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Flu shot ... facial, too?
Medical spas growing in popularity with physicians and their patients, offering services without a co-pay

BY EMILY HAGEDORN, Californian staff writer
Thursday, Nov 2 2006 10:25 PM

Last Updated: Thursday, Nov 2 2006 10:32 PM

Medical spas offer luxuries not only to patients, but also to physicians: cash payment and no involvement by insurance companies.

Such pleasantries, combined with strong demand by the aging baby-boomer population, make the massage-and-Botox "medspa" niche very popular among local physicians.

In fact, most family practice physicians in town are branching out into cosmetic services, said Dr. Jeff Freesemann, president of the Kern County Medical Society.

"Patients will pay $400 to get the hair off their back but not a $20 co-pay to get their hypertension or diabetes under control," Freesemann said. "And from the doc's point of view, these things are cash pay."

Many physicians are either opening up their own centers or offering cosmetic amenities such as spider vein removal and facial peels in their own practices, he said.

Since 2000, the number of cosmetic minimally invasive procedures, such as soft tissue fillers and microdermabrasion, has increased by 53 percent, totaling more than 8 million procedures nationwide in 2005, according to the American Society of Plastic Surgeons.

Hannelore Leavy, founder and executive director of the New Jersey-based International Medical Spa Association, calls this type of care "retail medicine."

Freesemann disagrees with the moniker, saying the "milk you for your money" attitude is something most physicians try hard to get away from.

"I still consider us somewhat of a profession, not a Wal-Mart," he said. "It (the business) seems fairly superficial, but that's what patients are demanding."

Many physicians have started providing medspa services to help supplement income lost to rising costs and declining reimbursement rates, Freesemann said. The payment rate for physician services will be reduced by 5.1 percent after the first of the year, the Centers for Medicare and Medicaid Services announced in August.

And since insurance companies don't usually cover cosmetic surgery anyway, the hassle of billing is eliminated.

Dr. Milan Shah, operations officer of the Bakersfield Wellness Center, scoffs at the "easy money" opinion some physicians have of the industry.

These services bring other costs and concerns that most physicians haven't had to deal with in their private practices, he said.

"It's not a quick buck," said Shah who, unlike many other physicians jumping into the trend, has been in the cosmetic surgery field since he graduated from medical school. "Is it a lucrative field? Definitely. But you've got to do it right."

The lack of insurance company involvement also means a lack of referrals to your office, he said. Marketing and advertising become necessary if the physician wants a constant revenue source.

"You have to build yourself a reputation," he said. "There's lots of guys out there who have failed at this."

Like the hopes of the clientele, the medspa industry is rather young, which also makes it a trend many people want to break into, Shishodia said.

"Two years ago, nothing like this existed," he said.

The newness of this business also makes accurate estimates on its economic impact hard to come by and trust, said Leavy, the International Medical Spa Association founder.

Her organization, which was started in 2002, estimates there are between 2,000 and 2,500 medspas across the country. But she said that's a very conservative estimate.

"They are growing by leaps and bounds," she said. "The technology has gotten so fast -- we can't keep up."

Wellness-focused baby boomers are also to thank for medspas' popularity, Leavy said. "That generation is starting to get wrinkles and double chins," and they want to compete with younger people in their careers.

This niche can only grow in popularity, she said. "We seem to have found the fountain of youth."

Questions to ask before getting a cosmetic treatment at a medspa

  • Who owns this medspa? A licensed physician must own the majority of the business, said Erlinda Suarez, staff analyst with the Medical Board of California.
  • If a physician doesn’t perform the procedure, is a physician on-call? Depending on the procedure, licensed nurses and physician’s assistants can perform the service, but a physician must supervise, according to the medical board. Supervision can be defined as a doctor on the premises or on-call, Suarez said.
  • Does the medical professional have a license to do the work? All physicians and nurses must have a medical license, Suarez said.
  • What type of training has the medical professional had?
  • How often does the medical professional perform the procedure?
  • What is involved?
  • What are the possible complications? What’s the protocol if something happens?
  • Does the medical professional have before-and-after photos you can see?
  • Are there any former patients you can talk to?

Other sources: Dr. Jeff Freesemann, president of the Kern County Medical Society; Dr. Milan Shah, operations officer of the Bakersfield Wellness Center, and Hannelore Leavy, founder and executive director of the International Medical Spa Association

Average physician fees for common minimally invasive procedures

Botox: $363 Cellulite treatment: $129 Chemical peel: $628 Collagen filler: $390 Hyaluronic acid (i.e. Restylane): $557 Laser hair removal: $406 Laser treatment for leg veins: $366 Microdermabrasion: $177 Sclerotherapy: $311

Source: American Society of Plastic Surgeons, 2005

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