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Marketing, Contracting and Reimbursement for the Advanced Pr

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Tory Ford

on 14 March 2014

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Transcript of Marketing, Contracting and Reimbursement for the Advanced Pr

Marketing, Contracting and Reimbursement for the Advanced Practice Nurse
Angela Oakley, Tory Ford, Jay Ford, & Crystal Lillibridge
Promotion and Marketing
Family Nurse Practitioners (FNPs)
Marketing Strategies for Novice FNPs
New graduate FNP
Recover and seek employment!
Maintain positive self-esteem, flexibility, enthusiasm, identify unique skills, and take risks
Contract Considerations and Negotiations
Everything advanced practice nurses (APNs) do to promotion of their roles, practice, and services….
How to Promote and Market
Promotional materials for agency include FNP
Websites for agency to include FNP names
Visible signage
Description of FNP role given to client on 1st visit
Ask client about how they were informed
Business cards
Thank you notes (for referrals, and visits)
Join local business groups
Joining APN professional organizations
(Hamric et al., 2009)
Strategies for Seeking Employment
Develop a professional portfolio
Self-Promotion Campaign
Develop a professional purpose
Motivation, mission, values, goals

Create a perception of personal and professional purpose and quality practice to achieve:
Join local chamber of commerce, attend local networking groups, offer to be a speaker for local service groups, business brochures and cards, local health fairs
Demonstration of unique value
Self-appraisal of marketable, unique skills
Desirability and necessity
Identify strengths and how to meet needs of health care system and populations
Market survey
Service value
Cost-effectiveness and economic worth

The Interview
Pre-interview: knowledge is the key

Does an FNP need a contract?
Legal Limits
(What to consider?)
How NP is Reimbursed- Hourly
Get paid while there, no matter how late
Usually set hours and employer does not want over time
Holidays and on-call pay extra
People paid by the hour tend to link income to happiness more than other ways to be paid
Not patient based, so same pay if 4 patients or 6 patients seen an hour
How FNP is Reimbursed- Salary
Get paid, even if not at work
Guaranteed pay
More flexible schedule
Mutual trust of job being completed
Can have bonuses
Not patient based, so same pay if 4 patients or 6 patients seen an hour
No overtime, on-call, or holiday pay
How FNP is Reimbursed- Per Patient
Home health
FNP solo practice
Get paid for directly what FNP is doing
Need extra money- see more patients
Seeing fewer patients as a new graduate FNP
For vacation, no pay if no patient seen
"Turn and burn" mind set
Lag time for pay
Less predictable
Identify Opportunities for Self-Promotion
1) Understand the product
Promotion and Marketing
How Business is Reimbursed
FNP sees the patient and codes visit per the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), Current Procedural Terminology (CPT), Evaluation and Management (E/M), and/or NANDA diagnoses
Use FNP or physician national provider identifier (NPI), depends on state and practice, to bill Medicare, Medicaid, private insurance, or patient
Provider must be able to bill these plans based on the application process
100 percent of contracted rate if billed under physician and 85 percent if billed under FNP
Future billing
Pay before services
Negotiation Strategies:

-Explore the organization or employer's leadership style, practice habits, and their mission, vision, and culture (Danna & Porche, 2014).
-Write down an outline of what you personally require for bottom line salary and benefits (Allen, Ch'jen, Trimpey, & Russell-Lindgren, 2000).
-Have the contract evaluated by an attorney to define any terminology that the NP is not familiar with (Danna & Porche, 2014).

-Make sure to be on time and professionally dressed (Allen et al., 2000).
-Keep emotions in check and stay focused on important aspects of what you desire (Allen et al., 2000).
-Take notes to avoid any miscommunication (Allen et al., 2000).

-Redraft the agreed upon terms, as well as have legal counsel assist and review the unsigned contract (Allen et al., 2000).
-Close negotiations and have the contract signed and finalized as soon as possible (Allen et al., 2000).
How to approach negotiations?
Promotion and Marketing (Angela)
Preferred Reimbursement
To start, salary with option for bonuses and then after progressing on the novice to expert scale, per patient
Elements of an Employment Contract (what do you want?)
Things to Remember for Reimbursement
Do not expect 100 percent of billing returned based on contracted rate for non-paying patients and overhead
Expect to pay the physician for consultations
Remember benefits are considered reimbursement
If salary or hourly, look at profits bringing in for future negotiations
Professional billing advisor recommended for APNs wanting to get involved in billing
(Buppert, 2011)
(Buppert, 2011) (Khan Academy, n.d.)
(AANP, 2011) (Buppert, 2011) (Dykman, 2011)
(AANP, 2011) (Buppert, 2011) (DeVoe & Pfeffer, 2009) (Dykman, 2011)
"Reimbursement is an indirect process supporting
patient care that provides a vehicle for APN compensation for the services rendered to patients." (Hamric et al., 2009, p. 570)
Who get's reimbursed?
(Gapenski, 2012) (Hamric et al., 2008) (MacDonald, 2014) (Wound, Ostomy & Continence Society National Public Policy Committee, 2012)
(Hamric et al., 2009)
FNP novice entrepreneur
Why?-Creative force to increase care quality
Who?-Visionary, decision-maker, risk-taker, problem-solver, self-confident, committed, creative, flexible, and responsible
Strategy-Create a practice name to establish consumer base

(Hamric et al., 2009)
(Hamric et al., 2009)
Self-promotion communicates value and helps to build professional profile, credibility, and reputation to the benefit of the individual and the FNP profession
(O'Sullivan, 2013)
2) Believe in the product
3) Know the audience
4) Determine key messages
5) Plan of action
6) Power of being heard
List professional skills and capabilities
Identify strengths and weaknesses
Distinguishing qualities, clarity of skills helps to define uniqueness and value
Professional self-esteem (self-belief)-act with conviction and project confidence to instill trust and assign value to role
Understand tangible benefits of role
Economic, quality care, productivity benefits
Frame communications meaningfully and identify professional practices within context most appealing to
prospective employer/stakeholder
Identify gaps in knowledge, practice priorities, favored medium of communication
Features (practice) and benefits (results) to enrich self-presentation
Outcomes-oriented approach leads to marketable position
Delivery is key, communicate fittingly, informatively, and memorably
Clarity-clear message
Consistency-establish trust
Credibility-verity of words and actions
Creativity-strive for impact
Successful self-promotion
Repeat, contrast, deliver, plant the seed
(O'Sullivan, 2013)
Resume and curriculum vitae
Query and cover letters
Three things to remember:

1. One who does not ask will not receive.

2. One who does not deserve will not receive.

3. Even when one asks and deserves, one will
need to do some selling to get what one wants.

(Buppert, 2008, p. 317)

Representation of personal and professional accomplishments and potential benefits to employer
Resource to enter job market
Listing of education, positions, contributions
Assort relevance to desired position
Networking is a key marketing strategy
Resume-introduction to prospective employer including relevant information
Key words-align resume with job description
Social media-LinkedIn, Facebook, Monster.com
Focus on substantive accomplishments to stand out from the competition
Accurate and eye catching
Curriculum vitae-representative of one's entire career (for those envisioning teaching)
Terms of contract
Termination clause
Professional membership
Malpractice expenses
Compliance with laws and policies
Mandatory practice requirements
Job title and responsibilities
Conflict management and dispute resolution
Confidentiality clause
Support services
Effective Marketing Strategies (Tory)
Contracts and Negotiation (Jay)
Reimbursment Strategies (Crystal)
(Hamric et al., 2009)
(Advance Healthcare Network, 2013)
Query letter-used to determine employment opportunity and request informational interview
Engage, indicate familiarity with practice, identify referral, state why interested, positive and assertive conclusion
Cover letter
Brief/engaging response to job posting
(Hamric et al., 2009)
Accustom to the public face of the practice
Website, brochures, marketing materials
Prepare questions about setting and position expectations
Team interview versus individual
Take proactive control of the final impression
Leave a reminder (resume, cover letter)
Send brief, handwritten follow-up note
Seek education
No pestering
(HealtheCareers.com, 2014)
(Hamric et al., 2014)
Any communication provided to consumers on the value of a product (Hamric et al., 2009)
Lack of knowledge (colleagues, consumers)
Who FNPs are?
What FNPs offer?
Where FNPs can practice?
When FNPs practice?
Why use FNPs?
Dress appropriately, scout the location, arrive early
Ask questions to get idea of prospective employer's expectations (interest in NPs, special interests, salary/benefits, malpractice coverage, call requirement, non-compete clause, autonomy related to developing patient panels)
How much?
Usually a percentage of billed care
How much?
1-5 years experience, 35+ hours per week $84,850 base, total of $91,060
(Buppert, 2011)
(Hamric et al., 2014)
How Much?
1-5 years experience, $42.50 per hour
External activities
Internal activities
Professional conferences
Education/training opportunities
Contribute opinion articles to journals/newsletters/social media sites
Involvement in research projects
Open to innovation
Commit to professional development
Educate others about role and benefits of FNP
Remain visible
Nurture professional relationships
Act professionally at all times
(O'Sullivan, 2013)
(O'Sullivan, 2013)
"Our every action is guided by knowledge, enabled by skill, and motivated by compassion "
Power of networking begins a conversation, then building on the relationship
Prepare in advance to meet influential people
Practice a firm handshake
Research people you expect to meet
Prepare brief yet compelling self-promotion speech
Relax, open up, and connect
Follow-up with a personal, hand-written note to build on the encounter
Proactive preparedness
(Advance Healthcare Network, 2013)
• Adolescent gynecology specialist
• Architectural consultant
• Bioterrorism preparation
• Birthing center
• Brokering services (e.g., for specifi c populations)
• Chronic illness management
• Convenient care clinic
• Correctional health care
• Daycare consultant
• Diabetes management
• Disaster preparation
toys, personal care, therapeutic devices,
population-focused programs of care [e.g.,
heart failure clinic])
• Psychiatric counseling
• Radio/television/media consultant
• Retirement center
• Risk management consultant
• Same-day surgery center
• School/college health
• Special populations (e.g., lesbian/gay health,
Latino health, immigrant health)
• Stress management consultant
• Transition coach (for health care issues)
• Women’s health
• YMCA/YWCA and Boys’/Girls’ clubs (for health
promotion activities)
AIDS, Acquired immunodefi ciency syndrome; HIV, human immunodefi ciency virus.

• Older adult care
• Employee programs for health care cost
• Fitness/exercise consultant
• First-assistant surgery services
• Genetics
• Health policy consultant
• Health/wellness promotion
• HIV/AIDS care
• Homeless shelters
• Lactation consultant and equipment rental
• Lifestyle change
• Mammography, breast health counseling
• Medical, nursing, health care writing
• Menopause center
• Mobile health services (e.g., mammography van)
• Multidisciplinary clinical practice
• Nurse case manager
• Occupational health/workers’ compensation
• Pacemaker center
• Palliative care
• Pain management
• Patient navigator
• Product development (e.g.,
Resistance from physicians and, the public
Through Education and Promotion of:
Barriers can be overcome
4 P’s of Marketing
5th P

Communicate Value of a product
Removes Barriers
Educates the public and colleagues
Areas of Service
(Hamric, Spross, & Hanson, 2009)
Box 20-2, 581
New full time FNPs typically earn $84-$98 thousand a year: an average of $46 dollars an hour (AANP, 2011).
FNP should understand where the organization or practice obtains most of it's revenue.

(Buppert, 2008)
Practice expectations

1. Do you have full autonomy?

2. Are there any barriers?

3. Are you staying within your scope of practice?
(AANP, 2014)
Three difficult clauses that FNPs seek legal council to decipher:

1. Restrictive covenant

2. Bonus formula

3. Termination clause
(Robers, 2010)
Typically, an attorney will negotiate a flat fee for service to review a contract.

(Buppert, 2008)
New FNPs need to assess:

1. How many patients they can see.

2.How much consultation time is going to be needed per patient.

(Buppert, 2008)
Secondary employment or
dual employment
Procedure for contract amendment
Proprietary statements
Competitive clause
Paid leave
(Danna & Porche, 2014)
What to consider?
Disaster #1
(Noncompetition Clause)
Disaster #2
Disaster #3
(Misaligned with
scope of practice)
American College of Nurse Practitioners
National Association of Pediatric Nurse Associates and Practitioners;
National Organization of Nurse Practitioner
National Conference of Gerontological Nurse Practitioners
National Association of Nurse Practitioners in Women's Health
Nurse Practitioner National Marketing Campaign
Healthcare Organization

Staff buy in and support
Referral and partnership building
Respect and value
Utilization of services
Word of mouth referrals
Support and trust
(Buppert, 2013)
*Refer to contract handout for the groups own elements.
(Buppert, 2008)
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