It’s been dubbed the spa for the future, nevertheless the medical spa is really as old as “taking the waters.” Based on Hannelore Leavy, founder and executive director through the day Spa Association, European spas have been medical, centered around mineral springs and waters. “Treatment was and still is prescribed and monitored with a physician,” said Leavy inside an interview from her office in West New York City, N.J. Spas established in this country’s early history were also useful for medicinal cure, but a transition occurred about mid-twentieth century, essentially phasing out medicine and emphasizing beauty treatment. American spas are now coming full circle, going back to their roots of integrative wellness.
Water therapy goes back many thousands of years, having been used by highly-developed, ancient civilizations for treating disease and by primitive shamans for purification of body and spirit. Through tradition and legend, continued consumption of some locations of mineral springs brought regarding 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 centuries 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 throughout this nation’s early settlement brought using them the “old country” notion of the spa. Already widely used by Native Americans, medicinal treatment at natural springs became a recognised “cure all” provided by coast to coast, leading to the construction of exclusive spa resorts. In a age where medicine was still depending on what we today term alternative therapies, integrative care was the norm. But as health care became more medicalized, as well as a booming industrial society became more beauty-conscious, the 2 separated paths. Medicine moved in to the hospital and clinic and spas became pampering salons for that wealthy, a trend that remained strong for many years.
What has evolved and exactly why are medical spas popping up now? The perfect solution has numerous 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; and a medical system that’s been overwhelmed with insurance dictates, paperwork and restrictions on service.
Dr. Michelle Palmer, an esthetics educator and naturopath with a doctorate in alternative therapies, setup her first medical spa fifteen years ago. From her headquarters in Phoenix, Ariz., Palmer offered her carry out the existing trend. “I’ve always had a passion for coping with anyone by and large. Bodywork, naturopathic and esthetics; that for me may be the future. There’s a tremendous market with naturopaths.” There’s a course now available for nurse practitioners and bodyworkers in becoming naturopath practitioners. “I believe Sept. 11 changed a great deal of directions. The better aggressive methods are down. Today the general public is over-educated, but the advantage is the fact patients want total care and lighter treatments.”
Just two simple words, but, across the board and through the entire industry, there is not any consensus concerning what exactly spa los angeles is and should be. That’s less than surprising in light of the reality that the marriage between medicine and spas is pretty new within our modern experience.
For the most part, Americans came to expect a routine of sorts in medical care: being ushered inside and outside immediately using a stark (sometimes emotionally, in addition to physically) environment, being poked and prodded then dismissed by using a prescription, order for lab tests or even a “come again, same time next season.” We might feel assured our overall health is intact, but repeating the ability could certainly wait another year, thanks a lot. However, our relationship with spas has been one among romance — pampering and private attention, soothing touch and a sense of rejuvenation upon leaving the premises. Combining both, in a way, has turned into a conundrum. Wellness centers, doctors’ offices with spa services, spas with medical exams, anti-aging treatments and spiritual guidance — which of them qualify as being a medical spa? And which will determine that definition?
Based on Marian Urban, a frontrunner within the medical spa movement and managing editor of Medical Spas magazine, the phrase “medical” is the key. Speaking from her office in Santa Fe, N.M., she said, “The medical spa is definitely the European concept. It’s nothing new; that’s the way that they maintain their health. No matter how you set it, a medical spa must have a health care provider on board, and it has to be a full-time position.” In an approved facility, if you find no physician on staff, there might be a liability issue. “It’s the way in which for the future,” she said, “but it needs to be looked at very carefully. You can be facing liability within a lawsuit. A medical spa is not just a face.”
Generally, the public has associated medical spas with cosmetic surgery as well as other beauty-related procedures, but Urban highlights that the medical spa these days focuses on total wellness of the individual. “There are actually a variety of physicians arriving, a wide scope. It’s not only a place you will have a facelift. You may spend weekly where you can whole battery of tests run for a complete picture of health. In my view, medical spas will be the hospital of the future, for anyone searching for alternatives.”
Leavy views the medical spa arena as two very different modalities. “There is a doctor’s office that adds on spa services, like homeopaths, internists, dentists or cosmetic surgeons. Doctors are discovering that spa services are good for their patients, for relaxation, to ease anxiety, so when medically beneficial, for example pre- and post-surgery. In skin diseases, it will also help with the recovery process in the patient. Also, they are realizing this stuff will not be paid by health insurance and people are likely to pay a whole lot for doing it. They don’t need to bother about HMOs. It is really an important aspect for doctors, to escape paperwork and health insurance. They could earn income that’s not regulated by medical health insurance. Research has shown that men and women are going to alternative practices and spending more income for alternative remedies than on regular doctors.
“On the flip side, there’s the spa aligning itself together with the medical. Sometimes they should use a medical director, if it’s what the state requires.” Leavy also emphasizes the necessity for staff to become educated in what to consider in referring a customer for medical consultation. “A spa therapist must be able to tell the difference between an age spot along with a melanoma.” The spa therapist, as defined by Leavy, is someone trained being an esthetician (also as a massage therapist) that has basic familiarity with spa treatments as well as a comprehensive expertise in the body and ailments, and contraindications of certain treatments.
According to Palmer, the healthcare industry will have the last say in defining the medical spa. “Whatever they (facilities and staff) are performing, medicine is going to be responsible. They’re likely to regulate it.” It can be a phenomenal team with doctors and estheticians, she said. The physician can be an M.D. or D.O. You could add an R.N., esthetician, masseuse, nutritionist and others to produce a complete medical spa team. The important facet of this, she noted, has the appropriately-trained staff member for every single treatment.
While consensus regarding definition, defined purpose and guidelines for your operation of medical spas still hangs in limbo, most skilled professionals manage to agree that a person is forthcoming. Through conferences, symposiums and personal encounters, attempts are being designed to formally gather opinions and set up industry standards. In June 2002, the National Coalition of Esthetic Related Profession Associations (NCEA) hosted an open forum to share viewpoints and discuss future directions, devoting an entire session to health problems. The Medical Spa Conference, sponsored from the Spa Professionals Alliance and scheduled for November of the year, has as the headline “How could we discover a balance between your spa profession and the medical profession?” Organizers aspire to increase awareness and data in the field, said Urban from the conference. “The focus would be to draw out education and have people talking one-on-one, instead of have it be considered a large trade show. Our company is coming up with people who have been working together with medical spas for a long time, but haven’t wanted to use the term medical because they’re afraid. It’s not really a light word to use.”
Will be the doctor actually in your house? Otherwise, there might be trouble in paradise. Although some facilities took on full-fledged medical directors, others have contracted for the name and an occasional personal appearance. What responsibilities come under the title of medical director inside 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 may serve as executive director from the NCEA along with the Society of Dermatology SkinCare Specialists (SDSS). As a leading expert around the business aspects, she addressed several issues that should be considered regarding medical facilities, medical directors and federal and state regulations.
Speaking within an interview from her Glen Rock, N.J., office, Warfield said, “I contacted the medical director’s association and they also have no such definition to get a medical director within a medical spa. It’s a gray area. If the medical director is certainly a doctor, could they be normally the one whose name is occurring the leasing or purchasing contract of your medical device to be used inside a spa?”
Under federal regulation, any item of equipment offered passes through a classification procedure by the Food and Drug Administration (FDA). How the government classifies a system will determine whether it is defined as “prescriptive,” meaning simply a prescriptive user can order its purchase. “Then it’s around each state to ascertain who is able to use that device by prescription,” said Warfield. In most states, an order for purchase is limited to physicians. Federal laws not just include medical devices, noted Warfield, but also cosmetics. “Are they drugs? And in some states, their state boards of cosmetology will be going after medical spas since they are not properly licensed with all the state board of cosmetology.
“Another denote consider will be the Occupational Safety and Health Administration (OSHA),” said Warfield. Under OSHA are three facets of medical regulation that could affect medical spas.
– The Bloodborne Pathogen Standard requires facilities to have in place an exposure control arrange for blood or another potentially harmful body materials. “Would be the estheticians wearing vinyl gloves to do facial and the body treatments that might stick them at risk for exposure?” asked Warfield. “I think, these treatments place you at an increased risk.”
– The Risks Communication Standard involves hazardous materials in the workplace. By way of example, glycolic acid is still classified as a hazardous substance. The American National Standards Institute (ANSI), now adopted by OSHA, regulates the use of lasers. “When the facility has place in a laser, they will be looking at compliance with safety for this,” said Warfield.
– Medical spa owners also need to pay attention to the Clinical Laboratory Improvement Amendments (CLIA), which regulate the caliber of all laboratory testing (except research) performed on humans in the usa. Some medical spas are accomplishing hair analysis, staining procedures and live blood cell testing. Being a hospital, CLIA regulations is going to be applicable. “You can’t just put out a shingle and begin to do many of these things,” said Warfield.
Whether the business is named a hospital or medical practice, compliance with these regulations will likely be required. In each state, the board of medicine will determine if certain equipment can be utilized by physicians only or under physician supervision. Within a survey of state medical boards conducted this year through 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. “There are delegation rules concerning who a health care provider can delegate responsibility to and that varies state to state,” said Warfield. “Even the board of cosmetology, how is the fact that going to affect scope of licensure of estheticians? For instance, we currently have more than 20 states which do not recognize esthetician licenses in medical practice.
“If a medical spa is certainly medical, there’s a brand new act to be aware of — the Health 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 comply with specific standards to maintain and transmitting health facts about individual patients. Facilities will need to be in final compliance by April 2003.
“So is definitely the medical spa a medical practice or maybe it a spa?” asked Warfield. Their state laws vary and may have an affect on how the medical spa operates, not simply as a medical center and also like a cosmetology facility. “Under some state laws, should it be considered cosmetology, then a state laws of cosmetology apply.” Highlighting the expression “medical,” Warfield noted if your physician is training of a medical spa, the consumer is not planning to identify herself as a client, but as being a patient. “No matter how much we would like to contact them clients, they’re still patients. The consumer perceives this as medical treatment.
“The last reason for this is certainly accreditation,” said Warfield. “Some states have enacted rulings which require medical facilities utilizing a certain measure of anesthesia to accredit their facility. For instance, laser resurfacing requires nerve blocks.” A spa offering this particular service must be accredited. This is also true for other medical procedures now being performed in offices and spas beyond the arena of hospitals and medical centers. Two examples of non-profit, private accrediting organizations are definitely the Joint Commission on Accreditation of Healthcare Organization (JCAHO) and the American Association for Accreditation of Ambulatory Surgery Facilities, Inc. (AAAASF).
Licensing can be another thing that requires investigation and varies among states. “Check out every one of the agencies you must have a look at,” said Urban, “and get each of the licenses in position” whether for business, physician or staff. “This is why it gets tricky. This is certainly brand-new and everyone is trying to figure out the way you insure these people,” she added, having a warning the malpractice faction is “quickly becoming educated” and is actually a threat to such businesses.
No matter who is licensed for which, when an independent esthetic practitioner shares a similar waiting room using the physician, the physician ultimately carries the responsibility. “When someone is working under a doctor’s office, they get to be the doctor’s employee,” said Palmer. “The doctor has taken liability. That’s challenging. Doctors have so much liability the esthetic industry doesn’t understand. But the end result is not am I licensed, but am I properly trained?”