22 MANAGING YOUR PRACTICE
time, travel time, and home visits. For accounting purposes, this should be recorded in 10- or 15-minute increments. Current rates vary nationally, but most nurse case management charges range from between $70 an hour to $125 an hour.
• Become familiar with and follow standard accounting practices.
• Secure the advice of a tax accountant.
• Conduct business audits every 2 to 3 years.
Is Help Available?
Online help for geriatric care managers can be found on the National Association of Professional Geriatric Care Managers' Web site at www.caremanager.org.
Is This a Viable Practice Model for APNs?
Each day nearly 6,000 Americans turn 65 years old. In 10 years, that number will increase to 10,000 Americans each day. As the baby boom becomes the "senior boom," the need for APN-GCMs will explode.
Based on patient requirements, an APN-GCM can handle from 5 to 10 patients simultaneously, billing $1,000 to $3,000 per month. Depend- ing on the practice model, it may take a few years to develop a sub- stantial patient base; however, many APN-GCMs subcontract their services to hospitals, physician practices, long-term care providers (e.g., rehabilitation and skilled nursing facilities), home health care agencies, and outpatient clinics to supplement their practices.
NEW PRACTICE MODELS FOR APNS! THINKING OUTSIDE THE BOX 23
employee who suffers a heart attack can cost thousands of dollars to the employer's health care plan and result in the loss of the employee's pro- ductivity, require payment for sick time and short-term disability expenses, and necessitate the development of a back-to-work program in order for this employee to return to work and be productive. Sub- contracting with an on-site occupational health APN is cost effective and convenient, and provides quality primary care service. Ultimately, the employer and employee both win.
What Services Can Occupational Health APNs Provide?
On a scheduled basis, an occupational health APN provides on-site pri- mary care medical management of acute and chronic illnesses, illness prevention and health promotion activities, new employee and annual physicals, disaster and emergency planning, and telephone triage. Refer- rals are made for drug and alcohol rehabilitation, unemployment case management, and family social work management. The following steps can be used to develop a plan for an occupational health service:
1. Make an initial on-site assessment of the plant/business.
2. Based on assessment findings, generate a problem list with pos- sible interventions.
3. Discuss program and service options with management and employees.
4. Develop a plan of care outlining how services are evaluated on an ongoing basis.
Steps for Developing an Occupational Health APN Practice
Step 1: The practice plan
• The plan outlines how the practice is structured (e.g., sole pro- prietorship, S corporation, limited partnership, or other). Outline plans for securing capital.
Step 2: Marketing
• A brochure explains the services the occupational health APN provides, the cost benefits of occupational health care, and the
24 MANAGING YOUR PRACTICE
advantages of a positive business culture. The brochure with a cover letter is mailed to members of the local chamber of com- merce, potential clients found in the Yellow Pages, and plants/
businesses in the community identified by a windshield survey.
• Telephone calls and visits are made to prospective clients.
Step 3: Legal issues
• Maintain your APN license.
• Review and adhere to your state's scope of practice for APNs.
• Follow your state's requirements for license or certification as an occupational health nurse (if necessary for an APN).
• Follow recommendations for best practices, consultations in occupational health, clinical guidelines, and protocols for practice from the American Association of Occupational Health Nurses (AAOHN).
• Consult a lawyer specializing in worker's compensation and occupational health cases to determine liability and assist in developing a contract.
• Secure a professional liability insurance policy to cover the deliv- ery of APN services, occupational health services, and general business liability.
• Review all contracts and legal forms with legal counsel to ensure proper compliance with state laws.
• Develop patient files, and include signed contracts, release forms, and accurate, current, and meticulous progress notes.
Step 4: Billing issues
• Establish a billing process using accounting software that pro- vides the capability to maintain proper patient and business finan- cial information.
• Do monthly billing to contracted plants and businesses.
• Invoice all services rendered on behalf of the patient, based on the service contract, which includes, but is not limited to, telephone time, travel time, supplies, and home visits. For accounting pur- poses, these should be recorded in 10- or 15-minute increments.
NEW PRACTICE MODELS FOR APNS! THINKING OUTSIDE THE BOX 25
• Become familiar with and follow standard accounting practices.
• Secure the advice of a tax accountant.
• Conduct business audits every 2 to 3 years.
Is Help Available?
Online help for nurse practitioner occupational health consultation is available from www.aaohn.org. Information about state licensure for occupational health is available at www.ncsbn.org. Information about the requirements for state certification for occupational health is avail- able at www.abohn.org/certif.htm. The National Institute of Occupa- tional Safety and Health (NIOSH) offers training for occupational health professionals at its education and research centers (see w w w.cdc .go v/niosh/centers .html).