Am I Ready to Start My Own Practice-What Did I Not Know! Nurse Practitioner Entrepreneurship Conference Northeastern University Deborah Paschal, CRNP

Discover key elements of independent practice often not even thought about as a factor in new practice start-up and operations Panel Objective

Explore those different approaches needed to ensure success, sustainability and financial viability into retirement! Breakout Objective

Impact of Health Care Change on NPs Fewer primary care physicians, more primary care NPs Full Practice Authority legislation expanding NPs as Next Gen PCPs 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! Impact of Health Care Change on NPs 20,400-physician shortage by 2020. (Spotlight PA fn1) while NPs are fastest-growing hc discipline (Schrand reference? ) NPs will be next gen of PCPs 2.NPs will develop primary care solutions but will not benefit financially because deep down we’re not in this for the money. Really? 3.Full Practice Authority legislation does not ensure reimbursement of NPs as PCPs by insurers 4. NPs will develop Primary care solutions but will not benefit financially because deep down we’re not in this for the money 5. Really? Then why do we care that Medicare pays us only 85% of physician rate? Need to Reform our thinking about reimbursement. 6. Need to reform our thinking about our reimbursement goals in light of our new PCP role for new patient populations, including commercial lives. 7 The goal is not equal pay; the goal is pay for performance contracts that leverage the natural result of nursing’s engagement culture 8 What stands in the way?

NPs as Next Gen PCPs Good news: quality and utilization outcomes rock Bad News: outcomes are not sustainable without Business and Reimbursement 101 skillsets 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??? NPs as Next Gen PCPs

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!!! The NP Value Proposition : 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. If these results are not just chance, but because nursing is hard-wired into a model of care that is built on patient engagement and self-sufficiency, then we can say with high degree of confidence the results are reproducible for P4P reimbursement purposes. The goal is not equal pay; the goal is pay for performance (P4P) contracts that reward the well-documented outcomes of nursing’s patient engagement culture. Informed risk-taking (downside and upside) is key to a margin that supports mission.

What Does “Entrepreneur” Mean? One who organizes and manages an enterprise Usually with considerable initiative and risk

So What’s Holding NPs Back? Lack of business skillsets Lack of managed care contracting expertise Lack of experience outside not-for-profit environments Hard to put on “Game Face” to compete Where will start-up seed money come from??? So What’s Holding NPs Back?

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 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

This Is What Success Looks Like Mission > safety net Margin > self-pay, >Medicaid, and >85%xPhysician FFS Mindset =The confidence to articulate value and compete This Is What Success Looks Like Today’s Message NPs will be next gen of PCPs NPs will develop Primary care solutions but will not benefit financially because deep down we’re not in this for the money Really? Then why do we care that Medicare pays us only 85% of physician rate? Need to Reform our thinking about reimbursement. The goal is not equal pay; the goal is pay for performance contracts that leverage the natural result of nursing’s engagement culture 5. What stands in the way?