Realistic look at both internal and external strengths and weaknesses of your clinic. Goals of your business, and possible ways of reaching your goals.
1-Don ’ t put it off, the busier you the more you need a plan. It doesn ’ t need to be done all at one. It can be it bits and pieces as you have time. Short and simple as long as it gets your message across. 2-If you fail to plan you plan to fail. Business failure #1 reason is lack of business plan. If you are afraid of the writing of the business plan failing there are many resources available to assist with writing a plan. 3-Lack of business knowledge is reason enough to do it. The business plan is not for anyone but yourself unless you are trying to secure a loan for your clinic. So at this point business vocabulary is not the goal. At later point you can acquire help in changing the wording to secure a loan. 4-Money is not always the objective but without clear cut goals the likely-hood of success decreases, loss of money can bring a clinic down. 5-It can be Short and simple, it does not have to be some glorious plan, it is a work in progress, it will go through many changes and be updated frequently.
2-Business plan should include standards of care, and what you will do to keep patients happy and returning for care. 5-Too quick of growth can bring a business down as does not growing fast enough.
It is a single page. Using simple terms it is a miniature of your business plan for your clinical practice and is used to excite your reader about what are trying to do. If you are looking for a loan you need to say so in your executive summary. 1-Objectives: It is what you want to accomplish with your clinic. It is the who what when where why and how of your clinic. 2-Mission statement Reflect on your personal mission and what values are important to you and the care that you provide. Also include your target population and their needs. Ex. North Portland Nurse Practitioner Community Health Clinic “The clinics mission is to develop and maintain comprehensive pediatric health care for the diverse cultural groups residing predominantly in north and northeast Portland. We believe that health care is a right, not a privilege, and therefore services are based on need instead of geographic, ethnic, or socioeconomic boundaries.” Don’t make your mission statement too narrow you need room to grow. 3-Describe the services that you plan to provide along with any products 4- Short summary of the market needs that you plan to provide for. 5-the marketing strategies that you plan to employ. Including Advertisements. Except for the mission statement which will guide you through the process of writing your plan your Executive statement should be written last.
1-Sole proprietorship, partnership (individuals may be sued), Limited liability company (only the corporation may be sued), subchapter S (limited shareholders share holders individually taxed instead of corp.) or C (corporation is taxed and then listed on share holders income tax as schedule E, No limit on share holders) corporation. 2- history of cash flow, # of patient, if you are looking to expand your clinical practice, you need to have supporting data for expansion including, deferred patients, increasing need. 3--Start up cash flow, equipment, supplies, initial marketing, comprehensive business insurance, medical malpractice insurance, business lic. and expected patient flow for startup and approximation of new clients per month for beginning practice. ( Interview with Aaron Hartle, started with no patient base month of Oct had 128 new patients averages about 80 new patients a month). A medical clinic requires special permits to operate. A clinic needs to be registered with the state business registry. This ensures that the business name cannot be used by another business. Online registration is available and takes about 15 min to fill out depending on the complexity of the business. The fee is 22-52 dollars. To register a business you need to have a business name, Business type, Business location, Business activity type, Dates you will open, Name address, phone numbers, email, FEINs (federal employer identification number and SSNs, and a form of payment. 4-You need to know the location , size, and layout of your practice, is there enough parking and possible opening dates of the practice. Also surrounding businesses and traffic flow. Change #3 business lic. #4 is there enough parking
1-What services are you going to provide. On site labs, Paps EKG’s, Monospots. Etc. Special education programs. Certain diagnosis that you plan on providing particular services for. Preventative services, maintenance services. 2-How does this compare to your competition what services are being provided around you. 3-Provide service literature including pamphlets or handouts describing what it is that your practice will provide for the population. 4-What technology will you be using, or gaining during your practice (EKG Xray, Computer programs, etc.) 5-Where do you want your practice to expand in the future. Are you going add other equipment or practitioners for instance you may not start with an Xray machine Is this something you may want to add at a later time. How do you see your practice expanding.
1-What portion of the population will you be serving, family practice, pediatrics, women’s health. what are the unique features of your target segment of the population. How are you best going to serve them. It is estimated that 1 PCP is needed for every 2,000 residents. 2-Is there a niche in the market hasn’t been met before. is it a sub-specialty or disease process that you are embracing. 3 Long term trends ex prices increasing, pharmaceutical companies, suppliers, How are hospitals growing. Is this going to pull from your clinical practice. Decreases of general practitioners, is this going to help or hinder your practice. Will this cause fragmented care. What will the outcome be? House calls are increasing, is this going to be another niche to look into. What is the public opinion and education about nurse practitioners. What is the general consensus about nurse practitioners and the care; 4 with increasing financial strain will they continue to see general practitioners or only seek health care under urgent conditions. 5-Are you in an area where the health care is expanding. What is going on in the industry around you. Pay attention to hot buttons in health. Political awareness and the effects it will have on your industry. 6- other practitioners, pharmaceuticals, educational facilities, realtor, and the availability of nurse practitioners from educational facilities: how will this effect your practice and how do you address it. 7-Are all providers offices in a central location are there areas where there are fewer providers located where it would be more beneficial. Also look at the distribution of the population around the area.
1-Right now finances are low so now people will limit things by choice. So do you provide value. 2-How many providers are already in the area. Are the practices full. Is there more room for growth can you show a need. 3-How many clients do you already have. How fast are you predicting growth. Increasing or decreasing pt #’s, how is this going to effect your practice. What if things went really bad or really well, how will you handle each situation and what is the best guess for what will really happen. Be realistic about your growth because nothing sells a business better to bankers than realistic numbers. 4-Referral plans and collaborating practices. How will you make referrals and who will you be collaborating with. What alliances have you formed and what are their strengths and weaknesses. How available are they to you. 5- External- things you have no control over. Ex. How are hospitals growing, malpractice insurance changes and litigation, Nurse practice act, increasing or decreasing population, trends on health insurance, standards of care, Internal- things you have control over. Own education, employees, availability How do you capitalize on strengths and minimize weaknesses. 6- different types of marketing include word of mouth, billboards, media advertisement, flyers, telephone directory, web page advertisements, press releases, trade shows, newsletters, community involvement, networking, grand opening, professional organization involvement, direct mailings, novelties, and signs for your practice. All signs should include name of practice and phone number being legible from the street ( Aaron HArtle has found that word of mouth advertising is great it just goes slow, he works in conjunction with a pharmacy they put a magnet in each rx bag with his clinic contact information on that has also worked well. Special promotions like offering the flu shot for less and contacting schools offering sport and scout physicals for $15 a piece gets the family in to see the clinic. Aaron’s experience with paper advertising was that it is very expensive and does not work.) There are ways to get more out of your word of mouth advertising Things to include in advertisements: photos, office location with map, hours of operation, Insurance and HMO programs, special procedures, contact info, your website
1-Do you want a website for your practice. May expand your image. Know what you want to include on your website. How interactive do you want it. Things that need to be included in a health care web site are: contact info. Emergency info. Credible links to health info websites. Office location, hours, Services provided and brief bibliographies of the providers. Budget for ongoing updates and make it easily found for a reasonable fee and search engine friendly. Log on regularly and evaluate the content for updates. 2-Can you do it yourself or do you need to hire someone to assist you with this endeavor. Do you have the budget to do this. This is one area where friends and family can be a great asset in assisting with set up and save you money if they have website know how.
1-What kind of employees do you need? 2-Are you going to hire a business manager, accountant, etc. Or are you going to use Outsourcing as part of your business strategy. Growth may change it. Nurses or MA’s 3-Other assisting personnel, receptionist, etc. Is there tasks that wont be completed with the job descriptions you have provided. Where are the gaps. Arrange to fill them by reevaluating your job descriptions. 4-Job descriptions. Include plan for growth and continuing education. Make it easy to understand, with a clear scope of responsibilities. As you write your job descriptions be familiar with legal scope of practice and follow it carefully. Have a plan for employee evaluation and keep records of those evaluations.
1-Pt flow, growth of company, 2-Divide costs into fixed and variable costs. Fixed: costs that will stay the same no matter how many patients you see. Rental of property, malpractice insurance, utilities, employee costs, Variable: related to each visit. Average cost of supplies per visit, income per each visit and subtract variable cost divided into overhead or fixed cost to show how many patients you must see to break even. 3-You need to have set goals and reevaluation dates in order to assess progression of your clinic and encourage longevity.
Gives a layout of typical business plan with guides of what information is needed Organization created by retired business executives in order to assist others with their business endeavors. You can email in questions and receive answers back. Also including business plan guidelines and advise on the website. Definitely an advertisement but good for initial look and information on business plans with a sample business plan outline. Includes blog spot specifically for Np entrepreneurs.
Creating a Business ..
Creating a Business Plan for Clinical Practice By: LeeAnn Klemetson BSN RN Lindsay Holt BSN RN
Introduction <ul><li>The purpose of this presentation is to take you through the steps of constructing a business plan for creating a nurse practitioner clinic including reasons for generating a business plan and overcoming the most common excuses. </li></ul><ul><li>The number 1 reason for business failure is lack of a business plan. </li></ul><ul><li>Starting a clinic can be an overwhelming task and by using a business plan the work is broken down into manageable steps. </li></ul><ul><li>A business plan is the foundation for which you build your business </li></ul>
What is a business plan? <ul><li>A strategic plan of a clinical practice that details the set up, goals, and expectations of your clinic. </li></ul>
Excuses for not creating a business plan. <ul><li>Time </li></ul><ul><li>Fear of Failure </li></ul><ul><li>Lack of Business Knowledge </li></ul><ul><li>Fear of Money </li></ul><ul><li>Fear of Undertaking a Huge Project </li></ul>
Why create a business plan? <ul><li>Avoid the primary cause of most business failures. </li></ul><ul><li>Understand the needs and wants of target market. </li></ul><ul><li>Get a jump start on the competition. </li></ul><ul><li>Choose the right avenue of care or niche in the market. </li></ul><ul><li>Hire and maintain the right staff. </li></ul>D'Angelo, J. M., 2007
Why create a business plan? Cont. <ul><li>Address problems before they arise </li></ul><ul><li>Maintain a solid patient base </li></ul><ul><li>Develop a solid financial plan </li></ul><ul><li>Build a marketing program that will drive business </li></ul><ul><li>Keep your business from growing to fast </li></ul><ul><li>Securing a business loan </li></ul>
Key points of a business plan: <ul><li>Executive Summary </li></ul><ul><li>Company description </li></ul><ul><li>Product or health care service </li></ul><ul><li>Market analysis </li></ul><ul><li>Strategy and implementation </li></ul><ul><li>Web plan summary </li></ul><ul><li>Management team </li></ul>
Executive Summary <ul><li>Objectives </li></ul><ul><li>Mission statement </li></ul><ul><li>Health care service and products </li></ul><ul><li>Market analysis </li></ul><ul><li>Strategy </li></ul>
Company description <ul><li>Ownership </li></ul><ul><li>Company history for ongoing clinics </li></ul><ul><li>Startup plan for new clinics </li></ul><ul><li>Clinic location and facilities </li></ul>
Product or Health care service <ul><li>Health care service description </li></ul><ul><li>Competitive comparison </li></ul><ul><li>Service literature </li></ul><ul><li>Technology </li></ul><ul><li>Future services </li></ul>
Strategy and Implementation <ul><li>Value proposition </li></ul><ul><li>Competitive edge </li></ul><ul><li>Sales forecast </li></ul><ul><li>Strategic alliances </li></ul><ul><li>Strengths and weaknesses </li></ul><ul><li>Marketing </li></ul>
Web plan Summary <ul><li>Website marketing strategy </li></ul><ul><li>Development requirements </li></ul>
Management Team <ul><li>Organizational structure </li></ul><ul><li>Management team </li></ul><ul><li>Management team gap </li></ul><ul><li>Personnel plan </li></ul>
Financial Analysis <ul><li>Important assumptions </li></ul><ul><li>Break even analysis </li></ul><ul><ul><li>Projected profit and loss </li></ul></ul><ul><ul><li>Projected cash flow </li></ul></ul><ul><ul><li>Projected balance sheet </li></ul></ul><ul><ul><li>Income per visit – variable costs / into fixed costs= # of pts to be seen to break even. </li></ul></ul><ul><li>Long term plan </li></ul>
Help for writing a business plan <ul><li>www.score.com </li></ul><ul><li>www.bplans.com </li></ul><ul><li>www.nursepractitionerbusinessowner.com </li></ul>
Conclusion <ul><li>Take home message: </li></ul><ul><ul><li>A business plan is must and increases your chances of success </li></ul></ul><ul><ul><li>You have to put in the effort to do the research to formulate a good business plan. </li></ul></ul><ul><ul><li>Don’t be afraid to ask questions and use the resources available to you. </li></ul></ul>
Resources <ul><li>Berry, T. (nd). Bplans. Retrieved October 24, 2008, from www.bplans.com . </li></ul><ul><li>Building your practice through word-of-mouth referrals. (2008). Retrieved November 3, 2008 from http://www.nursepractionerbusinessowner.com </li></ul><ul><li>D’Angelo, J. M., (2007). Top 10 reasons for writing a business plan. Message & Bodywork. 122-126. </li></ul><ul><li>Danna, D., & Porche, D. (2007). Business plan: An entrepreneurial proposal. The Journal for Nurse Practitioners. 173-174. </li></ul><ul><li>Heiser, S. (2004). How to write a business plan. Professional Nurse. 19(12) 54-55. </li></ul><ul><li>Huss, W., Coleman, M. M., (2006). Start your own medical practice: What they don’t teach you in medical school. Sphinx Publishing, Naperville. </li></ul><ul><li>North Portland Nurse Practitioner Community Health Clinic, Mission statement. Retrieved October 28, 2008, from www.volunteermatch.org. </li></ul>
Resources cont. <ul><li>Marfell, J., Stone, S. (2008). Defining your mission statement. Advance for Nurse Practitioners. Retrieved October 28, 2008, from nurse- practitioners.advanceweb.com </li></ul><ul><li>Moore, P., & Dayhoff, N. E. (2005). Business plan development: The first step to building a successful cns business. Clinical Nurse Specialist. 19(1) 20-22. </li></ul><ul><li>SCORE, (2008). Business plan for a startup business. Retrieved October 23, 2008, from www.score.org . </li></ul><ul><li>Small business readiness assessment tool (2008). Retrieved November 10, 2008 from http://web .sba.gov/sbat/sbat/dsp_sbat.cfm?Tool=4 </li></ul><ul><li>US Department of Health and Human Services, (2008). Shortage designation:Hpsa’s, mua’s, mup’s. Retrieved October 24, 2008, bhpr.hrsa.gov/shortage/ </li></ul>
Resources cont. <ul><li>Online business registration (2008). Retrieved November 11, 2008 from http;//secure.utah.gov/osbr-user/user/whatdoineed.html </li></ul><ul><li>Zaumeyer, C. R., (2003). How to start an independent practice: The nurse practitioners guide to success. F.A. Davis Publishers, Philadelphia. </li></ul>