In this episode, hosts Brad and Michael are joined by Paulina Riedler, CEO and co-founder of SpaKinect, a leading telehealth provider in the medical aesthetics industry. Paulina shares how SpaKinect tackles compliance challenges in the aesthetics industry, highlighting the importance of good faith exams and the impact of telemedicine. Learn how to navigate key compliance challenges and state-specific regulations when practicing across multiple states. Tune in for steps to enhance your compliance strategy and safeguard your practice.
Listen to the full episode using the player below, or by visiting one of the links below. Contact ByrdAdatto if you have any questions or would like to learn more.
Transcript
*The below transcript has been edited for readability.
Intro: [00:00:00] Welcome to Legal 123s with ByrdAdatto. Legal issues simplified through real client stories and real world experiences, creating simplicity in 3, 2, 1.
Brad: Welcome back to another episode of Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd.
Michael: Thanks, Brad. As a business and health care law firm, we meet a lot of interesting people and learn their amazing stories. This season’s theme is Compliance Fundamentals. We’ll take real client stories, scrub their names to protect confidentiality, and we’ll build the stories around navigating the compliance obstacles in the business of health care.
Brad: Yeah. Michael, and we’re talking about compliance a lot this season, and for some people that can be a very scary word. What does that mean?
Michael: Well, yeah, it’s a broad word that’s used to describe all the laws that govern the practice of medicine or other health care practices. As we’ve [00:01:00] talked about in other episodes, they’re both state and federal laws that can come into play and health care is one of the most heavily regulated industries in the United States. And so to be compliant means that you’re running your practice in line with these various laws.
Brad: Perfect. Now, as we discuss in other shows, compliance should never be stagnant. But before we bring on this amazing guest that’s sitting next to you Michael, are you familiar with the concept of traveling doctors from the 1700s and 1900s?
Michael: Brad, I was not licensed yet, so I’m not familiar.
Brad: So based on that, you’re licensed in the early 1900s. Got it. So I was reading this article in the Traveling Doctors, also known as “roving physicians”, which I think is really kind of a cool name for me. And they played a key role in health care in the 18th and 19th century, especially obviously in the rural areas.
Michael: I’m picturing you, like over the weekend, dusting off your old encyclopedia set [00:02:00] to find this nugget that you’re wanting to talk about right now; this riveting topic from the old days. I won’t make too much fun of you because we have a guest here today who’s also a client, and so… well, I say that, maybe I will, but we’ll keep going. I’ll entertain your roving doctor conversation.
Brad: Thanks, I guess, for being nice. Even though you’re making fun of my encyclopedia collection, I guess. Well, anyway, the article discussed the challenges that doctors have for these long traveling distance, obviously had to go by horse and carriage, and if you didn’t know, they didn’t have the cell phone to kind of how do you get there? They couldn’t even listen to a podcast. I mean, the horror.
Michael: Sounds exhausting. I mean, how would they reach these towns?
Brad: They actually relied heavily on the word of mouth, building reputation, which critical they had, obviously earn the trust of the community, especially since they might be the only medical, health care or medical doctors [00:03:00] from miles and miles away.
Michael: Yeah. I’m guessing if they didn’t build trust, they would get a really bad Yelp review.
Brad: Yeah. Bad Yelp review back then was tartan feathering.
Michael: Oh, okay. Yeah. All right. Well, what about payment? I can’t imagine that people just had cash laying around.
Brad: Yeah, that’s a great question too. They actually didn’t really have that much cash either. Many of these patients because they didn’t have cash, they actually did a lot of bartering back then. So the doctors would be paid with goods, with livestock or produce as payments, which reminds me, actually, when I was a kid, my dad, when he would treat a lot of shrimpers, we actually got paid. We’d have a big ice chest of shrimp would come home, and that was the payment that my dad received for providing medical services.
Michael: I’m facing such a dilemma right now. I don’t know whether to make fun of you because you’re that old that you experienced bartering or to make fun of you because you grew up in Louisiana and they were still bartering and probably still are today. Which route should I go?
Brad: You’re right.
Michael: r all the above?
Brad: It could be.
Michael: Alright, well, what can we learn from [00:04:00] their journeys?
Brad: Yeah. So the story reminds me of the importance of trust, obviously, and potential connections to the health care, as well as the challenge that you see with medical services in these small towns. And it highlights how far we’ve come, obviously, with the introduction of telemedicine and the ability for doctors and other providers to instantaneously be in someone’s home.
Michael: I kind of see where you’re going now, Brad. For those who do not know, Brad was a history major and you’re just trying to flex, I can tell. I do appreciate the insights, but let’s bring our guest on today. I have a feeling she’ll have something to say about something you just mentioned – telemedicine. So joining us today is Paulina Riedler. She is the CEO and co-founder at SpaKinect, a bachelor of science in nursing, a working mom, trying to achieve work life balance, a client and friend of ByrdAdatto, and a first time guest on our podcast. [00:05:00] Welcome.
Paulina: Thank you, Michael and Brad, that was so lovely to watch you guys banter back and forth, thank you for having me. Yeah.
Brad: We’re super excited to have you here. And actually, we’re going to start with the most important question. As a nurse, would you be interested in going from town to town and being paid with produce and livestock?
Paulina: Absolutely. Well, fresh produce, fresh livestock, yeah.
Brad: I could see you, Kevin.
Paulina: I don’t know how I get the livestock back home but-
Brad: TSA would probably fine with it.
Paulina: Yeah.
Michael: Okay. Well, a lot of our audience is probably familiar with your company, SpaKinect, but for those who have not yet met your company, why don’t you tell us a little bit about SpaKinect?
Paulina: Yeah, so SpaKinect was founded in 2012. My husband and I founded SpaKinect when we saw there was a need for more compliance support, and we had a solution using telemedicine to solve, solve some of the problems that we were seeing. So what SpaKinect does [00:06:00] is we provide good faith evaluations via telemedicine to medical spas and medical practices offering aesthetics in 33 states. So we specialize in medical aesthetics, so treatments like Botox, injectables, laser hair removal, body contouring, now weight loss and GLP ones as well. So as the industry starts to expand into more wellness, we are starting to offer evaluations for more things.
Brad: That’s very cool. And as you heard in the beginning of this podcast, we’re focused on compliance fundamentals And you kind of said it a little bit, but let’s go dive deeper into it. When you started SpaKinect, what was the compliance problem that you did solve?
Paulina: You touched on that, Michael. I’m an RN. So what we were seeing in 2012 was, we were based in California at the time, and the nursing board and the medical board was really starting to crack down on a lot of nurse injectors, especially RN injectors who were [00:07:00] operating outside of their scope. And so what we saw is actually, there was a, an article in the Ventura County Star, and there was an article about a nurse, an RN who was arrested on criminal charges. Hmm. she had been going to patients’ homes and doing Botox and didn’t have any physician oversight, so she was charged with practicing medicine without a license. And at the time, I didn’t know a ton. I was in the functional medicine space. I didn’t know a ton about aesthetics, but it really piqued my interest because one, as an RN I could never imagine being arrested with criminal charges, so that was scary to me.
So we did a little more research and we had a friend who had a couple of medical spas in San Diego, started asking him what’s going on? Why do you think this is happening? And he explained to us that in order to get a physician or a nurse practitioner to do a good faith exam, you have to either pay them, hire them, retain them. And at that [00:08:00] time, not a lot of people were using telemedicine. So for this particular case, the nurses wanting to go to people’s houses and what is she going to do, bring the physician with her, that’s just very costly, right? It didn’t make business sense, so that’s why she was skirting around the law. And we just immediately saw that we were already doing telemedicine in another industry, and we were like, why don’t we just pivot and use telemedicine? Why isn’t anybody doing this?
So the more people we talked to realized that there was nobody doing this at the time, so we created an industry that didn’t exist. as we started going to different medical spas in California and saying, “Hey, would you pay for this service? We hired one nurse practitioner, we found her on Craigslist, that was where you found employees at the time. That was before Indeed and all the other stuff. So it was great. We found our first couple of clients and we took off from there. That was 13 years ago – almost.
Michael: That’s crazy. And I don’t [00:09:00] think, a lot of people may not realize that back in 2012 Telemedicine was not heavily adopted yet.
Paulina: No. And especially not in the aesthetics industry. Maybe more so for primary care, internal medicine and some specialists in the hospital I remember we had the big – I can’t remember what it’s called, but we had the big machine on wheels that you could like roll in and pipe in a specialist if you needed to. But I mean, as in aesthetics, it was virtually unheard of. So there was an uphill battle for us to get people to adopt this new technology, and I’m talking at that time most people were using a laptop to have their patients sit in front of us. We were using Skype at first. This was the first, the first six months being Skype, so that’s how long ago this was. But yeah, it was definitely an uphill battle. People were not comfortable and confident using telehealth at that time.
Michael: Well, let’s talk, because I feel [00:10:00] like – and you probably experienced this, like covid, there was a shift. Telemedicine became very normalized. And so since Covid, we’ve state legislatures and boards across the country are kind of debating what do we do with telemedicine, because they really lessened the restrictions. Kind of talk about your experiences on how states and boards have viewed telemedicine and just kind of that impact. Y’all been on the front lines this whole time.
Paulina: Yeah. I mean, after Covid, we grew tremendously, and that was because the demand grew tremendously. People were way much more receptive to telemedicine. People were already doing that in their own lives. And so, getting people to understand the idea of having an iPad in front of your patient, we’re going to pipe in one of our providers, they seem to be much more receptive [00:11:00] to that. Every state, as you mentioned, has their own regulation, so that’s why we have you guys. That’s why we talk almost every day because there’s so much that’s changing all of the time. But I think that what’s interesting is that telemedicine is not going anywhere. And I think that now a lot of people are having to, a lot of practices are forced to adopt it. The benefits to me are only positive.
Obviously there are some challenges that the industry faces as a whole, but overall, I think the benefits outweigh the cons. I think people getting access to care easier, access to care, that there’s only an upside there. And that can translate to aesthetics as well. But even when you look at primary care people who don’t – pediatrics, you don’t have to get in a car with your sick kid, go to an office with other sick kids, expose yourself, and then your other kids. So it’s just, to me it’s positive overall for aesthetics. During Covid what was [00:12:00] interesting is we started rolling out the ability for us to evaluate patients at home because everyone was social distancing. So we said, okay, if you only want to see one patient in your office at a time, we’re going to evaluate your patient before they even come in that way. You have all of their information, you have their full H&P. And when they come into your office, you can limit the amount of people that you need to have in there at one time.
Michael: Interesting. I have a quick follow up because I was thinking about just your journey and you had this initial uphill battle of people didn’t use telemedicine in this space, and so you’re having to educate them. And the other one is, the core problem you’re solving, which is the good faith exam. I mean, I know we know from what we do that people would be reduced to tears when we would tell them that you’re supposed to have this step in the treatment process where a nurse practitioner or PA or doctor is [00:13:00] evaluating a patient and clearing them for a treatment. Talk about what that was like raising awareness. Did you have resistance when you were trying to…?
Paulina: A hundred percent. We had a lot. And I’m sure that we both have similar experiences in that respect as you counseled people, like you said. But I think it definitely made us, I think, more resilient as a company. It made us really have to hone in on the process that we go through with all of our clients, which, it’s easier now. It’s much more of a sort of, I would say, more widespread of an understanding of what a good faith exam is. Even though there’s still a lot more education that needs to be done. But in the beginning, I would say the people who were coming to us in the beginning was all through word of mouth. The first six or seven [00:14:00] years of the business’s existence.
We did not invest in any marketing or advertisings— all referrals and word of mouth. And so, these are people who genuinely cared about compliance or had already been through an investigation. And then they’re telling all their friends about what happened to me, and then that’s scaring the crap out of their friends, and so they’re coming to us. But I will say that I always joke, like, we had a lot of clients in the beginning who begrudgingly became clients, because they really didn’t understand the need, but they were like, everyone’s telling me I need to do this. I really don’t want to. I don’t understand why I need to pay you guys. I’ve been operating like this for 20 years. I’ve been doing Botox 20 years. I know what I’m doing, right? So we still get some of that.
It is challenging, but we just always try to reiterate the – I don’t like to scare people too much, but I do like to use the client stories that I’ve had. And every client that we’ve had who has been using [00:15:00] SpaKinect, who has been investigated by a board has never – we’ve never had any issue with them using SpaKinect. Our clients have gone through investigations with multiple State medical boards, so we’re super confident. Obviously we have the best legal team on the planet, so we’re super confident in our process. And so, I like to use those stories to try to help clients understand the ones who are giving me resistance. But I’m at a certain point, I also can’t convert everybody. They’ve got to be willing to spend the resources and the time and be willing to invest in the longevity of their business.
Michael: I can picture like, the hardest calls you get are probably like some mean attorney named Brad Adatto, told me I need this, and –
Paulina: He’s the worst.
Michael: The guy’s awesome, man.
Brad: I heard about him. And I think it’s interesting because I’m going to ask you a question that you kind of answered, but before Covid, I know Michael and I would speak nationally on the use of [00:16:00] telemedicine, and people would eyes would glaze over because no one was familiar with it. But for those audience members who still haven’t really experienced, kind of walk our audience through like what is telemedicine and how do SpaKinect kind of use, especially in the aesthetic industry?
Paulina: So we use a synchronous telemedicine model. That means that the patient and our provider are speaking to each other at the same time, so we use a video platform that’s built into our system. It’s HIPAA compliant. The way that it works is that when a patient comes into a medical spa, let’s say ABC Med Spa, they come in, they have an appointment. Usually the client will book them at like 15 minutes early if they need a good faith exam done or if they need it renewed. So the patient will come in, typically they’ll put them in the treatment room, and they’ll hand them an iPad or a mobile device. They’ll input the patient’s name, their date of birth, what are the treatments that that patient’s wanting to get. And then it will instantly connect, typically within two minutes, one of our providers picks up, [00:17:00] which is a pretty short amount of time to wait. And then they’ll go through an evaluation.
So they’ll ask them questions about their health history. What medications are you taking, what’s your surgical history, anything that’s going to be really relevant to the treatments that they’re getting or wanting to get. And then our provider will issue a treatment plan and an order, and they will submit that document and it goes immediately into the client’s portal. So oftentimes the treating provider, so let’s see if ABC Med Spa has a nurse and this patient’s going to get Botox; that nurse will usually be in the room too, sometimes they’ll step out for the consult and come back. And that gives our providers an opportunity to talk to that RN and say “Hey, this patient has a history of skin cancer, make sure you’re going to avoid this area or that. And that’s the part that I love is that we get to speak to those providers and not only build those relationships, but it also instills the peace of mind for that treatment provider that [00:18:00] they have us to rely on, and they’re making sure that they’re practicing safely.
Michael: Interesting. That’s so fascinating. Well, so you said…
Brad: Can I jump in real quick on that? You said you use video for all your connection, even though it says telemedicine, you’re using video medicine is what I’m hearing?
Paulina: Yes. We are using video medicine.
Michael: That was a trick question, Brad. No, that’s cool. You also said HIPAA compliant when you were talking about the software that y’all use. And I want to kind of expand on that because I’m picturing, especially the audience members who are not as familiar with this. Of course, we get a chance to talk about compliance. So if someone’s using it and they’re wanting to use a telemedicine; talk about what SpaKinect does to kind of protect patient privacy and security from [00:19:00] a data perspective.
Paulina: Yeah. So that’s a big part of our job, right? We’re obviously getting patient data and we have to make sure that all that data is secured. I wish that I could speak more intelligently on the back end of our system, but I will say that our system meets all of the standards for being HIPAA compliant. We have policies in place, internal security protocols that only allows certain people permission access to the system as well as on the client’s end. And that’s actually something that we realized as we started to grow is that a lot of our clients would say like, “Okay, I have nurse Sally here, and then we have like 14 other employees and I want all of them to have logins to the system.” And it’s like, “No, they don’t all need logins to the system.” We only need people who are treating the patient to really have login to the system.
That’s kind of another piece that I think is a big piece of that puzzle, [00:20:00] right? Because if we allowed everyone to have access, obviously not everyone in the office needs access. So we really limit the amount of people who have access to the system. We also have password protocols so they have to change their password, I think it’s every six months. There’s a lot changing as well as technology advances so quickly. I like that you asked this question because it’s something that in the last year and a half, we’ve really had to invest some more resources into make sure that we are staying up to date with all of the changing technology as we want to advance our technology, now with AI, there’s so much more. And I think there’s still a lot of gray area because it’s advancing so fast. So we always take a really conservative approach to everything that we do. And I think there’s some technological advances that we have wanted to make, but have been a little bit cautious because we want to make sure we’re doing it safely. [00:21:00]
Michael: Yeah, it makes sense. And then to your point, the way you started it, there’s some of the security aspects of things is. I mean, you really have to have an IT person in here. I mean, it is…
Brad: Are you the IT person?
Michael: I’m not. No, I give the same answer that Paulina does, which is, there’s a lot there.
Paulina: It’s really good, I promise.
Brad: Well, that’s amazing. And so now we’ve learned a little bit about how telemedicine works, how you guys implement it. And you’re saying it, it’s a growing industry, obviously, because when you started, no one really knew what it was. And now, I don’t know about you, but when we go to these trade shows that I see, SpaKinect, and then I see so and so and so and so. So there’s other people obviously entering this area, so just taking a step back, just the entire industry, what do you think the biggest challenge that telemedicine industry is now facing?
Paulina: That’s a really good question. I think that the advancement of technology, I think [00:22:00] is an opportunity and also a threat. I think regulations like us as a medical company, we are really subject to whatever regulations come through, whatever state legislations come through, what boards decide to do or change at a moment’s notice. And I think that that is one of the biggest challenges that we face as an industry, not only aesthetics, but telehealth, because there are 50 states that can decide what – and they’re all on a different agenda. And so it makes for companies who are doing telehealth in all 50 states. It’s a very complex issue to navigate. I think that is probably one of the biggest challenges. I talk to people a lot who are starting – I just recently talking to a doctor who has a mental health telehealth network in all 50 states and they’re scaling, and this is the biggest challenge [00:23:00] they face, is scaling in all 50 states, scaling in telehealth operations, because so much has to go into the different state regulations, making sure they’re abiding by every single one. And they’re all so vastly different and vastly enforced or not enforced. So, I think that is a huge challenge.
Michael: Have you noticed, I’m pivoting a little bit, just thinking about your journey from 2012 to now, have you noticed the states becoming more sophisticated on things like the good faith exam?
Paulina: Yes. And I love that. I mean, people might think the opposite, but I really like when they actually release what it is that they want you to be doing or not doing because it just leaves less up to interpretation and less gray area. I actually like when states are more explicit. Texas has some pretty clear language. There’s New York, there’s California, but there are states where it [00:24:00] is still like the Wild West, and they, and there is so much gray area. We always tell our clients that it’s best practice to have a good faith exam done before treating any patient with a medical procedure. But they’ll come back and say, well, the State board doesn’t say anything about good faith exams. And I think that is a little bit tricky too, because good faith exams is kind of an industry term, right? I try to use other words like a history and physical, or an order but yeah, I would prefer that every state would just tell us what we can do.
Michael: Yeah. And then a final question for the audience’s benefit, do you have like a certain type of license of the people that do the good faith exams for SpaKinect?
Paulina: Yes. So they’re all nurse practitioners. They’re all licensed nurse practitioners in multiple states. Sometimes we have PAs that work with us as well, and then we have physicians that oversee all of those nurse practitioners on our team.
Michael: Awesome.
Brad: Busy crew.
Paulina: [00:25:00] A busy crew. Yeah.
Michael: No, I mean, we blew through our 25 minutes. It was so crazy. We’re believe it or not, already out time. It was so fun.
Paulina: It was so fun talking compliance with people that like to talk compliance.
Michael: I know. We got to stick together. There’s not many of us.
Paulina: There’s not many of us.
Brad: Michael has compliance is awesome on his back. He’ll show you later.
Michael: Compliance is cool. Well, thank you so much for joining us on the Legal 123s with ByrdAdatto. We will go to break next and then Brad, you and I can come back with a little legal wrap up.
Paulina: Thank you guys for having me.
Michael: Absolutely. Thanks for coming.
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Brad: Welcome back to Legal 123s with ByrdAdatto. I’m your host, Brad Adatto, with my co-host, Michael Byrd. Now Michael, this season our theme is Compliance Fundamentals, and we just had an amazing conversation with Paulina and really diving deep in the telemedicine world. With the time we have left, what are some takeaways that you’ve learned today?
Michael: Yeah, I was thinking about kind of where we left off our conversation, not the part where we were all enjoying geeking out on compliance conversation, but the part where I asked her who SpaKinect uses to solve the problem of good faith exam. And it made me just start thinking about for those that do their own good faith exams, is that it’s [00:27:00] really important on a state by state basis to understand that there are scope of practice issues with who can do it. And so, a doctor can do it, but it’s not a blank check. A doctor has to understand the treatments that are being provided so that they can understand obviously what the risks are, and so they can clear the patient and make the diagnosis.
And the same would go for anyone; a nurse practitioner or a PA. And then generally speaking, nurse practitioners across the country can do a good faith exam. Again, assuming that they have the proper training and understanding that each state may look at the certification that goes with an NP a little bit differently. And so NPs, for those who don’t know, receive this kind of advanced training in a specific area. And so [00:28:00] some states may view an NP that, for example, treats the pediatric population as not having that advanced status for cosmetics for adults, and so that’s an important variable. And then for PAs, again, generally that’s going to work. There are a few quirky states that don’t allow PAs to do a good faith exam. And so, it just reinforces the importance of, not only understanding the processes that needed to be in place, but understanding the people that can do them. And that again, we talk about compliance not being stagnant. These are all things that change constantly, not just here’s the rules and you can bank on that for forever. And then the final piece to that is that if the board is enforcing it, they [00:29:00] may be in a heavy climate, enforcement climate, or they may be a state that hasn’t enforced it at all and you have to factor that in.
Brad: Yeah. All those are really good points, Michael. And one of the things I was thinking of when you were talking about this, it goes back to you said physician, nurse practitioner, PA, and a lot of times people think, well, I can just delegate this over to an RN, and we’ve learned that there’s consequences. I mean, Paulina started the company because she heard about an RN getting arrested. And there is no way to kind of get around that. And that’s why companies like SpaKinect makes so much sense is because it allows someone to come in and help that RN in their need, as we said, that RN had that she might have been in a better situation, obviously not being arrested. And more importantly, what we deal with is people’s license get in jeopardy. Well, next Wednesday we’ll continue our journey of learning compliance fundamentals when Dr. Chris Surek from the Academy for Injection Anatomy, will be joining us to discuss developing and implementing a training course. Thanks again for joining us today. [00:30:00] And remember, if you like this episode, please subscribe, make sure to give us a five star rating and share with your friends.
Michael: You can also sign up for the ByrdAdatto newsletter by going to our website at byrdadatto.com.
Outro: ByrdAdatto is providing this podcast as a public service. This podcast is for educational purposes only. This podcast does not constitute legal advice, nor does it establish an attorney-client relationship. Reference to any specific product or entity does not constitute an endorsement or recommendation by ByrdAdatto. The views expressed by guests are their own, and their appearance on the program does not imply an endorsement of them or any entity they represent. Please consult with an attorney on your legal issues.
