It’s been dubbed the spa of the future, although the medical spa can be as old as “using the waters.” Based on Hannelore Leavy, founder and executive director during the day Spa Association, European spas have been medical, centered around mineral springs and waters. “Treatment was yet still is prescribed and monitored by a physician,” said Leavy in an interview from her office in West The Big Apple, N.J. Spas established within this country’s early history were also utilized for medicinal cure, but a transition occurred about mid-20th century, essentially phasing out medicine and emphasizing beauty treatment. American spas are now coming full circle, returning to their roots of integrative wellness.
Water therapy dates back many many thousands of years, having been made use of 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 hundreds of years on European and Commonwealth soil. Two such locations, Bath in England and Spa in Belgium, are appropriately named and amongst the more historically famous.
Europeans immigrating to America during this nation’s early settlement brought together the “old country” idea of the spa. Already popular by Native Americans, medicinal treatment at natural springs became a well established “cure all” available from coast to coast, leading to the construction of exclusive spa resorts. Within an age where medicine was still depending on what we today term alternative therapies, integrative care was the standard. But as medical became more medicalized, along with a booming industrial society became more beauty-conscious, both 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 popping up now? The answer has many facets. One of them, the improving demand for services by today’s consumer for alternative therapies and dexnpky83 treatment; an emphasis on preventive wellness care; along with 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, setup her first medical spa 20 years ago. From her headquarters in Phoenix, Ariz., Palmer offered her take on the existing trend. “I’ve always had a passion for coping with the person by and large. Bodywork, naturopathic and esthetics; that in my opinion is the future. There’s a massive market with naturopaths.” There’s even a course now on offer for nurse practitioners and bodyworkers to get naturopath practitioners. “I feel Sept. 11 changed a great deal of directions. The more aggressive therapies are down. Today the public is finished-educated, however the advantage is patients want total care and lighter treatments.”
Just two simple words, however, throughout the board and throughout the industry, there is not any consensus with regards to what exactly spa los angeles is and ought to be. That’s not so surprising considering the truth that the relationship between medicine and spas is fairly new in your modern experience.
For the most part, Americans have come should be expected a routine of sorts in medical care: being ushered inside and outside as quickly as possible via a stark (sometimes emotionally, and also physically) environment, being poked and prodded and then dismissed having a prescription, order for lab tests or possibly a “come again, same time the new year.” We might feel assured our health and wellbeing is intact, but repeating the experience can certainly wait another year, many thanks. On the flip side, our relationship with spas is among romance — pampering and private attention, soothing touch and feelings of rejuvenation upon leaving the premises. Combining the two, in a way, has changed into a conundrum. Wellness centers, doctors’ offices with spa services, spas with medical exams, anti-aging treatments and spiritual guidance — which of them qualify being a medical spa? And who will determine that definition?
According to Marian Urban, a leader from the medical spa movement and managing editor of Medical Spas magazine, the term “medical” is the key. 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 the way they maintain their health. Irrespective of how you put it, a medical spa ought to have a health care provider aboard, and it should be an entire-time position.” Even in a certified facility, if you find no medical doctor on staff, there might be a liability issue. “It’s just how of the future,” she said, “but it must be considered cautiously. You might be facing liability inside a lawsuit. A medical spa is not only a face.”
Generally, the public has associated medical spas with aesthetic surgery and also other beauty-related procedures, but Urban points out how the medical spa these days targets total wellness of the individual. “You will find all types of physicians coming in, a broad scope. It’s not only a place you have a facelift. You can spend weekly where you can whole battery of tests run for an entire picture of health. I think, medical spas will be a healthcare facility of the future, for anyone searching for alternatives.”
Leavy views the medical spa arena as two very different modalities. “There is the doctor’s office that adds on spa services, like homeopaths, internists, dentists or cosmetic surgeons. Doctors are discovering that spa services are beneficial to their patients, for relaxation, to ease anxiety, and also as medically beneficial, such as pre- and post-surgery. In skin diseases, it can help with all the healing process of the patient. They are also realizing these matters are not included in health care insurance and individuals are likely to pay a great deal for this. They don’t have to bother about HMOs. This is an important factor for doctors, to escape paperwork and health insurance. They are able to earn income that’s not regulated by medical insurance. Studies show that individuals will certainly alternative practices and spending more cash for alternative remedies than on regular doctors.
“Alternatively, there’s the spa aligning itself with all the medical. Sometimes they need to use a medical director, if it’s what the state requires.” Leavy also emphasizes the need for staff to get 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 being an esthetician (also being a masseuse) who may have basic understanding of spa treatments as well as an extensive knowledge of the body and ailments, and contraindications of certain treatments.
Based on Palmer, the medical field will have the final say in defining the medical spa. “Whatever they (facilities and staff) are going to do, medicine is going to be responsible. They’re going to regulate it.” It could be a phenomenal team with doctors and estheticians, she said. The doctor is an M.D. or D.O. You can add an R.N., esthetician, masseuse, nutritionist among others to create a complete medical spa team. The key aspect of this, she noted, has the appropriately-trained staff member for every treatment.
While consensus regarding definition, defined purpose and guidelines to the operation of medical spas still hangs in limbo, most industry experts often agree that a person is forthcoming. Through conferences, symposiums and private encounters, attempts are being created to formally gather opinions and set up 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 issues. The Medical Spa Conference, sponsored with the Spa Professionals Alliance and scheduled for November on this year, has as its headline “How can we find an equilibrium involving the spa profession along with the medical profession?” Organizers aspire to increase awareness and knowledge from the field, said Urban from the conference. “The main focus is to reveal education and possess people talking one on one, rather than already have it be described as a large trade show. Our company is coming up with those who have been dealing with medical spas for many years, but haven’t wished to use the term medical because they’re afraid. It’s not really a light word to use.”
Is the doctor actually in the house? If not, there could be trouble in paradise. Although some facilities took on full-fledged medical directors, others have contracted for the name along with an occasional personal appearance. What responsibilities come under the title of medical director within a spa and the reason why full-time presence so necessary?
Susanne Warfield is president and CEO of Paramedical Consultants, Inc. and publisher of PCI Journal. She also can serve as executive director in the NCEA as well as the Society of Dermatology SkinCare Specialists (SDSS). As being a leading expert on the business aspects, she addressed several issues that should be considered regarding medical facilities, medical directors and federal and state regulations.
Speaking inside an interview from her Glen Rock, N.J., office, Warfield said, “I contacted the medical director’s association and they have no such definition for the medical director in a medical spa. It’s a gray area. If the medical director is actually a doctor, is it normally the one whose name is occurring the leasing or purchasing contract of the medical device to be used in the spa?”
Under federal regulation, any device being sold undergoes a classification procedure with the Food and Drug Administration (FDA). How the government classifies a product determines regardless of whether it can be labeled as “prescriptive,” meaning simply a prescriptive user can order its purchase. “Then it’s around each state to ascertain who can use that device by prescription,” said Warfield. Generally in most states, the order for purchase is restricted to physicians. Federal laws not just include medical devices, noted Warfield, but also cosmetics. “Will they be drugs? As well as in some states, the state boards of cosmetology are inclined after medical spas since they are improperly licensed with all the state board of cosmetology.
“Another point out consider is definitely the Occupational Safety and Health Administration (OSHA),” said Warfield. Under OSHA are three areas of medical regulation that could affect medical spas.
– The Bloodborne Pathogen Standard requires facilities to get in position an exposure control plan for blood or another potentially harmful body materials. “Are definitely the estheticians wearing vinyl gloves to perform facial and body treatments that will put them at risk for exposure?” asked Warfield. “For me, these treatments put you at risk.”
– The Risks Communication Standard involves hazardous materials in the workplace. For example, glycolic acid continues to be classified as a hazardous substance. The American National Standards Institute (ANSI), now adopted by OSHA, regulates using lasers. “In the event the facility has invest a laser, they are taking a look at compliance with safety for the,” said Warfield.
– Medical spa owners also need 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 United States. Some medical spas are accomplishing hair analysis, staining procedures and live blood cell testing. As a hospital, CLIA regulations will probably be applicable. “You can’t just put out a shingle and initiate to complete most of these things,” said Warfield.
Whether the business is named a hospital or medical practice, compliance with these regulations is going to be required. In each state, the board of medicine will determine if certain equipment can be used by physicians only or under physician supervision. Inside a survey of state medical boards conducted this current year by the American Electrology Association, 13 states have restricted utilization of laser for hair removal to physicians only, with another seven allowing its use by others under direct physician supervision. “There are delegation rules regarding who a health care provider can delegate responsibility to and also this varies one state to another,” said Warfield. “Also the board of cosmetology, how is that going to affect scope of licensure of estheticians? By way of example, we currently get more than 20 states that do not recognize esthetician licenses in medical practice.
“In case a medical spa is in fact medical, there’s a whole new act to be aware of — the Health Insurance Portability and Accountability Act (HIPAA),” Warfield said. Established in 1996, this act requires all medical care organizations that maintain or transmit electronic health information to abide by specific standards to maintain and transmitting health information about individual patients. Facilities will need to be in final compliance by April 2003.
“So is definitely the medical spa a medical practice or possibly is it a spa?” asked Warfield. The state laws vary and definately will have an affect on the way the medical spa operates, not just like a medical center but also as a cosmetology facility. “Under some state laws, if it is considered cosmetology, then a state laws of cosmetology apply.” Highlighting the phrase “medical,” Warfield noted if a physician is exercising of your medical spa, the customer is not going to identify herself as being a client, but alternatively as being a patient. “Regardless how much we would like to contact them clients, they’re still patients. The individual perceives this as medical therapy.
“The last point of this really is accreditation,” said Warfield. “Some states have enacted rulings that need medical facilities employing a certain measure of anesthesia to accredit their facility. For instance, laser resurfacing requires nerve blocks.” A spa offering this service is necessary to be accredited. The same holds true for other surgical procedures now being performed in offices and spas beyond the field of hospitals and medical centers. Two samples of non-profit, private accrediting organizations are 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 factor that requires investigation and varies from state to state. “Take a look at all of the agencies you have to take a look at,” said Urban, “and get all the licenses in place” whether for business, physician or staff. “Here is where it gets tricky. This really is brand-new and everyone is trying to figure out how you insure these individuals,” she added, by using a warning the malpractice faction is “quickly becoming educated” and is indeed a threat to those businesses.
No matter who is licensed for which, when a completely independent esthetic practitioner shares the same waiting room with 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 takes liability. That’s challenging. Doctors have a great deal liability that this esthetic industry doesn’t understand. But basically not am I licensed, but am I properly trained?”