Advanced Practice
Nursing Role: Financial Management Issues
Spring 2002
FIRST CLASS MEETS
Jan 23
Credits: 1, (7,
2 hour seminars)
Class Hours: Weds 12-1:50 every other week
Class dates: Jan
23, Feb 6, Feb 20, Mar 6, Mar 20, Apr 3, Apr 17
Office Hours: by
appt.
Classroom: 4 Dieffendorf
Recommended Prerequisite: N511
Faculty:
Dr. Carol Brewer
Stockton Kimball Tower, Room 912 (Office)
Office: 829-3241
Secretary: Marianne Messina, 829-2342
Communications:
Email: csbrewer@acsu.buffalo.edu
Listserv address: n516-list@listserv.buffalo.edu
Description
| Objectives
| Requirements
| Grading
| Assignments | Schedule
| Readings
| Links
| Additional Resources|
Course
description
This course is designed to introduce the APN to concepts relevant to
managing the clinical and fiscal outcomes of their practice. An organizing
framework of entrepreneurship is used. Reimbursement mechanisms and the
implications for practice in various settings, basic budgeting concepts
used to manage a practice and standardized decision making methods used
to evaluate the cost effectiveness of clinical outcomes will be discussed.
Evidenced based practice and the implications for cost and quality will
be discussed.
The
University has a responsibility to promote academic honesty and integrity
and to develop procedures to deal effectively with instances of academic
dishonesty. Students are responsible for the honest completion and representation
of their work, for the appropriate citation of sources, and for respect
for other’s academic endeavors. By placing their name on academic work,
students certify the originality of all work not otherwise identified by
appropriate acknowledgements.
NOTICE FROM THE
OFFICE OF DISABILITY SERVICES:
"If
you have a disability (physical, learning, or psychological) which may
make it difficult for you to carry out the course work as outlined, and/or,
requires accommodations such as recruiting note takers, readers, or extended
time on exams and assignments, please contact the Office of Disability
Services(ODS), 25 Capen Hall, 645-2608, and also the faculty during
the first two weeks of class. ODS will provide you with information
and review appropriate arrangements for reasonable accommodations."
Requirements:
This course is structured in a workshop format. There will be some
lecture, discussions and in-class exercises as well as guest presentations
and a final student presentation. Each student is expected to complete
required readings prior to class and to participate actively in class discussions.
Attendance is required.
Skills: basic understanding
of the internet, email, spreadsheets and word processing is expected.
Basic knowledge of a spreadsheet is essential today. If you do not
know Excel, I strongly encourage you to take one of the CIT courses available.
1. Delio, SA, (1999):
The Perfect Practice for an Efficient Physician.Englewood
CO: Medical group Management Association
and
2a. Go to http://www.planware.org/busplan.htm.Download
the Free-Plan (another version on the internet is Biz-Plan).There
are many other resources available on the internet.
OR
2b. Mannino, MJ. (1994).
The Business of Anesthesia: Practice Options for Nurse Anesthetists.
Park Ridge, IL: American Association of Nurse Anesthetists Publishing.
And required for
all students (except highly recommend for Anesthesia students)
3. Buppert, C. (2000).
The primary care providers guide to compensation and quality: how to
get paid and not get sued. Gaithersberg MD: Aspen Publishers, Inc.
Highly recommended:
Bolles, R.N., (2002).
What color is your parachute? Ten Speed Press: Berkley, CA, ch 12.
On reserve:
Bolles,
R.N., (2002). What color is your parachute? Ten Speed Press: Berkley,
CA, ch 12.
Buppert, C. (1999).
Reimbursement for nurse practitioner services. Nurse Practitioner Business
Practice Legal Guide. Gaithersberg, MD: Aspen, Inc.
Buppert, C. (2000).
The primary care providers guide to compensation and quality: how to
get paid and not get sued. Gaithersberg MD: Aspen Publishers, Inc.
Calmelat, A. (1991)
Tips for starting your own nurse practitioner practice. Nurse Practitioner
18, 4, 58-68
Mazzocco, W.J., (2000)
Nurse practitioners and incident to billing: the indirect billing method.
Medscape Nursing 1-7
Zaumeyer, C., Zukowski,
L. (1995). The nurse practitioner as entrepreneur: How to establish
and operate an independent practice. Fort Lauderdale, FL: Women’s Health
Watch.
Grading:
Part A50%
Part B50%
After
2 days, late plans will be penalized 5%.
Grade guidelines:
A = 94-100
A- = 90-93
B+ = 87-89
B = 83-86
B- = 80-82
C+ = 77-79
C = 73-76
D = 70-72
F = below 70
There is no existing
text book that meets the needs of this course exactly.Therefore,
I have assigned certain resources and indicated the availability of many
more.Some texts are highly recommended
for your permanent library, such as Buppert's two books, but only a few
chapters are pertinent to this course. Other chapters may be pertinent
to the other two role courses.
When the readings refer
to the business or company, substitute in your mind your practice and/or
professional career.How can you
use these techniques of analysis to "grow" yourself?
You have two assignments
for this class both of which are related to writing a business plan.However,
in this case, the focus is YOU; your planned practice as well as your professional
career.We are going to focus on
you as the center of the business and development process.This
business plan is an allegory for the process in which successful career
people engage.It means determining
where you are going, how you are going to get there, and what the outcomes
of the process will be.The parts
of the business/career plan you will be expected to turn in are in two
parts.The first part (Part A)
will be a solo assignment, and second (Part B) can be accomplished with
NO MORE than 2 people.
If you are not in a
clinical assignment, you may find interviews with a business manager or
a nurse practitioner in a practice similar to one you would prefer very
useful for some parts of the assignments.
Part A: 50%
1.20%
Practice Overview
(This is the equivalent of the market analysis; address each of the points
below). No more than 3-4 pages. Should be short, clear and concise, outline
form acceptable where appropriate and understandable.
Describe
the practice in which you wish to pursue a career.
a.Business
Environment and Market definition:
If you do not already know what type of practice in which you wish to practice,
then for the purposes of this assignment you must choose one.
a.Describe
a practice location, community characteristics, practice size, patient
characteristics (age, sex, socioeconomic status, insurance status, ethnicity,
geographic location or other pertinent characteristics).
b.What
is the legal form of this practice and why was it selected; are there any
advantages/disadvantages for you personally?
b.Buyer
behavior /Customer profile:
Describe the physicians and other personnel with whom you expect to work.
Describe your expected role in this practice and the patient load you expect
to carry.What kind of patients do
you expect to see, if different from or a subgroup of, the general practice?
What are the most common patient problems you expect to see?How
will you address cultural issues relevant to your practice?
c.SWOT
analysis: What
are your strengths (Why should someone hire YOU?) and weaknesses (internal/personal/professional)
that will affect your practice/patients and relationships with your coworkers?
Opportunities and threats (external to you, for ex: great mentor available
but poor job security)?
Against
this backdrop you will write the next section.If
you do not know, you will need to select a potential area of practice and
develop the rest of this plan as if it is fact.
2.5%
Write a mission for your practice and a vision for your career. (1/2 to
1 page)
3.10%
Mission, goals and objectives.1-2
pages
a.What
do you have to offer any potential employer? And how will you continue
to develop your expertise, professional skills, and reputation (eg minimize
weaknesses)? How and when will you do this?
i.Include
at least three 1 year goals, two 3 year goals, and one 5 year goal, with
at least three objectives for each goal.
1.Note:
Goals and objectives should deal with developing your practice and professional
career, not your personal life.
2.Note:
language varies here: strategies and goals are general statements that
address the SWOT analysis, objectives (but sometimes called goals!) are
the specific measurable statements.
4.10%
Quality assessment plan (not part of the usual business plan).1-2
pages
a.This
section should explain how you will monitor the quality of at least
ONE specific service (see Buppert). What will you monitor, how, and what
outcomes are expected?
5.5%
References/grammar.
Document any resources used, including people, using APA format. Online,
text and other resources should be listed using APA documentation, and
appropriate references used in the text.
Part B:Salary
Proposal (based on revenue generation) (50%). (3-5 pages)
Partner with someone
in a very similar situation to you.
Using the 20 most common
CPT codes and reimbursements for visits or procedures that you will use,
write a salary proposal estimating the revenue you will bring to the practice
within the first year.Describe the
process you used to estimate the revenue and simplifying assumptions you
made to estimate it.Include realistic
estimates of productive time, keeping in mind that you do not see patients
all the time (eg you need time for charting, lunch and vacations/sick days
etc), and that it will take you some time to become efficient.
Include a copy from
Part A of the practice description on which the following is based.
1.(5%).
Your specific CPT/Procedure code list with estimated reimbursements.
Explain estimated prevalence of the CPT codes, and source of reimbursement
information.
2.(15%)
Show, preferably on a spreadsheet, how you estimated your revenue generation
for the practice you are in.This
should be estimated for the first year of practice and include all non-productive
time. Eg don't assume you will immediately be fully booked! And you need
lunch, sick days and vacations..
3.(10%)
Present range of salaries researched on internet or other sources
(updated for inflation if necessary), and how/why they do or do not apply
to your situation(s).
|
|
|
|
| Jan 23 | Topic
I Entre/ intra-preneurship
Definitions and discussion of the business plan as a career guide. Mission, goals, objectives. Legal and financial considerations: permits and licensure |
Many
resources are available online and in the library. You are responsible
for identifying adequate resources to develop your plan. Read all documents
from Free Plan http://www.planware.org/busplan.htm Mannino: Ch 1, 2, 4, 7 |
| Feb 6 | Topic
2 Guest Speaker: Leo
Blatz, MS, RN,
Contract and salary negotiation |
Mannino
Ch 6 Buppert (1999) ch 10,
The Employed Nurse Practitioner, p273-304 Bolles ch 12-The Seven Secrets of Salary Negotiation |
| Feb 20 | Topic
3: Estimating salary and revenue. |
Mannino
Ch -3 Buppert (2000) PCP Guide Ch 9, 10, 11, 13 |
| Mar 6 | Topic
4: Charging for your services Guest Speaker: Donna
Keith McKain, RN NP Homelink Medical Services Payment for services
and billing, income estimation Medicare
|
By
now you should have the CPT code information you need.If
necessary, you should interview an ANP in the desired type ofpractice
to obtain this information. Bring to class information about the reimbursement
available for your services from Medicare (check HCFA internet sites) or
other insurance. http://www.medscape.com/medscape/Nurses/journal/2000/v02.n02/mns0320.mazz/mns0320.mazz.html http://www.medscape.com/medscape/Nurses/AskExperts/2001/12/NP-ae89.html http://www.medscape.com/CBuppert/GreenSheet/2001/v03.n08/green0308.html |
| Mar
20 |
Topic
5: Practice management Information systems,
productivity, cultural and ethical issues (no pay patients), cost effectiveness Guest speaker: Jennifer
DiFlavio, MBA. Manager MF Gates Ambulatory Care Clinics |
Delio:
The Perfect Practice ch 1-15 Part A due |
| Apr
3 |
Topic
6 Quality management |
Buppert
(2000) PCP Guide. Skim/review ch 1-8 Determine the quality
targets you intend to meet for your practice. Identify the processes and
outcomes you want to monitor. Determine how you will collect and monitor
the data |
| Apr 17 | Topic 7 Group presentations of salary proposals. | Part
B due Prepare a one page summary of your salary proposal to distribute to class. |
Shareware
http://www.planware.org/busplan.htm
http://www.planware.org/papers.htm
http://www.planware.org/online.htm
http://www.business.com/directory/healthcare
http://www.businessweek.com/smallbiz/index.html
http://www.Practicesupport.com
http://geography.about.com/education/geography/msub55.htm
http://allnurses.com/jump.cgi?ID=78
http://www.nursefriendly.com/nursing/directory/ny.html
http://www.lopez1.com/lopez/business.htm
http://www.lopez1.com/lopez/business.htm
http://www.monsterhealthcare.com
Salary websites
from Money September 2000p113, roughly in order of value:
Optional readings
and resources
There are two copies
of BIZPLAN Builder on computers in the lab.
The paper text is only available with this more expensive version of the
software. The paper text is available from Ms Dickey to check out from
the lab.
For free shareware
try http://www.bplans.com
Business Basics software
can be bought and downloaded directly to your computer from the http://www.JIAN.com
web site. An optional, more complete software version is:
JIAN Tools for Sales
(2000). BizPlan Builder Interactive Vs 7.0. Mountain View, CA:Thompson
Executive Press.
Tiffany, P & Peterson,
S.D., (1997). Business Plans for Dummies. IDG Books Worldwide: Foster
City, California
Baxter, E. (1993).
Head nurse’s perceptions of their roles. Part 1-2. Canadian Journal
of Nursing Administration. 6 (3), 7-16.
Blouin A.S., &
Brent, N.J.,(1995). Legal insights: the nurse entrepreneur. Legal aspects
of owning a business. JONA 25, (6), 13-4.
Crofts, A.J. (1994).
Entrepreneurship: the realities of today. Journal of Nurse Midwifery.
39 (1), 39-42.
Curran, C.R., (1995).
An interview with Sandra C. Matherly and Shannon Hodges.
Nursing Economics 13 (3), 125-128.
Haag, A.B., (1997)
Writing a successful business plan. AAOHN Journal, 45 (1), 25-34.
Kaplan, SM. (1991).
The absolutely basic concepts of being a nurse entrepreneur. Pediatric
Nursing. 17 (2), 179-182.
Orga, J., (1996). Becoming
a nurse entrepreneur. Tennessee Nurse, 59 (2), 13-4.
Pinardo M., and Newell,
M. (1997). Reinventing your nursing career. Aspen Publishers
Vogel, G. & Doleysh,
N. (1994). Entrepreneuring: A nurse’s guide to starting a business"
(2nd Ed). New York, NY: NLN Press.
Woerner, L. (1994).
Business risk and the health care entrepreneur. Holistic Nursing Practice.
8 (2), 22-7.
Books:
Arkbauer, JB (1995).
The McGraw Hill Guide to Writing a High-Impact Business Plan; A Proven
Blueprint for Entrepreneurs. New York: McGraw Hill
Gumpert, D E (1996).
How to Really Create a Successful Business Plan. Boston, MA: Inc
Publishers
Harper, S.C., (1991).
The McGraw Hill Guide to Starting your own Business: a Step by Step
Blueprint for the First Time Entrepreneur. McGraw-Hill: New York
JIAN Tools for Sales
(1997). BizPlan Builder. Mountain View, CA:Thompson Executive Press.
Pinson, L. Anatomy
of a Business Plan: A Step by Step Guide to Starting Smart… (1996)
3rd edition. Chicago: Upstart Publishers
Purdy, W. (1996). The
Service Business Planning Guide: The Complete Handbook for Creating the
Winning Business Plan….Boston MA: Inc. Business Resources