CAPITOL BUDGET PROPOSAL:TELEHEALTH/ VIRTUAL CARE
Final
Project
Southern
New
Hampshire
University
IHP-450-X5747
Healthcare
Management
and
Finance
22EW5
FINANCIAL
CONDITION
❖
Health
care
services
in
a
total
of
121,136
clinic
visits,
including
primary,
specialty,
dental
and
behavioral
health
visits.
The
expenses
were
$44,242,674
compared
to
its
$48,255,993
in
revenue
and
$40,851,325
in
assets
(VFC,
2018)
❖
At
the
end
of
June
2018,
the
total
assets
amounted
to
$24,
286.
070
whereas,
in
in
2017,
they
were
amounted
to
$18,078,363
(VFC,
2018).
❖
Total
number
of
liabilities
in
2018
was
$1,101,514,
in
comparison
to
$1,460,695
in
2017
(VFC,
2018).
2
3
HEALTHCARE
TRENDS:
TELEHEALTH
❖
According
to
Barron
et
al,
the
rise
of
virtual
care
has
been
driven
by
the
need
for
social
distancing
and
enabled
by
a
wide
range
of
policy
flexibilities
implemented
by
federal
and
state
legislators,
regulators,
and
payers
(2021).
❖
The
integration
of
digital
health
solutions
such
as
telehealth
visits,
remote
monitoring,
asynchronous
telehealth,
continuous
and
passive
sensors
offer
potential
to
provide
access
to
high-quality
care
and
positive
patient
and
physician
experiences
at
a
lower
cost
(Barron
et
al,
2021).
PROPOSAL ITEMS
❖
On-demand
urgent
care,
near-virtual
office
visits
and
virtual
home
health
services.
❖
Utilizing
the
technology
this
day
in
age,
allows
advancement
to
be
made
in
care
that
is
already
offered,
as
well
as
extending
care
to
patients
who
may
not
be
able
to
be
physically
present.
❖
It
creates
a
great
opportunity
for
medical
staff
to
educated
their
patients.
5
STRATEGIC
GOALS
❖
Avoid
a
trip
to
the
Emergency
Department
or
an
urgent
care
center.
❖
Such
usage
could
be
further
scaled
to
address
a
larger
portion
of
low
acuity
visits
in
the
Emergency
room.
❖
This
enables
providers
to
better
manage
their
patients
at
the
Venice
Family
Clinic.
❖
Patients
who
have
chronic
conditions
may
achieve
care
with
remote
patient
monitoring,
digital
therapeutics,
and
virtual
coaching.
6
O -
.
T
V
F
C
E
D .T
.
PROPOSAL
OPTIONS
V
.
T
,
,
,
,
,
,
N -v
.
T
V
F
C
.T
“
”
,
,
.
7
R
- -
-
-
(J ,
2021).T
-
(J ,
2021).
A
$26.84,
$27.26
(P
,
2020).
T
(P , 2020).
A
B ,
COVID-19
(2022).T
$636
2028
(B ,
2022).
V
.
FINANCIAL
RESEARCH
8
ORGANIZATIONAL
RESOURCES
Once
the
application
is
purchased,
additional
staff
such
as
IT
members
will
have
to
safely
install
the
new
application
and
any
equipment
it
may
require.
Following
installing,
all
staff
members
such
as
medical
administration,
nurses,
medical
assistants,
doctors,
case
managers,
social
workers
etc.
will
have
to
learn
how
to
effectively
use
the
new
system.
Software,
imaging
technology,
access
to
technical
support
staff,
staff
training
and
access
to
sufficient
internet
will
need
to
be
met
to
construct
the
use
of
telehealth
(HealthIT,
2019).
9
Routine
meetings
with
any
pro
and
cons
of
the
new
application,
emails,
and
phone
calls.
Conferences
to
bring
up
any
ideas
or
strategies.
A
budget
change
proposal
will
be
documented
which
will
lay
out
the
additional
resources
or
reduction
that
may
be
needed
for
funding
to
work.
This
will
be
laid
out
with
department
supervisors
and managers.
COMMUNICATION
10
STATEMENTS
◾
According
to
the
Venice
Family
Clinic
Financial
Statements
from
2018,
$520,
926
was
used
on
technology
expenses
which
is
where
telehealth
will
largely
play
a
role
in
(VFC,
2018).
11
EXPENSES
❖
Training
of
all
staff
members
on
all
17
sites
in
the
Venice
Family
Clinic,
along
with
the
training
of
IT
members.
❖
According
to
Horiachko,
a
telehealth
implementation
ranges
from
$15,000
to
$150,000
depending
on
factors
such
as
the
size
of
the
team,
integration
numbers,
branches,
and
features
(2022).
❖
Features
such
as
appointment
management,
text
chats
and
video
calls
will
have
to
be
included,
as
well
as
the
application
for
iOS,
Android,
or
Web
(Horiachko, 2022).
REASONING
❖
According
to
the
Venice
Family
Clinic
Financial
Statement
of
2018,
there
was
an
increase
in
total
assets
from
2017
to
2018
of
$3,565,758
(VFC,
2018).
❖
There
was
also
a
decrease
in
net
profit.
❖
Due
to
the
increase
of
total
assets,
this
allows
for
the
Venice
Family
Clinic
to
implement
virtual
care
in
their
future
financial
statements.
13
RATIO
❖
A F
C
C ,
COVID-19
$200
C
C
A ,
R
E
S
(CARES)
A
(2022).
❖
R
.
14
RATIO
CALCULATIONS
According
to
the
Financial
Statement
in
2018
of
the
Venice
Family
Clinic,
a
total
of
$260,082
was
used
in
expense
for
training,
travel,
and
workshop
purposes
(VFC,
2018).
With
the
implementation
of
virtual
appointments,
all
staff
members
will
have
to
be
trained
efficiently
to
be
able
to
deliver
safe care to the patient.
Using
return
of
assets
will
allow
me
to
budget
appropriately
for
this
implementation
to
ensure
sustainability.
According
to
Nowicki,
excess
of
revenues
over
expenses
divided
by
net
assets
multiplied
by
100
will
allow
me
to
lay
out
the
capital
budget
item
to
the
Venice
Family
Clinic
(2022).
15
Please
see
excel
spread
sheet
for
Projected
Departmental
Budget
16
Providers
are
exploiting
the
use
of
telehealth
and
virtual
care
to
reach
patients
in
remote
locations
and
enhancing
global
patient
satisfaction.
Health
insurance
such
as
Medicare,
Medicaid
and
third-party
payers
are
compensating
rates
for
both
virtual
and
in
clinic
visits
(Snoswell et al, 2020).
In
a
financial
perspective,
a
financial
benefit
from
telehealth
short
term
may
be
the
changes
of
patient
insight
levels
and
increase
in
patient
volume
following
the
rates
of
reimbursement.
Telehealth
can
deliver
clinical
health
services
via
communication
technology
to
bridge
the
division
of
provider
and
patient
(Snoswell
et al, 2020).
Staff
training
and
purchases
of
software
needed
will
increase,
however
revenue
will
decrease
following
implementation
of
telehealth.
SHORT
TERM
IMPACT
17
LONG
TERM
IMPACT
◾
Acc
or
d
ing
to
D
al
y
,
tele
health
visit
s
ar
e
paid
at
the
same
service
amount
as
an
in
clinic
visit
appointment
during
the
COVID-19
pandemic
(2020).
◾
Acc
or
d
ing
to
D
al
y
,
Med
icare
is
e
valuati
ng
whethe
r
to
make
telehealth
waivers
permanent,
which
then
may
expand
provider
eligibility
list
with
available
payment
from
Medicare
(2020).
◾
Medicare
telehealth
visits
have
increased
about
12.00
per
week
to
hundreds
of
thousands
per
week,
which
will
affect
the
long-term
impact
financially
while
being
able
to
deliver
care
to
many
patients
in
need
r
em
otel
y
(
D
al
y
,
2020).
18
◾
Telehealth
may
impact
cost
due
to
shorter
interactions,
reduced
travel,
economic
of
scale,
increase
revenue,
or
moving
elements
of
care
from
clinicians
to
technology
such
as
monitoring
devices
or
to
the
patient
themselves
(Snoswell
et
al,
2020).
◾
Since
the
implementation
of
telehealth,
it
has
been
shown
that
there
is
a
$361
in
savings
per
patient
or
$8566
total
in
service
cost
compared
to
home
care
programs
over
a
6-month
time
span
(Snoswell
et
al,
2020).
◾
The
cost
of
telehealth
is
about
$327
versus
conventional
care
for
$333
(Snoswell
et
al,
2020).
◾
According
to
Lagasse,
virtual
care
was
accounted
for
20%
of
all
medical
visits
in
the
United
States,
which
was
projected
to
drive
$29
billion
in
total
cost for services (2020).
◾
The
adoption
of
telehealth
offers
safe
and
reliable
virtual
visits
as
necessity
for
telehealth
as
it
continues
to
grow.
◾
The
cost
benefit
of
the
implementation
is
an
increase
in
patient
acuity,
amongst
reimbursement
from
Medicare,
Medicaid
and
third-party
payers.
COST
BENEFIT
19
STRATEGIC
PLANNING
Making
telehealth
available
year-round
makes
it
possible
for
more
patients
to
be
see
for
various
reasons,
thus
allowing
patient’s
insurance
to
be
billed
for
the
same
amount
Telehealth
has
been
ideal
for
improving
patient
outcomes.
It
allows
patients
to
easily
follow
up
with
their
providers
remotely
where
they
can
be
assessed
before
a
readmission
becomes
needed,
which
may
help
save
a
lot
of
money
in
the
long
run.
It
will
also
support
care
coordination
by
allowing
communication
via
telephone
to
happen
more
regularly,
which
allows
patients
to
be
monitored
for
acute
and
or
chronic
conditions
that
may
worsen
without
medical
attention.
Acc
or
d
ing
to
D
al
y
,
Congr
ess
is
being
asked
b
y
hospitals
to
expand
f
eder
al
tele
health
pr
ograms
(
2020)
.
20
CONFLICTS
◾
A
decrease
in
reimbursement
rates
due
to
patients
deciding
to
choose
in
clinic
visits
instead
of remote.
◾
The
potential
of
any
software
issue
during
transmission
of
the
remote
visit.
If
there
are
any
potential
software
or
connecting
issues,
patient
may
be
discouraged
to
try
again.
◾
Having
a
team
ready
to
troubleshoot
potential
issues
will
be
beneficial.
◾
Another
conflict
that
may
also
arise
is
the
potential
for
HIPAA
to
be
violated.
21
REFERENCES:
Bailey,
V.
(2022).
Cigna:
Virtual
care
reduces
healthcare
costs
by
about
$100
per
visit.
https://mhealthintelligence.com/news/cigna-virtual-care-reduces-healthcare-costs-by-about-100-pervisit
Barron,
M.,
Mishra,
V.,
Lloyd,
S.
&
Augenstein,
J.
(2021).
How
to
measure
the
value
of
virtual
healthcare.
https://hbr.org/2021/06/how-to-measure-the-value-of-virtual
health-care
Blandford,
A.,
Wesson,
J.,
Amalberti,
R.,
Alhazme,
R.
&
Allwihan,
R.
(2020).
Opportunities
and
challenges
for
telehealth
within,
and
beyond,
a
pandemic.
The
lancet,
8(11),
E1364-
E1365.
Daly,
R.
(2020).
Medicare
considering
making
telehealth
expansion
permanent,
verma
says..
https://www.hfma.org/topics/news/2020/05/medicare-considering-making-telehealth-
expansion-
permanent--verm.html
doi:
https://doi.org/10.1016/S2214-109X(20)30362-4
Haddad,
L.,
Annamaraju,
P.,
&
Toney-Butler,
T.
(2020).
Nursing
shortage.
https://www.ncbi.nlm.nih.gov/books/NBK493175/#:~:text=Nursing%20shortages%20lead%20to%20errors,patient%2Dto%2Dnurse%20ratios.
HealthIT
(2019).
What
are
the
technical
infrastructure
requirements
of
telehealth?
https://www.healthit.gov/faq/what-are-technical-infrastructure-requirements-telehealth
Horiachko,
A.
(2022).
Cost
of
telemedicine:
Is
it
a
worthy
investment?
https://www.softermii.com/blog/cost-of-
telemedicine#:~:text=The%20telehealth%20implementation%20cost%20for,availability%20of%20branches%2C%20and%20features.
22
Jercich, K. (2021). On-demand virtual care may not lead to cost savings down the line. https://www.healthcareitnews.com/news/demand-virtual-care-may-not-lead-cost-savings-down-line
Lagasse, J. (2020). Telehealth is expected to drive $29 billion in healthcare services in 2020. https://www.healthcarefinancenews.com/news/telehealth-expected-drive-29-billion-healthcare-
services-2020
Morris, G. (2022, April 27). Post-pandemic nursing shortage: What it means for aspiring nurses. https://nursejournal.org/articles/post-pandemic-nursing-shortage/
Nowicki, M. (2022) Introduction to the financial management of healthcare. Gateway to healthcare management.
Portney, D., Ved, R., Ellimoottil, C., Nikolian, V., Wei, A., Buhmueller, T., Killaly, B., & Alam, H.(2020). Understanding the cost saving of video visits in outpatient surgical clinics. Mhealth,
6(32). doi: 10.21037/mhealth-20-33
Snoswell, C. Taylor, M. & Caffery, L. (2020). Determining if telehealth can reduce health system costs: Scooping review. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7605980/
SPD (2022). How to develop a telemedicine application in 2022? the startup edition. https://spdload.com/blog/telemedicine-app-development/
Spencer, A. (2021). What is the real cost of employee training programs? https://www.bizlibrary.com/blog/training-programs/cost-of-training-employees/
Telehealth (2014). Start and resources guide. http://www.integration.samhsa.gov/hit/telehealthguide_final_0.pdf
Venice Family Clinic. (2018) Venice family clinic annual report 2018. https://s3.amazonaws.com/media.venicefamilyclinic.org/2019/06/2018-VFC-Annual-Report.pdf
Venice Family Clinic. (2022). Venice family clinic resumes in-person appointments for routine health care. https://venicefamilyclinic.org/news/press/venice-family-clinic-resumes-in-person-
appointments-for-routine-health-care/
◾
Venice Family Clinic. (2022). Venice family clinic resumes in-person appointments for routine health care. https://venicefamilyclinic.org/news/press/venice-family-clinic-resumes-in-
person-appointments-for-routine-health-care/
