Outpatient Clinic Discussion

Model CASE 5 SHASTA FACULTY PRACTICE: Cost-Benefit Analysis Copyright 2018 Foundation of the American College of Healthcare Executives. Not for sale. Model with Questions, Student Version This case analyzes the use of physician extenders in three settings: an outpatient surgery preoperative and postoperative clinic, an internal medicine (family practice) clinic, and an eldercare clinic. The model is designed to focus on one setting at a time. Thus, each clinic has to be analyzed independently. The model consists of a complete base case analysis–no changes need to be made to the existing MODEL-GENERATED DATA section. However, values in the INPUT DATA section of the student spreadsheet have been replaced by zeros. Students must select appropriate input values and enter them into the cells with values colored red. After this is done, any error cells will be corrected and the base case solution will appear. The KEY OUTPUT section includes the most important output from the MODEL-GENERATED DATA section. Outpatient Surgery Preoperative and Postperative Clinic INPUT DATA: KEY OUTPUT: Clinic Data: Number of days per year Number of visits annually Number of physician FTEs Physician costs Physician revenues Cost, Productivity, and Reimbursement Assumptions: Assumed total volume increase Outpatient Clinic Discussion

Extender annual compensation Extender assists physician: Physician productivity gain Physician billing gain Extender replaces physician: 0 0 0.00 $0 $0 Historical Using one extender to* Assist/work alone Replace one phys. Act independently Expected volume** Maximum Volume 0 #DIV/0! #DIV/0! #DIV/0! 0 *Assumes historical physician productivity **Assumes physician productivity increases can handle hig 0.0% (Assumed total increase in clinic volume) $0 0.0% (Increase in number of physician billings due to extender) 0.0% (Increase in physician billing amount due to extender) Page 1 Extender productivity Extender reimbursement % Assists/works alone mix Model 0.0% (Extender visits as a percentage of average physician volu 0.0% (Percentage of physician reimbursement paid to extender) 0.0% (100% = used only to assist physician; 0% = used only to w in-between indicate mix of both roles)

MODEL-GENERATED DATA: Current (Historical) Situation Baseline physician revenues Baseline physician costs Contribution $0 0 $0 Using One Extender to Both Increase Physician Productivity and Bill Separately (Assumes Historical Physici as Enhanced by Exte Baseline physician revenues $0 Incremental physician revenues #DIV/0! Extender revenues #DIV/0! Total revenues #DIV/0! Baseline physician costs $0 Extender costs 0 Total costs $0 Contribution #DIV/0! Change from historical: Dollar change Percentage change #DIV/0! #DIV/0! Using One Extender to Replace One Physician (Assumes Historical Physician Productivity) Baseline physician revenues Incremental physician revenues Extender revenues Total revenues Baseline physician costs Incremental physician costs Extender costs Total costs Contribution $0 #DIV/0! #DIV/0! #DIV/0! $0 #DIV/0! 0 #DIV/0! #DIV/0! Change from historical: Dollar change Percentage change #DIV/0! #DIV/0! Page 2 Model Adding One Extender to Practice Independently (Assumes Initial Physician Productivity) Baseline physician revenues Extender revenues Total revenues Baseline physician costs Extender costs Total costs Contribution $0 #DIV/0! #DIV/0! $0 0 $0 #DIV/0! Change from historical: Dollar change Percentage change #DIV/0! #DIV/0! Volume Growth Without Using Extenders (Assumes that Physicians Can Increase Productivity to Meet Inc Baseline physician revenues Incremental physician revenues Total revenues Baseline physician costs Contribution Change from historical: Dollar change Percentage change $0 0 $0 0 $0 $0 #DIV/0! Page 3 Model 12/1/2017 ves. Outpatient Clinic Discussion

Not for sale. nt surgery c, and an eldercare clinic. o be analyzed made to the existing tion of the student ut values and enter be corrected and important output Contribution $0 #DIV/0! #DIV/0! #DIV/0! $0 Dollar Change #DIV/0! #DIV/0! #DIV/0! $0 Percentage Change from Historical #DIV/0! #DIV/0! #DIV/0! #DIV/0! productivity vity increases can handle higher volume nic volume) an billings due to extender) mount due to extender) Page 4 Model Page 5 Model ase Productivity to Meet Increased Volume) END Page 6 Question 1 Describe the differences between nurse practitioners and physician Question 2 Consider the Outpatient Surgery Preoperative and Postoperative Clinic. a. What type of extender is most suitable for this clinic? Justify your answer. b. Assume that one extender is hired and that the number of physicians remains at the level given in exhibit 5. Outpatient Clinic Discussion Outpatient Clinic Discussion

1. Furthermore, the extender can be used both to increase physician productivity and to increase volume. What would be the financial effect on the clinic? c. Now repeat the analysis, but assume that the extender replaces one physician. d. Repeat the analysis again, but now assume that the extender is used solely to increase the clinic’s capacity. (The extender acts independently to increase patient volume.) e. Which of the three scenarios (increasing physician productivity/capacity, replacing a physician only, or increasing capacity only) appears to be best at this point? f. Outpatient Clinic Discussion

Suppose that the expected volume increase could be met by increasing the productivity of the current physician staff. How would this fact influence the final decision? increase eplacing Question 3 Consider the Internal Medicine Clinic. Repeat Question 2 in this setting. Question 4 Consider the Eldercare Clinic. Repeat Question 2 in this setting. Question 5 Compare the relative attractiveness of using extenders at the three clinics. Explain your results. Question 6 Considering all your findings, what are your conclusions and recommendations regarding the use of physician extenders? Question 7 In your opinion, what are three key learning points from this case? … Outpatient Clinic Discussion