Male Speaker 1: Welcome to today’s episode of True To Form with your host, President and Co-Founder of Crystal Clear, highly regarded speaker, and two-time Inc. 500 Entrepreneur, Tim Sawyer. True To Form is a podcast that highlights leaders making headway in the aesthetic, anti-aging, and elective medical industries. Learn from the experts to discover the secrets to success and the pitfalls to avoid when it comes to growing your aesthetic revenue with the authentic, the transparent, Tim Sawyer.
Tim: Hello and welcome to the True To Form podcast that connects you to the people, technology, and hot topics that shape the elective medical community brought to you by Crystal Clear Digital Marketing. And I am your host, Tim Sawyer. To our returning guest, welcome back. And for our first-time listeners, we appreciate you joining us and we encourage you to become a subscriber. In case you missed it in our most recent episode, we interviewed Audrey Neff, a six figure, fast moving urban professional aesthetic user. And as a millennial, she talked about how she makes decisions around who she chooses other providers. Her turns ons and turns offs. And we encourage you to listen to that.
Today we are going to dive into one of the most challenging and important parts of running a successful elective medical practice and this is how to run a successful practice in a compliant way. So, we are going to talk about risk mitigation. We are going to talk about best practices, I really think you’re going to enjoy, and we are fortunate enough today to have one of the leading – the national leading attorneys in this space for elective medical compliance. And it is my pleasure to introduce Brad Adatto. He is a partner of the law firm ByrdAdatto, a healthcare law firm with offices in Dallas and Chicago. Brad represents medical providers in the spectrum of issues that arise on the business side of medicine. He specifically helps medical practices, medical spas, surgery centers designing business models, employment agreements, other contracts, and federal and state regulatory compliance.
Brad routinely lectures throughout the country for medical conferences and at academic institutions on the business of medicine. And the best part about it is Brad is also one of the coolest compliance attorneys in the world and they do exist. He is a true white rhino in the space. So without further ado, I would like to introduce my good friend, and welcome to the program, Brad Adatto.
Brad: Thank you, Tim. I don’t really know if I could ever recover from this great introduction, but I will try to live up to being the white rhino.
Tim: Hey, we appreciate. You can be a lawyer. You can do compliance, and you can still have fun, right?
Brad: Yes, sir. And is this the Part 1 so that disclosures — and we can disclose the fact that we are both rooting for the teams that even though I am here in Dallas that I am not a Cowboy fan. That I am Saints fan, can I disclose that right now?
Tim: You can. You can.
Brad: Okay.
Tim: [Indiscernible] [00:03:11] than anybody that protects [indiscernible] [00:03:14]. All right. Thank you for coming on this program, but what I want to talk today about is kind of – it’s a unique choice, right? So, as a lawyer I am assuming you are going to law school and you probably didn’t have on board somewhere that said become one of the leading attorneys in the country around elective medical compliance. So, talk a little bit about your journey and how you got to actually bring your expertise to this space?
Brad: Yeah, sure. So growing up, actually I grew up in a house where I was kind of the mud of the family because my mom side of family, they are all dentists. My grandfather, uncles were all dentists. And then my dad side of family were all MDs. My dad is a retired orthopedic surgeon now. And then his father was a [indiscernible] [00:04:04] and his mother was a nurse. My mother was a social worker. So, very heavy in the medical community, but I knew early on…
Tim: No emphasis on education in your home, I can tell.
Brad: Exactly. And I realized early on that as much as like being around doctors and nurses, actually being one was not going to be something that I was interested in. But, I was very interested in the legal aspects of it. And I can remember early on even in sixth grade thinking that being attorney actually sounded like a cool thing. And so, getting into this space was easy in the sense of putting a foot into the medical community. And then probably over a decade or so ago – actually probably more that that because I have been this space for the 20 years. So maybe about 15 years ago was the first time I started really learning about plastic surgeons and how they start doing their offices and understanding about med spas. And then as it progressed and eventually I joined my partner Michael Byrd in Dallas. When I moved to Dallas really started getting more of flavor of other spaces in the sense of understanding what else is happening.
And then as our practice grew with other plastic surgeons and dermatologists, and ambulatory surgery centers, we also started picking up more and more individuals who are not your traditional core doctors like dermatologists and plastic surgeons who were doing a lot of elective procedures which often as you’ll know is referred to as med spas service or medi spas or there are different versions that are out there. And eventually we ended up hooking up with a good man who you might like to Alex Thiersch from Chicago who helps run AmSpa. And that kind of helped Catalyst interest in other areas where we have gotten to know a lot more organizations out there that are in this aesthetic space. That was a great journey because I have been able to work with all the different kind of doctors, but the aesthetic space is definitely an area as you kind of mentioned we are very heavy in. And speak at a lot different plastic surgery conferences across the country plus speaking at A4M [Phonetic] [00:06:12] and VCS and the Aesthetic Conference. And you name the ascetic conference basically we are somehow involved and speaking at those.
Tim: So let me ask you this, Brad. You say you have been involved in this space for 15 years. How has from a compliance standpoint in other words to the present that you are looking at this construct, how has it changed? How has it changed? How has it evolved? What’s better? What’s worse?
Brad: I think the first major piece that’s started happening is you had – and this is the slow evolution. It was dominated by derms and plastics. They are truly the only people who really where in this area. But then we started slowly noticing is these other physicians – and again in the industry they call them core physicians who really were in the space and just were unhappy with their lot as being internists or being ER doctors or whatever, they started seeing ways to develop cash businesses. And so, they started looking at other ways to bring in revenue. Although they kept their day job, they started opening up these aesthetic facilities in the med spas. And what quickly caught on is other medical providers who were working with these individuals your nurse practitioners, your PAs, your RNs, aestheticians started realizing, oh, gosh, I can kind of do this. And then we started seeing the funds started paying attention because a lot of money is being pushed to this. And a lot of the funds want to find ways in which they can capture cash. So I would say just massive acceleration over the last decade of that shifting and probably even the last four or five years a much larger acceleration of having non-core doctors in this space, but even more importantly non-physicians in the space, who are really not only doing well, they are almost dominating certain areas of the country because they had that entrepreneur spirit when they are opening up these med spas and they are looking at it in a different way of how the consumer want to be treated versus how would a patient want to be treated. And so that’s a huge shift that I have seen. But with that, comes a lot of misunderstandings of what compliance you have to abide by. Because if you had your typical doctors in this space, they had the training and understanding of the things you can and can do. And what’s happening unfortunately is that there has been bastardization of, oh, well, my buddy in Louisiana did this way, so I am going to do it that way in Texas, or, my buddy in Arizona did that way, so I am going to do it this way in Illinois.
And unfortunately, that doesn’t translate. There typically are three major rules that we have to abide by. And that has to do with your ownership, who can diagnose and treat, and who you can delegate and supervise to. And that’s where I think a lot of people are getting in trouble. They don’t realize it’s – they are looking to the federal government for clarity. That’s not the way it is. Every single state is going to have different rules those particular issues. And that’s a shift I have seen is eight – nine years ago, we weren’t running into this over and over again. Now we are running into the same issues over and over again because people are from the non-physician [indiscernible] [00:09:22] space or non – and has a due, they are unfortunately setting things up. IV bar is the perfect example. There are a lot of IV bars that I speak within a given week, and a lot of them are unfortunately set up incorrectly because they understand the rules that – and regulations on how to set up them correctly and because of that they are exposing either themselves and/or the medical providers who are working with them.
Tim: And how – this is the thing that scares me is so if you look at the landscape right to your point, you had – so the plastic surgeons, the dermatologists, cosmetic dermatologists are entrenched for a long period of time. Then you’ve got the migration of the folks the non-core like you said the other doctors who are coming in and now bringing esthetics into the practice that third layered although not in order of importance is the entrepreneur, the nurse practitioner, the PA, who are opening up medical spas. And it feels like me because I am out there all the time and you hear some crazy business models that people want to get in the space because they think it’s a gold rush. It feels a little bit like the Wild West. And what are the common mistakes that somebody makes that’s excited about getting esthetics and non-invasive or whatever it is? And what are they ignoring? The most of the most common thing that they ignore that can get them [crosstalk [00:11:00]…
Brad: The way to get in trouble, the number one way which they get in trouble has everything to do with the initial inpatient encounter because even if you set up correctly in a state which non-physician can own it, most state still say, hey, at the end of the day, this medical procedures are being rendered, we want to make sure that when someone ultimately starts receiving medical services that someone is gone through the process of examining which is so interesting you might here call the good faith exam or the initial assessment or the patient examination. There are a lot of different words out there in the industry. But, mostly you will hear the good faith exam. And that’s the trigger that almost every medical board or board of medical exam as whatever your state has that’s the easiest thing to note is that something went wrong when a person starts receiving Botox but never saw a physician or a nurse practitioner or a PA, everything else surrounding that meaning whether or not they are meeting the delegation rules or the ownership rules, those are really harder to kind of quantify.
But if someone walks in a room and you are in Forth Worth, Texas and you decide that you want to get some fillers put in and you walk in. And you have been following this awesome and she seems really cool. She has got a great website or she has good social following. And you go in and she immediately starts to put the fillers in you. And you have never seen a physician or a nurse practitioner while in Texas that’s a flat out violation of rules right there because there is never a good faith exam. And because of that, a lot of people don’t realize that. I mean by that even the nurse doesn’t because she has been trained probably really well. In fact, she probably knows how to put the fillers in or Botox better than a lot of physicians do, which they will tell you. And some of them have been doing it for 15 – 20 years. What they don’t realize is that’s outside their scope or practice, they don’t have the authority or autonomy to prescribe Botox or fillers. And that’s where they all get in trouble. Every single time I ever had a medical board investigation, it’s always kind of almost triggered from that almost – every time from that one issue.
Tim: And Brad, what if you had to I am just curious, if you had to through a guess out there, not that we are going to hold you to it, what percentage of practices are actually in compliance with that very basic notion? [Indiscernible] [00:13:28], which is called – yeah, I get it, but…
Brad: Yeah, and believe it or not, I would say a small portion. And the reason why I say that is I have plastic surgeons that I work it. And they didn’t understand that they had to see the patient first even though that they are in their office. I mean I have an investigation right now in the front of our medical board in which a person walked in. The doctor was in the office. Doctor spoke with the tech multiple times. Told the tech what the answer to the questions pressed and – had cold sculpting done, had some bad results; filed a complaint the medical board. And the big issue the medical board has, hey, you never saw the patient. You never did a good faith exam. And he was like, I was in the office. I answered all their questions, helped them through their concerns, and even spoke with the patient on the phone at one point. But the problem was he never laid his eyes on that or the nurse practitioner PA. And even those he is a plastic surgeon, even he messed it up. So, it’s very easy to mess that piece up.
Tim: Wow. What’s the common remedy for that? So, in other words, you get [indiscernible] [00:14:31], it doesn’t go right, [indiscernible] [00:14:32] and then is it fine, or is it – what can go wrong to these people?
Brad: So, what we always recommend is number one I the moment it occurs, you need to go back and do some due diligence as to how that happened. And the first thing you need to do is put proper SOPs, standard operating procedures, so that it won’t happen again. So that’s the first thing you need to do. So the next time someone comes in for their initial examination, you know who needs to the see, how they need to treat it, and how they come up with the treatment plan. After that, you can push them off and say, “Okay, now my RN is going to awesome. She is going to treat you for the next couple of months on these particular procedures or you’re not qualified for cold sculpting or laser, whatever it is that we qualify for. And what we found, at least the vast majority of times is this is the first time you’ve done something like that. And you kind of throw yourself because it is a technical violation in most states, that if you do that, a lot of times, they’re willing to kind of dismiss the charges against you and say, okay, you’ve learned your lessons. And not only did you learn your lesson, you came clean and you actually fixed it, and that’s what most of the boards want to see. If you turn around and start blasting them, telling the board they don’t know what that, if they’re thinking and they’re not doing it right, that ends up rolling up in the face.
Tim: Right. So stonewalling is never a good practice for, and it’s amazing because you would think, are a lot of the shortcuts in compliance, do you think it’s a function of ignorance, I don’t mean that in a belligerent way, but is it ignorance? Is it more costly to be more compliance with people go out, I’ll take my shot and what’s your encouragement, it’s kind of, I know, the old, the legal analogy is an ounce of prevention, right, is worth a ton of on the back end, so what can we recommend that they – to help them get through why they need to do this and where does – the follow up question for that would be where do most complaints come from? In other words, is it a competitor, is it a X, whatever it is?
Brad: Well, I would say the number one thing that as far as when you said who makes complaints, angry people, angry people that always wants to complain, so a lot of times it’s your patients, so your former employees or your competitors. Those are the main people who are going to make a complaint. Most medical boards have a requirement that they had to at least open an informal investigation and determine whether or not there’s any merits to, so a lot of times it’s DS and they just kind of dismiss it outright because you did something you were supposed to do and everything went wide, right? And they said, okay, we don’t see anything here. And let us kind of get rid of it.
But going back to your other question that which is, why would someone didn’t want to prepare themselves and that kind of goes back to that 550 rule, which is, either way, you have to pay an attorney somewhere along the way, you might not as well pay him five bucks up front to do it correctly, versus 50 bucks to fix it on the back end. And yeah, it is expensive to be compliant in the sense of, you can’t just go in there, form an entity and think you’d be fine. And, the reason why it is again, it’s not like the medical boards are kicking down doors, looking for your papers and making sure you’re compliant, because it’s pretty easy for them.
They get hundreds of complaints per year and depending on what state you’re in, it could be up to 1000. And so they’re always investigating. And so if you’re in the process of, you have low risk tolerance, and you’re out there doing something and you’re like, oh my gosh, she might be compliant, that’s – do a practice assessment, have someone to analyze your structure to make sure you’re correct. And at least you know what things you need to fine tune. And again, where people get in trouble, they do get an investigation open, they kind of bury their heads in the sand and they don’t do anything about it. And the boards don’t like that, whether it’s the nursing board or the medical board.
Tim: Right, right. Let me ask you this, because this comes up a lot. The person who says, hey, I’m not taking insurance. And so as it relates to HIPAA in particular, so a lot of the regulatory environment associated with HIPAA, I’m not taking turns. It doesn’t apply to me. Speak to that.
Brad: Yeah. So they may be correct. So federal HIPAA is very restrictive in some way as to who is it’s going to apply to, there is certain criteria you have to make and generally speaking, people who are just or cash based business are never really in HIPAA, federal HIPAA. However, a lot of states,
Texas, Florida, Washington is in the process, California at the top of my head have all adopted their own version of their state HIPAA, or state privacy acts. So you still have to comply with certain privacy requirements.
In fact, I think Texas is a little bit too aggressive and California is definitely very aggressive compared to even to the federal HIPAA as to what requirements are needed to comply and that’s payer in different meaning. It doesn’t matter if someone, it’s your billing one of the blues or your billing Medicare or someone’s walking in and paying you in cash or credit card. Either way, that you have to meet that state’s rules. The other thing is happening in certain states where they don’t have any privacy policies, what the plaintiff’s bar has done is when they’re suing someone for breach of privacy, they’re making arguments to the courts that, hey, look at these great guidelines that are out there, the Federal Government’s already out there, the fact that you’re not even coming trying to comply with these rules, you’re negligent, you knew or should have known better, and the courts are starting to adopt that as ways in which medical practices should have protected the health care information or the protected health information, the PHI. So either way, you’re going to, it’s something that they should take serious because they’re again, that’s exposure on to the compliance concerns.
Tim: And is that still the people consider that’s still a gray area? Or is it becoming a little bit more black and white?
Brad: I would say maybe five, eight years ago, it would – maybe 10 year definitely gray, I’d say in the last four or five years, if you talk to the right people, they would not consider that issue gray. If you don’t have a process of understanding how you maintain your medical records, examining how you’re protecting them and how you’re transporting it and does at least a minor risk assessment, then that exposure, you will get nailed by either your state, again state agency or the federal agency, if you are dealing with HIPAA.
Tim: Yeah, and it’s funny because we talked about this at the medical spa show, which I rec – in Vegas every year, which I recommend everybody go to, it was incredible. And we were talking about this before on the podcast. I was on a panel with Dr. [indiscernible] [00:21:38] who’s a plastic surgeon, Dr. Jay Burns who is a plastic surgeon. And we were talking about the competitive landscape, right, so you’ve got this massive proliferation and non-invasive technology, which has been leveling the field somewhat, the playing field between the people who aren’t cosmetic derms and aren’t plastic surgeons. And one of the pushback from the plastics, I thought it was cool that we were all in the same room together, you don’t see that all the time.
The pushback from the plastics is they’ve had so much training, not only in their craft, but also in the practice of medicine and the procedures that you have to put in place. And the consensus that I felt was the biggest risk to over regulation of everybody is going to be the lack of self policing. Right? In other words, we’re not – you’ve got, so for example, you can probably speak to this case that was out in New Mexico where, you know, the details better than me, almost burn the person’s face off, and how much of that is going on out there and driving the regulatory environment and the follow up would be, do those regulatory bodies even fully understand the complexity of all these technologies?
Brad: No. They don’t. And the reason why I know that is we’re constantly on the phone either with medical boards or nursing boards, trying to understand their statutory rulings or the medical board or nursing word rulings. And then obviously, constantly analyzing how the statutes affect, the statues definitely are not keeping up with the technology. And so then we are having to make judgment calls about whether or not something, how invasive of a procedure is something and if that technology is being used to alter skin or fat, is that the practice of medicine, so answering your first part is, they’re not keeping up with that.
And so that’s probably why so many people are so confused about what you can and can’t do. I think that was your statement earlier about, they’re not – they would like to understand how to do things correctly, and they’re not ignorant in the sense of their head in the sand. A lot of them just don’t realize or they call the nursing boards, even the nursing board can’t explain or the medical board can’t explain it well, because they don’t even know how to understand all their statutes. And what’s happening, the New Mexico case is an example of somebody who was not properly trained, using equipment they shouldn’t have been using, or in the recent – more recently, which was happened in Houston, I think, actually the weekend, we were in Vegas for the national show.
You had an untrained individual with no license, so is an MA, for practical purposes, was arrested for having his own Med Spa where he would do injections under no supervision whatsoever. And that has caused states like Texas, to try to pass more aggressive bills, making it harder and harder for anyone to own a Med Spa, including even physicians, which bill by the way, thanks to the hard work of and spa and our firm ended up not passing. And actually, the senator who was putting that together ended up killing it. But if the industry going back to your statement of policing themselves, starts doing a better job making sure the right people are being trained, and following the right rules, that actually some type of consistent standard of care that everyone is expected to follow would be very helpful to industry because otherwise you’ll have these reactive – they’re going to react by saying, in Texas, only a few people in the world could do these certain procedures or New York, only doctors can fire lasers or let’s go to the New Mexico example.
They could turn around and say the same thing, only doctors can own and fire lasers, no one else can do it. But that’s just not how the industry’s develop now. And you can train, text to do it under the proper supervision and guidance. And those are the areas in which, if we don’t have any compliance, and we don’t police ourselves, being the industry of police itself, you’re going to have these draconian statutes also coming out because they think they’re going to be protecting, they’re going to overreact in the sense they think they’re protecting the public.
Tim: Right? And like I said, the technology is moving at the speed of light. And, the average regulator, sitting in somebody somewhere, let’s face it, I mean, they don’t understand the technology, they don’t understand the chemistry, the biology of it, and, what may appear to be safe to some people who are knowledgeable to somebody who’s completely ignorant on the subject, it all seems crazy. You know what we’re shutting this thing down. And I think that’s the point which is, people have to be careful. The other thing I wanted to, because this issue keeps coming up in our conversation, which I love is that this is a very complex, regulatory environment, it’s state to state, it could be different in some parts of the states in California. What is the work that I know, you in collaboration with Alex and through your efforts at AM Spa have been working to aggregate some of these laws, is there a library that’s being created? What is the work that you’re doing? And how could somebody go about accessing that work?
Brad: Yeah, absolutely. So AM Spa, we have worked with AM Spa on developing a 50 state survey, so that it has certain key questions that the vast majority of people want to understand about ownership or treatments or who can do what kind of, those typically are the kind of questions and AM Spa now, if you’re a member, you can get depending on your membership, access to certain states in which you’re in or other states where they have AM Spa and access plus kind of plan where they also have additional criteria. So you actually get a bigger list of questions versus the – and so we have been working with AM Spa for I guess, 2.5 years now, kind of helping the fully develop that. And at our firm, we basically have two full time attorneys dedicated to continuing analyzing state laws just because it just takes that much time and effort to understand what’s happening in the industry.
Tim: And I think I want to say one more thing you said earlier about – sorry.
Male Speaker 2: I said, if it was me, I’d be scared as hell to go out right now and, start up, like you said, so I’ve got a friend, I live in Rhode Island, my friend is in Massachusetts, he tells me this is what I do. You can’t just apply that in another state and go out and do it and think you’re going to be okay. You really have to dig in and, so what would be your kind of, so either someone is getting ready to integrate wellness or aesthetics or, they’re going to open a practice. What’s your like, 1, 2, 3 checklist for, hey, these are the big three things you really want to do.
Brad: Yeah, the number one is, you would want to make sure that the ownership structure is correct. That tends not to be the thing that drives any of these investigations, because again, the state’s not looking to see who owns it. That’s an after the fact issue where we’ve had people get hit because of a patient complaint. And when they further investigated, they realize they were not set up completely. So that’s the first thing. The second thing and again, is you had mentioned something, a lot of times, I’m talking to plastic surgeons, and they say, or dermatologists like, these other guys, they don’t – these other physicians don’t understand all the training that we’ve had, but – so they’re kind of fussing about this, but they don’t see them as full competitors yet, because a lot of, you talked to young plastic surgeons, they say, the amount of money I can make in the surgery room, why would I care about having a med spa, but then your senior plastic surgeons who are ready to slow down, they’re like, oh, wow, I need to start recapturing these patients that I’m not going to be doing surgery for, I’m going to want to increase my med spa and they start getting it, oh, well, there’s – this is a great moneymaker for me because of all my training.
Those physicians who don’t have that background in the sense of that board certified and one of those two, they need to go out and make sure they get the training. So if you are personally opening up with another doc who just happens to be an ER doctor, and you’re planning to have lasers and IV and Botox, that ER doc needs to go and get training at all the different facilities because if he’s overseeing it and supervising those individuals and does not have that background, he does not have a defensible position as to why he should be working with them. In certain states like Florida, that wouldn’t work. But other states, that’s fine. Florida is probably more restrictive as to who can render static services that are non-physicians, meaning that you have to kind of, you must partner with a medical director who’s either a dermatologist or plastic surgeon. Basically in Florida, there’s some exceptions I don’t want to bore the group with, but again, going back to what you had said, that’s the problem is every state can be different. So just because I did that way in Florida, doesn’t mean I can do it in Massachusetts or Massachusetts, you can actually go get a license from the state, for other non physician to open a box store Med Spa. So, every state can be different in that sense.
Male Speaker 2: Wow. So there’s two more topics we’re going to cover and then we’ll wind it down. I cannot let you go without talking about these two issues. One is, do you think there will ever be and how could it happen, description, a universal set of standards for how these practices should function. Right? In other words, because there’s no standard for what is, a qualified safe Med Spa, right?
Brad: Correct. Not yet, but I know that that is a big project that AM Spa is working on this year, trying to incorporate certain elements that every single compliant Med Spa should have in place. It’s very similar to the emerging world or ASC world, the lab world that in every state, there are certain rules that you have to abide by. But then there’s some universal acceptable rules that everyone does. And that’s one of the things that I think will be helpful when people are opening up their places. These are universal rules that you need to follow, as far as following the standard of care and doing things the right way. So I definitely think that would be something great for the industry to start looking at. And again, going back to being here in Texas, we are actually working with Texas now on trying to develop some of those rules. And so that if they do come back and start adopting some new rules in the next session and next legislative session, and that is adopted, that we can use that a catalyst, other big states like Florida or California or New York and showing that there are ways in which a state can kind of incorporate stuff to have good practices, but at the same time, protecting the industry in general.
Male Speaker 2: Yeah, so you guys are literally on the front line. I mean, you’re not just out there defending people and creating best practices, you’re actually – you’re maybe lobbying is – may or may not be the proper term, you’re actually lobbying and your –
Brad: Yeah, our firm isn’t lobbying, but we’re working with lobbyists on drafting language and since we’re so involved with compliance issues.
Male Speaker 2: Wow. So let me and I want to get to how people can send you their information requests and all that, but I have to, in the last topic that we have, because it would be reckless and irresponsible for me not to address social media and compliance and a couple of issues. One is, the fun side what you can post and then the other one is the insane desire for a surgeon, physician, business owner to openly refute a complaint on a social media. Can you speak to that?
Brad: Yeah, absolutely. So number one is, the medical industry is highly regulated as it relates to medical advertising. You have FDA rules, which is federal, you have FTC rules which are federal. So you have two federal entities that can file complaints as to how you’re doing certain advertisements. Those are rare, happening more than they used to, but rare for them to go after medical providers, the FDA and FTC, where they normally get really hit hard is by your local medical boards, because there is a host of rules, mostly following the concept of both, you can’t advertise something that’s false, deceptive or misleading, and then doing so, understanding that your state’s going to find different ways in which that can be false, deceptive or misleading. And so when you are putting it on your website or using your social media, you need to have great policies and procedures in place to understand how to limit what can be posted and that’s the fight that anyone would always have with a marketing side.
So I actually met many people who are with Macy’s and Dillard’s and they’re used to advertising those big box stores. And they’re taking that same awesome concepts that you can do over there and bring it into med spas, but then they have to then have certain language, because in the medical industry, there’s certain things you can and cannot say. So the big piece to be mindful of as you approach this, which has been a big believer in advertising, obviously, and I think, done correctly, as you probably can attest, it is a huge shift in the market and it’s a huge shift of how you can bring your patients in and do well in life. But I also think you have to be aware of the limitations and mostly surrounding those three major elements, the false, deceptive or misleading aspects of it.
Male Speaker 2: Got it. And what about the guy who just can’t help himself and needs to when someone says you suck, you burn my face, and he wants to go back at that person on a social medium.
Brad: So, unfortunately, going back to, I think, your question on privacy, you cannot acknowledge someone is your patient. There are – there are two rules of school and this one that I’ve seen, and I’m sure you would actually could, probably a panel and you’ve said this, but, the first one is, it’s okay every once a while to have a bad review. In fact, it doesn’t really hurt you, in the sense of so long as you have a process of collecting and making sure that the patients that love you are posting good reviews. So the solution to pollution is dilution. Did I get that one right?
Male Speaker 2: Yes, you did. Well said, pollution is dilution.
Brad: And so by having great reviews out there, at that one or two, crazy patients that I was unhappy that no one could ever satisfy, it won’t look as bad for you in that sense that every once in a while, you have a bad review, but unfortunately, because of the industry that we’re in and because of the restrictions that we have on person’s privacies, you cannot acknowledge the fact that that individual is your patient. So, there are some groups that will say, okay, develop a standard response of some sort, tweak it so that it’s somewhat engaging, but at the same time, don’t blast that person or try to turn around to them. There’s a case going on in Florida right now, where there’s an anti slap case where a physician wouldn’t suit his patients and in certain states, if you’re suing someone prohibiting them from the first amendment rights, they can turn around, sue you and then get attorneys fees and damages. So be very mindful of, that’s probably not the best structure to have a business of suing your own patients, for them expressing just like in your services.
Male Speaker 2: You would think that would makes sense. So we got a couple of minutes left. I really wanted to give you an opportunity to talk a little bit about this really unique platform that you’ve developed at Byrd Adatto and that is the access plus program, which we certainly work with a lot of folks who are in it, love it, talk a little bit about, this is your chance to shine, talk a little bit about what it is, the value proposition? And then also, how could someone reach out to you and folks are going to definitely have hopefully, you could provide your information, people are going to have some email requests around things they’d like you to bring to the legislative attention. But also, talk a little about access plus, and how folks can reach out to you.
Brad: Yeah, so over the years, again, I’ve been at this for over 20 years. The traditional law firm model is, you build something by the hour, and they pay you by the hour. And we found that that meant our clients were afraid to pick up the phone and call us. Because they were – they’re like, oh gosh, if they call them and it will cost X dollars, and what if there’s really nothing big and then I’m calling them for no reason. And so we found that that was not a good plan, if you’re trying to help people do, you try and keep them compliant and then they refused to call it because they’re afraid of the charge. What’s the way that we can do it? And that’s how – that’s kind of how access plus is born by developing basically a membership program where we have over 100 clients now that subscribe to a monthly subscription at different rates depending on their needs.
And but no matter what, they get some access to pick up the phone call their attorneys for us to call them back or to email us with a question and we respond and we say, oh, thanks for reaching out, not a big deal, I totally understand your concern, here’s the answer, you’re fine. Or, let’s slow down, I think we need to work to that, you definitely need agreement that’s going to violate the state’s anti kickback law, let’s get a project together. And again, depending on your plan, that’s all prepaid for it. And again, it’s one monthly fee per month again, that we have on our website, we have a list of that with those different lists of plans are, but we actually have a lot of clients that are off menu because of their needs are greater as far as their services, but it really means right now, just within a small period of time, basically almost less than a year, it’s almost 75% of a business now. So it is completely turned upside down.
Male Speaker 2: Yeah, I mean, you’re really changing the traditional legal paradigm, right? People don’t have to, like you said, phone rings, the guy slips the meter and you’re off to the races. You can actually, I love the idea of subscription based legal services, particularly when it’s from it – you guys are competent and you’re the leaders in this and so I highly recommend. And if somebody wanted to inquire about access plus or about AM Spa, the American Medical Association, those who don’t know, getting access to the database and memberships, how would someone go about doing that?
Brad: Yeah, sure, you can go to our website, www.byrdadatto.com, that’s Byrd Adatto.com. And on that website, we actually have a button that says, how we charge and so you can actually go down and learn all about how we charge and obviously, our bios are up there. And then there’s an info button that if you want to learn about access plus, we have a person that can kind of provide you more information on that. Or if you just want the information in general about the firm, we’re up there and obviously, my pretty picture is up there on the website or my bio with my email and all my contact information. So, after this call, you have other questions, let me know you heard the podcast and reach out and I’ll set up a console and I’ll just waive my initial console fee that we typically charge. Thanks for listening to this.
Male Speaker 2: And so dude, I know you’re on the road all the time. You’re one of those animals, I see you everywhere I go. Where are you going to be next? Where can somebody find you, like up the booth, give you a hug, say hello.
Brad: Sure. Well, let’s see, well, I just saw [indiscernible] [00:41:48] A4M and obviously saw your peeps and asaps in New Orleans. That was just what two weeks ago. I feel like it was yesterday. And then I’ll be at Vegas at VCS this coming June. I’ve got AM Spa coming up, oh my gosh, it isn’t next week. Wow. Yeah. So next week, I’ll be in Vegas and then I have a boot camp in Dallas coming up. I think that’s in early September and then I’m an ASPS in San Diego. Those are the ones I can think of top my head, I think I have another boot camp in Florida, or two. But yeah, those are the ones I can think of off the top of my head. Actually on our website, we actually have all our speeches listed also under the speak page. So if they want to find us, they can find us on the website also.
Male Speaker 2: That’s great. Listen, Brad, I really appreciate, first of all, say hi to all the folks at Byrd Adatto and we really appreciate you taking time. I know you’re a super busy guy. I look forward to seeing you on the road. I only have one more request. And that one more request is that you agree to come back and I think next time, we’ll talk about commissions and kickbacks and revenue sharing, how to do that the right way, I can’t wait to have that conversation. And as always, guys, we appreciate you listening. Anybody interested in learning more about Crystal Clear digital marketing and what is that we do, you can go to crystalcleardm.com just go to the website, you’ll find a number there. Reach out to Andrew and the boys would be happy to answer any questions that you have. You can email me directly at tsawyer@crystalcleardm.com. And with that said, Brad, thank you very much; enjoy the rest of your day and to our listeners, we thank you and we look forward to seeing you again soon guys.
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