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APRN Business Savvy for the Entrepreneur & EmployedBeth A. Bish APRNCo-owner Bluffton PediatricsChristine Smith-Clymer, Executive Director Bluffton Pediatrics

Disclosures

We have actual & potential conflict of interest in relation to this presentation. We are entrepreneurs.

APRN Business Savvy for the Entrepreneur & Employed Activity Objectives

The participant will learn about

1. the “how to” of developing a business plan AND receive resources to begin the process

2. the basics of complying with Ohio laws, Ohio BON regulations and professional guidelines

3. the “behind the scene” aspects of APRN revenue generation and one’s potential financial worth to a company as well as your self

4. the various elements of an employment contract with its monetary and lifestyle benefits and limitations

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Introductions - Speakers

Beth A. Bish APRN Christine Smith-Clymer

Introductions - Audience

• Certified Nurse Practitioner

• Clinical Nurse Specialist

• Certified Nurse Midwife

• Certified Registered Nurse Anesthetist

• X factor

APRNs Non APRNs

APRN Business in Ohio

• Ohio Board of Nursing publication - Ohio Workforce Data Summary Report

• Data collected July to December 2017

• 16,760 APRNs as of June 30,2017

• 687 fewer APRNs as of December 31, 2017

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63

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EMPLO YED CNP CRNA CNS CNM O THER

Licensed Employed Self employed - Primary Self employed - Secondary

Possibilities

Our Story

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Business Plans

• Idealist• Looks cute

Sunflower

• Detailed plan• Time consuming

Traditional

• 9 areas to address• Quicker – from head to paper

Lean

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Sunflower Business Plan

Traditional Business Plan

1. Title Page2. Executive Summary3. Company Description4. Products and Services5. Marketing Plan6. Operational Plan7. Management8. Financial Plan

Lean Canvas

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Common Elements – Traditional & Lean

Element Business Model Canvas Lean Canvas

Target New and existing businesses Startup businesses purely

Focus Customers, Investors, Entrepreneurs,

Consultants, Advisors

Entrepreneurs purely

Customers Lays emphasis on customer segments,

channels and customer relationships for all

businesses

Does not lay much emphasis on customer

segments because startups have no known or

tested products to sell

Approach It lays down the infrastructure, lists the nature

and sources of financing and the anticipated

revenue streams of the business

It begins with the problem, a proposed

solution, the channels to achieving the

solution, costs involved and the anticipated

revenue streams

Competition It focuses on value proposition in quantitative

and qualitative terms as way to stay smart in the

market

It assesses whether the business has an

unfair advantage over the rest and how to

capitalize on it for better grounding

Application It fosters candid understanding, creativity,

discussion and constructive analysis

It is a simple problem-solution oriented

approach which enables the entrepreneur to

develop step-by-step

https://canvanizer.com/how-to-use/business-model-canvas-vs-lean-canvas

Resources

https://www.sba.gov/business-guide

https://nursing.osu.edu/sections/office-of-innovation-and-strategic-partnerships/

https://www.nnpen.org/

Questions

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Basic Compliance

• Ohio Law ( O.R.C. 4723)

• Ohio Board Of Nursing Rules

• Professional guidelines

Ohio Revised Code (O.R.C.) 4723

• Know the law – It takes more than 1 hour every 2 years to know what the law statesAND how it applies to your practice

Ohio Board of Nursing Rules

Chapter 4723-1 Board Organization and Records Chapter 4723-2 Licensing for Active Duty Military and VeteransChapter 4723-3 DefinitionsChapter 4723-4 Standards of Practice Relative to Registered Nurse or Licensed Practical NurseChapter 4723-5 Nursing Education ProgramChapter 4723-6 Alternative Program for Chemical Dependency/Substance Use Disorder MonitoringChapter 4723-7 Examination and LicensureChapter 4723-8 Advanced Practice Registered Nurse Certification and PracticeChapter 4723-9 Prescriptive AuthorityChapter 4723-13 Delegation of Nursing TasksChapter 4723-14 Continuing EducationChapter 4723-16 HearingsChapter 4723-17 Intravenous Therapy Courses for Licensed Practical NursesChapter 4723-18 Practice Intervention and Improvement Program (PIIP)Chapter 4723-20 Prevention of Disease TransmissionChapter 4723-23 Dialysis TechniciansChapter 4723-25 Nurse Education Grant ProgramChapter 4723-26 Community Health WorkersChapter 4723-27 Medication Administration by Certified Medication Aide

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Professional Guidelines

https://www.aanp.org/index.php

https://www.aacn.org/certification/advanced-practice

https://www.pncb.org/

Overarching Principle -Scope of Practice

Is the procedure/ activity

prohibited by the Ohio Revised

Code or the Ohio Administrative

Code?

YES

Is the procedure/activity consistent with

the Ohio Nurse Practice Act, rules

regulating the practice of nursing, and

Interpretive Guidelines of the Board?

NO, PROCEED

NO

YES, PROCEED

Overarching Principle -Scope of Practice

Do practice guidelines of a national specialty or

advanced practice organization support inclusion of this

procedure/activity in your particular practice?

Questions – Do you possess the depth & breadth of

knowledge to perform this procedure/ activity/safely?

AND Do you possess the depth & breadth of knowledge

to respond appropriately to complications or untoward

effects of the procedure/activity?

You must be able to provide documentation, upon request of the Board, to show evidence of your knowledge to perform

the procedure/activity. Such knowledge is generally obtained through education emanating from a recognized body of

knowledge relative to the care to be provided. Documentation would include:

APRN educational programs

Preceptorship, fellowship, or internship; and/or

Other formally organized educational experience

YES, PROCEED

NO

NO

YES, PROCEED

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Overarching Principle -Scope of Practice

Questions – Do you possess the depth & breadth of

current skills and clinical competence to perform

this procedure/ activity consistently and safely? AND

Do you possess the depth & breadth of skills and

clinical competence to respond appropriately to

complications or untoward effects of the

procedure/activity?

You must be able to provide documentation, upon request of the Board, to show evidence of your skills and abilities to perform the procedure/activity. Documentation would include:

• APRN educational programs• Formally organized educational experience; and / or • Return demonstration or skills check-off

YES, PROCEED

NO

Overarching Principle -Scope of Practice

Is this an acceptable standard of care? Would a reasonable, prudent APRN perform this activity in this setting and under these circumstances? Will you assume accountability for providing safe care in performing the procedure/activity?

If YES, you have concluded that the procedure/activity is within your scope of practice. Proceed to agency/ institutional education, competency, credentialing or privileging criteria and other considerations

NO

YES, PROCEED

Other considerations –

Federal & State statutes and regulations, i.e., laws and rules of Medical & Pharmacy Boards,

Department of Health, Job & Family Services, Medicaid & federal Medicare

Policies & procedures of employer, i.e., agency or institution as well as payer and malpractice

carrier policies

APRN Essentials whether Entrepreneur or Employed

• Collaborating physician • Standard Care Arrangements (SCA)• Prescriptive Authority & the Formulary

• Prescribing Schedule II Controlled Substances• License Renewal• Signing your name• Documentation

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Resources

http://www.nursing.ohio.gov/

https://cdn.ymaws.com/oaapn.site-ym.com/resource/resmgr/conference/2017_Conference/Handouts/LAW_AND_RULE_PRACTICE_LAW_UP.pdf

http://codes.ohio.gov/orc/4723

Questions

Employment Contracts

• Term and Termination

• Salary and Benefits

• Work Schedule

• Duties

• Post Employment Restrictions

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Employment Contracts – Terms and Conditions

• Duration of employment

• Scope of services to be performed

• Terms of on-call responsibilities

• How can the agreement be altered or updated

• Income guarantees

• Reason for termination

Employment Contracts - Salary and Benefits

• Compensation

• Benefits

• Bonuses

• Vacation Time

• Time off for continuing education

• Assistance with CEU

• Expenses reimbursement for CEU

• Education loan forgiveness

Employment Contracts – Work Schedule

• Number of office hours per week

• Expectations of number of patients per day

• On-call responsibilities

• Expectations regarding nonclinical work to be done

• Patient base

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Employment Contracts – Difficult Clauses

• Restrictive covenants

• Bonus formulas

• Productivity-Based Formula

• Quality-Based Formula

• Profit-Based Formula

• Patient Satisfaction Based Formula

• Termination clause

• Termination without cause

This Photo by Unknown Author is licensed under CC BY

Resource

Nurse Practitioner's Business Practice

and Legal Guideby Carolyn Buppert

Questions

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Behind the Scenes

Employment or Practice Ownership

Considerations for the Nurse Practitioner

• Your medical practice is a business

• Realize your competencies

• Seek out excellence in the other aspects of your business

• You need to focus on providing excellent service to your patients

This Photo by Unknown Author is licensed under CC BY-NC

Behind the Scenes

Create a company to practice under

• Responsibility to maintain credentials:

• NPI

• CAQH

• CLIA

• DEA

• TDDD

• BWC

This Photo by Unknown Author is licensed under CC BY-ND

Behind the Scenes

• Electronic Medial Record

• Compliance

• Risk Management

• Billing and Coding

• CPT

• HCPCS

• ICD-10

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Behind the Scenes

• Identify Key Financial Indicators

• What is your breakeven?

• Review your performance

• Days in AR

• Reimbursement Rate

• Insurance Mix

• Workflow cycle time

• Performance dashboards

This Photo by Unknown Author is licensed under CC BY-ND

Resources

https://proview.caqh.org/

https://nppes.cms.hhs.gov

https://wwwn.cdc.gov/clia

Resources

https://www.ama-assn.org/practice-management/cpt

https://www.cdc.gov/nchs/icd/icd10cm.htm

https://oig.hhs.gov/reports-and-publications/archives/workplan/index.asp

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Questions

"What do you need to start a business? Three simple things: know your product better than anyone. Know your customer, and have a burning desire to succeed." —Dave Thomas,

Founder, Wendy's