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Executive Summary, Overview, and Financial Data for Investment in the Rural Urgent Care Center

I. Executive Summary Urgent care is the delivery of ambulatory care in a facility dedicated to the delivery of unscheduled, walk-in care outside of a hospital emergency department. Development of the Rural Urgent Care (RUC) facility in Sylacauga, Alabama will facilitate access to care providers through extended service hours within closer geographic proximity to patients, families, and caregivers. The Director of Emergency Services will provide clinical monitoring to ensure quality service provisions. The RUC facility will act to alleviate demand for emergency department (ED) services by shifting lower acute patients to a less resource-intensive environment.

II. Program Overview: Market Opportunities and Utilization Patterns The RUC will provide treatment to patients suffering from non-life-threatening conditions that require quick attention, including bone fractures, pneumonia and flu, and minor lacerations. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rates of inappropriate ED utilization by triaging non-emergent patients to less acute settings. The ED is not the most appropriate care setting for many patients. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another 20 percent (refer to Figure 1)1. At the other end of the acuity spectrum, most emergent patients would be better served in an inpatient unit, but many are forced to board in the ED because beds are unavailable.

Figure 1

1 Centers for Disease Control, National Hospital Ambulatory Care Survey. Advisory Board Company. Washington, D.C.

Triaging patients to an appropriate site of care properly allocates resources to meet patient acuity and results in better clinical outcomes. RUC staffing and treatment approaches are fundamentally different from those in an ED; patients get more abbreviated and pointed clinical work-ups, which provides care more efficiently by clinicians who are oriented to less intense discovery and intervention.

The RUC will also address community needs for convenient, reliable access to care. Current alternatives to RUCs include the ED, which like other comparable U.S. and U.K. EDs, has long wait times and potentially stressful patient environments. Decreasing wait times is positively correlated with better outcomes.

Figure 2

Services To meet the needs of the community and provide the appropriate level of care without unnecessary duplication of a resource-intensive emergency department, the RUC will provide basic emergent procedures, diagnoses, and treatments.

 Nursing triage

 Physician assessments

 Minor procedures

 Basic lab services

 Basic diagnostic imaging

 Vital signs

 IV therapy

 EKG

 Wound care The potential to house ambulance services out of the RUC provides additional requirements and opportunities. To accommodate the needs of the EMS crew, multiple waiting room/bunk rooms will be added to the facility, as well as a separate entry point for the ambulance service. Supplies will also be warehoused at RUC for easy restocking of ambulances. The RUC can also be part of the disaster-planning strategy by providing easy access to needed equipment and supplies during emergencies.

Other Potential Offerings The RUC could offer opportunities to leverage the convenient retail setting to provide additional revenue-generating clinical services. For example, Occupational Safety Testing could be provided utilizing a secure bathroom to provide basic drug testing. Currently, the service is offered at the hospital, but is much better suited for a freestanding center. The RUC's diagnostic lab and x-ray services could also be offered on a referral basis for local GPs, providing a more convenient location for these services than the hospital and creating greater access to care.

Yearly Staffing Costs by Clinical Lead Model

Position FTEs Salary/Year/FTE

Physicians 1$ 200,000$

Nurse Practitioners 2$ 85,000$

Nurse 2$ 60,000$

Radiology Technician 1$ 45,000$

Assistant/Receptionist 3$ 30,000$

**** Benefits are assumed to be 25% of Salaries

Salaries will increase 3% each year.

Facility Facility design must meet the needs of clinicians and consumers. Consumers invariably associate the quality of healthcare services with the aesthetics of the site of care. The facility will be designed to blend into the local architecture to be a part of both the eastern and western communities. The RUC will have the following basic space layout:

Facility Description

Space Description Quantity Square Feet Per Room

Total Space

Central nursing/Physician station 1 500 500

Exam rooms 5 100 500

Treatment room 1 150 150

Radiology room 1 200 200

Staff offices 2 100 200

Reception/waiting area 1 400 400

Employee break room 1 250 250

Medical records 1 250 250

Laboratory 1 200 200

Restrooms 3 50 150

EMS facilities 2 80 160

Utility rooms 2 150 300

Subtotal: Usable Square Footage 3,260

Circulation, mechanical, telecom/IT, other space

915

Total Facility Size 4,175

Operating Model The RUC will open after the normal working hours of local physicians. These operating hours also align with the peak ED visit times, which significantly trail off after midnight.

III. Market Profile Market Overview Define your service area.

RUC Service Area

Area 3 years ago

2 years ago

1 year ago

Number of persons in RUC

service area

Total 64,009 64,209 64,395

Demand Forecasting

Adjusted Demand of Services Forecast

IV. Financial Analysis Capital Requirements To estimate the total funds required for launch prior to commencement of operations, the hospital has developed the following assessment of anticipated expenses related to the building of a single RUC with 3,260 sq. ft. of usable space and 4,175 gross sq. ft., as described in an earlier section relating to facility design and a basic review of expected equipment costs.

Year 4,882 5,126 5,382 5,652 5,934

Month 407 427 449 471 495

Week 94 99 104 109 114

Day 13 14 15 16 16

Visit volume will increase by 5% each year

Service Area Visits Year 1 Year 2 Year 3 Year 4 Year 5

Capital Requirements per RUC Site

Total Construction Cost $3,246,605 Contingencies, Professional Fees, Management & Overhead, Equipment

$2,216,341

Total Project Costs $5,462,946 Construction Costs per Square Foot $777.63 Project Costs per Square Foot $1,308.49 Square Footage 4,175 Reimbursement Model The RUC will charge a flat per-visit fee of $450, based on similar current hospital ED visit charges. This rate will stay constant. Contractual discounts for insurance is 30% of gross patient revenue. Expenses

OPERATING COSTS

Utilities $208,750

Repair/Maintenance $40,500

Housekeeping $20,000

Telephone Service $16,806

Depreciation $32,000

Malpractice $50,000

Miscellaneous/Other $20,000

SUPPLIES

Medical Supply Costs $65,767

Other Non-Personnel Costs $95,351

All expenses listed to increase by 3% per year.

Services Offered

Nursing Triage Physician Assessments

Potential Diagnoses

 Common illness

 Respiratory illness

 Allergies

 Bladder infections

 Eye/ear/sinus infection

 Strep throat

 Mononucleosis

 Pregnancy testing

 Skin rashes

 Sport injuries/sprains/strains

General Services

Monitoring Services

 Emergency transfer to KEMH

 Vital signs

 IV therapy (antibiotic, hydration)

 EKG

 Wound care

 Immunizations, TD, Pneumovax, Flu Vaccines

Minor Procedures

 Incision and draining of abscess

 Excision of skin

 Aspiration of cyst

 Sutures

Lab Services

 Blood

 Urine

 Other

Diagnostic Imaging

 Ultrasound

 X-ray