295 295 Case 3 291 372 Physician Care Services, Inc. 875 291 Copyright © 2013. Health Administration Press. All rights reserved. P hysician Care Services, Inc. (PCS), was founded as a for-profit corporation on January 1, 2000. Three physicians each own 20 percent of the stock, and one physician owns 40 percent. PCS currently offers nonemergent care services in two locations—at the Alpha Center just outside the city limits of Middleboro in Mifflenville and at the Beta Center in Jasper, close to the Jasper industrial park and suburban neighborhoods. At these locations ambulatory medical care is provided on a walk-in basis. PCS centers do not offer emergency services. If a patient arrives needing emergency services, an ambulance is called to transport the patient to the nearest hospital emergency department. The Alpha Center opened in January 2000. Originally, it only treated occupational health clients. This policy was changed in 2004 when private patients were accepted. The Beta Center opened in January 2006 and has always treated private as well as occupational health clients. PCS specializes in providing services that are deemed convenient by the general public. Patient satisfaction remains its highest operational goal. At present, staff physicians employed by PCS do not provide continuing medical care. PCS physicians refer patients to area physicians as warranted for continuing and/or specialized medical care. Although patients often return to a PCS center, chronic illness management is not provided. 77 Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 77 11/22/13 8:44 AM 78 The Middleboro Casebook P ati e n t S e r v ic e s O ccu pat i o n a l H e a lt h C l i e n t s Occupational health clients are sent to a PCS center by their employer for treatment of a work-related injury (which is usually covered by workers’ compensation insurance), for pre-employment or annual physicals, and for health testing, which are paid for directly by the employer. Because of special work conditions, usually involving hazardous chemicals or materials, some local corporations contract with PCS to provide comprehensive physicals in accordance with Department of Transportation and other federal and state laws and regulations. Local corporations consider PCS a cost-effective and convenient alternative to a hospital emergency department. These corporations use PCS in lieu of employing a physician. Corporate clients expect PCS to assist with all phases of case management involving worker injury. They hold PCS accountable that their workers receive timely, appropriate, and cost-effective services. Physicals for Occupational Safety and Health Administration compliance are currently priced between $300 and $500 each. Physicals for local police and fire include pulmonary function tests (PFT), laboratory tests, and electrocardiograms (EKGs). They are currently priced between $250 and $350 per physical, depending on contractual volume. Pre-employment physicals are typically priced between $60 and $95 and include a urine dip test. Services provided for occupational health clients are billed directly to the employer. P r i vat e (R e ta i l ) C l i e n t s Copyright © 2013. Health Administration Press. All rights reserved. Private clients also seek medical care from PCS centers. All aspects of general medical care are provided except OB/GYN. Private patients are attracted to PCS because they do not need an appointment. PCS accepts cash, checks, and credit cards at time of service. As of 2008, PCS directly bills the larger health insurance plans covering its market area: ◆◆ Statewide Blue Shield ◆◆ American Health Plan ◆◆ Cumberland River Health Plan ◆◆ Central State Good Health Plan At time of service, retail clients covered by these plans are screened to verify eligibility and to determine whether they have satisfied any required deductibles. If deductibles have been met, patients will be required to pay just the copay amount, and a bill is sent electronically to the insurance plan for the account’s balance. If deductibles have not been Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 78 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. 79 met, then the patient will pay the bill at time of service, and PCS will enter the bill into the insurance company’s system as partial fulfillment of any outstanding deductible. If the patient does not have coverage from one of these insurance companies, she receives a bill to claim reimbursement directly from her insurance plan. PCS also directly bills Medicare. A recent study suggested that these four private insurance companies and Medicare cover approximately 85 percent of PCS’s private clients. Any client who has a history of bad debt at PCS or is unable to pay at time of service is referred to a hospital emergency department for service. PCS maintains an aggressive credit and bad debt collection policy and does not serve Medicaid patients. Patients living within a 30-minute travel distance from a PCS center typically constitute 80 percent of PCS’s private pay patients. Copyright © 2013. Health Administration Press. All rights reserved. O r g a ni z ati o n and M a n a gem ent Each center is located in approximately 6,000 square feet of rental space devoted to patient services. The Alpha Center is located on main roads between Middleboro and Mifflenville in a small shopping center. The Beta Center is located on the first floor of a new office building adjacent to a large shopping mall in Jasper. Ample parking is provided in both locations. Each center maintains attractive signs. Each center is open 60 hours per week, 8:00 a.m. to 7:00 p.m. on weekdays and 9:00 a.m. to 2:00 p.m. on Saturdays. Both centers are closed on Sundays and Memorial Day, July 4, Thanksgiving, Christmas, and New Year’s Day. Each center has four fully furnished patient examination rooms and one extra room. Currently each center has some excess space. For patient care the minimum staffing at each center is one receptionist/billing clerk, one medical assistant, and one physician or nurse practitioner. Additional staff (e.g., advanced registered nurse practitioner, physician assistant, medical assistant) is scheduled based on anticipated high-volume days. Typically the nurse practitioner works on Saturdays and assists with physicals and other services on high-volume days. Physician assistants also assist on high-volume days. The central administrative and billing office is an additional 2,500 square feet and is located adjacent to Alpha Center. The central office staff includes the president, medical director, director of nursing and patient care, business office manager, and the billing and bookkeeping staff. Charges Each center uses the same price schedule. The basic visit charge (CPT 99202) has changed each year. Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 79 11/22/13 8:44 AM 80 The Middleboro Casebook January–December Private Pay ($) Occupational ($) 2010 94 161 2011 99 170 2012 104 180 2013 110 189 2014 120 201 Current detailed prices include: CPT Procedure Copyright © 2013. Health Administration Press. All rights reserved. Code Description Price ($) 99201 Office visit, brief, new 96 99202 Office visit, limited, new 120 99203 Office visit, inter, new 201 99204 Office visit, comp, new 226 99211 Office visit, min, est 65 99212 Office visit, brief, est 96 99213 Office visit, limited, est 201 99214 Office visit, inter, est 201 99215 Office visit, comp, est 294 Additional charges are levied for ancillary testing and specialized physician services, such as suturing. A patient returning for a medically ordered follow-up is charged $96 for the return visit. Based on Current Procedural Terminology (CPT) comparison, PCS fee levels are competitive within the area. No similar medical service is offered within a 45-minute radius from each center. In the past—as part of an advertising campaign to attract private pay patients—each May and June PCS has offered discounted physicals, such as camp physicals for children at $48 and for all children in a family for $69. Steve J. Tobias, MD, board chair and president of PCS, says national studies suggest that urgent care visits are at least $10 less than a visit to primary care physician in Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 80 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. 81 private practice. Other studies indicate that urgent care visits cost $250 to $600 less than emergency department visits for the same CPT code. Some occupational health clients are charged based on a negotiated volume-based price, especially for physicals. PCS’s medical director negotiates specific fees for physicals and specific medical tests ordered by an employer. Typically, an employer approaches PCS in need of a specific type of physical, such as the annual physical required by the Department of Transportation for all operators of school buses, or specific medical test for employees. PCS submits a bid to perform a specific number of physicals based on a flat rate per physical. As of 2007, PCS does its own payroll. Employees must have direct deposit with a local bank. Each employee receives an electronic pay stub biweekly (with accrued balance of vacation and sick time) and a W-2 at the end of the year. Board of Directors Copyright © 2013. Health Administration Press. All rights reserved. The board of directors is composed of the four physician owners and meets quarterly to review operations. The annual board meeting occurs in December, at which time officers are elected for the coming year. As majority stockholder, Dr. Tobias is chairman of the board and president of PCS. Jay T. Smooth, MD, is the board secretary. Other board members are Rita Hottle, MD, and Laura Cytesmath, MD. Current owners have the option of buying any available stock at its current book value. An outsider can purchase stock in this company only if all the current owners refuse to exercise this option and he receives the approval of the existing owners. It should be noted that PCS has paid a stock dividend in three of the last five years. President and M e d ic a l D i r e c t o r Dr. Tobias is also the medical director of PCS. He is a graduate of the medical school at Private University and has completed postgraduate medical education at Walter Reed Army Hospital in general internal medicine. He is board certified in general internal medicine, emergency medicine, and occupational health. He also holds a master’s in public health from State University. As medical director, Dr. Tobias is responsible for medical quality assurance programs and the recruitment and retention of qualified physician employees. He is also responsible for securing the services of consulting radiologists to read all X-rays. He receives a separate salary as medical director and as president. Compensation for the medical director position began in 2008. Before Dr. Tobias founded PCS, he was a full-time emergency physician at Middleboro Community Hospital. He originally worked to establish joint venture urgent care centers with Middleboro Community Hospital. When this approach failed, he recruited the other stockholders and moved ahead with PCS. As president, Dr. Tobias is responsible for the management of all resources and strategic planning. Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 81 11/22/13 8:44 AM 82 The Middleboro Casebook Dr. Tobias schedules the other physicians and the nurse practitioners. He also works in the centers and provides on-call services as needed. He has consulting medical staff privileges in the Department of Medicine at Middleboro Community Hospital. C l i n ic a l S ta f f In total, the clinical staff is composed of seven physicians, three nurse practitioners, and two physician assistants. All physicians hold medical staff privileges at an area hospital. Name Medical Specialty Certification Bennet Casey, MD Family practice Board certified Mark Welby, MD Family practice Board certified Steve Tobias, MD, MPH ** Emergency medicine Board certified Jay Smooth, MD * Emergency medicine Board certified Rita Hottle, MD * Emergency medicine Board certified Laura Cytesmath, MD * Emergency medicine Board certified Micah Foxx, DO, MPH Occupational health Board certified Melisa Majors, MD Occupational health Board certified Carl Withers, ARNP Family and adult health Jane Jones, ARNP Family and adult health Gerri Mattox, ARNP Family and adult health Copyright © 2013. Health Administration Press. All rights reserved. Rutherford Hayes, PA Mary Fishborne, PA * Owner ** Owner and president Until 2007, staff physicians were retained as independent contractors and received no benefits above their hourly wage. Beginning in 2007 when nurse practitioners were added, physicians (and all other employees) who worked more than 1,000 hours were provided comprehensive benefits, including family medical coverage. Also as of 2007, PCS reimburses all physicians and nurse practitioners for their medical malpractice insurance. Full coverage is provided when a member of the medical staff works 1,400 hours at PCS. Others receive a partial reimbursement. Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 82 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. 83 Physicians are paid $100 per hour. Nurse practitioners receive $50 per hour. These payment levels have been fixed for two years and are considered within the appropriate market range. Drs. Smooth, Hottle, and Cytesmath also work as emergency physicians at Middleboro Community Hospital. Dr. Casey serves as medical director one day per week at an area corporation, where he specializes in occupational health. Dr. Welby also works at Convenient Med Care, Inc., in Capital City. Dr. Foxx, who recently relocated to Jasper with her family, is available to work no more than six shifts per month, a condition she has established until her children reach school age. Dr. Majors also works as an emergency physician in Capital City. Physician assistants are paid $40 per hour and assist physicians on anticipated high-volume days. Dr. Tobias schedules all members of the medical staff for work on a monthly basis with the understanding that if a physician is unable to work, it is her responsibility to secure a replacement from the qualified medical staff of PCS. Physicians and nurse practitioners work an entire shift (e.g., 11 hours on a weekday). Fridays and Saturdays are typically assigned to the nurse practitioners. Physician assistants are on call for busy days to assist physicians. The clinical staff of PCS meets quarterly to review areas of concern. Dr. Tobias does random reviews of medical records to ensure compliance with standards of clinical practice. He is also responsible for all issues involving credentialing. M e d ic a l A s s i s ta n t s Copyright © 2013. Health Administration Press. All rights reserved. Medical assistants at each center are trained to take limited X-rays, draw specimens for laboratory testing, do EKGs, and conduct simple vision and audiometric examinations. Each center is equipped to do: 1. On-site X-ray 2. PFT 3. EKG 4. Audiometric and visual testing 5. Some laboratory testing (e.g., strep screen, dip urine) 6. Drug and breath alcohol testing A regional laboratory processes more advanced laboratory work. Two medical assistants are assigned to each weekday shift. One is assigned for 7 hours per day (i.e., 35 hours per week) and the other is assigned for 4 hours per weekday and Saturdays (i.e., 25 hours per week). Responsibilities include examination room Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 83 11/22/13 8:44 AM 84 The Middleboro Casebook preparation, assisting the physician or nurse practitioner, patient testing, case management, scheduling visit follow-up care, and addressing patient questions. Each center maintains a pool of qualified medical assistants who are trained, evaluated, and scheduled by the director of nursing and clinical care. C e n t r a l O f f ic e S ta f f Dr. Tobias devotes his time to being both the president and medical director at PCS and filling in at a center when needed. As president he is responsible for the overall management of PCS. Joan Carlton, LPN, is director of nursing and clinical care. She trains, supervises, and schedules the medical assistants. She is also responsible for ordering medical supplies, meeting with occupational health employers as needed, and general administrative duties as assigned by Dr. Tobias. If needed, she substitutes for a medical assistant at a center. Martha Coin directs the business office and has three full-time staff. She schedules the receptionist staff at each center. She and her staff assist the receptionists and billing clerks at each center, manage all insurance billing, and manage the general ledger, including accounts payable and accounts receivable. If needed, she or a member of her staff substitutes for the receptionist at a center. The central office billing staff also maintains a list of available (and trained) fill-in receptionists to cover absences and other needs. R e c e p t i o n i s t S ta f f Copyright © 2013. Health Administration Press. All rights reserved. One full-time (35 hours per week) front desk receptionist is hired for each center. Aside from greeting and registering all patients, the receptionist is also responsible for appointments, billing, records for occupational clients, and managing cash receipts. One or more additional receptionists are hired for the remaining 25 hours per week. A d d i t i o n a l I n f or m ati on In 2008 PCS began using URGENT CARE MIS, an electronic medical information, general ledger, and billing system. Computer terminals were installed in the reception area in each center, at the central office, and in each examination room. PCS uses this system for all phases of financial and medical record keeping and billing, appointment services, case management, staff scheduling, and data management. This system captures, stores, and reports all CPT codes and links medical procedures with revenue and expense information. The health insurance billing system has a direct Internet link with the participating insurance companies and Medicare. PCS purchased the hardware and leased the required Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 84 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. 85 software for ten years. It receives hardware maintenance, software updates, and technical assistance from the vendor. A 2013 study of medical records indicated that the most common CPT codes at PCS are ◆◆ 99212/3 and 99202 Office/Outpatient Visit, ◆◆ G0001 Drawing Blood, ◆◆ 85029 Automated Hemogram, and Copyright © 2013. Health Administration Press. All rights reserved. ◆◆ 71010/2 Chest X-Ray. Injuries and rechecks generally account for 20 percent of all visits. Paper medical records that existed prior to 2008 are retained in active file for seven years, and then transferred to closed files. When interviewed, Dr. Tobias indicated that discharging Nancy Stone, RN, as director of nursing and clinical services in 2012 was a hard decision. Some employees still regret this situation. Stone was well liked but just could not get along with some of the physicians and had a great deal of difficulty coping with multiple job responsibilities. At the end of her tenure she refused to provide patient care as needed at the Beta Center. After she was discharged, Stone complained that she had “too many duties to do well, and PCS was more interested in getting patients in and out than in providing patients quality medical care.” She has retained an attorney and informed Dr. Tobias that she is suing him and PCS for “wrongful discharge.” As she stated at the initial hearing for the lawsuit, “Meeting job expectations was hard when the job lacked any formal job description.” Dr. Tobias shared in the interview that he felt compelled to act even though Stone is the sister of the vice president for human resources at Carlstead Rayon, a growing occupational health client of the Alpha Center, and that additional details are not available given that this case is currently being handled by legal counsel. Dr. Tobias stated that the owners should look forward to achieving even greater corporate profitability. Dr. Tobias indicated that no one foresaw the terrible first three years of financial losses. He also said that within the past few years, PCS has earned its place in the regional medical care system and its future appears solid. It should be noted that, at the end of 2007, one of the original physician partners, who is no longer affiliated with PCS, exercised his option to be bought out by another stockholder. Dr. Tobias was the only partner willing at that time to increase his ownership in PCS. Dr. Tobias also indicated that the owners might now be in the position to open a third and even fourth location. He also discussed purchasing buildings to house the existing centers and adding some services to better serve their occupational and private pay clients. Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 85 11/22/13 8:44 AM 86 The Middleboro Casebook Copyright © 2013. Health Administration Press. All rights reserved. “We are a debt-free corporation that is beginning to earn serious profits,” he said. “Along the way we have distinguished ourselves by the high quality of care we have provided—our patients and occupational health clients are delighted with our highestlevel commitment to patient care, convenience, and affordable prices. While it has been a long road, I have every reason to believe we will continue to prosper and expand.” The original real estate leases on the Alpha and Beta Centers expire at the end of 2015. Dr. Tobias said that he timed the expiration of these leases to coincide with when PCS would be ready to make a major strategic move. Each current lease has a renewal clause for up to 36 months, with an escalation clause so that rents do not increase more than 15 percent per year. Tobias estimates that appropriate facilities could be acquired for $150 per square foot (including land, site improvements, and facilities) and that it would take approximately six months from the time the contract was executed to when the center could be fully operational. When asked to identify future challenges, Tobias noted that he felt that volume had just about hit the level at which total service time averages about 20 minutes. He did indicate, however, that there might be a need for larger waiting rooms and that those patients waiting for more than 90 minutes might be a problem. Tobias was, however, pleased that patients generally reported “complete satisfaction” with the quality of care provided by PCS. Dr. Tobias repeatedly cited the competent clinical and administrative staff. Overall, he indicated that he was concerned about continued rapid growth. “Our early success with occupational health may be slowing. If we lose a significant amount of manufacturing in our area, we potentially lose occupational health clients. Our future in occupational health will follow the local economy.” Dr. Tobias noted that regional unemployment has already affected occupation health. Fewer people are being hired and working. Fees paid by the workers’ compensation program have been fixed for 24 months. People who are unemployed lack health insurance. Dr. Tobias expressed a great deal of optimism that the full implementation of the new federal health insurance plan (the Patient Protection and Affordable Care Act) would significantly expand PCS’s pool of private clients. Two years ago, PCS instituted an appointment plan for occupational health clients, which Dr. Tobias reported has been very successful. Under this plan, occupational health clients are scheduled for physicals or medical testing. Under the “call before you come” system, patients (or employers) can call ahead to determine the approximate wait time, make a decision, and—if they want service—register for service at an approximate time that day, thereby ensuring themselves a specific place in the queue for service even before they arrive at a center. Every patient who arrives at a center is given an approximate wait time by the receptionist and told they need not wait in the waiting area to preserve the scheduled time for their appointment. While “first in, first out” is generally used, urgent care cases (especially injuries) are bumped ahead of nonemergency patients. Signs in the waiting area Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 86 11/22/13 8:44 AM Copyright © 2013. Health Administration Press. All rights reserved. Case 3: Physician Care Services, Inc. 87 explain to patients that some occupational health clients are served by appointment and that appointments override arrival order. PCS advertises its services in the regional market. It uses billboards on main roads and newspaper advertising. It also uses an extensive website and social media. The director of nursing and patient care visits current and prospective occupational health clients and typically answers approximately 15 to 25 telephone inquiries per month regarding quotes for specific services, such as employee physicals. When interviewed, other PCS physicians offered different perspectives. Three physicians expressed concern about the manner in which Dr. Tobias schedules the physicians. They were never sure exactly how many shifts per month they would work and at which center. All prefer to work at only one center and indicated that this type of stability leads to a better medical care team. Records suggest that certain physicians may have productivity profiles significantly different from those of other physicians. It appears that on busy days, revenue per visit drops, a trend that suggests that physicians do less ancillary testing when they are busy. The target for physicians and nurse practitioners is 3 to 4 patients per hour. Three physicians have also requested extra compensation for busy days. They contend that they tend to be scheduled on “very busy days” and receive the same hourly compensation as physicians who work on slower days. Dr. Tobias indicated that he does not feel that their claim is warranted. In 2010, two (nonowner) physicians said that because they are paid by the hour, they should be paid for the time they spend treating those patients who arrive right before closing time. Up until this change, all staff were only paid for the hours in their shift (e.g., 11 hours), which was sometimes less than the number of actual hours worked. Employees are expected to treat all patients that arrive during working hours even if this extends their work time beyond closing time. All physicians reported that they felt that their pay level was reasonable given their responsibilities. Six occupational health nurses at area corporations were interviewed. Each indicated that she and her corporation were satisfied with PCS. A number of these nurses indicated that they appreciated PCS—specifically the medical assistants—keeping them informed about specific patients and that PCS was creative in explaining restriction and suggesting “light duty,” medically appropriate work an injured worker could perform for the employer as an alternative to her regular duties until she was ready to resume her regular duties. Dr. Tobias recently returned from a professional meeting with statistics that he felt could help PCS better estimate its future market. These statistics apply to this state: Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 87 11/22/13 8:44 AM 88 The Middleboro Casebook Average Number of Physician Visits—Ambulatory Care per Person, per Year, by Age and Sex (National Statistics) Age Males Females 0–14 3.37 3.09 15–44 1.99 3.92 (includes OB/GYN) 45–64 2.98 4.34 65+ 4.51 5.19 NOTE: Visits unrelated to workers’ compensation and occupational health At this meeting, Dr. Tobias also learned that other urgent care corporations use the following parameters in their fiscal and market planning. ◆◆ For every 15 percent increase in a basic visit fee, there will be a 25 percent reduction in utilization of retail patients without health insurance (i.e., who pay by cash, check, or credit card). ◆◆ Patients covered by insurance, including Medicare and commercial insurance, are generally not price-sensitive as long as the annual increase in the basic visit fee does not exceed 20 percent. Copyright © 2013. Health Administration Press. All rights reserved. ◆◆ Annual increases up to 15 percent in ancillary charges do not affect the number of new visits by retail clients. It appears that ancillary charge increases above 15 percent may reduce return visits by as much as 45 percent regardless of payment source. At the next board meeting, Dr. Tobias plans to discuss a series of new ideas and opportunities that deserve the board’s attention. Currently his ideas and opportunities include the following: Prescription Drugs for R e ta i l P at i e n t s This service is currently available to patients covered by workers’ compensation. State law allows physicians (and nurse practitioners) to dispense prescription drugs as long as adequate records are maintained. National firms specializing in drug repackaging let PCS buy prepackaged prescription drugs ready for sale to a patient. PCS has already established its formulary Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 88 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. 89 Copyright © 2013. Health Administration Press. All rights reserved. for workers’ compensation patents. PCS has determined that by maintaining 12 specific drugs in pill form it can meet approximately 60 percent of the retail demand that PCS physicians create for prescription drugs. The charge for prescription drugs for workers’ compensation patients is directly billed to the employer as part of the overall charge for service. Dr. Tobias indicated that PCS should consider extending this service to all patients. By only providing “high-volume” drugs, PCS can guarantee high inventory turnover. An appropriately sized initial inventory for retail patients can be capitalized for a center for $1,000. All suppliers promise a next-day replenishment of inventory items. The shelf life of all drugs is more than one year. Even with a markup of 800 percent, PCS prescription prices will be competitively priced in the area. The question is whether this service should be expanded to retail patients. By reviewing medical records of current retail patients (nonphysicals), PCS has determined the number of prescriptions received per visit by patients. Age of Patients Average Number of Prescriptions Received per Visit 0–14 1.20 15–44 0.80 45–64 1.10 65+ 1.90 The average supplier cost per PCS prescription is estimated to be $5. To maintain the proposed inventory, additional software costing $12,500 per year is required to verify insurance coverage and copays and process insurance payments. Dr. Tobias would like to potentially begin this service within six months. Questions remain, however, whether any prescriptions issued by PCS should be refilled without another medical visit. Questions also remain as to billing procedures when patients do not have a current prescription plan card at time of service. An urgent care center in Capital City recently ended its pharmaceutical sales to retail patients because of the high number of refused claims by drug plans. Drug Testing for H e a lt h y E m p l o y e e s The director of human resources at a local company, a current PCS occupational health client, has stated that its new labor contract includes a clause stating that “all workers and job applicants are subject to mandatory random drug testing and any worker who fails or refuses the test will be immediately discharged or not hired.” The client has asked PCS to perform drug tests on referred workers or job applicants. Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 89 11/22/13 8:44 AM 90 The Middleboro Casebook Note that under the new state law and workers’ compensation regulations, drug testing is also required for all workers who are injured at work. Employers are also able to institute random drug testing. Some other clients have even requested that PCS select some of their workers for testing using a random selection process. A process using employee Social Security numbers has been discussed. Other occupational health clients have previously suggested that PCS begin this type of service. Currently a test is available from a reference laboratory for a processing cost of $8 per test. Results screen for the presence of all common illegal drugs. The list price for this test is $42 and $63 if a certified medical review officer (MRO) reads the test. Dr. Tobias is a certified MRO. The test requires about 10 minutes of a medical assistant’s time, specifically to maintain compliance with the chain of custody protocol during collection. P h y s ic a l s by Appointment for Employees Increasingly, employers are issuing formal requests for proposal (RFPs) for occupational health physicals that require appointments. For example, a current RFP from a local employer is for 350 annual physicals during 2015 that must be done between 3:15 p.m. and 4:30 p.m. Monday through Friday at the Beta Center. (The company’s employees work 7:00 a.m. to 3:00 p.m.) The physical must include the following components: Copyright © 2013. Health Administration Press. All rights reserved. PCS List Price Medical history and examination $70 EKG $70 X-ray chest $101 Urine (dip) test $20 Complete blood count with differential $40 Vision screen $27 Audiometric test $3 Each physical will take approximately 80 minutes to complete. The PCS list price for this package of services and tests is $331. PCS vendor costs for the physical (e.g., X-ray reading fees, laboratory charges) are estimated to be $70.00. The PCS bid for this contract will be evaluated on the basis of total price and fulfilling expectations related to schedule and timing. Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 90 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. 91 Currently, this employer uses the emergency department at Middleboro Community Hospital for all matters involving occupational health. Dr. Tobias feels that the board must develop policies regarding these types of requests. M a n a g e m e n t P o l ici e s C o n c e r n i n g W a i t i n g Copyright © 2013. Health Administration Press. All rights reserved. Dr. Tobias is concerned that patient waiting time may be a problem. Waiting appears to be defined by patients as the time they spend in a reception area, not the time they might spend in an examination room waiting to see the clinical staff. National studies indicate that approximately 57 percent of patients coming to an urgent care center wait 15 or fewer minutes. Dr. Tobias will tell the board that PCS must begin to address this problem after they first have a better understanding of current waiting times and issues. A consultant has told PCS that its service times for retail patients are approximately 20 percent of gross billed charges. For example, a patient visit that costs $100 (gross billed charges) takes approximately 20 minutes—20 percent of 100—of service time. For all workers’ compensation cases and employer-paid physicals, service time is approximately 25 percent of gross billed charges. As demand increases during the day, the clinical care team sequentially sees patients in multiple examination rooms. Typically, a visit begins with a brief encounter with the medical assistant, who records vital signs, takes a medical history, and records the reason for the visit. The physician or nurse practitioner then enters the room (with the chart) and performs an additional examination. Specific medical tests may be ordered. The medical assistant administers these tests (e.g., X-ray) and/or collects blood or urine for laboratory processing. The physician or nurse practitioner ends the visit providing the patient with a specific diagnosis and treatment plan, additional medical orders, or a referral. A mbu l at o ry P h y s ic a l T h e r a p y National studies estimate that approximately 30 percent of the occupational health clients (injuries covered by workers’ compensation) and 5 percent of retail clients (nonphysicals) at centers like PCS are referred to physical therapy for treatment. Dr. Tobias has indicated that PCS may have the opportunity to move into this market. Area providers typically receive $195 from workers’ compensation funds for an initial physical therapy evaluation and (on average) $125 per therapy visit. On average each workers’ compensation case generates 5.75 visits—an initial visit and 4.75 additional visits. Most commercial and managed care plans pay $60 per visit and $100 for an initial evaluation. Dr. Tobias has recommended that PCS consider, depending on estimated demand, offering physical therapy services for one or both centers (e.g., 7:00 a.m. to 2:00 p.m. Monday, Wednesday, and Friday and 11:00 a.m. to 7:00 p.m. on Tuesday and Thursday). Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 91 11/22/13 8:44 AM 92 The Middleboro Casebook Staffing could include one full-time physical therapist (PT) at $80 per hour (or $75,000 plus benefits) and part-time physical therapy assistants (PTAs) at approximately $25 per hour. PTs can simultaneously manage between two and five patients and supervise a PTA, who provides the direct therapy, given specific treatment plans. Dr. Tobias also says that PCS may be able to contract for the needed PT and PTAs from local nursing homes. The PT must do the initial patient evaluation and establish the treatment plan but need not be on site to supervise the PTAs. Equipment for each center could be purchased and installed for approximately $30,000 (five year depreciation, no salvage value). Operational costs, such as laundry and medical supplies, are estimated to add approximately $15 per visit. The one-time information system upgrade for ambulatory physical therapy would cost $6,500. Other costs may need to be estimated. A consultant has recommended that PCS only service workers’ compensation patients to start, but Dr. Tobias indicates that full coverage needs to be considered. O t h e r I s s ue s Copyright © 2013. Health Administration Press. All rights reserved. The board members know that one member of the board will come to the next board meeting in hopes of discussing whether PCS is for sale and how best to position PCS for sale. He believes that PCS cannot be a long-term successful player in the increasingly competitive medical marketplace. He stated, “I am very concerned that the big box stores will add walk-in services to go along with their pharmacies. I just do not see how we can compete. Our market area is just too volatile!” It is known that Dr. Tobias has always said he would be willing to sell PCS for “the right price.” He has also stated when the regional economy and manufacturing pick up, PCS’s occupational health business should rebound along with its overall profits. PCS is liable for a 31 percent federal tax and 9 percent state tax on its profits. Carry-forward losses experienced in the initial years of operation have expired. Local real estate taxes on owned land and buildings are 4 percent of assessed valuation. Current assessed valuation of land in the county is approximately 40 percent of market value or total development cost. Originally three-year renewable leases were used to secure the needed medical equipment (e.g., X-ray machines, computers) and most furniture. In 2005 PCS’s accountant recommended that because PCS was now earning a profit and had used all of its carry-forward tax credits, it should consider borrowing funds to purchase needed equipment and should cancel all outstanding equipment leases. Between 2005 and 2007, it did. Each center required between $150,000 and $200,000 worth of new equipment. The only equipment leases that remain are for color copiers and general office equipment. PCS maintains a line of credit with a commercial bank in Capital City. Its cost of capital is 2.5 percent above the Wall Street Journal prime rate. Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 92 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. 93 Copyright © 2013. Health Administration Press. All rights reserved. Based on its annual credit review, PCS has been informed that its cost of capital could increase by 1 or 1.5 percentage points over the next 18 months. The bank stated that the management and organization of PCS are seriously flawed: “PCS has become too dependent on Dr. Tobias in his many roles. His duties need to be divided between two or more qualified professionals.” If PCS does not address this situation, its credit worthiness will be significantly downgraded. This situation was also noted in the 2013 audit and management letter. Officials in the City of Jasper have requested a meeting with PCS to discuss emergency planning and expanded services. Their specific questions will include whether PCS would expand hours on Saturday and offer services on Sunday afternoon. Their letter indicated that the majority of urgent care centers nationally offer services on Saturdays (8:00 a.m. to 8:00 p.m.) and Sundays (9:00 a.m. to 7:00 p.m.). A formal response to this inquiry is due within the week. Additional information regarding PCS utilization, patient demographics, and finances may be found in the following tables. Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 93 11/22/13 8:44 AM 94 The Middleboro Casebook Table 3.1 PCS Utilization Report Alpha Total Visits Private Visits Alpha Occupational Health Visits Beta Private Visits Beta Alpha Beta Total Occupational Health Visits Gross Charges ($) Gross Charges ($) Gross Charges ($) 2014 January 909 302 185 192 230 78,450 94,040 172,490 February 1,030 402 170 207 251 87,650 102,272 189,922 March 1,039 449 165 204 221 92,425 93,092 185,517 April 1,100 481 190 187 242 101,925 96,844 198,769 May 988 480 103 167 238 82,660 92,876 175,536 June 1,067 493 150 195 229 94,625 94,168 188,793 July 1,195 460 252 219 264 112,940 107,748 220,688 August 1,276 503 260 217 296 120,075 116,812 236,887 September 1,031 406 165 209 251 87,050 102,552 189,602 October 1,048 403 233 205 207 101,635 89,144 190,779 November 905 329 225 168 183 90,625 76,956 167,581 December 799 325 230 119 125 91,225 53,160 144,385 Total 12,387 5,033 2,328 2,289 2,737 1,141,285 1,119,664 2,260,949 Copyright © 2013. Health Administration Press. All rights reserved. 2013 January 894 312 180 202 200 72,228 75,038 147,266 February 990 398 166 214 212 79,732 79,526 159,258 March 1,048 440 173 217 218 86,095 81,413 167,508 April 1,102 486 176 203 237 92,154 84,592 176,746 May 999 476 115 163 245 79,069 81,872 160,941 June 978 478 132 133 235 82,622 75,752 158,374 July 1,031 455 204 117 255 93,925 78,948 172,873 205,600 August 1,276 501 251 269 255 108,564 97,036 September 970 396 160 202 212 78,324 78,098 156,422 October 1,056 447 203 199 207 92,778 76,466 169,244 November 1,005 423 254 178 150 99,867 59,432 159,299 December 1,000 405 240 190 165 94,995 64,685 159,680 Total 12,349 5,217 2,254 2,287 2,591 1,060,353 932,858 1,993,211 2012 January 876 303 170 213 190 66,842 73,912 140,754 February 938 365 169 200 204 73,720 75,800 149,520 March 993 402 190 205 196 81,928 74,420 156,348 April 963 406 156 194 207 75,924 75,806 151,730 May 1,001 426 155 175 245 78,014 82,950 160,964 June 986 453 145 143 245 79,192 78,982 158,174 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 94 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. Alpha Alpha Beta Beta Alpha Beta Total Total Visits Private Visits Occupational Health Visits Private Visits Occupational Health Visits Gross Charges ($) Gross Charges ($) Gross Charges ($) July 1,027 451 81,998 168,372 184 127 265 86,374 August 1,259 493 271 227 268 107,692 95,148 202,840 September 909 312 203 189 205 74,138 74,686 148,824 October 1,057 449 213 178 217 91,656 76,322 167,978 November 974 425 207 164 178 87,780 64,836 152,616 December 1,012 401 231 193 187 89,604 70,682 160,286 Total 11,995 4,886 2,294 2,208 2,607 992,864 925,542 1,918,406 95 Table 3.1 PCS Utilization Report (continued) 2011 January 866 313 160 200 193 62,917 60,235 123,152 February 887 375 153 145 214 68,415 58,115 126,530 March 978 397 187 189 205 76,933 61,332 138,265 134,499 April 954 376 159 205 214 69,604 64,895 May 1,035 445 193 165 232 83,245 63,885 147,130 June 1,047 463 193 160 231 85,207 63,125 148,332 July 968 421 195 107 245 80,989 59,866 140,855 August 1,212 504 241 207 260 98,316 74,091 172,407 September 986 323 200 188 275 71,207 74,869 146,076 October 990 409 198 156 227 80,221 61,893 142,114 November 974 400 212 145 217 81,760 58,700 140,460 December 960 394 223 156 187 83,086 54,093 137,179 Total 11,857 4,820 2,314 2,023 2,700 941,900 755,099 1,696,999 Copyright © 2013. Health Administration Press. All rights reserved. (This table can also be found online at ache.org/books/Middleboro.) Week Mon Tues Wed Thurs Fri Sat Total 20 18 38 Alpha 1 2 52 34 27 23 27 26 189 3 53 37 29 24 25 22 190 4 52 33 33 22 21 20 181 5 51 27 24 25 22 16 165 Total 208 131 113 94 115 102 763 Table 3.2 Detailed Utilization (Visits—All Types) for August 2014 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 95 11/22/13 8:44 AM 96 Table 3.2 Detailed Utilization (Visits—All Types) for August 2014 (continued) The Middleboro Casebook Week Mon Tues Wed Thurs Copyright © 2013. Health Administration Press. All rights reserved. Sat Total 19 9 28 Beta 1 Table 3.3 Alpha Center Patient Records, August 4–9, 2014 Fri 2 28 26 14 16 26 12 122 3 28 30 18 14 19 9 118 4 29 25 15 19 21 13 122 5 28 24 18 21 23 9 123 Total 113 105 65 70 108 52 513 Total 321 236 178 164 223 154 1,276 DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 1 1 815 23 1 2 1 1 2 120 1 2 817 64 2 2 2 1 2 120 1 3 819 34 1 2 3 1 2 96 1 4 820 45 1 2 2 1 2 124 1 5 822 17 6 2 1 1 2 120 1 6 822 56 4 1 1 8 2 288 1 7 830 19 6 1 2 2 2 120 1 8 833 7 4 1 3 1 2 96 1 9 855 56 1 2 1 1 2 120 1 10 905 32 2 2 1 1 2 128 1 11 910 34 4 1 2 1 2 120 1 12 915 23 1 2 1 9 1 80 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 96 11/22/13 8:44 AM Copyright © 2013. Health Administration Press. All rights reserved. Case 3: Physician Care Services, Inc. DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 1 13 925 21 7 2 2 9 1 80 1 14 1000 54 6 1 1 1 2 120 1 15 1012 51 1 1 1 8 2 276 1 16 1025 56 1 2 2 1 2 120 1 17 1105 49 4 1 2 1 2 126 1 18 1108 23 4 1 1 8 2 279 1 19 1203 45 2 1 2 8 2 243 1 20 1209 71 1 1 2 3 1 120 1 21 1215 71 1 1 2 3 2 140 1 22 1230 23 4 1 2 8 2 212 1 23 1245 28 1 1 2 8 2 230 1 24 1250 45 2 2 1 1 2 145 1 25 1255 47 1 2 2 1 1 120 1 26 1320 45 1 2 3 1 2 96 1 27 1345 22 2 1 1 8 2 201 1 28 1355 19 1 2 1 8 2 212 1 29 1420 34 1 2 2 9 2 80 1 30 1430 25 1 1 2 2 2 201 1 31 1435 68 1 1 2 3 2 201 1 32 1435 43 1 1 2 1 2 201 1 33 1512 3 2 1 1 1 2 120 1 34 1517 50 7 1 2 1 2 120 1 35 1537 63 2 1 2 1 2 209 1 36 1539 21 2 2 2 8 2 201 1 37 1545 56 1 1 2 9 1 80 1 38 1550 66 1 2 2 3 2 250 1 39 1555 19 1 1 1 8 2 270 1 40 1600 50 2 1 1 9 2 201 97 Table 3.3 Alpha Center Patient Records, August 4–9, 2014 (continued) (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. 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Table 3.3 Alpha Center Patient Records, August 4–9, 2014 (continued) The Middleboro Casebook DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 1 41 1600 43 2 1 2 9 2 201 1 42 1610 68 1 1 2 3 2 230 1 43 1625 50 2 1 2 9 2 350 1 44 1630 23 1 1 2 1 2 212 1 45 1645 18 1 1 1 1 2 208 1 46 1705 27 2 1 2 8 2 212 1 47 1740 45 2 2 2 1 2 240 1 48 1750 61 2 1 1 8 2 201 1 49 1800 57 4 2 1 1 2 120 1 50 1830 42 1 2 2 1 2 120 1 51 1830 40 1 1 1 1 2 120 1 52 1850 34 2 1 1 2 2 120 2 1 812 45 4 1 2 9 1 400 2 2 824 23 1 2 1 1 2 120 2 3 833 35 8 1 1 9 2 201 2 4 845 23 1 2 2 2 2 120 2 5 905 55 1 2 2 2 2 120 2 6 910 19 1 1 2 1 2 120 2 7 925 21 4 2 2 1 2 120 2 8 1010 33 2 1 1 8 2 201 2 9 1030 33 1 2 2 2 2 130 2 10 1055 33 2 1 1 9 1 275 2 11 1120 68 2 1 2 3 2 96 2 12 1205 61 1 2 2 8 2 201 2 13 1215 35 1 1 1 9 2 130 2 14 1215 4 1 1 1 1 2 120 2 15 1309 29 7 1 1 9 1 120 2 16 1310 25 6 2 1 1 2 120 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 98 11/22/13 8:44 AM Copyright © 2013. Health Administration Press. All rights reserved. Case 3: Physician Care Services, Inc. DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 2 17 1320 23 2 2 1 1 2 120 2 18 1400 55 8 1 1 2 2 130 2 19 1420 21 7 2 1 1 1 143 2 20 1421 21 1 2 1 8 2 240 2 21 1425 23 2 2 1 1 2 156 2 22 1507 50 2 2 2 2 2 138 2 23 1515 67 2 1 1 3 2 120 2 24 1555 4 1 1 3 2 2 145 2 25 1610 30 1 2 1 9 1 400 2 26 1620 24 2 1 1 1 2 120 2 27 1630 28 2 1 1 9 1 80 2 28 1650 37 1 1 2 8 2 201 2 29 1705 25 2 2 2 1 2 120 2 30 1720 22 1 2 1 1 2 120 2 31 1800 56 1 2 1 8 2 201 2 32 1810 77 1 1 2 9 1 300 2 33 1820 54 1 1 1 1 2 120 2 34 1825 32 1 1 2 1 2 120 3 1 801 24 2 1 1 1 2 120 3 2 810 45 1 1 2 8 2 201 3 3 825 2 4 1 1 1 2 120 3 4 835 34 1 1 1 1 2 120 3 5 845 66 1 2 2 3 2 150 3 6 915 44 1 1 1 9 1 80 3 7 920 26 4 1 1 9 1 300 3 8 950 23 1 2 1 1 2 120 3 9 1020 21 6 2 2 1 2 135 3 10 1040 25 1 1 1 1 2 120 99 Table 3.3 Alpha Center Patient Records, August 4–9, 2014 (continued) (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. 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Table 3.3 Alpha Center Patient Records, August 4–9, 2014 (continued) The Middleboro Casebook DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 3 11 1105 28 1 2 1 8 2 201 3 12 1130 69 1 2 2 3 2 120 3 13 1145 52 2 1 1 1 2 120 3 14 1200 50 2 2 2 8 2 156 3 15 1210 24 1 2 2 2 2 130 3 16 1245 21 7 2 3 1 2 135 3 17 1315 22 7 1 2 8 2 201 3 18 1315 21 2 2 2 8 2 250 3 19 1420 69 4 1 3 1 1 150 3 20 1450 23 4 1 2 8 2 201 3 21 1510 17 7 2 2 9 1 250 3 22 1520 14 2 1 1 8 2 201 3 23 1530 25 2 1 1 2 2 120 3 24 1600 31 2 2 3 1 2 96 3 25 1630 45 1 2 2 1 2 120 3 26 17151 55 1 1 2 1 2 120 3 27 1805 61 2 1 1 1 2 120 4 3 810 17 1 2 1 8 2 201 4 4 815 4 2 1 1 2 2 120 4 5 840 25 4 2 1 9 1 95 4 6 850 7 1 1 3 2 2 96 4 7 930 36 8 2 1 9 1 250 4 8 1000 44 2 2 1 9 1 400 4 9 1020 9 2 2 1 1 2 120 4 10 1050 44 1 2 2 8 2 201 4 11 1130 47 1 2 1 2 2 120 4 12 1205 34 4 1 1 8 2 201 4 13 1230 29 6 2 2 8 2 237 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 100 11/22/13 8:44 AM Copyright © 2013. Health Administration Press. All rights reserved. Case 3: Physician Care Services, Inc. DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 4 14 1245 28 1 2 3 2 2 140 4 15 1400 44 1 2 1 2 2 150 4 16 1430 12 1 1 2 1 2 120 4 17 1530 50 2 2 2 8 2 201 4 18 1600 23 1 1 1 1 2 120 4 19 1610 26 1 2 2 9 1 80 4 20 1620 39 2 2 2 9 1 300 4 21 1630 69 2 2 2 3 2 160 4 22 1730 30 1 2 2 1 2 145 4 23 1845 38 1 1 2 1 2 160 5 1 800 13 1 1 2 1 2 120 5 2 815 22 1 2 1 9 1 300 5 3 825 23 2 2 1 1 2 120 5 4 915 19 9 2 1 2 2 120 5 5 940 36 7 1 2 2 2 120 5 6 1000 45 2 1 1 9 1 300 5 7 1000 23 2 1 2 9 1 300 5 8 1045 60 1 1 3 2 2 96 5 9 1130 59 1 2 2 8 2 201 5 10 1215 52 4 1 1 2 2 120 5 11 1230 35 4 2 3 2 2 96 5 12 1240 21 7 2 1 1 2 120 5 13 1250 66 2 2 2 2 2 120 5 14 1310 45 2 2 1 8 2 201 5 15 1320 23 1 1 1 1 2 130 5 16 1350 21 1 2 1 1 2 150 5 17 1440 37 1 1 2 9 1 400 5 18 1510 40 6 2 2 9 1 400 101 Table 3.3 Alpha Center Patient Records, August 4–9, 2014 (continued) (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 101 11/22/13 8:44 AM 102 Copyright © 2013. Health Administration Press. All rights reserved. Table 3.3 Alpha Center Patient Records, August 4–9, 2014 (continued) The Middleboro Casebook DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 5 19 1540 50 9 1 2 2 2 120 5 20 1620 66 8 2 2 3 2 130 5 21 1650 45 2 2 1 2 2 120 5 22 1715 54 2 2 2 8 2 201 5 23 1730 74 1 1 3 3 2 120 5 24 1730 3 1 2 2 2 2 120 5 25 1800 19 2 1 1 8 1 201 5 26 1820 47 2 2 1 8 1 201 5 27 1830 57 2 2 2 1 2 120 6 1 900 35 2 1 3 9 1 80 6 2 900 12 2 1 1 1 2 201 6 3 905 27 1 2 2 8 2 201 6 4 915 44 2 1 1 9 1 400 6 5 930 55 2 2 2 1 2 120 6 6 1000 23 3 1 1 1 2 120 6 7 1015 19 2 2 2 9 1 80 6 8 1015 7 7 2 2 9 2 201 6 9 1025 70 9 1 1 3 2 56 6 10 1040 24 8 1 1 9 1 80 6 11 1050 17 9 2 2 1 2 76 6 12 1100 19 2 2 2 1 2 76 6 13 1105 24 1 1 1 2 2 56 6 14 1115 16 2 2 2 2 2 76 6 15 1130 44 8 1 1 8 2 201 6 16 1145 48 2 2 1 8 2 201 6 17 1200 8 1 1 2 1 2 120 6 18 1215 76 1 1 2 3 2 130 6 19 1220 35 2 2 2 8 2 201 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 102 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. DAY NUM ART AGE TOWN SEX FIRST INS PHY 6 20 1230 50 1 1 1 9 1 80 6 21 1240 9 1 2 2 1 2 135 6 22 1240 23 2 1 3 1 2 120 6 23 1300 37 4 1 3 1 2 120 6 24 1315 61 5 2 2 1 2 120 6 25 1320 50 1 2 1 1 2 120 6 26 1340 72 2 1 2 3 2 120 Totals 189 CHGE 103 Table 3.3 Alpha Center Patient Records, August 4–9, 2014 (continued) $30,300 DAY = 1=Monday, 2= Tuesday, 3= Wednesday, 4= Thursday, 5= Friday, 6= Saturday NUM = Arrival order (1 = first person to arrive) ART = Arrival time TOWN: 1 2 3 4 5 AGE = Age in years Middleboro Mifflenville Jasper Harris City Statesville 6 7 8 9 Carterville Boalsburg Minortown Other Copyright © 2013. Health Administration Press. All rights reserved. SEX 1 = male, 2 = female FIRST = Is this your first ever visit to a PCS center? 1 Yes 2 No, and it is not a medically ordered return visit 3 No, it is a medically ordered return visit INS = Insurance coverage/payment 1 Commercial insurance 2 Cash, check, or credit card 3 Medicare 8 Workers’ compensation 9 Employer pays PHY = Physical? 1 Yes 2 No CHGE = Gross billed charges ($) (This table can also be found online at ache.org/books/Middleboro.) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 103 11/22/13 8:44 AM 104 Copyright © 2013. Health Administration Press. All rights reserved. Table 3.4 Beta Center Patient Records, August 4–9, 2014 The Middleboro Casebook DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 1 1 800 44 3 2 2 8 2 385 1 2 810 32 3 1 1 1 2 135 1 3 810 45 3 2 1 8 2 370 1 4 845 66 3 1 1 3 2 96 1 5 845 21 5 1 1 8 2 380 1 6 900 7 9 2 3 1 2 150 1 7 915 34 3 2 1 8 2 350 1 8 930 51 3 2 1 8 2 360 1 9 945 59 3 2 1 1 2 180 1 10 1000 40 3 1 1 8 2 360 1 11 1005 23 5 1 2 9 1 300 1 12 1025 32 3 2 1 8 2 310 1 13 1035 40 5 2 2 1 2 160 1 14 1110 75 5 2 2 1 2 150 1 15 1150 22 3 1 1 9 1 300 1 16 1200 19 3 1 1 8 2 420 1 17 1015 56 3 2 2 9 1 150 1 18 1220 23 3 1 1 1 2 160 1 19 1310 34 3 1 1 8 2 310 1 20 1330 25 9 1 1 1 2 150 1 21 1410 49 3 2 2 9 1 150 1 22 1410 69 3 2 1 1 2 170 1 23 1430 70 9 2 2 3 2 135 1 24 1440 44 3 1 3 8 2 96 1 25 1450 25 3 1 1 8 2 325 1 26 1500 32 3 2 1 1 2 160 1 27 1605 37 9 2 2 8 2 375 1 28 1725 40 3 1 1 8 2 300 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. 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DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 2 1 815 23 3 1 1 1 2 190 2 2 830 19 3 2 1 8 2 280 2 3 900 25 4 1 1 8 2 345 2 4 930 45 3 2 2 1 2 150 2 5 950 56 3 1 1 1 2 140 2 6 1015 8 9 1 1 1 2 120 2 7 1050 56 3 1 2 2 1 80 2 8 1120 23 9 1 1 1 1 80 2 9 1145 50 3 1 2 8 2 340 2 10 1215 56 3 2 1 8 2 350 2 11 1230 44 5 2 2 9 1 250 2 12 1250 47 3 1 1 8 2 285 2 13 11305 56 3 2 2 9 1 250 2 14 1310 23 9 2 1 1 2 130 2 15 1345 58 5 2 2 9 1 75 2 16 1400 44 5 1 1 1 2 150 2 17 1430 12 3 1 1 1 2 150 2 18 1500 40 3 2 1 8 2 315 2 19 1520 39 5 1 2 1 2 150 2 20 1520 47 9 1 2 8 1 250 2 21 1545 50 5 1 1 8 2 250 2 22 1610 46 5 2 1 9 1 250 2 23 1630 45 3 2 1 8 2 325 2 24 1645 23 3 1 2 1 2 140 2 25 1705 48 3 1 2 1 2 150 2 26 1730 32 3 1 2 1 2 140 3 1 800 23 3 1 1 1 2 160 3 2 845 19 3 1 1 1 2 160 105 Table 3.4 Beta Center Patient Records, August 4–9, 2014 (continued) (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. 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Table 3.4 Beta Center Patient Records, August 4–9, 2014 (continued) The Middleboro Casebook DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 3 3 920 44 3 2 2 8 2 275 3 4 1030 32 3 1 2 2 1 150 3 5 1110 50 5 1 2 8 2 350 3 6 1150 43 3 2 2 9 1 300 3 7 1200 50 3 2 2 1 2 150 3 8 1240 48 3 1 2 1 1 80 3 9 1250 50 5 1 1 8 2 350 3 10 1330 9 3 2 3 2 2 96 3 11 1600 45 3 2 1 1 2 160 3 12 1640 34 3 1 2 9 1 300 3 13 1700 56 3 1 1 9 1 300 3 14 1715 75 3 1 2 3 2 125 4 1 800 44 3 2 2 9 1 350 4 2 845 46 3 1 2 8 2 375 4 3 915 48 3 1 1 1 2 240 4 4 940 40 3 1 1 1 2 260 4 5 1035 23 9 1 1 8 2 350 4 6 1050 30 9 1 1 8 2 410 4 7 1130 50 3 1 1 1 2 160 4 8 1210 27 5 1 1 3 2 160 4 9 1230 22 9 1 1 3 2 120 4 10 1245 18 3 1 1 9 1 350 4 11 1320 23 3 2 2 1 2 140 4 12 1430 69 9 2 1 3 2 225 4 13 1510 45 9 1 2 9 1 250 4 14 1530 23 3 2 2 1 2 160 4 15 1610 12 3 2 3 1 2 150 4 16 1720 35 5 2 2 9 1 300 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. 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DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 5 1 800 23 5 1 2 9 1 280 5 2 815 29 3 2 1 1 2 160 5 3 900 40 3 2 1 9 1 300 5 4 915 48 9 1 1 9 1 300 5 5 945 66 3 1 1 8 2 360 5 6 1015 45 2 1 1 1 1 150 5 7 1030 33 3 2 3 1 2 96 5 8 1140 21 5 1 1 9 1 300 5 9 1205 19 5 2 3 1 2 200 5 10 1210 45 3 2 2 8 2 340 5 11 1240 60 3 1 2 2 2 101 5 12 1250 55 3 2 1 8 2 320 5 13 1300 14 9 2 1 1 2 140 5 14 1320 23 3 2 1 9 1 300 5 15 1340 60 3 1 2 1 2 160 5 16 1400 69 3 1 2 3 2 120 5 17 1430 45 3 2 2 8 2 340 5 18 1500 4 5 1 3 1 2 96 5 19 1520 66 3 2 1 3 2 170 5 20 1540 19 5 2 2 9 1 240 5 21 1600 27 3 1 1 9 1 240 5 22 1700 44 3 2 2 1 2 160 5 23 1710 50 9 1 1 1 2 180 5 24 1710 20 5 1 1 8 2 310 5 25 1710 38 3 1 1 9 1 260 5 26 1740 34 9 2 2 1 2 140 6 1 910 5 3 1 1 1 2 160 6 2 930 23 3 2 2 1 2 170 107 Table 3.4 Beta Center Patient Records, August 4–9, 2014 (continued) (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. 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For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 107 11/22/13 8:44 AM 108 Table 3.4 Beta Center Patient Records, August 4–9, 2014 (continued) The Middleboro Casebook DAY NUM ART AGE TOWN SEX FIRST INS PHY CHGE 6 3 1040 43 3 1 2 9 1 300 6 4 1050 44 3 2 1 9 1 150 6 5 1110 11 3 1 2 1 2 120 6 6 1120 48 9 2 2 1 2 150 6 7 1140 12 3 1 3 8 2 96 6 8 1215 12 3 1 2 9 1 200 6 9 1220 56 3 1 2 9 1 200 6 10 1300 60 5 1 2 9 1 200 6 11 1310 34 3 2 1 8 2 350 6 12 1330 63 3 1 2 3 2 140 Totals 122 $27,177 DAY = 1=Monday, 2= Tuesday, 3= Wednesday, 4= Thursday, 5= Friday, 6= Saturday NUM = Arrival order (1 = first person to arrive) ART = Arrival time TOWN: 1 2 3 4 5 AGE = Age in years Middleboro Mifflenville Jasper Harris City Statesville 6 7 8 9 Carterville Boalsburg Minortown Other Copyright © 2013. Health Administration Press. All rights reserved. SEX 1 = male, 2 = female FIRST = Is this your first ever visit to a PCS center? 1 Yes 2 No, and it is not a medically ordered return visit 3 No, it is a medically ordered return visit INS = Insurance coverage/payment 1 Commercial insurance 2 Cash, check, or credit card 3 Medicare 8 Workers’ compensation 9 Employer pays PHY = Physical? 1 Yes 2 No CHGE = Gross billed charges ($) (This table can also be found online at ache.org/books/Middleboro.) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 108 11/22/13 8:44 AM Copyright © 2013. Health Administration Press. All rights reserved. Case 3: Physician Care Services, Inc. RECORD DATE MD/ARNP DAY CTR REVENUE ($) VISITS 1 Sept 1 Holiday 1 1 2 Sept 2 1 2 1 3,156 17 3 Sept 3 3 3 1 3,788 21 4 Sept 4 3 4 1 3,956 23 5 Sept 5 1 5 1 3,059 24 6 Sept 6 11 6 1 3,076 19 22 7 Sept 8 1 1 1 3,044 8 Sept 9 1 2 1 3,657 34 9 Sept 10 3 3 1 4,366 20 10 Sept 11 3 4 1 4,381 25 11 Sept 12 4 5 1 3,547 38 12 Sept 13 11 6 1 3,148 16 13 Sept 15 1 1 1 3,008 23 14 Sept 16 1 2 1 3,005 18 15 Sept 17 3 3 1 3,976 21 16 Sept 18 3 4 1 3,740 19 17 Sept 19 4 5 1 3,547 30 18 Sept 20 11 6 1 3,005 20 19 Sept 22 1 1 1 3,259 32 20 Sept 23 1 2 1 3,051 22 21 Sept 24 3 3 1 3,906 18 22 Sept 25 3 4 1 3,856 22 23 Sept 26 4 5 1 3,944 24 24 Sept 27 11 6 1 3,452 20 25 Sept 29 1 1 1 3,056 20 26 Sept 30 1 2 1 3,067 23 27 Oct 1 3 3 1 3,010 23 28 Oct 2 3 4 1 2,840 18 29 Oct 3 5 5 1 3,049 20 30 Oct 4 11 6 1 1,599 10 42 31 Oct 6 1 1 1 6,559 32 Oct 7 1 2 1 3,769 21 33 Oct 8 3 3 1 3,276 20 20 34 Oct 9 3 4 1 3,806 35 Oct 10 4 5 1 3,051 18 36 Oct 11 11 6 1 3,028 20 37 Oct 13 1 1 1 5,278 33 38 Oct 14 1 2 1 4,650 28 39 Oct 15 3 3 1 3,920 20 109 Table 3.5 Revenue Generation by Physician, Center, Day of Week, September 1– November 29, 2014 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 109 11/22/13 8:44 AM 110 Copyright © 2013. Health Administration Press. All rights reserved. Table 3.5 Revenue Generation by Physician, Center, Day of Week, September 1– November 29, 2014 (continued) The Middleboro Casebook RECORD DATE MD/ARNP DAY CTR REVENUE ($) VISITS 40 Oct 16 3 4 1 2,534 14 41 Oct 17 5 5 1 4,020 28 42 Oct 18 11 6 1 3,699 24 43 Oct 20 1 1 1 4,460 36 44 Oct 21 1 2 1 4,739 28 45 Oct 22 3 3 1 4,230 22 46 Oct 23 3 4 1 3,288 19 47 Oct 24 4 5 1 3,805 25 48 Oct 25 11 6 1 3,397 22 49 Oct 27 1 1 1 5,520 39 50 Oct 28 1 2 1 4,367 28 20 51 Oct 29 3 3 1 3,650 52 Oct 30 3 4 1 3,090 18 53 Oct 31 4 5 1 3,001 20 54 Nov 1 11 6 1 1,145 10 55 Nov 3 1 1 1 5,350 35 56 Nov 4 1 2 1 2,768 15 57 Nov 5 3 3 1 3,587 21 58 Nov 6 3 4 1 4,879 26 59 Nov 7 5 5 1 2,757 19 60 Nov 8 11 6 1 1,036 10 61 Nov 10 1 1 1 5,567 31 62 Nov 11 1 2 1 2,586 17 63 Nov 12 3 3 1 5,980 32 64 Nov 13 3 4 1 4,771 24 65 Nov 14 4 5 1 2,061 14 66 Nov 15 13 6 1 2,212 22 67 Nov 17 1 1 1 5,789 35 68 Nov 18 1 2 1 3,879 23 69 Nov 19 3 3 1 5,879 31 70 Nov 20 3 4 1 4,244 24 71 Nov 21 5 5 1 2,959 17 72 Nov 22 11 6 1 2,055 15 73 Nov 24 1 1 1 4,789 30 74 Nov 25 1 2 1 4,444 25 75 Nov 26 3 3 1 5,546 32 76 Nov 27 Holiday 4 1 77 Nov 28 9 5 1 4,007 30 78 Nov 29 11 6 1 2,335 16 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 110 11/22/13 8:44 AM Copyright © 2013. Health Administration Press. All rights reserved. Case 3: Physician Care Services, Inc. RECORD DATE MD/ARNP DAY CTR REVENUE ($) VISITS 79 Sept 1 Holiday 1 2 80 Sept 2 2 2 2 5,157 25 81 Sept 3 6 3 2 4,286 14 82 Sept 4 6 4 2 4,367 16 83 Sept 5 7 5 2 4,156 17 84 Sept 6 13 6 2 1,956 10 85 Sept 8 2 1 2 6,648 30 86 Sept 9 2 2 2 5,978 29 87 Sept 10 6 3 2 4,934 20 88 Sept 11 6 4 2 2,166 12 89 Sept 12 7 5 2 4,305 16 90 Sept 13 13 6 2 1,510 9 91 Sept 15 2 1 2 6,250 28 92 Sept 16 2 2 2 4,850 20 93 Sept 17 6 3 2 3,956 18 94 Sept 18 7 4 2 4,707 20 95 Sept 19 8 5 2 3,958 18 96 Sept 20 13 6 2 1,941 10 97 Sept 22 2 1 2 5,790 28 98 Sept 23 2 2 2 4,415 20 99 Sept 24 6 3 2 3,083 14 100 Sept 25 8 4 2 3,546 16 16 101 Sept 26 8 5 2 4,026 102 Sept 27 12 6 2 1,850 12 103 Sept 29 2 1 2 4,890 24 104 Sept 30 2 2 2 3,827 18 105 Oct 1 5 3 2 4,080 18 106 Oct 2 5 4 2 3,080 15 107 Oct 3 8 5 2 2,044 9 108 Oct 4 13 6 2 830 4 109 Oct 6 2 1 2 4,560 20 110 Oct 7 2 2 2 4,050 20 111 Oct 8 5 3 2 4,069 20 112 Oct 9 5 4 2 3,827 18 113 Oct 10 6 5 2 1,566 11 114 Oct 11 13 6 2 1,209 6 115 Oct 13 2 1 2 4,038 19 116 Oct 14 2 2 2 4,740 20 117 Oct 15 5 3 2 3,567 17 111 Table 3.5 Revenue Generation by Physician, Center, Day of Week, September 1– November 29, 2014 (continued) (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 111 11/22/13 8:44 AM 112 Copyright © 2013. Health Administration Press. All rights reserved. Table 3.5 Revenue Generation by Physician, Center, Day of Week, September 1– November 29, 2014 (continued) The Middleboro Casebook RECORD DATE MD/ARNP DAY CTR REVENUE ($) VISITS 118 Oct 16 5 4 2 5,035 18 119 Oct 17 6 5 2 3,077 15 120 Oct 18 13 6 2 1,518 8 22 121 Oct 20 2 1 2 5,734 122 Oct 21 2 2 2 3,657 19 123 Oct 22 5 3 2 3,256 20 124 Oct 23 5 4 2 3,070 13 125 Oct 24 6 5 2 3,058 12 126 Oct 25 12 6 2 1,656 8 127 Oct 27 2 1 2 5,020 22 128 Oct 28 2 2 2 4,640 20 129 Oct 29 5 3 2 2,748 15 130 Oct 30 5 4 2 2,978 14 131 Oct 31 6 5 2 2,007 9 132 Nov 1 13 6 2 1,205 6 133 Nov 3 2 1 2 3,557 17 134 Nov 4 2 2 2 4,047 15 135 Nov 5 6 3 2 3,344 18 136 Nov 6 6 4 2 4,289 20 137 Nov 7 8 5 2 3,756 14 138 Nov 8 13 6 2 1,034 4 139 Nov 10 2 1 2 4,420 30 140 Nov 11 2 2 2 4,510 16 141 Nov 12 6 3 2 3,089 16 142 Nov 13 6 4 2 3,837 15 143 Nov 14 8 5 2 4,730 17 144 Nov 15 13 6 2 1,856 10 145 Nov 17 2 1 2 4,298 21 146 Nov 18 2 2 2 3,587 12 147 Nov 19 6 3 2 2,689 13 148 Nov 20 6 4 2 4,856 22 149 Nov 21 7 5 2 3,962 14 150 Nov 22 13 6 2 1,091 10 151 Nov 24 2 1 2 5,029 24 152 Nov 25 2 2 2 2,538 12 153 Nov 26 6 3 2 2,177 12 154 Nov 27 Holiday 4 2 155 Nov 28 9 5 2 2,002 8 156 Nov 29 13 6 2 1,053 5 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 112 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. CODES For Table 3.5 MD/ARNP Day Center 1 B. Casey Monday Alpha 2 M. Welby Tuesday Beta 3 S. Tobias Wednesday 4 J. Smooth Thursday 5 R. Hottle Friday 6 L. Cytesmath Saturday 113 Table 3.5 Revenue Generation by Physician, Center, Day of Week, September 1– November 29, 2014 (continued) 7 J. Withers 8 L. Jones 9 M. Foxx 10 M. Majors 11 C. Withers, ARNP 12 J. Jones, ARNP 13 G Mattox, ARNP Revenue = Total gross billed charges Visits = Number of paying patients Copyright © 2013. Health Administration Press. All rights reserved. (This table can also be found online at ache.org/books/Middleboro.) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 113 11/22/13 8:44 AM 114 Table 3.6 Statement of Operations ($) The Middleboro Casebook 2014 2013 2012 2011 2010 Revenue Patient services, gross 2,246,188 1,993,211 1,918,406 1,696,999 1,690,252 Contractual alllowances 179,695 159,457 153,472 135,760 135,220 Patient revenue, net 2,066,493 1,833,754 1,764,934 1,561,239 1,555,032 Other revenue 18,520 22,463 22,252 23,595 23,684 Total revenue 2,085,013 1,856,217 1,787,186 1,584,834 1,578,716 Salaries and wages 1,131,608 1,001,556 982,450 839,229 838,226 Staff benefits 392,301 310,482 294,735 243,376 234,703 Administrative expenses 18,330 17,339 10,494 10,056 9,562 Advertising 3,000 3,400 3,856 3,003 2,340 Collection fees 1,267 845 342 659 589 Computer support 21,556 31,443 34,256 35,378 25,398 Consultants 1,529 1,270 948 805 355 Copyright © 2013. Health Administration Press. All rights reserved. Expenses Equipment leases 4,100 4,100 4,100 1,800 1,800 Insurance 28,100 24,100 24,100 18,560 24,100 Laboratory 44,870 45,292 42,550 44,691 39,254 Laundry and housekeeping 12,830 12,256 8,156 3,440 2,440 Legal/audit 8,450 8,450 8,450 7,850 7,850 Medical supplies 61,450 58,220 57,354 58,556 28,340 Office supplies 18,437 29,348 28,420 28,556 28,360 Printing and postage 10,122 9,450 9,014 3,588 2,013 Professional fees 23,955 23,425 23,302 23,884 24,885 Rent 78,500 78,750 58,900 58,900 58,900 Repairs and maintenance 3,167 2,966 1,529 2,349 3,620 Telephone 10,315 7,495 6,519 2,550 2,044 Utilities 18,925 16,800 13,560 13,720 13,900 Depreciation 72,556 70,449 70,383 68,363 79,262 Bad debt expenses 8,437 5,629 4,303 3,494 3,102 Total expenses 1,973,805 1,763,065 1,687,721 1,472,807 1,431,043 Income (loss) before taxes 111,208 93,152 99,465 112,027 147,673 Federal and state taxes 44,483 37,261 39,786 44,811 59,069 Income (loss) after taxes 66,725 55,891 59,679 67,216 88,604 (This table can also be found online at ache.org/books/Middleboro.) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 114 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. 2014 2013 2012 2011 2010 Cash, operating 153,449 163,035 86,999 76,223 84,550 Accounts receivable 139,385 134,450 131,560 130,455 168,455 Inventory 3,339 4,125 5,233 28,734 30,335 Prepaid expenses 3,078 4,565 4,021 5,688 8,944 Total current assets 299,251 306,175 227,813 241,100 292,284 Investments 368,825 341,010 405,903 353,628 314,040 Equipment and leasehold improvements, gross 1,197,602 1,125,046 1,054,597 984,214 915,851 Less accumulated depreciation 645,239 572,683 502,234 431,851 363,488 Equipment and leasehold improvements, net 552,363 552,363 552,363 552,363 552,363 1,220,439 1,199,548 1,186,079 1,147,091 1,158,687 Assets Current 115 Table 3.7 Balance Sheet for Fiscal Year Ending December 31 ($) Property and equipment Total assets Copyright © 2013. Health Administration Press. All rights reserved. Liabilities and net assets Current liabilities Accounts payable 49,668 13,534 13,796 10,455 77,454 Accrued expenses 29,000 27,387 30,100 45,662 23,145 Accrued payroll taxes 2,134 945 823 1,126 569 Total current liabilities 80,802 41,866 44,719 57,243 101,168 0 84,770 124,339 132,506 167,393 80,802 126,636 169,058 189,749 268,561 Long-term liabilities Notes payable Total liabilities (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 115 11/22/13 8:44 AM 116 Table 3.7 Balance Sheet for Fiscal Year Ending December 31 (continued) The Middleboro Casebook 2014 2013 2012 2011 2010 Authorized and issued 720,000 720,000 720,000 720,000 720,000 Cumulative operating gain/ (deficit) after taxes 371,637 352,912 297,021 237,342 170,126 Dividends payable 48,000 Net assets Common stock note1 Net assets 1,139,637 1,072,912 1,017,021 957,342 890,126 Net assets and liabilities 1,220,439 1,199,548 1,186,079 1,147,091 1,158,687 NOTE: 1. Common stock: $12 par, 60,000 authorized and issued. (This table can also be found online at ache.org/books/Middleboro.) Copyright © 2013. Health Administration Press. All rights reserved. Table 3.8 Compensation for the 12 Months Ending December 31, 2014 ($) Salary Benefits Total President 40,000 14,400 54,400 Medical director 20,000 7,200 27,200 subtotal 60,000 21,600 81,600 Casey 114,400 41,184 155,584 Welby 116,600 41,976 158,576 Tobias 125,400 45,144 170,544 Smooth 77,000 27,720 104,720 Hottle 52,800 19,008 71,808 Clinical staff (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 116 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. Salary Benefits Total Cytesmath 52,800 19,008 71,808 Withers 11,000 2,420 13,420 Jones 7,700 1,694 9,394 Foxx 5,500 1,210 6,710 Withers, ARNP 10,000 2,200 12,200 Jones, ARNP 4,000 880 4,880 Mattox, ARNP 12,000 2,640 14,640 Others 3,100 682 3,782 subtotal 592,300 205,766 798,066 Medical assistants 92,280 33,221 125,501 Receptionists 86,128 31,006 117,134 Others 2,400 528 2,928 subtotal 180,808 64,755 245,563 Director of nursing and quality 64,000 23,040 87,040 Business manager 62,500 22,500 85,000 Business office staff (4 FTE) 120,000 43,200 163,200 Others 52,000 11,440 63,440 subtotal 298,500 100,180 398,680 1,131,608 392,301 1,523,909 117 Table 3.8 Compensation for the 12 Months Ending December 31, 2014 (continued) Professional services Copyright © 2013. Health Administration Press. All rights reserved. Administrative services Total Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 117 11/22/13 8:44 AM 118 Table 3.9 Proposed Operational Budget for 2015 ($) The Middleboro Casebook Patient Revenue 2,424,000 Deductions 198,768 Net revenue 2,225,232 Salaries and wages 1,181,200 Expenses Staff benefits Administrative expenses 21,500 Advertising 3,000 Collection fees 1,800 Consultants 3,750 Computer support 34,000 Equipment leases 4,100 Insurance 28,100 Laboratory 49,000 Laundry and housekeeping 13,500 Legal/audit Copyright © 2013. Health Administration Press. All rights reserved. 425,230 8,450 Medical supplies 64,750 Printing and postage 11,000 Professional fees 28,000 Rent 78,500 Repairs 3,500 Telephone 11,000 Utilities 19,200 Depreciation 73,000 Bad debt expenses 10,400 Total expenses 2,072,980 (continued) Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 118 11/22/13 8:44 AM Case 3: Physician Care Services, Inc. Income (loss) before taxes Table 3.9 Proposed Operational Budget for 2015 ($) (continued) 152,252 Taxes Income (loss) after taxes 119 60,901 91,351 NOTE: Budget parameters Alpha Visits, budgeted Average revenue per visit ($) with no increased basic visit fee Beta Total 7,500 5,100 160 240 12,600 Copyright © 2013. Health Administration Press. All rights reserved. (This table can also be found online at ache.org/books/Middleboro.) 2014 2013 2012 2011 2010 Middleboro Community Hospital ED 210 200 190 180 180 Webster Hospital ED (Quick Med)1 140 140 140 125 125 Convenient Med Care, Capital City1 125 125 125 115 115 Capital City General ED 180 180 170 150 150 Medical Associates1 125 125 125 115 115 PCS1 120 110 104 99 94 Table 3.10 Market Analysis of Basic Visit Charges as of July 1 ($) 1 = Comparisons based on CPT 99202 Seidel, Lee F., and James B. Lewis. Middleboro Casebook : Healthcare and Operations, Health Administration Press, 2013. ProQuest Ebook Central, Copying andStrategy distribution of this PDF is prohibited without written permission. http://ebookcentral.proquest.com/lib/waldenu/detail.action?docID=3433061. For permission, please contact Copyright Clearance Center at www.copyright.com Created from waldenu on 2019-06-27 05:19:09. 00_SeidelLewis (2258).indb 119 11/22/13 8:44 AM 
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