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?
- Knowledge of geriatrics and common issues that are facing them.
- 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
- Access to LTC facilities.
- Communication System
- Determine your billing process
- Transportation
- 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 starting an independent practice in Feb 2017
Please tell me more…
Do you have a specific question Ann?
I am interested in starting a long term care practice, but I am a NP student and I have no idea where to start.
Amanda,
Respectfully, I’d recommend that you first focus on completing school and then work for a while in a wide variety of areas and develop your NP legs. Spend a good amount of time working in long-term care, assisted living and other geriatric type practices as a NP. The patients in LTC need highly skilled, strong nurses and nurse practitioners to help manage their complex needs. It has it’s own microculture and I applaud you for wanting to be a part of it.
It’s not hard to get started in this field, and I encourage you to start with honing your skills.
I look forward to your questions as you move forward!
I find this information very informative. Am a new NP looking to start as an LTC provider. What are the steps that I need to begin?
Hi Angel,
This was the topic of yesterdays QOW that we send out…How do I get started in xyz? If you don’t mind, I’ll post my email here, as there is so much in this question.
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Our question this week is representative of the majority of questions I receive here at NPBO…and that is just how do I get started.
Five recent questions….
I would like to open a women’s health clinic but have no clue as to where to start.
I am considering starting an NP business. I need the help, information and a mentor to assist me. Thanks
How do I get started in my own practice, I’m in NY.
I’m an experienced RN…how to I get started with a business.
I want to open a home health agency, what do I do?
The answer to each of these questions is the same and yet different. But let’s start at the high level of what any person would need to do in order to get started in business.
Create Your Vision
Do some soul searching. What is it that you really want to do? Are you willing to sacrifice time and energy up front while this gets off the ground? Is it something you can see yourself doing for a long time? Do you have the time, support and resources to get started on this journey?
What does your business look like when it opens, a year and five years down the road.You need to get some clarity about your vision.
Research
Do your homework. What does it take to open a business in your specific location? What are the barriers? What’s legal and what’s not? What can your charge/get reimbursed for your products or services? Is there an audience who is willing to pay the price? What do you project in terms of customers/patients and income? What will be your expenses? What challenges do you foresee? Can you, on paper, see that this will work? If not…where can you tweak your numbers?
Obviously, this is high level and it’s impossible to answer further without knowing more about each individual’s dreams, where they are located and how they envision their business. So now what?
Many nurses and nurse practitioners have started businesses on their own. There’s no secret there.
However, if you want to model what has worked for others, make faster progress and avoid the inevitable pitfalls, here are a couple of suggestions:
Take a look at our NPBO™ Practice Startup System. It will walk you through from start to finish how to set up your practice.
And consider setting up consultation/coaching time with me. We can work specifically on your issue, get your questions answered in depth so you can get started.
If you have further questions, let us know.
I have 2 job offers in LTC. One is with an established NP practice that staffs LTC/SNF facilities. I would have a salary but I would be new into the facility trying to build the client base. The other is in a LTC/SNF facility I currently supervise for. They want me to manage their 23 bed SNF and be the NP for that SNF. I am a new NP but a very experienced critical care nurse (28 years as an RN). This is a new model of care for this facility. I am thinking I could break ground and get more NP’s into the facilities owned by the same family. What is your opinion?
Hi Lorraine,
Without knowing more, its difficult to give you specific advise. One thing you can do is a SWOT analysis on each offer to see what is right for you. Here is what a SWOT analysis looks like.
Image ByXhienne – SWOT pt.svg, CC BY-SA 2.5, Link
Good evening
I have been a LTC nurse for over 15 years. I am currently the director of Nursing in a LTC (181 beds for the past 3 years). I am also a FNP and just open a clinic and would love to start a long term care practice, but not sure how to go about the process. Since I already have a clinic. Can I just start offering my service to LTC or is there other steps that I need to take. Please advise. Thank you
Guerda, you’ll find a more in-depth answer to your message on FB.
The short answer to this question is Yes! It can certainly be done. The most important part of this is going to be with your billing and make sure that appropriate POS is listed in the billing and your biller understands you are seeing pts in a couple of locations.
I am an NP in an Internal Medicine Practice. We visit many LTC facilities and are looking for more ways to provide comprehensive care and services to the residents. Any advice? Thank you in advance
Hi Elizabeth. Don’t forget things such as annual wellness visits, cognitive/depression screening, and the like. Remote pt monitoring may not be needed in an LTC facility, but if you are also seeing patients in ALFs, consider that as well.
Hi Ms. Barbara !!
Thanks for all your amazing advices and videos !! I'm in to Post-acute care and considering starting a specialty nursing home practice in Maryland, which is a FPA state. I do like to have a collaborating MD for consultations though. How do I go about it. Would you be able to help answer some questions ?
Thank you,
With great respect !!!
Priya Srinivas, NP
Hello Priya,
If you are practicing in an FPA state, you don’t need a CPA per se. However, for SNFs CMS does require a physician to be the admitting/attending provider of record and also do every other visit. So you will likely work with that individual in coordination care. If the patient is not in SNF and is only getting custodial care, you don’t have that requirement.
The other thing I’ll say, is that we all do collaborate with others when needed for the patients care. So you are good there.
Hope this helps! Thanks for stopping by.
I am a NP have been one for 9 years & have had experience seeing NH patients. instead of having someone contract me .. I want to be the direct person in a NH facility. I had a clinic for a short term. What is the first thing i need to do to get started? Which insurances do I need. to be credentialed with & how can i make contact to offer my services to facility?
You’ll want to create your own business structure if you have not already so you can get credentialed under your own business. NH residents will likely have Medicare and Medicaid insurances that will cover LTC visits. The patients may have other insurance plans that will cover visits in LTC, look to see what your current patients have and start there. If you are considering an SNF, you’ll want to be familiar with the Medicare rules regarding visits and attendings.
As a healthcare provider, I highly recommend considering a long-term care (LTC) practice for Nurse Practitioners (NPs). This field offers immense satisfaction, allowing you to make a significant impact on elderly patients' lives. The demand for skilled clinicians in LTC is only growing, and with proper training and business management, it can be a financially rewarding venture.
Thank you for the information. Do you do consultation for a provider looking to start this type of business in Maryland?
Yes, you can learn about your options as https://npbusiness.org/shop
Please let me know if you have additional questions.