Advanced practice nurse entrepreneurs in a multidisciplinary surgical-assisting partnership

AORN Journal, Sept, 2005 by Linda DeCarlo

How conflict is resolved determines the success of the partnership. The perspectives of all those involved should be considered when the partnership faces difficult situations. (17) Partners need the ability to

* identify the opposing forces causing the struggle,

* determine the interdependence between individuals, and

* recognize the emotional component of the issue. (10)

ESTABLISHING A MULTIDISCIPLINARY SURGICAL-ASSISTING PARTNERSHIP

The first step to establishing a multidisciplinary surgical-assisting partnership in a community is to define the target hospitals, key surgeons, and geographic areas (Table 2). Assessing the needs for surgical-assisting services requires answering several questions.

* How are surgical-assisting services currently being provided?

* Are the hospitals and surgeons in the community satisfied with the current system?

* Are surgical procedures being performed without an assistant, when using an assistant would improve patient safety?

* Are surgical assistants available after hours and on weekends?

* Are surgeons, office schedulers, and hospital personnel making numerous calls to find assistants?

The supply of surgical assistants (eg, RNFAs, CNSs, NPs, physicians) in the area who are self-employed, physician-employed, and hospital-employed then can be compared to the number of surgical procedures during which an assistant' is required and reimbursement for assistants is available. If the answers to the assessment questions reveal dissatisfaction of physicians and their office staff members with the current system, an opportunity exists to implement a multidisciplinary surgical-assisting business partnership.

BUSINESS PARTNERSHIPS. The partnership concept is present in many aspects of providing surgical-assisting services. A partnership exists between APNs who are providing surgical-assisting services and their shared office coordinator. A partnership exists with each of the surgeons for whom surgical-assisting services are provided. During each procedure, there is a partnership with the hospital staff members assigned to the procedure. Furthermore, a partnership is created with the patient the moment the practitioner introduces himself or herself and begins a preoperative assessment.

In this business model, each practitioner is either a sole-proprietor or a corporation depending on personal preference and the recommendations of an accountant. Surgical assistant compensation comes directly from insurance companies and is based on individual performance. The office coordinator, who is responsible for scheduling, billing, and acting as a liaison with insurance companies and surgeon's offices, is paid a percentage of collections.

Using a shared office coordinator for scheduling and billing helps practitioners who do not have the time, knowledge, or expertise to perform these functions. Frequently, it is more cost-effective and efficient to hire someone to perform these tasks rather than try to do them oneself. (15) Most practitioners find that there are not enough hours in the day to perform surgical-assisting services in the OR, bill for services, and schedule additional procedures.