The Jones Clinic

The affordable care act increased the number of people who can access health care services, which projected a shortage of physicians by up to 96000 by 2020 (Fox & O’Bear, 2014). To bridge this gap, nurse practitioners are seeking for independent practice as their services are much needed because they can effectively complement the roles of physicians (Fox & O’Bear, 2014). NewYork has abolished the requirement of a collaborative agreement between nurse practitioners and physicians. West Virginia is in the process of doing the same thus giving NPs total control over care as opposed to the restricted prescription (Fox & O’Bear, 2014).

With these developments, the business structure most appropriate will be a Limited Liability Company (LLC), with the name ‘The Jones Clinic’. This model is the required structure for independent clinical practice in most states including NewYork and it has multiple advantages (Fox & O’Bear, 2014; Markwick, 2016). It has minimal legal requirements and comes as a separate entity distinct from the individual. The owner also enjoys limited liability as personal assets are not tied to the company. There is also no double taxation. However, it also has limitations including difficulty in obtaining huge capital, restriction on membership, varying laws, and a short business life depending on the state’s directive (SC Lowcountry Score, 2016).

Costs

The startup cost for the business is expected to cover, the lease of the working premises, purchase office medical equipment. Markwick (2016) recommends that the locations of the clinic should be well thought out and researched to get affordable lease rates. Purchasing equipment may also be too expensive and finding clinics that are closing up will avail lower purchasing rates for used equipment at. However, the overall costs of both methods should be compared as the second-hand equipment attracts extra expenses during transport and for repairs. Office equipment will be furniture and a computer system that will be using the electronic health records system. A software developer will also have to be paid for installation services. Miscellaneous expenses will cover indoor fittings to customize the premise to a clinic (Markwick, 2016).

Expense

Costs

Registration of LLC

$65

Office space (Rent) and internet

$1505

Furniture (Table, chairs and decor)

$55

Business Account opening

$50

Computer system +EMR installation

$657

Examination Table

$172

Supplies (Gloves, scalpels, gowns)

$50

Liability Insurance

$1700

Totals

$4204

Expenses incurred per month will include:

Expenses

Amount

Rent+ internet subscription

$565

Workers (2)

$250

Supplies (gloves, scalpels)

$170

Tax

$174

Marketing

$100

Malpractice Insurance

$130

Continuing education

$445

Totals

$1834

Services

Primary care services will be offered including consultation services diagnosis and prescription. Routine assessment including vital signs measurement including routine assessment of blood pressure, respiration rate and body temperature. Services of suturing, spirometry, and nebulizer treatment will also be provided at the center. The facility will also offer health literacy for each patient and will extend similar educational services at the community level to aid in the prevention of diseases and to improve self-care. According to research, nurse-led care is better in patient education and counseling than physician care (Fox & O’Bear, 2014; Markwick, 2016). Lastly, partnerships with laboratories and imaging facilities will be established for efficiency and speed in diagnosis. Such long-term engagements will offer subsidized rates that will benefit the clinic.

Monthly Income

DeCapua (2016) provides a simple guide and formulae of calculating the earnings from an independent practicing NP. It factors in the average number of patients and costs per day, the duration is taken off work per year and constant percentages to be deducted from the gross earnings (DeCapua, 2016). Using this formula, the following information about the clinic is projected. St Jones Center will be seeing an average of 20 patients per day and each will pay $74.2 on average. Thus per day, the center will earn $1484. It will work from Monday to Friday but will remain closed during the public holidays, thus having 20 working days and generating $29680 in a single month. In a year (12 months), $356160 can be brought, however, in six weeks will be left out to accommodate time off either as sick leave or continuing education. Thus the revenue generated in a year will be $311640, translating to $25970 per month. Assuming a 90% collection rates, the cash obtained will be $23373. 20% will then be deducted to cater for the monthly expenses and a further 10% will be separated out as profit. Thus in a month, Jones salary will be 70% i.e. $16361.

However, variations are expected in the final figure at the end of each month. Where Medicaid patients are treated, only 85% will be reimbursed (Bohr, 2014). Also, to reduce the proportion of the bills left unpaid, the clinic will prefer self-paying clients in which the rates will be subsidized for affordability and profitability (D’Andrea & Zaumeyer, 2018). The affordable health care act increased the proportions of citizens who pay for pay for some of the health services. Thus, maximizing on the self-paying clients will reduce the hustle of dealing with private insurers or even Medicare/Medicaid. And rather than turning away some patients due to finances, the clinic will partner with funding institutions to minimize the unpaid bills (D’Andrea & Zaumeyer, 2018; United Collection Bureau, 2015).

References

Bohr, D. (2014). Billing compliance for non-physician providers: Understanding the CMS billing regulations. Compliance Today, (March), 31–33.

D’Andrea, L., & Zaumeyer, C. (2018). A Nurse Practitioner’s Guide to Starting an Independent Practice. ReachMD Page.

DeCapua, M. (2016). How Much Revenue Does a Primary Care Nurse Practitioner Generate? Barton Associates. Retrieved October 19, 2018, from https://www.bartonassociates.com/blog/how-much-revenue-does-a-primary-care-nurse-practitioner-generate/

Fox, B., & O’Bear, P. (2014). Financial and Regulatory Considerations for a Nurse Owned Medical Clinic. Southern Adventist University.

Markwick, L. (2016). Starting your own primary care NP practice--lessons learned. JNPA The Journal, 1–16.

SC Lowcountry Score. (2016). Legal Structures For A Business: Selecting The Best Business Structure. SC Lowcountry Score, 1–6. Retrieved from http://otsegocc.com/wp-content/uploads/2016/03/Select-the-Best-Business-Structure.pdf

United Collection Bureau. (2015). Self-Pay Accounts Receivables : The Problem and the Opportunity. Toledo: United Collection Bureau Inc. Retrieved from http://ucb.212contenthub.com/wp-content/uploads/2015/11/Self-Pay-Accounts-Receivables-The-Problem-and-the-Opportunity.pdf