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Posted December 16, 2008
When Helen Carcio was a girl, her grandmother lived with her family. The beloved matriarch had given birth to 10 children, and as she got older, urinary incontinence became a pervasive problem.
"She always smelled of urine and would leave stains on our furniture," recalls Carcio, now an adult nurse practitioner and continence care expert. "I remember feeling embarrassed to have friends over. They told me my house smelled like kitty litter. If only they knew the real truth!"
Carcio's memories of her grandmother's struggle are what inspire her to teach about incontinence today. The practice she opened in 2005, Health and Continence Institute of New England (HCI), is all about restoring dignity through dryness. Its dual strategy is to provide treatment to patients and to equip other NPs to open continence care centers.
Dispelling Myths
HCI has two components. In the clinical portion, Carcio sees patients 2 days a week, treating about 15 older adults in hour-long sessions. Her 10-step approach to "bladder health" - which she says is easier for patients to talk about than "incontinence" - includes diagnostic testing, behavior modification, pelvic floor rehabilitation, vaginal support devices and medication. She boasts a 50% dry rate and reports that all her patients make progress toward that goal. Her methods are conservative; she has recommended surgery for only 12 of the more than 2,000 patients she has treated.
When she's not seeing patients in her office, Carcio spreads the good news that incontinence is not an inevitable consequence of aging. She reaches potential patients through administrators of long-term care facilities and through community groups and senior centers, where she presents bladder health programs designed to give adults with less severe incontinence tips about bladder irritants and other tools to help them help themselves.
Although she specializes in women's health, Carcio also treats men. In fact, men with urinary incontinence make up about 10% of her practice. Stress incontinence is primarily a women's issue, since it is often the result of childbearing. But overactive bladder and urge incontinence are equal opportunity conditions. If continence services for women are sparse, Carcio says, those for men are even scarcer. Her audiences consist of men and women, making a sensitive and gently humorous delivery important.
Carcio also talks to other health care providers in her community. She says these primary care, urology and women's health professionals are often relieved that someone else is willing to tackle the treatment of incontinence. If that someone is a nurse practitioner known for her teaching abilities, all the better.
Teaching the Teachers
The second component of Carcio's practice is teaching other providers about incontinence and helping them set up bladder health programs of their own. Carcio offers a 2-day seminar on establishing and marketing a bladder center. The seminars take place at HCI in South Deerfield, Mass. About 75% of participants are NPs, and 25% are physicians.
The seminar covers clinical topics such as diagnosis, treatment options, coding and available products. It also addresses business considerations such as grant writing, marketing, and maximizing reimbursement. The$1,500 seminar also entitles attendees to continuing support and advice for 3 months after they start a bladder center, and Carcio sometimes visits the new practices to give hands-on advice.
Ultimate Reward
The take-home message for NPs, Carcio says, is that it's OK to profit from the services they provide. The stereotype of the selfless, serviceable nurse can still make "nurse practitioner entrepreneur" sound contradictory. Get over it, she urges. The aging of the population is a perfect opportunity for NPs to establish themselves as the providers of choice in continence care and aesthetics.
"One could even provide both services in a single practice. Advertise that you have 'both ends covered!'" Carcio jokes.
An average NP-managed bladder health center can bring in more than $200,000 a year, Carcio estimates. HCI grosses about $2,400 per patient, and the charges are typically covered by Medicare and other insurance programs. Patients don't schedule with Carcio for single visits, but rather for six to eight visits over 3 or 4 months.
Carcio raised the start-up funds for HCI with two grants and less than $10,000 of her own money. In the beginning, Carcio ran the business out of two rooms she rented for $500 a month from a primary care office. Three years later, she owns that office building and the primary care practice rents from her.
No matter how lucrative her business, Carcio says her greatest reward is the appreciation of her patients. At the end of her treatment, one patient took the diamond ring off her finger and insisted that Carcio keep it.
"She is a stoic Vermont Yankee and won't take it back," Carcio recalls. "I have it in safe keeping for when her children come looking for it."
--Jill Rollet is the managing editor for ADVANCE for Nurse Practitioners and coordinator of the Nurse Practitioner Entrepreneur of the Year competition. Reach her at jrollet@advanceweb.com.
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