Legal considerations: The virtual consult

The noninvasive procedures that cosmetic surgery practices offer — from laser hair removal and skin resurfacing to injectables — are often provided by nurses, nurse practitioners, physician assistants, laser technicians and other non-physicians. But the doctor, nurse practitioner or PA has to have some sort of supervisory role. That means doing an initial consult with these patients — sometimes, follow-up consults.

The question Alex Thiersch, a Chicago-based attorney and founder of the American Med Spa Association, addressed yesterday at the Vegas Cosmetic Surgery and Aesthetic Dermatology 2016 meeting in Las Vegas, is, Does telemedicine, Skype, Facetime or other virtual means of interacting with patients suffice?

Thiersch, who presented “Physician supervision: What about telemedicine, virtual consults, Skype, etc.” tells Cosmetic Surgery Times that it often becomes an issue when the physician, nurse practitioner or PA needs to see patients for noninvasive procedures that they’re not performing. But the law, in general, is that these advanced level practitioners should see patients at least once before treatment begins.

Whether or not these visits have to be done face-to-face (in the flesh) or by computer is not only on cosmetic surgeons’ minds, but also an issue that medical boards and states are closely examining, according to Thiersch.

“It’s is kind of the undecided question right now,” he says. “Some states are more lenient than others.”

The key for cosmetic surgeons is to check with their local healthcare attorney or state medical board to find out what the law requires.

“It often depends on the treatment and how invasive it is. But there are a lot of states that would allow a telemedicine-like consult after the doctor has at least seen the patient once but not the first time,” Thiersch says.

Thiersch’s advice? Until the laws are more settled, proceed with at least a little bit of caution and don’t practice in gray areas when it comes to virtual or telemedicine consults.

The final takeaway: “This is where nurse practitioners and physician assistants make their money because they can fill that gap between physician presence at the facility and supervision.”