One can hardly turn on the news today with hearing something about some natural disaster. In recent weeks it’s been about earthquakes, tornados, floods and wild fire. And of course, the Northern Hemisphere Hurricane Season is upon us.

Clinicians need to be prepared for disasters…not only at home, but in your business as well. Even if you think it will never happen to you, you need to be prepared for the “never gonna happen” event.

Making a disaster plan is really just a business plan for disasters. Here are a few things to address:

1. Take a look at everything in your office. Think about what would happen if it was not available. What would you do? How would you continue?
2. How will you communicate and take care of your employees?
3. Payroll…it’s gotta happen. Are you using a payroll service that is off site that will be able to generate that paycheck?
4. Is there an alternative site you can operate if your building is unsuitable? Perhaps you can work something out with another provider with the idea you can each use the others space in order to keep you business going.
5. Where will you be able to get equipment and supplies? Have all sorts of alternatives listed…everyone in your neighborhood may be headed for the local supply house for computers, etc.
6. Data:  Back up your charts and practice management system regularly and store it off site. Consider storing it several miles away…say 50-100 miles. If you entire town floods, having a copy in your house may not help you.
7. Video tape your office – include all equipment, furnishings and supplies. Consider giving a copy of the tape to your insurance agent, as well as storing a copy off site (see #5 above) as well as a copy for your files.  (This is a great idea for your home as well).

You can get more free information, including templates to make your plans at www.Ready.gov .

Photo Credit:  1985 — Typhoon Pat — Image by © Royalty-Free/Corbis

Today my question comes from Tina in Atlanta, Georgia.  She is asking, “What are the requirements for nurse practitioners starting their own business in Georgia and in other states.  And so, I’m going to answer this more on global level — a national level because we have different practice acts from state to state, as we’re all aware.

So, the first thing that you need to do is go to your Board of Nursing, read your practice act, and see what it is that you are allowed to do.

The second thing that you want to do is go to the Secretary of State for your state, and see what kinds of rules and regulations there are about businesses in your state, and find out what kind of licenses you need, and if there’s any restrictions.  Those restrictions will vary from state to state.  I’m in Washington State, it’s a pretty independent state, and we don’t have problems starting businesses.  But a nurse practitioner in California may find out that they cannot own their own practice, but it would have to be owned 51% by a physician and they can only own 49%.  You’ve got to know your own rules and regulations for your state.

So, hopefully, that gives you an idea of where to get started, again, Board of Nursing and then your Secretary of State.

If you have a question for us that you would like us to address on an NPBO Video Minutes, please go ahead and let us know on our blog at www.npbusiness.org.  And you can also comment on this video at that site as well.

So, I look forward to talking to you next time for another NPBO Video Minute.

Action alert from the American College of Nurse Practitioners: Virtual Capitol Hill Day to support HR4993/S2814, the Home Health Care Planning Improvement Act of 2010 which would allow Nurse Practitioners to order home health services under Medicare.

On Thursday, July 22, 2010, nursing organizations across the broad range of nursing specialties will join together in support of H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010. On that day, thousands of nurse practitioners from across the country will participate in a “Virtual Capitol Hill Day,” by contacting their Members of Congress and asking them to cosponsor this important bill.

PLAN TO GET INVOLVED! By planning just a few minutes to take action, you can have a tremendous impact. Just follow the 3 simple steps below. We have only a few days before Members of Congress return home for recess. We must put Policy into Action now!

What is the Home Health Care Planning Improvement Act of 2010?
Currently, nurse practitioners are not able to order home health care services despite the fact that physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives are authorized Medicare providers. H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010, as introduced by Representative Allyson Schwartz in the House of Representatives and Senator Susan Collins in the Senate, recognizes and authorizes nurse practitioners as eligible health care professionals who can order home health services under Medicare, ensuring that Medicare patients requiring these services receive optimal continuity of care.

Plan to Take Action!
Step 1: Is your Member of Congress already a cosponsor? (You can do this step in advance so that you can plan your letters / phone calls on July 22!)
• Go to http://thomas.loc.gov, and type in “the Home Health Care Planning Improvement Act,” in the space provided.
• Click on H.R. 4993.
• Click on the “cosponsors” link.
• Check the list to see if your Representative is a cosponsor. (Don’t know who your representative is? Go to www.house.gov)
• Click on S. 2814. (at the top of the page listed as “related bills”)
• Check the list to see if either or both of your Senators are cosponsors. (Don’t know who your Senators are? Go to www.senate.gov)
• If your Member of Congress is ALREADY A COSPONSOR, skip to step 3. Don’t forget to contact those Members who have not cosponsored the bill.

Step 2: Plan your message.
The easiest and most effective way to reach your Member of Congress is to call his/her Washington, DC office. However, if you would prefer to use email, Members of Congress have online email systems that you can access through their web pages (found at www.house.gov and www.senate.gov respectively.) You can also find the phone numbers for your Members’ Washington, DC offices on their web sites. You can use the letter below as a guide for your email or phone conversation.

Dear Representative / Senator _________:

As a practicing nurse practitioner, I am writing/calling to request that, before you/Congressman _____ return(s) home for the August recess, you/he/she cosponsor H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010, as introduced by Representative Allyson Schwartz in the House of Representatives / Senator Susan Collins in the Senate.

Medicare policy is compromising my ability to provide adequate care for my patients because, under Medicare, I am not authorized to order home health services even though I can provide all other aspects of care for that patient leading up to and after the home health services order has been placed. This requirement necessitates inclusion of another provider who may indeed not be aware of the patient or their condition. In many cases, this means that my patient must come in for a second office visit, at considerable cost to both the patient and to Medicare.

[insert personal story here: (i.e. I live in a rural area and don't have access to a physician to sign off on my order. / I have my own practice and don't have a relationship with a physician. / I have a patient who was not able to get the services she needed because of this law.)]

Please help me to be able to serve my patients and help them to access the Medicare services they need by cosponsoring this important legislation.

Thank you,

Step 3: Saying THANKS
If your Member of Congress is already a cosponsor of this bill, take a moment to say “thanks for being a leader on this important issue!” If your Member of Congress signs on to the bill and sends you a note to let you know, pick up the phone and say thank you. This campaign focuses on a very important issue – but it is only one of many issues that you and your organization may care about. Saying thanks is an easy way to let your Members of Congress know that their efforts are appreciated AND it may make them more inclined to help out in the future!

According to the Pearson Report, there are now almost 158,000 Nurse Practitioners in the United States, however, the actual number of NPs in their own business is unknown. The purpose of this project is to discover how many NPs own their own business and practices as well as how many are considering joining their ranks.

Within the next few years, nearly 32 million Americans will gain health insurance. It’s a well known fact that there is a health care provider shortage. Nurse Practitioners are, and will continue to help fill that gap. As of right now, no one knows how many of us are in our own practices and how many NPs want to start their own practices to help meet the needs of the American public.

You are invited to take part in this survey. It phase 1 will take no more than 5-7 minutes to complete. You will find the survey @ www.NPBusinessSurvey.com.

This Action Alert comes from the American College of Nurse Practitioners:

Support H.R.4993/S.2814, the Home Health Care Planning Improvement Act of 2010

Now is the time for you to put Policy into Action as an advocate to ensure positive policy change for NPs and their patients.

H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010, as introduced by Representative Allyson Schwartz in the House of Representatives and Senator Susan Collins in the Senate, recognizes and authorizes nurse practitioners as eligible health care professionals who can order home health services under Medicare, ensuring that Medicare patients requiring these services receive optimal continuity of care.

ACNP members have long identified the ability to order home care as a Public Policy Agenda priority for nurse practitioners.  The 2010 Public Policy agenda states, “Recognize nurse practitioner’s authority to order home health and hospice services and to admit patients to skilled nursing facilities.”

Representative Schwartz (PA) and Senator Collins (ME) have taken the initial step by introducing this bill.  Now is the time for you to put Policy into Action by urging your Representative and Senator to support and co-sponsor this legislation.

Rep Schwartz has a goal of 100 co-sponsors by the end of summer (currently there are 50).  NPs who have long expressed frustration about this barrier now must accept the challenge to take action to ensure this critical policy change for NPs and their patients.

Ask YOUR Representative and Senators to COSPONSOR H.R. 4993 / S. 2814, the Home Health Care Planning Improvement Act of 2010.  If you do not know who your Representative and Senators are, please visit www.house.gov and www.senate.gov, respectively.  Congressional support must be secured in order for this important legislation to be considered.  Please WRITE TO CONGRESS TODAY!

A sample letter to your member of Congress may be found here.

View the NP Roundtable letter here.
ACT NOW!!  YOU CAN MAKE A DIFFERENCE!

For Resources to Support Your Advocacy Efforts

CLICK HERE TO ACCESS ACNP’s ADVOCACY RESOURCES.

Please report back to ACNP@ACNPWEB.ORG about your communication and whether you received a response.

Today I’ve got a question from Nurse Practitioner Dwayne.  Dwayne asks the best strategies for marketing a specific type of healthcare model to other practitioners and providers. Dwayne has a diabetes clinic.

Here are a few ideas for you and other NPs that you can do right now.  First thing I would suggest that you do is figure out who exactly are the people that you are serving.  You say diabetics.  Is that Type I, type 2, is it adult, is it children, is it adolescents or is it all of the above?  So, once you have that really narrowed down you’ll also know where these people hang out because you’ll want to get your name in front of them.  So, that will be a good thing to do.

Next thing that you’ll want to is go ahead and let the Emergency Rooms know and the Discharge Planners because often times these people show up in the hospital, and they do not have a provider, and they’ll be able to send them your way.

Then I want you to target the primary-care providers.  I would love it if you were in my area and you were taking diabetic patients because right now those that do have a specialty in diabetes—they are not taking new patients because they are all overloaded.

The next thing you want to do is call those offices.  Call the other endocrinology offices and diabetologists and say hey, you’re opening up and that you have openings and you can see patients because most of them are overbooked and they’d be glad to refer people to you so that you can see those patients.

And then the last thing I would do is make sure that you get online.  You want to go to local.google.com and enter in your practice information because what happens is somebody maybe in San Francisco looking up a diabetic specialist in the San Francisco and your name will pop up in Google, and more patients are doing that.  Be sure and do that.  That’s for everybody in any kind of a practice situation.

So, until next time for the next NPBO Minute, you can visit www.NursePractionerBusinessOwner.com or you can visit www.NPBusiness.org and leave a comment in our blog.

Nurse Practitioners that accept Medicare in their practices need to be aware of how this will impact their practices. With the exception of Midwives, NPs are allowed only 85% of the physician allowable. Here is the update:

The Continuing Extension Act of 2010, enacted on April 15, 2010, extended the zero percent (0%) update to the 2010 Medicare Physician Fee Schedule (MPFS) through May 31, 2010. At this time, Congress is debating the elimination of the negative update that took effect June 1, 2010. The Centers for Medicare & Medicaid Services (CMS) is hopeful that Congressional action will be taken within the next several days to avert the negative update.

To avoid disruption in the delivery of health care services to beneficiaries and payment of claims for physicians, non-physician practitioners, and other providers paid under the MPFS, CMS had instructed its contractors on May 27th to hold claims for services paid under the MPFS for the first 10 business days of June (i.e., through June 14, 2010). This hold only affects MPFS claims with dates of service of June 1, 2010, and later.

Given the possibility of Congressional action in the very near future, CMS is now directing its contractors to continue holding June 1 and later claims through Thursday, June 17, lifting the hold on Friday, June 18.

This action will facilitate accurate claims processing at the outset and minimize the need for claims reprocessing if Congressional action changes the negative update. It also should minimize the provider and beneficiary burdens and costs associated with reprocessing claims.

We understand that the delayed processing of Medicare claims may present cash flow problems for some Medicare providers. However, we expect that the delay, if any, beyond the normal processing period will be only a few days. Be on the alert for more information regarding the 2010 Medicare Physician Fee Schedule Update.

Source: LEARNRESOURCE-L Email Update, National Institutes of Health, U.S. Department of Health and Human Services dated June 14, 2010

Posted: 6/14/2010

As you think of your Nurse Practitioner owned business and practice, consider these thoughts.

Answering Nurse Practitioner questions about business…

Teresa has asked me what do I think about having a niched practice such as with men’s health, since women have GYNs; and I’ll tell you, I think it’s a great idea.

First of all it does a couple of different things.  It allows you to practice in an area that you have passion for, and I think that is so important.  I mean, let’s face it.  We all work really hard, and we’re working harder every day.  So, why not practice in an area that brings you a lot of pleasure, it brings you a lot of joy, and it allows you to use your expertise in that particular area.

So, one of the things that I would recommend if you are just getting started in your practice is go ahead and have a general practice, build it up, just let everybody know that you have a growing interest, and a growing expertise in men’s health, pain management, bladder health, dermatology, whatever it is.  And then as you get more patients in that particular area, and once you have enough that you can start backing off on the primary care, you’ll be able to just move right into that particular specialty and move forward and enjoy your practice a great deal.

Now this is something that I talked about not too long ago in Progress Notes, which are business tips for nurse practitioner entrepreneurs.  You can access archive by going to www.NursePractitionerBusinessOwner.com and clicking on Progress Note Archives.  If you would like to sign up for the newsletter there you can go ahead and do that there.  And I’ll see you next time for the next NPBO Minute.

Nurse Practitioners who accept Medicare, will want to be aware of this:

May 27, 2010 — The dreaded 21.3% reduction in Medicare reimbursement for physicians will likely take effect June 1 as scheduled following the failure of House and Senate Democrats tonight to pass the necessary legislation to stop it.

The Memorial Day recess for Congress officially begins Monday, but lawmakers will start to leave the nation’s capital tomorrow. Democratic leaders who have tried to avert the massive Medicare pay cut say they simply have run out of time to cut a deal. They might have beat their deadline if it had not been for staunch opposition from both Republican and Democratic lawmakers who argued against the deficit spending involved in the legislation.

Anticipating that Congress might not act in time to avert the June 1 pay cut, the Centers for Medicare and Medicaid Services has instructed its carriers this week to hold payment on claims with June service dates for the first 10 business days of the month. That way, if Congress retroactively postpones the pay cut early next month, carriers would process the suspended claims at either the current reimbursement rate or any higher — and temporary — rate that lawmakers might approve.

The Centers for Medicare and Medicaid Services has taken this route before when a rate decrease took effect, only for Congress to avert it after the fact.

Organized medicine has lobbied Congress hard to block the pay cut. It warns that many physicians would respond to the reduction by turning away seniors, as well as military families covered by TRICARE, which bases its fee schedule on Medicare rates. Physicians on average depend on Medicare for 31% of their revenue, according to the Center for Studying Health System Change.

Unease Over Deficit Spending Stymied a Legislative Solution

House Democrats were hoping to postpone the pay cut until January 1, 2012, and increase Medicare rates 2.2% for the rest of the year and 1% in 2011. To become law, the measure also would have needed Senate approval. Senate Democrats had said earlier that they would legislate through the weekend to finish what the House started.

The solution to the Medicare reimbursement crisis — dubbed the “doc fix” by lawmakers — was part of the Democrat-sponsored American Jobs and Closing Tax Loopholes Act that also would have extended unemployment compensation benefits and a slew of tax breaks as well as ended other tax breaks. House Democrats, however, could not muster enough votes to pass the bill due to the red ink it represented, even after they had whittled down the doc fix to satisfy Congressional budget hawks, which included Blue Dog Democrats. The original version of the bill would have extended the effective date of the pay cut to January 1, 2014.

As the legislation stood earlier today, it would have cost $127 billion in total spending, raised $43 billion in new revenue, and increased the federal deficit by $84 billion. The doc fix accounted for $23 billion of the cost — down $40 billion from before.

Late Thursday night, House Democrats announced that they would split the American Jobs and Closing Tax Loopholes Act into 2 bills — one for the doc fix, and the other for everything else — and vote on them separately Friday. However, Senate Democrats said Thursday night that even though they would meet again on Friday, they would not vote on any House bill until they reconvened on June 7 after the Memorial Day recess. Part of the problem for Senate Democrats is that they anticipate the same kind of stonewall opposition to deficit spending that their House counterparts encountered.

A spokesperson for Senate Majority Leader Harry Reid (D-NV) told Medscape Medical News that Senate Democrats will seek unanimous consent for a 14-day extension of the Medicare pay cut as well as the unemployment benefits and tax breaks, but that Republicans are likely to block it. Democrats expect that Republicans will propose their own short-term extension, drawing on unspent funds from last year’s economic stimulus legislation. In turn, Democrats plan to block the Republican measure because it diverts money from job creation, the spokesperson added.

Source:  http://www.medscape.com/viewarticle/722634?sssdmh=dm1.619218&src=nl_newsalert&uac=14312EX