Module 2 Step 4 – Determine a type/location for your business Brick and Mortar The traditional and most common healthcare practice has a physical building that patients will visit for healthcare services. Therefore, this practice will have a physical address. The location of the practice may be a standalone building, in a strip mall, an office building, or in one’s home. Locations can even be associated with other businesses such as shopping malls, department or grocery stores, or even cosmetic or barbershops. Telehealth             A telehealth practice allows the NP to visit with their patient electronically using computers and cellphones. Though not a new approach, the response to the epidemic has brought telehealth practice to the forefront. Telehealth practices allow the NP to treat patients from their home or office without having to travel. You can find a comprehensive description of telehealth can be found here (Brewer, 2021). https://www.npschools.com/blog/day-in-the-life-of-a-telemedicine-np Home Health Nurses have traditionally gone to patients’ homes providing home health care services. Therefore, establishing an entire practice where the NP offers services going into the patient’s home and giving healthcare is another option. Note: A consideration with telehealth and home health practice will be what you will use as your business address. If you choose to use a home address and prescribe controlled substances, the DEA will have the right to inspect your home, so consider this with caution (DEA, 2021).  Step 5 – Choose a legal business structure A business is any activity that is designed or entered in the hopes of making a profit (Hill, G., & Hill, K., 2021). Choosing the correct business legal structure is paramount because it is complicated to change once established and identified legally. There are many forms of business structures for healthcare practices.  These include: sole proprietorship general partnership limited partnership limited liability company (LLC) C corporation (standard corporation) S corporation limited liability partnership (LLP)   Though a healthcare practice can be a sole proprietorship, it is advised not to take this approach due to the many reimbursement parties such as insurance companies. These third parties often only do business with companies and not individuals. There are other considerations to ponder with a tax and legal specialist, including: Potential risks and liabilities of your business Costs and administrative requirements of maintaining the entity Limitations on the number of owners Permanence and transferability Tax ramifications of the entity; and Tax ramifications and benefits to the owner Here is a deep dive into the legal forms of healthcare practice and considerations (Medscape, 2021): https://www.medscape.com/courses/section/870049 Additional information is available from the Small Business Association (SBA, 2021): https://www.sba.gov/business-guide/launch-your-business/choose-business-structure The Texas Secretary of State website gives Texas-specific information of business structure (2021): https://www.sos.state.tx.us/corp/businessstructure.shtml The following is a Nurse Practitioner specific discussion (Hofmann, n.d.): https://npbusiness.org/choose-legal-structure-practice/             Once the business structure is determined, there are different ways to establish the business. The most assured, though the more expensive route, is to hire an attorney to file the appropriate documents to the Secretary of State providing you with the documents and instructions to maintain your business legally. It may also be completed on your own using online packages such as (Legalzoom, 2021):   https://www.legalzoom.com/business/business-formation/             Part of the process of legally establishing the business will be the application for an Employee Identification Number (EIN). Also known as a Federal Tax ID number, an EIN is a unique nine-digit number that identifies your business for tax purposes (Nwatu, 2016). The sole purpose of the EIN is to identify your business for tax administration for your business. You can apply for an EIN here: https://www.irs.gov/businesses/small-businesses-self-employed/employer-id-numbers Step 6 - Secure funding for your business There is no doubt that starting a medical practice can be expensive. The startup will need funds throughout the process. Securing these finances can be a challenge. Sources of finances include self-funding, loans, and grants (How to start a nurse practitioner private practice, 2020). Self-funding: Funds collected through personal savings, friends, or family. This option gives you the most significant control over your nurse practitioner private practice but comes with considerable risk. Loans: Money provided by banks and credit unions. With a loan, you’ll retain complete control over your practice.   The Small Business Association (SBA) can guarantee loans for small businesses. https://www.sba.gov/funding-programs/loans There are pros and cons to consider with SBA loans. A discussion about SBA loans is available: https://www.lendingtree.com/business/sba/pros-and-cons-of-small-business-administration-loans/ Small Business Grants: Grants can also help you meet your operating costs. Many organizations offer grants, including the federal government. The Office of Management and Budget administers a searchable database of discretionary funding opportunities from federal agencies. www.grants.gov The Health and Human Services Administration has an extensive list of grants available for application: https://data.hrsa.gov/tools/find-grants Here is additional information, and advice for nurse practitioners funding a new practice (Hofmann, n.d.). https://npbusiness.org/finance-practice-startup-growth/ Obtaining the resources for starting a healthcare practice can be a challenge. Many believe they can never start a business because they do not have the money. Additional resources are available, such as borrowing from friends and family, crowdfunding, or even working with angel investors and venture capitalists (Gibbons, 2020).           Step 7 - Set up utilities for the business. Depending on the type of business chosen to practice, your facility will have basic service and utility needs. Telephones- Communication is necessary, and a potential customer/patient will need to connect with you or your office. There are many options to consider. Cell phone - A cell phone is a must for proper communication. Landlines – though a dwindling technology, phone companies provide a phone connected to specifically purposed wired telephones. VOIP – Voice Over Internet Protocol uses newer technology, connecting phones through internet lines. An internet connection is required, along with a VOIP service provider. Ethernet cables connect phones to the internet.            An in-depth discussion of the many options of business phones is available in this article on Business.com (Freedman, 2021): https://www.business.com/articles/need-a-business-phone-number-but-not-a-business-phone/ Answering Machine: Patients will need to know what to do if they cannot immediately contact you via a phone call. A simple message on your phone system is adequate as long as clear directions are available, including what to do in an emergency, and gives clear instructions of their next option. Including your cell phone number on an office phone message is an option but could potentially lead to unwanted calls during your personal time. The following article gives reasons not to provide your cell phone number and what options to use otherwise (Robbins, 2020): https://www.mightycall.com/blog/avoid-using-a-personal-cell-phone-number-as-a-business-line/ Answering Service – A paid service that receives after-hour phone calls, prioritizes messages and sends them to your personal phone. This minimizes after-hour interruption by filtering incoming calls by preset parameters allowing only specific calls to get to the provider. There are many options for answering services (Watts, 2021): https://fitsmallbusiness.com/best-answering-service/ Water- Establish an account with your local municipal district to provide water and sewer services to your facility. Electricity - Establish an account with a local electricity provider to initiate and maintain electricity at the business. Internet – Health care practices will need internet services.  Your office will use the internet for access to the world wide web, VOIP, and Fax. In today’s healthcare offices, internet access is essential. Choose a local internet provider to obtain and maintain your internet access. Step 8 - Equipment: computers, fax, health care equipment. Computers Using computers to document the events of the visit is necessary from the receptionist to the biller. Today's desk and laptop computers have adequate power and capacity for modern office and mobile healthcare platforms. Discussions about considerations of operating systems, types of electronic health records, office networks, can be found here (O'Flaherty, 2017). https://pauloflaherty.com/2017/07/06/buying-computers-for-medical-practice/ Each office is unique, and it is possible to be a one-person healthcare office that uses only one computer. More employees and computers will be needed if a high volume of patients is necessary to make the practice successful. The receptionist, triage nurse, provider (laptop and desktop), referral/telephone nurse, biller, and office manager will need a separate computer. The six-employee office scenario requires seven computers. Fax The use of fax machines persists despite the modernization of the healthcare office. Though not the traditional fax machine, most offices use scanners and electronically fax through a fax service or email. Tom’s Guide is a helpful website that routinely monitors and ranks software and lists the top online fax services (Perenson, 2021). https://www.tomsguide.com/us/best-online-fax,review-2124.html Scanners Where the fax machine is moving to extinction, the scanner is quickly taking its place. Though the dream of a paperless office was very bright, its reality was much more brutal to meet. Paper documents exist with almost every interaction. Ensuring that the paper is electronically stored is the job of the scanner. PC Magazine is another online site giving up-to-date information about office electronics (Hoffman, 2021). https://www.pcmag.com/picks/the-best-scanners Health Care Equipment The type of peripheral equipment a healthcare office may have will depend on the provider's specialty of service and the expense they are able and willing to pay. You can obtain medical supplies and equipment from various sources, including medical office suppliers, equipment from other medical offices, and even on eBay or Amazon. Examples of healthcare equipment include:   EKG  Spirometry Wound care instruments Autoclave  AED   Find an extensive and comprehensive list of healthcare equipment to be considered here (CME Corp, 2021).   https://blog.cmecorp.com/a-quick-check-list-of-medical-equipment-items-for-your-primary-care-practice   References: Brewer, B. (2021). A day in the life of a TELEHEALTH nurse practitioner - duties & team. Retrieved September 13, 2021, from https://www.npschools.com/blog/day-in-the-life-of-a-telemedicine-np DEA, 2021. Authority to make inspections. Title 21 Code of Federal Regulations. ADMINISTRATIVE FUNCTIONS, PRACTICES, AND PROCEDURES. §1316.03. Accessed 06 Oct 2021 at https://www.deadiversion.usdoj.gov/21cfr/cfr/1316/1316_03.htm Find Grants - Search HRSA Awarded Grants. (n.d.). Retrieved September 20, 2021, from https://data.hrsa.gov/tools/find-grants Freedman, M. (2021, July 16). Need a business phone number, but not a business phone? Retrieved September 21, 2021, from https://www.business.com/articles/need-a-business-phone-number-but-not-a-business-phone/ Gibbons, S. (2020, October 20). 7 obstacles that prevent people from starting businesses (and how to overcome them). Retrieved September 14, 2021, from https://www.forbes.com/sites/serenitygibbons/2020/10/20/7-obstacles-that-prevent-people-from-starting-businesses-and-how-to-overcome-them/ Grants.Gov - Find. Apply. Succeed. (n.d.). Retrieved September 20, 2021, from https://www.grants.gov/ Hill, G., & Hill, K. (2021). Legal dictionary - law.com. Retrieved October 06, 2021, from https://dictionary.law.com/Default.aspx?selected=111 Hoffman, T. (2021, July 16). The best scanners for 2021. Retrieved August 15, 2021, from https://www.pcmag.com/picks/the-best-scanners Hofmann, J., MBA. (n.d.). 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Retrieved September 20, 2021, from https://www.lendingtree.com/business/sba/pros-and-cons-of-small-business-administration-loans/ Medscape, (2021), Legal Forms of Organization for a Medical Practice. Retrieved October 06, 2021, from https://www.medscape.com/courses/section/870049 Nwatu, I. S. (2016, June 15). What is An EIN and Why Is It Important? Retrieved October 06, 2021, from https://www.sba.gov/blog/what-ein-why-it-important O'Flaherty, P. (2017, July 06). Things to consider when buying computers for your medical practice. Retrieved August 15, 2021, from https://pauloflaherty.com/2017/07/06/buying-computers-for-medical-practice/ Perenson, M. (2021, July 28). Best online fax services for 2021. Retrieved August 15, 2021, from https://www.tomsguide.com/us/best-online-fax,review-2124.html Robbins., J. (2020, December 1). Six reasons to stop using your personal personal phone for work. 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