Is incorporation necessary??????

Nurses Entrepreneurs

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Hello to all. Maybe this is a naive question, and I apologize if so!

I'm an RN employed part-time in the ICU of a local hospital. I've been approached in the last few weeks about doing private pay/private duty homecare when their family member comes home. I'm interested in doing this. The family is well off financially, and would love to have a 24 hour pvt duty nurse, which I won't do. But if they want someone to come out a couple of times a week to do a good head to toe assessment of their grandma and follow overall progress as she heals from her surgery and recovers from her stroke, that seems like it would be ok. They will likely have insurance paid home health, but I doubt this lady is going to have skilled needs for very long. Her primary caretaker has already been caring for her PEG tube, and while the pt is in the hospital, they have started trache and ostomy teaching.

I work part-time by choice, and will not be leaving my hospital job to do private duty. I have almost 7 years of home health experience, both as an LPN and as an RN/case manager. I enjoyed HH very much but NOT the on call, weekends/holidays, etc...and I'm not an evening/night person at all. I also have almost 9 years of ICU/CCU experience, and had a brief stint with med-surg and nursing home stuff way back when I first graduated.

I called NSO this morning, and they said all I have to do is add a "self-employed" clause to my policy. If I later decide to incorporate, then I'd need to have a business policy. The cost is the same for the highest amount of coverage an RN in this state (Maryland) can have, which I already had anyway.

I'm having a hard time seeing the value of S-corp or LLC right now for what I'm considering doing. If I have a payment arrangement with the family, a doc to call PRN, and I have malpractice that covers me in the situation, isn't that enough? Is all of this contract stuff necessary?

I don't at this time need my private duty stuff to be anything other than self supporting. I don't plan to hire employees or contract myself out to hospitals, and as long as my side business is supporting itself, that's fine. If I make a little extra money, that's great.

If this works out, I have already spoken to one of the two surgeons who did this patient's surgery about the possibility of seeing other patients on a private pay basis for them, and he was all for the idea.

Any thoughts on this arrangement? Is there a benefit to incorporating? Can I just use QuickBooks or something like that to keep track of what I'm paid and report that as income at the end of the year? I'm already on my husband's insurance (he's active duty military) and on the no-benefits option at my hospital.

Thanks for the thoughts.

Ck your county/state website for small business start ups -- you should be able to get some idea on which way you want to go.

My husband's vet clinic is a "DBA" - "doing business as" -- and is not incorporated or a limited partnership.

SJ

See the thread entitle is "incorporation - liability - confusion" The link is https://allnurses.com/forums/showthread.php?t=78807

I have been an RN for 20 years, but I am also a Registered Financial Counselor. The answer is no. The main purpose of incorporating as an S or forming an LLC is to protect yourself from liability. If you have firm assurance from your that you are covered, then you probably wouldn't need to incorporate. I would double check with a lawyer in your state. Our business is litigation crazy as you know. Ask him/her if there is any possibility someone can sue you personally without, or in addition to, making it a malpractice suit. If there is, don't risk it, forming an LLC (which I would reccomend), is not that expensive (certainly a lot less expensive than your house, which they could take).

Quickbooks is very good, but also very expensive. I have 2 business and do not use anything more than a $2 ledger I get from Wal Mart.

My expertise is taxes, if you have any more questions.

I'm having a hard time seeing the value of S-corp or LLC right now for what I'm considering doing. If I have a payment arrangement with the family, a doc to call PRN, and I have malpractice that covers me in the situation, isn't that enough? Is all of this contract stuff necessary?

It sounds like your question is primarily about liability. If so, incorporating will do nothing for you. As a licensed professional, you are personally responsible for your practice, makes no difference if you are a hospital employee or employee of your own corporation or (as you are right now), a sole proprietor.

The main reason that professionals incorporate (including physicians), is for benefits. And if your income is going to be substantial from this business, then it is worth looking into different business entities.

For most other types of businesses, the primary reason is to limit liability so it was a good question.

I'm EXTREMELY uncomfortable with nurses taking on business like this from contacts they have made through their employer. No offense, but unless you have obtained specific permission from your employer to do this it is unethical, is likely a violation of your employment with the hospital and quite possibly could be a civil tort (read: you could get sued by the hospital). Since it is likely that the hospital either directly provides these services or indirectly does so through an affiliate or division, what you intend to do appears to me to be nothing less than stealing.

Imagine if an accountant working for a firm chose to assist some of the firm's clients accounting needs outside of work for private pay. Since the accountant would have no knowledge of the client without being employed by the firm, he has no right to take advantage of the firm's client roster for private gain. This is the same thing, and it's against the law, having been proven in courts across America many times over.

Not your customer. It's the hospital's... Unless they give you permission to take said customer, then all is well. But be respectful and ASK first. If they say no, don't do it.

Good luck!

I'm EXTREMELY uncomfortable with nurses taking on business like this from contacts they have made through their employer. No offense, but unless you have obtained specific permission from your employer to do this it is unethical, is likely a violation of your employment with the hospital and quite possibly could be a civil tort (read: you could get sued by the hospital). Since it is likely that the hospital either directly provides these services or indirectly does so through an affiliate or division, what you intend to do appears to me to be nothing less than stealing.

Imagine if an accountant working for a firm chose to assist some of the firm's clients accounting needs outside of work for private pay. Since the accountant would have no knowledge of the client without being employed by the firm, he has no right to take advantage of the firm's client roster for private gain. This is the same thing, and it's against the law, having been proven in courts across America many times over.

Not your customer. It's the hospital's... Unless they give you permission to take said customer, then all is well. But be respectful and ASK first. If they say no, don't do it.

Good luck!

I absolutely agree. This hospital did all the leg work, advertising, developing relationships with physicians and other health care providers to ultimately "obtain" this patient. This would be especially problematic if this hosp has its own PD or HHA agencies. The original writer references the patient may have insurance coverage for private duty care. Even so, that does not mean the carrier will accept invoicing from an independent. Frankly, most wont from a nurse who is working independently. Most carriers have provider application processes and review new providers as possibles only once or twice a year. Just like a health care entity, you would have to verify the insurance and see if you meet their requirements. Dont assume this family is willing to pay you cash and then submit your bill to their carrier and hope for the best. Many do unfortunately and are sorely disappointed to learn that their provider was not on the approved list of that insurance company. So in addition to the legal and ethical issues at hand, There are many complicating factors. On a personal level, I can tell you that if a family with the best intentions ends up holding the bag and not getting paid by insurance but has already paid the nurse, they may go after the hospital as a recourse and that will not serve you well in your bread and butter relationship with your primary employer.

I absolutely agree. This hospital did all the leg work, advertising, developing relationships with physicians and other health care providers to ultimately "obtain" this patient. This would be especially problematic if this hosp has its own PD or HHA agencies. The original writer references the patient may have insurance coverage for private duty care. Even so, that does not mean the carrier will accept invoicing from an independent. Frankly, most wont from a nurse who is working independently. Most carriers have provider application processes and review new providers as possibles only once or twice a year. Just like a health care entity, you would have to verify the insurance and see if you meet their requirements. Dont assume this family is willing to pay you cash and then submit your bill to their carrier and hope for the best. Many do unfortunately and are sorely disappointed to learn that their provider was not on the approved list of that insurance company. So in addition to the legal and ethical issues at hand, There are many complicating factors. On a personal level, I can tell you that if a family with the best intentions ends up holding the bag and not getting paid by insurance but has already paid the nurse, they may go after the hospital as a recourse and that will not serve you well in your bread and butter relationship with your primary employer.

Thank you for the backup on that. :)

It just seems all too often that we (nurses) neglect some important ethical and legal points when we set our eyes on going into business for ourselves.

I am all for nurse entrepreneurs. I think it's AWESOME, as long as it is done the RIGHT way. :)

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