Rural Urgent Care Centers Business Plan

Background and Financial Data for Investment
in the Rural Urgent Care Center

Background

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 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.

I. 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) . 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

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

STAFFING
FTE Salary Total
ED Physicians 2.0 $ 200,000 $ 400,000
Subtotal $ 400,000
Benefits as Percentage of Salary 20%
Housing Allowance $ 48,000
Total Wage and Salary Cost $ 528,000
Hourly
Rate Total
Hours Total
Locum Tenens Physicians $ 120 60 $ 374,400
Subtotal $ 374,400
Travel Allowance $ 24,000
Housing Allowance $ 96,000
Total Wage and Salary Cost $ 470,400
FTE Salary Total
Nurse Practitioners 2.0 $ 100,000 $ 200,000
Subtotal $ 200,000
Benefits as Percentage of Salary 20%
Total Wage and Salary Cost $ 240,000

Staffing Model per Shift

Position FTEs
Clinical Lead 1.0
Nurse 1.0
Physician Assistant 1.0
Radiology Technician 1.0
Medical Assistant/Receptionist 1.0

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 Sq. Ft. 3260
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.

II. Market Profile

Market Overview

Define your service area.

RUC Service Area

Area 3 years ago 2 years ago 1 year ago
Number of people in the RUC service area Total 64,009 64,209 64,395

Demand Forecasting

Adjusted Demand of Services Forecast

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

Year 4,882 4,914 4,946 4,979 5,012
Month 407 410 412 415 418
Week 94 95 95 96 96
Day 13.4 13.5 13.6 13.6 13.7

III. 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 $262, based on similar current hospital ED visit charges. This averages the costs of Level 1-Level 3 visits, with expected fee growth of 5%. The reimbursement would remain consistent with similar visits at the current ED, thus local payers should be willing to accommodate the fee.

Break-Even Analysis per RUC Site

Revenue per Case $ 262.01
Cost per Case $ 13.47
Contribution Margin $ 248.54

Direct Costs $ 1,914,607
Indirect Costs $ 118,840
Total Costs $ 1,976,647

Pro Forma

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
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
Operating Model — Phased Operating Hours
Phase I Phase II Phase III Phase IV
Monday-Friday Hours 8 16 20 24
Saturday & Sunday Hours 10 16 20 24
Hours of Operation per Week 5 PM-1AM (M-F)
10AM-8 PM
(Sat. & Sun)
Total Operating Hours 60 112 140 168

Financial Analysis — Detailed
RUC
OPERATING HOURS
Monday-Friday Hours 8
Saturday & Sunday Hours 10
Hours of Operation per Week 5PM-1AM M-F
10AM-8PM Sat. & Sunday
Total Operating Hours 60
REVENUE

FORECASTED VOLUME
Adjusted Demand Forecast 4,881.84
Visits per Month 406.82
Visits per Week 93.88
Visits per Day 13.37

PATIENT REVENUE
Payer Reimbursement $
1,279,043
Fee per Visit $
262

ADJUSTMENTS
Government Grant $
820,155

Total Revenue $
2,099,197

RUC

STAFFING
FTE Salary Total
Physicians 2.0 $ 200,000 $ 400,000
Nurses 2.0 $ 80,000 $ 160,000
Physician Assistants 2.0 $ 80,000 $ 160,000
Radiology Technicians 2.0 $ 63,000 $ 126,000
Medical Assistants/Receptionists 2.0 $ 55,000 $ 110,000
Medical Director 1.0 $ 25,000 $ 25,000
IT Support 0.5 $ 80,000 $ 40,000
Subtotal $ 1,021,000
Benefits as Percentage of Salary 20%
Housing Allowance $ 48,000
Total Wage and Salary Cost $ 1,273,200

OCCUPANCY COSTS
Utilities $ 208,750
Repair/Maintenance $ 40,500
Housekeeping $ 20,000
Communication
Internet $ 240,000
Telephone Service $ 16,806
Miscellaneous/Other $ 20,000
Total Occupancy Costs $ 546,056

SUPPLIES
Variable Medical Supply Costs $ 65,767
Other Non-Personnel Costs $ 95,351
Total Supply $ 161,119

Direct Operating Expense $ 1,980,375

INDIRECT EXPENSE
Management Overhead $ 118,822.49

Total Expense $ 2,099,197
Costs per Visit $ 430
PROFITABILITY
Operating Income $ - $ s -