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Medspa Legal & Legislation > Medical director reimbursement suggestions?

Any recommendations or guidance on how to reimburse a medical director for a small boutique med spa? In CT, I only need a collaborating physician so there's no direct supervisory role but I do plan on working closely with a Dermatologist and not sure what kind of financial package to offer.

11.20 | Unregistered CommenterLou P.

I am looking into this as well here in Texas.

11.22 | Unregistered Commenterapril

We started paying our medical director a percentage but switched to a flat fee after a couple years, that was basically an average of his percentage. It became too cumbersome to figure the percentage because we were paying him for the medical services (laser, medium depth chemical peels) but not the regular spa services (facials, waxing, superficial chemical peels). We also pay his portion of malpractice that covers his license in our facility.

11.24 | Unregistered CommenterM Nielsen

In our state DOH is really cracking down on" no direct supervision" closing medispas left and right. Patients need to be seen by an MD or in many states by An ARNP before any laser treatments or Injectables.

11.27 | Unregistered Commenterrafii

I think its good for the state to close these types of unsupervised facilities. A laser is a medical device and should have medical supervision. An esthetician can certainly perform laser treatments if properly educated in laser theory, laser principles, laser safety, etc and trained on the specific laser modality. Performing injectables is outside the scope of practice for an esthetician and should be done by a licensed medical professional, like an MD, nurse, ARNP or PA.

I think the key question is how much liability the physician maintains in the event of an adverse outcome. If the physician is required to maintain medical malpractice insurance even though he is only "collaborating" rather than supervising, then his license will always be on the line. In this case, the risk to the physician is the key factor in determining how much he/she must be compensated to work with you. I have heard all sorts of ranges in California between $500 per month and 10% of total Revenues. So, it just depends on how much liability there is if anyone sues the practice and the risk tolerance of the physician.

12.13 | Unregistered CommenterKevin DC

In CT, lasers are out of the question unless under direct supervision. I'm basically looking to open a skin boutique where I'd like to do micro pigmentation, facials, peels, sclero, filler and toxins. I plan to continue training with the Dermasculpt cannulas and work in a medical capacity a few days a week. Thanks for the advice.

12.17 | Unregistered CommenterLou P.

$500 a month here in Massachusetts.

12.19 | Unregistered CommenterMaureen

We have two part time MD's and both are considered employees and paid an hourly wage. This is how they are compensated at the hospital where they also work.

12.23 | Unregistered CommenterMike B

Mike B, what you are doing may be illegal. Physicians cannot be employees of a corporation owned by a layperson - unless the corporate practice of medicine laws are dramatically different where you are. Rather there needs to be a MSA (Mangaement Services Agreement) that allows your corporation to be paid a fee for the services you provide (running the office, marketing, HR, etc.) A physician is required by law to be an employee of a professional corporation. Similarly you as a layperson cannot own any piece of that professional medical corporation.

The laws are set up so that the physician is able to make independent assessments and judgments without the profit motive associated with a non-professional corporation. I would suggest you check with a healthcare lawyer in your state as setting up your office in the manner you have described could be very problematic with regulators.

01.3 | Unregistered CommenterKevin DC

Also consider that in most states, more than one facility license may be needed-such a salon license and a laser facility license. Many medical spas do not realize that if they offer facials or other esthetic services they need an additional license. Of course your liability insurance carrier needs to be consulted during the process to be sure that you can cover all the services you wish to offer.

I frequently have to advise med spa owners that the lowest supervisory compensation is not necessarily the best compensation for a variety of reasons. For one thing, there would be a lower expectation of supervision for a lower fee. $500, in my experience, is too low. The value of doctor's time is about $450/hr..so how much supervision can someone expect for one hour per month? This is the say medical boards will look at this issue...percentages are problematic too.

01.9 | Unregistered Commenterj.d.

Does anyone have experience with an MD being a co-owner/partner with an NP as part of a compensation package?

01.11 | Unregistered CommenterLou P.

Lou P., that type of arrangement is the best arrangement...it is better to partner with the doctor. There are a variety of ways and options that benefit both the NP and the MD/DO which also minimizes liabilities.

01.13 | Unregistered Commenterj.d.

I have both a functional medicine practice as well as a "medical spa". My collaborating physician in Florida meets with me once a month and is available by phone when needed. I pay him based on the number of cases reviewed with me and the amount of time it should take as everything is prepared prior to his arrival. We exchange lots of information both ways as I have a strong nutritional background and lend advice on how systems work or don't work , therefore the amount I pay him may be seen as less than what he should be paid but it works for us in the present moment. I pay him $200/hour.

01.15 | Unregistered Commenteresarey l

Regulations vary considerably from state to state as to ownership and oversight. It is best to consult a lawyer that specializes or familiar with Med Spa regulation. The regulations differ for an APRN vs. a Nurse or layperson regarding ownership and oversight. It also depends on whether your state requires a collaborative agreement, supervision or classifies APRN's as independent. This will then determine the amount of time your Physician needs to be present and thus how much compensation is customary.

01.17 | Unregistered Commenternixz

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