It’s been dubbed the spa of the future, but the medical spa is as old as “taking the waters.” Based on Hannelore Leavy, founder and executive director during the day Spa Association, European spas have been medical, focused on mineral springs and waters. “Treatment was and yet is prescribed and monitored by way of a physician,” said Leavy within an interview from her office in West Ny, N.J. Spas established in this country’s early history were also employed for medicinal cure, but a transition occurred about mid-twentieth century, essentially phasing out medicine and emphasizing beauty treatment. American spas are actually coming full circle, going back to their roots of integrative wellness.
Water therapy extends back many many thousands of years, having been employed by highly-developed, ancient civilizations for treating disease and through primitive shamans for purification of body and spirit. Through tradition and legend, continued use of some locations of mineral springs brought about the establishment of healing centers. The spas of Roman times included elaborate bathhouses where a multitude of treatments associated with healing were offered. Roman expansion and invasion left its mark and spas flourished for years and years on European and Commonwealth soil. Two such locations, Bath in England and Spa in Belgium, are appropriately named and on the list of more historically famous.
Europeans immigrating to America throughout this nation’s early settlement brought along with them the “old country” reasoning behind the spa. Already popular by Native Americans, medicinal treatment at natural springs became a well established “cure all” provided by coast to coast, ultimately causing your building of exclusive spa resorts. Within an age where medicine was still according to what we should today term alternative therapies, integrative care was the norm. But as health care became more medicalized, plus a booming industrial society became more beauty-conscious, both the separated paths. Medicine moved in to the hospital and clinic and spas became pampering salons for that wealthy, a trend that remained strong for several years.
What is different and why are medical spas sprouting up now? The solution has lots of facets. Among them, the improving demand for services by today’s consumer for alternative therapies and dexnpky83 treatment; a focus on preventive wellness care; and a medical system that’s been overwhelmed with insurance dictates, paperwork and restrictions on service.
Dr. Michelle Palmer, an esthetics educator and naturopath using a doctorate in alternative therapies, set up her first medical spa 10 years ago. From her headquarters in Phoenix, Ariz., Palmer offered her handle the existing trend. “I’ve always had a passion for working with the person overall. Bodywork, naturopathic and esthetics; that for me may be the future. There’s an enormous market with naturopaths.” There’s a good course now offered for nurse practitioners and bodyworkers to get naturopath practitioners. “I think Sept. 11 changed plenty of directions. The better aggressive treatments are down. Today everyone is over-educated, although the advantage is the fact that patients want total care and lighter treatments.”
Just two simple words, and yet, over the board and during the entire industry, there is no consensus concerning what exactly los angeles med spa is and should be. That’s not surprising in light of the truth that the relationship between medicine and spas is pretty new in your modern experience.
Typically, Americans have come to expect a routine of sorts in medical care: being ushered inside and outside as quickly as possible via a stark (sometimes emotionally, along with physically) environment, being poked and prodded and after that dismissed having a prescription, order for lab tests or possibly a “come again, same time next year.” We could feel assured our health and wellness is intact, but repeating the ability can simply wait another year, thanks a lot. However, our relationship with spas has been among romance — pampering and personal attention, soothing touch and a feeling of rejuvenation upon leaving the premises. Combining both the, in a sense, has turned into a conundrum. Wellness centers, doctors’ offices with spa services, spas with medical exams, anti-aging treatments and spiritual guidance — the ones that qualify being a medical spa? And that will determine that definition?
According to Marian Urban, a leader inside the medical spa movement and managing editor of Medical Spas magazine, the saying “medical” is extremely important. Speaking from her office in Santa Fe, N.M., she said, “The medical spa may be the European concept. It’s nothing new; that’s how they maintain their own health. Irrespective of how you add it, a medical spa must have a doctor on board, and it has to be a complete-time position.” Even in a licensed facility, if you have no medical doctor on staff, there may be a liability issue. “It’s just how of the future,” she said, “but it must be investigated thoroughly. You can be facing liability in the lawsuit. A medical spa is not just a face.”
Generally, the general public has associated medical spas with cosmetic surgery and also other beauty-related procedures, but Urban indicates how the medical spa these days targets total wellness in the individual. “You will find all sorts of physicians arriving, a broad scope. It’s not only a place you will have a facelift. It is possible to spend every week and have a whole battery of tests run for a complete picture of health. In my view, medical spas will likely be a healthcare facility for the future, for anyone looking for alternatives.”
Leavy views the medical spa arena as two very different modalities. “You have the doctor’s office that adds on spa services, like homeopaths, internists, dentists or plastic surgeons. Doctors are finding that spa services are helpful to their patients, for relaxation, to relieve anxiety, and also as medically beneficial, for example pre- and post-surgery. In skin diseases, it will help with all the recovery process of the patient. They are also realizing these things will not be included in medical health insurance and individuals are likely to pay a lot for this. They don’t need to bother about HMOs. It is an important factor for doctors, to escape paperwork and medical health insurance. They could earn income that’s not regulated by medical insurance. Research has shown that men and women will alternative practices and spending more cash for alternative remedies than on regular doctors.
“However, there’s the spa aligning itself with all the medical. Sometimes they must use a medical director, if it’s just what the state requires.” Leavy also emphasizes the demand for staff to become educated in what to look for in referring a person for medical consultation. “A spa therapist should certainly tell the difference between an age spot plus a melanoma.” The spa therapist, as based on Leavy, is someone trained as an esthetician (also as being a masseuse) who may have basic understanding of spa treatments as well as a substantial knowledge of our bodies and ailments, and contraindications of certain treatments.
According to Palmer, the medical industry may have the last say in defining the medical spa. “Whatever they (facilities and staff) are performing, medicine will be responsible. They’re gonna regulate it.” It may be a phenomenal team with doctors and estheticians, she said. A doctor is definitely an M.D. or D.O. You can add an R.N., esthetician, massage therapist, nutritionist among others to create a complete medical spa team. The most important aspect of this, she noted, has the appropriately-trained staff member for each and every treatment.
While consensus as to definition, defined purpose and guidelines for that operation of medical spas still hangs in limbo, most skilled professionals appear to agree that a person is forthcoming. Through conferences, symposiums and personal encounters, attempts are being intended to formally gather opinions and set industry standards. In June 2002, the National Coalition of Esthetic Related Profession Associations (NCEA) hosted a wide open forum to share with you viewpoints and discuss future directions, devoting a full session to medical problems. The Medical Spa Conference, sponsored with the Spa Professionals Alliance and scheduled for November of this year, has as its headline “How can we discover a balance between your spa profession along with the medical profession?” Organizers want to increase awareness and knowledge from the field, said Urban of the conference. “The focus is usually to enhance education and have people talking one-to-one, as opposed to get it become a large trade show. Our company is discovering individuals who have been utilizing medical spas for many years, but haven’t desired to make use of the term medical because they’re afraid. It’s not really a light word to utilize.”
May be the doctor actually in the house? Or even, there may be trouble in paradise. While some facilities took on full-fledged medical directors, others have contracted for any name along with an occasional personal appearance. What responsibilities fall under the title of medical director in a spa and why is full-time presence so necessary?
Susanne Warfield is president and CEO of Paramedical Consultants, Inc. and publisher of PCI Journal. She also functions as executive director of the NCEA and the Society of Dermatology SkinCare Specialists (SDSS). As a leading expert around the business aspects, she addressed several issues that must be considered regarding medical facilities, medical directors and federal and state regulations.
Speaking in a interview from her Glen Rock, N.J., office, Warfield said, “I contacted the medical director’s association and they also have no such definition for the medical director inside a medical spa. It’s a gray area. If the medical director is actually a health care provider, will they be the one whose name is going on the leasing or purchasing contract of your medical device for use in a spa?”
Under federal regulation, any piece of equipment for sale goes through a classification procedure from the Food and Drug Administration (FDA). How the government classifies a product will determine regardless of whether it can be labeled as “prescriptive,” meaning only a prescriptive user can order its purchase. “Then it’s up to each state to find out who can use that device by prescription,” said Warfield. In many states, the transaction for purchase has limitations to physicians. Federal laws not only include medical devices, noted Warfield, but also cosmetics. “Could they be drugs? And in some states, their state boards of cosmetology will be going after medical spas as they are not properly licensed together with the state board of cosmetology.
“Another point out consider will be the Occupational Safety and Health Administration (OSHA),” said Warfield. Under OSHA are three areas of medical regulation that can affect medical spas.
– The Bloodborne Pathogen Standard requires facilities to obtain in place an exposure control arrange for blood or other potentially harmful body materials. “Are the estheticians wearing vinyl gloves to do facial and the body treatments that would place them vulnerable to exposure?” asked Warfield. “In my opinion, these treatments place you at risk.”
– The Health Risks Communication Standard involves hazardous materials on the job. For instance, glycolic acid is still considered a hazardous substance. The American National Standards Institute (ANSI), now adopted by OSHA, regulates using lasers. “If the facility has invest a laser, they are checking out compliance with safety for this,” said Warfield.
– Medical spa owners also require to be aware of the Clinical Laboratory Improvement Amendments (CLIA), which regulate the standard of all laboratory testing (except research) performed on humans in the usa. Some medical spas are doing hair analysis, staining procedures and live blood cell testing. Being a hospital, CLIA regulations will likely be applicable. “You can’t just put out a shingle and begin to complete many of these things,” said Warfield.
Regardless of if the business is known as hospital or medical practice, compliance using these regulations will be required. In each state, the board of medicine will determine if certain equipment works extremely well by physicians only or under physician supervision. In a survey of state medical boards conducted this season with the American Electrology Association, 13 states have restricted consumption of laser for hair removal to physicians only, with another seven allowing its use by others under direct physician supervision. “In addition there are delegation rules with regards to who a health care provider can delegate responsibility to which varies state to state,” said Warfield. “Also the board of cosmetology, how is that planning to affect scope of licensure of estheticians? For instance, right now we acquire more than 20 states that do not recognize esthetician licenses in medical practice.
“When a medical spa is certainly medical, there’s a brand new act to understand — the medical Insurance Portability and Accountability Act (HIPAA),” Warfield said. Established in 1996, this act requires all medical organizations that maintain or transmit electronic health information to adhere to specific standards in maintaining and transmitting health facts about individual patients. Facilities will need to be in final compliance by April 2003.
“So may be the medical spa a medical practice or perhaps is it a spa?” asked Warfield. Their state laws vary and may have an impact on how the medical spa operates, not just as a medical center but also as a cosmetology facility. “Under some state laws, should it be considered cosmetology, then a state laws of cosmetology apply.” Highlighting the word “medical,” Warfield noted if a physician is exercising of any medical spa, the buyer is just not likely to identify herself being a client, but as a patient. “No matter how much we would like to give them a call clients, they’re still patients. The buyer perceives this as medical treatment.
“The last reason for this is accreditation,” said Warfield. “Some states have enacted rulings which require medical facilities employing a certain degree of anesthesia to accredit their facility. For instance, laser resurfacing requires nerve blocks.” A spa offering the service is needed to be accredited. This is also true for other medical procedures now being performed in offices and spas away from the field of hospitals and medical centers. Two examples of non-profit, private accrediting organizations would be the Joint Commission on Accreditation of Healthcare Organization (JCAHO) along with the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF).
Licensing is yet another thing that requires investigation and varies from state to state. “Look at all the agencies you must take a look at,” said Urban, “and also have every one of the licenses set up” whether for business, physician or staff. “Here is where it gets tricky. This is brand new and everyone is trying to ascertain how we insure these individuals,” she added, having a warning how the malpractice faction is “quickly becoming educated” and is indeed a threat to the businesses.
Regardless of who is licensed for what, when an unbiased esthetic practitioner shares the identical waiting room with all the physician, the physician ultimately carries the obligation. “When someone is working under a doctor’s office, they become the doctor’s employee,” said Palmer. “The doctor has taken liability. That’s a challenge. Doctors have so much liability that this esthetic industry doesn’t understand. But the bottom line is not am I licensed, but am I properly trained?”