Ever wonder who are Nurse Practitioners, what we do and where to find us? Here’s a small samples of NPs and our practices from around the country. Feel free to share the video with your friends, your colleagues, your patients, your networks. Post it on your websites and your blogs. Spread the word about NPs.

Many Nurse Practitioners and other advance practice clinicians who want to start a practice, are worried about the cost to get started in a traditional office practice and are looking for options. One such option is a practice focusing long term care (LTC).

Geriatrics is one area that is vastly underserved, especially for those who reside in LTC. The need is only expected to increase as our population ages.

This is not a new type of practice. Many of us who are Geriatric Nurse Practitioners (GNPs) have practiced in LTC facilities for years. Over the years, we’ve not see more ANPs (adult nurse practitioners) and FNPs (family nurse practitioners) in LTC as well. What is becoming more common (albeit still relatively rare) is that the NPs working in LTC are doing so as self employed individuals. NPs who have businesses that focus on seeing residents of LTC facilities will tell you that they not only enjoy their work, but managed properly, it can also be financially rewarding.

So what do you need to get started?

1. Knowledge of geriatrics and common issues that are facing them.
2. And understanding of the needs of the LTC facility – this will help you structure your time, assuring you are also seeing patients within the required laws and standards
3. Access to LTC facilities.
4. Communication System
5. Determine your billing process
6. Transportation
7. Insurance credentialing.

For NPs that are in states that require you to have a collaborating physician, this type of business will guarantee you will have one, as residents of LTC facilities are required to have an attending physician.

You will want to contact LTC facilities to determine their needs in getting providers in to see patients, both at required visits and for sick calls. Find out who the physicians of record are, as well as who is the facilities medical director. You will want to contact them and offer your services to manage their LTC residents. Understand, they will likely remain the physician of record and will need to make periodic visits according requirements and the resident’s status. Most physicians who maintain office practices as well as seeing residents of LTC facilities will welcome someone managing the needs of those patients.

LTC facilities are one of the most regulated health care environments today. It’s unglamorous (you’ll never see a TV show about LTC like you do with ER and trauma shows) and unpopular. The needs of the facility in terms of reporting to providers, getting forms signed off, etc are high due to regulation. However, you’ll find that with a system, you can easily provide an excellent service to the residents and facilities, and be rewarded for your efforts. It’s a business that can truly be a win-win-win for all involved.

I am frequently asked “what kind of business can I have”? While there are several forms of business, most NPs and PAs choose a clinical practice. And while most chose primary care, more are choosing a niche or specialty practice. One such niche is urinary incontinence (UI) care.

A continence practice is a fantastic opportunity for the advanced practice clinician. There are three very important factors for this type of business. First, there is a huge need; second there are few clinicians involved and finally, the evaluation, management and procedures are reimbursable.

A flexible, scalable model

What is nice about this type of practice is that it can be set up to work within office (yours or someone’s), a long term care facility and even within the home using a house call model. It can be full time or part time. And for those that already have a primary care practice, this is a great add-on service that can help build your practice revenues.

For those that like to work with a patient for a specified length of time, have them get better, and only see them back for “tune-ups”, an incontinence practice is ideal.

This business model is also scalable. You can start of doing it all yourself and as the business grows (if that is your plan), you can add additional providers and staff in order to accommodate your growing business.

Reimbursement

Medicare and most insurance companies will reimburse for assessments and procedures that are done in an incontinence practice. This will include your initial assessment, urodynamic testing (simple or advanced), microscopy, ultrasound, laboratory testing (both send-out and point of care), patient counseling, pelvic floor rehabilitation and more depending on how you set up your practice.

Often, tools that patients might use are hard to find and this can be an additional source of revenue. You can offer hard to find items to your patients in your office or through your website.

A Day in the Practice

As with any practice, your day will vary depending on location (office vs long term care facility for example) and other factors, however the basics are the same. Your job will include (but is not limited to):

• Evaluation of incontinence for pelvic floor dysfunction, overactive bladder or other issues that may be causing or contributing to UI. You will likely perform simple cystometrography as part of your workup.
• Counseling patients regarding behavioral modification, prevention and treatment of constipation, diet modification, fluid management as well as exercise they can perform.
• Treatment of the cause with medications and pelvic floor rehabilitation and electrical stimulation as indicated.

Getting Started

Like any business, you have perform the necessary analysis and evaluation to determine if this is the correct business for you. You’ll need to learn how to get reimbursed and how to maximize those reimbursements as well as know what it takes to operate a business. And of course getting started and finding your patients and referral sources (ie, the marketing) is key.*

Continence is a state that all people strive for. When it’s not present, it affects an individual physically, emotionally, financially and socially. This is an area that clinicians can make a huge difference in the lives of their patients. The need is great, the need is now.

For more information on building a business and building a continence practice, Helen Carcio, NP @ The Health & Continence Institute (HCI) offers an opportunity for the entrepreneurially minded NP to establish a lucrative continence care program of excellence.  She offers course intensive courses a few times per year and it’s a training well worth going to.

© 2011 Barbara C Phillips, NP

Time to Clean House!

Now that you have an understanding of the issues involved in selling a practice, let’s look at what you can do to prepare and position your practice for eventual sale.

Before you ever think about listing your practice for sale there are a number of things to do … in other words it’s time to clean house! You might compare this to getting ready to sell your home. You don’t just put your house on the market; typically you make some repairs, spruce up the house and the yard. Because a clean and clutter free house shows and sells better!

The same is true for business! Nobody wants to buy a messy business or a practice that looks bad: looks bad to the eye and looks bad on paper. Here are some of the areas to examine and get in order, preferably months before ever listing the practice.

1. Business and accounting records: your records must be up to date and complete.
2. Medical records: make sure all records are up to date and well organized, particularly if they are paper charts.
3. Accounts receivables: make sure your accounts receivable (AR) has been worked and is current; resolve any outstanding disputes.
4. Office policies & procedures, employment, training and safety manuals: make sure your documentation is up to date and complete.
5. Tax records: all must be up to date, organized and complete. Resolve any outstanding tax issues including employment, federal, state and local taxes.
6. Inventory your medical and office supplies  and equipment.
7. Staffing: fill any necessary open positions.
8. Clean and brighten up your office if need be. Remember first impressions are everything!

Next then, how do you go about finding a buyer for your business and what price should you ask? As you may suspect, determining the sale price for a professional practice is not an exact science. Most practices will be sold for multiples of available cash flow, annual net earnings, annual gross collections, or any number of formulas.

With respect to finding a buyer, there are many options available to you as well. These range from contacting your local hospital to getting your business listing in front of the graduating class of different medical schools, to placing newspaper and online ads.

Another venue to consider is to utilize the services of a business broker, just like you would utilize a real estate broker when selling your home. A business broker will be able to assist in setting a realistic sales price and list your business within their network.

Visit the links below to get information about the services different brokers offer and to find listings for medical offices that might be similar to yours. Please note we do NOT endorse or recommend these brokers, the links are simply included for your information.

• http://www.medicalbusinessexchange.com
• http://medicalbusinessbroker.com
• www.medicalpracticebrokers.com
• http://www.businessbroker.net/Keyword/Medical-Businesses_For_Sale.aspx
• www.sunbeltnetwork.com
• www.vrbusinessbrokers.com

Finally, take time to consult with both your legal and tax advisors to help you plan for and construct a favorable sale. And remember, anything will sell as long as the right buyer comes along and the price is right!

©2011, Johanna Hofmann, MBA, MAc, LAc. All Rights Reserved.

Visit www.NPBO.biz/aanpconf.html and enter today!

Several of my patients told me that I was like Oprah. Who doesn’t want to be likened to one of the most successful women of their time? The video will tell you why my patients made this unlikely comparison.

I had the wonderful opportunity to be interviewed by ReachMD host, Mimi Secor, NP and I’m thrilled to share that  Seven Steps to Starting your own NP Practice, is being broadcast live on ReachMD this week.  The program can be heard on XM Satellite Radio Channel 160, on the live stream at ReachMD.com or via the MedicalRadio mobile app. The schedule is as follows:

This Week’s Schedule  (All times Eastern)

The program can also be heard on-demand, 24 hours a day, 7 days a week by clicking here.

Let us know what you think!

When we opened our Nurse Practitioner owned practice in 2006, we used an EMR from day one. We scanned in things like insurance cards and imported them directly into the EMR.

Unfortunately, we did not have the fax networked  so we could receive faxes directly into our system (my mistake, but we’ve recently corrected).

But beyond the faxes, we receive paper via couriers, patients and mail. We shred all the time, and indeed have burned through FOUR shredders since the beginning. But the paper continued to build up.

This week, we called a company (HIPAA compliant of course) to come in and get the paperwork that had already been scanned into the charts. They rolled in a huge paper-bin, we filled it up and then some, and the rolled it back out to their truck where we saw all that paper being eaten up.

If you’d like to avoid this or at least reduce the amount of paper in your office, try these tips.

• Use an EMR. There are plenty of them available for you to use from free and low cost to those that cost a ridiculous amount of money (IMHO).
• Next, make sure you have a good scanner. We’ve been using a Brother all-in-one that has served our purposes since 2006 without so much as a hiccup. I also hear frequent praises for the ScanSnap.
• If you don’t network your faxes to receive them electronically (that was so silly of me), use a service such as UpDox. We are using them now and I’m kicking myself for not doing it earlier.
• Invest in a really good shredder. Don’t go even moderately good…you’ll burn them out.
• Don’t be afraid to use a shredding service. While they all offer ongoing services for a monthly fee, they also offer one time or periodic services. That pile you see in the picture…cost $40.00 to shred.
• When requesting records from other offices, ask for them to be sent as PDF’s. No paper and you’ll be able to import them directly into your EMR.

Now that all that paper is out of the office, we fell like we can breathe again. That is until it builds up again.

Share your tips for reducing paper in your office below.

What are your plans for 2011? Does it include starting up your own practice, or perhaps revamping and growing your current practice?  If so, I’d like to share our course with you.

Since 2006, literally hundreds of Nurse Practitioners, Physician Assistants and other clinicians have been asking me about practice startup, business development and marketing.

I consistently receive emails, web messages, phone calls and even snail mail asking me some of the following questions:

• How do I start my own practice?
• How do I get patients into my practice?
• How do I find a collaborating physician?
• Will my idea for a business work?
• How go I get paid?

We’ve answered these questions and more in the NPBO™ Practice Startup System. Visit the course website, watch the video, and then, if it’s right for you, sign up. You’ll save significantly if you register before the end of the year.

Nurse Practitioners and other clinicians are wise to have built up a cash reserve for their practice. If you’ve not yet done this, this tip will get you started.

Financial experts often advise us that we should have a three month cash reserves at all times. The premise behind this is to protect you should you get sick, lose your job or have unexpected expenses crop up.

This is even more important for your business. In fact, three months is not enough. You really need to look at five to six months (or more) of having a cash reserve. If you haven’t done this yet, you’ll need to start now. With all of the uncertainty and the economy today you will certainly want to protect your business and yourself.

Here are a few suggestions to get you started.

1. First of all if you are still employed while you are building your business, start by setting aside 5-10% of your net pay into a reserve fund.
2. To determine the ideal amount of your reserve fund, add up all of your monthly expenses and multiply it by the number of months you wish to have in reserve. Hint: you will want to do this for your personal expenses as well as your business expenses.
3. Put aside a set amount. If this sounds like too much work, or your expenses vary too much, consider setting aside $100 (or more) a week. At the end of the year you will have $5,200, which is a nice cushion to start with.
4. Keep in mind, this reserve fund is for emergencies, large purchases, etc. You will still need to do this for taxes, in a separate fund. Many businesses find themselves in trouble and are unable to pay their taxes. Do not let this happen to you.

Do this now! Regardless of what your current financial status is, this is something that all of us need to do. And once you get into the habit of saving, you’ll be amazed at the results.

NPBO™ Action Step:

• Open up a separate account for this fund, one where you will not withdraw from it readily.
• Identify the maximum you can set aside each week.
• Identify the minimum you can set aside each week.
• Strive for the maximum and don’t fall below the minimum.
• Establish your deposit schedule and stick with it.
• Keep this fund separate from your tax fund.