PostPaRtUm
homE
visits
A
caPital
bUdgEt
IdEa
ThE
Who
Venice
Family
Clinic
serves
the
underserved
of
Los
Angeles
and
surrounding
towns
in
California
•
Began
as
a
small,
after
hours,
volunteer
community
clinic
•
Now
19
clinics
and
growing,
including
mobile
care
•
The
mission
of
VFC
is
to
improve
the
health
of
people
and
communities,
including
low
income
and
homeless
populations
•
They
focus
on
primary
care
and
multiple
specialties
such
as
substance
abuse,
prenatal,
behavioral,
pediatrics,
even
dental
and
vision!
(About
the
Clinic,
2021)
A
dEEPER
look
at
thE
statE
of
affaiRs
To
be
more
accurate,
the
finances!
•
V
FC
m
a
d
e
i
n
r
e
ve
nu
e
:
6
4
,
0
9
0
,
6
0
4
•
Total
expenses:
57,889,215
•
Their
liquidity
ratio
status:
4.62
•
N
e
t
a
ss
e
t
s
:
52
,
2
5
0
,
66
9
•
L
i
a
b
i
l
i
t
y
:
11
,
3
0
5
,
7
4
2
•
Venice
Family
Clinic
presents
in
good
financial
standing.
They
are
able
to
meet
financial
demands
expected
and
unexpected
and
still
pull
in
a
profit
HEalthcaRE
tREnds
•
Popularity
of
home
health
care
and
telehealth
•
Less
time
spent
fighting
transportation,
childcare
needs,
and
stress
•
Patients
are
able
to
feel
more
comfortable
within
their
own
environment
Despite
its
top-notch
work
with
prenatal
care,
VFC
and
the
families
that
receive
care
would
benefit
heavily
from
home
postpartum
care
What
coUld
Possibly
bE
missing?
BEnEfits
of
homE
visits
foR
PostPaRtUm
follow
UP
•
Home
visits
are
shown
to
be
an
effective
way
of
prevention,
early
detection
and
management
of
post
partum
depression
(ftilani
et
al.,
2017)
•
Reduced
rates
of
child
maltreatment
and
lowered
emergency
care
use
for
families
(Rosenberg,
2021).
•
Increased
rates
of
successful
breastfeeding(Amare
et
al.,
2018)
•
R
e
du
c
e
d
i
n
f
a
n
t
m
o
r
t
a
l
i
t
y
a
nd
i
n
c
r
e
a
s
e
i
n
m
o
t
h
e
r
’
s
s
e
l
f
-
p
e
r
c
e
i
v
e
d
c
o
n
f
i
d
e
n
c
e
(
ft
ok
h
t
ar
i
e
t
a
l
.
,
2018)
G
oa
l
s
The
VFC
claims
its
main
mission
is
to
provide
primary
health
care
to
people
in
need
(About
the
Clinic,
2021).
Postpartum
care
is
an
avenue
not
yet
touched
upon
by
VFC,
however,
it
does
offer
prenatal
care
As
shown
by
the
benefits,
offering
postpartum
home
care
would
create
continuity
and
bridge
another
piece
of
healthcare
to
those
in
need
S
o
w
h
a
t
a
R
E
t
h
E
o
Pt
i
o
n
s
…
.
Option
One:
Buy
a
new
van
A
new
Ford
transit
van
would
cost
44,575$
This
includes
additional
safety
features,
GPS
installed,
storage
customized,
and
so
on
Basic
maintenance
can
be
included
through
dealer,
will
not
cover
broken
parts
but
basic
things
such
as
oil
changes
or
defective
pieces
covered
by
warranty
(ex:
GPS
malfunction)
(Ford
ftotor
Company,
2022).
Option
Two:
Buy
a
Used
Van
A
used
Ford
Transit
cargo
van
(2017)
costs
a
n
a
v
e
ra
g
e
2
4
,
000
$
Limited
ability
to
customize
from
seller,
however
company
can
customize
after
market
however
they
would
like
ftaintenance
is
up
to
the
buyer
Cheaper
option
and
long
term
owned
investment
(Kelly
blue
book,
2022).
Option
Three:
Lease
a
Van
The
cost
to
lease
a
Ford
Transit
Van
would
be
809$/
month
This
is
based
on
a
36-month
lease
and
the
ability
to
drive
an
average
of
100
miles/
day
Annual
cost
of:
9,708
3
year
cost
of:
29,124
Covered:
ftaintenance
including
but
not
limited
to
all
parts
on
the
car,
oil
changes,
basic
upkeep
(tire
replacement
not
included)
(
F
or
d
Mo
tor
Co
mpany
,
20
22
).
Additional
costs
to
UndERstand
•
ftedical
supplies
to
go
in
the
van
for
initial
inventory
•
ft
i
n
i
m
u
m
3
,
000
$
w
i
ll
i
n
c
l
ud
e
v
i
t
a
l
s
m
a
c
h
i
n
e
,
s
t
e
t
h
o
s
c
o
p
e
,
s
c
a
l
e
,
b
a
s
i
c
m
e
d
i
c
a
l
su
pp
l
ie
s
f
or
v
i
s
i
t
s
,
e
s
t
i
m
a
t
e
d
1
,
000
$
p
er
m
o
n
t
h
t
o
re
s
t
o
c
k
b
a
s
i
c
m
e
d
i
c
a
l
su
pp
l
ie
s
a
t
most
•
Insurance
on
Vehicle
•
Insurance
for
this
vehicle
costs
an
average
of
1704$
a
year
will
depend
on
plan
selected,
coverage,
actual
model
bought,
etc.
(
Insureon,
2021).
•
Lettering
on
Van
(lease
and
buyer
friendly)
•
Basic
lettering
that
can
be
removed
from
vehicle
if
leased
would
cost
$150
so
to
identify
the
van
as
company
property
(
Durso,
2020).
•
Gas
•
$800
Fuel
money
per
month
(may
change
at
any
given
time).
This
was
calculated
based
off
100
miles
per
day
estimate
x
miles
traveled
in
a
month
estimate
divided
by
ftPG
of
vehicle
(both
average
the
same
about),
and
times
the
average
price
of
gas
in
CA
at
this
time.
•
ftaintenance
•
W
i
ll
v
ar
y
b
a
s
e
d
o
n
o
p
t
i o
n
s
e
l
e
c t
e
d
bu
t
g
e
n
era
l
$
6
,
000
sh
o
u
l
d
b
e
s
e
t
a
s
i
d
e
t
o
c
o
v
er
maintenance
This
Photo
by
Unknown
b
Author
is
licensed
under
CC
BY-ND
StRatEgic
Planning
•
Additions
of
services
and
products
within
an
organization
always
b
r
i
n
g
i
n
t
h
e
c
o
n
s
i
d
e
ra
t
i
o
n
of
t
h
e
l
o
n
g
-
t
e
r
m
f
i
n
a
n
c
i
a
l
s
t
a
nd
i
n
g
of
t
h
e
c
o
m
p
a
n
y
,
m
a
i
n
l
y
w
i
t
h
i
n
3
-
1
0
y
e
ar
s
of
i
m
p
l
e
m
e
n
t
a
t
i
o
n
(
N
o
w
i
c
k
i
,
2022).
•
The
idea
for
postpartum
visits
is
covered
within
the
VFC’s
mission
statement
and
its
goal
to
deliver
high
quality
primary
health
care
to
people
in
need
(About
The
Clinic,
2022).
•
It
should
be
noted
that
there
are
multiple
government
grants,
including
community
engagement
grants
or
federal
reimbursement
through
postpartum
programs
that
may
fall
into
this
category
and
provides
reimbursement
and
funds
to
the
company
for
the
adoption
of
this
implementation
(Postpartum
Support
International,
2022).
•
Even
if
implementation
is
not
successful
the
vehicle
can
be
sold
(unless
leased,
then
cancelled)
and
things
such
as
supplies
can
be
reused
within
the
clinic
or
mobile
units
What
doEs
thE
comPany
makE
back?
•
Addition
of
home
health
care
can
raise
net
profits
12
to
15
p
er
c
e
n
t
,
a
nd
/
o
r
p
r
of
it
s
u
p
t
o
2
48
,
000
d
o
ll
ar
s
(
Fi e
r
ce
H
e
a
l
t
h
c
ar
e
,
2016).
•
Reimbursement
profit
for
a
home
health
care
visit
can
average
35-36
percent
per
visit
(Grunig, 2021).
•
A
v
era
g
e
p
r
of
i
t
p
er
v
i
s
i
t
ra
n
g
e
s
f
r
o
m
1
7
-
7
2
d
o
ll
ar
s
m
i
n
i
m
u
m
(CT.gov,
2022).
•
A
c
o
n
s
er
v
a
ti
v
e
e
s
ti
m
a
t
e
d
p
r
of
it
of
4
2
00
-
1
8
2
00
d
o
ll
ar
s
p
er
year
based
solely
on
visit
profits
•
There
are
multiple
government
issued
grants
to
help
companies
with
these
programs
that
can
be
applied
for
•
Price
to
add
service
would
cost
0.28
percent
at
most
based
on
revenue
earned
vs.
overall
costs
last
fiscal
year
.
O
R
g
a
n
i
z
a
t
i
o
n
a
l
REsoURcEs
•
Budget
•
Staff
to
drive
and
attend
visits
•
Training
•
ftedical
supplies
commUnication
To
alert
the
clinic
-
f
l
y
e
r
s
a
nd
e
m
a
i
l
s
a
l
e
r
t
i
n
g
s
t
a
ff
of
c
h
a
n
g
e
a
nd
opportunities
for
training
as
applicable
-
D
e
b
r
i
e
f
i
n
g
s
fo
ll
o
w
i
n
g
e
a
c
h
‘
s
h
i
f
t
’
e
s
p
e
c
i
a
ll
y
within
first
few
weeks
of
implementation
-
W
ee
k
l
y
hudd
l
e
s
d
i
s
c
u
ss
i
n
g
e
ff
e
ct
i
v
e
n
e
ss
a
nd
possible
areas
of
change
For
the
managers/
supervisors
•
Preparation
for
introductory
budget
proposal
•
fteetings
quarterly
to
assess
revenue
vs
expense
•
Once
implemented,
meetings
with
staff
to
analyze
benefits
and
concerns
•
Salaries
•
The
overall
fiscal
report
of
the
year
•
Number
of
staff
•
ftedical/
office
supplies
•
Training
•
New
budget
set
aside
for
emergencies/
maintenance
StatEmEnts
it
will
affEct/
bUdgEting
R
E
a
s
o
n
i
n
g
•
V
FC
s
p
e
n
t
1
,
8
0
4
,
22
4
m
i
ll
i
o
n
o
n
e
d
u
c
a
t
i
o
n
a
n
d
o
u
t
r
e
a
c
h
t
o
community
2018.
2,232,926
in
2021.
•
Outreach
is
rising
and
a
goal
the
clinic
stands
by.
The
addition
of
telehealth,
mobile
clinics,
and
transportation
for
patients
has
grown
and
been
an
investment
the
last
few
years
•
The
clinic
has
stated
within
its
budget
it
plans
to
add
more
mobile
and
community
outreach
vehicles
(Venice
Family
Clinic,
2022).
•
This
plan
will
increase
revenue
by
allowing
for
more
visits,
increase
the
number
of
patients
seen
(families
can
opt
in
even
if
not
from
clinic
before),
increases
continuity
of
care
which
may
lead
to
families
staying
with
the
clinic
for
pediatric
care,
and
promotes
many
benefits
for
mom
and
baby
Ratios
Return
on
Investment
Ratio:
Divide
the
cost
of
investment
by
profit
and
times
by
100.
The
overall
ROI
of
the
company
is
0.92
based
on
last
years
outreach
cost
and
revenue
(Nowicki,
2022).
Liquidity
Ratio:
Total
assets
divided
by
total
liabilities.
Current
ratio
4.62,
anything
above
1
is
considered
good.
This
tells
how
well
the
company
can
pay
off
unexpected
and
planned
costs
(Nowicki,
2022).
Payback
Period
Analysis:
To
calculate
divide
the
initial
cash
outlay
of
the
project
by
the
cash
inflow
the
project
makes
per
year.
Based
on
all
estimated
options:
•
To
buy
new:
2.5
years
•
To
buy
used:
1.3
years
•
To
lease:
0.5
years
Debt
to
Capitalizing
Ratio
:
take
long
term
debt
and
divide
it
by
long
term
debt
+
net
assets
(Nowicki,
2022).
THE
IMPACTS…
Short
term
•
Short
term
large
budget
impact
•
Increase
in
patient’s
seen
•
Increase
in
revenue
Long
term
•
Required
long
term
costs
•
Additional
employees
•
Less
cancellations/
no
show
appointments
•
Continuity
of
care
•
Positive
for
families
JUSTIFICATION
•
Estimated
Revenue
and
utilization
of
service
will
outweigh
t
h
e
s
h
o
r
t
-
t
e
r
m
c
o
s
t
•
Training
that
will
need
to
be
done,
can
be
done
during
office
hours
and
will
not
require
any
additional
degrees/
certificates
•
Increase
in
patients
seen
•
Decrease
in
postpartum
health
consequences
CONFLICTS
•
D
e
s
p
i
t
e
i
t
s
w
e
ll
t
h
o
u
g
h
t
-
u
p
u
s
e
,
t
h
e
i
m
p
l
e
m
e
n
t
a
t
i
o
n
m
a
y
b
e
und
e
r
-
u
t
i
l
i
z
e
d
•
Persons
outside
of
travel
zones
may
not
benefit
from
it
•
Families
may
decide
to
continue
with
another
practice
•
Inability
to
hire
suitable
staff
REfEREncEs
A
b
o
u
t
t
h
e
c
l
i
n
i
c
.
V
e
n
ic
e
F
a
m
i
l
y
C
l
i
n
ic
.
(
2
0
2
1
) .
h
tt
p
s
:
//
v
e
n
ic
e
f
a
m
i
l
y
c
l
i
n
ic
.
o
r
g
/
a
b
o
u
t
-
t
h
e
-
c
l
i
n
ic
/
f
i
n
a
n
ci
a
l
s
Am
a
r
e
,
Y
.
,
S
c
h
ee
l
b
ee
k
,
P
.
,
S
c
h
e
ll
e
n
b
e
r
g
,
J
.
e
t
a
l
.
E
a
r
l
y
po
s
t
n
a
t
a
l
h
o
m
e
v
i
s
i
t
s
:
a
q
u
a
l
i
t
a
t
i
v
e
s
t
u
d
y
o
f
b
a
rr
i
e
rs
a
n
d
f
a
ci
l
i
t
a
t
o
rs
t
o
a
c
h
i
e
v
i
n
g
h
i
gh
c
o
v
e
r
a
g
e
.
B
M
C
P
u
b
l
i
c
Hea
l
t
h
1
8
,
1
0
7
4
(
2
0
1
8
) .
h
tt
p
s
:
//
d
o
i
.
o
r
g
/
1
0
.
11
8
6
/
s
1
2
88
9
-
0
1
8
-
5
9
22
-
7
B
u
t
z
n
e
r
,
M
.
,
&
C
u
ff
ee
,
Y
.
(
2
0
2
1
) .
T
e
l
e
h
ea
l t
h
I
n
t
e
r
v
e
n
t
i
o
n
s
a
n
d
O
u
t
c
o
m
e
s
A
c
r
o
ss
R
u
r
a
l
C
o
mmun
i
t
i
e
s
i
n
t
h
e
U
n
i
t
e
d
S
t
a
t
e
s
:
N
a
rr
a
t
i
v
e
R
e
v
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doi:
10.1097/01.NAJ.0000794264.86475.7b
Xiao
R…
(2018).
Impact
of
Home
Health
Care
on
Health
Care
Resource
Utilization
Following
Hospital
Discharge:
A
Cohort
Study
T
h
e
Am
e
r
ic
a
n
J
o
u
r
n
a
l
o
f
M
e
d
ici
n
e
,
V
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l
um
e
1
3
1
,
I
ss
u
e
4
,
3
9
5
-
4
0
7
.
e
3
5
