Nurse Practitioners, Telehealth, And The Future of The Nurse Practitioner Medical Practice. The Business of Medicine for Residents, Fellows and Nurse Practitioners.
I recently found an interesting study on habit formation. It suggested that a new habit can be developed in as little as 21 days. The average time for full development was 66 days.
After six months of lockdown all of us are forming new habits, getting used to new and changing lifestyles. In medicine the biggest change, now grown beyond a habit to a norm, has to be the emergence of telehealth.
Although CMS continues to tinker with telehealth rules--as late as last week releasing new guidelines that will expand telehealth rules--it’s here to stay. I don’t think anyone expects a return to pre-pandemic restrictions.
This presents a new opportunity for nurse practitioners, and I regularly field calls from them, queries framed around the question, “What do I need to do to start a telehealth practice?” Most callers understand the clinical piece but lack focus on the more important aspects of developing a successful business.
The thing I find lacking most is a clear focus on what the goals and objectives are. Specifically, what market are you going to serve? Leaving an active practice where you’ve had the time to develop a patient base is going to make it easier, but like all medical practices, how do you grow your business to fit your vision?
Market assessment is a critical part of this. What’s the target market? Adding telehealth to a brick and mortar practice as a way to treat your current patient base? Aligning with an overworked family practice physician to ease his load and increase his patient base? Working to develop a presence in the nursing home/assisted living market? Positioning yourself in the underserved rural markets, possibly in partnership with a healthcare system?
What is your market? How do you break in? Can you find both the financial and clinical rewards you’ve defined in your goals and objectives? How long will it take? What is the marketing effort and capital that needs to be executed to establish a presence? Is the return on the cost to do so make it all worthwhile?
In states where NPs must work with a collaborating physician there’s the big question of finding one. I always suggest a sophisticated presentation be developed for presentation to prospective physicians, one that outlines your work experience/history, levels of clinical activity, training, and a summation of your target market. When you are asking someone to work with you at this level, you need to show them that you are not “risky” and have a commensurate level of professionalism they will be comfortable with.
And you need to define just how they are going to get paid.
Find an EHR vendor who has had extensive experience in telehealth and telehealth billing. Understand the costs.
Social media is crucial. Familiarize yourself with DoctorLogic, PatientPOP and other platforms that understand how to integrate them into your business plan.
Starting a telehealth practice is no different than starting a medical practice in almost all ways. For a complete overview of “how to do it” I’d refer you to www.FirstMEDPractice.com, the platform developed specifically for providers entering the world of medical business.
Possibly the most important thing of all: Who will pay you, and how much. State’s oversee telehealth rules, and what’s required can vary from state to state. Compliance is the issue here. Insurers can also be fickle in this area, and issues related to credentialing with payers can be complex (and take months to achieve), especially if you anticipate providing telehealth to patients across state lines. Be sure to follow payment updates too; I expect insurers will be renegotiating telehealth rates after the pandemic.
---Tom Ellis III/September 2020
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