fi h-p8
Providing quality primary health care to people in need
Street medicine mobile medical office/lab proposal
Southern new Hampshire university
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Organizational Strategic Goals
The Venice Family Clinic (VFC) is a private, not for profit operation which was founded in 1970 which has twelve locations and a Street Medicine program.
This program allows a team from the Clinic to go out into the community and provide care to homebound and homeless patient.
VFC provides quality, comprehensive health care to the low income, homeless, and in-need population.
The VFC offers a full array of traditional and non-traditional medical services.
VFC provides is own pharmacy services.
The Venice Family Clinic (VFC) was founded in 1970 by Dr. Philip Rossman and Dr. Mayer Davidson in Los Angeles, California (About the, n.d.). The Clinic was a volunteer endeavor and provided basic healthcare from a borrowed dental office after hours. It is now is a private, not for profit, community-based operation that provides quality, comprehensive health care to the low income, homeless, and in-need population who would otherwise go without health care (About the, n.d.).
The VFC offers primary, specialty, and behavioral healthcare in addition to dental, vision, substance abuse, health education, nutrition, alternative medicine (such as yoga, chiropractic, acupuncture, etc.) as well as full pharmacology services (About the, n.d.). It offers twelve care locations as well as a street medicine program. This program allows a team from the Clinic to go out into the community and provide care to homebound and homeless patients that would not ordinarily be able to take advantage of clinic services. The street medicine program not only provides medical care, but also psychiatric care (About the, n.d.).
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Organizational Strategic Goals (continued)
Community health centers provide primary care for most of the underserved population.
The Affordable Care Act (ACA) is essential to providing this care as it provides a large part of the financial support for these centers.
If repealed, the centers like VFC would have a difficult time maintaining their operations.
The ACA is looking to expand telehealth use). Telehealth can improve patient care by allowing them healthcare access remotely.
Proposed changes in federal policies can hinder Medicare participants to take advantage of it.
The fate of the ACA will be a major contributor to whether or not programs like telehealth will remain a viable healthcare resource for clinics such as VFC.
Because community health centers provide primary care for most of the underserved population, the affordable care act is an essential part of providing this care as it provides a large amount of funding (Paradise, Rosenbaum, Markus, Sharac, Tran Reynolds, & Shin, 2017). This funding is an essential part of the financial support for these centers. The VFC also received a good portion of its funding from the federal government to service its patient population. If the ACA was repealed, the centers like VFC would have a difficult time maintaining their operations, causing the community it serves to again become medically underserved and at risk (Paradise, et al., 2017).
The ACA also has tremendous impact on telehealth initiatives and Congress is looking to expand telehealth use (A tell-all, 2019). Telehealth can improve patient care by allowing them healthcare access remotely, but there are some proposed changes in federal policies that can hinder Medicare participants to take advantage of it (A tell-all, 2019). This problem coupled with the fate of the ACA will be a major contributor to whether or not telehealth will remain a viable healthcare resource for community healthcare centers like VFC.
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Healthcare Trends
Technology - important in community-based medicine.
Electronic Health Records, artificial intelligence, and virtual health enable “in-need” communities to receive primary and chronic illness care without going to a medical office.
Technology can reduce the population’s utilization of healthcare resources keeping costs down.
Technology is becoming increasingly important in community-based medicine. Electronic Health Records, artificial intelligence, and virtual health enable “in-need” communities to receive primary and chronic illness care without having to meet with a clinician in the medical office (Burrill, 2018). This can be imperative for clinics such as VFC because they have many patients without access to transportation to the clinic or are unable to get out due to illness or mobility problems. Telehealth can help keep patients in touch with providers and is a paid resource through Medicare/Medicaid services (Burrill, 2018). As healthcare moves towards focusing on overall wellness, it can reduce the population’s utilization of healthcare resources to keep costs down (Burrill, 2018). This is especially important in community-based medicine.
The funding for the Affordable Care Act (ACA) was doubled when patients gained insurance through the program as well as incentives for providers to practice in community health centers (Role of, n.d.). These centers serve low income and uninsured populations to provide low or no cost medical care across the board. The centers also employ thousands of people and reduce ER visits and more extensive care by providing pre-emptive care for patients at the community level (Role of n.d.). With the increase of use in community health centers, the ACA created the Community Health Center Fund to help support the increased demand (Role of, n.d.).
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Financial Condition of the Organization
Receives private donations, grants, insurance reimbursements, and subsidies from federal and state government.
The VFC receives community support from various partnerships and investments.
Increased services in 2018 were due to increased funding.
Most financial reimbursements come from third-party vendors with government contracts then grants second.
Total current assets from 2017 to 2018 increased over $6 million dollars with total liabilities decreasing by approximately $350,000.
VFC’s 2018 current ratio is 22.05. This is current assets ($24,286,070) ÷ current liabilities ($1,101,514). The 2017 current ratio is 14.93 ($18,078,363 ÷ $1,210,695). This shows that the current ratio is increasing, showing increased financial stability.
The clinic operates in the black, receiving private donations, grants, and subsidies from federal and state government as well as insurance reimbursements (VFC Audited, 2018). The VFC also receives community support from various partnerships and investments. Due to this funding and support, the VFC was able to increase its services in 2018 (VFC Audited, 2018). Most of its financial reimbursements come from third-party vendors with government contracts with grants second (VFC Audited, 2018). The VFC’s total current assets from 2017 to 2018 increased over $6 million dollars with total liabilities decreasing by approximately $350,000 (VFC Audited, 2018).
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Proposal for Street Medicine Program
The program provides “house calls for people without a home.”
The Street Medicine program brings healthcare to individuals who are homeless, shut in, and considered high risk.
Pre-emptive care and testing to reduce admissions and re-admissions to acute care facilities.
A mobile medical office/lab unit would bring pre-emptive care to the streets.
Type of vehicle - RV or box truck style vehicles could be retrofitted to become office/lab facilities.
This would entail not only purchasing the vehicle and equipment/supplies, but also entail some installation fees.
The Street Medicine program through VFC is meant to bring healthcare to those individuals who are homeless, shut in, and considered at high risk. This program gives these individuals medical services and testing that can keep them from being admitted to the hospitals or other acute care facilities, as well as avoiding readmission for chronic, uncontrolled illness or disease. It gives them pre-emptive medical care and observation to ensure health status and compliance with medical orders. These people would otherwise not have this medical care due to transportation, monetary, and trust issues. The goal of this program is to provide medical care services for individuals in the community who are at risk. To do this, staff must get out in the community proper to provide this care. A mobile unit would do this.
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Proposal for Street Medicine Program (continued)
Equipment and Supplies - necessary to give simple testing and primary care including seasonal vaccinations, CBC/lead testing, strep, flu, glucose, and urinalysis testing, wound care, examination services, as well as simple hygiene services.
Patient education are an important aspect of care in this mobile office.
The mobile office would utilize laptops with mobile hotspots and Wi-Fi technologies to access patient records and communicate with the clinic.
The proposal utilizes existing program staff but another option could be to hire specific staff for the mobile office/lab unit.
Additional costs - VFC insurance, maintenance for the equipment and the vehicle, and gasoline.
Pharmacological supplies would be utilized from the VFC stores utilizing Federal and State programs.
The goal of this program is to provide medical care services for individuals in the community who are at risk. To do this, staff must get out in the community proper to provide this care. A mobile unit would do this. The first option is what type of vehicle to purchase for this mobile office/lab. There are RV type vehicles that could be retrofitted to become a mobile office and there are box truck type vehicles that could also be retrofitted to become office/lab facilities. This would entail not only purchasing the vehicle and equipment/supplies, but also entail some installation fees.
The vehicle would be outfitted with equipment and supplies necessary to give simple testing and primary care including seasonal vaccinations, CBC/lead testing, strep, flu, glucose, and urinalysis testing, wound care, examination services, as well as simple hygiene services. Patient education would also be an important aspect of this mobile office.
The mobile office would utilize mobile hotspots and Wi-Fi technologies to access patient records and communicate with the clinic offices. Each medical provider on the unit would have a laptop to document. Although the proposal is to utilize existing staff that already go out into the community, another option could be to hire a specific staff that would do nothing but Street Medicine care and interventions in the mobile unit.
The unit would be covered under the VFC insurance, with additional insurance being added for vehicle insurance. Additional costs would include maintenance for the equipment and the vehicle as well as gasoline. Pharmacological supplies would be utilized from the VFC stores utilizing Federal and State programs.
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Options
Outright purchase, installation to outfit/retrofit the vehicle - would take approximately 26 weeks to set up for delivery and use
Mobile medical vehicles can range anywhere between $175,000-$350,000 depending upon options and features.
Leasing a vehicle - Feasible but includes interest fees, and possible end of lease purchase fees.
Rental of Mobile Unit – not a viable option due to vehicles having to be customized for use.
A. Outright purchase of the unit would cause a short-term impact to the first quarter expenditures. Installation would also be an expense to outfit/retrofit the vehicle. A typical mobile unit would take approximately 26 weeks to set up for delivery and use (Odulair, 2019). Mobile medical vehicles can range anywhere between $175,000-$350,000 depending upon options and features (La Boit, 2017). Medical units average between 26 ft. to 40 ft. models dependent upon proposed usage. They get anywhere between 18-24 mpg depending upon the usage.
B. Option two would include leasing a vehicle. Although not much information could be found on this option, it is feasible but also includes an interest fee that adds to the cost of the vehicle. In addition, there is the question of whether or not the mobile unit would be purchased at the end of the lease, creating an additional cost.
C. Option three is rental of a unit. This is not a viable option because each mobile unit is fitted for specific uses.
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Outright Purchase of the Unit
Includes purchase of unit, retrofit, and installation of equipment.
Lease of the Mobile Unit
Includes lease of vehicle, retrofit, and installation of equipment.
Rental of Unit
Not a viable option due to its having to be customized for clinic use.
Interest on lease.
Lease to purchase option.
Financial Research
Medical Office/Lab Vehicles can be purchased or leased. The best option is to purchase. Costs are dependent upon the size of vehicle chosen and options chosen.
Mobile health clinic vehicles can provide cost benefits to an organization by providing early diagnosis and interventions to patients at risk, improving their ability to maintain their health status
Visits to the ER can be avoided by primary care interventions. Medical costs have only increased over the years. Mobile units could avoid these unnecessary costs and help improve health care.
The CDC reports that chronic disease is avoidable through preventative care and accounts for 75 percent of healthcare.
Medical Office/Lab Vehicles can be purchased or leased. However, if the unit is to be used to accommodate a specific practice, then the best option is to purchase. There are several companies that will help an organization to choose, design, and construct a mobile medical vehicle. Costs are dependent upon the size of vehicle chosen and what other additions are necessary to make it functional (Guide to, n.d.).
Mobile medical vehicles can range anywhere between $175,000-$350,000 depending upon options and features (La Boit, 2017). Medical units average between 26 ft. to 40 ft. models dependent upon proposed usage. They get anywhere between 18-24 mpg depending upon the usage.
Mobile health clinic vehicles can provide cost benefits to an organization. This is done by providing early diagnosis and interventions to patients at risk which improves their ability to maintain their health status, reduce ER and hospital visits, and improving their quality of life (Guse, 2018). In addition, these units can reduce costs in the clinics proper as it would reduce operating costs.
A 2015 report by the Massachusetts Health Policy Commission noted that 40 percent of visits to the ER between 2010 and 2014 were visits that could have been managed earlier by primary care interventions (Guse, 2018). Back then, the cost of an ER visit was $474.00. With over a million non-necessary ER trips in that year, the cost was over $558 million dollars. Costs have only increased over the years. Mobile units could avoid these unnecessary costs and help improve health care for all (Guse, 2018).
Beaton (2017) states that the CDC reports that chronic disease is avoidable through preventative care and accounts for 75 percent of healthcare spending by $260 billion dollars per year.
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Financial Research (continued)
Preventative medical care not only saves lives, but also billions of dollars in acute care services and hospital stays.
Mobile clinics give at risk patients access to care (approximately $6.5 million visits a year).
The average return on investment of a mobile office/lab clinic is 12:1, meaning for every $1 spend, $12 are saved on healthcare.
Mobile services promote preventive care, creating cost savings and improved healthcare outcomes.
Visits to mobile clinics save $200 on average, which is estimated to be one fifth of the cost of an ER visit.
Preventative medical care could not only save lives, but also billions of dollars in acute care services and hospital stays.
Mobile clinics give at risk patients (uninsured, public insured, and low income) access to care (approximately $6.5 million visits a year). The average return on investment of a mobile office/lab clinic is 12:1, meaning for every $1 spend, $12 are saved on healthcare (Impact Report, 2019). In addition, mobile services promote preventive services, creating cost savings (on average of $1,600) and improved healthcare outcomes by providing cheaper healthcare with fewer visits to acute care facilities. Visits to mobile clinics save an average of $200, which is estimated to be one fifth of the cost of an ER visit (Impact Report, 2019).
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Organizational Resources
Resources and departments that would be imperative to this project’s institution would include:
Financial manager
Finance offices
Street Medicine director and staff
IT Department
Pharmacology
Lab Services
Supply Director
Some resources can be taken from clinics; however, others may have to be purchased outright. Deals and specials would be looked into.
All of these departments are imperative to the functionality of the proposal. The mobile unit proposal depends highly on all of these departments for not only funding, but also its supplies, equipment, and personnel.
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Communication
Communication is key for this project to come to fruition. For this project, communications would be conducted via:
team meetings
Street Medicine Department meetings
Weekly updates would be included in communications and filed for reference.
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Statements
The consolidated statement of financial position and the 2018 annual report were used as well as the Street Medicine program. This program could be expanded to include not only visits to the homeless, but also a mobile office and lab services to give them more comprehensive medical care.
In 2018, current assets total $24,286,070 and current liabilities total $1,101,514 for a net increase of 22.05%.
2017 showed assets of $18,078,363 with liabilities of $1,210,695 for a net increase of 14.93%.
These numbers show that the financial stability of VFC is getting stronger.
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.
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Reasoning
Can utilize existing expenditure lines.
Truck would need to come from an asset account as it needs a large amount of cash up front.
Financing vehicle could be an option but would include a greater outlay of funds in the long run.
This Photo by Unknown Author is licensed under CC BY-SA
Many of the items for the mobile unit can be taken from existing expenditure lines as these are already items used in the VFC already. The mobile office truck funds would need to be taken from an asset account as this item needs a larger amount of cash for its purchase. It could also be financed, but a cheaper solution would be the outright purchase of the vehicle.
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Budgetary Accounts
Accounts affected by this
Personnel
Equipment
Insurance
Salaries
Medical supplies/medical waste removal
Office supplies
proposal include:
Pharmacy supplies
Repairs/maintenance
Technology expenses,
Telephone, travel/training/workshops,
Property/equipment
Net asset account. (This last account would be use for the purchase of the truck.)
There are many different accounts that would be affected by this proposal. It assumes many aspects of the brick and mortar facilities and thus would be included in those account lines. Some of supplies and equipment would need to be purchased outright, however; some of it could also be taken from the clinic sites. The truck purchase and its retrofitting is a very large expense and could be taken from a short term investment net asset account.
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Expenses
Expenses associated with this proposal include:
Purchase or lease of a box truck to house mobile office/lab
Team of three medical personnel (MD, RN, and MA)
Purchase of lab equipment, medical supplies and other equipment necessary to outfit truck
Technology to allow remote access to clinic proper.
Lines Affected:
Expense lines that would be impacted include Education and Outreach, In-kind Laboratory, In-kind pharmacology/Lab supplies, and Personnel.
The proposed expenses can be purchased, but some of the supplies and/or equipment necessary for the function of the mobile office/lab could be taken from the supplies already purchased by the clinic. The supplies could be taken from the above lines or any other account lines as the board sees fit.
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Ratios
The ratios used to determine the feasibility of the proposal are:
Payback Period Analysis = Year Before Recovery + Unrecovered Cost at Beginning of Year ÷ Cash Flow During Year
Present Value = PV = FV/(1 + i)n.
Return on Investment = Investment gain – cost of investment/cost of investment.
The ratios used to determine the feasibility of the proposal are PPA, PV, and ROI. The mobile office/lab is an investment in the Street Medicine Program. It will enable providers to give the homeless/shut ins greater medical care without utilizing acute care services.
Utilizing PPA, the organization will determine how much time it will take to realize a net profit on the investment.
Present Value is defined as the current value of a future sum of money or cash flow at a specific rate of return.
ROI is the ratio of profit or less of an investment in a fiscal year. It is determined by taking the net profit and subtracting what was spent.
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Ratio Calculations
Payback Period Analysis = Year Before Recovery + Unrecovered Cost at Beginning of Year ÷ Cash Flow During Year
Assuming the VFC pays off $50,000 per year, it would take a little over 6.53 years to realize a profit on this investment.
PPA = 6.53 years + 26,700 ÷ 50,000 = 6 + 0.53 = 6.53 years.
Present Value = PV = FV/(1 + i)n.
PV = 326,700 ÷ (1 + 0.6)7 = 326,700 ÷ 1.504 = $217,220.
This shows that the mobile unit will generate discounted cash flows in excess of what is needed to repay the cost of the unit.
The ratios used to determine the feasibility of the proposal are PPA and PV. The mobile office/lab is an investment in the Street Medicine Program. It will enable providers to give the homeless/shut ins greater medical care without utilizing acute care services.
Utilizing PPA, the organization will determine how much time it will take to realize a net profit on the investment.
Present Value is defined as the current value of a future sum of money or cash flow at a specific rate of return.
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Cost Benefit
The financial need percentage increase is calculated to be approximately 32%.
Increased overall health will decrease monies spent on emergency room and hospital stays.
Improved health status would decrease use of the time, supplies, and acute care services.
Long term, the mobile office enables the Street Medicine program to see more clients for the same amount of money.
The financial need percentage increase is calculated to be approximately 32%. Over time, the percentage will increase as the preventative care starts to overtake the necessity for acute care services. Increased overall health will decrease monies spent on emergency room and hospital stays.
Increases in health status would decrease use of the time, supplies, and acute care services. Preventative care increases overall health status which then requires fewer acute care or emergency visits. Long term, the mobile office enables the Street Medicine program to see more clients for the same amount of money.
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Strategic Planning
The strategic plan is to instill its use within the last six months of the fiscal year.
The program should decrease monetary outlay of acute care services and increase funding received due to preventative care programs.
Funds for the various line items would come from existing budget lines.
The mobile unit is not expected to create a profit for the first six years, but not cause any spending deficits.
Mobil unit would expand upon VFC’s mission to provide quality medical/health care to those in need.
Purchase of a 28 ft. box truck would be the most efficient way of adding this item to the budget. Although an initial outlay would be costly, leasing the vehicle would increase its cost in addition to adding interest payments. Supply and equipment purchase are necessary to utilize the intended use of the truck, although the supplies can be taken from existing stores. The equipment purchase can be done alone, or if possible, by utilizing an exiting purchase contract for additional savings. Installation fees will vary depending upon whether the purchase was done along or with the purchase contract, which could be included. Internet access and mobile hot spots can be bundled into existing wireless/internet contracts. Gasoline for the unit would be taken from the utilities expense line.
Personnel would include a team of three healthcare personnel including a medical doctor, a registered nurse, and either an LPN or a medical assistant to assist in examinations and procedures as well as providing education. In addition, the units varied points of service would require the team concept for safety reasons. Funds for these individuals would be taken from personnel lines. The mobile unit personnel team would be utilized from existing staff that currently provide serves to the Street Medicine program but could be rotated if necessary. Overall, continuity within a team for the mobile unit would create a more trusting environment by those it serves.
Maintenance and repairs of the mobile unit and its equipment would be taken from the existing expense line. Insurance can also be included in the existing policies and costs. These lines could offset the existing transportation of patient/client expense line as the point of care would be going to the patients rather than the patients being transported to a VFC facility.
The strategic plan for the mobile unit is to instill its use within the last six months of the fiscal year. The unit will provide care to the currently clients of the street medicine program and increase the mobile client use each year. With preventative care, although the number of clients would increase, the severity of their disease processes should decrease to maintenance levels with referral services still in place. This program should decrease the monetary outlay of acute care services, thus saving money for healthcare facilities overall and increase federal, state and other third-party payers due to the preventative care programs.
Although the mobile unit is not expected to create a profit for the first ten years, it should also not cause any spending deficits. It would, however, expand upon VFC’s mission to provide quality medical/health care to those in need (Annual Report, 2018).
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Short Term Impact
First quarter expenditures – impacted most heavily in first quarter. Includes installation.
Mobile medical vehicles range between $175,000-$350,000 depending on options and features.
Cheaper than lease to purchase contract with interest payments.
Although it would be a negative impact to current assets at first, government support through Medicare and Medicaid would increase revenues in the first year.
Mobile unit would enhance preventative care while providing a reduction to acute care.
Option two would include leasing a vehicle. The lease would have a short term impact but also include an interest fee that adds to the cost of the vehicle.
Outright purchase of the unit would cause a short-term impact to the first quarter expenditures. Installation would also be an expense to outfit/retrofit the vehicle. A typical mobile unit would take approximately 26 weeks to set up for delivery and use (Odulair, 2019). Mobile medical vehicles can range anywhere between $175,000-$350,000 depending upon options and features (La Boit, 2017). Medical units average between 26 ft. to 40 ft. models dependent upon proposed usage. They get anywhere between 18-24 mpg depending upon the usage.
These monies would come from short term investment asset accounts which are a culmination of federal, state, and private contributions. Outright purchase would be expensive at the outset but relieve the organization of a longer lease to purchase contract plus interest payments. There are sufficient funds in the short-term investments to allow for a such a purchase. The mobile unit, including purchase of the unit, equipment, and installation, would be in use within the first 6 months of the fiscal year. Although it would be a negative impact to current assets at first, government support through Medicare and Medicaid would increase revenues in the first year.
The impact on the acute care setting would decrease due to preventative care being in place. The mobile office/lab would give testing results before the decision for acute care would be necessary. The mobile office would be dispatched to the various parts of the city to ensure the homeless and some shut ins are given preventative care (Guse, 2018). In this scenario, patient referrals could be generated prior to acute care services being necessary. The mobile office not only improves access to the vulnerable populations but provides preventative interventions for chronic conditions as well as cost saving benefits for the acute care system (Guse, 2018).
The mobile office/lab unit can also be used to document and share information with other agencies as necessary to ensure a cohesive and fluent patient health care experience, allowing them to receive the services needed to decrease their need for acute healthcare.
Option two would include leasing a vehicle. Although not much information could be found on this option, it is feasible but also includes an interest fee that adds to the cost of the vehicle. In addition, there is the question of whether or not the mobile unit would be purchased at the end of the lease, creating an additional cost.
Option three is rental of a unit. This is not a viable option because each mobile unit is fitted for specific uses. The VFC would use this unit for preventative exams and simple testing and could also be used to give its homeless clients a viable hygiene option with shower and bathroom facilities.
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Long Term Impact
Long term impacts - increase in revenues through government funding and other third-party payers due to its increase in healthcare prevention services.
Decrease use of emergency room and acute care facility admissions.
Assuming payments of $50,000 per year, it would take 6.53+ years to realize a profit.PPA = 6.53 years + 26,700 ÷ 50,000 = 6 + 0.53 = 6.53 years.
Net Present Value helps understand the generation of future cash flow.
PV = 326,700 ÷ (1 + 0.6)7 = 326,700 ÷ 1.504 = $217,220.
PV shows the mobile unit will generate discounted cash flows in excess of what is needed to repay the cost of the unit.
Long term impacts include an increase in revenues through government funding and other third-party payers due to its increase in healthcare prevention services. It would also decrease the amount charged to third party payers via use of the emergency room and acute care facility admissions. Using Payback Period Analysis (PPA) helps determine how long the mobile unit would take to turn a profit. Assuming the VFC pays off $50,000 per year, it would take a little over 6.53 years to realize a profit on this investment. In addition, we can also calculate the Net Present Value (NPV) of the mobile unit in relation to generating future cash flow. This shows that the mobile unit will generate discounted cash flows in excess of what is needed to repay the cost of the unit.
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Conflicts
Conflict:
The concept of the mobile clinic/lab does not conflict with the mission of the VFC.
Concerns:
Personnel on mobile unit being trained to understand its unique clientele.
Homeless have physical, mental, addictive, and emotional issues.
Safety of mobile unit staff.
Security of the vehicle.
The concept of the mobile clinic/lab does not conflict with the mission of the VFC. One concern would be ensuring that those who work with the mobile unit and street medicine program are trained to deal with such a unique clientele as the homeless, as they not only have physical health concerns, but most have untreated mental health issues, addictions, and emotional issues that must also be considered. Another concern is ensuring the safety of the crew, as well as ensuring that the vehicle itself remains intact and functional as it provides care in dilapidated and higher crime areas.
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References
About the Clinic. (n.d.). Retrieved from https://venicefamilyclinic.org/about-the-clinic/
A tell-all on telehealth: Where is congress heading next? (2019). Retrieved from https://doi.org/10.26099/rcdd-my07
Beaton, T. (2017). How preventive healthcare services reduce spending for payers. Retrieved from https://healthpayerintelligence.com/news/how-preventive-healthcare-services-reduce-spending-for-payers
Burrill. (2018). Health care outlook for 2019: Five trends that could impact health plans, hospitals, and patients. Retrieved from https://www.modernhealthcare.com/article/20181207/SPONSORED/181209938/health-care-outlook-for-2019-five-trends-that-could-impact-health-plans-hospitals-and-patients
FAQ: Proposed Changes to the Public Charge Rule. (n.d.). Retrieved from https://www.nilc.org/issues/economic-support/pubcharge/proposed-changes-to-public-charge-rule-faq/
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References
Guide to Buying a Mobile Clinic - Getting Started. (n.d.). Retrieved from https://www.odulair.com/how-to-buy-mobile-clinic-medical-vehicle.html
Guse, L. (2018). How and why develop a mobile medical clinic program. Retrieved from http://info.lifelinemobile.com/blog/how-and-why-develop-a-mobile-medical-clinic-program
Impact report - Mobile health map. (2019). Retrieved from https://www.mobilehealthmap.org/impact-report
La Boit Specialty Vehicles Inc. (2017). Retrieved from https://www.laboit.com/
Nowicki, M. (2018). Introduction to the financial management of healthcare organizations (7th ed.). Chicago, IL; Health Administration Press.
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References
Guide to Buying a Mobile Clinic - Getting Started. (n.d.). Retrieved from https://www.odulair.com/how-to-buy-mobile-clinic-medical-vehicle.html
Guse, L. (2018). How and why develop a mobile medical clinic program. Retrieved from http://info.lifelinemobile.com/blog/how-and-why-develop-a-mobile-medical-clinic-program
Impact report - Mobile health map. (2019). Retrieved from https://www.mobilehealthmap.org/impact-report
La Boit Specialty Vehicles Inc. (2017). Retrieved from https://www.laboit.com/
Nowicki, M. (2018). Introduction to the financial management of healthcare organizations (7th ed.). Chicago, IL; Health Administration Press.
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References
Paradise, J., Rosenbaum, S., Markus, A., Sharac, J., Tran, C., Reynolds, D., Shin, P. (2017). Community health centers: Recent growth and the role of the aca. Retrieved from https://www.kff.org/medicaid/issue-brief/community-health-centers-recent-growth-and-the-role-of-the-aca/
Pourat, N., Bonilla, A. G., Young, M.-E. D. T., Rodriguez, M. A., & Wallace, S. P. (2018). There and back again: How the repeal of aca can impact community health centers and the populations they serve. Family & Community Health, 41(2), 83–94. https://doi.org/10.1097/FCH.0000000000000181
Role of medicaid expansion care delivery community health centers - commonwealth fund. (n.d.). https://doi.org/10.26099/x5h2-x902
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References
Telehealth reimbursement guide. (2019). Retrieved from http://caltrc.org/wp-content/uploads/2019/04/Reimbursement-Guide-May-2019.pdf
Telemedicine—Benefits and Challenges. (2019). Retrieved from https://blueehr.com/blogs/telemedicine-benefits-and-challenges/
Venice family clinic annual report. (2018). Retrieved from https://s3.amazonaws.com/media.venicefamilyclinic.org/2019/06/2018-VFC-Annual-Report.pdf
Venice family clinic consolidated financial statements. (2018). Retrieved from https://s3.amazonaws.com/media.venicefamilyclinic.org/2019/06/VFC_2018_Audited_Financials.pdf
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