Tak­ing med­i­cal spas se­ri­ously

New reg­u­la­tions sought for some com­mon cos­metic pro­ce­dures

Modern Healthcare - - Front Page -

As less in­va­sive cos­metic treat­ments such as Bo­tox and laser hair re­moval have come within fi­nan­cial reach for an in­creas­ing num­ber of pa­tients, so too have con­cerns grown about who is per­form­ing such pro­ce­dures and whether they are be­ing done safely.

At the root of much of many of the safety wor­ries is the fact that more of these ser­vices are now be­ing de­liv­ered at what are known as med­i­cal spas, or medis­pas. The term “med­i­cal spa” usu­ally refers to a fa­cil­ity that per­forms tra­di­tional spa treat­ments, such as fa­cials and mas­sage, but which also pro­vides more med­i­cally ori­ented cos­metic pro­ce­dures, in­clud­ing in­jectable fillers and skin resur­fac­ing. In many re­gions of the coun­try, those spas can be found any­where from the lo­cal mall to a den­tist’s of­fice.

Ac­cord­ing to Eric Light, ex­ec­u­tive di­rec­tor of the In­ter­na­tional Med­i­cal Spa As­so­ci­a­tion, a trade group based in Min­netonka, Minn., there are roughly 2,500 med­i­cal spas op­er­at­ing across the coun­try. And that num­ber is grow­ing, Light says, adding that his as­so­ci­a­tion cur­rently rep­re­sents about 10% of the mar­ket.

Lax over­sight?

The is­sue, ac­cord­ing to many physi­cians who rou­tinely per­form these ser­vices, is that there is lit­tle to no over­sight of these spas. In the ab­sence of over­ar­ch­ing fed­eral rules for cos­metic med­i­cal pro­ce­dures, de­ci­sions re­gard­ing train­ing re­quire­ments, dis­clo­sure and physi­cian su­per­vi­sion are left up to in­di­vid­ual states, says Lawrence Green, a Rockville, Md.based der­ma­tol­o­gist.

“Each state makes their own rules,” says Green, who also is chair­man of the scope of prac­tice com­mit­tee for the Amer­i­can So­ci­ety for Der­ma­to­logic Surgery, and an as­sis­tant pro­fes­sor of der­ma­tol­ogy at Ge­orge Washington Uni­ver­sity School of Medicine and Health Sci­ences, Washington. “In many cases, you have peo­ple who are not prop­erly trained who are per­form­ing these pro­ce­dures.”

That was the case in Mary­land, too, un­til re­cently, he says. Green lob­bied along­side the state’s med­i­cal so­ci­ety, mak­ing the case to the Mary­land Board of Physi­cians that changes needed to be made. And in Au­gust, the state en­acted some of the tough­est reg­u­la­tions of out­pa­tient cos­metic med­i­cal pro­ce­dures in the coun­try. The new rules de­fine which cos­metic pro­ce­dures are med­i­cal and which ones are not. Mi­cro­derm abra­sion, for in­stance, is not con­sid­ered a med­i­cal pro­ce­dure, while Bo­tox—in­jec­tions for treat­ment of fa­cial wrin­kles—and laser treat­ments are. The reg­u­la­tions also stip­u­late to whom a physi­cian can del­e­gate a pro­ce­dure, and they re­quire that per­son­nel re­ceive train­ing from an ac­cred­ited con­tin­u­ing med­i­cal ed­u­ca­tion body, and not from a de­vice man­u­fac­turer, Green says.

Fi­nally, Mary­land’s new rules in­clude strin­gent rules for record-keep­ing, li­cen­sure and med­i­cal di­rec­tors. They also re­quire that those del­e­gated by a physi­cian to per­form pro­ce­dures, such as physi­cian as­sis­tants or nurse prac­ti­tion­ers, ad­here to su­per­vi­sion and train­ing re­quire­ments.

“We were so for­tu­nate that the board of physi­cians took on this is­sue and de­cided to do some­thing,” Green says. “I wish it could hap­pen in other states. The bot­tom line is that we need to per­form these pro­ce­dures safely and give pa­tients the best pos­si­ble re­sults.”

The mo­ti­va­tion for the new rules was purely and sim­ply to im­prove pa­tient safety, says Karen Wulff, pol­icy an­a­lyst for the Mary­land Board of Physi­cians. “At this point, we are still try­ing to get the word out,” Wulff says. “When it comes to get­ting things done, though, reg­u­la­tions are the gold stan­dard.”

And al­though states vary con­sid­er­ably in their reg­u­la­tions, sev­eral also have be­gun to

In many states, there is lit­tle or no reg­u­la­tory over­sight for med­i­cal spas that pro­vide a va­ri­ety of cos­metic pro­ce­dures.

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