By: Johanna Hofmann, MBA, LAc

Nurse Practitioners and other health care providers are no different than other individuals who want to succeed 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 here to order your copy of “Smart Business Planning for Clinicians” and kick start your business today.  http://npbo.biz/BusinessPlanning.html

© 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

As a professional, you are very aware of the need to protect your personal and professional information. But how much thought have you given to your digital identity? Are you even aware of the far reaching consequences that miss or stolen digital identity can have?

The following is a true story that was recently shared with me. Imagine that an old friend looks to see if you are on Twitter. They find you, and they see your picture. However, they are perplexed because your tweets are very much out of character, and indeed quite inappropriate for a professional. In truth, it’s not your account. It’s your name and your picture, but it’s not you. Now imagine if you will, that the person searching for you is a potential employer, business partner, post grad school acceptance committee or a disgruntled patients lawyer.  Ahh…big problem!

It’s not always a matter of deliberate stolen identification, but mis-identification is far more common. Do you know, for example, how many Barbara Phillips’ are out there? I share my name with other NPs, physicians, real estate agents and more. Chances are it’s not much different for you. This is why it’s so important for you to claim and then protect your digital identity.

Here are five steps you can take now:

1.  Search. Log on to Google (your favorite browser) and search for yourself.  What do find? How many people have your name? Do they have accounts of Google, Facebook, Twitter, LinkedIn?
2. Create a Google profile. Include a professional picture and some professional information. There is no need to share personal information.
3. Purchase you name as a domain name. For example I have www.barbaracphillips.com. If you can put up a website or blog, or even just a one page with a snapshot of you as a professional. If that seems too difficult at this point, get the name anyway and just hold on to it. Domain names @ www.1and1.com or www.godaddy.com run less than $10.00 per yr.
4. Claim your name and create profiles on LinkedIn, Twitter, Google Plus and Facebook. There are literally dozens of other SM sites, and you may want to create a presence there as well, but at least do the big 4.
5. Create a Google Alert for your name.  You will be notified every time goggle finds your name mentioned on the internet. You can set it up to be notified daily, weekly or monthly.

While this can seem to be a lot of work, and may even be overwhelming, it’s really important that you take the time and begin to work on this step by step. Doing so will help protect you digital identify and your digital reputation.

(c) Barbara C Phillips, NP, 2011

One of the most common obstacles the clinicians (nurse practitioners, physician assistants and registered nurses)  I work with need to overcome is fear.

Many  may be afraid of making the transition from being a paid provider in a clinic to running their own clinic and paying others, afraid of marketing themselves, afraid of learning new skills, or of any of a number of other things.

When I look at the literally hundreds (if not thousands) of questions I have received over the past few years, most of the fears can be summarized in three ways:

• Fear of Rejection
• Fear of Failure
• Fear of the Unknown (this is The big one).

Though the sources of fear may be different, the effects are often the same: fear slows us down and can even paralyze us. It makes it hard of us to pursue our goals and dream. You know what I mean if you have ever found yourself struggling to reach a goal.

Several years ago during a personal development program I was enrolled in, I first heard a definition of FEAR described as – False Evidence Appearing Real. It made sense to me then and makes sense now. In other words, we fear the changes we need to make, we fear the unknown – we want guarantees. Humans for the most part do not like unknowns, especially in our profession.

So while fear can be paralyzing for many, it has also been called one of our most powerful motivators to move forward. But how can we make that leap from that gripping fear that holds us hostage, to one of forward moving action?

1. Identify the real issue that is keeping you from moving forward. When we understand our fear, we can begin to take small steps forward.
2.  Keep track of your progress (journals are great for this) and make sure you reward yourself for the actions you have taken.
3. Get the support you need from family, friends and colleagues.
4. Make sure you are involved with professional and business groups and organizations – not only for the support, but for education. Having the know-how to move forward will help reduce your fear and can support you in your goals.
5. To short cut your own journey through fear, many will find it beneficial to work with a coach who can expertly guide you through that which is stopping you.

Thriving as a business owner is not just about the how-to’s of starting, running and growing a business. It’s also not just about professional development. We must participate in personal development of the mind, body and spirit. That is when we will truly come into our own.

(c) 2011Barbara C Phillips, NP

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As I said above, if you really want to take a short cut, then you’ll want to join us for a free webinar happening on September 20th. More details are here http://www.prattbennet.com/barbaraphillipsSLJ.html, and here Are You Worth It?

There is no question that Nurses and Nurse Practitioners play increasingly vital roles in our health care system. Yet our effectiveness is being undermined by the rising impact of environmental stress caused by alarms on monitors, ringing pagers, the pressure to manage more patients in less time, increasing amounts of paperwork, and a number of other drains on our energy.

This constant barrage of stress can seriously erode our effectiveness by disrupting our mental focus and damaging our capability to do the complex cognitive tasks required for our patients’ care.

An equally serious concern is that such constant and/or high stress levels have been conclusively linked to a long list of health issues ranging from tooth decay to obesity, type II diabetes, high blood pressure, heart disease, stroke, some forms of dementia, and shortened lifespans.

In other words, if we don’t take action now, the quality and effectiveness of our work, as well as our physical and emotional health will certainly deteriorate.

Fortunately, a key piece of this problem- stress -can be powerfully isolated and lowered through cognitive training. “The Stress-Less Journey” is a coaching program designed for and co-created with Nurses & Nurse Practitioners to give them the tools to consciously decrease their stress and increase their cognitive capabilities. The program draws on brain-based coach Pratt Bennet’s 20 years of experience and on a wealth of scientific, peer-reviewed research related to stress management and life enhancement. In this program, Nurses and NPs will learn:

• How to leverage positive mindsets to improve their ability to think creatively and problem-solve;
• Why daily meditation, simple breathing and/or mindfulness exercises can improve their attention, focus, and energy levels;
•  How to save mental and physical energy by creating a toolkit of personal Best Practices;
• Why engaging in at least 30 minutes of aerobic exercise 3 times a week will improve their cognitive capabilities;
• How to lower their blood pressure and raise their mental acuity by spending more time with the people they care about;
• Which foods improve their focus, memory, and affect;
• How to improve the quality of their sleep and thus the quality of their memory, mental flexibility, and attention;
• Why taking better care of themselves physically and mentally will help them take better care of their patients;
• and much more.

Like the patients we serve, WE deserve the best tools, training, and support available to take excellent care of ourselves and “The Stress-Less Journey” will help us design a path to improved performance through improved thinking and living. Learn more about the program’s curriculum, objectives, and cost by joining me and Pratt for a free webinar by clicking the link: http://www.prattbennet.com/barbaraphillipsSLJ.html

I’ll see you there! And in the meantime, tell us what you are already doing to show you are worth it!

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