medical spa: is this for me? · 2019. 9. 23. · –medical director vs “on site plastic surgeon...
TRANSCRIPT
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Medical Spa: Is This For Me?
Karol A Gutowski, MD, FACSPrivate Practice
Clinical Associate – University of Chicago
Clinical Associate Professor – University of Illinois
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Disclosures
Merz – Trainer, Advisory Board
Will use brand names due to lack of distinguishing generic names
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Presentation Level of Evidence
Levels of Evidence and Qualifying Studies (Therapeutic Studies):I High-quality, multi-centered or single-centered, randomized controlled
trial with adequate power (N ≥ 100); or a systematic review of these studies
II Lesser-quality, randomized controlled trial; prospective cohort study; or systematic review of these studies
III Retrospective comparative study; case-control study; or a systematic review of these studies
IV Case series
V Expert opinion; case report or clinical example; or evidence based on physiology, bench research or "first principles“
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Disclaimers
• Variations in state regulations
– Who can inject
– Who can operate a laser
– Definition of supervision
– Midlevel independent practice
• Unclear or changing regulations
• Local market & competition will determine your business plan
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Take Home Messages
• Med spa does NOT print cash – you can loose $$$– Don’t run in a race to the bottom (GroupOn)
• Consider partnering with a med spa first• Build yours as a separate business
– Need a business plan
• Medical devices drain your revenue– Buy a machine, you now work for that company– Consider rentals
• Medical injectors may be mercenaries• Consider joining AmSpa
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AmSpa Med Spa Landscape
• Most are NOT owned by core aesthetic MDs
• 20% fail in year 1
• 20% fail in year 2
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My Background
• Academics– Loved it but aesthetics is not a priority
• Hospital Employed Medical Group– Even worse than academics (and I was Chief)
• Private Practice– No limits
– I can waste all the money I want
– 4 med spa affiliations
– My own med spa
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aFresh Med Spa
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My Chicago Area Locations
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What we Offer Across 5 Locations
Machines we Have• CoolSculpting x4• Icon Laser x2• BodyJet Water Lipo x2• Smart Lipo Triplex x2• Vectus Laser x2• Ulthera x2• Cutera XEO Laser• Microneedling x5• Cynosure MPX IPL• Venus Versa IPL & RF• Venus Bliss• Venus Legacy• Hydrafacial• Zimmer Wave
Conditions Treated• Noninvasive fat reduction• Noninvasive skin tightening• Red & vascular lesions• Brown & pigmented lesions• Laser hair removal• Skin rejuvenation• Minimally invasive fat reduction• Cellulite• Skin care & maintenance• Hair restoration (limited)
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Questions to Ask Yourself(and your spouse, lawyer, accountant,
practice manager, therapist)
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Questions
• Why am I doing this?– For the money or for your patients?
• How much $$$ can I invest (afford to lose)?– What is my ROI timeline?
• Do I have the time?– Marketing, training, Yelp review headaches
• Do I have the patient base?
• Do I like skin care, injections, lasers, etc?
• What is my practice 5 and 10 year plan?
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Consider a Partnership with a Med Spa
(Learn from their successes & misfortunes)
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Partnership with a Med Spa
• No additional cost
• Low risk
– Medical director vs “On Site Plastic Surgeon”
• Source for surgical patients
• Satellite office without overhead
• Trusted place to refer what you don’t offer
• Needs to be a Win-Win-Win
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Partnership Pyramid
Medspa Owner Medical Director
Patient/Customer
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Partnership with a Med Spa
• Takes some time & work
– Educate staff
– Show yourself
• May not get any referrals except complications
• Don’t have control over staff
• Legal issues
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Building Your Own Med Spa(Welcome to the business world)
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Considerations
• In office vs adjacent vs off-site
• Traffic and visibility
• Space allocations
• Revenue generated per room
• Marketing plan– Events, outreach, promotions, etc
• Staff recruitment– Will they bring patients?
– Will they take YOUR patients?
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The Non-MD Injector(Mercenary, Prima Donna, or Partner)
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Injections are the Revenue Source
• Low overhead– Buy what you need
• Repeating customers
• Person doing the injections is critical– Honest
– Well trained
– Aesthetic eye
– Bonds with patients
– Can build a practice and maintain it
– May become a big overhead cost
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A Story of Three Injectors
• Let me tell you a story….
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Injector Headaches
• Do your research before hiring
• Don’t let them manipulate you
• Firewall between injector and product reps
• Don’t wait to fire
– They can hurt your business
• Noncompete clauses
• Care with social media
• Hard to keep patient lists secured
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Buying Medical Devices for Your Med Spa
(A fool and his money are soon parted)
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Considerations
Your device needs depend on• What you offer vs what you want to offer/expand• Practice model
– Academics– Employed– Small group– Solo
• Geographic location• Patient demographics• Patient demand – Real vs Generated• Budget with limited resources
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How Will You Get Suckered Into This?
• FOMO - “Everyone is doing it”
• Industry “Cosmetic Summit” at luxury hotel
• Unrealistic proforma by sales team
• Patients are “asking for it”
• Dr Oz gave it thumbs up
• The KOL pitch/deal
This is all coordinated by industry
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Revenue per Hour
• You can make high profit per hour injecting– Neuromodulators take 10 min
– Patients keep coming back
– May convert to surgery
• You make more per hour in surgery– But has more non-compensated time
– Patients don’t come back for years
• You may NOT make money using machines– Your staff can make you money using machines
– May convert to surgery
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What is the best way to get a laser rep to stay out of your office?
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Buy their laser!
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You’ll make big $$$ off this laser!
You Laser Rep
I’ll make big $$$ off this
laser!
I’m going to make big
$$$ off this laser!
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You Laser Rep
I’ll make big $$$ off this
laser!
I’m going to make big
$$$ off this laser!
You’ll make big $$$ off this laser!
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My Doc is making big $$$ on this!
Your Staff
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My Doc is making big $$$ on this!
Too bad it doesn’t
work…But I have to make
the sale.
Your Staff
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Questions to Ask Yourself
• How does this fit into my strategic plan?– Do I have a plan?
• Adding a new service or just refining a current one?• Can I do this a different way
– Chemical peel vs laser
• Am I offering noninvasive & minimal downtime options?– Not all devices have minimal downtime
• Can I get out of this if I don’t like it?– Easy for skin care products & injectables– Hard for devices
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Who is Driving the Demand?
Is this a response to my patient needs or to marketing hype?
Does your plastic surgeon do the LaserLift Breast
Augmentation©I just saw on Dr Oz?
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Source of Additional Procedures
• Success with non-surgical procedures builds trust for a surgical procedure
Happy with results of fillers, then
Ultherapy
Demands I do her tummy tuck!
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Procedure Spillover
• Non-invasive to invasive
• CoolSculpting
– Liposuction
– Tummy tuck
• Invasive to non-invasive adjuncts
– Laser resurfacing after blepharoplasty
• Injectables & energy-based devices
– Total nonsurgical facial rejuvenation
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Grow the Pie or Re-Slice the Pie?
• Grow your practice or just change it
• Patients may have a fixed budget for services
• Need to bring in NEW patients
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Grow the Pie or Re-Slice the Pie?
• Grow your practice or just change it
• Patients may have a fixed budget for services
• Need to bring in NEW patients
Nonsurgical $20K
Product Sales $10K
Surgical $70K
Total $100K
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Grow the Pie or Re-Slice the Pie?
• Grow your practice or just change it
• Patients may have a fixed budget for services
• Need to bring in NEW patients
Nonsurgical $20K
Surgical $50K
Product Sales $10K
Surgical $70K
Nonsurgical $20K
Product Sales $10K
New Device $20K
Total $100K
Total $100K
Re-Slice
+ Device Payments
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Grow the Pie or Re-Slice the Pie?
• Grow your practice or just change it
• Patients may have a fixed budget for services
• Need to bring in NEW patients
Nonsurgical $20K
Surgical $50K
Product Sales $10K
Surgical $70K Nonsurgical
$30K
Nonsurgical $20K
Product Sales $10K
Product Sales $15K
New Device $20K
New Device $30K
Surgical $75K
Total $100K
Total $100K
Total $150KRe-Slice
Grow
Pay off device
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Projected Revenue ≠ Profit
You just worked 12.5 months to make the device manufacturer money
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Additional Costs
Marketing Costs
Staff Costs
Revision CostsSpace & Overhead Costs
Lost Procedure Costs
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Increased Revenue ≠ ROI
• Consider for your Return on Investment
– Initial capital outlay
– Disposable costs
– Service contract
– Staff costs
– Overhead
• How many $$$ per hour will this room make?
– Marketing
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Marketing Costs
• Does device come with marketing material
– Is it any good?
• Word of mouth is best
– Initial reduced cost treatments
– Select “promoter” patients
• Budget for marketing
– Local media
– Website changes
• GroupOn can lose YOU money
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Deferred ROI
• Don’t expect a positive ROI in the 1st year
– Or 2nd year…
• Track your costs & revenues
– Assess regularly
• Don’t create a monster you don’t want to feed
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Regulatory & Liability Issues
• Device operated by technician
– Do you need to be on site?
• Notify medical liability carrier
– May increase premiums
• Additional staff training
– Laser safety officer
• Organizational challenges
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Rent Per Use (Per Day)
• No worries about:– Capital investment
– Long-term contracts
– Maintenance
– Obsolescence
– Storage space
• Dedicated technician
• Many devices
• “Try before you buy”
• Scheduling issues
• Less revenue (split with owner)
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Buy Pre-Owned on Secondary Market
• Tend to be older devices
• May not matter– Fractional CO2 laser
• After sale service– Not likely from manufacturer
– May come from secondary seller
– Independent service companies
– May come with warranty
• May take a “trade-in”
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Lease to Own
• Usually a purchase with initial payment + monthly payments for 2-3 years
• Financing may be through 3rd party
• Allows for small capital investment
• Hope monthly profit exceeds payments
• Don’t expect to return it
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Buy Demo Model
• Tend to be current
• May be “worn”
• Usually “certified”
– Warranty
• Still have manufacturer relationship
• Not many available
• Establish relationship with rep
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Buy New
• Large capital investment
• Get it when you want it
• Less risk of device problems
2104
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What to Negotiate
• Extended service contract
• More disposables
• Return after 3 months if not satisfied
• Marketing budget
• Financing terms
• Additional staff training
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Device Legal Limitations
• Price limitations
– Not allowed to advertise services below a certain price per treatment
• Location limitations
– Not allowed to move device to other locations
– May void warrantee if moved
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New Business Model: You Pay the Device Company!
• CoolSculpting
– Pay per application area
• Ultherapy
– Pay $1 per line
– Full face: 800 - 1000 lines
– Necks: 300 - 400 lines
• Makes “touch-ups” expensive
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Results not Great – Back Up Plan?
• Surgeons can “backstop” the device
• If results suboptimal, can still offer
– Liposuction
– Skin excision
– Other modalities
• Reduced price
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Talk Before You Buy….
• Talk to your staff
• Ask your patients– “We may be offering RadioFrequency
Rhinoplasty©, what do you think?”
• Discuss with your accountant
• Ask rep for 3 users to talk to…
• …then also find others (Google)
• Talk to Hot Topics instructors
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Think & Have a Plan
• Adding a med spa can grow a practice if done in a logical way with a business plan
• Otherwise,
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Medical Spa: Is This For Me?
Karol A Gutowski, MD, [email protected]
Available at DrGutowski.com
[FOR PHYSICIANS]