One of the things that nurses struggle with the most when starting their businesses, is understanding the legal aspects of entrepreneurship. Our patients have a hard time understanding our medical jargon, which is probably exactly how we feel when someone starts rattling off a bunch of legal phrases. We nod our head in understanding so that we don’t look less intelligent, but we really have almost no idea what language the lawyer is actually speaking. Lori-Ann Rickard has a unique position of being understanding of nurses which helps her communicate to us in a way that makes sense.
You are the President and Managing Partner at Rickard & Associates law firm. You specialize in healthcare. What made you decide that you wanted to work in healthcare law?
I’m the President and Managing Partner of Rickard & Associates. I started practicing health law because as a law student I was assigned a partner mentor who specialized in healthcare. My father is a United Methodist Minister and healthcare was something I could do in the law that involved a “helping profession.” Just felt right.
I understand that your mom was a psychiatric nurse. What role did that have on your current understanding of nurses and their needs?
My mother got a five year nursing degree from the University of Michigan in 1947. Her father objected to her leaving Albion College to get her BSN. Her mother had to get a teaching job to help my mother pay for her tuition. Needless to say, this was at a time when very few women got a 5 year nursing degree.
She then married a Methodist minister and stayed at home to raise 4 of her own children, 2 adopted daughters whose parents were killed in a plane crash, lead 3 church choirs and played the organ every Sunday. When the kids got old enough, she dove back into nursing. She was thrilled. She referred to it as “jumping over the convent wall.” I was the youngest child and everyday she came home THRILLED to be a nurse. She loved helping people whether it was the patients or the staff. My mother could talk to a perfect stranger for 30 minutes and she would know everything about you and you would feel like you had known her for years. Nursing was hard and grueling but she loved it. She emphasized how difficult it was to both care for the patients and also manage the expectations and demands of the doctors. She often felt that nurses were undervalued and not treated as an important part of the team. Toward the end of her career, she worked as a pool nurse to avoid the bureaucracy of the hospital.
You once told me that “Running a business is like anything – you must know what you are doing and have good advisers.” Who should we look to for advisors? Rickard & Associates for legal requirements of our starts up? What about the rest of starting a business? Do you have suggestions?
Every business owner needs what I call a “Board of Directors.” Those people who are the trusted advisers. A great accountant; a healthcare lawyer; IT professional; etc. No one can start up a company alone. You need good advisers, a good banking relationship, a business plan, and some capital.
What are some of the biggest struggles and cautions of going into the “business of healthcare”?
You have to be able to run a business not just provide healthcare. This involves marketing, IT, employee issues, communication issues, etc. Always remember that healthcare has special rules about referrals. You can’t pay anyone or give someone a gift (or something of value) in order to get patients. There are anti-kickback rules that prohibit this. Also, Insurance companies’ contracts require you to charge the same pricing to everyone. Make sure you have an advisor to help you with these rules. They are not the same as other industries. This is one of the reasons an experienced healthcare lawyer is so important.
I read articles daily of nurses who have started their own companies and are succeeding. What opportunities have you seen opening up that nurses could pursue as entrepreneurs?
The Affordable Care Act is broadening the use of physician extenders, nurse practitioners and nurses. The “medical centered home” requires 24/7 monitoring of patients. I think this is a growing area that nurses can take advantage of. Healthcare is in desperate need of innovation so “thinking out of the box” is in rare supply.
How much money should the average start-up be prepared to spend on legal fees? Keep in mind that many of these nurses still work full time or part time at the hospital.
I don’t think there is a single answer to this question. You need a business plan and work with an accountant or a mentor to determine how much capital is required for your business.
What are your 5 most important points of advice that you could give to anyone wishing to start a healthcare business?
1. Get Appropriate advisers
2. Write a business plan
3. Strategy, Planning and Goals always works better than hard work and good intentions;
4. Have a 1 year, 5 year and 10 year plan.
5. Visualize what the business will look like. Follow your heart, be authentic and offer something no one else provides.
Do you have any incredible success stories that you could share with us? Perhaps a nurse that has made it big in the business world.
I have worked for 27 years with many fabulous businesses that started small and grew to amazing proportions. I can’t single out any one in particular.
Do you have any unfortunate stories that you could share with us to prepare and warn us of the possible pitfalls of being a self-employed nurse?
About half of all start ups fail in the first 3 yrs. You need to have enough capital to get you through those initial tough years. Sometimes the best advice is “don’t quit your day job.” The nice thing about nursing is you can often choose different days or shifts. If you can continue your income while you are starting your business, that always helps.
What are your 5 best resources for nurses who want to pursue starting their own business?
I think I would start with some background in business. Take some business courses. Read some great business books. Take a class in how to prepare a business plan. Find a mentor who has done what you want to do and offer to work for them for free. Learning from someone who is already successful is the best way to learn.
About Lori-Ann Rickard
(Taken from: larlegal.com)
Lori-Ann Rickard founded Rickard & Associates in 2000 after years as an associate and partner in private practice at a large Detroit corporate law firm, and eight years serving in-house as corporate counsel for the St. John Health System, a member of the largest Catholic Health system in the country, Ascension Health System. An accomplished litigator and experienced corporate attorney, Ms. Rickard is a recognized leader in the ever-changing field of health care law. With clients ranging from national healthcare systems, ambulance companies and medical vendors to all types of physicians, Ms. Rickard combines cutting edge legal knowledge with the desire to help clients reach intelligent, practical legal solutions that meet their unique needs.
Ms. Rickard is a nationally known public speaker and continues to lecture for St. John Health System, Beaumont Health System, Quincy Medical Group, Oakwood Health System, Michigan Peer Review Organization, National Congress on Healthcare Compliance, the American Ambulance Association, Michigan Association of Ambulance Services, the Michigan EMS Expo, etc. Some of her presentations include: “Is the Sky Falling? Name, SSN, DOB, Address all on the web@XYZMedicalPractice – Is your practice prepared?”; “Cashing in on Technology and How it Impacts your Practice”; “The Dark Side of the EMR and How to Live with it”; “Hot Topics in EMS Today”; “Running a Medical Practice 101”; “Riding Along with HIPAA”; “Disaster Planning for Physicians”; “Medicare Appeals and Compliance Update”; “Planning the Plan: EMS Agencies Roles in the Disaster Planning Community”; “Cultivating Your People”; “Compliance: Maintaining Effectiveness & Joint Ventures”; “HIPAA Security, The Final Frontier – Maybe?”; “Moving Forward with HIPAA, What’s New, What’s Next?”; “Solutions to HIPAA Implementation”; “Employment Strategies for Physician Offices: What Every Employer Should Know”; “ABC’s of CPT- How to Determine if a Problem Exists”; “Compliance: Do the Right Thing, It’s Good for Business”; “Compliance Effectiveness: How Buy-In Generates Effectiveness (Keep Your Wealth)”; “Healthcare Fraud: The Crime of the Millennium”; “Risk Assessment”; “Physician Compliance Training” and “Compliance: Back to Basics”.
In addition, Ms. Rickard has published several books, authored and co-authored numerous articles on healthcare matters, including “HIPAA: Breach Notification Rule under HITECH – The Final Rule”, Health Care Weekly Review, 2013; “Prior Determinations: How Helpful Will They Be?”, The Health Lawyer, 2008; “Sicko’s Misdiagnosis Leads to Wrong Prescription”, Crain’s Detroit Business, 2007; “Unresolved Issues in Disaster Planning for Hospital Clients”, The Health Lawyer, 2007; “Deficit Reduction Act Expected to Ring in the New Year with Increased Qui Tam Activity”, Andrews Health Care Fraud Litigation Reporter, 2006; “Recent Developments in Regulation of Pharmaceutical Marketing Practices”, The Health Lawyer, 2006; “Avoiding Impropriety in Pharmaceutical Marketing Practices”, Health Care Compliance Association, 2006; “Changes in the Medicare Appeals Process”, Health Care Weekly Review, 2006; “Balancing Compliance With Necessity in the Wake of Bioterrorism Incident”, Health Care Compliance Association, 2006; “Disaster Planning: Balancing Compliance With Necessity”, Healthcare Weekly, 2005; “Bioterrorism: Healthcare Preparation and Response”, Healthcare Weekly, 2005; “HIPAA, Are We Done Yet?”, Healthcare Weekly, 2004; “Physician Compliance Plans: A Guide to Implementing a Compliance Plan in Your Office”, 2003; “ABC’s of Coding and Auditing”, 2002; “Get Hip with HIPAA Workbook”, 2002-2003; “Physician Buy-In: Strategies for Persuading Physicians to Care About Compliance”, Journal of Healthcare Compliance, 2001; and “Keeping Good Lawyers: Best Practices to Create Career Satisfaction”, published by the ABA Law Practice Management Section in May 2000.
Ms. Rickard has been interviewed by HealthSparx.com “How Law and Order for Healthcare Has Changed in the Last Ten Years” 2013; RT Image “Staffing: The Dotted Line vs. The Bottom Line”
2009; AMedNews.com “Is Your EMR Legal?” 2008, “Recoup d’état: Fighting Recoupment Efforts” 2005, “Bully Case Verdict a Warning for Doctors” 2005; NPR Day to Day “Bike Paramedics Cycle to Emergencies” 2006; The Daily Oakland Press “Where Were You When The Lights Went Out” 2006; Healthcare Risk Management “Be Voice of Reason When Sending Help” 2005,”Update your Email Policy Now to Keep Up with Usage” 2005 ; McKnight’s Long-Term Care News & Associates “Wound Care Feature: Prevent Defense” 2005; and the Abilene Reporter News “Don’t Let That Hospital Bill Be a Headache” 2005.
She is an active member of the American Health Lawyers Association, State Bar of Michigan Health Law Section, American Bar Association, National Academy of Ambulance Coding, and American Academy of Professional Coders and was honored with the distinction “Best Lawyers in Michigan” by the 2013 Best Lawyers publication. She is a Certified Professional Coder (CPC), Certified Ambulance Coder (CAC) and has also been certified by the Institute of Continuing Legal Education in Probate and Estate Planning.
Ms. Rickard received her Bachelor of Science degree, cum laude, from Eastern Michigan University in 1983 and her Juris Doctorate degree from Wayne State University in 1986, where she was a member of Wayne Law Review. Ms. Rickard is a member of the State Bar of Michigan, The Florida Bar and admitted to practice in several federal courts. Ms. Rickard was an assistant teacher of Civil Trial Advocacy at Wayne State Law School.