Let’s face it, owning a business is not for everyone. Nurse Practitioners, Physician Associates and other clinicians are all educated to be employees and many of us happen to like it that way. But then there is that strong minority of clinicians that wonder…can I? Shoud I? Do I have what it takes to own my own business.  

This questions, or a close rendition is often asked by entrepreneurs in nearly every type of business. What do you think is the most important skill an entrepreneur needs in order to succeed in business? Here are some answers to that question (taken from a variety of industries). You’ll  see that these skills and qualities mirror the skills we need to have in order to care for our patients. Imagine that.

1. Flexibility – In any business, but especially in health care, flexibility has to be the operative word. We have certain plans for our patients, for our schedules…and well, you know this story…something comes up and you need to make a change.
2. Self Confidence – A lot of things don’t happen without confidence in your abilities to provide excellent care and to rely on yourself in order to get your business up and running.
3. Resourcefulness – Of course, along with flexibility, we’ve had to learn to be resourceful. With out patients, that may mean we are trying to find resources for them, or think creatively in how we are going to get them the help they need. We no no less in our own business.
4. Persistence – Things don’t often happen as quickly and as easily as we plan. In many businesses, you’ve got to have persistence and the ability not to give up. While it’s always possible that the day may come when you have to throw in the towel, you’ve got to have the persistence in order to keep going.
5. Creativity – Thinking outside the box is essential. Just thinking about having your own business get us outside of our self imposed boxes. However in order to really thrive…you have to scribble outside the lines.
6. Compassion - You’ve got the compassion for your patients, but don’t forget to have a bit for yourself and your family as well. You are all in this together.
7. Innovative – What can you do differently and better than everyone else in your niche? What can you take from an unrelated niche and apply it to healthcare and your patient population – especially if it will change how something will be done. Be innovative and you’ll be successful.
8. Decisiveness – You have to make decisions. Period. They may not be popular decisions, but you get to make them nevertheless. It will have to do with business, payroll, staffing, patients, contracts and oh so much more.
9. Organized – Yes, we’ve got to get organized. You’ll be doing so much more than you are doing now and your life will be so much easier if you get, and stay organized. You are wearing a dozen or more hats…believe me , it helps to be organized.

Yes, there is a lot more, but these are the most common I’ve seen written by other business owners. Let us know what you think are the most important qualities that business owners should have. What’s your top three?

Have you ever had a day where it felt like you were part of a blooper series? Well, that’s how a recent trip to KY felt where I was invited to speak at the Kentucky Coalition of Nurse Practitioners and Nurse Midwives annual conference.  It’s a fantastic and highly recommended conference and the people I met were wonderful! Getting there…we’ll that’s where my bloopers come in.

This year’s conference was in Louisville, KY. But I guess for some reason, my brain read Lexington, KY. So I dutiful made my flight reservations for Lexington, talked to everyone about going Lexington and continue to read about Lexington when I was actually seeing the word Louisville. (Our brains are so amazing…I was expecting Lexington and never registered Louisville).

Travel day arrived. I worked late to clear off my desk and then headed for the airport. Before I went to park my car, I remembered I needed some cash so stopped by the bank ATM. That was my first “blooper”. Suddenly after about 10 years, my PIN no longer worked and the system locked me out. Scrounging around the car, I was able to come up with about $3.00 in change. At least I could tip the shuttle driver.

I arrived at the airport with not a lot of time to spare. Apparently Sea-Tac thought it was late enough to close down all but one security line. Many of us waited and waited as the line slowly moved forward. Perhaps TSA thought no one would be flying that evening. Wrong!

I didn’t have to hurry though…unbeknownst to me, my flight was being delayed about 90 minutes. Actually both legs of the flight were delayed – which was good. Had plenty of exercise though running from one terminal to another to catch a flight that was not going anywhere.

Finally I arrived in Lexington. It was a beautiful morning after the all night flights. The sun felt great as I stood outside waiting for the hotel shuttle to come. And waited, and waited. I called twice – they kept telling me they were there, and I kept saying I was here. After an hour, I decided to take a cab. The cabbie was a very nice man, telling me all about Lexington. I kept asking him is he sure he was taking me to the correct hotel as I thought it was right next to the airport (it was…in Louisville). He told me it was the only one in town. Okay…I was tired, maybe I was wrong.

I arrived at the hotel to check in. I didn’t see any Nurse Practitioners and he told me they did not have me down for an early check-in. Odd. As a matter of fact, I didn’t have a reservation. Even odder. This very nice man (I’ll call him Jon) finally figured it out…I was in the wrong city.

No problem Jon tells me. He calls their sister hotel in Louisville to confirm I am scheduled to be there. And he proceeds to help me find a way to get there – 70 miles away. I go into the hotel restaurant to have some ice tea and a salad as it will be an hour before the rental car company can pick me up.

But…I wait and I wait. They don’t come…or at least they never came into the hotel where I told them I was waiting. Two more phone calls…I’m finally picked up.

It was a beautiful drive to Louisville from Lexington. Lots of horse farms. I had to stop a few times just to walk around as I was still without sleep. But finally I made it and had time to wash up before having dinner with friends.

The next morning (what time zone was I in anyway?), I had plenty of time to check in to the conference get ready for my presentation. A nice long shower was in order.  I left the bathroom door ajar in order to get some moisture into my room. Unfortunately, the smoke alarms mistook steam for smoke. It was a battle trying to keep the maintenance folks out of my room until I could get some clothes on. (“No you cannot come in…I’m naked!”)

Fortunately that was the end of the bloopers other than more delayed flights and last moment gate changes (no changes when I got off the first plane) causing me to sprint again to another terminal. (I’ll choose another airline next time).

So as I reflect on the bloopers, a few lessons come to mind.

1. Don’t make reservations while doing 11 other things.
2. Double check my destination (I might add day and time as well).
3. Keep a $20 bill stashed in the car/wallet.
4. Saying please and thank you goes a long way.
5. Never stop laughing; it’s really not that bad.

I know I’m not the only one with bloopers, share your’s below.

Each day I receive plenty of email from Nurse Practitioners, Physician Assistants/Associates and other clinicians who have questions about starting a practice, practice models, business development or a variety of other topics pertaining to practice operations, management and marketing.

This video (below) answers a question I received from one individual but encompasses a question I hear more and more often about starting or converting to a cash practice, also known as a direct pay practice.

While many have expressed interest in either starting a practice, focusing simply on direct pay models and avoiding insurance (and its inherent cost and headaches) or switching their already established practice to a cash basis, there are some pros and cons to this. In the final analysis it will depend on the provider and ultimately, their patient base.
Take a listen (6 minutes) and see what you think. Please be sure to leave a comment.

Most health care providers who have a clinical practice, or any type of business where they rely on clients, will need to market in order to sustain and grow that practice and business.  While knowing how to market is essential, it’s also just as valuable to know what you should not be doing when you are marketing. It goes without saying that that most common problem is just not marketing, but today let’s focus on the 5 of the most common marketing blunders I see health care providers make.

  1. Religion and Politics: It’s often been said that religion and politics don’t mix with anything. I tend to agree.  While we can all acknowledge that a persons faith does play a part in health, in most cases you are better off leaving these topics out of our marketing.  When is it appropriate? If your business is specific to a certain group based on religion/faith, and these are the specific folks you are offering your services to, then feel free. Just be aware, that you’ll potentially lose patients that have other feelings.

 2. Omitting Contact Information: Believe it or not, health care providers have created brochures – beautiful brochures –  for their practice and omitted contact information from their marketing. Always check and double check all of your marketing materials to ensure you have the proper contact information clearly displayed.

3. About you!  Health care consumers want to know about you, their health care provider. Anymore they don’t want to come into your office without knowing something about you first. Make sure you have a page on your website that tells something about you the health care provider as well as something about the practice itself (ie, health beliefs, mission, value statement, etc).

4. Drowning in brochures. When you call on another office or business to leave some of your marketing materials, be mindful of how much you are leaving behind. The office may not need/want that many and may be too shy to ask. Their patient population may not be ideal patients for your own practice. There can be any number of reasons. Be sensitive to their needs as well as your own.

5. Automation. Many practices utilize an auto attendant to answer their phone. While I understand the benefits of this for the practice (I love automation), it is also a very cold way to greet your patients at best, and at worse, can be seen as uncaring and downright hostile. The same goes with patients being place on terminal hold as if their time is not important. So while automation is important and often necessary for some practices, take care to minimize its use.

The one thing that is not listed here, but permeates this short list is poor customer service. For any practice, this is one of the most important marketing concepts to keep in mind. Poor customer service will definitely get people talking about your practice, but not in a good light. So if you do nothing else for the year, remember that excellent customer service, along with excellent clinical care will get people talking about you, raving about you and your practice. And when it comes down to it, that’s the most powerful marketing of all.

Do you have marketing blunders to share? Feel free to share with us.

© 2012 Barbara C. Phillips, NP

By: Johanna Hofmann, MBA, LAc

Nurse Practitioners and other health care providers are no different than other individuals who want to success in business and in life. True success in life comes in many flavors and certainly is not limited to money alone. However, money is used to measure business success and by default money is used to measure the success of the business owner.

With that in mind, what is it that sets truly successful business owners apart from the not so successful?

Is it that the successful were born with talents and gifts that others lack? There are scores of talented and truly gifted people, yet that alone does not translate into success of any kind.

Or perhaps it was good luck that got them to their success? Many people are blessed with all sorts of good luck. Good health, being born into a well to do family or growing up in a country, such as the USA, where education is available to all who want to get educated.

Yet not everybody takes advantage of the opportunities available to them. Nor do those that do necessarily become successful.

Or is it simply that hard work and the consistent execution of goals and plans led to their super success in business (and life)? Time and again it’s been shown that the super successful approach things different, they think different.

While there are many traits common to super successful people here are a few I think are of particular importance.

1. Successful people love what they do; they have passion for what they do!
   That makes sense. It is much easier to get good and improve on something that you enjoy doing as compared to doing something that just “leaves you cold”.
2. They effectively manage their time and money.  Successful people have become masters at managing their time effectively. They also know the value of each and every single dollar. They track where their money is going and they know the reason why.
3. They have learned to deal with failure and rejection and bounce back quickly. Failure is the shortest route to success (well, it can be). While many of us equate failure with having failed as individuals, the super successful know that failure is simply part of the game. Expect to fail, don’t take it personally and get back in the game!
4. They plan, have written goals and take action on those goals. “If you don’t know where you’re going any road will take you there”. While this may be true for many, it is not for the truly successful.  They know what they want and they know how to get there. They don’t get in and just start driving – they know where they are going.  They have defined clear, written goals and they know the steps to take to reach their goals.

Do you have a plan, a written plan? Are you clear on what you want to accomplish in your personal life and your business? And … do you know how to get there?

Here is where “Smart Business Planning for Clinicians” can help. The first section of our course discusses in detail how you determine your wants and needs and then how to translate them into goals.

We designed and created our course to:

• Help you determine what it is that you want
• Assist you with formulating clear goals and strategies for your business
• Guide you in translating your goals and strategies into financials you can take to your banker

Click the link to order your copy of “Smart Business Planning for Clinicians” and kick start your business today. Go to  http://npbo.biz/BusinessPlanning.html and see how we can aid in your business success.

© 2012-Johanna Hofmann, MBA, LAc

I believe it’s safe to say, that you are someone who wants to achieve success.

Your definition of success is personal, but it will likely include goals for professional, financial and personal success. In order to do so, creating SMART goals are essential (we’ve touched on this before).  Consider theme words as an add-on bonus to your goals. They help move you forward more quickly.  

So what do I mean by that?

Think about setting an intention in the form of a theme word for the year. As you know, intentions can have far reaching effects. Think about it…you had an intention to win a tournament, play high school/college basketball, become a health care professional. There have been times in your life when you may have reached a goal and thought, well that was easy, as you had not consciously worked toward it.

This is the idea of setting an intention. It’s thought when we set an intention, all sorts of unseen and unconscious energy is put forth to meet that intention. This is no different when we write out our goals – our goals are more likely to come to fruition.

Many self-development gurus advocate for goals and intentions. And many feel that it’s a powerful statement to declare a theme word for the year. Thus I invite you to set an intention for 2012 and see what comes forth in the coming year.

My word for 2012?  It was a touch call. My initial thought was Focus.  However, in the end, I decided on Balance. In my mind, in order to achieve the balance I’m after in all aspects of my life and my business, I’ll also need to master focus.  I can’t wait to see how this plays out for 2012.   What’s your word? Please feel free to share below.

It’s just about that time … many of us start to think about goals for the New Year. Does this sound like you: exercise more often; lose weight; eat healthier; better self care; take a vacation; start my own practice, etc. The list just goes on and on.

The sad thing is that for most people goals remain just that… an ambition or a dream that stands little chance of becoming reality.

But why is that? Why do so many people set goals but then don’t stick with them? Research has shown that the #1 goal (exercising!) is forgotten by the middle of February, when most fall right back into their old habits.

You see, there are 3 main reasons contributing to this phenomenon:  goals are too unrealistic, there is no measurability attached to them and they are not written down.

The goal is too unrealistic

It’s easy to see how some goals might be too unrealistic. Just look at an example:  Jack is significantly out of shape, he does not exercise on a regular basis and his goal is to FINISH the Tour de France within the year. While some might be able to pull this off, for most of us (and for Jack!) it would be VERY difficult, if not next to impossible.

Suffice it to say, it is important to set goals that we can accomplish; otherwise we just set ourselves up for failure. Let me be clear though, this does not mean that you should not stretch and push yourself to test your own limits and reach new heights.

The goal has no measurability attached to it

When setting a goal we need to build in some measure to let us know that we are on the right track to accomplish it. If the goal lacks a way of measuring progress, it most likely will fall to the wayside.

A prime example here is “I will start to exercise”. Well, how many days per week are you going to exercise? How long will each workout last? Will you work out in the morning or in the evening? And what type of exercise will you do? … All of this is very easy to measure: either you worked or you didn’t!

Defining what it is that you will do to meet your new goal allows you to measure your success and build in some degree of accountability. That way you stay on track from the start (or you get back on track) so that you can reach your goal (starting to exercise) and stick with it (exercise from now on).

Goal is not written down

Remember the saying: “If it’s not written down it doesn’t exist”? Well, this certainly seems to be true for goal setting. It’s likely we will forget a goal unless we wrote it down. And it’s likely that we get off track with a goal unless it got written down. More often than not a goal unwritten becomes vague and often morphs into something different altogether.

Think about your charting. For most providers it’s difficult to follow up and remember everything discussed with a patient, even though the visit may have happened just a few days ago. You may have discussed and agreed on a certain treatment goal, but unless you wrote it down (charted it) it’s hard to follow up because you may not remember all the details.

Additionally, setting goals allows you to get clarity on what it is that you want and what you may expect from others. Having clear goals makes it easier to evaluate opportunities and choose the best course of action at the time.

Goals allow you to define milestones to measure your progress and make corrections should you have gotten of course. On the other hand, if you don’t know where you’re going it really doesn’t matter how, when or if you get there!

So take the time to plan for the months ahead, it just might be well worth your time!

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

This is literally the most common question I receive from Advanced Practice Nurses (NPs, CNMs, CNS, CRNA’s) and Physician Assistants/Associates (PAs). So this week, I thought I would create a video to answer just that question. It’s short, about 10 minutes explaining the framework I teach in practice and business startup.

Please share your own tips with your colleagues below.

You are invited to join us on a FREE webinar on Sunday 10/30/2011. Keep reading to learn more!

As a Nurse Practitioner and a Physician Assistant, you work exceedingly hard every day to make sure your patients get the best you can offer. You have been well educated as a clinician and are quite accomplished in your area of expertise.

However, one thing that NPs and PAs don’t always understand (heck, it’s not often understood by those who educate us) is that we are a “business” unto ourselves. In fact, every “revenue generating” clinician  is a “business”.

Yet business education is lacking in our schools. Makes sense – they are busy making sure we are excellent clinicians!

It’s time we, truly begin to grasp the concepts of business in healthcare. I don’t mean just the kind of healthcare business that counts it’s beans at the end of the day, but a business in which the modus operandi  is creating a culture where healthcare a  “win-win-win” for all involed.

In order to get there…we need to be more aware of business concepts, how practices work, and how we can effectively make a difference in our own practices, or the practices of others.

And this is exactly what I want to talk about this Sunday, October 30th at 5PM Pacific on a free webinar. Space is limited, so please, go here now, listen to the video and sign up for the webinar.

See you on Sunday!

All health care professionals including advanced practice clinicians (nurse practitioners and physician assistants) want to prevent any potential legal actions related to the excellent care they provide.

Let me first start off by saying, I am not an attorney and I don’t play one in real life, on TV or on the internet. I had never even been in a real courtroom until recently. However, back in 2006 became involved in an investigation of another health care professional that has only recently gone to trial, and have spent a good amount of time researching the topic for past and future presentations. Thus, I’d like to share just a few tips that you can take to protect yourself as you continue to provide excellent care to your patients.

Documentation:
First and foremost, pay attention to your documentation! Make sure it tells the story, discusses your findings, your assessment and your plan. Whoever is reading the note, should be able to understand how you got to your proposed plan AND be able to pick up where you left off, making any necessary adjustments.

Don’t assume that someone can read your mind and don’t assume you will remember 1, 6 or 52 weeks later. While not everyone is able to complete each and every chart in the room before the patient leaves, make serious attempts at getting your charting done as soon as it’s feasible. Memory fades over time. Need a refresher on documentation? Here is a primer on documentation published by CMS.

Coding and Billing:
You may not be doing the billing in your office, but chances are you are responsible for coding the level of the visit. It’s your responsibility to be aware of the requirements for level of care regardless if your CPT code reflects the work and acuity of the patient, or the time spent. Make sure you have documented accordingly. If you need to brush up on your E&M coding skills, you can get some great free education at www.emuniversity.com. Coding the wrong level of service, or even “incident to” inappropriately, can land you in hot water.

Medication Errors:
Believe it or not, medication errors continue to be quite common. In fact, according to the 2009 NP claims study*, more than 80% of medication errors are prescription-related and 1/3 of those involved prescribing the WRONG medication.

Make sure you check and double check your prescriptions for spelling, dose , indication, side effects and contraindications.  If you are using any of the electronic prescribing tools available, it should help, but they are not foolproof. Take advantage of the various tools you can use in the room with you including those on your PDA or smartphone. Epocrates, my favorite is only one of the various tools available.

Protect Yourself:
If you have legal concerns, it’s always best to check with an attorney who is familiar with health care, advanced practice issues, and is in your state.  Make sure you have appropriate liability coverage. All healthcare providers today have a tremendous responsibility to do the best they can do, often under less than ideal situations.  Despite this, we continue to do our best to provide the best level of care we can for our patients and clients. These suggestions can help protect you (and your patients) even years into the future.

Share your tips with your colleagues below:

*2209 NP Claims Study can be found at www.nso.com/NPclaimstudy2009