Barbara C Phillips, NP

Many Nurse Practitioners and other advance practice clinicians who want to start a practice, are worried about the cost to get started in a traditional office practice and are looking for options. One such option is a practice focusing long term care (LTC).

Geriatrics is one area that is vastly underserved, especially for those who reside in LTC. The need is only expected to increase as our population ages.

This is not a new type of practice. Many of us who are Geriatric Nurse Practitioners (GNPs) have practiced in LTC facilities for years. Over the years, we've not see more ANPs (adult nurse practitioners) and FNPs (family nurse practitioners) in LTC as well. What is becoming more common (albeit still relatively rare) is that the NPs working in LTC are doing so as self employed individuals. NPs who have businesses that focus on seeing residents of LTC facilities will tell you that they not only enjoy their work, but managed properly, it can also be financially rewarding.

So what do you need to get started?

1. Knowledge of geriatrics and common issues that are facing them.
2. And understanding of the needs of the LTC facility - this will help you structure your time, assuring you are also seeing patients within the required laws and standards
3. Access to LTC facilities.
4. Communication System
5. Determine your billing process
6. Transportation
7. Insurance credentialing.

You will want to contact LTC facilities to determine their needs in getting providers in to see patients, both at required visits and for sick calls. Find out who the physicians of record are, as well as who is the facilities medical director. You will want to contact them and offer your services to manage their LTC residents. Understand, they will likely remain the physician of record and will need to make periodic visits according requirements and the resident's status. Most physicians who maintain office practices as well as seeing residents of LTC facilities will welcome someone managing the needs of those patients.

LTC facilities are one of the most regulated health care environments today. It's unglamorous (you'll never see a TV show about LTC like you do with ER and trauma shows) and unpopular. The needs of the facility in terms of reporting to providers, getting forms signed off, etc are high due to regulation. However, you'll find that with a system, you can easily provide an excellent service to the residents and facilities, and be rewarded for your efforts. It's a business that can truly be a win-win-win for all involved.