How this NP Built a 15k Patient Practice
Kelly Goodman, NP
When Kelly Goodman began working as a nurse practitioner in the Washington D.C. area a decade ago, her first stop was at a podiatry office. She subleased space and helped cover for an internal medicine doctor who was also subleasing in the building.
But as more doctors along the East Coast ditched insurance in favor of concierge medicine – including the one Kelly was assisting – it became apparent that she needed to make a change. Rather than continuing with a doctor whose patients could no longer see her, Kelly made the bold choice to start her own practice.
In 2009, she moved down the hall in the same building and started Spring Valley Health and Wellness. As she worked to figure things out during her first year as a business owner, she saw how much her practice was filling a need in the area.
“The number one reason I started my own practice was the change in the healthcare system. So many of the doctors started dropping health insurance and going concierge. When that happened, I began to wonder who was going to take care of these people. They were dropping like flies in the emergency department. Nobody had a primary care provider, and I thought to myself, ‘You know what? I’m going to take care of these people.’ And it worked out.”
That’s not to say there weren’t some bumps along the way:
“I didn’t really know what the heck I was doing. There were moments where I wanted to pull my hair out, but it was the best decision I ever made. I certainly had no idea where it’d take me ten years later.”
What started with Kelly and one front desk staffer in that cramped, subleased office space has grown into three thriving practices in the Maryland and Washington D.C. area. Kelly moved her primary practice to Bethesda, Maryland in 2011 and renamed it Kelly Goodman, NP & Associates, PC.
Kelly opened Promenade Primary Care in Washington D.C. in 2016, and in October of 2018, she opened KellyCare in Clarksville, Maryland. Her patient base has grown to over 15,000 between her first two locations (her 3rd location opened in Fall of 2018).
As Kelly’s business grew, her responsibilities changed. She went from a one-woman show to recruiting, hiring, and managing a team of NPs who could help serve her growing client base.
Hiring the Right People
One lesson Kelly learned quickly was that it’s just as important (if not more) to hire for the culture of her practice, not just skillset.
“I want to know when I interview someone if we have the same beliefs in how we practice medicine. That means getting here on time, respecting the patient’s time, and getting back to people. Do you treat the front desk staff and the patients with respect? Our culture is one of transparency and honesty. We treat each other like family. You can be great, but if you don’t have that, you’re not a good fit.”
Once she finds someone who’s a good culture fit, Kelly invests serious time in training her NPs in all the areas they didn’t learn about in school. They come to her practice knowing how to diagnose illnesses, but can they submit an insurance claim?
Most of the time, they’ve never been trained in these finer details of the job.
“All our NPs start at the front desk for a week and answer phones. From there, they go to clinical. All they do is scribe for me for almost two weeks. We also help them begin to navigate EMRs, electronic medical records. After that, it’s two more weeks of billing and learning the best ways they can respond to patients.”
Knowing Your Value
Kelly invests in training each employee because providing the highest level of patient care is what her practices are all about. In fact, since Kelly implemented an admin fee in 2014, part of what her patients pay for is exceptional customer service.
“I was in practice 2009 to 2014 before I started charging that fee. Things had to change once I got really busy and wasn’t getting home before 8:00 at night because I needed more help. As an NP, we have a lesser fee schedule, and when you factor in the paperwork that goes into this job, things just weren’t adding up.”
The default expectation when a business introduces new fees is that customers will react poorly. Kelly admitted that when she began charging patients a $79 fee in 2014, she did get some pushback, but she simply sat down and had a direct conversation with concerned clients, explaining her rationale. She only lost three people. The fee – which is now $129 for individuals, $249 for families up to four, and $379 for families of five or more – offers a slew of benefits, including extended hours, free paperwork and same-day appointments.
“People didn’t balk at the fee because we’re very responsive. We get things done immediately. We don’t wait two weeks to get back to you. We’re really about time. We respect the patient’s time, we value the time we have with them, and we run on time. Our patients appreciate that. In a busy world where everybody’s late and always running to the next thing, time is the key factor to success here.”
The admin fee was a game changer for Kelly’s business. No longer did she have to worry about her cash flow or when she was going to get paid by the insurance companies.
This new revenue stream allowed her to open Promenade and KellyCare, her second and third locations. Not only that, it gives her a big edge when trying to attract and retain the area’s top NPs.
“The fee helps me pay NPs more. I get the best that’s out there. I can also pay my front desk staff a little bit more, which is key because they do the backend stuff for us as far as online authorizations and talking to the insurance companies.”
Raising the Bar
As much as it made sense to charge the fee, Kelly struggled. So much of her wanted to just keep pushing through and delay adding the fee. But as the owner of a growing business, she knew it was a move she had to make.
“Being nurses, we’re so used to taking care of everybody. But at some point, you have to say, ‘I’m a professional, I give good care, and there’s value in that.’”
Good care starts when patients walk through the door, which is another area where Kelly has spent considerable time and effort to differentiate her practices. She provides scripts that her front desk staff can follow for every type of interaction they have. This ensures her staff feels prepared and that a high level of patient care is maintained.
“It’s all scripted. We have a written policy in place about how we talk to people, how we greet people, how we take copays. I want to make sure there’s always someone available to greet people, to check them in and check them out.”
In an industry where the bar is set so low for customer service, simply making an effort can set you apart from the crowd. But for Kelly, effort is a starting point. When it comes to patients, she asks two things of her front desk staff: be friendly and be accountable.
“Number one: just be nice. If you start there, you would be amazed at how far above the bar you are. Then being accountable, getting back to people, and closing the loop. We call everybody back. It’s easy, but not everybody does it.”
When she started her business in 2009, Kelly faced an obstacle most new business owners tackle: learning how to get paid. In her case, she was dealing with insurance companies famous for rejecting claims for the smallest errors or omissions. She stressed over submitting a claim and making sure it was coded correctly.
Like many NPs, Kelly never received formal instruction on coding and billing insurance claims. Through trial and error, she had to figure it out on her own, which made for many late nights at the office. It’s part of the reason she trains her new NPs so thoroughly on coding and billing – mistakes with claims can cost practices thousands of dollars and create endless headaches.
The majority of Kelly’s business still comes from insurance. Her primary location is the largest medical home in Montgomery County, accepting Blue Cross Blue Shield, Medicare, Cigna, United, and Aetna. In fact, Kelly’s practices saved Blue Cross Blue Shield $1.7 million in 2017, and as a thank you, Blue Cross Blue Shield raised her annual fee schedule in 2018.
These are the types of positive changes Kelly has been able to affect in her business since scaling back her patient workload in recent years. She still sees patients from 7:30 am to 4:30 pm Monday through Thursday, but she now reserves Fridays for either administrative work (i.e. QuickBooks payroll) or visiting her other practices. As for Saturdays – that time is for her two sons and their travel baseball schedule.
Stepping back to work on her business (instead of in it) was an easy choice to make.
“It wasn’t difficult for me. I love being here and seeing my patients. But I need an admin day to get all the business stuff done.”
Focusing on the business also helps her sharpen her leadership skills and further hone the culture she’s worked so hard to build. After nearly a decade as a business owner, Kelly realizes that culture isn’t “set it and forget it.” It has to be lived every day.
“It all starts at the top. If you’re not a good leader or you don’t believe in what you’re doing, then nobody else is going to believe it in either, including your patients. We’re here to take care of our patients, number one. Number two, we take care of each other. I want everyone to have a good experience when they come here.”
The NP-Owned Future
With the opening of her third location, Kelly doesn’t take it for granted how far she’s come from that subleased office space in northwest D.C. She started with a mission to serve people who no longer had a primary care physician after their doctor switched from insurance to concierge. Now her businesses represent something more.
“In the beginning, I wanted to be a cornerstone in the community. I wanted people to know that they are going to get the best care ever with us. Now when people talk about me, they say, ‘Kelly Goodman is a nurse practitioner in the Safeway building and she’s the best NP around.’ That is awesome validation for me.”
Now, Kelly tries to give back when she can by helping other NPs who are daring to strike out on their own and start a practice. It’s not just about helping NPs succeed – it’s also about helping address a need.
“My goal is to pave the way for other nurse practitioners to succeed and help fill the shortage we have of doctors in this country. Personally, I think NPs do it better. We went to nursing school because we want to help people, and that’s such a key factor in the whole primary care setting. People want to be heard and be validated. They want a solution and they want somebody who cares about them.”