Am I Ready to Start My Own
Practice-What Did I Not Know!
Nurse Practitioner Entrepreneurship
Conference
Northeastern University
Deborah Paschal, CRNP
Panel Objective
• Discover key elements of independent
practice often not even thought about as a
factor in new practice start-up and
operations
2
Breakout Objective
• Explore those different approaches needed
to ensure success, sustainability and
financial viability into retirement!
3
• Fewer primary care physicians, more
primary care NPs
• Full Practice Authority legislation expanding
• NPs as Next Gen PCPs
Impact of Health Care
Change on NPs
• To preserve nurse-led care, number of
nurse-led care start-ups must grow and
operate sustainably
• 2019 inescapable CMS migration to Pay for
Performance (P4P) reimbursement: Hello,
TCPI/Quality Payment Programs!
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• Good news: quality and utilization outcomes
rock
• Bad News: outcomes are not sustainable
without Business and Reimbursement 101
skillsets
NPs as Next Gen PCPs
• Good news: Business & Reimbursement 101
is teachable!
• Bad news: NPs are NOT born Entrepreneurs
• Good news: we can develop NP
Entrepreneurs by leveraging Nursing’s VALUE
PROPOSITION
• …HUH???
5
The NP Value Proposition :
• QUALITY OUTCOMES @ LOWER COSTS: Every study
demonstrates that NP PCP outcomes are as good or
better than physician PCP counterparts, with
significantly lower costs; our results will continue to
compare favorably because we are hard-wired into a
holistic, engagement care model
• Every study, including recent Medicare study1,
finds that the cost of care—including ER visits and
inpatient stays—is 20-30% less for patients of NP
PCPs than of physician PCPs. And the quality of
care is same or better.
1http://onlinelibrary.wiley.com/doi/10.1111/14
75-6773.12425/abstract
• P4P PAYERS WELCOME: Quality outcomes + lower costs
means P4P (Pay for Performance) reimbursement is
good for NPs as well as payers. Medicare shifts to P4P
reimbursement in 2019!!!
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What Does
“Entrepreneur” Mean?
• One who organizes
and manages an
enterprise
• Usually with
considerable initiative
and risk
• Lack of business skillsets
• Lack of managed care contracting expertise
So What’s Holding NPs
Back?
• Lack of experience outside not-for-profit
environments
• Hard to put on “Game Face” to compete
• Where will start-up seed money come
from???
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Priorities and Next Steps
Go to YOUTUBE!!
Who you’re going to work with (your target market)
How you’re going to attract them to your practice (your marketing)
What specific services you’re going to offer (your product) and
How you’re going to price your services (your pricing structure)
Lack of Cash Flow
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Find a collaborating physician
How do you become a provider for with insurance companies
PECOS/Medicare/Medicaid
Finding a qualified and reliable billing provider - You provide the services, they get billed for at once, and you
receive reimbursements promptly
Mission
Margin
Mindset
• > safety net
• > self-pay, >Medicaid,
and >85%xPhysician
FFS
• =The confidence to
articulate value and
compete
This Is What
Success Looks
Like
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