Power point buisness in clinical practice

This is a power point presentation, my focus for this project would be working as a Family nurse practitioner in a primary care setting treating patients with chronic diseases based in Florida. Please if you have any questions please reach out. Thank you! Please also include notes in the powerpoint Thank you!

Project Presentation: A Business Review of a Clinical Practice- Family Nurse Practitioner

This week we have been exploring and examining the elements and the forces that shape our role and facilitate our participation as advanced practice nurses in the US healthcare system. In this activity, you are required to conduct a business evaluation of a clinical practice. If you intend to open your own practice, this exercise can help you better understand the details of a feasibility report required for business registration. Or you may be tasked to participate in a business review of the unit in which you work and will find this exercise helpful. The following video explains the project.

Transcript of video of information about project

Coming up. I'm going to go through the rubric and just let you know exactly what is going to be involved in this.. Let's just talk a little bit about this project. This can either be like your dream job. It could be maybe where you want to work, where you dream to work. Maybe you want to open your own practice. Maybe you want to work in a birth center, maybe you work at a hospital. Maybe you want to work in a clinic. This really is whatever you're desiring. Everybody's presentation is not going to be the same. We have FNPs in here, we have midwives in here, we have NNPS, PNPs. Everybody's area is going to be different. The first part that you're going to do, if you look at the rubric, there's different sections that need to be covered in this presentation. The first part  that's going to be presented is going to be the workplace setting. Where do you desire to work? Like I said, it can be an actual practice that's already established. It can be maybe, you want to open a methadone clinic, I mean there can be endless possibilities. But describe that area, what part of the country, and talk about your community. How big is this clinic going to be? Is this going to be rural? Is it going to be urban, private practice, health department? Is there a need for it? You need to be looking at the research in the area that you're wanting to do this. If you want to do a med spa and there's already 10 within a three mile radius, well, then that's probably not the best choice. You really need to look at the area where you're going to work at. If you're wanting to open something, you're going to join a practice that thing. Because I want to see in your presentation not just, I'm going to work in Frisco Texas. But there needs to be more to this from when you're talking about your workplace setting. Look at the community need, look at, maybe you want to do primary care and there's a big issue with diabetes. I mean, that's everywhere it just depends. Maybe there's an access to care issues. You want to set something up. Maybe you want to do in a practice that just has one, an FNP and you want to join that person so that you can maybe provide OB service. There's endless possibilities on what this needs to be. Make sure though, that you look at the rubric and you can see what is required in when we're talking about the workplace setting. The next part that you're going to do is your employment contract. Now, we talked about this in some of the modules, so you can make your employment contract whatever you want. Remember this is your dream job. I laugh when I see people present this, they'll just say two weeks of vacation and I'm like, no, you are definitely going to need more than that. You need to be thinking, how much time do you want off? Do you want education money? Do you want your malpractice insurance to be covered? What malpractice insurance do you want? Are you going to be required to pay a tail insurance? Because I can tell you, speaking from experience, when you first get your job, your first advanced practice nurse job, sometimes you will just take whatever you can get. But I can tell you sometimes it's better to wait. Because the legalities of contracts, and if you break the contract, if you have a non-compete where you can't practice within 30 miles for a year or two. Those are things that you definitely have to have upfront in your employment contract because they will then in turn protect you. These are the things that I want you guys to start thinking about in present on is what type of malpractice insurance that you're wanting? Look at vacation time off. Do you get, like I said, education money? Do you get 2000 a year? Do they pay for your licensing? Do they pay to be a part of your organization? For midwives, ACNM I mean, there's different parts of it that you need to consider on what you're really wanting. In this section if you can have at least, I would say maybe five major things. I mean, you could talk about an employment contract for hours. But I want you to pinpoint the main things that you're wanting to include in your employment contract. That's another section that you're going to look at. Now, this course does not require you to do a full business plan. I know when you look above on this rubric, you see some different pretty intense business plans. This final presentation is not a full business plan. But you need to know how much you're worth. I would like to see a sample of maybe what a workday is going to look like for you. If you're in a clinic, how many visits are you going to plan on seeing a day? What type of visits? I want you to include how much you're going to get reimbursed from Medicare, Medicaid, or private insurances? Or is it going to be like a cash pay system? Maybe you don't want to deal with insurance. However, if you don't want to deal with insurance, I still want you to look up how much Medicare and Medicaid reimburses for say, like a wellness visit. Say you live in a rural area, you can actually go on their site. You can go down to your state. You can look and find out how much you're going to get paid if you see somebody for a wellness visit. I want you to look at maybe if you're in a clinic setting now, if you're doing any OB, typically OB will do a bundle package. Once you do that delivery, you'll get a set amount of funding based on the care through the pregnancy and then to the postpartum. That could be if you're doing a birth center or you're seeing people care. Even if you do OB and maybe say you work at a MFM clinic, you're still billing for those visits. That's a little bit different because they're higher risk in your specialty. But you need to look at it. Well, maybe you're wanting to do a hospital. Well, you're still getting paid to work in a hospital. Someone's got to be providing those services. You need to search in that if somebody comes in, or maybe you're a PNP, NP power where you're going to have to look more in depth on how is it getting billed, the reimbursement part of it? I want you to see what your value is, what you can bring in because unlike being a nurse, you're now a provider. You can bill for your services. I want you to bring that in. If you're wanting to start your own business. If you're wanting to run a clinic, What are some expenses? This is not a full business plan, but I do want to see here and this can be over a few slides, the insurances that you're going to accept, how much you're going to receive for those visits, how much you're going to get paid. Because if you have an MA that's working with you, if you have somebody at the front desk, you're the one that's bringing in the money. It's not like you can say, well, I'm going to get 85 dollars for this wellness visit and say they're booked in a 20 minute spot. Well, 85 dollars is probably not going to make everything in your office flow. When you look at it this way, sometimes we're, physicians have no bedside manner. All they care about is making money. But you also have to look at the side that it's a business and even though you're there to make a difference and to care for your patients. This is also something that you have to consider, that you have to be bringing money in to make the business work. On funding and payments, I expect that you're going to provide wherever you're going to work. The reimbursement of that. You're doing visits include that Medicare, Medicaid, private insurance sliding scale.

Shirley Marion: Then what's coming in and what's going out. I'd like to see what a typical day looks like. Then if you can break it down maybe like a month or a year of business expenses, then you can put that here. But like I said, this is not an extensive Excel spreadsheet. More like bullet points so that you can really see the value of funding and payments based on your chosen job that you're wanting. Now we're going to talk about collaborative agreement. For that, depending on what state you're practicing in, depends on how you're going to do your collaborative agreements. Some states will require you, like I'm in Texas, I am connected with a doctor at the Texas Medical Board, so we are connected. For my prescriptions and things like that, every so often I've got to sign a paper and the physician that I worked with, he has to sign the paper so that that collaboration is legal. Now, state law, each state is different. If maybe you live in a state where you are not required to have a collaborative agreement, then you can say, I'm going to work here. We don't have a collaborative agreement. Then you need to probably talk and expand on the collaborative practice and also looking at maybe the legalities with not having a collaborating physician. Those are things sometimes it's informal, sometimes it's not non-informal. There typically is each state will require if there is a collaborative agreement, they have to sign so many of your charts, have a monthly meeting, that thing. Each state is different, so you're going to have to look at your state and look up the law and see exactly what all it entails for this section of the collaborative agreement. It's going to take a little bit of researching, but it's good because when you're done with school, you're going to know what's expected of you concerning the collaborative agreement. Now, that's the collaborative agreement. The APR and practice protocol is a little bit different because you're saying first you need to describe the setting that you're in and then talk about your practice protocol agreements. If I'm a nurse midwife and I'm delivering babies, when something goes outside of my scope, there typically is a protocol on what I need to do. Say, I have a patient that develops preeclampsia and I need to start their severe and I need to start mag sulfate. In my practice protocol, that tells me that's what I need to do. Sometimes this can be based if you're talking like at a hospital, they actually will have bylaws on what sets up the APR and practice protocol. Even if you are in a state that does not require collaborative agreement, you still might have a practice protocol. For instance, say you are in a state that does not APRN Practice Protocol, and you have a patient that needs emergency surgery. Your protocol is probably what in emergency situation you're going to either send them to the hospital. You've now gone out of your scope. You will have things that are in place when things go out of your scope that you refer and consult. Correct? These are the things that you need to be thinking of. If you're in a clinic, If I have a patient that maybe need surgery, they're coming in for a complaint. Obviously, I am a nurse midwife, I'm not a surgeon. There's a practice protocol in the clinic that would then tell me at that point, you need to refer to your physician in the clinic, if you're thinking about that. There's different things, so this is going to be practice specific. It could be in the hospital where you have different protocols that are driven. But this is all things that need to be discussed and this is different than collaborative. That's going to be more the legalities of the state. This is going to be the practice protocol. Just make sure that there is a difference and make sure that you address those in a different way. The next part is going to be assessment and evaluation. As you become a provider, you're going to learn like I just talked about a few minutes ago. Now you're billable provider. You are the one that's bringing money in, whether it's for the hospital or whether it's for the clinic. You're bringing money in. With that, you should have some assessment, and it could be that you see so many patients a day. It could be that maybe your outcomes are good. I'm going to open my own practice, you still need to have some a self-evaluation, you just can't go rogue. Describe outcomes that will be assessed to evaluate the effectiveness of practicing. How often is that going to be? Is it going to be you just start and you have it in 90 days? You have it once a year? It's amazing how a lot of these smaller, they don't have anything in place for this. Even if it's done informally, these things need to be done. How do you know that you're where you need to be? If you see so many patients, is that tied to a bonus? Those are definitely things that you need to be thinking about. Assessment, evaluation, and how are you going to be evaluated? Moving on is the presentation of audio and quality. When I listened to your presentation, you are speaking nice and clear. I don't have dogs barking in the background. I don't have a lawnmower going. This needs to be done in a quiet room. It needs not to have any small children running around. You need to prepare for this. Because if you are going for a job interview, these are important things of having good audio quality.

With COVID, a lot of interviews and stuff they were taken, we did a lot of Zoom calls to interview. Audio quality is very important. The other thing is going to be your presentation, the visual quality. Now, a lot of people when they do PowerPoints, they love to put so much information on their PowerPoints, and especially as you guys have progressed, you do not put lots of information on a PowerPoint or you will not engage the person that's listening to you. That's just not a smart thing to do. It's more like bullet points. Say your collaborative agreement on your state law, your whole state law should not be on your presentation. You will mention something briefly and then you will expand on it. There shouldn't be paragraphs in your presentation. It's more bullet points. Now you can have maybe a table, like for the business aspect, that's fine. But remember, the presentation, who's ever watching that keep them engaged, and also pictures are a nice thing as well. The next thing is going to be that you're going to be graded on is APA. If you're saying that, I don't know, you want $150,000 your first year and you're presenting. You're presenting that to someone that's interviewing you that you want 150,000. You're telling me that based on what? How do you know that that's what you're worth? Well, you're going to probably look at your market in that area. What's the entry level? How much are they making? Well, the entry level is only 110,000, and you're wanting 150. You have to be realistic with what you're wanting and you're backing it up by research, by what's the market look like. There's definitely going to be some APA. Everything should be spelled correctly, that kind of a thing. Just be looking to make sure that your APA, if you're using references you need to make sure you have a reference page at the end. That will be graded on as well. The other thing that we'll be looking at is actually going to be the timing. I can tell you that some people really like to talk really, really long. So if you look at the rubric, there's going to be a timing. You're going to have to practice this a couple of times till you get your timing right. It shouldn't be short and sweet. It's got to have a little bit of meat to it as you're presenting. But you'll see in the rubric where it's going to tell you exactly the timing and how many points you're going to miss based on the timing of the presentation. The other thing that I want to talk about is a week or two before your presentation is due, you are going to actually submit your PowerPoint slides in PDF form. I don't want you waiting until the last minute and at least I know if you've got your slides ready, then I know that you're headed in the right direction. A week or two before, you're going to see that on the due date where you're going to submit your PowerPoint slides. Not the presentation, just your slides in a PDF file. Now, not everybody is techno savvy. So I'm going to share with you a video.

That is going to be what you need to submit a couple of weeks before. Let me get back on little PowerPoints. Make sure that's submitted. It's going to be due a couple of weeks before your presentation is due, but it will be a part of the rubric where you will get points. This allows us to be able to look at your slides, listen to you at the same time, and make sure that you are including everything that needs to be presented. That's why I have that on there, so that you could see how you need to create your PowerPoint slides into a PDF and then submit that to us. The final thing is when you go to submit your presentation, you can do it either on Kaltura, which is right in the course, and then you can upload it or you can just send a YouTube link. Now what has happened in this past is students will put a file like an MP4 file, and then that requires us to actually have to download it to our computer. You can either do it on Kaltura or you can do PowerPoint slides, you can do it on Zoom, and then you can just upload it to the YouTube link. All you have to do is put the YouTube link when you do the submission for your presentation. That all you have to do is just give us the link, we can just click right on it, watch it, and that's it, or you can do the Kaltura. Either one, but please do not submit all these different files that require us to download. That puts our computers at risk. Please, if you submit something else, I will return it to you and I will not grade it. Just make sure that you're aware of that. Also on this assignment, please review the late policy. This is a major component of your grade and I do not want anyone failing because they have not planned ahead. That's why the PowerPoint slides are due a couple of weeks before, so then when this comes due, all you've got to do is you record and get your thoughts together and then submit it. Make sure that you are doing that. If you have any questions about your presentation, you can reach out to your faculty in your section and hopefully that will get resolved. I'm here though, if you need anything, feel free just to send me an e-mail. That's totally fine. Any other questions? Hopefully this was helpful for you. Bye-bye.

*Of note, the slide deck & presentation are due at the same time not a week apart. 

Without a business plan, you can’t approach investors. A well-developed business plan allows them an objective assessment of the viability of your proposed practice. The completed business plan, which we do not cover in this course, also serves as a road map to manage potential changes and problems that may occur during the start-up and initial operation of a new business and also includes strategic planning to help prepare for future events. Regulatory associations and state legislature determine what services an APRN-led practice can offer. Hence, it is important to have a well-defined description of the services that will be offered. It is also as important to define what services you do not offer.

This is an exercise for you to practice putting a business plan together. Below, please review the viewing and reading materials provided along with five examples of previous students’ business plans. This will help you in writing your own. Please make sure to follow the step-by-step instructions and the rubric in writing up your business plans. You will share and present your business plan and have the opportunity to review each others.’

Student examples: 3 links

Whitney Krupala Business Review Presentation - YouTube

(14) Whitney Krupala Business Review Presentation - YouTube

https://www.youtube.com/watch?embeds_referring_euri=https%3A%2F%2Fbaylor.instructure.com%2Fcourses%2F227865%2Fassignments%2F2286138&source_ve_path=Mjg2NjQsMTY0NTAz&v=-acrHDMKoV8&feature=youtu.be 

Sustainable Business Operations for NPs: What to do Before You Start a Business - YouTube

Buisness plan components example

Is uploaded to see a sample of what information to include in slides

More examples towards end

 

  Financial Information

Funding and Payments

· Average cost to see a patient in an outpatient clinic: $100.00

· Medicare pays NPs 85% ($85)

· Medicaid pays NPs 100% ($100)

· Third-party private insurance plan pays 85% ($85)

Annual Salaries (Average in the US)

· Physician: $313,000

· Nurse Practitioner (NP): $112,000

· Registered Nurse (RN): $72,000

· Medical Assistant (MA): $36,000

· Billing staff: $33,000

· Secretary: $36,000

· Expect to pay collaborating physician $5–$20 for each chart reviewed

 

Developing a Business Plan for Advanced Practice

Review the presentation below for a summary of the components and order of a business plan:

Financial Information

Funding and Payments

· Average cost to see a patient in an outpatient clinic: $100.00

· Medicare pays NPs 85% ($85)

· Medicaid pays NPs 100% ($100)

· Third-party private insurance plan pays 85% ($85)

Annual Salaries (Average in the US)

· Physician: $313,000

· Nurse Practitioner (NP): $112,000

· Registered Nurse (RN): $72,000

· Medical Assistant (MA): $36,000

· Billing staff: $33,000

· Secretary: $36,000

· Expect to pay collaborating physician $5–$20 for each chart reviewed

Five Project Samples for Your Review

Note that you are not required to submit a project report. You are only required to submit an oral presentation. Select each tab to see samples for review and learning purposes.

Rubric

1. A Business Review of a Clinical Practice Presentation Rubric
2. Criteria	3. Ratings	4. Pts
5. Workplace Setting Identify your anticipated (or desired) working arrangement. This may be an actual practice already in place or can be an idea of a practice you would like to see yourself work at. Describe the attributes of the practice: location (local and national/country), description of the community or practice, e.g., rural, urban (size), private practice, health department, etc., population(s) served, current or projected personnel, resources available, and physical site.	6. 10 pts 7. Meets Criteria 8. Topic covered thoroughly 9. 5 pts 10. Partially Meets Criteria 11. Topic covered marginally 12. 0 pts 13. Does Not Meet Criteria 14. Topic missing or work is late	15. / 10 pts
16.Employment Contract 16. Discuss 3-5 essential elements of an employment contract with your anticipated employer. (If you choose "solo practitioner", discuss the legal issues you must establish prior to starting such a practice)	17. 10 pts 18. Meets Criteria 19. Topic covered thoroughly 20. 5 pts 21. Partially Meets Criteria 22. Topic covered marginally 23. 0 pts 24. Does Not Meet Criteria 25. Topic missing or work is late	26. / 10 pts
27. Funding and Payments Describe the financial basis of the practice (i.e. sources of funding.) Include types of payment e.g. third-party payers (Medicare, Medicaid, and/or private insurance), capitated payments, fee for service, sliding scale, etc., and sources of expenses. Every student must state specific reimbursement rates for visits for Medicare, Medicaid, & 1 private insurance.(either wellness or problem visits.) Provide a sample day of potential visits and the amount you will receive based on reimbursement. State the amount you expect yourself to individually be paid annually for your services. Include monthly or yearly abbreviated budget.	28. 15 pts 29. Meets Criteria 30. Topic covered thoroughly 31. 8 pts 32. Partially Meets Criteria 33. Topic covered marginally 34. 0 pts 35. Does Not Meet Criteria 36. Topic missing or work is late	37. / 15 pts
38. Collaborative Agreement/APRN Practice Protocol -Develop and describe a collaborative arrangement that will be necessary to implement your practice. Note: "collaborative arrangements" means formal and/or informal – required by law and those that are important in terms of one's practice, but not necessarily required by law. For example, in Texas, the law requires the APRN to have a formal collaborative relationship with a physician (MD or DO). This is not true in New Mexico and other states. Base this section on the state or country you plan to practice. -Describe the type of APRN practice protocol agreement that would need to be in place in order to practice in the identified practice site.	39. 20 pts 40. Meets Criteria 41. Topic covered thoroughly 42. 10 pts 43. Partially Meets Criteria 44. Topic covered marginally 45. 0 pts 46. Does Not Meet Criteria 47. Topic missing or work is late	48. / 20 pts
49. Assessment and Evaluations Describe outcomes that will be assessed to evaluate the effectiveness of the APRN’s practice including the frequency. State the individual(s) who will perform the assessments, what they will include, and how often they will be done.	50. 10 pts 51. Meets Criteria 52. Topic covered thoroughly 53. 5 pts 54. Partially Meets Criteria 55. Topic covered marginally 56. 0 pts 57. Does Not Meet Criteria 58. Topic missing or work is late	59. / 10 pts
60. Presentation Visual Quality Presentation of slides has photos, engaging, and appear professional/Student is dressed professional. We should be able to see you and your slides.	61. 5 pts 62. Meets Criteria 63. Slides are easy to read and engaging 64. 3 pts 65. Partially Meets Criteria 66. Slides are difficult to read and/or distracting from the presentation 67. 0 pts 68. Does Not Meet Criteria 69. No slides or work is late	70. / 5 pts
71. Audio Quality	72. 5 pts 73. Meets Criteria 74. Audio is clear and easy to understand 75. 3 pts 76. Partially Meets Criteria 77. Audio is difficult to understand or distractions are present 78. 0 pts 79. Does Not Meet Criteria 80. No audio or work is late	81. / 5 pts
82. APA and Grammar	83. 10 pts 84. Meets Criteria 85. No errors 86. 5 pts 87. Partially Meets Criteria 88. Few errors 89. 0 pts 90. Does Not Meet Criteria 91. Several errors	92. / 10 pts
93. Slide Deck Submission	94. 5 pts 95. Meets Criteria 96. Submitted by due date 97. 0 pts 98. Does Not Meet Criteria 99. Did not submit or submitted late	100. / 5 pts
101. Duration of Presentation	102. 10 pts 103. Meets Criteria 104. Duration is 10-14 minutes. 105. 5 pts 106. Partially Meets Criteria 107. Duration is 7-9 minutes, or 15-17 minutes 108. 0 pts 109. Does Not Meet Criteria 110. Duration is <6 minutes or >18 minutes	111. / 10 pts
112. Submission type 113. view longer description	114. 0 pts 115. Full Marks 116. 0 pts 117. No Marks	118. / 0 pts
119. Total Points: 0

120. In the popup, select the list item  Embed Kaltura Media. This will open your  My Media page. Find the video you wish to submit and press the  Select button to the right.

121. This will embed the video wherever your cursor is within the text box. You may also add text or other information in the response field.

· To include the PDF of your slides:

1. Choose a  submission type when prompted.

2. Follow the on-screen prompts.

3. Select the  Submit Assignment button.

Make sure you turn in both parts of your assignment (PPT and video).

Technical Support

For help with recording a video or submitting it to your instructor, consult the  Library Guides: Kaltura help page at BaylorLinks to an external site.. (Make sure to select the "For Students" tab for specific details and screenshots.)

View Rubric

A Business Review of a Clinical Practice Presentation Rubric
A Business Review of a Clinical Practice Presentation Rubric
Criteria	Ratings	Pts
Workplace Setting view longer description	10 pts Meets Criteria Topic covered thoroughly 5 pts Partially Meets Criteria Topic covered marginally 0 pts Does Not Meet Criteria Topic missing or work is late	/ 10 pts
Employment Contract view longer description	10 pts Meets Criteria Topic covered thoroughly 5 pts Partially Meets Criteria Topic covered marginally 0 pts Does Not Meet Criteria Topic missing or work is late	/ 10 pts
Funding and Payments view longer description	15 pts Meets Criteria Topic covered thoroughly 8 pts Partially Meets Criteria Topic covered marginally 0 pts Does Not Meet Criteria Topic missing or work is late	/ 15 pts
Collaborative Agreement/APRN Practice Protocol view longer description	20 pts Meets Criteria Topic covered thoroughly 10 pts Partially Meets Criteria Topic covered marginally 0 pts Does Not Meet Criteria Topic missing or work is late	/ 20 pts
Assessment and Evaluations view longer description	10 pts Meets Criteria Topic covered thoroughly 5 pts Partially Meets Criteria Topic covered marginally 0 pts Does Not Meet Criteria Topic missing or work is late	/ 10 pts
Presentation Visual Quality view longer description	5 pts Meets Criteria Slides are easy to read and engaging 3 pts Partially Meets Criteria Slides are difficult to read and/or distracting from the presentation 0 pts Does Not Meet Criteria No slides or work is late	/ 5 pts
Audio Quality	5 pts Meets Criteria Audio is clear and easy to understand 3 pts Partially Meets Criteria Audio is difficult to understand or distractions are present 0 pts Does Not Meet Criteria No audio or work is late	/ 5 pts
APA and Grammar	10 pts Meets Criteria No errors 5 pts Partially Meets Criteria Few errors 0 pts Does Not Meet Criteria Several errors	/ 10 pts
Slide Deck Submission	5 pts Meets Criteria Submitted by due date 0 pts Does Not Meet Criteria Did not submit or submitted late	/ 5 pts
Duration of Presentation	10 pts Meets Criteria Duration is 10-14 minutes. 5 pts Partially Meets Criteria Duration is 7-9 minutes, or 15-17 minutes 0 pts Does Not Meet Criteria Duration is <6 minutes or >18 minutes	/ 10 pts
Submission type view longer description	0 pts Full Marks 0 pts No Marks	/ 0 pts
Total Points: 0

Student Example (came from ppt)

Running head:

BUISNESS PLAN My business desired business plan is to work for Minute Clinic as a family nurse practitioner (FNP), preferably in Mesquite, TX. Minute Clinic is a well-established walk in clinic that accepts patients from age two and above for diagnosis and treatment of common acute ailments such as Upper respiratory infection, flu, pneumonia, otitis media and so forth. Minute clinic (MC) is located inside CVS pharmacies at select locations through the US, and is owned by CVS Health, Inc. Minute Clinic is open seven days a week including major holidays. The office I intend to work is located at 1413 Oates Dr, Mesquite TX. The patient population is private pay, insurance or Medicare, Medicaid is not accepted. Clinic sites are staffed with a two nurse practitioners (NP) that rotate days, only one NP is on staff per day. The NPs do all the clinical work as well as all other clinic duties including; collecting payment, answer phones, inventory and ordering supplies, basic cleaning and upkeep and maintenance on equipment. The clinic provides all supplies needed for clinical exams including lab coats and stethoscopes. Mesquite, TX is an urban suburb of Dallas, TX, with a population of about 144,000, the average family income is about $40,000, the largest employer is The United Parcel Service, 59% Caucasian, 21% African American the remainder of various ethnicity (City of Mesquite, 2017). The city is accessible by major highways connecting to the rest of the DFW Metroplex. The practice is located off Interstate 635, a major highway in the Metroplex. There is ample parking and a traffic light is situated at the intersection entrance to the practice making for easy driving access. There are two main competing clinics within a five-mile radius, a Care Now and a Wal-Mart urgent care clinic. Both of which are the same type of walk-in clinics that treat the same conditions as Minute Clinic. [Type text] [Type text] 2 [Type text] Employment Contract Minute Clinic is an at will employer, meaning there is no specific term to employment and either party may end employment at any time (Buppert, 2015). All NPs employed by MC have to operate under state laws governing NP practice as well as specific rules as outlines by MC. There are no restrictive covenants to practicing after end of employment. The NP may work at any place of their choosing (Watson, 2015). The essential elements of a contract are as follows: • Pay- Payment is to be per hour, and with increase pay for weekend/holiday work. A workweek is 40 hours, with the option for voluntary overtime. • Benefits- health, dental, life, vision and short and long term disability. To be allowed to participate in a 401-k fund with matching employer funds. • Hours- A work week is 40 hours, and at least two weekend shifts per calendar month is required, with an option to voluntarily do more weekend days. Weekend days are Saturday and Sunday. The NP needs to work three major holidays per year, one of those holidays must be either Thanksgiving, Christmas or New Years. The NP will need to be on call at least three days per month, to fill in at other MC in the area due to illness and emergencies. The clinic cannot stay open past the set closing time unless of an emergency satiation. • Meal breaks- A mandatory break for one hour per day will be given. Working thru breaks is not permitted. • Malpractice Insurance- Minute Clinic will provide all malpractice insurance free of charge to the NP. But the NP may elect to purchase their own coverage at their own expense in addition to the MC coverage. 3 BUISNESS PLAN • Paid time off- To earn a set number of hours per two-week pay period, to be accumulated to be used as needed and never to expire. Upon termination of employment the unused hours will be paid out as cash to the employee. • Scope of Practice- The NP can only practice under rules set by the State of Texas, and MC cannot ask the NP to perform any duties not allowed by State and Federal regulations. All fees needed to obtain a prescribing license are to be paid for by MC, including a DEA license. Minute Clinic provide a list of medications that may be prescribed, the NP may not use any medication not on the list. If there is a reason that a non-listed medication needs to be given, the on call supervising physician need to approve use. • Equipment- Minute Clinic will provide for all equipment needed for clinical exams and testing. • Dress Code- All NPs will wear business casual attire and wear white knee length lab coats provided by MC. The NP may elect to their own lab coats at their own expense. • Social Media- Photos and videos of MC offices may not be published on personal social media sites unless MC gives written permission. • Licensing and Credentials: The NP is responsible for maintaining all licensing and continuing education, but MC will reimburse for all related expenses. Financial Basis of Practice Minute Clinic is a for profit publicly traded company owned By CVS Health Care, Inc. The sources of funding are as follows: [Type text] [Type text] 4 [Type text] • Self-pay, patients may be upfront for services. • Private Insurance- A co-pay, if applicable is collected at time of service. Insurance payment is considered payment in full, but any rejected claims or services not covered are the responsibility of the patient. • Medicare- The same rules as above for private insurance applies. There is no sliding scale based on income and fees are non-negotiable, accepting patients “pro bono” is grounds for automatic termination. The starting salary for NP is $52/Hour, plus differential for weekend and holiday. There is a bonus system based on the amount billed and patients seen. If the NP meets a certain goal set by MC, then they receive a performance bonus each calendar year in addition to the annual employee increase based on performance review. Minute Clinic does not reveal the threshold needed to receive bonuses based on billing. This is to deter from overbilling. Minute Clinic pays for expenses, but each location has a budget based on billing. If a location gives a lot of vaccines for example, the vaccine budget is increased. If vaccines have to be discarded due to overstock, then the budget will be decreased. Whether or not an office remains open is based on billing as well. If over a long period of time billing at a certain location is below corporate expectations then the entire office may be closed. Bottom line is the NP has an obligation to performing quality healthcare, but has fiduciary responsibility to the company to maximize profits. Examples of expenses are as follows: stethoscope, lab coat, otoscope and accessories, rapid strep test, rapid flu test, pregnancy test, UA dipstick, tongue depressors, gauze, cotton, gloves –(small, medium, large), Vaccines- (Dtap, MMR, Polio, Flu, Gardasil and 5 BUISNESS PLAN PPD), 3ml syringes, 20G needles, exam table paper, electric BP cuff, manual BP cuff, thermometer, Mono spot test, blood glucose machine, band aide for adults and kids, alcohol pad. Financial Plan Compensation at MC is based on an hourly starting pay rate of $52/hour. There is no direct quota for the amount of patients seen in a certain clinic per day, but rather based on the overall annual performance of a clinic. Meaning, each clinic can calculate and estimate a financial plan based on previous years results. For example, the MC location on Oates Dr. in Mesquite, received a top grade for financial and clinical performance. Minute Clinic does not share exact numbers with staff NPs. But each clinic can make estimates in terms of performance. • The fee for a basic exam ranges from $89-129, based on complexity and if it is a first time visit (Price list, 2017). • Common tests such as flu, UA and rapid strep are $35 each test. • The average charge for a routine sick visit and a test will be between a $135-150 fee. Insurance will only pay MC a percentage of the fee based on the contracted rate. • Earning $52 per hour in fees to break even for your salary is not a difficult task. Examine 1-2 patients per hour is a very reasonable goal to reach. • Corporate profits and overall financial stability needs to be taken into account. As each office is an integral part of the company. • An estimate of an average fee based on insurance reimbursement is about $75-90, based on the level of service. The NP would need to see about 20-25 people per [Type text] [Type text] 6 [Type text] day. This takes into account some full pay cash patients and higher cost services such as vaccines and lab testing. This also takes into account that there will be days where over 40 patients are seen per day during peak flu season in winter. During the summer months there will be days that less than 20 patients per day are seen. Also CVS pharmacy will gain a profit as well, as the majority of scripts will be filled in the CVS pharmacy that the MC operates. If you are sick, one would rather get the medicine where they are, rather than having to drive across town somewhere else. • Although the exact cost of expenses is not known, if a gross profit of $400,000/per year can be achieved, this will be a 4x the annual salary of about $100,000 per year. This will be seen as favorable and productive by corporate. Collaborative Agreement In terms of supervising physicians, the NP does not get involved in who the person is. Part of the contract with MC is, the NP shall use the physician assigned by MC and may not use an independent physician. But informal arrangements are allowed in terms of referral to physicians. For example, if a patient asks for a referral for a PCP, any physician can be recommended to the patient. Therefore having a relationship with physicians in the area is helpful to practice. Some common doctors to refer are PCP, dermatology, pediatrics and GI. As a nurse at Medical City Hospital for the past 11 years, I can recommend physicians in a number of specialties. In addition, I know many doctors personally and I am able to call or text them on their cell phones to arrange an appointment for a patient. If a patient comes in with a severe rash, if I can refer them to a dermatologist and be 7 BUISNESS PLAN able to have them seen faster than the usual process, this will help give the patient the relief they need. In addition, this will make for high customer satisfaction and hopefully an increase in clinic business. Informal agreements also can also be used to seek medical advice. The NP is allowed to call an MD or another NP of their choosing for informal advice. If a question about a dose of drug or a diagnosis rises, the NP may seek informal advice. Protocol Agreement The APRN protocol agreement must be in compliance with The Texas Board of Nursing rules governing the practice of advance practice nurses (Buppert, 2015). Minute Clinic has strict practice guidelines that must be followed. This includes: • Supervising physician- All rx meds must include the name and license number of the supervising physician, as required by Texas regulations. • The type of drugs allowed to be prescribed. Minute Clinic does not allow for the dispensing of any Federal or State scheduled medications, even if the NP has a DEA number. Minute clinic does not allow for the dispensing of birth control, blood thinners such as Coumadin and Xarelto, injectable or sub q medications, cardiac medications such as Digoxin and Coreg. • Patients that are pregnant, immunocompromised and less than two years old are not permitted to be treated at MC. • Medications that at not on the MC formulary may not be dispensed unless permission is given from the MC designated supervising physician. [Type text] [Type text] 8 [Type text] • Medications dispensed at a different dose or durations than stated in the MC formulary needs to documented using a known reference. Examples include, Sanford Guide, Medscape and Epocrates. • Minute Clinic will provide all malpractice insurance and premiums, but the NP may buy supplemental coverage at their own expense. This is not a comprehensive list, but some of the key elements that would be included in the practice protocol. APRN Assessment At MC nurse practitioners are evaluated annually. The district manager does the evaluation; in the Dallas area the Dallas regional manager who is also a nurse practitioner performs the evaluation. Minute Clinic has a point system for annual raises, the more points one is able to accumulate the higher the raise. The increase is based on a percentage ranging from 1%-5% of base pay. The point calculation system is not released to the employee. The criteria is based on several criteria. • Patient satisfaction- This is based on patient phone and e-mail surveys conducted by MC on random patients that are seen in the clinic. The score is averaged and a composite score is made. The better higher the score, the more points attained. • Fiscal performance- As stated previously MC is a for profit publicly traded company on the NYSE. The more income generated the more points accumulated. • Employee performance- These are basics such as punctuality, reliability, APRN protocol compliance and clinical decisions. Student precepting is also qualifier for annual points. 9 References BUISNESS PLAN Buppert, C. (2015). Nurse practitioner's business practice and legal guide. Jones & Bartlett Publishers. City of Mesquite, TX (2017) Retrieved from: https://cityofmesquite.com/ Price List (2017) Retrieved from: http://www.cvs.com/minuteclinic/services/price-lists Watson, M. (2015). Basic principles to consider when opening a nurse practitioner‐owned practice in Texas. Journal of the American Association of Nurse Practitioners, 27(12), 683-689.

Example 2

OVERVIEW:

URBAN HEALTH CLINIC (UHC) Native American Non-profit Organization Mission: Provide free patient-centered healthcare services to low-income Native Americans (American Indians and Alaska Native) located within the metropolitan area of Phoenix, Arizona. The clinic serves over 50 primary appointments daily, 15 sick/emergency visits daily and over 1,500 patients yearly. Services: Offer a variety of comprehensive medical assistance across the lifespan of an individual. Our services are available from infants to elderly adults and include specialty care for urban Native Americans. The services are delivered by culturally competent providers with sensitivity to all we serve daily. Services include primary medical care, wellness visit, prenatal care, minor dental care, behavior health, other available services. The staff consists of physicians, advanced practice nurses, dentists, registered nurses (RNs), medical & dental assistants and other medical personnel. Urban Health Clinic is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Federal Tort Claims Act (FTCA) Public Health Service organization under 42 U.S.C. 233(g)-(n). Location: 1908 Ivy Lane Phoenix, AZ 82005 UHC is an Equal Opportunity Employer. Urban Health Clinic Overview: Services Primary Care: Prevention, Treatment, & Education Chronic Management: Diabetes, Obesity and Hypertension Annual physical exam for men & women; School physicals Dental visits: Preventative & Basic care Prenatal and Wellness visits Pregnancy testing & Prenatal lab work, Prenatal care, Labor and Delivery care & classes, Post Partum Care, Case management, Home Visiting Program referral for Native American families with children under 5, living off reservations in Maricopa County. Mammograms, Well Women exam with pap smears & WIC referrals. Pediatric Services Wellness & Sick care visits, Immunizations and flu shots, Newborn care, and Chronic disease care such as Allergies, Asthma, Diabetes Behavior Health Substance Abuse education & treatment, Behavioral and Developmental Assessments, & Integrated Behavioral Health (IBH) program Urban Health Clinic Management & Health Workforce Required Roles: Chief Operating Officer (CPO) Chief Medical Director (CMD) Chief of Human Resources (CHR) Medical Team Physicians: 2 Family Nurse Practitioners: 2 Certified Nurse Midwives: 2 (1 new addition- CNM Jolley) Dentists: 1 Dental Assistants(Assts): 1 RNs: 4 Nursing Assts: 2 Social Workers: 1 Behavior Health Counselors: 1 Auxiliary Team X-ray Tech: 2 Lab Techs: 3 Administrative Assts: 1 Human Resources (HR) Techs: 1 Drivers: 2 (I FTE, 1 PT) Basic contracts are provided to Physicians, APRNs, and Dentists. The arrangements only include salary, reason for hire (services to perform), probation period, and credentialing requirements. Credentialing must be maintained per issuing state or licensing board and reviewed by HR annually. Proof of certification must be provided within 30 days of hire. Urban Health Clinic Health Center Requirements Grantees have various requirements they must met to received funding. Each funding instrument may differ depending on the agency and type of health center requested. Here are the funding instrument requirements for UHC, as a grantee, must follow: be located in specific geographic areas, have an established fee schedule that meets certain requirements (depending on type of center and/or population), have appropriate governance, offer specific health services, meet certain reporting and quality assurance requirements, and license providers and seek accreditation (Heisler, 2017). These requirements apply to activities that are within the scope of Public Health Service Act (PHSA) Section 330 grant, but do not apply to other activities. Health Resource Services Administration (HRSA) is required to determine whether health center grantees meet these requirements (Heisler, 2017). Urban Health Clinic Financials: Federal Funding HRSA’s Bureau of Primary Healthcare (BHPC) Grant UHC was awarded a federal grant of 5.5 million over five years ($1.1M yearly). Currently, in 2nd year of this funding cycle. This grant is UHC’s second five-year grant award after completing their first grant in good standing. The CPO oversees all aspects of UHC and ensures compliance. Funding is provided yearly as long as the health center remains compliant. HRSA’s Compliance Manual is the definitive publication that all federal health centers must follow in order to continue to receive funding. Annual site visit must occur to inspect health center and ensure compliance is met. Federal staffers will review The Joint Commission (TJC) standards, credentials of the staff, and any other requirements. Due to the vulnerable Native population served at the clinic, funding allow free services to all patients without payments. UHC plans to continue providing services in the Phoenix area and reapply at the beginning of the 5th year of this cycle for a new federal grant to expand services. UHC’s CPO is reviewing state funding opportunities, in an effort, to expand services, increase staff, and provide additional reserves to sustain the clinic. Urban Health Clinic Financials: Operational Budget Staffing: ~54 percent allocated to salaries & benefits Supplies: ~10 percent: medical, dental, and administrative Referral Services: ~6 percent: outside services, specialty care Transportation costs: 5 percent: gas & maintenance of vehicles Equipment/maintenance costs: 6 percent: medical, dental, radiology, & lab Utilities costs: 2 percent (building is paid in full; only utilities) Training/education: 5 percent: staff and patient education Administrative Cost: 12 percent: IT costs, expansion costs, staff insurance, reserve cash for unaccounted expenses, membership fees, etc. (Operational numbers are listed on Appendix 1) Urban Health Clinic APRN’s Protocols: FNPs & CNMs All APRNs are presented a general contract that is provided to all medical staff. The contract, as all, includes a six month probation period. Newly certified APRNs are assigned to work with an experienced nurse on staff that has been employed with the Health Center at least 2 years. CNMs staff the prenatal clinic and manages a daily schedule of patients for various services. FNPs work in the primary clinic and see patients on a daily schedule as well. All APRNs must be licensed to practice in Arizona and do not require a collaborative agreement per the State Board of Nursing in Arizona. APRNs must upkeep their licenses and remain in good standing as part of their employment contact with the health center. CNM & FNPs work daily with Physicians and other APRNs on complicated cases to provide the best outcome for their patients. The CMD evaluates the entire medical team at the end of their probation period, then annually based on their standard protocol. APRNs, along with the CMD, created APRN & RN standard operating procedures (SOPs) and protocols based on the TJC standards and are the guidebooks for the nursing staff. All APRNs, along with all staff members, at UHC must take part in federal site visits that reviews the UHC’s overall performance based on preset requirements listed in the HRSA’s Compliance Manual (examples are listed on the Appendix 2). Urban Health Clinic Health Center Staff Benefits Although staff salaries are not as high as larger hospitals or private practice, the staff received other benefits and advantages for working at UHC. Benefits include, but are not limited to: Health centers, which are located in medically underserved areas, are also automatically designated as health professional shortage areas (HPSAs) and are therefore eligible for National Health Service Corps (NHSC) providers status (Heisler, 2017). They have the opportunity to received scholarships for additional education, tuition reimbursement, and other federal benefits. UHC is a Health Center Program grantee under 42 U.S.C. 254b, and a deemed Federal Tort Claims Act (FTCA) Public Health Service organization under 42 U.S.C. 233(g)-(n). This Act covers medical providers and malpractice insurance is an option but highly recommended. This opportunity decreases malpractice costs for providers. Urban Health Clinic APPENDIX 1: Operation Budget $594,000 Staffing $110,000 Supplies $66,000 Referral Services $55,000 Transportation $88,000 Equipment/Maintenance $22,000 Utilities $55,000 Training/Education $110,000 Administrative $1,100,000 estimated annual budget **In the first month of the 4th quarter, an evaluation occurs to determine any remaining monies. Any remaining monies is allocated to staff benefits & training, equipment & maintenance, and IT upgrades as required.** Urban Health Clinic APPENDIX 2: SITE VISITS REQUIREMENTS The Health Center Program Site Visit Protocol (SVP) is the tool for assessing compliance with Health Center Program requirements during operational site visits (OSVs) and look-alike initial designation site visits. The SVP is designed to provide HRSA the information necessary to perform its oversight responsibilities using a standard and transparent methodology that aligns with theHealth Center Program Compliance Manual(Compliance Manual). Download the entire SVP or download specific SVP sections: Introduction Needs Assessment Required and Additional Health Services Clinical Staffing Accessible Locations and Hours of Operation Coverage for Medical Emergencies During and After Hours Continuity of Care and Hospital Admitting Conflict of Interest Collaborative Relationships Financial Management and Accounting Systems Billing and Collections Budget Program Monitoring and Data Reporting Systems Board Authority Board Composition Federal Tort Claims Act (FTCA) Deeming Requirements Performance Analysis Promising Practices Eligibility Requirements for Look-Alike Initial Designation Applicants Quality Improvement/Assurance Key Management Staff Contracts and Subawards Reference: (HRSA.gov, 2018) Urban Health Clinic References Human Resource Service Administration. (HRSA). (2018). Health Center Program Requirements Retrieved from https://bphc.hrsa.gov/programrequirements/index.html Scope of Practice. (n.d.) Arizona Scope of Practice Policy: State Profile. Retrieved from http://scopeofpracticepolicy.org/states/az/ HRSA. (2018). Compliance Manual Retrieved from https://bphc.hrsa.gov/programrequirements/compliancemanual/index. html HRSA. (2018). Health Center Program Site Visit Protocol. Retrieved from https://bphc.hrsa.gov/programrequirements/svprotocol.html Elayne J. Heisler. (2017). Congressional Research Service. Federal Health Centers: An Overview. Retrieved from https://fas.org/sgp/crs/misc/R43937.pd