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AZRMC Board of Directors Business Plan Presentation

Austyn Ukrainetz

School of Nursing-Azusa Pacific University

GNRS 568 Healthcare Finance

Professor Cindy Rishel

November 14, 2021

Hello Everyone,

My name is Austyn and I am one of the many members on the Azusa Regional Medical Center Business Development Team. My role throughout this process has been to design a marketing plan to excite the community about a new up and coming Diabetes Clinic. I have prepared a thorough list of office and medical supplies that will be needed for the startup of the clinic, worked out budgets and salaries for our fabulous employees, and have been a head designer, lead, and resource for my very competent team. I currently hold this role through the Hospital medical center and will be paid through them. You could say I am the “Charge Nurse” of this operation. Although there are many members of this team, I will be the person in charge of making sure everything is up to date and being done in an appropriate manner and in an efficient amount of time.

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One Stop Shop Diabetes Clinic

Type 2 Diabetes Mellitus patients
50 years old or older, male, overweight with a family history of familial type 2 diabetes
Poor blood glucose control and/or non-healing skin ulcers or other diabetic-related wounds
Devoted to serving the needs of these high-risk specialty T2DM patients
Will serve multiple purposes and ease the burden on the inpatient care staff

The purpose of this investment proposal is to provide more for the community in which the Hospital is a part of. Azusa Regional Medical Center, also known as AZRMC, has a high percentage of adult Type 2 Diabetes Mellitus patients that are cared for on the inpatient units of this hospital (Rishel, 2021). These patients have an average length of stay of 5.8 days due to the complexities of type 2 diabetes mellitus disease (Rishel, 2021). The common demographic for these patients is 50 years old or older, male, overweight with a family history of familial type 2 diabetes, and having an HA1C greater than 9.0 (Rishel, 2021). Patients are frequently hospitalized for poor blood glucose control and/or non-healing skin ulcers or other diabetic-related wounds (Rishel, 2021). Based on this current information, Senior Leadership at AZRMC has decided to create a hospital-based outpatient clinic to provide care for T2DM patients with skin/wound care needs (Rishel, 2021). The expectation is that this clinic will be devoted to serving the needs of these high-risk specialty T2DM patients and will serve multiple purposes and ease the burden on the inpatient care staff (Rishel, 2021). The Outpatient "One Stop Shop" Diabetes Care Clinic would be a place where patients could either "walk-in" or be referred to once discharged from the Hospital. This clinic will have every service a diabetic patient needs. For example, the clinic will have an education section to help patients choose their health and treatment plans. The clinic will also have a podiatrist to address any foot or leg issues and an ophthalmologist to diagnose and treat any eye issue caused by their diabetes. Wound care and other services will also be offered at this "one-stop-shop" clinic.

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Community

Continued education, supplies, and care after being discharged from the hospital
Under-educated, overweight, and without the necessary supplies and resources to properly care for their disease outside of the hospital
Restore confidence in patients who have diabetes to care for themselves
Be able to provide such resources to keep them out of the hospital and instead seen and treated on an outpatient basis.
Serve the underprivileged population of type two diabetic patients

Data and research have shown an overwhelming number of type 2 diabetic patients who need continued education, supplies, and care after being discharged from the hospital. These patients are under-educated, over-weight, and without the necessary supplies and resources to properly care for their disease outside of the hospital. The hope is that implementation of a clinic such as this will restore confidence in patients who have diabetes to care for themselves and will be able to provide such resources to keep them out of the hospital and instead seen and treated on an outpatient basis. The clinic will have readily available resources and treatment plans to provide adequate outpatient care to patients who need help regulating care for their poor blood glucose control and/or non-healing skin ulcers. The clinic would serve as a way for the hospital to lessen the burden of consulting on every patient needing specific diabetic services. Consultation and treatments would be provided to patients, decreasing the time these patients would have to spent inpatient.

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Projected Revenue

Medicare is expected to be $75,000 in the first three months
Increase to $146,250 in the following few months
Medicaid is expected to be $21,600 in the first three months
Increase to $105,300 in the following few months based on projected growth in inpatient services
Private Insurances is expected to be $36,000 in the first three months
Increase to $147,000 in the following few months based on projected growth in patient services

The projected revenue from Medicare is expected to be $75,000 in the first three months (July, August, and September) of operation due to low patient census during the start-up phase. This revenue is projected to increase to $146,250 in the following few months based on projected growth in patient services. The clinic will treat roughly 10 Medicare patients a month during the first three months, excluding July, 13 patients a month during the next three or four months, and will continue to see 22 patients or more a month for the remainder of the first year. The projected revenue from Medicaid is expected to be $21,600 in the first three months. This revenue is projected to increase to $105,300 in the following few months. The clinic can suspect to treat roughly 4 Medicaid patients a month during August and September, seven patients a month during the next three or four months, and 13 or more patients a month for the remaining months of the year. The projected revenue from Private Insurances is expected to be $36,000 in the first three months. This revenue is projected to increase to $147,000 in the following few months. The clinic can calculate to treat roughly four patients a month with private insurances, excluding the month of July, 11 patients a month for October, November, and December, and 23 a month for the remainder of the year. This calculation is the same for Self-Pay and other Insurances. Revenue will continue to increase within every few months based on the projected growth.

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Advantages and Disadvantages

More inpatient beds
Training and education coming directly from a diabetes-management-specialty nurse practitioner to the new staff on the clinic
Better Flow
Inadequate staffing
A low level of "at home confidence" in patients
Providing and managing their care

AZRMC and the Clinic will be working side by side. Not only will we look at advantages and disadvantages of the CLinic, but at the Hospital as well. Two strengths of the proposed project are the availability of more inpatient beds and training and education coming directly from a diabetes-management-specialty nurse practitioner to the new staff on the clinic. The clinic will allow patients to be treated in an outpatient setting instead of being admitted to the hospital. This will allow for better flow, allowing for more available beds for the ER to see patients and better push-through in the hospital when admitting patients to the medical/surgical floors. Having a nurse practitioner specializing in this type of care can allow for advanced training and informational services for the new nursing staff who will soon be staffing the clinic. Two weaknesses of the proposed project are the issue with inadequate staffing and having a low level of "at home confidence" in patients when providing and managing their care. In terms of insufficient staffing, only two nurses are expected to see over 30 patients a day in the hospital. If the hospital cannot hire more help, will there be a sufficient number of trained nurses to staff the clinic so it can run effectively? Patients already report not feeling comfortable managing their care at home when discharged from the hospital. Due to this, will these patients feel confident and comfortable receiving care in the clinic and outpatient setting, and with the expectation that they continue and follow up with their care on their own at home?

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Expected Outcomes and Benefits

Multiple Rooms/Offices all pertaining to specific healthcare services
A doctor or Nurse Practitioner will always be staffed
fewer diabetic readmissions
Preventative care, supportive care, and information on diabetic education
Brand Growth
Competent Staff to provide quality care

This clinic's vision is to have multiple rooms or offices, all pertaining to specific healthcare services. Dietary needs, wound care, podiatry, ophthalmology, education, etc., will each have their own space to be able to offer their services to those diabetic patients in need. A doctor or Nurse Practitioner will always be staffed, as well as a nurse, a technician, a pharmacist, a secretary, and a telehealth therapist or in-person psychologist. . The hope is to see fewer diabetic readmissions due to the clinic's availability of the resources given to patients. Preventative care, supportive care, and information on diabetic education will better prepare patients to take charge of their own care outside the hospital. Research has shown in patients discharged to post-acute care facilities or sent home to manage care themselves that "multicomponent interventions have reduced readmissions through enhanced communication, medication safety, advanced care planning, and improved training to manage medical conditions that commonly precipitate readmission" (Kripalani et al., 2014). Referrals to the Clinic would thus serve as a very resourceful intervention to help reduce the number of hospital readmissions.Two opportunities for a successful implementation of this program are brand growth or Hospital recognition improvement and the opportunity to hire a completely new, specialty-trained staff for the clinic. With the clinic's success, more people will recognize the organization of Azusa Regional Medical Center as a premier treatment and care center. Hospital and clinic competence will grow, Azusa Regional will be more recognizable as a great facility, and knowledgeable and educated staff will provide excellent care to their patients.

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Projected Costs - Expenses

Initial planning and purchasing of resources and supplies for the clinic will begin a few months prior to the clinic's opening day.
The clinic will focus on marketing
glucometers, stripes, gauze, lancets, Band-Aids,
venous dopplers, computers, a printer, a fax machine, lab draw carts, an EKG machine, vital sign machines
Capital purchases will include two quality EKG machines, four portable digital vital sign machines, and one Venous Doppler/Ultrasound machine
Policies will be made and printed, and resources and education will be posted throughout the clinic
All capital expenses will be completely paid off before the opening date of July 1

Initial planning and purchasing of resources and supplies for the clinic will begin a few months prior to the clinic's opening day. In month one, which would be April, the purchases for office supplies, medical supplies, and capital expenses will be purchased for the clinic. Staff would also be hired during this month and in May. The clinic will focus on marketing, using the allotted $3,500 budgeted for marketing during the initial three months of April, May, and June. Once business and clientele increase, a portion of the marketing money can be distributed into other expense accounts. $500 over the course of the first three months will be used to entice and excite patients and list the benefits this clinic will offer starting in July. In terms of equipment needs, glucometers, stripes, gauze, lancets, Band-Aids, and other equipment of the sorts needs to be purchased in order to check blood sugars. Wound care supplies such as creams, antibiotics, gauze wraps, non-stick Telfa pads, Tegaderm, Mepilex, etc., would need to be ordered. Large equipment includes venous dopplers, computers, a printer, a fax machine, lab draw carts, an EKG machine, vital sign machines, folders, and a filing system. Education pamphlets will also need to be created and printed in multiple languages. A way to store medications such as insulin would also be needed. May will be the month that design will take place. Organization of equipment, beds, and supplies will be set up. Policies will be made and printed, and resources and education will be posted throughout the clinic. In June, one month before the clinic officially opens, staff will be trained. A flat rate based on salary will be paid to each employee with the successful completion of both online and in-person training. Based on the directions on this assignment, the opening of the clinic will be July 1^st. The clinic will not treat any patients but will continue daily simulation training and policy education classes to guarantee success once patients arrive in August. Salaries and wages will then be distributed depending on the title and certifications held by the employee. Capital purchases will include two quality EKG machines, four portable digital vital sign machines, and one Venous Doppler/Ultrasound machine. Two EKG machines would be a total of $2,195 each. Four digital vital sign machines would cost $2,500 each. Finally, a Venous Doppler/Ultrasound machine would cost a total of $11,510. All capital expenses will be completely paid off before the opening date of July 1. This equipment is detrimental to the clinic's success and therefore needs to be purchased and set up appropriately before the arrival of the patients. The clinic will pay for the capital expenses, other office supplies, and medical supplies through the generous donation from Azusa Medical Center and Donors who support the cure and treatment of diabetes.

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The Budget

Azusa Regional Medical Center

{Outpatient “One Stop Shop” Diabetes Care Clinic}

Open 8am-8pm Monday through Saturday

Proposed Budget

Income Statement: April 2022 through June 2022 and July 1, 2022 – June 30, 2022

Fiscal Year: 2022 April 2022 through June 2022 will be building/startup months but have been included in the yearly budget

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Revenue Sources

Self-paying or out-of-pocket patients and insurance like Medicare and Medicaid,
Grants and Donations
Government-sponsored programs
GOvernment Funded Programs and resources

Along with self-paying or out-of-pocket paying patients and insurance like Medicare and Medicaid, grants and donations are another expected source of revenue. Due to the association with AZRMC, many donors would likely donate to the clinic in order to help fund staff and supplies to provide quality outpatient services. Donations from happy clients and patients are also likely, based on the clinic's availability of treatment and care. Sponsorships may also help earn money for the clinic. Depending on the item and the donating foundation, the clinic could possibly represent its brand through its pens, signage, equipment, etc. Government-sponsored programs, primarily for research and education, may also give to the clinic. This idea can go two different ways as well. A government-funded program may donate to the great cause of helping and healing diabetic patients' medical problems. These government-funded programs may also supply the clinic with free education classes that can be hosted in the clinic. In this instance, the clinic would not be receiving money but would be gaining a free source of knowledge and teaching for the patients. Government-funded programs and Medicare and Medicaid Insurances will also encourage low-income communities and the older generations to come and receive care and treatment in these clinics (CMS, 2021).

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Timeline

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Conclusion

Return of investment for the first year of operation for this clinic would be $114,857
The burden on hospitals in terms of care for diabetic patients will lessen.
Quality of life for staff and patients will increase
People will be healthier and happy on a day-to-day basis.

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References

Cindy Rishel (2021). Week 5: Healthcare Business Scenario-Hospital-based Wound Care Clinic.

CMS (2021). Centers for Medicare & Medicaid Services. Retrieved from: https://www.cms.gov.

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Kripalani, S., Theobald, C. N., Anctil, B., & Vasilevskis, E. E. (2014). Reducing hospital readmission rates: Current strategies and future directions. Annual Review of Medicine, 65(1), 471–485. https://doi.org/10.1146/annurev-med-022613-090415

Manary, M. P., Boulding, W., Staelin, R., & Glickman, S. W. (2013). The patient experience and health outcomes. The New England Journal of Medicine, 368(3), 201–203. https://doi.org/10.1056/NEJMp1211775

Penner, S. J. (2017). Economics and financial management for nurses and nurse leaders. Springer Publishing Company.

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ZipRecruiter. (n.d.). Job search - millions of jobs hiring near you. ZipRecruiter. Retrieved October 24, 2021, from https://www.ziprecruiter.com/.