10 Steps to Starting Your Independent Nurse Practitioner Practice

On a weekly basis, I am finding email, phone calls and letters from Nurse Practitioners who are looking for information on stating their own business.

This article is a synopsis of an article I wrote that was orginally published in Advanced for Nurse Practitioners. It has since been updated and can be found at NPBO.

 

1. Develop a support system.

None of us operates in a vacuum. It is essential that you develop a team of professionals to assist you. That team may starting with an business attorney and CPA in order to start you out on the right foot both legally and financially.

You will also want to network and mastermind with other NP Business Owners who have already traveled this road. It will likely save you time, money and frustration.

2. File the necessary paperwork.

The paperwork alone will keep you busy! You will need to file for the necessary business licenses and permits. You need to get an NPI number, which should correlate with your new Tax ID number. As soon as humanly possible, if not before, begin the credentialing process with Medicare. That one will take the longests. File the others as soon as you can.

3. Find an affordable location.

Where you want to locate your practice is an important decision. Consider how much space you need now and for futuer growth. In your mind, walk through your space to determine what you think you will need. Make sure it feels good as well as make good financial since. Considerations including leasing a medical office, buying and remodeling a space as well as building from the ground up.

4. Research budgetary projections.

As soon as possible, start gathering information about reimbursement rates from payers. With this information, you’ll be able to make some projections about your potential gross and net income. Don’t forget to factor in the lower reimbursements that many still pay NPs.

5. Scout around for insurance.

Shop early for your liability insurance. Almost all payers want to see proof of your malpractice coverage prior to credentialing you. This includes many of the plans you may already be credentialed with.

6. Hunt for affordable and functional equipment.

I don’t buy the idea that you have to spend a huge amount of money to open your business. Nor does everything need to be brand new. I did a lot of shopping at surplus retailers as well as eBay. Likely you will purchase both new and used equipment. Consider keeping your shopping list to those items that you will really needed initially, as well as those items that you can show a good return on investment (ROI).

7. Outline your staff strategy.

What roles will have to be filled as your practice grows. Who can you utilize in more than one positing as you get going? Remember, when thinking about staff, you will have lots of additonal fees and taxes associated with being an employer.

8. Learn all you can about billing.

If there is one thing I wish I had known more about before beginning this practice, it would be billing. Reimbursement is the cause of most of my business headaches, and has nearly closed more than one practice. I cannot emphasie this enough. Learn it, and then monitor those who are doing it for you.

9. Let people know about you.

Marketing! I once read that we only think we are in busines to provide whatever widge we are providng, when it truth, our true job is to market. We have no business without our clients and patients. The way they find us is marketing – yellow pages, word of mouth, referrals, insurance companies, websites, and newspaper ads to name just a few.

10. Look Ahead.

Take the time to identify your goals and keep them updated. Decide how you want to grow and when it is time for you to move on. Make sure, as much as possible that you build a business that fits you and your lifestyle.

I believe that more and more resourceful and creative nurse practitioners will make the jump into private practice. It only takes a few core steps to mark out the path to myriad opportunities.

Comments 28

  1. I’m really glad that you have made your sites for those of us who will some day become independent practitioners. I look forward to the day that Florida becomes an independent practice state. I’ll be glad to see us get the ability to prescribe narcotics for that matter! Only two states left!

  2. I have been an Nurse Practioner for over fifteen years and did start my own business in 2005. I found it very difficult to sustain beyond six months which was all I had prepared for. I made very little money as a Clinician and most of my money as a Educator. I contracted with a local community organization to provide HIV/AIDS Health education. Those six months were difficult but I now know where my real passion lies. It was like obtaining a business degree and although I made alot of mistakes I learned from the experience. I am currently working for NYSDOH as a Public Health Consultant. but would give almost anything to have the chance ,one more time to have my own practice. I decided I will have that chance and will start out slow this time setting up my Women’s Health traditional and holistic practice in my home. If anyone has any tips on getting a collaborating physcian please share with me.
    The Sister’s Upper Room
    Jamila Ali RN-C WHNP MSN

  3. Post
    Author

    Hi Jamila,

    You are so right on when you say starting a practice is like getting a business degree. I figure I’ve earned am MBA & a PhD! 🙂

    Getting a collaborator will vary from state to state. But in general, the place to start is in your own community. In NY you have to have someone sign on as a collaborator…so what about the person who currently signs for you? If not what about their colleagues? Others in your specialty? Seek out physicians who are already working with an NP in private practice, or are at least familiar with working with NPs.

    A few other resources:

    Carolyn Zaumeyer’s book “How to Start an Independent Practice”discusses this in Chapter 5.

    The December issue of Advance for Nurse Practitioners (being mailed now) has an article on “ Finding a Collaborator”.

    NPBO has articles as well as a sample agreement used and shared by one of the members.

    Keep us posted on how you are doing.

    Barbara

  4. I am currently attending an post masters FNP program and would like to start my own practice. I have worked for myself before contracting my services to ICU’s doing acute care dialysis and found it very rewarding. What I would love to find would be a mentor, I’m sure I would argee to slave labor for the opportuinity to learn how to start my own practice. Dermatology would be my preference and I would move where nessisary to obtain the experience. I wouldn’t expect to be employed by them, rather something like an intern in return for the skills to set up my own practice.

  5. Just starting out – where do you find financing for a start up business in an economy we’re in right now? I’m afraid to really “dream” until I know what is available to me.

  6. I am in the early stages of independent practice – just got the motivation to take the big leap, but hesitant due to the “little things”. I want to provide my services to ALF’s, as an independent contractor. Who would I seek as a mentor to help me decide how to reimburse the ALF – a percentage of collections, or per patient, etc. I would take all my equipment/supplies, would have my own insurance (also need help in figuring out if I need additional malpractice coverage in addition to the policy I have with my current employer). I also would have someone do my billing. I am in the process of writing a proposal for the ALF, but not sure how to reimburse them.

  7. Post
    Author

    Hi Debora,

    I see patients in ALF myself, I really enjoy it. It’s a good business model with low overhead.

    You do not need to “contract” with them. You bill Medicare directly for your services, much like an office visit, only use the E&M codes that are specific for ALF’s. No sure why you need to “reimburse” the facility.

    You definitely need malpractice, your own business license, structure, EIN and NPI.

    There are some articles on AFL here and on http://www.NursePractitionerBusinessOwner.com.

    Feel free to contact me through this blog.

    Barbara

  8. I’m about to join an NP practice (as an independent contractor) that’s already established. We provide care to home bound pts. We are planning on expanding services to include office-based care, as well. Two questions: 1 – there’s a clause in our agreement that’s states I would not be able to have a professional relationship with pts for a year if I were to leave the practice. Should I seek to exclude new pts that I bring in to the practice? 2 – how would we make the transition to my becoming a full partner in the practice? Would I need to buy in with a cash amount equal to the met worth of the business? How does that usually work? Thank you!

  9. I would like to start my own practice in Texas, and I would like to know the steps that I need to follow up.

    Thanks

    Aida

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    Author
  11. have been offered a site fully equipped and has a collaborator. I am fully lic and certified. I thought the new grads as of 2015 require the DNP. I am only MS level. they want me to get them started as an APN facility and OH big one no rent for one year to get it up and running. I want to but nervous. I have experience opening other people facilities not my own.

  12. Post
    Author

    Hi Kris,

    We are not yet at a place where DNPs are the entry level for Nurse Practitioners, but it will come.

    Congrats on this opportunity you have ! It’s good to be nervous, even though you have experience. Keep us posted on how you do and let us know if you have questions.

    Barbara

  13. I am interested in having my own private practice in texas. I don’t know how to start. Are there many practice option? example owning a clinic, home health or nursing homes? I am so clueless.
    Please help.

    Thanks.

  14. Post
    Author

    Hello Nta,

    There are many practice and business options for NPs. It really starts with what you want to do, identifying your own clinical strengths (if you are interested in a clinical business) and then researching the area to determine feasibility.

    There are several options for you to receive more assistance and I’ve listed several of them on http://npbusiness.org/work-barbara/.

    Let me know if you have further questions.

    ~ Barbara

  15. Thanks for your prompt responses. I registered today with the nurse practitioners business owner. I surely will go the site and check it out.
    How long does the whole process take? Is the inital financial requirements too heavy?

  16. Post
    Author

    Welcome to NPBO™!

    The answers to these questions depend on what exactly it is you want to do. Be sure and join us for the Members Only Q&A call and we can discuss your situation specifically. Also, make sure you get involved in the private FB group for members only. I look forward to learning more about your journey to owning your own practice!

  17. Hi Barbara
    Any insight of the dangers of joining a start up company as the NP? I guess l can explain in detailed… as l want thru grad school my employer at the time owned a home health company n l was the DON. Now that l a NP he wants me to come up with a way to start a wellness venture ran by NP. l am clueless as l just graduated… speechless!! l live in dallas TX

  18. Post
    Author

    Hi Ester, while this sounds like a good opportunity, I would look at it very carefully.

    I’m not clear from you question if you would be the business owner, if this would be a partnership or if you would be the employee/intrapraneur, but here are some thoughts.

    As you just, you just now graduated. I would advise you to focus on becoming an expert clinician. As a rule, I generally recommend that new grads take the time to hone their clinical skills….and start to learn about business.

    Every NP needs to have basic business skills including how reimbursement works, negotiations, contracts and more.

    Let me know if you have further questions about this.

    ~ Barbara

  19. Hi Barbara
    Thanks for the prompt response. I’m a contracted employee to a boss that is not a medical professional (can’t hire medical professionals). Per my understanding l am contracted in his wellness company that has no structure at the moment. My fear is that he believes l can come up with a business plan and structure of how he can generate revenue from having me as an employee:). My brain is completely stuck as I’m a novice FNP n not sure how l can go about all this….
    About the basics business skills acquisitions what settings is better? clinics or hospital? any insight?

  20. Post
    Author

    Ester,

    While this sounds like a good opportunity, I would think about it carefully. While working in wellness can be wonderful and fulfilling, would you be better served to spend some time as a “regular” employee learning how to manage patients with a variety of needs first? And then later, with the background of what happens when one is not well…venture into wellness. You’ll have a greater depth of experience and expertise to guide your patients at that point. (IMHO).

    What your current employer is asking you to do (from what I understand) is to really create the practice (and teach him what to do) in terms of clinical operations, business operations, billing, fee schedules etc. It’s a lot for a “novice NP” to create when you are just starting your practice.

    If you really want to go forward with this, I would recommend getting a course that walks you through all this, work with a mentor and take your time.

    ~ Barbara

  21. Hi Barbara
    Thanks for your input. l have recommended your 2.0 course to my boss. hopefully we both can learn together as we explore this lovely profession. Thank again!

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    Author
  23. I have been in practice for the last past 3 years working at a Community Health Center. What I want to do is open up a women’s health clinic in NY to serve the underprivileged and underserved population. I would be partnering with another NP who is a close friend of mine. I do not know where to start this process or how to build a timeline.

  24. Post
    Author

    One of the first places to start, especially since there are two of you is to explore your goals and values individually….and then together. Make sure that you both on the same path. Partnerships, especially when there is any ambiguity, can deteriorate rapidly.

    You also want to explore the finances of doing this project and make sure that’s it’s going to be financially feasible. What will your cost be, what will your reimbursements be? Obviously, a lot to explore. You didn’t say, but if you are considering a non-profit model, keep in mind you still need to make money to cover cost. And there are additional requirements to be a non-profit.

    If you really want to dive deeply into this, I’d recommend our course. You can find more details here.

  25. hello Barbara

    I am considering starting own Np practice as well and am currently doing the research in seeing if I can make the leap and if it will be cost beneficial.

    I am having trouble getting information on what reimbursement pay would be for common visits that my target population would be.

    Do you have links or helpful info that could help with this gathering of data.
    I don’t want to put all investment into an office lease, state licensure, etc when the reimbursements are not going to pay out what I would need.
    Trying to do a cost analyses but do not have a good resource for this.
    Tried calling the main provider BCBS, but cannot get through to anyone to call me back. any help would be very appreciative.

    Thank you
    sonia

  26. Post
    Author

    Hi Sonia,

    You are absolutely correct, you need to gather all your information before you invest in starting a business.

    Medicare and Medicaid (and workers comp) reimbursement rates are all public information, so you’ll be able to get that information from the appropriate websites.

    Unfortunately, commercial payers don’t readily share their “proprietary” information such as reimbursement rates. However, most often you can call “provider relations” and give them 5-10 CPT codes and ask about reimbursement.

    If you are unable to get a hold of someone, try provider enrollment at BCBS instead of a provider rep.

    Hope this helps. Good luck and let me know how it goes.

    ~ Barbara

  27. Hi Barbara,
    How would I go about researching an NP led business where the only focus is routine school/sports physicals. No brick and mortar location but travel to different schools to perform them low fee cash only basis.

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    Author

    1. Is there a need for this in your community?
    2. How many schools are there and how many students?
    3. How would you receive payment for those services?
    4. What will be your fee?
    5. What will the overhead be?
    6. Will you be able to see enough students, at your fee schedule to cover all cost and make enough money?

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