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Business Plan

BusinessPlan

ExecutiveSummary

ARural Urgent Care (RUC) center will be created in Sylacauga,Alabama. The facility is set to provide ambulatory care for residencethat hail from the surrounding areas. Walk-in patients are alsocatered for, especially those that do not have severe problems. Theaim for creating the RUC center is to relieve the pressure that themain medical facility experiences. The sector that usually has manypeople is the emergency department. The RUC will reduce the waitingtime in the ED as well as delivery of quality medical care withoutindividuals encountering unnecessary expenses.

Themain hospital will coordinate with the RUC for the provision oftrained personnel. They will also supervise the operations of thefacility to ensure that it works well for the community. Theirworking hours will be similar to ensure that people have differentalternatives when they are seeking help. The less acute cases will bedirected to the RUC, thus, creating more time for physicians in themain hospital that can be used to treat the seriously ill patients.The ambulance that will be located at the RUC will improve theresponse time since the distance covered to reach a particularpatient will have reduced. The strategy will end up saving morelives.

ProgramOverview

ThisRUC is expected to provide care for patients that do not suffer fromany fatal issue which may need immediate actions. Such conditionsinclude fractures, minor injuries, pneumonia, and flu. The RUC havebeen used as a way of cutting down the unnecessary reliance on the EDby people with less serious conditions. The strategy of shifting somepatients from the ED to the RUCs first started in the late 1980s andearly 1990s. Only about 40% of patients that visit the emergencydepartment do not have any life threatening issues. The majority doesnot need the services of the sector, and they could easily find thesame care in the RUCs. The figure below shows the demographics ofpatients that visit the ED and the urgency of their conditions.

Figure1:

Aligningthe patients in terms of the urgency of their conditions is asuitable measure for allocating the site that will best meet thepatient’s needs. The employees at RUCs have better methods oftreating patients which are dissimilar to the manner of treatmentprovided in the ED. At the ED, everything is rushed since the medicalofficials are under immense pressure and they cannot spend more timethan is necessary on a single patient. The staff at the RUC givesmore personal time with each patient since they are not dealing withextreme issues.

Theexpected RUC should satisfy the wants of the community which isconvenient access to medical services. The community has threealternatives for treatment. The RUC will be the third option. Theother pre-existing ones are the ED and General Practitioners.However, General Practitioners usually see their patients by means ofan appointment. An individual cannot randomly go to their locationand expect to receive immediate attention. They also operate solelywithin business hours. Thus, patients resort to visiting the ED. Theemergency department ends up having many people that seek care andthe waiting time increases. The figure below shows the waiting timesin the ED before the creation of an RUC and after its development.

Figure2:

Location

Sylacaugais a city in the county of Talladega. It has a population of about13, 000 inhabitants. Most of the major medical centers are locatedwithin the city and the arrangement creates difficulty in accessingthem by people that live outside the urban area. Whenever theresidents require medical care and their primary physician isunavailable, their only option is to visit the emergency departmentof the Coosa Valley Medical Center. The best location for the RUCshould be in a region where every person that has acute issues canquickly reach the facility. The convenience of its position willdivert the trend of people visiting the ED even with minor illnessesand injuries.

Services

TheRUC should fully satisfy the health requirements of the people ofSylacauga without having to establish another emergency departmentcenter that will be extremely costly. The facility will have basicoutpatient procedures, diagnoses, and treatment for patients withless serious ailments. The following table shows the basic servicesthat will be available.

Nursing Triage

Physician Assessments

Potential Diagnoses

  • Common illness

  • Respiratory illness

  • Allergies

  • Bladder infections

  • Eye/ear/sinus infection

  • Strep throat

  • Mononucleosis

  • Pregnancy testing

  • Skin rashes

  • Sport injuries/sprains/strains

General Services

Monitoring Services

  • Emergency transfer to KEMH

  • Vital signs

  • IV therapy (antibiotic, hydration)

  • EKG

  • Wound care

  • Immunizations, TD, Pneumovax, Flu Vaccines

Minor Procedures

  • Incision and Draining of abscess

  • Excision of skin

  • Aspiration of cyst

  • Sutures

Lab Services

  • Blood

  • Urine

  • Other

Diagnostic Imaging

  • Ultrasound

  • X-ray

Table1

Oncethe RUC offers ambulance services, many benefits can be reaped fromthe venture. The response time of the EMS will be faster sincepatients in remote areas can be reached at a shorter time. Theservice can also provide a faster way of transferring patients thatwere mis-triaged during their evaluation. The facility will have tocreate a separate waiting room and bunkers for the crew of theambulance service. Storing supplies at the RUC will improve theefficiency of the EMS since they will not have to go to the mainhospital for resupply.

OtherPotential Offerings

TheRUC can create other opportunities for creation of revenue that willmake it a viable move in provision of medical services. Theseopportunities include Occupational Safety Testing, and also a closedbathroom could be available for drug tests. These two services couldearn the facility some extra income. Local practitioners could usethe centre for referral of some services like laboratory and x-rays.Patients will prefer the facility since it will be nearer and theywill spend less time waiting before they are served.

Staffing

Themix used in the staffing of the RUC will include support from thehealth department. There are different options that can be used tostaff the facility. The table below indicates these options.

Model #1

Model #2

Model #3

Clinical Lead

ED Physicians

Locum Tenens Physicians

Nurse Practitioner (NP)

Summary

  • Emergency Department physicians who rotate between the main hospital’s ED and UCCs

  • Employed through the main medical center

  • Temporary, hourly-rate physicians with UCC or ED experience

  • Recruited through agency

  • NPs with significant outpatient clinic experience

  • Employed through the main medical center

Finances

  • Employed physicians –

$200K salary / year + benefits + housing allowance

  • Significant Recruitment Costs

  • $120/hour + housing + travel allowances

  • Locum Tenens Recruiter Fees

  • Employed NPs – $100K salary / year

  • Recruitment Costs

Analysis

  • Difficulty recruiting ED physicians for RUCs

  • Retention concerns

  • Superior ability to treat emergent patients

  • Additional service offerings possible

  • Standardized emergency care throughout system

  • Increase the ability of main hospital’s ED to cope with volume peaks/troughs

  • High Costs

  • High skill levels

  • Pre-existing RUC experience

  • Continual rotation of physicians may result in divergent care quality

  • Recurrent recruiting/placement required

  • Limitation of service offerings (variance of physician skill levels)

  • Moderate Costs

  • Reduced clinical skills available

  • Concerns about clinical quality without full-time physician oversight

  • Inability to provide emergent level care

  • Limitation of potential service offerings

  • Lowest cost

Table2

Thefigure below shows the expected yearly staffing costs using theclinical lead model.

Figure3:

Thefirst model that uses physicians from the main ED is the best optionfor staffing the RUC. The physicians can switch between the twofacilities to ensure the quality of medical services provided at RUCis not compromised. Nevertheless, it is rather difficult to hire andmaintain staff from the main ED and the alternative model seems morepractical. Using the Locum Tenens and Nurse Practitioners will ensurethat the RUC center is fully staffed at any given time of day ornight. Using this model, doctors from the region can come atdifferent times where they can supplement their income through hourlywages. These physicians could also build a patient base at thefacility. The director of the RUC can provide oversight for thecenter to ensure that no service which is provided can becompromised.

Thefacility will have to handle a lot of people in a day yet its staffwill have to remain small. To ensure that this objective works, thestaff will need to have the skills of performing different duties atonce. The table below shows the proposed model that indicates how theshifts for the staff will look like.

Position

FTEs

Clinical Lead

1.0

Nurse

1.0

Physicians Assistant

1.0

Radiology Technician

1.0

Medical Assistants / Receptionists

1.0

Table3

Facility

Thedesign of the establishment must satisfy the requirements of themedical department as well as fulfill the needs of the patients.Patients tend to relate the quality of services provided to theappearance and beauty of the facility. The design should fit into thearchitectural style common to the city of Sylacauga. The structureshould also focus on medical efficiency and patient safety. Thepatients should be placed in a waiting area where they can bedirectly monitored by the staff incase the condition of any of thepatients worsens. The examination room should be next to the nursingstation to ensure proper assessment of patients and also enablecommunication among the staff. The entrance will be at the front withan emergency exit at the back. The EMTs will be given a separateentry point that can quicken their exit when called to an emergency.The table 4 shows the detailed description of the facility.

Space Description

Quantity

Square Feet Per Room

Total Space

Central nursing/Physician station

1

500

500

Exam rooms

5

100

500

Treatment room

1

150

150

Radiology room

1

200

200

Staff offices

2

100

200

Reception/waiting area

1

400

400

Employee break room

1

250

250

Medical records

1

250

250

Laboratory

1

200

200

Restrooms

3

50

150

EMS facilities

2

80

160

Utility rooms

2

150

300

Subtotal: Usable Square Footage

3,260

Circulation, mechanical, telecom/IT, other space

&nbsp

&nbsp

915

Total Facility Size

4,175

Table4

OperatingModel

`TheRUC working hours will begin at the time when the local physicianshave closed their offices. Setting up the opening hours in thismanner will reduce the number of people that visit the main hospital.The opening time for the RUC is also the time when many people seekemergency care and they only begin to reduce after midnight. Thetable below shows the proposed operating hours of the RUC facility.

Hours of Operation

Monday – Friday Hours

8

Saturday &amp Sunday Hours

10

Hours of Operation per Week

5 PM- 1AM (M-F) &amp

10AM – 8 PM (Sat. &amp Sun)

Total Operating Hours

60

Table5

Everypatient will be first received by the receptionist before a nursegives them the initial assessment. Every patient will be examined bya physician that is present at the facility. The estimated total timefor this entire process is 15 minutes for each patient. However, thelength of time will be determined by the complexity of the patient’scondition.

MarketProfile

MarketOverview

Theservice area around Sylacauga has several homes and people withfamilies that will act as the customers for the RUC. Many people fromaround the region require a medical facility that does not have thelong waiting time associated with the main ED. The table below showsthe service area for the RUC around Sylacauga.

Area

3 years ago

2 years

ago

1 year

ago

Number of persons in RUC service area

Total

64,009

64,209

64,395

Table6

DemandForecasting

Fromtable 5, it can be noted that the number of people that will use theservices of the RUC are increasing every year. The figure below showsthe demand service forecast for the region which is seen to annuallyincrease by 5%.

Figure4

FinancialAnalysis

CapitalRequirements

Thetotal funds needed to launch the project of developing RUCs in theregion can be estimated by assessing the requirements of constructinga single facility with an area of about 3, 260 square feet of usablespace, and 4, 175 square feet as the gross size. The following tableshows the cost of every item needed in the construction of the RUC.

Total Construction Cost

$3,246,605

Contingencies, Professional Fees, Management &amp Overhead, Equipment

$2,216,341

Total Project Costs

$5,462,946

Construction Costs per Square Foot

$ 777.63

Project Costs per Square Foot

$ 1,308.49

Square Footage

4,175

Table6

ReimbursementModel

Thefacility will charge a flat fee of 450 USD at each visit, which willrelay the rates that the main ED charges per visit. The rate willremain the same. Patients with insurance will receive a 30% discountto their total costs.

Pro-FormaIncome Statement for the RUC

Basedon the already set operating hours, the figure 5 below shows thePro-Forma that has been generated.

Figure5

References

Kralewski,J., Dowd, B., Knutson, D., Savage, M., &amp Tong, J. (2013). Medicalgroup practice characteristics influencing inappropriate emergencydepartment and avoidable hospitalization rates.&nbspTheJournal of ambulatory care management,&nbsp36(4),286-291.

NicoleLurie, MD, MSPH Tamara Dubowitz, MSc, SM, ScD.(2012). “HealthDisparities and Access to Health.”JAMA.