The questions and answers below address a format for an integrated nursing network of Nurse Practitioners and NPs—American Advanced Practice Network. This document is for informational purposes only and does not contain guarantees of performance or results.
American Advanced Practice Network (“American-APN”) is a multi-location “integrated nursing network without walls” comprised of Nurse Practitioners and Advanced Practice Nurses. American-APN is supported by a Digital Care Delivery (DCD) platform developed by CareSpan Technologies, Inc. and receives business support services delivered under contract with CareSpan Integrated Networks, Inc. This combination of clinicians and a care delivery/business support infrastructure enables the delivery of collaborative primary care, behavioral health, palliative care and hospice support to vast numbers of people including those who are currently underserved, rural and remote, and with little or no access to quality care.
How does an NP/APN join American-APN? What are the benefits? The risks? The costs? Answers to these and other FAQs follow:
- What makes American-APN unique?
- What are the qualifications and requirements to be a member and practitioner in American-APN?
- What are the expected benefits of joining American-APN?
- What services will American-APN alone supply to my practice directly?
- There are many challenges that arise when building a practice. Can American-APN help me with practice issues as they appear over time?
- Does American-APN help with marketing my practice?
- How does American-APN assist with development of my patient base?
- How does American-APN assist with providing Remote-Patient-Monitoring?
- How does a group practice like American-APN help me with back-up coverage?
- Will American-APN help me stay current on practice and business issues
- How, exactly, does American-APN help me generate more revenue and let me keep more of what I generate?
- What are my financial obligations to American-APN? To CareSpan Integrated Networks?
- How much additional income could I expect to realize if I join American-APN?
- If I bring my high-volume practice to American-APN, does that provide an advantage?
- What are the potential economic risks associated with joining American-APN?
- What business support will CareSpan Integrated Networks supply for me through American-APN?
- Why does American-APN have an exclusive relationship for technology and services with CareSpan?
- American-APN appears dependent on CareSpan? What are the risks to this arrangement?
- How can American-APN influence CareSpan, including the Digital Care Delivery platform and the business services?
- How do I transition my current practice into American-APN integrated network?
- Can I maintain local autonomy over my practice given that American-APN is a multi-location group practice?
- Can I remove my practice from American-APN? Are there penalties for withdrawal?
- What legal requirements are essential for American-APN practitioners?
- How much does it cost to join American-APN?
- Are there ongoing costs to participation in American-APN?
- Who is leading American-APN? Who is on the Board of Directors?
- How can I influence the policies of American-APN? Can I participate in American-APN leadership?
Benefits of Joining American-APN
American-APN is the first multi-location integrated nursing network of Nurse Practitioners and APNs who, despite disparate geographical locations, are clinically integrated on a common digital platform for care delivery (in-person or virtually) and bill under a single tax ID number—thus allowing primary care of the underserved rural and remote populations of America as well as those in close proximity to services. The integrated network-clinic without walls realizes bargaining power with payers and economies of scale for business support.
American-APN seeks highly motivated Advanced Practice Nurses dedicated to advancing patient care at many levels. We don’t dictate how you should orient your practice or manage your patients clinically. Your practice business model, patient population and area of interest (e.g., primary care, women’s health, pediatrics, mental health, etc.) are at your discretion. Qualifications to be accepted as an American-APN practitioner, include the following:
- Be a Nurse Practitioner or APN, licensed and in good professional standing in at least one state in the U.S.
- Meet the credentialing requirements of American-APN as established by its Board of Directors
- Agree to abide by the American-APN Bylaws and Articles of Incorporation, and its Policies for quality clinical practice
- Enter a Practitioner Agreement with American-APN
- Agree to the contractual relationship between American-APN and CareSpan for use of the CareSpan Digital Care Delivery platform and the support of CareSpan Integrated Networks as they may apply to one’s local practice
- Meet the American-APN requirements for quality care delivery to one’s patients in support of the contractual obligations entered into by American-APN on behalf of its members.
The key benefits for any American-APN clinician-practitioner can be categorized as economic and supportive:
- Lower cost of practice overhead due to buying power and economies of scale
- Increased practice efficiencies and extended reach to more patients due to the enhancement of clinical workflow for both in-person and virtual care opportunities with CareSpan’s Digital Care Delivery (DCD) platform
- Increase in paying patients through group negotiating power with payers and focused marketing
- A compensation structure that rewards excellence.
- Ensuring stability and sustainability of practice, even for the lone practitioner in a rural location
- Collegiality and collaborative care despite distances between practice locations as a result of CareSpan’s DCD platform
- Practice mentoring by the American-APN leadership team
- Practice coverage during time off and vacations
- Shared best-of-breed resources
- Automated quality reporting metrics
- CME and business education and updates
American-APN provides direct services to support member clinicians that CareSpan Integrated Networks, by regulation, cannot. These services include:
- Executing contracts with third-party payers (insurance companies, self-insured employers and government). By law, only the professional corporation (PC or PLLC) whose members bill services under a single tax ID number can actually sign-off on the payer contracts for member advantage. CareSpan Integrated Networks and its legal team can negotiate the contracts on behalf of American-APN.
- Clinical care policies and quality oversight
- Mentoring members as practice challenges arise
- Adjudication of member disputes, complaints, suggestions, etc.
- Governance of the American-APN PC structure.
There are many challenges that arise when building a practice. Can American-APN help me with practice issues as they appear over time?
As a member of American-APN, no matter where you are geographically, it is vitally important that your practice is successful and personally fulfilling for you. Challenges are bound to arise and some of them will tax your knowledge and your resiliency. American-APN intends to provide a mentoring resource and support system that is available to each of its members. Senior leadership of American-APN will serve as mentors to collaborate one-on-one with members, listen, advise, share experiences, and help solve problems.
Definitely. American-APN assists you with creation of a local/regional/national marketing presence that brands and identifies each of its members’ practice locations uniquely. Local marketing for your individual practice, consistent with your own goals and objectives and as aligned with those of American-APN, is part of the business services provided. Network marketing establishes American-APN as a source of uniform, high quality healthcare, especially for the underserved, the rural and the remote.
One of the most powerful attributes of American-APN is the legal ability to seek out and negotiate contracts as a group with third-party payers—insurance companies, large self-insured employers and even government—for care of their insured populations. No single individual or small local practice has the bargaining power that a large, multi-location integrated group practice can bring to bear on behalf of its practitioners. There are two key attributes that allow American-APN to legally negotiate and contract on behalf of its widely distributed practitioners: (i) clinical integration, i.e., operating on a single data-gathering and clinical workflow platform (CareSpan) for care delivery and (ii) billing and collecting under a single tax ID number for services rendered.
The Integrated CareSpan Platform provides ‘next generation remote patient monitoring’ services. Patient monitoring devices are available for multiple health issues that challenge your patients. The monitoring and tracking prompts and services are built into the dashboard and data capture, following patient progress in real-time and over time. This reduces the treatment gap in time and distance, addressing shifts in health that significantly impact care quality and outcomes management. Provision of RPM offers another financial resource for your clinical practice.
Because each practitioner will be caring for patients using the CareSpan Digital Care Delivery platform, which among many other attributes provides for collaborative care and cross coverage, a member practitioner can “sign-out” to colleagues regardless of geographical location (so long as licensure laws are respected). The “on-call” practitioner(s) can see existing group practice patients as controlled by the attending member-provider as s/he sets up call coverage for the practice.
Yes. An important aspect of American-APN is to keep its practitioners appraised of clinical and business developments in the field of nursing practice.
Financial Impacts for American-APN Members
How, exactly, does American-APN help me generate more revenue and let me keep more of what I generate?
Sole practitioners and small group practices do not have the resources to cover large populations of insureds, and these clinicians must accept the terms offered by the payer who controls many lives (tens to hundreds of thousands). A very sizable integrated group practice able to cover large, geographically disbursed populations is in a position to strike a much more favorable contract with large payers. American-APN is designed to be such a large, disbursed “group practice without walls” that can exercise group bargaining power on behalf of its practitioners. This results in larger numbers of paying patients for the members covered by the contracts that American-APN enters on behalf of its practitioners’ practices. Workflow efficiencies inherent to the CareSpan DCD platform allow the practitioner to see more patients per day.
CareSpan Integrated Networks for practice business support, provided under contract to American-APN practitioners, means that each practitioner will have the best of professional business support at a lower cost-per-practitioner than it would be possible to obtain individually. The result: lower overhead.
Caring for more paying patients with good insurance coverage means more income. Lower overhead means more of that income in your pocket.
American-APN will be your integrated group practice, with its own management, Board and committee structure for managing this “integrated nursing network without walls.” The American-APN Directors may retain modest monthly or annual dues from the members’ reimbursements to fund group marketing, clinical quality assessments, etc. These benefits will inure to all clinicians.
CareSpan Integrated Networks provides your digital practice platform and business services, including the integrated EMR, e-prescribing, scheduling, billing and collections, accounting, insurance, supplies and the like. You will pay a monthly charge for technology and business services from the revenues that you generate. The benefit of American-APN is being able to purchase these services as a large group, lowering your per-practice expenditures significantly.
Though it cannot be guaranteed, our calculations suggest that with a fully developed practice, depending on business model, an individual practitioner is likely to take home 2-3 times more income under American-APN than practicing solo or in a small group.
Yes. The projected benefits from joining American-APN will accrue far more immediately to those who participate with a high-volume practice than to those just starting to build a practice. That is because there are fixed costs to any practice, regardless of size, but higher as a part of overall overhead to the newly building practice. In most cases, economies of scale afforded by the business services delivered to American-APN practitioners decrease the variable costs of a practice more than the fixed costs. Thus, the high-volume practice benefits most especially at the outset.
American-APN’s goal is to help you grow a thriving practice, not to penalize you for not having one at the outset. As with any business, there is a productivity threshold for realizing the full benefits of American-APN. We offer you a practice analysis, at no charge, to assist you personally in exploring whether American-APN is the right model to help you meet your goals and objectives.
Among the business support services that CareSpan Digital Services will offer to American-APN practice locations, depending on specifics of the final contract between CareSpan and American-APN, are:
- Revenue cycle management (billing and collections)
- Infrastructure purchasing (IT, telephony, computer hardware, etc.)
- Productivity and Remote Monitoring software
- Purchasing (office and clinic supplies; insurance)
- Scheduling and care coordination
- Credentialing, privileging
- Quality reporting
- Human resource management
- Payroll and accounting
- Legal (contracting advisory and negotiation; employee agreements; Direct Primary Care agreements and insurance plan tracking and management)
- Promotion (marketing and advertising business development; social media; website construct and maintenance/SEO)
To realize its obligations to payers and to efficiently operate as a single “integrated nursing network without walls” all members of American-APN must practice on a “clinically integrated” platform—for aggregate data analysis and quality reporting. CareSpan’s Digital Care Delivery platform is that “clinic in the cloud.” Moreover, CareSpan was founded as a digital care platform company that could bring needed healthcare—especially primary care—to underserved people worldwide. A founding Board member and investor in CareSpan was the late Colleen Conway-Welch, RN, MSN, PhD and Dean of the College of Nursing at Vanderbilt University. Colleen’s vision and influence was to position Nurse Practitioners and APNs as the premier providers of primary care to the remote, the underserved and those challenged by access problems of all types. She believed that CareSpan is the vehicle for care delivery to these populations.
Consequently, the leadership of CareSpan is devoted to the concept of American-APN and has underwritten the start-up legal infrastructure for the entire American-APN/CareSpan structure. Moreover, CareSpan’s DCD platform stands alone as the most comprehensive “clinic in the cloud” in existence today. American-APN and CareSpan are jointly bringing a new care delivery model to primary care—for the benefit of patients everywhere.
American-APN is contractually bound to CareSpan Integrated Networks for its care delivery platform, including the electronic medical record, e-prescribing and other features, and for business support services. This is a highly symbiotic relationship with many aspects of a partnership, both in spirit and functionally. However, should CareSpan breach the terms of the contract, American-APN may seek support services elsewhere. This would be inconvenient and entail a short period of potential disruption, but it would not result in negating many of the positive attributes of American-APN.
How can American-APN influence CareSpan, including the Digital Care Delivery platform and the business services?
CareSpan’s DCD Platform is a Covered Entity under HIPAA/HITECH law. As such it is a true outpatient clinic. It even has its own professional liability (malpractice) insurance. Like any clinic, CareSpan actively seeks input (suggestions, complaints, critiques) from those who practice on its platform and those who receive care via its platform. The same is true in a non-clinical sense regarding CareSpan Integrated Networks. Moreover, CareSpan employs a Chief Nursing Officer (JoEllen Koerner, RN, PhD); and, Dr. Sheila Ryan, Professor and Director of International Programs at the University of Nebraska Medical Center College of Nursing, serves on CareSpan’s Board of Directors to assure that the influence of the nursing profession exists at numerous levels within the CareSpan organization.
Practice Independence and American-APN
Transition into American-APN is a two-fold process:
- Transition Business Functions to A-APN
- Complete practice assessment
- Evaluate current business to determine monthly support costs
- Transition billing and accounting
- Merge and expand contracts
- Delivering Care on the CareSpan Platform
- Setup CareSpan Platform to Reflect YOUR Business
- Training and Certification on CareSpan Platform
- Transition Existing Patient Data to CareSpan
- Continue seeing YOUR Patients
- Expand your Patient Base through RPM & Virtual Care
Can I maintain local autonomy over my practice given that American-APN is a multi-location group practice?
Your practice business model, patient population and area of interest (e.g., primary care, women’s health, pediatrics, mental health, etc.) are at your discretion. If you enter a Practitioner Agreement with American-APN, you will have an opportunity to serve the patients for which American-APN holds service contracts and who fit your area of practice expertise. Of course, if you are affiliated with American-APN, you will be subject to certain evidence-based clinical guidelines and adherence to proper clinical protocols for demonstration of quality care adopted by American-APN. American-APN works with each member practice to maximize its potential in its local and regional market.
Yes, you can rescind your affiliation with American-APN and build a practice independently. The contractual obligations for business services will have to be honored for the remaining duration and under the terms of the contract. On withdrawing from American-APN, you may not be able to bill for services rendered to patients falling under contracts negotiated by American-APN on behalf of its members. However, every patient has the full right and authority to select the provider of their choice. They are free to transfer at any time.
Yes. You are required to keep your credentials current. As with any clinical relationship, quality is maintained by upholding the standards of care and quality as established by the leadership of American-APN, the relevant State Board of Nursing and the law. You must enter a Practitioner Contract with American-APN and agree to bill for service under the American-APN tax ID number. You must agree to use the CareSpan Digital Care Delivery platform for data collection, patient records and clinical workflow, both for in-person care and for care of patients at a distance (virtual care).
Membership in American-APN: Costs and Incentives
For established practices, there is no initial cost to join American-APN. New practitioners may incur some of the initial costs of starting a practice, with counsel and support from American-APN. In some cases, depending on the NP/APN’s commitment to the group practice, American-APN may assist new clinicians financially.
American-APN, in its contract with you and with CareSpan Integrated Networks, will retain a portion of generated revenue to support the committee and executive functions of the group practice, such as patient engagement, clinical quality oversight and mentoring programs. You will also pay a portion of the revenue that you generate for business support services. The overall costs of these services are projected to be substantially less that one would pay in a solo or small group practice.
Leadership and Governance of American-APN
Among the leadership team and Board already identified are:
- Kathryn “Kate” Fiandt, Nebraska—Chief Executive Officer and Director
- Lorraine Bock, Pennsylvania—Chief Operating Officer and Director
- JoEllen Koerner, South Dakota—Director
- Mary Kay Nissen, Iowa—Education Consultant
- Sheila Ryan – CSIN Board Advisor
American-APN always seeks involvement of its practitioners, which can take many forms. The American-APN group practice will have a small leadership team consisting of Chief Executive Officer, Chief Operating Officer, Chief Quality Officer and Chief Negotiations Officer. Each will establish a committee structure to obtain advice and guidance from the membership. If you have an interest, please notify a Board member or existing officer—or make you desire known if you aspire to an officer position.