NP Practice Owners : General Interest

Swine Flu Disaster!

Gretchen Moen — Wed, 06 May 2009 20:09:00 GMT

Do you have your disaster plan ready?? The avian flu spurred organizations to evaluate their disaster plans and to revise or add provisions in response to a national biohazard or infectious disease disaster.

Our county health department has been holding meetings for care providers to assist them in developing individual disaster plans as well as plans for working together in the event of a health care crisis or national disaster. Well, the H1N1 flu situation kicked it into high gear these past two weeks and some of us were not adequately prepared.

I like to think I am on top of most things but, alas, there are times when I drop the ball... What would you need to consider when you develop your disaster plan? One disadvantage we have is that the HVAC for the building is all interconnected. Each suite has their own control panel but the duct work and pipes all connect at some point in the ceiling and basement. The dentist offices would close but our patients would need to have access to us. What to do?

What kind of patients would you be able to help during a disaster? Our office would not be able to care for highly contaminated or infectious individuals but we could be a vaccination station or call center.
Who would man the office? Do you or your staff have children at home? What would happen if the schools or day cares were closed? Would your staff be willing to work in a potentially hazardous situation? How would you make that decision?
What type of personal protective gear do you need? Can you afford to buy the necessary gear?
What would happen to your equipment, supplies and records? Storage of HIPPA-sensitive material? Storage of temperature sensitive medications or vaccines?
What about simple "disasters": power out for more that 4 hours, phones out, computers down, locked out, patient or staff safety... we could go on and on.

Oh the advantage of having a smaller clinic! The health department sent e-mails with sample protocols for anyone who did not have a plan in place. We modified them slightly and had them ready within a couple of hours. The county nurse stopped in and issued N95 masks, instructed the staff, and reviewed our protocols. There were no committees to approve or disapprove of the written plan, no need for a timed roll out and very little lost time for education and implementation.

There are days I long to hire a person who can do the OSHA, BLS, HIPPA, RED FLAG, SAFETY, COLA and all the plans, rules and education requirements we need to review every year..... someday. For now, we are ready for H1N1, maybe H1N2.

Essential Office Technology

Joseph Marra — Thu, 02 Apr 2009 12:43:00 GMT

Computers can be a very worthwhile investment. Many day-to-day operations can be managed by this technology. Web sites are a great example of cost effective advertisements that pay for themselves. My web site http://www.urgentcarecenter.us/ introduces the staff, showcases the business, gives directions to our locations, and allows for communication between patients, and potential patients.

We also use our computers to submit our billing, generate letters to patients, transcription, e-mail, scheduling, and of course communication between "Advance" and myself.

I have not experienced the benefits of electronic records at this point, however will explore this logical step in advancement in the near future. This can potentially save you hundreds of dollars if not thousands over the long haul. Considering that my staff makes up over 30 new charts per week, which costs incurred includes staffing time, paper, the folder itself, stickers, and patient time to fill out these forms, is simply not cost effective in today's world.

You pay for the lump sum of money on the front end of the investment for electronic records. It is absolutely worth it!

I am currently limited to time to do the research on the different software that is available, however will be making time in the near future.

We are currently implementing software that my staff and I can dictate into that allows my transcriptionist to transcribe from any location that has a computer with an Internet connection.

An answering service is utilized 24/7 in my practice, that allows patient access in emergency situations to contact me for advice. My answering service calls my cell or my home phone to relay the message. A cell phone is invaluable doing this work.

It is difficult to imagine that just a few years ago that our technology did not even support pagers, cell phones, computers, etc... You can live without these things, however they sure make your life simpler in many regards. Then again, having this constant connection to you can get very frustrating after a day of many calls coupled with a very busy day! Keeping up with the competition has always been an art in business, and I don't see this changing any time soon.

Administration vs. Practice

Joseph Marra — Thu, 09 Oct 2008 11:39:00 GMT

Owning your own business comes with many challenges. Including, managing the practice as well as seeing patients. Although I love seeing patients, I also enjoy spending time managing my own practice. This includes hiring, advertising, determining hours of operations, etc...

After practicing for several years now, I have come to really enjoy the administrative end of the practice. In fact, I hired a CRNP last month and am now in negotiations for another psychiatric CRNP to start within the next couple of weeks.(If anyone that is credentialed in Pennsylvania is interested........)

I would really like to move in to the administrative end of the business. This not only allows me to keep close tabs on the business, but allows for employment opportunities and population awareness. I feel strongly that the more of us that open our own practice and pave the way, the more acceptable, or could we say "standard NP practice" would become mainstay medicine.

I have seen a huge difference in reimbursement as far as insurance companies that will credential NPs since I first started. We are on the cutting edge of change in this country. Some of us must work for others for now, depending on their situation and state regulations, and others may find the opportunities available for self-employment. Some NPs may even be happy working for someone else.

However, we can all make a contribution to our profession by talking to legislators and lobbyists. If the time permits, do what you can to make a change. We are far from "total" independence at this point, therefore we must continue to face the obstacles and overcome them one at a time. We have obvious opposition who want us to fail. With so many seeing the benefits including cost effectiveness accompanied by care and compassion, a positive change is inevitable.

We are also faced with voting for a new President at this point. Who can benefit us the most with our profession? The debate is still out on that issue, in my book. It is unfortunate that so much is involved in voting for the next president. Consideration must be made in regard to the financial stability of our country and even the world. War is another hot topic. Do we continue in Iraq until the job is done or do we withdraw troops so that our young people do not have to face continued tours of duty and risk of life or limb? What of Afghanistan? Are we spreading ourselves to thin? What of the environment and even our addiction on fossil fuels?

So many major issues to consider at this point, may make our drive for independence and our place in this world seem small. Though these are some major topics on the political trail, health care is also very important. Health care is fortunately on the table, and reform may indicate a much needed revision with current health care, including NPs.

So maybe our drive is not so insignificant after all, you be the judge.

Lessons From Exceptional NP Practices

Jill Rollet — Mon, 08 Sep 2008 15:20:00 GMT

I spent a lot time last week going over submissions to the ADVANCE for Nurse Practitioners Entrepreneur of the Year contest. All the judges' scores are in, and the editorial staff is meeting this afternoon to determine a winner. I'm afraid that meeting will take some time — we had so many exceptional submissions this year.

Your private practice colleagues really are a brave cohort. One started her practice with a million dollars, and another has plans to expand his two businesses to four in the next couple of years. They serve the rich (aesthetics), the poor (uninsured, older adults), and niche populations ("John Doe" patients with STDs, kids with ADHD). Several opened their doors decades ago and fought to establish the rules of practice that other NPs enjoy today. Several are still fighting those battles.

In this third year of our contest, I was struck by a few things that you might want to incorporate into your own practice to stay competitive:

Marketing materials have gotten a more professional look. Pamphlets and fliers are printed in color on good paper stock. There are tons of refrigerator magnets (something I always appreciate) and postcards. One NP sent in audio clips from his radio ads!
Almost everyone has a Web site with a user-friendly, professional look. If you don't have one, you should.
Several NPs forwarded newspaper articles that they had written or that featured their practice. One NP sent in video clips from TV news show interviews. She did a great job explaining what nurse practitioners do!
Several NPs designed their businesses in nontraditional ways to serve a population they're passionate about — a school for children with learning disabilities, a nonprofit organization to help older adults pay their bills, a seminar to teach other NPs the latest in incontinence treatment, a company that makes a better compression stocking to speed wound healing.