategies
Required Advertising Expenditures
Public Relations
Community Involvement
Obtaining Advertising Approval

Written Medical
Treatment Protocols

Step by Step Clinical Treatment Protocols & Procedures
Laser Hair Reduction
NdYAG 1064
Photo Facial
Fractional Resurfacing
Spot Testing
Set-up & Operation of Soprano
Set-up & Operation of IPL
Care & Maintenance of Lasers
Infection Control
Exclusionary List
ST Handpiece
Eye Protection
Laser Safety Precautions
Laser Committe
Q Switch
Laser eyewear inspections
LSO Responsibilities
Laser Safety Index
Sclerotherapy
Restylane and Juvederm
Levulan
Jessner Peel
Botox
Cosmelan
DermaSweep
Tooth Whitening
Other Tx Index
Accent
Portrait PSR 3

Home Care Instructions

Thermage
Fractional
Photofacial
Portrait
Hair Removal
Restylane and Juvederm
Jessner Peel
Tattoo Removal
Microderm
Botox
Cosmelan
Levulan
Laser Vein
Accent Home Care
Lipolysis
Sclerotherapy
Teeth Whitening

Consent Forms

Arbitration Agreement
Thermage
Fractional
Photofacial
Portrait
Hair Removal
Restylane and Juvederm
Jessner Peel
Tattoo Removal
Microderm
Botox
Cosmelan
Levulan
Laser Vein
Accent Home Care
Lipolysis
Sclerotherapy
Tooth Whitening

Medspa Build Out
Design
Full Color Floor Plan
Interior Elevations
Storefront Elevation
Interior Finish & Color Board
Interior Finish Schedule
Interior Finish Listing
Door & Frame Schedule
Glass & Glazing Products
Storefront Sign Panel
Lighting Fixture & Ceiling Information
Retail Display Elevations
Furniture Information & Prices
Cost Reduction Options
Vendor List

Clinical Chart
Documentation

Chart Organization Guide
Master Chart Checklist
History & Physical Exam
Sclerotherapy Progress Notes
Microderm & Peels Progress
Laser Hair Progress Notes
Cosmetic Filler Progress Notes
Tattoo Removal Progress Notes
IPLProgress Notes
Portrait Follow-Up logs
Technician Daily Checklist
Fillers Flowsheet
Body Contouring Analysis
Hair Removal Flowsheet
IPL Flowsheet
Nd Yag Flowsheet
Accent Flowsheet
Fractional Flowsheet
Client Intake Profile
Portrait Treatment Log
Tattoo Removal Progress Notes

Administrative &
Employee Forms

Spreadsheet Cashflow ProForma
Automatic Payment Form
Package Treatment Plan
Treatment by Treatment Plan
Master Price Book
Front Desk Operations
Front Desk Certification Manual
Refund Policy
Opening Receptionist Checklist
Closing Receptionist Checklist
Employee Forms
Uniform Specifications
Employee Evaluation
Employee Warning Notice
Employee Status Change Form
Reference Check
Interview Report
Interview Questions
Application for Employment
Office Policy Manual
Orientation Checklist
Form I-9
Time Sheet
Vacation Request
Corrective At Will Action Notice
Employee Policies Handbook
Employee Accident Report

Medspa
Business Plan

Executive Summary
Strategic Objectives
Mission Statement
Products and Services
Clinics in Operation
Consolidated Profit/Loss
Market Analysis Summary
Market Segmentation
Buying Patterns
Competition
Competitive Advantages
Physician Recruitment
Staff Recruitment
Staff Training
Marketing Strategy
Sales Strategy
Implementation Strategy
Management Team
Liability Protection
Funding Request & Overview
36 Month Pro Forma P&L
36 Month Expansion Pro Forma
Corporate Support Expenses
Cash Flow Per Clinic
Per Clinic Start Up Cost

This business plan successfully funded the build out of multliple aesthetic practices. It can also give your existing practice new ideas on how to improve and enhance your operational performance.

A template for these systems is available by following the link below.  It is called Medspa in a Box and it is offered by the following company:

www.SkinSalesTools.com

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

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How to Negotiate the Purchase of a Used Medical Laser

June 16, 2011 Leave a comment

Successful negotiation for a used medical laser comes from having solid information.  This is particularly true when buying a used medical laser.  Before beginning negotiations you should conduct online research on the availability and price of the lasers you are looking for.  An excellent resource for the value of used laser equipment is the area on Medical Spa MD where you can buy and sell used cosmetic lasers.  If a certain kind medical laser is for sale, it is normally available on Dotmed.  You should be able to get an average asking price for the laser you are looking to purchase.  You can use this information as a basis for negotiating the price if it appears that the broker’s asking price is too high.  Knowledge is power, and this is especially true in the used laser market.

If brokers justify a higher price because the laser is in good condition, it has a low pulse count, or it has been recently “refurbished” or serviced, then you need to ask them to provide documentation or proof of such claims.  In many cases, brokers will often raise their prices slightly to allow discounts when a buyer asks for one.  Keep in mind that the critical issue is not to just get a discount for discount’s sake, but rather to buy the laser at or below the prevailing market value.  Follow these guidelines when negotiating:

  • Only enter into negotiations with a broker with whom you feel comfortable and who may have been recommended by a fellow physician.
  • Make an opening offer that is low, but in the ballpark.
  • Decide ahead of time how high you will go and back away when your limit’s reached.

In addition to negotiating the price, you should also be aware of what standard accessories should come with the laser.  You need to require that the broker is very clear what is included in the price.  Common accessories are:  Keys, Operators Manuals, Treatment Parameters Guide, Operator Eyewear, Patient Eyewear, Footswitch, Cryogen, Treatment Tips, Light Guides, and Hand pieces, Additional Fibers, Water Refill Kits.

To be safe, some lasers should be installed by a laser service technician after it is delivered to your practice.  Ask your broker if this service can be offered with your laser purchase.  This usually costs extra, however it can be very worthwhile to ensure that the unit is set up properly and that no accidental misuse occurs.  If you have never operated the laser you intend to purchase, this is especially important.  You should also make arrangements for training if you have never operated this laser.  The laser broker can often arrange for training and you can ask that he build the cost of training into the purchase price of the laser.

Once an agreement has been made, you need to make sure the broker provides you with a detailed invoice that includes all items you will be receiving along with any guarantees that are being provided.  If the laser includes a warranty, be sure the warranty is clearly spelled out regarding exactly what it covers and the time period.  Once this is complete, it is time to prepare for shipping the laser to your clinic.  Be sure to verify that shipping insurance is provided on the laser during transit for the full purchase price.  Your worst nightmare would be the laser is damaged during shipment and you cannot get your money back from the broker.  Having insurance allows for reimbursement in the event an accident happens during transit.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

Used Medical Laser Financing

June 16, 2011 1 comment

Once you have found the used medical laser you want to buy, you have three ways to pay for it:

  1. Cash.  Need we say more?  Money talks, you know-what walks.  If you can close quickly on a laser purchase you can normally negotiate a larger discount.  Cash is the fastest way to close on anything and can save you significant dollars if you have it available to buy a laser.  If you have the liquidity, you can bring down the price by promising to pay same day or next day.  The ability to buy quickly from the seller always gets their attention and is an excellent way to save money.
  2. Credit Card / PayPal.  Not all laser brokers accept credit cards, but if they do, this is the safest way to go because you can dispute a charge if you’re having trouble with the laser or it isn’t what you were promised.  Always ask the laser broker if you can pay by credit card.  If you can’t pay the entire amount, perhaps you can pay some percentage of the payment with a credit card, sometimes up to 25 – 50%.   In my opinion any reputable used medical laser broker should accept credit cards for all medical laser purchases.  It is one of the key ways of showing they are reputable and that they stand behind the lasers they sell.
  3. Third Party Leasing.  You will typically pay a higher rate of interest if you choose to finance a used laser, in upwards of 12 to 18%.  You need to personally guarantee most laser leases, which isn’t fun, and you normally can’t pay off the lease early without a prepayment penalty.  You need to carefully review any type of lease agreement, especially for pay-off terms.  Ideally you would like to have a lease that is similar to a loan in which you can pay it offer early without any interest penalties.

It can be difficult to secure a lease, especially with the tightening credit markets.  Capital equipment makers, who had seen aggressive growth and comfortable margins before the economic slowdown, were hit hard when tight credit left few physicians available to buy big-ticket items.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

Stay Away From Medical Lasers That Are Not FDA Approved

June 15, 2011 1 comment

There are several manufacturers from China who are now promoting their aesthetic devices on the internet and Ebay.  While it is tempting to try these devices out and buy them due to their inexpensive price tag, the vast majority of this equipment is not FDA approved.   Section 510(k) of the Federal Food, Drug, and Cosmetic Act requires that all medical device manufacturers must register to notify FDA, at least 90 days in advance, of their intent to market a medical device.  Most foreign manufacturers have not done this.  Is is therefore illegal to use these devices in the United States.

It is extremely risky to be using any equipment that is not FDA approved.  It is very important to use only FDA approved devices and substances.  If anything were to go wrong during the treatment, the fact that a patient was given an FDA approved treatment limits your clinic’s liability dramatically.  In addition, you could be prosecuted by the FDA which is something don’t want to have happen.

As long as you follow the guidelines for use with those FDA approved aesthetic devices, you are on very safe ground.  A large portion of the liability is shared by the manufacturer, and most plaintiff’s go after the entities with the deepest pockets, which are typically the manufacturers.  If you are using a medical device that does not have FDA approval, you are on very shaky ground and if trouble arises, you could be the one left “holding the bag.”

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

Stay Away From Used Medical Laser Equipment That is “Too Old”

June 15, 2011 1 comment

It may be tempting to buy older medical laser equipment because of the great price, however you must be extremely cautious about this.  The newer equipment on the market has become more user-friendly and safer to use.  Using older technology can be much more “expertise” driven and in the wrong hands, can have disastrous results.  Some of the problems with older technology is inadequate cooling on the skin, a lack of ongoing calibration and maintenance, and a poor user-friendly interface that helps ensure the operator provides a safe treatment.  While newer equipment can never replace someone who has been properly trained in the safe user of lasers, it goes a long way to help prevent adverse reactions from occurring in the first place.

Ideally, you want to buy a laser that has seen little use that is no greater than 3 or 4 years old.  If you go too far beyond this point, you can run into a lack of third party support for the laser and a lack of people who can repair it or find replacement parts.  It can also be too outdated and more dangerous to use.  That said, some technology has not changed dramatically over the past 8 or 9 years and it may still be worth a look, laser hair removal being a prime example  If you find a laser with a low pulse count that is an older model unit (Candela Gentlelase for example), find out if the same unit is still manufactured today.  If it is, then obsolescence may not be a problem and you can potentially get a really great deal on a very effective and reliable laser.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

Why Medical Spas Fail Reason #6: Poor Liability Protection

June 15, 2011 Leave a comment

Liability protection is not just about properly medical malpractice coverage, it’s about several layers of protection within your aesthetic practice that help to insulate you from the potential you will be sued.  While you can never completely protect yourself from lawsuits, the following areas can serve as extra layers of protection:

1) Newer, Safer Equipment.  The newer equipment on the market has become more user-friendly and safer to use.  Using older technology can be much more “expertise” driven and in the wrong hands, can have disastrous results.  Some of the problems with older technology is inadequate cooling on the skin, a lack of ongoing calibration and maintenance of the older equipment, and a poor user-friendly interface that helps ensure the operator provides a safe treatment.  While newer equipment can never replace someone who has been properly trained in the safe user of lasers, it goes a long way to help prevent adverse reactions from occurring in the first place.

2) A Very Client-Friendly Practice.  It is important that your practice develops client friendly procedures within your practice.  Some of these include:  all clients who have received a procedure should receive a follow up clinical telephone call the day after treatment to make sure they are responding well to treatment.   Research has shown that most malpractice problems arise when patients feel they have no other recourse but to sue.   You should encourage your customers to contact you if they are dissatisified for any reason.   If they have any concerns regarding their treatment, you want to hear from them.  Doctors are required to be accessible telephone if they need to contact any client who is concerned for any reason.

3) Consent Forms Signed by Each Client.  Prior to receiving any treatment at your clinic, your clients should be required to read and sign an informed consent form that explains the risks associated with the treatment they are undergoing.  Typical risks include blistering, hyperpigmentation, and hypopigmentation.   In the event any of these adverse events happen to any client, you have signed a consent form that documents the client was aware of the risks prior to undergoing treatment.  If legal action is taken, you will have the consent form as proof that the client was aware of the risks of treatment.  Adverse events are very rare, however, and typically resolve over time so there is no lasting negative effect.  If no permanent damage remains, then there is no case for legal action.

4) Using FDA Approved Devices and Cosmetic Substances.  It is important to use only FDA approved devices and substances.  If anything were to go wrong during the treatment, the fact that a client was given an FDA approved treatment limits your clinic’s liability dramatically.  As long as you follow the guidelines for use with those FDA approved substances and devices, you are on very safe ground.

5) The Issue of Permanent Damage.  In order for a malpractice suit to hold up in court, there must be evidence of permanent damage.  In virtually every case with non-invasive cosmetic procedures, any damage caused to the client is typically temporary.  A good example would be hyperpigmentation.  In every case, hyperpigmentation will go away, leaving NO causation for someone to sue the center.

6)  Onsite Physician Providers.  The vast majority of reported lawsuits stemming from cosmetic procedures have been performed by poorly trained non-physicians who did not receive adequate physician supervision.  Having an on-site physician who has been trained and certified to perform and supervise all clinical procedures allows you to bypass a lot of the potential pitfalls of a standard “Medspa”

7) Arbitration Agreement Signed by Each Patient.  A signed arbitration agreement should be required of every client prior that undergoes any treatment offered at your clinic.  The arbitration agreement requires that any dispute that arises between a client and your practice will be determined by submission to arbitration as provided by state law and not by a lawsuit.  Both parties give up their constitutional rights to have any dispute decided in a court of law before a jury, and instead are accepting the use of arbitration.

8)  Professional Liability Insurance.  The final layer of protection is professional liability insurance.  You want to make sure you have a policy that covers both the physician and all individuals who are performing any aesthetic treatment under the doctor’s supervision.  The good news is there are now many insurance programs available for aesthetic practices and the price for coverage is very competitively priced.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097

Why Medical Spas Fail Reason #5: No Physician Ownership

June 15, 2011 1 comment

If you don’t have a doctor involved in your medspa, this could be the kiss of death to your business.

A major key to success for aesthetic practices who have weathered the recession has been the use of doctor-owners who provide high-end treatments and oversee the care delivered at each clinic.  Doctors should be viewed as profit centers who provide a substantial amount of the high-end services offered at each clinic.  This allows you to provide treatments that many competitors cannot at their facilities such as CO2 Fractional Skin Resurfacing, Laser Lipolysis, Body Jet Body Contouring, Fat Grafting, Laser Tattoo Removal, and other physician-based treatments.

The use of doctor-owners also increases customer-confidence and is used as a strong selling point to customers as they build relationships of trust with the doctor and other staff members.  In the event of an adverse reaction or customer concern, the value of a dedicated, full time physician to address customers’ concerns cannot be underestimated.  The vast majority of reported lawsuits stemming from cosmetic procedures have been performed by poorly trained non-physicians who did not receive adequate physician supervision.

Vin Wells, MHSA
www.RockBottomLasers.com
800-794-1097