Remarks By Eric Light
President of the International Medical Spa Association
Board of Advisors

To the Secretary for Health and Human Services
Public Advisory Board
Subcommittee on Privacy and Confidentiality

February 23rd, 2006

Mr. Chairman, members of the committee, my name is Eric Light and I am president of the Board of Advisors of the International Medical Spa Association. On behalf of the entire association, I would like to thank you for affording us the opportunity to speak with you today.

The International Medical Spa Association has perhaps the industry’s most conservative definition of a medical spa. We believe that a medical spa is a facility that operates under the full time, on site supervision of a licensed health care professional working within their scope of practice, with a staff that operates within there individual scope of practice as defined by a licensing board where one exists, and offering traditional, complimentary and alternative treatments in a spa like setting.

By our definition, the licensed health care professional does not necessarily have to  be an MD. We believe that a wide variety of practitioners, such as homeopaths, naturopathes, nurse practitioners, physican assistants, physical therapists, nutritionists etc., can operate a medical spa as long as they do so within ther scope of practice.

When you think of the words “medical spa”, you most likely think of a facility that offers minimally invasive aesthetic services such as laser hair removal, cosmetic injectables such as Botox, photo rejuvenation, chemical peels and medical microdermabrasion.

These types of aesthetic medicine facilites are locaated in a variety of settings, some of which automatically madate the use of HIPAA procedures. They include primary medical practice offices where aesthetic medicine is an adjunct, hospital based aesthetic spas, and aesthetic medicine spas owned by a physician and serve as their sole practice. There are no precise numbers, but recent surveys have indicated that these types of facilites account for 55 to 58 percent of the aesthetic medical spa industry revenues.

There are an estimated 950 – 1,250 freestanding aesthetic medicine spas in the United States. These include facilities that offers aesthetic medicine services exclusively with a doctor acting as medical director, or a franchised facility owned by a non-medical entity that functions as a management service organization (MCO) to a doctor. In addition, there are day spas offering medical aesthetics which have a physician as one of the partners and day spas that has a physician who visits the facility on a regular basis. These various permutations are estimated to to represent 25 to 29 percent of the industry.

The vast majority of aesthetic medicine spas use some form of electronic record keeping that limits information to those who really need to see it. While many programs come complete with firewalls that can separate the day spa from the medical aesthetic spa where they coincide, this software is not as sophisticated as that found in a conventional medical setting. There has also been little consideration given to the portability of these records, a need the industry is becoming more aware of – particularly where a client may be referred on to a plastic or cosmetic surgeon, or where a facility may be providing pre and post surgical care.

There are numerous spa industry service providers that offer medical related services and are more likely to use a paper records system. One group falls into the category of advanced skin care facilities – not medical aesthetic spas, but offering medical type treatment for acne, rosacea, and skin rejuvenation using FDA class 1 devices without any medical supervision. Another group warranting consideration are massage therapists that provide physician directed soft tissue injury treatments.

The fastest growing segment within the medical spa industry is the lifestyle or wellness medicine spa. This growth is a direct reflection of the increase in lifespan and a consumer desire to live longer smarter. While aesthetic medicine will continue to grow, a recent survey of female consumers revealed that 87 percent would rather feel beautiful longer on the inside than look beautiful longer on the outside.

Many lifestyle or wellness medicine programs focus on and are operated by physicians who are board certified in anti-aging medicine. But they may be overseen by a wider range of health care providers such as homeopath, naturopath, PA, physiotherapist, or other licensed health care professionals. If it is an MD, it is more likely to be an internist, endocrinologist, or OB/GYN than a dermatologist or plastic surgeon. More closely resembling the European model for a medical spa, the y practice preventive rather than reactive medicine and are more likely to incorporate complementary or alternative therapies into their programs of care.

Acording to the CDC, 35% of Americans suffer from a preventable lifestyle related disease. 24.4 million of them will die from that disease. Failing to embrace preventive medicine instead of reactive medicine is what is killing our health care system. Many consumers, believing that the traditional medical establishment is doing little to reverse these numbers, are turning to complimentary and alternative medicine instead. Consider the following examples:

A doctor placed a woman on painkillers and anti-inflamatories for cronic shoulder pain but it was causing her increasing gastric problems. So she came to a holistic medicine spa. During her assessment, the physican assistant/owner moved the woman’s handbag, which she immediately had weighed – 9.4 lbs. Treatment? She had a fanny pack purchased for the patient, ordered therapuetic massage, and because the woman was an avid golfer, sent her across the street to a golf pro to adjust the woman’s swing. In 4 weeks she was off painkillers and 3 weeks later won a golf tournament. Is that medicine? If so, how do we maintain patient confidentiality with a golf pro?

Or the woman who gained forty pounds from giving up smoking, was now having hip pain, and was being referred to a neurologist. Instead, she went to a spa where she was given a simple metabolic test, then placed on a suppliment based weight loss program, underwent bio-oxidative bath treatments to speed detoxification, massage to treat her soft tissue pain, and a manicure and pedicure as a reward. And this was at a day spa with no medical oversight. So what should we do when the client talks to the nail  technician about her wonderful “cure”

To require medical spas, whether they practice aesthetic, lifestyle or wellness medicine, to overhaul their computer systems to comply with new national records keeping standards would create an inordinate burden upon the industry. However, we recognize that our clients have an expectation of privacy that cannot be ignored. When you couple the word “medical” with “spa” your level of responsibility increases significantly.

What cannot happen is for HIPAA to be used as an excuse for not collecting client necessary health information prior to any treatment or service. Recently, a major resort in Hawaii began forbidding technicians from enquiring about customer health issues that might actually be a contra-indication to service. Lawyers advised the resort that it should eliminate any kind of client health screening – written or verbal. Instead, the spa’s clients would simply be asked to sign a waiver. When it was discovered that a technician had asked if a client was allergic to shellfish, she was terminated. This decision was upheld by a court in Hawaii that determined  the waiver oviated the need to follow scope of practice standards established by a licensing board.

The International Medical Spa Association recognizes that there may be a need for an interface with the information system you are considering, but believes that industry developed standards and guidelines would represent a much better solution than any type of government mandate. That is why the association has already begun discussions with software manufacturers, facility owners, as well as other industry associations to develop an industry wide approach to this issue . We would welcome guidance from your committee as we search out satisfactory solutions.

Again, thank you for letting me speak before you today.