Offering Ancillary Products and Services

Nutritional SupplementsI received a question from a new FNP. One of the current activities is that she has become a distributor for a company that promotes health and nutritional supplements to the public. Her question has to do with her clients or herself notifying their health care providers that they are taking supplements.

There are lots of NP’s who sell nutritional supplements either on the side or within their practices. Some of these companies are direct marketing companies or multi-level marketing companies, and others are organizations that only sell products within provider offices.

There is a lot of debate about health care providers selling anything in their offices as it may be seen as a conflict of interest. This includes anything we may profit from – use of labs, fitness centers and nutritional supplements. Don’t forget those that are providing skin care services, and provide the option of purchasing skin care products as well.

But wait…when we do labs in the office and bill the patients, we often have negotiated a lower fee from the lab and mark it up a bit to cover our cost. If we supply medications in our offices, we charge a fee for that as well. Heck..we charge a fee for seeing patients as well.

While we are providing a service…good health care, we are also running a business. Our patients depend on the fact that we are profitable so we can pay our overhead, pay our staff, and stay open in order to meet their needs. If you don’t make money, you cannot stay open. (Why is money such a dirty word in health care anyway? Ah…that a subject for another day).

So, if our patients are wasting their money on products we know not to be reputable, and they has of what they can should take, and one of those products you mention happens to be something you have in your office (you’ve also told them about a few products to pick up at the health food store), are we really violating our ethical duty (or perhaps a legal duty depending on your state law) to this patient?

Why is it okay for my patient to go into a health food store and take advice from a 19 year old who has no training in nutritional products, let alone health care and by those products, but not take advice from a licensed health care provider and purchase products in the office? Is it really any different if I promote a calcium or fish oil supplement I believe is better and the person really does need one?

Back to our new NP’s question (Congrats by the way!)…should she be notifying primary care providers? My answer is no. That said, she needs to encourage her clients to provider their PCP’s with the information needed so we can record it in their record. I love it when my patients bring me a list of everything they are taking.

I know I’ve opened a can of worms, so let the debates begin. What do you think this new NP should do? And how do you feel about offering ancillary products/services that would benefit your patients in your office?

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  1. Hello Barbara,

    Thank you sooo much for posting my question on your site; I just completed reading it out loud to my husband & we really enjoyed your commentary. You brought up several valid points.
    I posted this very issue on an NP message board site & oh my gosh, do they certainly think that what I want to undertake is unethical!
    The general consensus is; it is wrong to be able to pocket the profits and that I might influence/sway pts. into taking my products. How far from the truth.

    You are spot-on in your article when you stated that generating profits in healthcare is a dirty word; actually it’s a dirty word to many nurses, for doctors have no qualms about generating a sizeable income (example? Herding pts. into their practices like cattle).
    My NP friend just returned from a medical conference on venous procedures; the first thing that came out of the keynote speaker’s (a physician) mouth was: “We’re in this business for the money”.
    Nursing seems to be a martyr profession; that we should give our time and services away for next to nothing. But you’re right, it is a business & we do need to keep our doors open so that we may continue to provide quality care to our pts.
    This topic I have found, really has opened a can of worms & it has given me an insight to how many of my peers think.

    Thanks again!

  2. I agree with everything that’s been said. I don’t offer nutritional supplements but it’s something I’d like to look into. It’s hard enough to keep our doors open as it is–why not use this to help keep our services available? And these supplements are often helpful. I often suggest black cohosh to my clients…it makes sense to make available in my office a high-quality black cohosh supplement. If I didn’t have a fulltime paycheck in addition to my private practice I would be poor. Private practice can be a hard way to make a living–and I have a lot of patients! (Mostly Medicaid.) Yes, bring on the nutritional supplements!

  3. A cardiology practice in Kansas City created their own supplement: Cardiotabs.
    They sell them, they promote them and they have the local pharmacies carrying them. What’s the difference?

    Here’s the link to their product line:

    http://www.cardiotabs.com/

    What do youall think?

  4. I am interested in this topic. Has anyone found nutriceuticals that you would associate your name with? Go into any chiropractor’s office and you will see products for sale. I saw a DO recently, and he had all kinds of products, but did not push them on me. I did take 2 of them but had some concerns. I emailed the company twice, and they never answered me, so I stopped the products.

    I am working on an internet marketing class, and thought if i could get set up with a reliable company, that would provide me the work I need for class, and an income.

    paula

  5. Sylvia – having enough cash flow – be it from the sale of vitamins, carrying out procedures, or finally receiving payment from the insurance companies allows me to “donate” some of my services. For example, there is one woman I see, who I saw for free until she could obtain some insurance. While that was in progress, she’d occasionally bring in fresh crab (her son is a commercial fisherman). I plan on doing that for a few more individuals as well. However, there are times we do that inadvertently anyway…for all those individuals who do not want to pay their bills!

    Laura H – true words, it is difficult to make ends meet in practice, especially with mostly DSHS pts. I don’t know about other states, but I do know what reimbursement is here in WA. And finding psych services for those with DSHS is near impossible, so thank you for being there! If you are open to new pts, drop me a line…there are several I am trying to find someone for them to see.

    Laura T – there is no difference.

    Paula – there are some good products out there. I’m looking at one company that happens to be out of WA. They only sell to health care providers for them to have in their office. They apparently do quite a bit of research as well. I’ll be ordering a few things today for me to use, and if I like it enough, I’ll offer it in the office.

    Barbara

  6. Hi Paula,
    I am an indepenent distributor with Market America, an Internet marketing business.
    I take some of their products & can confidently say that I would recommend them to my clients. We also have numerous unsolicited testimonials & I can direct you to a web address so that you may read them.
    They offer (among many other products) a line of nutraceuticals, called NutraMetrix. Our weight management program has also had tremendous results. Dr. Shari Lieberman is the co-founder & she’s done a pilot study with promising results.
    The research is plentiful that supports their findings & if you would like additional information, i’d be happy to share with you. please see my website.
    You may also reach me at sevule@juddshouse.com
    hope to hear from you!

  7. I know of one practice here in Oregon, where the NP is a distributor for Univera, which has products for energy and joint issues like Regenicare, and Ageless extra. She started representing them after she saw personal results herself, although like with most nutraceuticals, it took at least 90 days, and it is not cheap. I have noticed that she never talks about the products, but they are on some of her counter tops and if patients ask about them or want to try them, that is when she will give them some samples, but of course usually it is only enough for a week, and then if they want to get more, they would have to purchase. I do see other types of practitioners such as Naturopaths, and Medi-spas that offer products quite frequently.

  8. Furthermore, if your an employee NP and promote supplements at the office of an employer, can the NP legally make commission on the sales

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