Family nurse practitioner Scharmaine Lawson-Baker e-mailed me in early October to say that Sen. John Kerry had mentioned her moments earlier in his remarks to a national conference on e-prescribing. "Hey, that's cool," I replied. "I know!!!!" she wrote back.

Scharmaine (who asked to be referred to by her first name in this profile) radiates the same exclamation point level of excitement when she talks about her practice making house calls to older and disabled, mostly indigent patients in New Orleans. Listeners are drawn to her, and she uses her charisma for good - whether it's finding housing and social services for her patients, arguing for expanded home health privileges for nurse practitioners, or promoting technology changes to the health care system.

Beginning in 2006, Scharmaine became a regular visitor to lawmakers' offices in Louisiana and Washington, D.C., after the Healthcare Information and Management Systems Society (HIMSS) interviewed her about health disparities and technology. She has since told such powerbrokers as Sens. Mary Landrieu, David Vitter, Ted Kennedy and Barack Obama how her PDA was key to getting treatment for her dispersed patients after Hurricane Katrina.

In 2007, Scharmaine convinced CBS to follow up on the continuing health care mess in her city. CBS Evening News anchor and managing editor Katie Couric spent a day following the NP as she made house calls to FEMA trailers. The 4-minute segment emphasized Scharmaine's crucial role as an independent health care professional - and how she is often her patients' only connection to health services.

On a big screen in a packed ballroom a few months later, Scharmaine replayed that TV report for the membership of the American Academy of Nurse Practitioners at the organization's annual conference. Proud colleagues gave her a standing ovation and stood in line for business tips and autographs?.

?But Scharmaine isn't this year's Nurse Practitioner Entrepreneur of the Year because she's a rock star. She is our winner because she survived significant challenges and built a successful business. She turned adversity into advantage - growing her practice, helping her patients and promoting her profession.

Opportunity Knocks
In late 2004, Scharmaine was treating patients in a family practice clinic in New Orleans. A local physician who was retiring asked her to assume the care of 15 homebound patients. Scharmaine had substantial home health experience as an RN, and the idea of providing more comprehensive home care as a nurse practitioner appealed to her. She pitched the idea of adding house calls to her employer, but he rejected the plan.

Yet the idea kept nagging at her. She knew there was a need: A few years earlier, she had tried and failed to find a house calls provider for her grandmother and had to move her to a nursing home. So she researched Medicare reimbursements and the legal aspects of NP-owned practice in Louisiana. She convinced herself she could make a solo house calls practice work.

In March 2005, she opened Advanced Clinical Consultants with $20,000 in personal funds and the most fuel-efficient SUV she could find. She signed on a collaborating physician and began making house calls. "I had no real interest in business as such," Scharmaine recalls. "But before I knew it, I had a business - I was in business!"

Within 3 months, the practice grew from 15 to 100 homebound patients. She had little competition for her patient base in the heart of the city, and Medicare payments were reliable and covering expenses. Scharmaine expected the practice to grow significantly and swiftly.

Mother Nature had plans of her own.

Disaster Strikes
Just 6 months after the launch of Advanced Clinical Consultants, Hurricane Katrina hit the Gulf Coast. Most of Scharmaine's patients were displaced or died in the floods that followed the storm. Using her salvaged PDA, Scharmaine was able to contact many of the patients who had relocated and to send lab tests and drug lists to their new providers across the country - even though she was temporarily transplanted to Texas. Sitting in San Antonio, she feared that her new business was a shambles.

When she returned home in November 2005, though, she found that her practice was needed more than ever. With no hospitals and a mere handful of health care providers, everyone remaining in central New Orleans was a patient who needed a house call.

Displaced physicians asked Scharmaine to check on their former patients. Neighbors buttonholed her after patient visits. Pastors set up clinics for her in their churches. Word spread, and the NP found herself with 300 patients within a few weeks.

She vowed to go anywhere she was needed. At first, this meant visits to crumbling houses on abandoned, debris-filled streets. After several months, it meant visits to the FEMA trailers sitting next to those houses. She created a small network consisting of social workers, a podiatrist, an optometrist and a pharmacist who would see patients at home. She helped patients fill out forms and phoned relief agencies. She was practicing as she'd always wanted to - providing truly holistic care.

Still, she says, there were some "loose ends."

Going Above and Beyond
Scharmaine acknowledges that she has a "fixer" personality. She looks for the root of a problem as the best place to aim the solution. So when one of her new patients developed hypertension that didn't respond to multiple medications, she got on the phone with FEMA and demanded a trailer. Her approach paid off: "Like magic, his blood pressure began to normalize until he was completely weaned from all antihypertensives," she remembers.

Housing for most of her patients was horrible then, and it hasn't improved much since. A house call to one patient would turn up three elderly roommates who had moved in after their own homes were destroyed. With waiting lists full for the few rentals available, Scharmaine believed the best way to find safe housing for her patients was to buy a few buildings herself.

That plan hasn't succeeded - yet. She did purchase an appropriate structure in 2006 and contracted with Catholic Charities and other agencies for group-home status. But she found that her residents had some complaints about sharing spaces. Then there was some damage. Today, the building accommodates her business office, and the housing aspect of hervision is on hold.

The Revised Plan
Life eventually settled into a new normal for New Orleans, but Scharmaine's patients had always been poor and remain that way. Medicare covers house calls, but not necessarily wound care supplies orincontinence pads. Some patients can't afford a prescriptioncopayment. Scharmaine started reaching into her pocket to give $10 here, $20 there.

With nearly 1,000 patients on the roster in 2007, it was clear that handing out cash couldn't continue. Scharmaine wasn't a private charity - but she could start one.

After a few months of confusion over paperwork, she founded Geriatric Initiatives, a nonprofit that formalized her provider network and offers cash and services to older or disabled adults.

"My philosophy is that no one, especially an 85-year-old woman making $300 a month in Social Security Income, should have to decide between purchasing a case of diapers and buying her diabetes pills," she proclaims.

Agency funds can be used to pay utility bills, buy necessities such as food or clothes, or to cover copayments and medical supplies. Geriatric Initiatives also helps eligible clients pay their rent.

The agency's staff of nurses and social workers (part paid, part volunteer) coordinates medical and hospice care and manages social services. The organization hopes to add mental health and dental care providers to the initiative - as well as that elusive housing component.

Business Is Business
Scharmaine says running the nonprofit is similar to, but a bit more intimidating than, running her primary practice. As with any business, paperwork and accounting are essential. But with a nonprofit, the stakes can seem higher, especially in the heightened scrutiny after Hurricane Katrina.

Scharmaine has discovered a talent for turning up resources. AARP now provides two office workers to Geriatric Initiatives for 18 hours a week, and the National Council on Aging supplies eight senior companions whom Geriatric Initiatives can assign to do light housework, cook a meal or just sit and talk with patients.

The NP has also developed some creative revenue strategies for her primary business. A post-storm grant from the state garnered $50,000 on the condition that Scharmaine would continue making house calls in Louisiana through 2011. She agreed, of course.

The practice brings in cash as a certified Medicaid enrollment center. The agency sends a check for every application Scharmaine's staff helps fill out, and the practice enrolls new patients at the same time. The business also participates in the Physician Quality Reporting Initiative, earning incentive payments from the Centers for Medicare and Medicaid Services for sending data about evidence-based practice.

Scharmaine cites constant innovation - acquiring more certifications, purchasing diagnostic equipment, mastering new procedures - as her strategy for staying profitable when her main source of reimbursement is Medicare. Her capstone project for her recently earned doctor of nursing practice degree focused on group visits, and she is working on a plan to implement the model in her home visits.

Labor of Love
Scharmaine draws a salary that is a bit better than average for an NP. She works hard for every dollar and she feels the weight of her responsibilities - for maintaining the practice, for being a role model for her employees and for keeping her patients' stories in front of people who can help.

"Nobody should go into house calls for the money," she emphasizes. "This is not a million-dollar job, and it should be looked at as service to the community that brings you untold nonmonetary rewards."

A patient testimonial expresses best what Scharmaine does for her community - and the nonmonetary rewards she receives as a result.

"I had been writing those FEMA people for months trying to get a trailer," a patient wrote to ADVANCE. "Well, that Scharmaine came right over and made about three phone calls. I had my trailer in 2 weeks, and she got my medicines delivered to my trailer! I just love that girl. She's got some kinda miracle stuff with her."

Jill Rollet is the managing editor and the coordinator of the Nurse Practitioner Entrepreneur of the Year competition.

Watch Scharmaine Lawson-Baker's 2007 interview with Katie Couric here. Listen to Sen. John Kerry's remarks about Lawson-Baker to the 2008 national e-prescribing conference here, about 8 minutes into the talk.