NR 510 Week 3: Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study- Part One
Carolyn Buppert suggests using the three P’s when preparing for a contract negotiation (Danielsen, Potenza, and Onieal, 2016). The three P’s stand for prepare, probe, and propose. When the negotiation discussion begins I would start of by stating the number of patients seen for the year and the billable hours that were paid. According to the AANP the US average of NPs see 3 or more patients per hour. A goal to increase revenue would be to start scheduling 3 patients per hour. According to Buppert’s payment model this will increase my revenues by more than $75,000 a year. As a contract employee I would be responsible to pay my own taxes, provide my own malpractice insurance, I would not receive medical benefits, and I would pay for my own continuing education, reducing my cost of employment to the practice. I would discuss patient satisfaction and new patient retention rates. An increase in these rates would show my value to the practice. I would also discuss patient outcomes and the increase or decrease in non-scheduled hospital admissions. A goal to increase revenue would be to decrease no-show rates. Initiating a telephone engagement protocol as stated by Clouse, Williams, and Harmon (2015) has to ability to decrease no-show rates and increase revenues. To take strain off the physician, comanagement of patients could be recommended. Comanagement means the NP and the physician work together to manage the health care needs of the same patients. Norful, de Jacq, Carlino, and Poghosyan (2018) state “the stronger comanagement is, the greater the potential for beneficial patient, clinician, and practice outcome” (p. 254). As the NP I could manage patient call backs of those with chronic illnesses that are being managed in extended care facilities.
Resources:
AANP. (2018). NP Fact Sheet. Retrieved from https://www.aanp.org/all-about-nps/np-fact-sheet.
Clouse, K., Williams, K., & Harmon, J. (2015). Improving the no-show rate of new patients in outpatient psychiatric practice: an advance practice nurse-initiated telephone engagement protocol quality improvement practice. Perspectives in Psychiatric Care, 53, 127-134.
Danielsen, , R., Potenza, A. & Onieal, M. Negotiating the professional contract. Clinician Reviews,28-33.
Decapua, M. (2016). How much revenue does a primary care nurse practitioner generate? Retrieved from
Norful, A., de Jacq, K., Carlino, R., & Poghosyan, L. (2018). Nurse practitioner-physician comanagement: a theoretical model to alleviated primary care strain. Annals of Family Medicine, 16(3), 250-256.
Professor
99213 and 99214 are billing codes that are used for patient office visits. 99214 is a higher code for providing more complex medical decision making. Jensen (2005) states that the “level of decision making in a patient encounter is based on three parameters: the problems addressed, the data reviewed, and the level of risk” (p. 53). To increase more 99214 billings there are several components that must be provided and documented during the office visit. These 99214 billing could be accomplished when seeing patients with chronic illnesses. When seeing a return patient with a chronic disease the pracitioner must do a review of systems which makes the exam extended problem-focused (Waller, 2007). During the exam if there is an additional system affected from the chronic disease process, this must be documented. The last component is the medical decision making, in which providers provide a points value to the diagnosis, data, and risk to determine if the patient visit is a 99213 or 99214 billing code. Another way to increase 99214 billings is to code using time-based billing. The practitioner must spend at least 15 minutes with the patient and half of that time must be used for counselling or coordinating care (Waller, 2007). Documentation is critical when determining the billing code for patients. Chief complaints can be similar, but the care can be completely different and that must be documented. Waller (2007) describes a scenario where the chief complaint of two patients is a cold with one patient having a sore throat, headache, no fever, and ENT WNL, while the other has a fever, sore throat, headache, enlarged tonsils with exudative materials needing a strep culture. The second patient needs far more care to diagnose than the first and should be coded as a 99214.
ALSO READ: NR 510 Week 3: Organizational Behavior and Business Influences and Advanced Practice Nursing Case Study Part Two
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Resource:
Jensen, P. (2005). Coding “routine” office visits 99213 or 99214? Family practice management, 52-55. Retrieved from https://www. Aafp.org/fpm.
Waller, T. (2007). Level-II vs. level-III visits: cracking the codes. Family Practice Management, 21-25. Retrieved from https://www.aafp.org/fpm/2007/0100/p21.pdf
It important to first sit down and make a list of all the attributes one brings to the practice and the overall income of the practice to be able to gauge ones contract negotiations (Buppert,2015). It sounds like the owner of the practice, like any other, is financially driven which is pertinent for keeping a business up and running. As an independent contractor the provider only goes to the place of business for agreed upon services and bills appropriately for these services. As an employee one is provided with benefits, follows the hours of the business, provided the equipment they need, and get malpractice through the business not on their own (Buppert,2015). Under an ongoing contract negotiation I believe it is important to negotiate hours, wages, number of patients seen per day. Generally, an NP needs to see 20 patients a day to generate enough money to make a practice profitable, therefore I believe this a reasonable number of patients to see (Buppert,2010). It is pertinent to revisit the reimbursement regulations to ensure your knowledge is up to date. One must also confirm date of covered care according to their contract prior to seeing any patients to be ensured payment is appropriate (Hahn &Cook,2018).
Buppert, C. (2015). Nurse practitioner’s business practice & legal guide (5th ed.). Retrieved from https://bookshelf.vitalsource.com
Buppert,C. NP, JD (2010) How Many Patients Can a Nurse Practitioner See in a Day?
Hahn, J. A., & Cook, W. (2018). Lessons learned from nurse practitioner independent practice: A conversation with a nurse practitioner entrepreneur. Nursing Economics, 36(1), 18-22. Retrieved from https://chamberlainuniversity.idm.oclc.org/login?url=https://search-proquest-com.chamberlainuniversity.idm.oclc.org/docview/2007005926?accountid=147674
Negotiating my 1099 independent NP contract takes the same level of skill that I need to manage my patient load. Determining my value is never going to be easy. If I go to low on my salary, I will undersell and overwork myself. If I go too high, I can run the risk of losing the contract. If I am unaware of the average national and state salaries, I will be putting myself at a great disadvantage (Buppert, 2016). Knowing how much NPs are making in my area is just one negotiation tactic that will prove helpful. Before I make my requests known, I should write down my unique candidate features (Jennings et al., 2015). These are great selling points because these are the skills that help me build the owner’s practice. These skills include and are not limited to my advance practice skills: assessing and diagnosing, prescribing medicine, interpreting laboratory and imaging tests, and counseling patients (Jennings et al., 2015). As a licensed medical clinician with expertise in a chosen specialty, I should make at least $50 per hour because of the clinical skills I bring to the table (Jennings et al., 2015).
Another benefit is that my employer does not have to pay for benefits, such as practitioner insurance coverage, paid vacation time, retirement contributions (401K). The owner also does not have to pay for insurance benefits, such as full coverage medical, dental, life, disability, or unemployment insurance. All of these costs take away from the owner’s profit. Buppert (2016) states the four P’s of negotiation are for the nurse practitioner to “prepare, probe, propose, and persuade.” An NP should know how much revenue he or she brings to the table before negotiating salary (Buppert, 2016). The delivery of care that NPs provide is what the employer is paying for. Lastly, I will point out how loyal and hardworking I have been through my current contract.
References:
Buppert, C. (2016). Three things to think about before signing an employment contract. The Journal for Nurse Practitioners, 12(2), 128-129. Retrieved from DOI: https://doi.org/10.1016/j.nurpra.2015.11.003
Jennings, N., Clifford, S., Fox, A. R., O’Connell, J., & Gardner, G. (2015). The impact of nurse practitioner services on cost, quality of care, satisfaction and waiting times in the emergency department: A systematic review. Nursing Studies, 52(1), 421-435. Retrieved from DOI: https://doi.org/10.1016/j.ijnurstu.2014.07.006