Agenda 04-01-2004 - Laserfiche WebLink

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Attachment 1: BOCC/BOH Joint Dinner Meeting 04/01/04 clients what they would be willing to pay for primary care services. According to the client survey, 72% of clients stated that "a required small nominal fee would not be a financial barrier to seeking care." The pricing strategy is different from private sector medical offices which may charge $100 or more per visit and require the payment in advance, while limiting the number of uninsured and Medicaid patients that are treated. Fin ancial/Overational Analysis The Orange County Health Department (OCHD) will operate the primary care services venture under its Personal Health Services Division (PHSD). Startup and operating costs will be included as part of the PHSD annual budget. The Health Department bills its services using a sliding scale, from which patients are charged varying amounts depending on family income level. Patients will be billed anywhere from 0% to 100% of charges, with the majority of PHSD clients being Medicaid clients and 0% pay clients (Appendix Q. [With the addition of a requested billing clerk position in the Central Administrative Services Division, we anticipate improved recovery of receipts from clients in the 20 -100% sliding fee scale range]. Current staff in the PHSD will be utilized to carry out primary care services. However, the Health Department requests to increase a current Family Nurse Practitioner position from .5 FTE to 1.0 FTE. With a decreasing yet substantial `no show' rate, we anticipate primary care services will be easily integrated into our current open access scheduling format for preventive services. In addition, staff schedules and hours of operation will be shifted so that some week night appointments will be available to provide better access for working clients and teens. The newly renovated Whitted building in Hillsborough (currently used for personal health preventive services) will be utilized to provide primary care services. Clinical space will be tight and the pharmacy will be crowded necessitating a new shelving system at some point, but this incremental change will be achievable with current space. There are approximately 1000 eligible clients currently seen within the Family Planning, Child Health, and Maternal Health programs (primarily women and children). However, it is not expected that all clients will seek primary care services. Projected primary care volume for the first year is anticipated to be 50% of the total client base, which yields 500 patients. It is estimated that each client will make 1.5 visits per year, which yields 750 visits /year (Appendix A). The minimum charge billable for a primary care visit will be $15. The average charge per visit is estimated to be $90. The minimum charge for a dispensed stock medication will be $3. Revenue Scenarios: (Appendix A) Each figure includes patient service revenue, lab, and medication revenues Worst Case (collecting only the minimum $15 fee) $115568 Best Case (collecting $90 from every client for every encounter) $73,375 Most Likely Case $49,364 OCHD will need minimal new equipment. The only projected major equipment needed for startup is 1 defibrillator and 1 EKG. In addition, other expenses will include DEA licenses for prescribing controlled substances by FNPs, pharmaceuticals (which is expected to be one of the largest expenses), training costs, and lab outsourcing fees (Appendix B). 3