[00:00:01] Speaker A: Welcome to Real Medicine real lives. I'm Dr. Yasser Sombal and together we're showing medical expertise in a human way.
Hello everybody and welcome to Real Medicine Real Lives, the show that brings medical expertise to life in a human way, connecting what's happening in healthcare to what patients and families feel every day. I'm Dr. Yasser Sombal and I'm your host. Today we're talking about a group that's quietly reshaping access of outcomes and innovation across the country. Nurse practitioners, not only as clinicians, but as founders, leaders and policy drivers.
Joining us are two powerful voices. Dr. Lorraine Bock has been a nurse practitioner since 1994, certified in both family and emergency care, and an independent practice owner since 1999 with advocacy that helped change policies so nurse practitioners can be recognized and paid directly by insurers.
And Dr. Lynn Raplesper, a nationally recognized expert in coding and documentation, founded NP Business Consultants LLC and leads major policy work through AANP while building nurse practitioner led models like Nurse Practitioner Wellness Care llc.
Together they are the co founders of nnpen, supporting nurse practitioners and entrepreneurs and expanding patient access through smarter systems.
Welcome both of you to the show today.
[00:01:29] Speaker B: Thank you.
[00:01:30] Speaker A: Thanks for coming on. So nurse practitioners are clearly often the front door to care and they're all over hospitals, practices, et cetera. I mean I know I used to have one and it was probably the best thing that I best year of my practice to be honest.
But many patients don't realize how much nurse practitioners actually influence practice models, businesses and sustainability and actually access to treatment in underserved areas.
This segment frames the guest origin to stories why nurse practitioners led Innovation Matters. Right now, both of you have long clinical careers and what moment made you say we need to build something bigger than just the exam room?
So I'll throw that out there. You can both answer independently.
[00:02:18] Speaker B: So for me it was the fact that the physician that I was working with became ill and we had a large practice and someone needed to take over the care for those patients. And so I ended up opening a practice so that the patients would have care in a place where they felt comfortable where they were, were comfortable with the providers, they knew the policies of the practice and what have you.
And that's what threw me into it was I needed to have a job and the doc was going to have to retire because of his illness.
[00:02:56] Speaker C: In my experience with nurse practitioners in the coding and billing space, I recognized that we needed business education because our education and training trains us to be nurse practitioners. But it doesn't train us to be business owners.
So there was a need marry the clinical side with the business side. And thus we founded the National Nurse Practitioner Entrepreneur Network.
[00:03:19] Speaker A: Gotcha. That coding is really important. You probably should teach a lot of physicians how to do that as well.
So, Dr. Bak, you've been a nurse practitioner since 94 and an independent owner since 1999.
What did the early days of practice ownership teach you about what patients actually need?
[00:03:38] Speaker B: But what patients really need is someone to listen to them. One of the things that I think we offer as nurse practitioners is the ability to look at the whole person. We aren't focused on a disease process. We aren't focused on a medical treatment. We're focused on the patient, their lives, their community, their family, and how their illness impacts all of that together. Because that's what happens to people. They don't become an isolated medical problem. They become a person who's ill in their life, and you have to look at that whole thing, and that takes time. They want to sit down, they want to talk to you, they want you to listen to them, and they want you to try and understand what's going on with them.
[00:04:21] Speaker A: Yeah, I completely agree. I mean, I think patients really feel like we're rushing them through all the time, and part of that is just, unfortunately, the models we all have to work under and the demand that we need. But I agree, it's really important to give patients the time that they deserve when they're in the room.
I think, clearly, nurse practitioners do that a lot better than we as physicians do, for sure.
But I completely agree with you, Dr. Rathlisber.
You became known for reimbursement, coding, and documentation.
What's the biggest myth clinicians believe about billing?
[00:04:57] Speaker C: The tough part about billing is making sure that your documentation supports the level of service that you're providing for your patients. I think that's the key. And again, we do not get business education. We don't get the coding and billing training, and many of us have to learn it on the job. So it becomes important for the clinician to really know how to utilize those codes. And certainly for a nurse practitioner, when we spend more time with the patients, we can utilize a lot of additional ways to document and bill for the services that we provide our patients so we can give them the time they deserve.
[00:05:30] Speaker A: And so, you know, I think you bring up a good point. And when you talk about providing the service or, you know, documenting the service that we're giving, et cetera, you know, I mean, I think a Lot of times we as clinicians, I mean, I'm guilty of this as well. And so what would you say would be a good way for us to say, you know, I feel like I say things the way I practice. Right. And so a lot of times it's not up to code to what the insurance company does. And so what recommendations would you have for people as myself or other nurse practitioners as far as improving that and any resources they may be able to go to to figure that out?
[00:06:12] Speaker C: That's a great question. And certainly technology can help us be better clinicians by allowing us to be able to document the care that we're providing for our patients. So AI scribing it really takes away the opportunity or gives us the opportunity one on one time with our patients as it records the conversation and puts it together. We still have to review the information though. That's the key part.
And the other thing is documentation, including looking at templates and macros and dot phrases as ways to make sure we're providing that evidence base and not missing key points in our ability to bill for some of the services.
It decreases the opportunity for denials to happen.
[00:06:58] Speaker A: And do you think they put such a big emphasis on documentation?
Do you find that to be a big hindrance to patient care? To a certain extent,
[00:07:09] Speaker C: I think it was utilize the tools that can help you become a better clinician, you'll be able to increase your efficiencies.
And I do think that sometimes the electronic health records are not as user friendly for the clinician who is maybe in the outpatient and office space as it is for the hospital. So I think looking at technology, how can we improve it to provide all clinicians the ability to utilize the technology to make them more efficient and more providing better care for our patients overall?
[00:07:43] Speaker A: Dr. Bak, you were going to say something.
[00:07:45] Speaker B: Well, I think that the AI scribe is really important because we miss so much that we talk about with our patients. If we're just relying on our memory of the visit to talk to them, they might ask us a question and say, well, what about my kidneys? And then you go back and you review the lab report that you had from a month ago or two months ago or what have you. A lot of times that two second discussion about, well, your kidneys, this was this two months ago doesn't get documented in a regular note because it was one or two sentences. But that really does allow you to improve and elevate your documentation and your billing codes because you're reviewing lab results with the patient and I think AI Scribes really help to make sure that it captures everything that you covered in the visit. If you're talking about the fact that they had to care for their ill mother or they were stressed out because something happened at home, that stuff oftentimes never got written when we were just doing manual documentation. And with AI Scribe, it gets put in there in such a way that it shows the complexity of what you're dealing with with that individual patient at every visit.
[00:08:54] Speaker A: Got you in the last couple of minutes. I'd like to give you each a chance to talk to us about why you built this national Nurse practitioner entrepreneur network and really what gap were you looking to close in healthcare with it.
[00:09:10] Speaker C: I think the biggest reason for starting NNPENN was the fact that Sandy Berkowitz, our original, really saw the need for nurse practitioners to start to be opening practices and she put a call out to an NP to start a practice and that led her to think, why are there no nurse practitioners wanting to do this?
So we all came together and decided that we needed to form this company to really give our nurse practitioners the opportunity to learn business skills, to be in a community where they're with other like minded nurse practitioners, to really emphasize the importance of our model, the nursing model, that holistic approach that that's a solution to changing the trajectory of healthcare because we're trying to keep our patients to the optimum level of wellness, identify illnesses early, interact quicker and keep people out of the er, urgent care and the hospital, which are the high cost centers. So we're able to try to do that with our nurse practitioners and providing all the support resources that they need as well.
[00:10:13] Speaker A: Coming up next, we're going straight into the business and system side. What it really takes to build a sustainable practice without losing your soul or your patients. So hang tight. We'll be back in a couple minutes to continue this conversation.
Stick with us. We'll be right back with more real stories, real breakthroughs and real lives transformed.
And we're back. I'm Dr. Yasser Sombol. Let's dive right back into today's medical conversation.
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Welcome back everybody. We're here with Dr. Lorraine Bach and Dr. Lynn from NNPEN. And now we're getting practical. Patients want time, attention, and trust. Clinicians want to serve, but practices must stay financially healthy to keep doors open.
Welcome back, everybody.
Thank you so, and I apologize if I said your name wrong again, but I'm working on it.
So sustainability isn't just a business issue, it's a patient care issue. Obviously, reimbursement, documentation, workflows, they're all broken. Access collapses. And so this segment kind of, we're going to translate the business side into patient impact.
So when a practice struggles financially, what's the first thing patients feel? For example, whether it's longer waits, fewer services, rushed visits, et cetera.
[00:12:06] Speaker C: I think one of the concerns is if you're not building a sustainable business, there's a chance that that business would close.
And that's the last thing we want nurse practitioner practice owners to do, is not be financially viable so that their practices are sustainable. They can stay open and serve the populations. So one of the things that we need to be aware of is what does our payer mix look like? How many patients do we need to see?
And how can we still provide the care to the folks that absolutely need care, but then provide some what we call side hustles to generate some additional revenue to keep our doors open?
[00:12:45] Speaker A: And how about you, Dr. Bak? What do you think?
[00:12:48] Speaker B: So I think the first thing that the patients feel is providers that are stressed. You know, if you're the owner of the practice and you're having some financial issues that weighs on your mind constantly and it can bleed over into your clinical room. You know, if you're worrying about getting phone calls, worrying about paying bills, you know, you're trying to juggle a lot of things as a practice owner, and you can't be really great at focusing on one thing when there's something that's so terribly stressing you out. So I think patients find that their providers become more distracted. Sometimes providers will take a second job to pay the bills for the first. For the first practice that they own, for the practice that they own. And they'll offer less hours so there's less accessibility.
And the. The patients know, the patients realize when their providers are stressed out because nurse practitioners build a different relationship with their patients than physicians do. We spend more time with them, we're talking to them, we see them in the grocery store. You know, they may even see us at our second job and wonder why. And I think that's what patients feel.
[00:13:53] Speaker A: That's true.
Dr. Ratzelberg what are the kind of top two or three documentation or coding mistakes that can really drain a practice silently, and how do you fix them?
[00:14:06] Speaker C: I think the biggest thing is really looking at your patients, going over the AI scribe conversation that you have and to document the complexity of the patients that you are servicing and how can you utilize those codes to maximize the opportunity for your billables. If you're spending a lot of time with a patient, make sure you're capturing the amount of time that you're spending with that patient and documenting the kind of care that you're given.
Really enjoy the time that we spend with them. And it does have value. So we want to make sure that we're going to capture those conversations and really look at opportunities to maximize the revenue stream, whether it's utilizing AI scribes in the way that we talked about earlier, that can enhance the ability to make sure that we get everything documented and we can code that efficiently.
[00:14:59] Speaker A: And how do you, Dr. Bak, for example, how do you build a practice model that protects time for education, prevention and doesn't just promote assembly line or volume per se?
[00:15:14] Speaker B: Well, there are billable codes for patient education and there is the ability to utilize other resources. There's a lot of resources out on the Internet that you can provide for your patient. For patient education. You don't have to do every teaching moment in the office. You can provide them with handouts, you can provide them with resources. You can also utilize ancillary staff such as your office nurses or your medical assistants.
The billing and coding doesn't specifically say that all education has to be delivered by the provider. There are things that you can have done by your staff so that you can continue to see patients and those things can be billed for as well. But I think patients appreciate most patients are very similar, savvy with the Internet now. But you need to direct them to really good resources and advising them and having, you know, I have a handout sheet in my office for certain medical conditions and I give the patient that sheet and it has reliable vetted resources on it that they can use to learn about different disease processes, which makes it better. And then all you have to do when they come back is talk about it. You know, document in your note, you know, referred patient to X or Y resource. And then when they come back, remember to talk about it so that you know that they did what you asked them to do and that they understand what's in the information that they resourced.
[00:16:35] Speaker A: I'd like to go back to you one more Time. Because I think you brought up, you know, the fact that nurse practitioners are able to spend more time with their patients.
And that is very valid. And I would like you to maybe elaborate why you think the difference is maybe for just people to understand in general why nurse practitioners are able to spend that extra time with patients versus, for example, their physician or, you know, is able to spend that time. Do you think it's, you know, I don't want to say one's neglectful versus one's more attentive. I don't think that's the issue. But I'd really like it to hear from your perspective. And so the patients and, you know, our viewers out there can understand that a little bit better. Better.
[00:17:19] Speaker B: I really believe that it's because from day one in our educational process, we are at the whole patient and we are taught that patients don't live in a vacuum of their illness, they live in their life. And we are taught from day one to recognize the things that impact them, such as, you know, they have six kids or their husband just lost their job, or, you know, they're caring for their elderly mother. And I don't think in physician education that is as focused on during the educational process. And I have a little statement that I say all the time.
PEOPLE CHUCKLE but really, nurse practitioners and physicians want the same goal for their patient. They want their patients to be as well and as healthy as they possibly can. The way that we go about it is a little bit different physically. Physicians are taught to take care of diseases.
Nurse practitioners are taught to take care of people who have diseases. And, you know, that sounds like, oh, you're doing the same thing, but we're really not. Physician model teaches them to learn about diseases. The nursing model teaches them to learn about life cycle and the diseases that impact people at certain life cycles. And I think that's how we can be better at spending time and getting more information and making our patients feel like we really understand what's going on with them.
[00:18:48] Speaker A: Yeah, I couldn't agree with you more. And I think just as a specialist, you know, I'm really focused on what my area is. So I'm a cardiologist, so when people come to see me, I'm really focused on what do I have to do from a cardiology standpoint. And I can recall when having a nurse practitioner how it helped me because they were more thorough about investigating things further that I may have not even thought about, just because that's just kind of how they're trained. And you're Absolutely right. So I think it's not a, I don't think it's an antagonistic system. I actually think it's a very complementary system when we work together, to be quite honest. So I like that.
[00:19:26] Speaker B: Absolutely. And it's funny, when I went to my cardiologist for the first time, he said to me, why are you here? Your numbers have you. And I said to him, I don't want to meet my cardiologist in the cath lab for the first time. I want to set up a relationship. And I think that's what nurse practitioners do, they set up relationships. They're not transactional, they're relationship builders. And unfortunately I think the medical model of training is more transactional.
[00:19:56] Speaker A: So in the last couple minutes, maybe both of you can kind of talk about if a nurse practitioner is ready to launch, what should they validate first patient need, payer mix, staffing or compliance. And so I'll give you each kind of a chance to go at that.
[00:20:14] Speaker B: All important. You know, unfortunately you can't validate one of those things and have a successful practice. You have to look at your community and what the needs are in your community. You have to look at the payer mix. If you're in a community that is very strongly people who don't have insurance know, people who are self employed or people who work as at jobs that don't traditionally have insurance offered, like hairdressers and waitresses and things like that. Maybe building a model that is insurance based is not going to be successful in your community. You have to look at your, you know, what's available as resources. Do you have people in your community that need help or are you oversaturated? You know, really looking at what, what does your community need and how can you fill that need? And it encompasses all four things that you mentioned.
[00:21:03] Speaker C: And I think it's really important for the NP to self reflect and make sure that this is something that they're ready and willing and able to do. And part of it is we're problem solvers. So we see needs in our communities and then we create businesses around those needs and doing that analysis of what's our community wants and what our resources are so critical to the success of an NP practice. For sure.
[00:21:28] Speaker A: Yeah. I mean, I think, you know, being clinicians and being part of this business, it's such a tough thing because there's a humanitarian side to what we do, obviously. But unfortunately medicine is a business just like anything else in, in this country, you know, and in the world. And so I think we're always torn between how do we balance that? And I think that's part of what makes us really bad business people in this aspect. Right. And in the fact that we're trying to balance what we need to do versus what we have to do. To a certain extent. Right. We have to keep the doors open, which is a financial responsibility, but we need to take care of patients, which is what we're trained to do. And so it's a really big tug of war, in my opinion, and it makes our job very challenging.
So we talked a lot about patients business. So up next, we're going to shift from the business to the policy and why rules about practice authority can decide whether a patient gets treated this week or months from now. So stay tuned. We'll be right back.
Stick with us. We'll be right back with more real stories, real breakthroughs and real lives transformed.
And we're back. I'm Dr. Yasser Sombal. Let's dive right back into today's medical conversation.
Welcome back, everybody, to Real Medicine, Real Lives. I'm your host, Dr. Yasser Sombal. And we've talked a little bit about sustainable nurse practitioner led based practices.
Now let's talk about policy side, because sometimes the difference between recovery and complication is simple, its speed of access, practice authority rules vary widely and can shape everything from rural access to chronic disease management.
This segment connects scope of practice debates to the patient sitting at home waiting for care.
Welcome back, both of you.
So you know, when people hear full practice authority, they think it's politics. I mean, what does it mean in a patient's life on a Tuesday morning, for example, what, what practice authority means?
[00:23:39] Speaker C: This authority is when we are allowed to practice at the top of our education and training.
And a lot of what is happening as barriers to practice are more regulatory barriers that really have nothing to do with patient care. It's a permission to practice that we have to fulfill in order to take care of our patients. And, and some of these barriers can truly affect the NP practice owner, especially if we have to be tied to a physician for a collaboration agreement, because if that agreement is severed for whatever reason, that nurse practitioner now is out of regulatory compliance. And what does that mean for the patient?
Those doors close.
And we don't want that to happen when it comes to taking care of our patients. We want to be there when they need us.
So this is one of the huge barriers that an NP practice owner faces. And then we also have a federal barrier with Medicare where you get 85% reimbursement. So we're starting out at a 15% deficit when we open up our practices. So I think Those are the two big things that really affect policy for nurse practitioners.
[00:24:47] Speaker A: Dr. Bak, do you have anything to add to that?
[00:24:50] Speaker B: I can just add that, you know, we have many nurse practitioners in states like where I live in Pennsylvania who have open practices. And then for one reason or another, either their physician collaborator retires or more commonly recently, is that their practice gets bought up by a large health system, and that health system will no longer allow that physician to collaborate outside the system with that nurse practitioner. And unfortunately, in Pennsylvania, you can't practice unless you have an active collaborative agreement with two. Two physicians, not just one, but actually two. And so I know many nurse practitioners, particularly in Pennsylvania, who've had successful practices, and then all of a sudden one day, their physician no longer can collaborate with them. They can't find another collaborator, and their practices have to close, and they have to close quickly because the nurses are out of compliance with the regulatory standards that they have to live with. And most of these practices are serving some sort of underserved population. Either they're in a very rural area where physicians don't want to go to practice because, you know, there's not enough there for them to make what they need to make to be sustainable for, you know, the bills that they have coming out of med school or what have you, they're in places, you know, they're, they're underserved because they're populations that have unique illnesses that there aren't practices that address. There are people like my practice in. I serve people who don't have insurance. So my model is built on a way to make healthcare affordable for people who don't have insurance. And, you know, when I was at risk of losing my collaborator, you know, my patients were at risk of losing their care, and they weren't going anywhere else because nowhere else would take them because they didn't have a lot of money and they didn't have insurance coverage because they either made too much to get it or they didn't qualify for Medicaid or their employer didn't offer it. And I think those are the people that become extremely vulnerable when regulatory barriers like the collaborative physician impact the ability of the nurse practitioner to keep their practice open.
[00:26:55] Speaker C: And furthermore, during COVID all of these regulatory barriers were eliminated during that two and a half year period.
And after that regulatory. And the pandemic was over, all those barriers came back to fruition and, and to Me, I think that that should show that the two and a half years really gave us a great track record to say these really don't serve any purpose, they don't protect patients. And there are regulatory barriers that can significantly impact the ability for that NP practice to stay open and provide access to care which we know is so needed right now, especially in rural underserved and patients who have no insurance.
[00:27:37] Speaker A: Great. And so, you know, you kind of both pushed for policy change and what policy shift have you seen as directly improved access or reduced delays, for example, for patients?
[00:27:49] Speaker B: Well, we know in states that have removed the requirement for physician collaboration that there are a number of factors that are improved that you know are traditional measures. Emergency department visits go down. In states that have full practice authority hospitalizations reduced because patients have access to care before they get so sick that they have to be admitted to the hospital.
We see a reduction in wait times for patients to get appointments to be seen. We see access in communities that might not otherwise have communities. So people are accessing care because they have something local that they can get to. People with transportation problems can't go to the big city where the practices are. They have to be seen in their local community. So I think all of those barriers definitely improve when full practice authority is enacted in a state.
[00:28:42] Speaker C: The other thing to pay attention to is the economics of a nurse led practice in a community. You know, we're embedded in the community, we're employing people of the community to work in our practices. We're creating an opportunity for the community to stay healthy to so that the workers are going to work and staying healthy. So overall the economics of an MP led practice speak for themselves?
[00:29:08] Speaker A: No, I completely agree. And it makes things more efficient. And so I think that's a great thing that's really changed things because I personally would agree that sometimes when I'm out of the office, I wish I had a nurse practitioner that could continue to see patients so that people can keep getting what they need and not dependent on delayed till I get back from out of town or something.
So what do you say to patients, for example? And I've run into this a lot actually my office will tell them when I used to have a nurse practitioner, Dr. Sombal's not here, but the nurse practitioner is going to be here this week to see patients. And they will say, you know what, I'm going to wait till Dr. Sambal comes back. So how do you address that fear for patients that are saying no nurse practitioner is not enough for me, I need to See the physician.
[00:29:56] Speaker B: So it's funny. When I first started in practice, I was the very first nurse practitioner in our community who wasn't the wife of a physician.
[00:30:02] Speaker A: There were.
[00:30:03] Speaker B: There were two others in our community, and people were really hesitant to see me because they didn't understand what a nurse practitioner does. And sometimes it's just a matter of putting them in the room with you, letting them spend the time with you, letting them understand that you are not trying to replace their physician relationship, but you're trying to augment it and that you do have an appropriate education.
You know, we can't fight with people, but we can try to change biases like, oh, I have to see the physician, because, you know, they're the physician, by just letting people get to know us and knowing what our background is and understanding their fears and talking with them about them.
[00:30:41] Speaker C: I think the other important piece to that is that we do not practice in silos. We will refer patients as needed to whomever is best for meeting the needs of that patient, too. If it's out of our scope or if there's an other resource within our community, we try to network with as many community resources as possible to make sure that our patients get the care that they need.
[00:31:02] Speaker A: And so just in 30 seconds of each of you can take a minute and just say, you know, 30 seconds and say, I mean, I run into this where I see patients, for example, in my office. Now, I don't have a nurse practitioner, but other offices that do, and they'll say, you know, I don't remember the last time I actually saw the physician. I've only seen the nurse practitioner when I go there. And so do you think at some point those patients should see the physician? Whether it's once every visit, once every six months, once every year when they show up, or how would you. How would you. What would you advise to physician practices that have nurse practitioners and physicians at the same time?
[00:31:40] Speaker B: Well, for me, patient choice is really important. If the patient wants to see the physician and they ask for an appointment with the physician, then they should be given an appointment with the physician. I. But there are many patients that don't want to see the physician. I mean, my practice, I haven't had a physician in practice with me since 1999. And my patients don't ask to see the doctor. In fact, if I'm out, they want to do telemedicine or they'll wait because they want to see me. So I think, you know, it really depends on what's going on with the patient. If it's something outside the nurse practitioner's scope of practice and expertise, they should be referred over to the physician in the practice or or to an outside practitioner. And all referrals don't necessarily have to go to physicians either. If someone's having a hearing problem, you refer them to an audiologist. So referrals are important, but patient choice is important as well.
[00:32:29] Speaker A: Okay, great. And so in the last couple minutes, let's talk about where do you see the biggest opportunity right now? Primary care, Behavioral health, access, Chronic disease management?
Where would be a good area for nurse practitioners to kind of get into that field?
[00:32:46] Speaker C: You highlighted all of the above. I think those are areas, I think nurse practitioners look for gaps and try to fill those gaps in care. One area that I think is very, a very useful way for NPs to participate is transitional care management. When people are being discharged from the hospital, we're the ones that can see them, look at their care and make sure that they're getting what they need so that they're taken care of and not going back into the hospital.
We're creating practices within the communities, meeting the needs that they want. We had a nurse practitioner who developed a van that went to looking at children and doing house calls that helped mom because she didn't have to drag all of her kids out to the office and expose them to who knows what, but able to provide that care in an ambulatory fashion in the home. And when we get invited into the patient's home, we can do a better assessment of what's going on. Do they have fruit in their fridge? Are there fall risk issues? Are they taking their medications?
Do they have a lot of cats and dogs in the house? You know, what their health and how can we improve that? So I think we go to where the patients are and that has a lot of importance.
[00:33:58] Speaker A: Okay, great.
All right, so in this final segment, we're going to come back and we're going to talk about home with real life solutions. You know, how a nurse practitioner led care models can improve outcomes today and where patients can find and follow your work.
And so before we go to the commercial, I'd really like you, if you guys can just kind of take a second, somebody talk about your website and how people can contact you
[00:34:22] Speaker C: for the National Nurse Practitioner Entrepreneur Network. They can find us at www.nnpen.org.
and Lorraine, you want to talk about the directory?
[00:34:31] Speaker B: Yeah. And we have a directory that we are putting together with nurse practitioner practices all across the country, and that is np directory.org www.npdirectory.org patients can go in there and sign up and they can search by zip code, they can search by specialty, they can even search as much as provider gender to find a practitioner in their community that they feel like they can connect with that meets their needs.
[00:34:57] Speaker A: Great. All right, guys, we'll be back in a couple minutes here to go to the last part of this conversation.
Stick with us. We'll be right back with more real stories, real breakthroughs, and real lives transformed.
And we're back. I'm Dr. Yasser Sombol. Let's dive right back into today's medical conversation.
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All right, everybody. Well, welcome back to our final segment. We've now looked at nurse practitioner entrepreneurship, the systems that keep care sustainable and the policies that shape access. So now let's talk about what this looks like in real life. The patient who gets seen, gets treated and gets their hope back.
This segment ties everything together.
The outcomes, earlier, diagnosis, better follow up, patient education, continuity, scalable community impact.
So let's end with a clear viewer, clear viewer takeaways and you know how we're gonna put this all together. So welcome back, everybody.
[00:36:23] Speaker B: Thank you.
[00:36:23] Speaker A: And so give us a real world picture. You know, what changes for a community when a nurse practitioner led practices expands access. And what do you see improves first?
[00:36:38] Speaker B: Well, I think the whole entire community becomes healthier because patients can access care more quickly. They aren't waiting at home until they sick enough to go to the emergency department. You know, I've spent part of my career in the er and one thing that frustrates me is people say, well, I wasn't sick enough to come until yesterday. Well, you know, if we have primary care access, they don't have to get that sick. They can come in sooner or they can do a video visit. And it really makes the whole community more healthy. People can go to work because they've gotten treated in their illness early. And instead of taking three days off to recover, they, you know, they've gone in, they've gotten seen. And I think that's really important to know that the whole community benefits because the nurse practitioner is there. They're looking at Other things in the community that might need to be done. There are plenty of examples of nurse practitioners who have looked at a community problem and become part of the solution in healthcare as well.
[00:37:30] Speaker A: So, Dr. Rasleberter, you've worked in hepatitis C treatment settings, and so what's one example of how removing system friction changes the outcome so fast?
[00:37:44] Speaker C: I actually created a practice where I go to addiction and rehab centers to provide hep C treatment on site. And the first time that I went to this facility, I saw a gentleman who had not been. He'd been diagnosed with hepatitis C but not received any treatment because he's been homeless. And so I did an assessment, provided the medications, did some education, and actually, I thought based on looking at him, he was very truly sicker than he was. He really looked like he might have real damage to his liver. But fortunately, the lab work did not, you know, bear that. And we treated his hepatitis C. And I actually got a chance to see him shortly after, and I almost didn't recognize him because the improvement overall in getting rid of the virus. He had much more energy, his diet and appetite improved. His skin looks so much better. And he looked at me. The first thing he said was, thank you. I would never have gotten treated if you hadn't come here and done this. And you saved my life. And now I feel like I have purpose and I can go forward. And to me, that's why I'm a nurse practitioner. That's why I do what I do.
[00:38:51] Speaker A: That sounds amazing. And so, Dr. Bach, you know, you mentor a lot of nurse practitioners into success. And so what's the most important mindset shift clinicians need to lead instead of still stay human with patients?
[00:39:04] Speaker B: Well, I think, you know, being aware of your own limitations and your own biases is really important.
You know, you can have a belief, but meeting the patients where they're at and allowing you the time to care for yourself, you know, you can become overwhelmed as a practice owner. You can end up being, you know, almost 24 7, working on taking care of the practice, and that is really difficult and hard on you. So, you know, self care is something that we try to talk about at NN pen.
Financial successes are important, but the emotional and physical and spiritual success of the nurse practitioner to be able to give to the patients, because if your tank is empty, you're not giving anything, so you have to protect yourself as well.
[00:39:48] Speaker A: No, I agree.
And so take us through the process of the mentorship for nurse practitioners. So they graduate from nurse practitioner school just so people kind of can get and understand. Like, we go to medical school, you go to residency, we go to fellowship, etc. What is it like for nurse practitioners when they graduate and how do they kind of develop that skill set, you know, once they get out of out of school?
[00:40:16] Speaker B: So I think you have to remember that nurse practitioners come into nurse practitioner programs with nursing experience.
You know, our physician colleagues go from college to medical school, but they really don't have experience in patient care, in diagnostics and looking at lab results and things like that. Nurses come into nurse practitioner programs with a background where they've already been caring for patients, They've already been dealing with disease processes. As a nurse, they've already, you know, learned about treatments and things like that. So it's a little bit different because our programs are designed to build on that nursing experience.
During the nurse practitioner program, they get their clinicals as well as their didactic learning, which expands how deep they look into disease processes, medications, lab results and what have you. And then they do clinicals with preceptors that are experienced and trained. So that's the process. Once you graduate from a nurse practitioner program, research has shown that you are ready to practice. You may not be ready to be out there on your own in an office by yourself, but you're ready to practice and you're safe.
Yeah.
[00:41:22] Speaker A: And I think that's really important. I really like that you said that about how nurse practitioners are nurses before they go to nurse practitioner school, which I think that makes a huge difference because you're right. Before they get there, they've had, you know, however many years of nursing school, however many years in practice, you have to actually be a nurse for a while before you can become a nurse practitioner. Is that correct or can you go straight on?
Yeah. So you actually have to be in the field for a while before you can go on to do your nurse practitioner degree and become a nurse practitioner. So I agree, we, as physicians, we don't get that at all. We actually go from college to medical school, and then even in medical school, we're really shielded when it comes to patient care or whatnot. As medical students, you know, you're not prepared. Because I remember my first day as an intern. I mean, I'll never forget this day for as long as I live.
And nothing prepared me for that first night of being on call as an intern carrying a beeper. You go from, you know, just writing notes and seeing patients and really not doing anything to all of a sudden you are a doctor and everybody's looking to you for answers at that very moment, and you're sitting around trying to figure out, wait a second. I know I've seen people replace potassium, but I've never really had to do it myself.
And so it's a very enlightening experience. So I like that you said that. And that's really important. I think that can actually help people when they're seeing nurse practitioners. And keep that in mind that that person is not just a new graduate.
There may be a new graduate in that role of which they're kind of taking care and assuming the leadership role, but they're not really a new graduate in the sense of being involved in patient care, which is a lot different than physicians when they're, when they graduate. So I think that's a. And I think that holds true for physicians at any level in their practice. I mean, I remember when I was an interventional fellow, you know, you're kind of like a technician. You know, you're being handed all the equipment and what you do. And I'll never forget my first case that I did on my own after I graduated fellowship in my first job.
And I had to think about it, and I think, well, what catheter do I need and what wire do I want to use and how big of a stent should I put in? Because I never had to think about that in fellowship because somebody just gave me that answer every single time. So I think that's a really great thing that you brought up there.
So if a patient is watching and they want to look for nurse practitioner led care, what things will you tell them to look for? To find a great practice to go to?
[00:44:05] Speaker C: They can first go to www.mpdirectory.org and actually search by zip code or by disease state. A nurse practitioner that's in their area, so they can make a connection that way. Also serving their community and seeing what they're in the community and they can seek somebody out.
Also, they can look to their national organizations as well.
Our organization, nnpen has a directory as well, so they can connect through us that way as well. But we're out there and we want to be able to serve the patients in the community. So just find a nurse practitioner and you'll have a great experience and I think it will change how you look at healthcare. One of the things that we focus on is prevention, health promotion, and intervening early in trying to diagnose chronic diseases and help patients through that process.
We focus on population health versus the disease itself. So I think that also is important for patients to realize. So MP led care can be a very valuable thing for patients out there that are listening.
[00:45:16] Speaker A: Great. And so in the last couple minutes that we have or so, if you each can kind of give us what your next big goal is for your organization and what success would look like a year from now for patients and for the profession.
[00:45:29] Speaker B: Well, I think from my perspective, success is going to look like getting our directory populated. We have a goal of getting 1,000 nurse practitioners across the country in there. We're halfway there right now. So for me, that's going to be my focus is to seek out and find and get enrolled into our directory nurse practitioners who own their practices across the country and then, you know, building relationships between those nurse practitioners in the directory so that they can have a network of support.
[00:46:00] Speaker C: In my role, I'm going to focus on looking at how we can expand the partnerships for NN Penn members so that they have access to thoroughbreds in our stable folks that understand nurse practitioners and the nursing model of care delivery so that we can start to really look at how we can help those nurse practitioners with the pain points of starting a business, building a business and sustaining a business through creating that community.
[00:46:26] Speaker A: Great.
Well, I really appreciate you both being here. And so for everyone, just to give us, you know, I have an idea. How do we. How do they connect with you guys? Where do they find you? Please give us an idea of where they look for you.
[00:46:41] Speaker C: Sure. For the National Nurse Practitioner entrepreneur network, it's www.nnpen.org.
[00:46:49] Speaker B: and then for our directory, it's www.npdirectory.org.
[00:46:56] Speaker A: great.
Well, Dr. Bak and Dr. Rafflesberger, thank you so much for bringing clarity and leadership to a conversation that affects every patient. Trying to get care without delay.
To everybody watching healthcare is a human.
Ask questions, advocate for access, and choose care teams who listen and follow through.
I'm Dr. Yasser Sambal. Thank you for joining us on Real Medicine, Real Lives, and we'll see you next time.
