Download St. John Health Business Plan

Business Plan
Title: Outpatient Infusion Center
Date: October 24, 2013
Prepared by:
Brook Grzadzinski, RN, BSN Clinical Nurse
Manager
This proprietary and confidential document is intended for the representatives of St. John Health.
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St. John Health Business Plan
Proposed Facility
Table of Contents
I.
Project Description………………………………………………….
A. Project Overview…………………………………………………
B. Details of Project…………………………………………………
II.
Benefits of Project……………………………………………………
A. Support of Mission/Vision/ Values………………………………
B. Relationship to SJH Strategic Plan…………………………..
C. Physician Alignment Opportunities……………………………
III.
Description of Operations………………………………………….
A. Summary of Services…………………………………………….
B. Operational Issues………………………………………….. ……
C. Assumptions & Success Factors…………………………………
IV.
Market Assessment……………………………………….………..
A. Market Trends and Size…………………………………………
B. Anticipated Market Share……………………………………….
C. Provider Resources………………………………………………
D. Market Capture Strategies…………………………………..…..
E. Competition……………………………………………………...
V.
Analysis of Alternatives………………………………………. ……
A. Alternative Strategies…………………………………………….
VI.
Financial Analysis……………………………………….…………
A. Financial Needs………………………………………………….
B. Financial Assumptions and Impact.…….……………………….
VII.
Project Timetable………………………………………….………
VIII.
Marketing and Communication Plan…………………………….
A. Marketing Plan Outline…………………………………………
IX.
Management Recommendations .…………………….…….……
This proprietary and confidential document is intended for the representatives of St. John Health.
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I. Project Description
A. Project Overview
With advancements in treatment of diseases and the rise of new infusion drug therapies,
the hospital needs a way to provide patient access to intravenous medications. Changes in
reimbursement are also a factor in getting patients to an outpatient setting, the choices are
no longer admission to hospital or use of the emergency department for infusion services.
Same day surgery department has been doing some infusion services but cannot handle
the volume of anything additional. Non-oncology patients need an area that is just for
them.
B. Details of Project
To incorporate a non-oncology outpatient infusion center to provide short and long term
infusion therapy to patients onsite at St. John Hospital and Medical Center.
 The infusion center can provide a full spectrum of infusion services for patients
who do not require hospitalization nor have home care services on board.
 Services can be provided to infants, pediatrics, adolescents, adults and geriatric
patients.
 The services may also offer hard-to-find medications or specialty infusion drugs.
 This may also be an opportunity to expand hours of operation, accepting late and
weekend appointments. Many outpatient infusion centers are only open until
5p.m.
 After hours PICC insertion, IR only inserts PICC’s until 3pm Monday thru
Friday.
 The location of the center can be right off the west entrance by the parking
structure. Since the breast center has closed this provides opportunity to use the
space.
 The Square footage of the area is 4400.
 The house officer can be the physician contact onsite so one would not have to be
employed separately. A nurse practitioner or physician assistant could be
available within the center for needs, for example, order for nausea medication if
the patient gets symptoms during infusion.
 FTE’s- 4.6 for nurses, 0.87 for desk clerk, 1.0 for NP or PA
II. Benefits of Project
A. Support of Mission/Vision/Values
This proprietary and confidential document is intended for the representatives of St. John Health.
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Care across the continuum is important. Having an infusion service on site will be
convenient for patients and providers. Our values of: service of the poor, reverence,
integrity, wisdom, creativity and dedication will all be represented. Since we are located
on site at the hospital our shuttle (within 15 miles) can be used to bring those that cannot
get transportation otherwise. Spiritually centered holistic care will also be embedded into
the culture of the infusion center.
B. Relationship to SJH Strategic Plan
The strategic plan for FY14 is to expand ambulatory/outpatient services as well as
increase the coordination of services. There is also accountability on the organization to
assist in reducing health care spending, making access easier and available for patients,
and provide high quality healthcare.
C. Physician Alignment Opportunities
Many physician offices are on site at the hospital which will allow them to have a close
relationship with infusion center. St. John physicians can review the patient’s electronic
health record and monitor care done at infusion center. Physicians can also order
additional services since patient is on site at hospital, ordering lab tests, radiology, etc.
III. Description of Operations
A. Summary of Services
The VECC should have minimal impact. They have a substantial amount of volume for
oncology patients. The infusion center can open more availability to many diseases and
treatments. For instance :
 Antibiotic, anti-fungal and antiviral therapies
 Anti-emetic therapy
 Blood transfusions
 Epogen, Neupogen, Neulasta
 Growth hormones
 Hemophilia factors
 Iron therapy
 IV immune globulin
 IV steroids
 Remicade
 Therapeutic phlebotomies
 Mediport and PICC line maintenance
 IV hydration
This proprietary and confidential document is intended for the representatives of St. John Health.
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B. Operational Issues
Currently there are four sites for infusion services. Webber Cancer Center in Warren,
River District Hospital in East China, St. John Hospital- Macomb Twp and the Van
Elslander Cancer Center (VECC) in Detroit. The Webber and the VECC are highly
focused in treating patients with cancer and administering chemotherapy. At SJH&MC
patients that need other treatments besides chemotherapy come through same day surgery
to get their infusion. Same day surgery has the population of elective surgery patients for
outpatient or inpatient admission. The current state is that they have difficulty in
accepting infusion patient’s based on high volume of surgical patients. There have also
been times where patients have come to the inpatient unit for their infusions and
reimbursement was lost due to not billing correctly. Having a separate infusion center
will provide better access for patients, more convenient hours for patients, more complete
billing, and to be more efficient in caring for patients needing infusions. The locations in
East China and Macomb Twp. can also be quite a distance away for patients to travel.
C. Critical Assumptions and Success Factors
Coordination of care is one of the system strategies. Providing a place for non
chemotherapy patients to come for their infusion services would help align with the
system strategy. Providers within the system will have options for their patients who need
outpatient infusion services. Outpatient services are being emphasized in the current
health care reform. Billing and reimbursement will be more standardized. Having the
outpatient infusion center onsite at the hospital will also make workflow easier.
Pharmacy is already onsite and can forward the medications needed for the infusion.
Laboratory and transfusion services are also onsite and can support the needs when
needed. If needed there can be resuscitative support from the ED or the patient can be
admitted if there are complications. Ancillary services can also be available. For
example, respiratory care or radiology.
IV. Market Assessment
A. Market Trends and Size (Past, Current, Future)
The service area for this outpatient infusion center will be Macomb and Wayne counties.
The population in these areas are: Macomb County (849,649) and Wayne County
(1,820,650), these numbers were estimated for the year 2012 (Semcog, 2014).
Keeping patients in hospitals for infusions is no longer the standard of care. Many
patients can be treated via outpatient and an infusion center in the area of Wayne and
Macomb Counties can provide this service.
This proprietary and confidential document is intended for the representatives of St. John Health.
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B. Anticipated Market Share
Payer mix will be important to consider. Some of the insurances we see are SmartHealth,
Medicare, Medicaid, BSBS, HMO’s, and private payers. As of October 1st, 2013 the
government issued the Affordable Care Act insurance exchange as a way to give more
access to health insurance for Americans. We have yet to see what insurances and
coverage’s come from this.
To start we will identify 80% of the payers that we anticipate to see. We will also
compile in an excel spreadsheet/charge master a list of the drugs and procedures that we
will perform. We will list out what the insurance carriers pay for their products and what
our purchase costs are.
C. Provider Resources
Resources that would be impacted are laboratory, pharmacy, blood bank, equipment
distribution center, housekeeping, rapid response unit, radiology and house officer. A NP
or a PA could oversee the area during business hours.
D. Market Capture Strategies
Since there is limited infusion centers even within our system we can gain within our
areas. We can also competitively compete with the Beaumont infusion center in St. Clair
Shores. Beaumont infusion is open 7 days a week at that location. Since our hospital
culture is about ‘believing in better’ and providing spiritually centered holistic care we
will be able to advertise this department with these great initiatives.
E. Competition
Having a state of the art infusion center with access to all hospital services will be
convenient for consumers. Henry Ford Macomb at 19 mile Road does have a rapid
treatment center onsite that is used for infusion therapy.
V. Analysis of Alternatives
A. Alternative Strategic
Having patients go to inpatient nursing units for infusion therapy is not ideal. Charges are
being missed due to nursing unit staff not educated on billing, nurses are not familiar with
charting for outpatient procedures, and inpatient beds are not available for patients that
need inpatient services. Infusion therapy can continue in Same Day Surgery but they
cannot take on additional volume, they would also be in the mix of patients having
This proprietary and confidential document is intended for the representatives of St. John Health.
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surgery-a different focus for that department. The cancer centers are an option but
patients needing something simple as hydration are being treated with cancer patients, for
the cancer center to increase volume of non chemotherapy related infusions also causes
concern for chair availability for patients needing chemotherapy.
VI. Financial Analysis
A. Financial Needs
Since the old breast center location is no longer in use this would be an ideal area to put
the infusion center. The area would need demolition to create an open floor plan with
space availability for patients to receive their infusion in reclining chairs.
The 4400 sq. ft. area can support 15 stations for infusion therapy. This would require 6
nurses to administer infusions, 2 unit clerks to man the desk as well as set up
appointments, verify insurance coverage and authorization of medication, 1 NP’s or PA’s
to oversee orders and order anything additionally if needed. If the house officer can be
the overseeing physician there may not be any additional spending to employ an
additional physician.
B. Financial Assumptions and Impact
With changes in healthcare costs and reimbursements due to economic changes and the
introduction of the Affordable Care Act there will still need to be a cost analysis done
prior to initiation the infusion center. There will need to be more investigation on these
new insurances and if they pay for certain intravenous therapy that we are willing to
offer. If there will be out of pocket costs for our services to the patient, is it considered to
be a realistic amount for them to continue with our services?
VII. Project Timetable
By December 2013 the project will get help from finance to determine revenue and
expenses for this project and determine whether it is financially sound and could be
profitable. If the project is supported then we will submit the budget for the project in
January 2014 to finance. Begin demolition and building in January and complete by June.
Grand opening set for July 1st. 2014 start of the fiscal year.
VIII. Marketing and Communication Plan
This proprietary and confidential document is intended for the representatives of St. John Health.
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A. Marketing Plan Outline
Advertise with signage in the physician lounge and reach out to local physician offices
affiliated with SJH&MC as well as the entire SJPHS. Also advertise on the St. John
Intranet page. Physician practices include but not limited to oncology, rheumatology,
hematology, infectious disease, etc.
IX. Management Recommendation
A clinical nurse manager will oversee the operations and performance management of the
staff. Since the span of control is not large the manager overseeing the inpatient IV Team
currently can also take on managing this department as well.
This proprietary and confidential document is intended for the representatives of St. John Health.
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References
Semcog. Southeast Michigan Council Of Governments. (n.d.). Retrieved October
21, 2013, from http://semcog.org
This proprietary and confidential document is intended for the representatives of St. John Health.
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