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<br />Appendix A
<br />Patient Revenues
<br />C D E F G H i J K
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<br />Total # of program clients
<br />rounded up
<br />1000
<br />Family Planning
<br />[Given]
<br />532
<br />STD
<br />[Given]
<br />201
<br />Child Health
<br />[Given]
<br />323
<br />Estimated % of clients that will use PC
<br />[Given]
<br />50%
<br />Expected # of PC clientslyr
<br />[D5'D9]
<br />500
<br />Expected # of encounters /client/yr
<br />[Given]
<br />1.5
<br />,Expected # of PC encounters/ r
<br />DI0*DI 11
<br />750
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<br />Given
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<br />Self-Pay: Sliding Scale
<br />0%
<br />0%
<br />28.8%
<br />216
<br />$ 90
<br />$ 90
<br />90
<br />$ 15
<br />$ 15
<br />$ 15
<br />$ 75
<br />$ 75
<br />$ 75
<br />$ 3,240
<br />$ 664
<br />$ 360
<br />$ 19,440
<br />$ 3,983
<br />$ 2,160
<br />$ 3,240
<br />$ 1,328
<br />$ 1,080
<br />20%
<br />20%
<br />5.9%
<br />44.25
<br />40%
<br />60%
<br />40%
<br />60%1
<br />3.2%
<br />2.6%
<br />24
<br />19.5
<br />$
<br />$ 90
<br />$ 15
<br />1 $ 75
<br />$ 293
<br />$. 1,755
<br />608
<br />$ 1,170
<br />$ 506
<br />80%
<br />100%
<br />80%
<br />100%
<br />0.9%
<br />8.2%
<br />6.75
<br />61.5
<br />$ 90
<br />$ 90
<br />$ 15
<br />$ 15
<br />$ 75
<br />$ 75
<br />$ 101
<br />$ 923
<br />$
<br />$ 5,535
<br />$ 5,535
<br />Medicaid
<br />90%
<br />49,4%
<br />370.5
<br />$ 90
<br />$ 15
<br />15
<br />$ 75
<br />$ 75
<br />$ -
<br />$ 56
<br />$ 33,345
<br />$ 338
<br />$ 30,011
<br />$ 309
<br />Private insurance
<br />90%
<br />90%
<br />0,5%
<br />0.5%
<br />3.75
<br />3.75!'$
<br />$ 90
<br />90
<br />$
<br />$ 15
<br />$ 75
<br />$ 56
<br />$ 338
<br />$ 309
<br />HeallhChoice
<br />Total
<br />100%
<br />750
<br />$ 5,693
<br />$ 67,500
<br />$ 43,489
<br />Lab Outsourcing Fees
<br />$3 fee for Stock Medications
<br />Notes
<br />* Appendix C
<br />Conservative estimate is that 5% of Reference Lab costs sent to UNC will be paid on the sliding fee scale
<br />Conservative estimate is determinded by multiplying total # of stock bottles /items X $3
<br />Note: multiple prescriptions will be dispensed from some large bottles of stock medicines
<br />$23,664 x 5% _ $1183 ; 1, 1 0J
<br />1564 x$3 = $4692 $4,692
<br />Total Anticipated Revenue $49,364
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