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COVID-19: The Sun May Shine Tomorrow, but How Will My Practice Survive?

2020-07-16 8:30 AM | Deleted user

As I make calls to lapsed NNPEN members, I brace myself for recounts of how NNPEN has failed the member. Truth be told, those conversations still happen too often, which accounts for our 2021 strategic focus on how to enhance member-to-member dialogue supported by, but not filtered through, NNPEN.

But as Summer Solstice rolls over us and brings with it the temptation to believe COVID-19 is no longer a threat, what I hear in these calls is not how NNPEN has failed the member. Instead, it’s narrowly suppressed panic about whether an NP-owned practice will survive the pandemic. As of March 12, 2020, patient visits have plummeted in response to orders from state, local, and federal regulators to cease all elective and preventive care. FFS cash flow dried up [while cash flow for practices accepting capitation risk did not!]. One NP owner is in self-care retreat after watching her colleagues hoard PPEs. Some practices were not sufficiently insured by their business interruption policies, and face business recovery plans with a new appreciation for the impact of the “once every 100 years” event on supplies, medical records and patient access. All this is in addition to worries about patient and provider survival –literally—in the ongoing battle with an invisible virus that dares us to unmask.

Almost every practice owner I spoke with is planning to transition–partially or entirely–from brick and mortar office space to a virtual practice for some obvious reasons:

  • Ongoing reduced costs.
  • Telehealth has become mainstream, the quality of its encounters is “good enough” and improving, and cost is not prohibitive: the NP practice has choices.
  • More patient access to the practice.
  • More reimbursable patient encounters. [Will payors maintain their favorable reimbursement stance? Look to CMS but NNPEN thinks yes.]
  • Less wear and tear on the practice owner.
  • Less contagion risk.

What does successful transition from brick and mortar office operations to a virtual practice look like?

In May 2020, NNPEN invited Sam Lippolis, Telehealth Advisor, to get this conversation started with our Office Ours participants.

Click here to listen to the extensive and practical dialogue Sam provoked. If you are an NNPEN member, you may access the recording as often as you like, no charge.  If you are not a member, the recording is available to rent. 

With Sam’s permission, we’ve edited her remarks below. 

Shared Secrets for Telehealth (TH) Success

1. How do I grow my patient panel into a virtual practice?

a. Try Sam’s Post-it strategy to generate TH candidates from your current patient panel in 30 minutes.

2. Does my state’s regulations permit TH practice and reimbursement that is sustaining?

a. See the State by State map on Sam’s website.

3. Telehealth device options?

a. Integrated w/ EMR in one platform.

b. HIPAA-compliant Zoom=$199/mo.

4. Integrating telehealth [TH] into my current practice: how to work the virtual and the face to face practices together?

a. Workflow: being on time matters; it’s annoying to sit in any waiting room!

  • Schedule TH visits first thing in morning and after lunch.
  • Pre-visit prep!

b. Risks of blocking virtual time on your calendar:

  • Not enough virtual patient volume.
  • No room for non-virtual patient complaints assessment.
  • Until you build volume, don’t do dedicated time blocks.

c. Phased approach to reach ideal schedule!!

5. Training and testing.

a. How does the patient connect to telehealth?

  • Patient & practice support.

b. ALL staff need to understand the workflow/be comfortable w/ TH so all staff need training.

  • Scripts [choreographed dialogue] are part of the preparation of staff.

c. Don’t waste billable time because TH access is untested on either patient or provider side.

d. Multiple practice sessions with different devices in different settings.

  • Discover Internet dead spots in home and office.
    You may need to toggle between 2 different devices: ipad to see patient and EMR too.

6. Virtual patient visits volume.

a. Need to keep up volume to get comfortable with virtual encounter.

b. Virtual visit etiquette FAQ should be created for patients and staff.

c. Goal: 5 virtual visits/week.

d. Patient acceptance of virtual visit depends on how invitation is worded and if the practitioner extends the invite: 30-60% increased acceptance if practitioner, not staff, extends the invite!

7. Work-life fit.

a. Invest in attractive virtual practice setting aesthetic.

b. Good lighting, private space, not cluttered, quiet.

c. Breathe deeply!

Action Cures Anxiety

We are planning an invitation-only virtual Office Ours on July 28, 2020 8:00 p.m. Eastern. This program is for NNPEN member-- past and present --practice owners who are at that fork in the road called Virtually Brick and Mortar. Virtually Brick and Mortar is built around a presentation created by American-APN called “Integrated Digital Healthcare: Technology in the Time of COVID-19.” Part of the program has been approved by the North Dakota Board of Nursing; NNPEN practice owners --past and current members --who attend will receive 1 CEU. The discussion will explore how the evolution of nursing has prepared nursing to excel in this turbulent time, as well as the role technology and the digital experience plays for patients and providers. Additionally, we’ll take a closer look at independent practice and the nurse practitioner entrepreneur. Nurses who have been delivering virtual care and contributing to the development of a platform that integrates the electronic health record, telemedicine technology, and the technology to deliver remote patient monitoring through advanced Bluetooth technology will be available to answer your questions. Transitioning from brick and mortar by integrating telemedicine into your practice can serve as something of a lifeline. Let us give you the information you need to make it work quickly for you. Indicate your interest by clicking here.

Finally, is there NNPEN member interest in a Transitioning My Practice support group facilitated by a fellow NNPEN member? We know you may not have an ounce of energy left over at the end of the day, but support from a like-minded community is more than gratuitous—it’s critical! We know attending one more Zoom session may not be part your summer plan.  However, if you are interested in a Transitioning Practices support group, click here. No pressure!

In the meantime, remember Yogi Berra’s advice: “When you come to a fork in the road, take it!” While wearing your mask, of course!

Stay healthy—we need you!


Sandy Berkowitz
Co-founder and CEO NNPEN

"We connect nurse practitioner entrepreneurs with each other and with start up resources."

Contact Info:

Tel: 860-322-0708

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