We Are Not Paying You

[mrcleanscrubs]

Dear Nurse Practitioners,

I have been forming an interest in establishing a private practice clinic in my future.

I know insurance/ billing is a major issue for all healthcare providers; I have even heard of insurance companies not reimbursing nurse practitioners, or even medical doctors.

Some providers have started clinics/ offices that only accept cash.

My questions for you all:

1. Do any of you have a private practice that does not accept insurance, only cash?

2. Have any of you heard of such a thing in your area?

3. *Kind of an off topic question* Can an AG-ACNP open their own practice?

Kindly,

MrCleanScrubs

[mrcleanscrubs, BSN, RN]

I know an MD who does this, but he also has a M-F job. This has been going on for quite a few years, so it doesn't look too hopeful as a main income.

Your odds are much better in a high socioeconomic zip code, but I am sure you know that.

Oh wow, as you said though, your odds are much better in an area of higher income.Thank you for that suggestion.

And yes, even in independent states, insurance companies will not reimburse NP's without a physician collaborator - in which cash only might be the case. But then again, who is to say cash only will be a success.

Thank you for your awesome input!

[mrcleanscrubs, BSN, RN]

At the suggestion of my past Attending/mentor, I'm going to do a cash-only private practice on the side (starting with one day a week). He does the same in my town and charges $500 for intakes (granted he's a physician). He does p/t as well and says he consistently gets calls for new patients, whom he cannot take on (he's full). So I will see what comes my way. My expenses so far have been setting up my LLC ($500, to round up), listing myself in Psychology Today ($30/m), I have a pending email to change my malpractice insurance (this will not go up by much, I think), I checked out a nice office I can rent for $15/hr, and I was recommended an EHR for $60/m. That all adds up to... not a lot. My skeptical brain cannot fathom that I could make a profit in my first month (if I even had just two-three patients), but that's what it seems like.

I'm not doing any outreach for now; I'm going to see if anyone contacts me this first week, and go from there.

I presume you are a Psychiatric Nurse Practitioner. If this is the case, you are doing yourself a great justice! I know a Physician Psychiatrist based in NYC who is well known and established - he told me he knows a Psychiatric Nurse Practitioner in Long Island, and that the NP makes more than he does. (Both take insurance though).

But this just goes to show that with a great clientele base, and great reputation, the possibilities are endless! It is my personal opinion that while nurse practitioners can do great in the inpatient setting - the outpatient/ private practice setting is where we really shine, and really pull in the profits. Thank you for sharing your experience in setting up your private practice!

Please keep us updated with your progress! I wish you the best of luck!

[ghillbert, MSN, NP]

Ability to open your own clinic is dependent on your state rules.

I don't think being an AG-ACNP is a limiting factor, depending on what type of patients you plan to see. As long as they are "acutely ill adults", you are good. You could have a specialty practice clinic, or you could contract yourself to hospitals.

[mrcleanscrubs, BSN, RN]

Ability to open your own clinic is dependent on your state rules.

I don't think being an AG-ACNP is a limiting factor, depending on what type of patients you plan to see. As long as they are "acutely ill adults", you are good. You could have a specialty practice clinic, or you could contract yourself to hospitals.

Greetings Ghillbert ,

Right, definitely dependent on state rules.

I see, so as long as I set up a clinic, let us say: 'MrCleanScrubs Acute Care Center' is the name, I may only care for adults who are acutely ill. Now would I be able to open a Cardiac office, as a specialty practice clinic?

I also like that hospital contract idea - I have never heard of contracting oneself to hospitals; how does this work?

Thank you.

[zoidberg, BSN, RN]

Here in SC, The physician groups passed legislation which led to the handful of privately practicing psych NPs having to close their practices. They had MD collaboration but they owned their practices. This occurred 5ish years ago, I can't remember exactly when. Since then we have attempted to pass APRN practice reform with no success so far.

[Oldmahubbard]

Here in SC, The physician groups passed legislation which led to the handful of privately practicing psych NPs having to close their practices. They had MD collaboration but they owned their practices. This occurred 5ish years ago, I can't remember exactly when. Since then we have attempted to pass APRN practice reform with no success so far.

Terrible and I call BS.