Thanks so much for your response! So glad to have you on the site. I saw you were selling your practice in Tacoma? I have a good friend who is a massage therapist there, and I also used to work for Advanced Women’s Health (two NPs owned the practice)-will not say much..but you must be doing well. Also saw that you contribute to your Washington ARNP newsletter, way to go! I am doing a site visit for Medicaid next week, and hope I pass, I am getting my written manual in place, emergency kit, exit signs, and I do have 24 hr call by phone, the work phone has all of the language about 911, rx refills, and hours, and then for urgent calls to call my cell phone to reach the provider. After hours I roll it over, so patients would only dial one number. I am physically there 5 days a week anyway. I am contracting with a telephone interpretive service that handles russian, deaf, etc, and have spanish hippa laminated. I am one weak away from getting credentialed with Medicare. Blue Cross, ODS, Providence, Cigna, Aetna, Health Net and United and Life wise are about 2 weeks away. I also am putting an ad in a small newsletter that goes to a senior community that is very excited about me doing housecalls in their area as they are elderly, and only about 10 miles from me. I will keep the radius short. I am on my 9th patient, starting to get word of mouth. The pharmacist at Rite aid sold me a sink (normally 900.00 but he kept it in a dusty garage and it is leaking, so I will need repairs, but it is non plumbbed, on castors and when working is fantastic. Quest lab has been very helpful at sending supplies. I highly recommend e- surg if you need supplies. I have Amazing Charts and bought a back up hard drive to archive and store,so for the inspection, I can show that I can safely store the records, in case for some reason an alarmed building and two locked doors were broken into and the computer was stolen. I will take my brochures to the hospitals. The assisted livings (2 of them are awkward in town because they made hugh errors leading to my fathers demise, but I will work around that). The chamber of commerce is going to be a huge source of networking with their eye opener breakfasts and passing out business cards. I am meeting with the nurse at the two school districts in town, and I met a sales coordinator for “Anytime Fitness”, and she has a non trained person giving classes on hormones and menopause, so I am going to get my foot in there, as she cannot do womens exams or give rxs if they need compounded hormones..I am also working on a couple class ideas for the library, such as a health prevention class: the importance and difference between flu shot, pneumovax, zostavax, gardisil, dexascan, colonoscopy, Dt and Tdap, paps, mammograms, etc. So people will know what they need and be partners in their care. I am working part time, and have other issues in my life, so I am getting this done as fast as I can. My goal is to double by next month, two t o fours patients a week! Thanks for your advice. Carla

NO ONE has someone sitting at their office 7 days per week. I’ve never had anyone ask me to do this..only to have a way for patients to contact a provider on call.

I’m not sure what is going on, but please call the Nurse Practitioners of Oregon and speak with someone about this. Call (503) 293-0011.

My phones, like I said, are forwarded to a cell phone that I have set up speccifically for the practice. Right now, I carry it all the time, but one of these days, I hope to share with others.

Keep us posted.

Barbara

I do have my office phone forwarded to my voice mail, but two days a week, I am working at another job, so if a care oregon patient wants to be seen by me at the clinic that day, they would have to wait til the evening. My question is, the days that you are out of the office, do you have to have a live person sitting in the office to triage, or can you just have the phone calls forwarded to the provider… I can certainly call them back, and if urgent they know to go to an urgent care or call 911. I was told a live person has to be in the office 7 days a week, for Care Oregon medicaid, but I do not know of another clinic that does that in real life.. I am not worried about the patients, it is the Care Oregon that I am concerned about, as I am single, no other income, and until I start seeing 6 patients a day, I will need to work another job.. at this point I have seen 5 patients in 2 months time, so I cannot afford to live on that. I am meeting with the medical credentialing person next week, and I will have my biller and a medical assistant there, so hopefully we will pass muster. C

Most of the time, when they want you available 24/7, they mean by phone, not in the office. My office hours are Tues-Friday…so we are not even there on Monday. However, you or someone else needs to be on call. Take a look at what your voice mail says.

I think in another post I mentioned how I manage call. But briefly, after hours my office phone is forwarded to my cell phone. The message on their is strictly for the office and tells people if they need to speak with “the provider on call” to leave a voice message with their “name, phone number where you can be reached, and the nature of your call”.

I’ve never gotten any grief about that from patients, other provers or even insurance companies.

Barbara

Your suggestions are good. Providence, United and Regence BCBS seem to be moving along..but ironically Medicaid (Care Oregon) has never answered her phone directly, it goes straight to voicemail, and the two time she called me, I was at my part time job, and my phone went to voice mail. She said “she was going to put my credentialing on hold if I could not be available 24/7 for the medicaid pts. That seemed unreasonable as many practices I know, doctors or otherwise, are not open 7 days a week. She knows I am physically open and present at the office 5 days a week, and two days a week, I am avail by phone, and can see patients in the evening on the days I work at the other job. I live 4 min from the practice and am willing to drive right in, or do housecalls. That does not seem unreasonable, so I am not sure what she means. Her call went to voice mail, but I called her back within 30 min of her call. I also have another NP who has had her practice 27 yrs, who is willing to share call, and I gave her that information. I would think she would want a clinic that takes Medicaid..I just had a call from someone who works in the newspaper, and another patient asking if I take “Lifewise yet”, so yes the insurance is a holdup. But I cannot live on zero income for 6 mos during credentialing, and most people told me they worked part time for quite a while and worked second jobs. I am going to a chamber meeting for new guests at the Marquis assisted living, and even though the Chamber of Commerce obviously is not filled with Medical people I am glad it is at a medical facility. That is in 2 weeks. I missed this years Cancer relay, and Kiwanas club run with the children due to my dads death and ceremony, but next year… That will help a lot. I just do not want to feel that when I am working at this other job, that I am torn, and that the insurance companies turn me down because of it. I also know that the NP wishes me to become a permanent fixture at her place, but she had her dream, and I have mine. My dream is to have a much lower overhead as well, to keep costs down. I firmly believe that Wilsonville is going to be a land of opportunity. I just read that the Tualatin Valley Fire and Rescue is moving their headquarters to Wilsonville, and they are building an 8.7 million dollar command post and business operations center here. The fire department is a tremendous source of reference and networking. Regarding drug screenings, there are 3 large companies that do pre employment screening. I could do the individual patrons for physicals, but I am not sure about the large contracts. One trucking company just went with Concentra, which is all they do. Thanks for the tips. It is just Medicaid that has me bummed, I need to be able to speak to this woman directly. CRA

Thank you! It was a strange day indeed yesterday….my entire after was filled with one family and one additional person. The entire family cancelled and the last person was a no-show - so on my one year anniversary, I actually saw less people than my first day in practice!

You know, insurance may be playing a huge part in why you are not seeing folks right now…at least that is so in my practice. I see very few cash patients. An NP I know, opened her practice with the idea of doing cash only…and her prices were extremely reasonable. She found that even with that…people who had insurance, wanted to use it, and those without, still wanted her to waive her cost.

The majority of people I see have insurance and will not come in and be seen if they have to pay for something entirely out of pocket. For example, the family I mentioned were all coming in for well child exams. I told the mother they may not be covered, as it appeared the kids all had exams within a 12 month period. And sure enough, when she checked that was exactly the case.

Keep calling the insurance companies and make sure your application is moving along the proper channels and not getting stuck on someone’s desk. As far as Medicare/Medicaid, I know of nothing that will move them along any faster. Keep records of who you talk with and when. This may help if things seem to get “lost”.

With school starting the end of August or September (depending on the location), you might think about doing a special for sports exams (those are not usually a covered benefit anyway). Along those lines, see about contracting with some of the trucking firms, delivery firms etc for doing CDL exams (also never a covered benefit for insurance purposes). Can you perhaps set yourself up to do drug screens and/or pre-employment exams for a local company?

Have you sent letters to your former patients (assuming it does not break some agreement you had with your former employer)? If you are having to work, is it a situation you can let people know what you also have your own practice? In my last position before opening my practice, I often had patients ask me where else they could see me since I was only there part time.

I’m sure others will have some suggestions as well.

Good Luck to you.