Conflict of Interest. Objectives. Entering into Private Practice: Challenges and Opportunities 8/17/2015

Transcription

1 Entering into Private : Challenges and Opportunities Grace Saidel Wlasowicz, RN, Ph.D., PMHNP BC University of Rochester School of Nursing Conflict of Interest The presenter has no conflicts of interest for to disclose for this presentation. Objectives Review 2 unique challenges for Advanced Nurses in private practice. Describe the essential steps to creating a private practice. List the advantages and disadvantages of private practice. 1

2 Unification Model at the URSON Historical Aspects of the NP role (AANP website) 1965 Dr. Loretta Ford and Dr. Henry Silver develop the first Nurse Practitioner (NP) program at the University of Colorado 1967 Boston College initiates one of the earliest master's programs for NPs 1985 AANP established and now represents 205,000 NP s 2013 the American Academy of Nurse Practitioners (founded in 1985) and the American College of Nurse Practitioners (founded in 1995) came together to form the American Association of Nurse Practitioners (AANP), the largest, full service national professional membership organization for NPs of all specialties APRN REGULATORY MODEL Consensus Model for APRN Regulation: Licensure, Accreditation, Certification & Education, 2008 APRN Regulation includes the essential elements: licensure, accreditation, certification and education (LACE). Licensure is the granting of authority to practice. Accreditation is the formal review and approval by a recognized agency of educational degree or certification programs in nursing or nursing related programs. Certification is the formal recognition of the knowledge, skills, and experience demonstrated by the achievement of standards identified by the profession. Education is the formal preparation of APRNs in graduate degree granting or post graduate certificate programs. 2

3 POSITION OF THE AMERICAN PSYCHIATRIC NURSES ASSOCIATION Psychiatric advanced practice nurses, whether they practice under the title of CNS or NP, share the same core competencies of clinical and professional practice While the individual APRN PMH may actually implement portions of the full scope and practice based on their role, position, description, and practice setting, it is importantly, the full breadth of their knowledge base that informs their practice Psychiatric Mental Health Nursing: Scope and Standards of (ANA, APNA, ISPN, 2007) Affordable Care Act: ACA The Affordable Care Act will expand mental health and substance use disorder benefits and parity protections for 62 million Americans. In addition, thanks to the health care law, beginning in 2014, insurers will no longer be able to deny anyone coverage because of a pre existing mental health condition. The law already ensures that new health plans cover recommended preventive benefits without cost sharing, including depression screening for adults and adolescents and behavioral assessments for children ( pressoffice/2013/06/03/background national conference mentalhealth). 3

4 IOM Report In 2008, The Robert Wood Johnson Foundation (RWJF) and the IOM launched a two year initiative to respond to the need to assess and transform the nursing profession. The IOM appointed the Committee on the RWJF Initiative on the Future of Nursing, at the IOM, with the purpose of producing a report that would make recommendations for an action oriented blueprint for the future of nursing. Through its deliberations, the committee developed four key messages: 1. Nurses should practice to the full extent of their education and training. 2. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. 3. Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. 4. Effective workforce planning and policy making require better data collection and information infrastructure. ( Future of Nursing Leading Change Advancing Health.aspx#sthash.RGeRTw8B.dpuf) Challenges for Starting a Private No formal business background in education Little knowledge in educational system related to coding/insurance/billing Push for prescribing with scarce supports during the assessment phase Is one hour enough time to develop an assessment and come up with a treatment plan? Pressure for time/money The #1 STEP Before you do anything else!!!!!!!! Review your Nurse Act in your state NYS Nursing:Laws, Rules & Regulations:Article 139 Montana Nurse Act 4

5 How to Start The Business 101 Goal of your private practice? Mission? Population served? Independent practice vs. collaboration? Existing office or new office? Location, location, location! Medication management vs. psychotherapy or both? How much time/how many patients? Source of referrals and when/who to refer out to? Consult with a lawyer, accountant, other professionals in private practice Shaping the practice What diagnoses/population will you treat? What won t you treat? What hours/days/time are you willing to work that coincide with patient availability? What model of treatment will you practice? What physician will you collaborate with? Do you have to? Collaboration? Billing? Medical staff? Regulatory issues: OSHA, Department of Health, Local Business License (DBA) Collaboration Agreement with MD s Relationship vs. Territory Collaboration vs. Supervision Nurse Act Scope of Payment practices Insurance reimbursement Liability 5

6 Private 101 NPI DEA # Tax ID # DBA Malpractice Insurance EMR Prescription Pads vs electronic prescribing Insurance Panels/credentialing Location, location, location??? Paperwork Electronic vs. Paper? New patient letter with contract Intake forms Follow up forms Release of information forms Lab forms Referral forms Contact Information How does the patient contact you after hours? vs. phone? Availability Vacation coverage Website 6

7 Ethical Dilemmas Insurance Panels Private Pay No shows Refusing to treat certain patients? Patients that are difficult to treat Patients that you can t help How to measure outcomes? Quality measurement ED/Hospital referral for increased acuity Hospital readmission rate Continuity of care Referral to psychotherapists Referral to PCP Standardized measures Recovery: 9 common elements (Davidson, O Connell, Tondora, Lawless & Evans, 2005) Renewing hope and commitment Redefining self Incorporating illness Being involved in meaningful activities Overcoming stigma Assuming control Becoming empowered Managing symptoms Being supported by others 7

8 Nurse Act Code of Ethics Insurance Policies & Procedures APRN s in Private Scope of Standards of Certification Evidence based icat Quality & Safety & Sa The burgeoning health needs of the population demand access to highly qualified providers. Advantages of Private Independence Payment reimbursement knowledge and control Choosing your work milieu Taxes: LLC vs. C corporation vs S corporation Disadvantages of Private On your own Time and stress Layers of complexity Isolating You don t work, you don t get paid Marketing/unknown revenue stream 8

9 Resources NPBusinessOwner.com Facebook Groups: Nurse Practitioners for Full Authorit Nurse Practitioners in Business Nurse Practitioner.org: Consultant Barbara Phillips References Barberio, J. (2009). Starting a practice and practice management. In: Joel, L.A. ed. Advanced Nursing. 2 nd ed. Philadelphia: F.A. Davis Company. Blazek, N. (2010). Insurer extends primary provider status to nurse practitioners. The Clinical Advisor. Retrieved 8/8/15 from exclusives/insurerextends primary provider status Buppert, C. (2008). Nurse Practitioner s Business and Legal Guide. 3 rd ed. Sudbury, MA: Jones and Bartlett Publishers. Capko, J. (2010). Secrets of the best run practices. 2 nd ed. Phoenix, MD: Greenbranch Publishing, LLC. Furlow, B. (2011). Business advice for nurse practitioners considering private practice. Clinical Advisor. Retrieved on 8/8/15 from exclusives/insurerextends primary provider status Hacker, S.M., Siegel, M.S., & Mark, D. The medical entrepreneur: Pearls, pitfalls, and practical business advice for doctors, 2 nd ed. (2010). Nano 2.0 Business Press. Nurse Practitioner Core Competencies. Retrieved from NALApril2011.pdf. O Brien, J.M. (2003). How nurse practitioners obtained provider status: Lessons for pharmacists. American Journal of Health System Pharmacy, 60(22). Retrieved on 8/11/15 from Zaumyer, Carolyn (2003). How to start an independent practice: The nurse practitioner s guide to success. Philadelphia: F.A. Davis. Questions? 9