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

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)[footnoteRef: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. [1: Centers for Disease Control, National Hospital Ambulatory Care Survey. Advisory Board Company. Washington, D.C.]

 

Figure 1

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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.

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

© 2015 Laureate Education, Inc. Page 5 of 7

Year4,8825,1265,3825,6525,934

Month407427449471495

Week9499104109114

Day1314151616

Visit volume will increase by 5% each year

 

Service AreaVisitsYear 1Year 2Year 3Year 4Year 5

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.

PositionFTEsSalary/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.