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Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership

AORN Journal, Sept, 2005 by Linda DeCarlo

The article "Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership" is the basis for this AORN Journal independent study. The behavioral objectives and examination for this program were prepared by Rebecca Holm, RN, MSN, CNOR, clinical editor, with consultation from Susan Bakewell, RN, MS, BC, education program professional, Center for Perioperative Education.

Participants receive feedback on incorrect answers. Each applicant who successfully completes this study will receive a certificate of completion. The deadline for submitting this study is Sept 30, 2008.

Complete the examination answer sheet and learner evaluation found on pages 431-432 and mail with appropriate fee to

More Articles of Interest: Specialty practice entrepreneur: the advanced practice nurse; Reimbursement Issues in Advanced Practice Nursing: An Overview; CNS Entrepreneurs: Innovators in Patient Care; Why don't we receive equal reimbursement?; Demonstrating APN value in a capitated market

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BEHAVIORAL OBJECTIVES

After reading and studying the article on advanced practice nurse (APN) surgical-assisting partnerships, nurses will be able to

1. identify changes occurring in the health care environment,

2. describe how the key attributes of entrepreneurs are applicable to advance practice nurses who are considering forming a multidisciplinary surgical-assisting partnership,

3. discuss the components that affect a multidisciplinary surgical-assisting partnership model, and

4. define measures that confirm the success of the multidisciplinary surgical-assisting partnership.

AORN Home Study

This program meets criteria for CNOR and CRNFA recertification, as well as other continuing education requirements.

A minimum score of 70% on the multiple-choice examination is necessary to earn 2.0 contact hours for this independent study.

Purpose/Goal: To educate perioperative nurses about advanced practice nurse surgical-assisting partnerships.

Home Study Program

Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership

Advanced practice nurses (APNs) have many options for defining their practice. They may be hospital-employed, physician-employed, or self-employed. Entrepreneurial APNs may have a solo practice or be part of a group. A group may consist solely of APNs or be a partnership that includes other independent nurse entrepreneurs or physicians.

This article reviews changes in the health care environment and reimbursement that provide nurse entrepreneurs with the opportunity to partner with other APNs and physicians and discusses key attributes (ie, clinical expertise, specific personal characteristics, interpersonal skills, business acumen) entrepreneurs need to be successful in a multidisciplinary health care delivery model. A multidisciplinary surgical-assisting partnership is a unique business partnership that provides the potential for enhancing collaboration, reducing competition, developing collegiality, and dealing with conflict.

CHANGES IN THE HEALTH CARE ENVIRONMENT

Constant and sweeping changes in health care delivery models and reimbursement are allowing nurses to redefine their roles and create new visions for the future. (1) in 1998, author Tim Porter-O'Grady, RN, EdD, PhD, CS, CNAA, FAAN, commented on the future of APNs. At that time, he believed that the opportunities for nurse entrepreneurs were greater than at any time in history. Despite the opportunities for independent practice, however, self-employed nurses were rare in the profession in the 1990s (2) and continue to be rare in 2005.

A significant change in the health care environment is the decline of physician interest in surgical assisting. The increasing numbers of unfilled surgical internships in medical schools is a result of more physicians choosing primary care over specialty practice; therefore, medical students are spending fewer hours in surgical rotations. (3) The lack of physicians assisting one another in surgery creates more opportunities for RN first assistants (RNFAs), nurse practitioners (NPs), and clinical nurse specialists (CNSs).

CHANGES IN REIMBURSEMENT. The value of mid-level practitioners is increasing as health care delivery models continue to change and reimbursement structures evolve. Since 1948, the American Nurses Association (ANA) has supported direct reimbursement to APNs. (4) In 1988, certified nurse midwives (CNMs) started receiving reimbursement at 65% of the physician's payment. (4) The Balanced Budget Act of 1997 approved NP reimbursement for Medicare patients. (4) Tricare, a federal health care program for civilian and retired members of the uniformed services and their dependents, provided the first full direct reimbursement for NPs and CNMs.

Medicaid reimbursement is unique to each state so there are 50 different programs. Reimbursement rates from Medicaid for mid-level practitioners vary from 60% to 100% of physician rates, with 41 states recognizing them as providers. (4) Surgical assistants recognized by Medicare are called first assistants, and their reimbursement is based on a percentage of the surgeon's fee. Physicians assisting in surgery are eligible for reimbursement at 16% of the surgeon's fee. Nurse practitioners, CNSs, and physician assistants are paid 85% of the fee an assisting surgeon would receive, which is 13.6% of the surgeon's Medicare reimbursement. (5)

Health Care Industry

Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership

AORN Journal, Sept, 2005 by Linda DeCarlo

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