Starting An Agency

Ylove113 · Mar 14, 2004

Hi, Kallie I am a RN in North Carolina and I am trying to get started on opening a personal care service agency. I am not familiar with writing policies and procedures. Can you help me or tell me where I can get help with writing the policies and procedures to get licensure.

I can relate to your concerns regarding starting an agency. I live in a rural area. I have had my certifications for my personal care agency for two years. My agency is incorporated. I purchased an office space. I have been ready to take patients for two years. I have tried to get assistance through the Small Business Administration, however, you have to be wealthy to qualify for one of their loan programs. "If I was wealthy, I wouldn't need SBA's assistance!" But, in the mean time I continue to work as an RN. I hope to someday locate the capital that I need to use for my business. If anyone has capital, and would like to invest, feel free to contact me. The personal care agency is funded through Medicaid.

suzanne4, RN · Mar 14, 2004

Ylove113: First thing, before doing anything else, you need to decide if you will take Medicare patients. If you do want to, they have a complete set of regulations that you must file, as well as the documentation needed, etc. Are you planning on being the only provider, or are you planning on hiring other nurses, etc? If so, you need to look into the regulations for your state. Some states have quite specific rules on what can be done and not done. I would worry about all of these things first, before even thinking about writing policies and procedures. That is the final thing that you need to deal with.

Good luck...................... :balloons:

Ylove113 · Mar 16, 2004

Hi Suzanne4, No I am not going to do Medicare patients, just Medicaid. I am going to be the only RN, but will have some Nursing assistants and PCA's and an Office Manager.

Ylove113: First thing, before doing anything else, you need to decide if you will take Medicare patients. If you do want to, they have a complete set of regulations that you must file, as well as the documentation needed, etc. Are you planning on being the only provider, or are you planning on hiring other nurses, etc? If so, you need to look into the regulations for your state. Some states have quite specific rules on what can be done and not done. I would worry about all of these things first, before even thinking about writing policies and procedures. That is the final thing that you need to deal with.
Good luck...................... :balloons:

suzanne4, RN · Mar 16, 2004

Even accepting Medicaid patients, there is quite a bit a paperwork that you need to get from your state. Make sure that you will be able to meet all of their requirements. I would start with this first thing, before attempting anything else.

I am always available if you would like to PM me. :balloons:

relysh717 · Mar 16, 2004

I have checked with several agencies in my state -but there was no special license/permit required to recruit nurses. Rules and regs are those basically what is stated in the Labor, Professional, Business codes, etc. I know, I need to do thorough research on this first.

Hi Suzanne4, No I am not going to do Medicare patients, just Medicaid. I am going to be the only RN, but will have some Nursing assistants and PCA's and an Office Manager.

suzanne4, RN · Mar 16, 2004

Not regulations about nurses, etc., but regulations concerning the type of documentation that you must keep, etc. Remember that dealing with Medicaid, you are dealing directly with the state and will be paid by them. They have a completewy different set of rules that you have to go by as well. They also have certain requirements as to who can do what, what types of care that you have to be able to provide, and what you cannot provide.

This is what I am talking about.....................Good luck.

natalyia · Mar 22, 2004

Hello there!

I would love more info on how you started your agency!! Please e-mail me when you have the chance!

natalyia

Hi,
I've started my own agency and have learned quite a bit in the last 5 years....e-mail me if u want more info.

natalyia · Mar 22, 2004

Hello there,

I would love to hear more about how you started and now maintain your agency! Please e-mail me!!!

natalyia.

Some of you are saying that it is expensive and need a lot of capital to start your own agency, but let me tell you what we did. I started my agency with $0.00 in the bank. That's right, zero! I was able to get my first contract with the local hospital (it's all about who you know!) If you've worked at a hospital before and got to know the staff and directors, then that's a big plus. I spent $100.00 on a package I received off the internet that came with a book and sample contracts to get me started. Once I got my contract, I pulled all the shifts in the beginning that way I got all the money I didn't have to pay any employees. By the way, I'm only an LPN and charged $32.00-$33.00 per hour. Just after two weeks, I hired about six more employees and they started pulling shifts. It also works out good because the hospital pays my invoice every two weeks, the same time they do their payroll. So, I pay my employees every two weeks when I get the check from the hospital. I realize not every hospital will do this, but if you can find one that will and get that contract, it really is not expensive to start. Also, you can purchase a program like Quickbooks for about $200.00 to process your payroll, it's really easy. Any questions, please feel free to email me. Hope this helps!

ThompsonRN · Mar 22, 2004

Hi LIHHRN. I do not know how to find out the current bill rates but I too need to know the answer. I am in the process of starting a supplemental staffing agency and will probably start with 2 LPN's, 2 CNA's, and 2 RN's. I would like to charge less than the average range to get a few contracts right away, but like you, I'm unsure of the bill rate being charged by the agencies. I live in Ohio and will market the Cincinnati area. If you've gained any insight, please pass it on to me. I can use all the help that anyone has to offer. Anyone who knows what the current bill rates are, please feel free to e-mail me.

Thanks

ThompsonLPN

suzanne4, RN · Mar 22, 2004

The current bill rates aren't your problem. First you have to know if the hospital will pay you every two weeks, many of them don't. You will be responsible for payment to your nurses even if the hospital pays you late.

You have to calculate out all of your expenses to start, and make sure that they are figured in. Such as insurance for your agency as well as the nurses that will be working. Don't forget Workmen's Comp, etc. Some of the bigger agencies will "low ball" a price to some of the hospitals to get their foot in the door, but they actually lose money, and can make it up somewhere else. Make sure that you aren't doing that. Worry about what the going rate that the nurses are getting paid in your area, not what the agency is charging the hospital, to set your rates. Will you be including benefits such as medical, vacation, etc.? These are all things that need to be considered...........not the other way around..........................

Thinggs also vary between city to city and state to state. So be sure to pay attention to that when you are looking at these posts.

Hope that this helps. :balloons:

natalyia · Mar 22, 2004

hello suzanne4,

just a few questions about your last comment re:starting an agency. you wrote about expenses that one would need to worry about, what sort of expenses are involved other than the obvious supplies needed, and a cushion of money in the bank to pay nurses bi-weekly in lieu of payment from the hospital? Also, what type of insurance are you referring to? is the insurance for your agency and for the nurses separate? and like thompsonlpn, i too would like info on what the current bill rates are. i understand your point that there are other issues to consider but we still need to know the competiton's rates otherwise we may get laughed out the office when trying to garnish a contract!

please help!

thanks,

natalyia.

suzanne4, RN · Mar 22, 2004

You need Liability Insurance for your agency. You usually will be providing malpractice insurance for your nurses. What about benefits for them? Bill rates are normally never shared with other agencies. They can vary quite a bit. Rate charged will also depend on the quality of your nurses and their dependability. From a business standpoint you are looking at things wrong. Calculate what your costs are and what you will be paying your staff and remember to include mandatory education that may not be reimbursed by the hospital, etc. Do not forget accounting/auditor charges, computer program for billing, advertising, phone service, etc. You need to come up with a workable number that way, do not base your rates on what others are charging. This is how you will make the best deal for yourself. And I am telling you this 100% from experience. I owned my own agency before I moved to the other side of the world. And I can definitely say that the rates we got were higher than many other agencies because the nurses that worked for my agency were quite flexible and could work many different areas. All of us are ACLS and PALS certified. I also have NRP certification. We are all able and qualified to work critical care, including CVICU, PICU, etc, Emergency, and OR.

All of us have been members of heart teams, etc. Prices charged will depend on what you can offer from your nursing side. Are they willing to take call? Will they work at the last minute? Are they flexible as to what units they will work for the day, and perhaps more than one? I remember one hospital in Michigan where I worked ER on Monday, admitted a patient with chest pain, did his heart the next day in the OR, took care of him the following day in the ICU. I also remember another facility, where I worked 4 hours in PACU, four hours in Endoscopy, and four hours in OR. Experience means more money. You also need to start with hospitals where you have worked and they are familiar with you.

That is the absolute best way to get started.

Good luck to you..............................

p.s. Feel free to send me a PM if you have other specific questions