As someone who LOVES nurses and business, my sweet spot is nurses who want to grow their practice. While in a related Facebook group, I noticed Dr. Irene Bean and reached out for a quick chat. 

Dr. Bean is an American Association of Nurse Practitioner Fellow, Duke Johnson & Johnson Leadership Program Fellow, Founder of Tennessee Nurse Practitioner Association and CEO of Serenity Health Care, PC & Weight Loss Clinic. Our interview is below:

Please give us an overview of your nursing career

I'm a family nurse practitioner with 15 years experience. Prior to that, I was a registered nurse for 7 years. I now own a family practice in Madison, Tennessee and I'm also the founder for the Tennessee Nurse Practitioner Association.

What I do is advocate for patients, as well as nurse practitioners. My goal is to advocate for patients and to be aware of changes which may affect them. It’s extremely important for a practice or the leader of a practice to understand changes which are evolving for business owners and their medical facilities.

Recently I read an article from ModernHealthcare.com related to MARCA changes. It mentioned that nurses may not be as aware of certain changes as compared with physicians. The article can be found here.

What are your are your thoughts on the comment that nurse practitioners may not be as aware as physicians about changes that impact their practice? 

Personally, I despise that comment. I think practitioners are extremely aware of what’s going on around them. I have a problem with generalizing practitioners, because when you are a nurse practitioner or an owner of a practice, it is your obligation to understand all of the information which revolves around CMS especially when accepting insurances.

If you are not aware of regulations which affects you as a provider, or unaware of your revenue, then your goals will not be as ambitious. Not all nurse practitioners, are aware of changes and challenges, possibly because they are not included in decision making, in some of the practices. For example, those who are employed by larger practices are provided limited information.  However, it remains their responsibility to stay abreast of regulations which affects them as a provider.

There are companies which require practitioners to service 30-40 patients per day.  CMS guidelines may not directly impact these practitioners because they are employed by larger companies.  Many large companies do not disseminate much of the changes to the employees because they may feel that the information does not pertain to the staff.  However, when employed by these companies, nurse practitioners are not “invited to the table”.  They are usually the last to know, unless they are determined and independently researches the changes.   

What do you think about the access we have to information now versus 4 or 5 years from now?

Information is readily available and accessible today, more so, than 4 or 5 years ago.  We have access to the internet, social media, and professional journals which may be as close as your smartphones.  The informational highway is much more accessible and you do not have to leave home.  But, if the provider is unwilling to research evidence-based practices, then, he/she is doing themselves and their patients a disservice.

There are so many avenues of information that are available to for anyone. Google is every man’s best friend and even patients. Everyone googles everything. So if there's anything which you are concerned with or any information which you feel that you need to be a great provider, then the information is available for you. I agree that there are various ways to pursue information which is vital for your practice.

What are your top three sources of information that you look at every day or week to stay up to date?

My personal choice of information to review on a daily basis is CMS website.  This site identifies information pertaining to insurers, guidelines for billing and coding, MIPS, and chart audits.   CMS has great resources.

The second source is the state Medicaid site.  The State Medicaid reinforces what is on the CMS website, in addition to focusing on federal guidelines, there are areas which pertains to Tennessee, only.  The information is readily available for all who seek assistance from the state plan.

Another resource is the Blue Cross and Blue Shield site. BCBS has a large visibility in the state of TN.  Many of their regulations mimic those of CMS and State of TN Medicaid Program.  

The billing component of a practice is extremely important. Each of the resources listed, gives a synopsis of what and how you should code.  Each provides details about when it is appropriate to use the CPT codes 99211-99215.  

There are companies getting into healthcare who connect that piece between patient’s information at home with a clinical team to make decisions. What are your thoughts on payments for such solutions that would help the nurse practitioner in care coordination and where is payments for those solutions coming from now?

Home health care, concierge services, and telehealth are growing in the healthcare industry.  These services allow healthcare professionals to reach patient who are in rural areas of and cannot access quality health care.  This is an advantage for both the patient and provider.  The delivery of this type of care engages the provider with a community which may otherwise not receive healthcare.  It is great that most insurances are reimbursing providers who offer this service for patients.  

For the past few years, the insurance companies are offering annual exams at the homes of the patients.  These exams allow continuity of care for the patients who are noncompliant with medications and office visits, preventative services, and vaccinations.

The concierge services are widespread. These services will provide services wherever a patient prefers. The patient is responsible for the payments for these services.  

Do you see insurance companies paying for these monitoring system solutions or do you know practice owners who are paying directly?

 Dr. Irene Bean, DNP, APRN, CME, FAANP,  Duke Johnson andJohnson Fellow

Dr. Irene Bean, DNP, APRN, CME, FAANP,  Duke Johnson andJohnson Fellow

No, I do not anticipate insurance companies paying for the monitoring systems, unless there is an available grant.  There are companies which are providing applications (Apps) on smartphones and HIPAA ready video connections.  Larger telehealth companies are utilizing monitors and wireless devices to access patients in various communities.   

Tell us a little bit about your upcoming events.

The Tennessee Nurse Practitioner Association will host our 3rd Annual Statewide Conference on March 27-30, 2018 at the Omni Hotel, Nashville, TN. The keynote speaker for the conference is Dr.  Margaret Fitzgerald.  She is an author, entrepreneur, and has been instrumental for thousands of RNs and APRNs who have taken and passed their boards with her certification examinations and practice preparation.  Also, Wendy Wright who is a National Speaker and have also prepared APRNs for certification will be our guest speaker.  Dr. Penny Jensen, DNP, advocated full Scope of Practice within the Veterans Administration. She is the former President for American Association of Nurse Practitioners and continues to advocate on behalf of 243,000 APRNs.  Dr. Dawn Vanderhoef, Director of Psychiatric Mental Health for Nurse Practitioners at Vanderbilt will provide a session on Mental Health, Dr. Tearsanee Davis, from Mississippi, will provide a session for telehealth, and Barbara Phillips will host a live workshop on how to “Start, Operate, and Grow Your Own Practice” and a host of other guest lecturers.

If you’d like to attend the conference, please register at www.tnnpa.com.  Students are also encouraged to attend for a great discount.

The Business of Product Design

Design Your Ideal Solution! 

Our guest on today’s podcast episode is Sarah Mott, founder of Nurse Born Products and inventor of the Koala-Qlip stethoscope holder. After carrying her stethoscope around her neck contributed to her neck pain and headaches, Sarah decided to look for a clip that would attach to her scrubs and carry her stethoscope.  Through her research, though, she found that no such product was on the market, so she decided to pursue inventing one herself.  


Sarah has worked with many resourceful and innovative nurses, and she even carries some of their products on her website.  Her advice to anyone looking to manufacture their invention is to first find a patent attorney to guide you through the process of creating a prototype, commissioning drawings of your product, and drafting non-disclosure agreements to be signed by anyone you deal with during the patenting process.  Second, commit some time to touring manufacturing facilities to learn the “manufacturing lingo” and the ins and outs of the manufacturing process so that you are well-educated when it comes time to choose and sign a contract with a manufacturer.


To learn more about Nurse Born Products, follow them on Facebook, Twitter (@nurseborn), and Instagram (@nursebornproducts), and join Sarah’s Facebook group “Nurse’s Club for Business” to network with other nurses involved in business endeavors.


The Business of eCommerce

The Business of eCommerce

I Didn't Know About eCommerce, But This What I am Learning....As a nurse who needed to explore other income options, the learning curve was steep. Add to these learnings, new tech stuff and many can get scared off from even starting. This year I have plans to do a better job of sharing what I have learned so far. 

First up are helpful tips courtesy of Dante Godfrey and William Harris.

The Business of the Quadruple Aim

I first met Asha Gaines on Twitter and connected on LinkedIn. After a few conversations, I finally was able to convince her to share with me her views on the Quadruple Aim

What problem related to healthcare delivery are you passionate about solving?

Medical error is the 3rd leading cause of death in our country. Misaligned incentives are the central dysfunction of our healthcare system. My mission is to accomplish the Quadruple Aim which is to improve the patient experience, to optimize patient outcomes, to lift the clinician experience and to decrease per capita health costs. If our country can align interests to build a workflow that lands a rover on Mars, surely we can find the will to accomplish these 4 healthcare aims and align incentives for Population Health.

When did you see this problem as a problem that needed to be solved?

On day one of my nursing career, 21 years ago I knew my idealized view of care was not the reality of practice. As a healer, I knew the healthcare system was not producing overall healing. This creates a cognitive dissonance or moral distress that leads to feelings of sorrow and grief and contributes to the epidemic of clinician burnout. Accomplishing the Quadruple Aim will return the joy back to healing and healthcare for millions of clinicians.

When did this problem seem like it was bigger than you?

I observed system error after system error, and as a bedside nurse, I saw no viable pathway to fix the root causes of the complex system dysfunction. Misaligned Stakeholder incentives produce sub-par health outcomes because of competing interests. The patient's best outcome should always be at the center of the care we deliver. Nurses are trained to provide whole-person, patient-centered care and are positioned well to offer needed insight as we pivot into new Value Based models of care that create Population Health.


Why do you feel you are uniquely postponed to address or give voice this problem.

I am a change agent. Disruption does not scare me, in fact, I welcome it. It is the pathway to transformation. My outlook has impacted personal choices I have made to the surprise of many loved ones. The journey has not been easy but wholeheartedness is worth the price paid. Purpose, connection to our passion and commitment to self-care produces a power that can move mountains. Breakthroughs often follow the breakdown. I see the Value-Based Care journey similarly. This endeavor will be hard, and we will make mistakes along the way, yet if we remain mission-focused and align incentives to create Population Health, we can manifest transformation that is worthwhile. 

Thank you for sharing that. Tell us more about your thoughts related to preventing illness vs predicting illness?

Healthcare is undergoing a transformational shift in mindset from one of reaction to pro-action. We are also in the midst of a digital revolution. These 2 trends will change everything. AI, Blockchain, and other technologies will allow us to predict risks and prevent potential co-morbidities, through the use of holistic data sources and a robust analytics platform that connects the dots and generates insight. Clinical care accounts for 20% of overall health outcomes, yet we spend 88% of healthcare dollars on clinical care. Restoring this imbalance includes focus on health behaviors, social determinants of health (SDoH), and the physical environment. The Quadruple Aim is a useful framework to develop a plan of action to more effectively cultivate opportunities for health and wellbeing.

What if, any the concern is there related to patient outcomes impacting hospital incomes?

Population Health intersects at the corner of outcome and income. It aligns economic incentives around health outcomes. The income of healthcare organizations will be dependent upon the outcomes it achieves. Cost visibility across the care continuum and transparency are a vital part of achieving the Quadruple Aim. Population Health will require all healthcare stakeholders to be more cost-conscious, internally aligned and to operate with a dynamic governance strategy.

Waste, Fraud and Abuse- Are these topics related to care giver burn out? What are your thought related to these topics?

The IHI (Institute of Healthcare Improvement) estimates that between 27%-41% of healthcare is waste, fraud or abuse. This country spent 3.4 trillion dollars on healthcare last year. That is almost $10,000 for every person in the country, and  $2,700- $4,100 is estimated as WFA. It is no wonder that the health outcomes we achieve are often subpar as compared with other industrialized countries in the world. As the conductors of the healthcare system, nurses are in a prime position to identify issues of WFA. We are intimately aware of the waste encountered in the system, and we are an untapped resource in building more efficient, effective and innovative solutions.

What has been the most rewarding thing about using social media for professional use?

Information is now democratic. It is open and available to anyone with a thirst for knowledge and understanding. I have cultivated a dynamic pop health social network that provides varied healthcare opinions and insights and yields a continuous learning environment. I curate content from my network to share with others because collaboration, connection, and cooperation are the only pathway to accomplishing the Quadruple Aim.


What would you say are the five important resources ( books, conferences associations) for a nurse who wants explore more on the topic?

IHI, RCA (Right Care Alliance), New England Journal of Medicine NEJM, "American Sickness" Rosenthal, "Why Hospitals Should Fly" Nance, Follow healthcare influencers on social media,

What would you like others know about what you do?

I seek to transform healthcare by using my nursing lens to optimize health outcomes. If we can build a workflow that lands a rover on Mars, surely we can design a workflow that accomplishes the Quadruple Aim. Workflow redesign is the heart of healthcare transformation. Let's dream fierce dreams, and work to manifest them into reality. An equitable learning healthcare ecosystem connects the dots across the care continuum and aligns incentives for Population Health. Collaboration, connection, and cooperation centered around our patient’s best outcome. This is the pathway forward. Onward-Forward. #OutcomeEvangelist


The Business of Fertility Education

Thanks to a generation who grew up with social media, more of us are sharing challenging parts of our life. In my own circle, I am learning how many in my age group under 34 are struggling with matters related to Fertility.

There are also unique challenges for moms over 35. What if there was more credible information out there about this topic? Nurses are the largest healthcare workforce and we live in community with women who are facing these challenges. What if more nurses were empowered to educate others about this topic?

Let's talk about how Monica Moore Nurse Practioner has been skillfully addressing this most complex challenge. 

What is your company name?

Fertile Health

What problem does your company solve?

Fertility Nurse education and enrichment.

When did you see this problem that needed to be solved?

20 years ago

Did the problem seem like it was bigger than you?

At times, but feel like I can make a difference.

How did you know you were uniquely positioned to solve this problem?

[I am ] passionate about education and feel that I have the ability to simplify complex processes.

What if, any, concern is there related to nurses not knowing about non-traditional roles?

I think the ability to continue and progress in current or different role is empowering.

Some say, "It's not what you know, it's about who you know". In terms of developing business relationships, do you agree with that statement? Please explain your rationale.

Yes, most of my referrals are word of mouth. I know that I am good at what I do, but need to meet the right [people] who are willing to take a chance on me and my services.

What was the process of moving away from the in clinical role into a business role?

I realized that I was becoming the go-to person for educating nurses, so decided to expand that role [ that is being the] go to person for educating nurses, so decided to expand that role.

What has the hardest thing been in starting in your specific type of business?

How to market myself and accounting and legal intricacies.

What has been the most rewarding thing about being in your type of business?

Love getting feedback. Nurses telling me that they wish they would have met me earlier...etc.

What would you say are the five important resources ( books, conferences associations) for a nurse who wants explore Business?

NNBA, entrapeuneur magazine, presentation blogs, ASRM (for fertility nurses)



What would you like others to know about what you do?

I am trained as an NP in women's health and worked in infertility field for 20 years. My company, Fertile Health, was created to educated and enrich nurses in fertility field. Will be at NNBA conference in November.