Today’s healthcare landscape is experiencing significant shifts and upheaval in some respects. Workforce depletion, the strain caused by the COVID-19 epidemic, increased needs, a changing (and aging) patient population, the increase in telehealth and technological advances, and more are creating huge demands for care that can’t always be met by Medical Doctors (MD’s) or physicians.
Other types of medical professionals are standing in that gap. Nurse Practitioners (NP’s) are increasingly taking on independent caseloads and beginning to operate their own practices. This is helping alleviate the workload that is burdening the healthcare industry and make medical care available to more people. If you are currently practicing as an NP or are interested in pursuing an NP qualification and starting your own practice, here’s an introduction to the process.
Defining a Nurse Practitioner (NP)
A Nurse Practitioner (NP) is one type of Advanced Practice Registered Nurse (APRN). APRN’s are medical nurses who have completed, at minimum, a Master’s degree in nursing. APRN’s are qualified to offer a larger number of technical types of care than a Registered Nurse (RN) is allowed or able to perform.
NP’s can come in a number of different specialty types. These include the following: Neonatal Nurse Practitioners (NNP’s), Family Nurse Practitioners (FNP’s), Acute Care Nurse Practitioners (ACNP’s), Women’s Health Nurse Practitioners (WHNP’s), Pediatric Nurse Practitioners (PNP’s), Adult-Gerontology Nurse Practitioners (AGNP’s), and Psychiatric Mental Health Nurse Practitioners (PMHNP’s). An NP who has studied in any of these specialty areas can consider opening their own practice.
An NP’s Ability to Practice Independently
To understand how NP’s can practice, it’s important to understand how medical care is defined in legislative language. Medical care provision can be divided into a few different areas.
Diagnosis refers to the act of examining a patient and providing a diagnosis of the determined condition of the patient based on that examination and analysis.
Treatment refers to providing treatment or designing, facilitating, and/or managing treatment plans for patients.
Medication prescription refers to the act of ordering, distributing or authorizing the use of pharmaceutical drugs or medication as part of a patient’s treatment.
Referrals refer to the process of recommending that a patient receive further attention or treatment from different or additional medical professionals or facilities and initiating that process.
These main service areas make up what is often referred to as the “Scope of Practice”. The cocktail of allowances concerning how a Nurse Practitioner may perform or not perform each one is determined by state law. Some states allow NP’s to provide “full practice” measures for patients in an independent practice setting. Others restrict or limit NP’s to certain areas but require that others only take place under the supervision of a physician or MD. Restricted actions often include prescribing medications.
For an NP interested in starting their own practice, or for an individual who is interested in becoming an NP and practicing independently in the future, it’s important to understand the specific requirements and restrictions in place in the state where you’d like to practice to make sure you understand what you would and would not be allowed to provide for your patients.
Steps for Opening an Independent Practice
In order to begin their own practice, NPs need to complete several important steps. Some of these items ensure that they are legally certified to provide medical care as an independent entity. Others establish connections with other entities that are necessary to make sure they can provide effective treatment and services for their clientele. And others help design and foolproof the process of establishing a venture like an independent practice. Each area is vitally important. If you are an NP, use this as a guide.
Secure a State License and Drug Enforcement Administration (DEA) Number
Some states require additional licenses or registrations when you establish your own practice. These requirements should be verified in the state in which you plan to open. At a minimum, you are required to hold a current RN and APRN license. A DEA number will be necessary for practices that plan to distribute or prescribe medications and controlled substances.
Negotiate Partnerships and Arrangements with External Bodies.
Regardless of specific state treatment restrictions, no medical facility will be able to effectively treat every ailment. It’s imperative that your practice establishes connections and “privileges” with a local hospital(s) and specialty practitioners. This will simplify the process of referring any patients to external care providers when needed.
Another necessity for your new practice is to establish contracts with insurance providers to make sure you can receive insurance reimbursement for the care you provide. Your practice will need to establish these arrangements with each individual insurance provider you’d like to accept. This process can take a fair amount of time. It’s important to begin early so that your payments and reimbursements aren’t delayed or refused when you begin treating patients.
Third: Build a Viable Business Entity
Starting any business requires thought and planning. Writing a business plan will help you think through each of the many aspects of starting an entity, and plan for how you’ll construct your practice from the ground up. Templates and resources for this process are available online, through business coaching resources offered by your local library or chamber of commerce, or through asking established practices for recommendations and advice.
Part of your business planning will need to include covering necessary startup costs. Licensing, rent, overhead, staff, administration, and more can cost a significant amount of money and often needs to be at least partially payable upfront before you ever receive compensation for your medical services.
Finding a suitable location for your practice will also be incredibly important. Rent costs, zoning, parking, location, and its accessibility for the demographic(s) you hope to serve will all need to be accounted for.
Finally, your practice will need ways of managing your billing and administration activities. There are several different methods and software available to accomplish this. It’s important to choose wisely and make sure the system you establish is adequate and will scale well with your practice as it grows.