Let’s face it, owning a business is not for everyone. Nurse Practitioners, Physician Associates and other clinicians are all educated to be employees and many of us happen to like it that way. But then there is that strong minority of clinicians that wonder…can I? Shoud I? Do I have what it takes to own my own business.  

This questions, or a close rendition is often asked by entrepreneurs in nearly every type of business. What do you think is the most important skill an entrepreneur needs in order to succeed in business? Here are some answers to that question (taken from a variety of industries). You’ll  see that these skills and qualities mirror the skills we need to have in order to care for our patients. Imagine that.

1. Flexibility – In any business, but especially in health care, flexibility has to be the operative word. We have certain plans for our patients, for our schedules…and well, you know this story…something comes up and you need to make a change.
2. Self Confidence – A lot of things don’t happen without confidence in your abilities to provide excellent care and to rely on yourself in order to get your business up and running.
3. Resourcefulness – Of course, along with flexibility, we’ve had to learn to be resourceful. With out patients, that may mean we are trying to find resources for them, or think creatively in how we are going to get them the help they need. We no no less in our own business.
4. Persistence – Things don’t often happen as quickly and as easily as we plan. In many businesses, you’ve got to have persistence and the ability not to give up. While it’s always possible that the day may come when you have to throw in the towel, you’ve got to have the persistence in order to keep going.
5. Creativity – Thinking outside the box is essential. Just thinking about having your own business get us outside of our self imposed boxes. However in order to really thrive…you have to scribble outside the lines.
6. Compassion - You’ve got the compassion for your patients, but don’t forget to have a bit for yourself and your family as well. You are all in this together.
7. Innovative – What can you do differently and better than everyone else in your niche? What can you take from an unrelated niche and apply it to healthcare and your patient population – especially if it will change how something will be done. Be innovative and you’ll be successful.
8. Decisiveness – You have to make decisions. Period. They may not be popular decisions, but you get to make them nevertheless. It will have to do with business, payroll, staffing, patients, contracts and oh so much more.
9. Organized – Yes, we’ve got to get organized. You’ll be doing so much more than you are doing now and your life will be so much easier if you get, and stay organized. You are wearing a dozen or more hats…believe me , it helps to be organized.

Yes, there is a lot more, but these are the most common I’ve seen written by other business owners. Let us know what you think are the most important qualities that business owners should have. What’s your top three?

Happy Nurses Week!  Hear more about Nurses and Nurse Practitioners and the Affordable Care Act.

Most health care providers, including nurse practitioners are ever vigilant to issues of malpractice. We all chant “do no harm”. And yet we are human. We fly through the day trying to get everything done – seeing our patients, refilling medications, filling out authorizations, reports and other paperwork; ordering consults, therapies and test; interpreting test results, and so much more. And occasionally something does not get the attention it deserves – including you!

Here are just a few tips that can serve to protect you against some of the most common complaints.

1.  Document, document, document. This means everything. Your discussions with patients, findings, results and your conversation with patients regarding results, any intended follow up and if so, with whom – including any referrals that you’ve made.
2. Medications.  Prescriptions remain a significant problem. Most commonly, it’ has to do with prescribing the wrong medication.  You’ll want to review which patient you are prescribing for, how much and how often; medication indications and likelihood of interactions.
3. Diagnosis. When you are diagnosing a problem, make sure you are ruling out the worse thing first. And pay attention to the “red flag” diagnosis – those that tend to end up in lawsuits more frequently than others. They include certain cancers – breast, cervical, pulmonary and colorectal; myocardial infarctions; and appendicitis to name a few.
4. Do not delay in making referrals or getting consultation when you are unsure. Make sure you document that you have done so, and follow up with any recommendations.
5. Talk with your patients. Make sure they get their questions answered, their concerns addressed. Work in partnership with them – it is their body after all.

Practice acts (ie, what we are allowed to do legally) for Nurse Practitioners vary across the country. Many now have practice acts that allows Nurse Practitioners to practice autonomously, which is a good thing as NPs should be able to practice to the extent of the educations preparation and experience. Even the Institute of Medicine’s report attests to that.

However, Nurse Practitioners in Florida have been faced with lots of challenges. One of them has to do with prescriptive rights.

The following interview was done on a local Florida station interviewing Jennifer Scott, NP. Take a listen to what she has to say. Feel free to spread the word.

You can learn more about Jennifer and what’s going on in Florida at her blog www.ARNP.blogspot.com.

By the way, this years annual conference for the American Academy of Nurse Practitioners, the largest NP conference in the country is set to unleash thousands of NPs in Florida. The possibilities can be endless!

Have you ever had a day where it felt like you were part of a blooper series? Well, that’s how a recent trip to KY felt where I was invited to speak at the Kentucky Coalition of Nurse Practitioners and Nurse Midwives annual conference.  It’s a fantastic and highly recommended conference and the people I met were wonderful! Getting there…we’ll that’s where my bloopers come in.

This year’s conference was in Louisville, KY. But I guess for some reason, my brain read Lexington, KY. So I dutiful made my flight reservations for Lexington, talked to everyone about going Lexington and continue to read about Lexington when I was actually seeing the word Louisville. (Our brains are so amazing…I was expecting Lexington and never registered Louisville).

Travel day arrived. I worked late to clear off my desk and then headed for the airport. Before I went to park my car, I remembered I needed some cash so stopped by the bank ATM. That was my first “blooper”. Suddenly after about 10 years, my PIN no longer worked and the system locked me out. Scrounging around the car, I was able to come up with about $3.00 in change. At least I could tip the shuttle driver.

I arrived at the airport with not a lot of time to spare. Apparently Sea-Tac thought it was late enough to close down all but one security line. Many of us waited and waited as the line slowly moved forward. Perhaps TSA thought no one would be flying that evening. Wrong!

I didn’t have to hurry though…unbeknownst to me, my flight was being delayed about 90 minutes. Actually both legs of the flight were delayed – which was good. Had plenty of exercise though running from one terminal to another to catch a flight that was not going anywhere.

Finally I arrived in Lexington. It was a beautiful morning after the all night flights. The sun felt great as I stood outside waiting for the hotel shuttle to come. And waited, and waited. I called twice – they kept telling me they were there, and I kept saying I was here. After an hour, I decided to take a cab. The cabbie was a very nice man, telling me all about Lexington. I kept asking him is he sure he was taking me to the correct hotel as I thought it was right next to the airport (it was…in Louisville). He told me it was the only one in town. Okay…I was tired, maybe I was wrong.

I arrived at the hotel to check in. I didn’t see any Nurse Practitioners and he told me they did not have me down for an early check-in. Odd. As a matter of fact, I didn’t have a reservation. Even odder. This very nice man (I’ll call him Jon) finally figured it out…I was in the wrong city.

No problem Jon tells me. He calls their sister hotel in Louisville to confirm I am scheduled to be there. And he proceeds to help me find a way to get there – 70 miles away. I go into the hotel restaurant to have some ice tea and a salad as it will be an hour before the rental car company can pick me up.

But…I wait and I wait. They don’t come…or at least they never came into the hotel where I told them I was waiting. Two more phone calls…I’m finally picked up.

It was a beautiful drive to Louisville from Lexington. Lots of horse farms. I had to stop a few times just to walk around as I was still without sleep. But finally I made it and had time to wash up before having dinner with friends.

The next morning (what time zone was I in anyway?), I had plenty of time to check in to the conference get ready for my presentation. A nice long shower was in order.  I left the bathroom door ajar in order to get some moisture into my room. Unfortunately, the smoke alarms mistook steam for smoke. It was a battle trying to keep the maintenance folks out of my room until I could get some clothes on. (“No you cannot come in…I’m naked!”)

Fortunately that was the end of the bloopers other than more delayed flights and last moment gate changes (no changes when I got off the first plane) causing me to sprint again to another terminal. (I’ll choose another airline next time).

So as I reflect on the bloopers, a few lessons come to mind.

1. Don’t make reservations while doing 11 other things.
2. Double check my destination (I might add day and time as well).
3. Keep a $20 bill stashed in the car/wallet.
4. Saying please and thank you goes a long way.
5. Never stop laughing; it’s really not that bad.

I know I’m not the only one with bloopers, share your’s below.

Each day I receive plenty of email from Nurse Practitioners, Physician Assistants/Associates and other clinicians who have questions about starting a practice, practice models, business development or a variety of other topics pertaining to practice operations, management and marketing.

This video (below) answers a question I received from one individual but encompasses a question I hear more and more often about starting or converting to a cash practice, also known as a direct pay practice.

While many have expressed interest in either starting a practice, focusing simply on direct pay models and avoiding insurance (and its inherent cost and headaches) or switching their already established practice to a cash basis, there are some pros and cons to this. In the final analysis it will depend on the provider and ultimately, their patient base.
Take a listen (6 minutes) and see what you think. Please be sure to leave a comment.

Professional Online Conduct

In today’s digital world, whether we want to or not, and even if we know it or not, we are online. It becomes imperative that clinicians control what is said about them and they know how to conduct themselves in an increasingly public online forum. In this article, I want to talk about what’s happening and in a future article; I’ll discuss ways in which you can have more control of your own online identity and maintain the best practices for professional online conduct.

In the March 21, 2012 issue of the Journal of the American Medical Association (JAMA), a research letter by Dr. Greysen, et al, discussed findings of a small study they conducted in partnership with the Federation of State Medical Boards (FSMB) looking at physician (MD/DO) conduct online. They found several violations which resulted in disciplinary actions by state medical boards including license restrictions, monetary fines, suspension and revocation of licenses to name a few.

Violations in the above study pointed to inappropriate patient communication online; online misrepresentation of credentials; use of the internet for inappropriate practice; failure to reveal conflicts of interest online; derogatory patient remarks; violations of patient confidentiality and depiction of intoxication and discriminatory language or practices.

Boards of medicine were alerted to these problems in a variety of ways, most commonly by patients and their families.

My question is: How well would we as Advanced Practice Clinicians (APNs and Pas) do in such a study? While we don’t have such a study (yet), based on what I’ve seen and what my colleagues tell me they’ve seen, I’m not sure we are doing much better.

I encourage you to take a look at your online behaviors in social media, blogging and video. Here are some suggestions that may help you assess your own risk for less than professional activity:

1. Assume that everything you do – especially in social media – is public and can be seen by patients, judges, the board of nursing and  your grandmother.

2. Ask yourself if you want any of these people to see that photo you posted, or should be hearing your discussion of a case or even a staff issue?

3. Think it through at least 3 times (or more) before you post anything or respond to someone’s post.

4. Never post in anger or frustration until you’ve thought it through (see #3) or at least counted to 25 (forget 10…at least 25).

5. And it’s worth repeating…assume everything online is public and can be found.

This is a topic that is worthy of a long discussion. Please share your thoughts below and how you might re-look at your participation in the online world and maintaining professional online conduct.

© 2012 Barbara C. Phillips, NP

From the Centers of Medicare and Medicaid Services, here is an important announcement on electronic health records.

As of Tue Jan 31, more than $3.2 billion in Medicare and Medicaid electronic health record (EHR) incentive payments have been made; more than 191,000 eligible professionals, eligible hospitals, and critical access hospitals are actively registered. Learn if you are eligible and, if so, what you need to do to earn an incentive. This session will inform individual practitioners about the basics of the Medicare & Medicaid EHR Incentive Programs. Remember: This is the last year that eligible professionals can participate in Medicare and get the maximum incentive payment.

Target Audience: Eligible Professionals (EPs), which include Doctors of Medicine or Osteopathy, Doctors of Dental Surgery or Dental Medicine, Doctors of Podiatric Medicine, Doctors of Optometry, Chiropractors, Nurse Practitioners, Certified Nurse Midwives, and Physician Assistants (PA) who practice at an FQHC/RHC led by a PA. (Note that hospital-based EP’s may not participate; an EP is considered hospital-based if 90% or more of the EP’s services are performed in a hospital inpatient or emergency room setting.) Medicaid eligible professionals must meet patient-volume criteria, providing services to those attributable to Medicaid or, in some cases, needy individuals.)

Agenda:
Are you eligible?
How much are the incentives and how are they calculated?
How do you get started?
What are major milestones regarding participation and payment?
How do you report on meaningful use?
Where can you find helpful resources?
Question and Answer Session
Registration Information: In order to receive call-in information, you must register for the call at http://www.eventsvc.com/blhtechnologies. Registration will close at 12pm on the day of the call or when available space has been filled; no exceptions will be made, so please register early.

Presentation: The presentation for this call will be posted at least one day beforehand at http://www.CMS.gov/NPC/Calls. In addition, the presentation will be emailed to all registrants on the day of the call.

A misconception among many nurse practitioners, physician associates and other clinicians is that we take care of EVERYONE within our area of expertise.  Yes…but. Do you really do a good job with everyone? Do all of your clients and patients really connect with you and you with them? Are you really able to help each and every one of them?  I thought so.

While we might care for “everyone”, the truth is there are certain patients that we do better with. We seem to be able to speak to them and they actually hear us…and we hear them. These are the folks we do our best work with.

How great would it be to have a practice full of these folks…your ideal patients? In truth, it’s hard to see that happening, however, you can increase the likelihood that new patients coming to see you will fit the profile of your “ideal patient”.

In order to do this, one of the first things you need to do is to identify just who is “ideal” for you? Here are just a few of the questions you may want to ask yourself:

• What do you know about them? Who are they? How old are they? Where to they live? Do they have families? What kind of problems and concerns do they have? How do they like to solve their problems?
• Where do they hang out? What are they looking for in a health care provider? What kind of assistance would they need? Where and how to they like to access care? What’s important to them?

The answer to these questions will help you identify who your ideal patient is, the messages you want to create for them (so they can HEAR you through all the marketing noise), and deliver it to them where they will SEE it.

While it would be nirvana to have a practice full of ideal patients, chances are you may still run into folks where the two of you don’t connect well or work well together. That’s part of the work we do. But how much nicer would it be if that was not your entire day.

Take the time to identify your ideal patients and then adjust your marketing practices. I think you’ll be pleasantly surprised at how your practice will change.

ACNP Advisory on Ordering Portable X-Rays

The American College of Nurse Practitioners (ACNP) wants members to be aware that that Centers for Medicare & Medicaid Services (CMS) is denying payment for portable X-Ray services ordered by nurse practitioners or any health care professional other than a physician.

The “MedLearn Matters” article issued last fall includes the unambiguous statement: “Portable X-Ray services may only be ordered by a Doctor of Medicine or Doctor of Osteopathy. Portable X-Ray services ordered by any other practitioners will be denied.”

The December 2011 HHS Office of Inspector General report entitled “Questionable Billing Patterns of Portable X-Ray Suppliers,” also declares “Federal regulations stipulate that portable x-rays must be ordered by a licensed medical doctor or doctor of osteopathy who is treating the beneficiary for a specific medical problem and who uses the results of the x-ray in managing it.”

We understand the importance of permitting nurse practitioners to order portable X-Rays. ACNP will be working vigorously to lift this prohibition.