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More on Private Nurse Practitioner Practices

Posted Aug 18 2011 11:19am
A lot of nurse practitioners are finding my blog through searches regarding opening up a private practice from this January blog post . (I refuse to use the word independent since no clinician practices within a vacuum and requires multidisciplinary support to care for the whole patient). I happen to have a dear friend and colleague,  Dr. Joy Elwell, FNP, DNP , who has her own private practice. I asked her a few questions regarding her experience and she was gracious enough to sit down and answer them for me and my readers. 

1. Why did you decide to open your own practice? 

Well, first, my experience was a bit unique, since I had my own practice within an institution, i.e. I worked for an institution and was able to see my own patients at that site. I decided to leave and open a free-standing practice in the community because at this point in my career, I believed I could serve the community better by being self-employed. I also believed that I would have greater satisfaction from my work by being self-employed. I can say, after being self-employed for a year, that both of these are true.
2. What are (were) the biggest challenges? 
Finances are always a challenge, regardless of the business. However, I had an established patient base who followed me to my present location. I was also already credentialed by insurance companies, so I did not have to wait very long to start receiving reimbursement. I also had a business plan, which was part of the curriculum in my DNP program, and that served me very well. Things like setting up payroll, direct deposit for employees, tax payments were challenges because we, as clinicians, are used to others taking those responsibilities. When it's your business, you are responsible for it all.

3. What are some of your successes? 
My practice is growing, Patients refer their families and friends. New patients tell me that employees at the insurance companies tell them, "Go to Joy Elwell; she'll treat you right". Last week a provider representative from a Managed Medicaid insurer walked in with a quality bonus check for $500. He said he wanted to hand-deliver it. And, I am able to practice the way I was educated and trained to; I can give each patient the time needed to provide quality care. 
4. What advice do you have for someone contemplating opening a practice? 
Write a business plan. If you can, build a patient base before you open. Avoid signing a "non-compete" contract with an employer. Be creative with space. Office rentals can be expensive; if you can obtain space in a school, or a church, consider it. I have a colleague in Arizona who has been given free office space in a firehouse. Be prepared to wait awhile to start being reimbursed by insurers. If you practice in a state requiring a mandatory collaborative practice agreement, take care with the financial arrangements. If you must pay the collaborating physician, a flat fee is always better than a percentage of your earnings. Develop relationships with as many physicians as possible. Network. In New York, with the constraint of the mandatory collaborative practice agreement, the NP must be prepared in case something goes wrong with that agreement. Consider signing agreements with 2 physicians. It is essential to protect the practice.
5. How much time did it take you to be up and running? 
It took 4 months, from the point that I found the office space which met my requirements, to the completion of the lease, and renovations, that I was ready to open.
6. Describe the credentialing process.
The credentialing process is fairly straightforward. Contact the insurer. Ask for a credentialing packet. Do NOT ask if the insurer credentials NPs. Why? Sometimes misinformed employees will say "no", when they in actuality do credential NPs. Be prepared to provide copies of numerous documents, including your RN license, NP certificate, diplomas, DEA certificate, proof of malpractice insurance, and collaborative practice agreement. I keep folders with multiple copies on hand, ready for this process. There is also an online service, which is free, through the Council for Affordable Quality Healthcare (CAQH). The Universal Provider Datasource is a part of CAQH's credentialing application database project that seeks to make the provider credentialing process more efficient for providers as well as healthcare organizations. You will still need to have documents on hand to update your profile, but insurers will be able to verify and update your documents through CAQH. Check it out at https://upd.caqh.org/oas/ .

7. Did you consider any other models of practice (i.e. private pay only, concierge, etc)? 
I rejected of these models. First, 85% of the population is insured, and many pay significantly for their insurance. So, to be private pay only would cost me patients. I philosophically disagree with the concept of concierge care, so that is not something I would pursue.
And last but not least, can you provide a brief Bio? 
A Family Nurse Practitioner with nearly 30 years of experience in nursing, Dr. Elwell holds a Bachelor’s degree in Nursing from Long Island University,  a Master’s degree as a Clinical Nurse Specialist from Lehman College,  a Post-master’s Certificate as a Family Nurse Practitioner from Pace University, and a Doctorate of Nursing Practice at Rush University.
Dr. Elwell designed, implemented, and directed the Primary Health Care Center at Concordia College, Bronxville, NY, where she served students, faculty, their families, and the community for 18 years. In 2010, she opened a community-based, NP-directed primary care practice in Scarsdale, NY.
Having taught in both undergraduate and graduate nursing programs, Dr. Elwell is a member of the faculty of Frontier Nursing University, Hyden, KY, teaching nurse practitioner and midwifery students. 
She is the Government Affairs Chair for The Nurse Practitioner Association New York State, the Region 2 Director for the American Academy of Nurse Practitioners. She was selected as a Fellow of AANP in 2011. Dr. Elwell has worked to eliminate barriers to NP practice and increase access to health care. She was recognized in 2007 as “NP of the Year” by The Nurse Practitioner Association New York State. Additionally, she is a member of The North American Menopause Society and Sigma Theta Tau.
She serves the congregation of Village Lutheran Church, Bronxville, NY as Parish Nurse Practitioner.
Dr. Elwell lives in Eastchester, NY with her husband, Tim Elwell, and their 3 children, Diana, Ryan, and Ian. 
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