It’s been dubbed the spa of the future, but the medical spa is really as old as “getting the waters.” As outlined by Hannelore Leavy, founder and executive director throughout the day Spa Association, European spas have always been medical, focused on mineral springs and waters. “Treatment was and yet is prescribed and monitored from 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 useful 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 extends back many many thousands of years, having been used by highly-developed, ancient civilizations for the treatment of disease and also by primitive shamans for purification of body and spirit. Through tradition and legend, continued use of some locations of mineral springs brought in regards to the establishment of healing centers. The spas of Roman times included elaborate bathhouses where a range of treatments connected 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 one of the more historically famous.
Europeans immigrating to America throughout this nation’s early settlement brought along with them the “old country” concept of the spa. Already traditionally used by Native Americans, medicinal treatment at natural springs became a well established “cure all” offered by coast to coast, creating the building of exclusive spa resorts. In an age where medicine was still based on what we today term alternative therapies, integrative care was the norm. But as medical became more medicalized, and a booming industrial society became more beauty-conscious, the two separated paths. Medicine moved in to the hospital and clinic and spas became pampering salons to the wealthy, a trend that remained strong for many years.
What has evolved and why are medical spas showing up now? The answer has numerous facets. Among them, the increasing demand by today’s consumer for alternative therapies and dexnpky83 treatment; a focus on preventive wellness care; plus 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 15 years ago. From her headquarters in Phoenix, Ariz., Palmer offered her carry out the existing trend. “I’ve always had a passion for handling anyone by and large. Bodywork, naturopathic and esthetics; that for me is definitely the future. There’s a tremendous market with naturopaths.” There’s also a course now available for nurse practitioners and bodyworkers to become naturopath practitioners. “I do believe Sept. 11 changed lots of directions. The more aggressive therapies are down. Today everyone has finished-educated, but the advantage is that patients want total care and lighter treatments.”
Just two simple words, and yet, throughout the board and throughout the industry, there is absolutely no consensus regarding just what spa los angeles is and should be. That’s not too surprising in light of the truth that the marriage between medicine and spas is relatively new in your modern experience.
Typically, Americans have come can be expected a routine of sorts in medical treatment: being ushered out and in immediately by way of a stark (sometimes emotionally, as well as physically) environment, being poked and prodded and after that 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 knowledge could certainly wait another year, thanks a lot. On the flip side, our relationship with spas is one of romance — pampering and personal attention, soothing touch and a feeling of rejuvenation upon leaving the premises. Combining both, in a way, has developed into a conundrum. Wellness centers, doctors’ offices with spa services, spas with medical exams, anti-aging treatments and spiritual guidance — those qualify like a medical spa? And who will determine that definition?
According to Marian Urban, a frontrunner in 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 will be the European concept. It’s nothing new; that’s the way they maintain their own health. Regardless how you add it, a medical spa needs to have a physician on board, and it must be a whole-time position.” In an accredited facility, when there is no physician on staff, there could be a liability issue. “It’s just how of the future,” she said, “but it needs to be considered thoroughly. You might be facing liability in a lawsuit. A medical spa is not just a face.”
Generally, the general public has associated medical spas with aesthetic surgery as well as other beauty-related procedures, but Urban highlights how the medical spa nowadays concentrates on total wellness of your individual. “There are a variety of physicians arriving, a large scope. It’s not simply a place you have a facelift. It is possible to spend weekly and also a whole battery of tests run for a whole picture of health. I think, medical spas will probably be the hospital of the future, for anyone seeking alternatives.”
Leavy views the medical spa arena as two totally different modalities. “You have 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 alleviate anxiety, and also as medically beneficial, including pre- and post-surgery. In skin diseases, it will also help with the healing process in the patient. Also, they are realizing these items are certainly not included in medical insurance and other people are willing to pay a good deal for doing it. They don’t have to bother about HMOs. It is an essential aspect for doctors, to get away from paperwork and health care insurance. They can earn income that’s not regulated by medical health insurance. Studies show that men and women will alternative practices and spending additional money for alternative remedies than on regular doctors.
“However, there’s the spa aligning itself with the medical. Sometimes they must use a medical director, if it’s precisely what the state requires.” Leavy also emphasizes the need for staff to be educated in what to consider in referring a client for medical consultation. “A spa therapist should be able to tell the difference between an age spot plus a melanoma.” The spa therapist, as based on Leavy, is someone trained as being an esthetician (also being a massage therapist) who may have basic expertise in spa treatments along with a thorough expertise in the body and ailments, and contraindications of certain treatments.
According to Palmer, the medical industry can have the final say in defining the medical spa. “Anything they (facilities and staff) are doing, medicine will probably be responsible. They’re going to regulate it.” It may be a phenomenal team with doctors and estheticians, she said. The physician can be an M.D. or D.O. You can add an R.N., esthetician, masseuse, nutritionist and others to create a complete medical spa team. The main element of this, she noted, is having the appropriately-trained staff member for each treatment.
While consensus concerning definition, defined purpose and guidelines for the operation of medical spas still hangs in limbo, most industry experts appear to agree that certain is forthcoming. Through conferences, symposiums and personal encounters, attempts are being designed 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 complete session to health problems. The Medical Spa Conference, sponsored with the Spa Professionals Alliance and scheduled for November of the year, has as the headline “Just how can we discover an equilibrium in between the spa profession and also the medical profession?” Organizers hope to increase awareness and data from the field, said Urban of your conference. “The target is to enhance education and also have people talking one-on-one, rather than have it be considered a large trade show. We have been creating individuals who have been utilizing medical spas for many years, but haven’t planned to use the term medical because they’re afraid. It’s not just a light word to make use of.”
Will be the doctor actually in the home? Or else, there could be trouble in paradise. Even though some facilities took on full-fledged medical directors, others have contracted for a name plus an occasional personal appearance. What responsibilities fall under the title of medical director in 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 serves as executive director from the NCEA along with the Society of Dermatology SkinCare Specialists (SDSS). Like a leading expert in the business aspects, she addressed several issues that should be considered regarding medical facilities, medical directors and federal and state regulations.
Speaking in an interview from her Glen Rock, N.J., office, Warfield said, “I contacted the medical director’s association and so they have no such definition for a medical director inside a medical spa. It’s a gray area. When the medical director is actually a health care provider, are they the main one whose name is going on the leasing or purchasing contract of any medical device to use within a spa?”
Under federal regulation, any piece of equipment being offered passes through a classification procedure by the Food and Drug Administration (FDA). How the federal government classifies a system determines whether it is 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 the majority of states, your order for purchase is restricted to physicians. Federal laws not simply include medical devices, noted Warfield, and also cosmetics. “Could they be drugs? And in some states, the state boards of cosmetology are inclined after medical spas since they are not properly licensed together with the state board of cosmetology.
“Another indicate consider is definitely the Occupational Safety and Health Administration (OSHA),” said Warfield. Under OSHA are three facets of medical regulation that can affect medical spas.
– The Bloodborne Pathogen Standard requires facilities to obtain into position an exposure control policy for blood or another potentially harmful body materials. “Are the estheticians wearing vinyl gloves to carry out facial and the entire body treatments that will stick them vulnerable to exposure?” asked Warfield. “In my view, these treatments place you at risk.”
– The Risks Communication Standard involves hazardous materials in the workplace. For example, glycolic acid remains to be considered a hazardous substance. The American National Standards Institute (ANSI), now adopted by OSHA, regulates the usage of lasers. “In case the facility has put in a laser, they will be considering 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 states. Some medical spas are doing hair analysis, staining procedures and live blood cell testing. As being a hospital, CLIA regulations will be applicable. “You can’t just put out a shingle and commence to perform most of these things,” said Warfield.
Whether or not the business is known as hospital or medical practice, compliance with these regulations will 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 year with the American Electrology Association, 13 states have restricted usage of laser for hair removal to physicians only, with another seven allowing its use by others under direct physician supervision. “There are also delegation rules concerning who a physician can delegate responsibility to which varies one state to another,” said Warfield. “Also the board of cosmetology, how is the fact likely to affect scope of licensure of estheticians? By way of example, right now we get more than 20 states which do not recognize esthetician licenses in medical practice.
“When a medical spa is certainly medical, there’s a new act to understand — the 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 comply with specific standards in maintaining and transmitting health information on individual patients. Facilities will need to be in final compliance by April 2003.
“So may be the medical spa a medical practice or is it a spa?” asked Warfield. Their state laws vary and can have an impact on how the medical spa operates, not just as a medical center but additionally being 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 in case a physician is exercising of the medical spa, the individual is not likely to identify herself being a client, but alternatively like a patient. “No matter how much we should call them clients, they’re still patients. The individual perceives this as treatment.
“One final point of this really is accreditation,” said Warfield. “Some states have enacted rulings which need medical facilities using a certain amount of anesthesia to accredit their facility. As an example, laser resurfacing requires nerve blocks.” A spa offering this particular service is necessary to be accredited. This is also true for other surgical procedure now being performed in offices and spas outside of the realm of hospitals and medical centers. Two types 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 another component that requires investigation and varies from state to state. “Have a look at all of the agencies you need to look at,” said Urban, “and possess every one of the licenses set up” whether for business, physician or staff. “This is why it gets tricky. This can be brand-new and everybody is trying to find out the way you insure these folks,” she added, with a warning how the malpractice faction is “quickly becoming educated” and is a real threat to such businesses.
Regardless of who is licensed for what, when a completely independent esthetic practitioner shares exactly the same waiting room using the physician, the physician ultimately carries the obligation. “When someone is working within a doctor’s office, they become the doctor’s employee,” said Palmer. “A doctor is to take liability. That’s challenging. Doctors have so much liability the esthetic industry doesn’t understand. But in essence not am I licensed, but am I properly trained?”