Classmates have presented their capital budget proposals and you are responsible for reviewing the proposals and providing feedback about each one. Review at least two classmates’ presentations. State whether you would approve their proposal and why you would or would not. Regardless of how you decided, use the critical elements located in the Final Project Rubric to identify specific strengths and opportunities for improvement in their proposal.
Classmates Stephanie and Margaret power point attached below. Please respond separately to bother power point proposals using rubric attached below as well
To improve the health of people and communities through accessible, quality care.
Community Mobile Radiology Unit
Southern New Hampshire University
Hello, my name is XXXX. Welcome to this meeting on Community Mobile Radiology Unit proposal.
1
Introduction
Venice Family Clinic started in 1970 by Philip Rossman, MD (founder) and Mayer B. Davidson, MD (co-founder) in a borrowed storefront dental office
Venice Family Center (VFC) a non-profit, private, community-based clinic including: 12 locations, 370 staff members and 1,371 volunteers
Provides comprehensive services including primary care, behavioral health services, dental and vision care
75% of clientele live below poverty line and 16% are homeless
Venice Family Clinic (VFC) is a community health facility that provides health care to those people in need (i.e. homeless and/or low-income). Currently 75% of the clientele treated by VFC live below the poverty line and about 16% are homeless. The present comprehensive services provide specialized treatment in various specialties, but their current Street Medicine program is diversified and an area of growth and progress.
2
Financial Status of the Organization
VFC’s current ratio for 2018 is 22.05. Current assets ($24,286,070) ÷ current liabilities (1,101,514).
VFC’s 2017 ratio = 14.93 (18,078,363 ÷ 1,210,695). Increase in the ratio shows financial stability and growth.
Revenue: insurance reimbursements, grants, donations, and additional subsidized by state and federal resources.
Largest portion of reimbursements received from “third-party” vendors and grants.
Improvement in care associated to the increase in assets from 2017 to 2018 of $6 million.
Reduction in liabilities total $359,000
Based upon the annual report from 2018 the acknowledged current ratio from 2017 to 2018 shows a growth from 14.93 to 22.05. These numbers reflect financial stability within the organization and growth/progress. Primary reimbursement received from “third-party” vendors with additional revenue acquired from grants , donations, scholarships, and federal/state subsidizing.
3
Current Healthcare Trends
There are various healthcare trends impacting the operations of many healthcare organizations. First and foremost technology has affected how information is collected, organized, and then disseminated within any healthcare organization. Using technology to provide access to the impoverished and homeless population is now readily available through mobile medical clinics and now mobile radiology units. Using state-of-the-art equipment we can now receive test results quickly and efficiently and reduce duplication of orders. Another trend that influenced healthcare is the transition to “value-based purchasing” not only in hospitals but also smaller clinics and private practices. Providing care and services based upon quality instead of quantity has affected healthcare outcomes. Access to mobile units can decrease the risk of health complications for at-risk populations and impact the health issues within the community.
4
Technology improves access to resources within the community.
Reduces duplication of ordering tests/labs.
Decreases time-frame for results processing and reporting
Value-based purchasing impacts the access and availability to testing
“Value-based programs, they are part of a larger government effort to pay providers for quality rather than quantity by providing better care for individuals, better health for populations, and lower cost” (Nowicki 2018, pg. 209)
Decreasing the risk of health complications for the homeless and poor communities can impact the health issues for society
Strategic Goals
Providing comprehensive health care that includes medical, dental, and mental health treatments for “pediatrics, general adult medicine, women’s, senior, homeless, and chronic care services” (VFC 2018)
Street Medicine program providing “house calls for people without a home.” Additional services to include mobile radiology services to the low income and homeless population will improve treatment options. (VFC 2018)
Most reimbursement received from Medicare/Medicaid and private health services (third-party payer) in addition to grants, scholarships, and financial aid which are impacted by government policies such as the Affordable Care Act which provides a large portion of our support. Current policy changes or repeal of the ACA would impact outpatient services such as radiologic testing
“Increased numbers of uninsured patients, together with both the loss of Medicaid revenues associated with the Medicaid expansion and most federal grant funding, would be a severe financial shock to health centers and likely leave them unable to sustain their operations and capacity at current levels” (Rosenbaum, Paradise, Markus, Sharac, Tran, Reynolds, and Shin 2017)
Within VFC’s mission and vision “to improve the health of people and communities through accessible, quality care” (VFC 2018). Access to quality care improves the health and wellness of the community, but also increases rates of reimbursement. Reimbursement rates based upon specified quality care goals and diagnosis-related groups (DRGs) can be influenced by utilizing the current Street Medicine program and expanding on the services provided. Any changes to the government policies such as the Affordable Care Act (ACA) will impact any outpatient services VFC can provide. “Increased numbers of uninsured patients, together with both the loss of Medicaid revenues associated with the Medicaid expansion and most federal grant funding, would be a severe financial shock to health centers and likely leave them unable to sustain their operations and capacity at current levels” (Rosenbaum, Paradise, Markus, Sharac, Tran, Reynolds, and Shin 2017).
5
Proposal for Community Mobile Radiology Unit
The current Street Medicine program provides necessary services within the impoverished community that would not otherwise be available. The ability to have basic radiologic testing in “real-time” reduces the time between assessment and treatment. Prevention of overworked staff it would be prudent to hire 2 additional staff members to operate the mobile radiologic unit to prevent delays in testing or lack of resources if short-staffed. Additionally the reduction in ER visits through the Street Medicine program and the mobile radiology unit can reduce misuse of resources and re-admission rates for those clients that can be maintained at “home”. Out-of-pocket expenses can also be reduced when not referring our clientele to an outside facility or affiliation.
6
Mobile Radiology Units in conjunction with the Street Medicine program can also provide basic radiological services to the homeless & homebound population.
Tests including chest x-rays (CXR), hip, knee and/or ankle x-rays in cases of minor injuries.
Hiring 2 additional staff members to properly operate the mobile units and equipment and prevent overworking existing staff
Reduction in unnecessary uses of Emergency Centers for non-emergency visits and potentially decrease readmissions if timely outpatient monitoring can be maintained.
Addition of mobile radiology unit also decreases the out-of-pocket expenses for our clientele from affiliation fees using other healthcare facilities
Proposal for mobile radiology unit continued…
The purchase of a mobile radiology van/bus customized for outpatient radiologic services will increase the access of healthcare within the community. Additional fees will be associated with the purchase to include equipment/supplies, customization process, taxes, licensing and insurance fees. Equipped with laptop/computers with hotspots/WIFIF and connecting with the existing electronic health record (EHR) would maintain contact with the clinic community and access to the patient medical records.
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Mobile units include the purchase of van/truck that can be customized for specialized use.
Proposal includes purchasing the vehicle, equipment/supplies, customization fees, and taxes, licensing and insurance fees.
Mobile unit would include laptop/computers with hotspots and WIFI technology to maintain contact with clinics and access to patient medical records
Proposed Options
Reviewing dealers currently providing van/buses for mobile units like Odulair VFC can have the vehicle customized and equipped with the necessary supplies and materials for efficient and effective care. The best option for VFC would be to purchase the vehicle outright versus a used vehicle which could include additional maintenance costs and or additional fees if the vehicle needs modification. Leading a vehicle would create possible end of lease fees and most companies will not allow customization of a vehicle after the lease is signed. All options would include the hiring of 2 staff members to operate the vehicle and equipment.
8
Purchase of one mobile X-ray van/bus (equipped) and the hiring of 2 X-ray technicians to staff the mobile unit
Lease a vehicle and have it customized with the necessary equipment. Up-front this would be a lower-cost item, but most leases do not cover any customization of a vehicle. Hiring of 2 radiology technicians will still be necessary to cover the operation of the unit
Purchase a used vehicle is an option but can come with many issues such as previous wear/tear, cost for repairs/adjustments or modifications and hiring 2 radiology technicians
Options continued…
Based upon Odulair website their customization process takes 26 weeks from start to finish which would provide ample time to retrieve the funds for purchase. The cost range depends upon the options selected but general cost is between $200,000-$350,000. Hiring 2 radiology technicians will ensure proper staffing of the unit at $99,000 per year.
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Purchase, installation/customization takes minimum 26 weeks for completion
Cost ranges between $200,000-350,000 depending on the specific equipment, features/options.
Hiring 2 Radiology technicians: approximately $99,000/year on average.
Leasing is possible but includes additional fees and possible end of lease fees
Purchase of used vehicle possible with potential additional fees applied to modifications, unknown wear/tear on the vehicle
Financial Research
Mobile Unit vehicles can be purchased or leased. Purchasing is the best option. Cost is variable depending on the vehicle chosen and customization
Access for the community to early testing improves diagnosis and treatment time.
Access for early testing is vital for not only the low-income population, but for those homebound who are unable to have needed follow-up testing
Unnecessary ER visits can be reduced through sharing the services between the Street Medicine Program and a Mobile Radiology Unit
Mobile services are influential in cost saving measures and improving health and wellness within the community
Mobile units are available for both purchasing or leasing but customization makes leasing the least feasible option. Many companies are available to assist in choosing and modifying the vehicle one site available included Odulair. Costs are variable depending on the options chosen but are within $200,000-350,000 range with varying sizes available.
“Higher demands are being placed on vehicles used for mobile medical needs…looking to outreach vehicles as a permanent part of their culture…requires that the vehicles last longer, making structural integrity and high-quality electrical systems imperative” (Blanchet 2008). Reliability is needed with the vehicle to withstand the demanding schedules needed to provide services within the community.
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Available Organizational Resources
Project Implementation would include:
Chief Financial Officer
Financial Manager
Department Heads
Human Resources
Street Medicine (director/staff)
IT department
Supply Director
Radiology Department
Additional resources include vehicle dealers, city clerk, department of motor vehicle, community supporters, and volunteers.
In addition to the finance department including the CFO and finance managers it will be necessary to have all department heads including the Street Medicine director involved as this proposal will be an expansion of the current services provided. Human resources will be needed for the creation of the job postings/listings. The radiology department at the clinic will be needed for a smooth transition within the program and connecting the mobile unit with the radiologists. IT department is needed for the computer connections and EHR maintenance and the central supply controller will be needed for any supplies necessary for operating the mobile unit. Additional resources as listed above include city workers, department of motor vehicles for registering/insuring the vehicle and involving our current volunteers and supporters to promote the program.
11
Communication
Utilizing the current email program by sending newsletters notifying each location of the upcoming program addition
Following up upon the email/newsletter set up departmental team meetings
Incorporate Street Medicine Department for finalization of the process and routine monitoring
Weekly meetings either in-person or via skype to guarantee the process is on track until go-live-date. Prior to the go-live date VFC will need to ensure that proper training on the use of the unit and ensure the new hires are familiar with the computer system
With the speed of technology these days using emails as a first line of communication seems reasonable. Using routine staff/department meetings to further the communication process will ensure that everyone is on board with the program. The Street Medicine program is needed for finalization and monitoring of the program release and continuation. Weekly meetings will be vital in the set-up and organization of the program prior to the go-live-date and may be needed following to acquire necessary feedback.
12
Statements
2018 annual report the current assets total $24,286,070 and current liabilities total $1,101,514 for a net increase of 22.05%.
2017 financials showed assets of $18,078,363 with liabilities of $1,210,695 for a net increase of 14.93%.
2018 annual report & Education & Outreach program would include the Street Medicine program. Expanding to include radiological services through a mobile unit would give improved comprehensive medical care to the community
Statement show confirmed financial stability of VFC and improved growth
https://s3.amazonaws.com/media.venicefamilyclinic.org/2019/06/2018-VFC-Annual-Report.pdf
https://s3.amazonaws.com/media.venicefamilyclinic.org/2019/06/VFC_2018_Audited_Financials.pdf
These statements were used to show whether or not it would be financially feasible to support such a project. The statements show the current assets ad liabilities. Over the past few years the clinic’s financial stability has been growing.
13
Reasoning
Purchase of the vehicle (van/bus) would need to come from an asset account as a large sum up front would be needed
Financing is an option, but outlying fees would add up (i.e. interest)
Purchasing a used vehicle is an option, but the outlying fees associated with modifications and possible wear/tear on the vehicle can become unreasonable
The mobile radiology unit can be equipped using current disbursement accounts already used by VFC such as the Street Medicine program, radiology department, and current supply vendors. Purchasing the vehicle is the best option paying cash upfront rather than leasing which could lead to outlying fees such as interest and end of lease fees.
14
Budgeted Accounts Recognized accounts affected by proposal
Salaries/benefits
Insurance
Equipment
Medical supplies/waste
Office supplies
Repairs/Maintenance
Technology expenses
Telephone & travel workshops
Net asset account (purchase of vehicle)
As listed above the accounts utilized will include those accounts already in use therefore adding additional costs would not be necessary. Many supplies can be added through the current supply chains while others would require individual purchase for outfitting the vehicle. Medical supplies/waste can be funded through the clinics in addition to the office supplies. Repairs/maintenance can be funneled into the current maintenance department utilized for the clinics. The one large purchase of the vehicle will need to be taken from a separate asset account due to the customization/outfitting of the equipment.
15
Expenses
Purchase or lease of van/bus for mobile radiology unit w/ customization
2 new hires (radiology technicians)
Purchase of medical supplies and equipment for outfitting vehicle
IT department for remote access, hotspot, and WIFI services for clinic communication
Education & Outreach program and Personnel departments expenses would be impacted
As discussed in the previous slide regarding the accounts being impacted I touched upon where many items can be added to many existing budgets including the wage/salary, medical supplies/waste, office supplies, and the IT department to mention a few. The largest impact would be to the Education & Outreach program and the Street Medicine program due to the proposed expansion of the services provided through the mobile radiology vehicle.
16
Ratios
Feasibility of proposal using:
Return on Investment = Investment revenue – investment cost ÷ investment cost
Present Value = PV = FV/[1+ i]ⁿ
Payback Period Analysis = year before recovery + unrecovered cost @ beginning of year ÷ cash flow during year
PPA provides the time-frame before VFC will see a profit on the investment.
PV (present value) is the current value of a future sum of money/cash flow at a pre-determined rate a return.
ROI is the ratio between net profit and cost of the investment.
The mobile radiology unit is an investment in the expansion of services provided by the Street Medicine program providing care to the low-income and homebound community.
17
Ratio Calculations
As seen with the above numbers if VFC can pay off $75,000 per year on the investment they will see a return on their investment before 6 years. Additionally they have a positive net value which means they are able to pay off their investments and are able to operate in the “black”.
18
Cost Benefit
Utilizing the current outreach programs to provide additional resources to the community
Homeless population are at risk for multiple health concerns that include chronic health conditions and the effects of the environment
Extension to the Street Medicine program utilizing a mobile radiology unit allows VFC to reach more individuals and provide necessary treatments
Decreasing the risk of health complications for the homeless and poor communities can impact the health issues for society.
Maintaining the quality care and increasing community education can impact the future success and longevity of VFC.
Reducing re-admissions impacting reimbursement rates for those individuals that need closer follow-up services to stay out of the hospital.
Providing safe, effective, and quality care to the impoverished and/or homeless population has a two-fold effect on the community. The homeless population are at risk for multiple health concerns that includes chronic health conditions and the effects of the environment. Living outside in elements can increase the risk of dangerous health concerns just from exposure to the hot/cold elements and poor hygiene. Decreasing the risk of health complications for the homeless and poor communities can impact the health issues for society.
19
Strategic Planning
Reduction in unnecessary ER visits and improved preventative measures for chronic health concerns.
One large cash expense for the vehicle and additional cash flow from current department budgets (i.e. medical supplies, office supplies, radiology department).
With the implementation of the mobile radiology unit there will be no profit for at least 6 years in addition to no additional shortages
A reduction in unnecessary ER visits will allow for improved preventative measures for chronic health conditions, particularly in the low-income population. Purchase and customization of the vehicle will take 26 weeks from start to finish with variable costs depending on the various options available and outfitting the vehicle to meet the projected needs. The computer system will be integrated with the existing program through VFC and having the IT department set-up the hotspot/WIFI will maintain connection with the clinic and access to the patient medical records. Medical and office supplies can be accessed through the central supply department budget. Understanding that there will be no profit for about 6 years, but the expansion of the Street Medicine program through the mobile radiology unit will increase the reach of the program within the community.
20
Short-Term Impact
Improved efficiency in patient care and compliance in treatment plans.
Low-income population most often delays treatment due to lack of finances/resources.
Improved patient compliance impacts readmission rates and reimbursement rates.
Reduction in readmissions influences the percentage of reimbursement rates and impact revenue.
The value in purchasing a mobile radiology unit is the improved efficiency of patient care and compliance with treatment plans. Caring for the homeless and low-income population requires additional planning to provide safe and effective care. Low-income populations often have a delay in treatments due to lack of resources, transportation, and finances, but if we as a local community center can provide access to necessary treatments within the community for those who lack the ability of transportation we can improve the health of this population and increase patient compliance. Improved patient compliance impacts the re-admission rates and in turn the reimbursement rates regarding specific diagnosis related groups (DRGs). A reduction in re-admissions influences the percentage of reimbursement rates, therefore any impact on re-admission rates will affect revenue.
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Long-Term Impact
Reduction in contractual fees associated with using outside referral sources for radiology testing
Residual fees in turn can impact patient out-.of-pocket expenses for the clientele
Reduction in time and efficiency for the claim process which impacts the re-imbursement rates
Reduction in delay in treatment, improve patient care, and improve patient loyalty
Profitability is impacted by patient retention.
The mobile radiology unit ca reduce the expense of contractual fees when using outsourcing our testing and procedures. These residual fees eventually add up over time and can in turn impact our patients and their out-of-pocket expenses. Improving time and efficiency between testing time, diagnosis, and treatment will influence the claim process which impacts the reimbursement rates. Adding the mobile radiology unit to the existing Street Medicine program will reduce the delay in treatments, improve patient care within the community and improve patient loyalty. Our profits are impacted by patient retention and must be addressed and monitored for longevity. “Since acquiring a new patient is six to seven times costlier than retaining an existing one, practitioners must provide experiences that will translate into revenue and profits for practices” (Parker 2018)
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Conflicts
Implementation of the Mobile Radiology unit does not conflict with the current mission/values of VFC.
Education and training can be a concern associated with working with the low-income population and the multiple chronic health concerns.
Area of concern can be location for parking the vehicle.
Unsafe locale and safety of the staff/patients
Where will the vehicle be housed when not in use?
VFC currently provides care and services to the homeless and low-income community and utilizing a mobile radiology unit/vehicle can continue this process without the added cost on the patient. Additional out-of-pocket expenses of having radiology testing at a contracted or affiliated facility is felt by the patient with a small fee for VFC.
Providing necessary training for the personnel will be needed especially when caring for this population. Dealing with the homeless population can lead to some unsavory clientele (i.e. mentally ill and addiction). One area that will need further addressing would be where to house the unit when not in use.
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References
Blanchet, K.D. (2008). Mobile Health Clinics and Telemedicine. Telemedicine and e-Health 14(5) pp. 407. http://doi.org/10.1089/tmj.2008.9969
Guide to Buying a Mobile Clinic – Getting Started. (n.d.). Retrieved from https://www.odulair.com/how-to-buy-mobile-clinic-medical-vehicle.html
Nowicki, M. (2018). Introduction to the financial management of healthcare organizations. Chicago, IL: HAP/AUPHA, Health Administration Press.
Parker, S.M. (2018). 5 Ways to Improve Your Medical Practice’s Profitability. Practice Builders Retrieved from https://www.practicebuilders.com/blog/5-ways-to-improve-your-medical-practices-profitability/
Rosenbaum, S., Paradise, J., Markus, A., Sharac, J., Tran, C., Reynolds, D. & Shin, P. (2017). Community Health Centers: Recent Growth and the Role of the ACA , The Henry J. Kaiser Family Foundation, January 2017. Retrieved from http://kff.org/medicaid/issue-brief/community-health-centers-recent-growth-and-the-role-of-the-aca/.
Venice Family Clinic (VFC) (2018). Annual Report. Retrieved from https://s3.amazonaws.com/media.venicefamilyclinic.org/2019/06/2018-VFC-Annual-Report.pdf
Venice Family Clinic (VFC (2018). Consolidated Financial Statements. Retrieved from https://s3.amazonaws.com/media.venicefamilyclinic.org/2019/06/VFC_2018_Audited_Financials.pdf
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