PERRLA Version 6 For APA



lefttopBusiness PlanThe New YouTopeka’s Nutrition and Weight Loss Centre2715 SW 29th St. Ste ATopeka, KS 66614Business Plan Prepared ByAmber HartBrandy HopkinsSusan Swords1700 SW College AveTopeka, KS 66621785-670-1010 brandy.hopkins@washburn.eduDate PreparedMay 3, 2012 Copy 1The New You Business PlanDESCRIPTION OF THE BUSINESSThe New You-Topeka’s Nutrition and Weight Loss Centre (TNY) is a bariatric clinic located in the Brookwood Office Park within the community of Topeka, Kansas. The clinic will offer bariatric services including weight loss management and nutritional counseling to those whose body mass index (BMI) is greater than 30, which classifies them as obese according to the Center for Disease Control (CDC). Patients will be from the Topeka and surrounding areas as the clinic site is centrally located and easily accessible. Advanced Practice Registered Nurses (APRNs) will provide bariatric services to patients ranging from ages twelve to adults of all ages. The APRNs will have proficient and advanced training in the area of bariatrics with one APRN with advanced training in pediatrics. A supervising physician will have a specialty in bariatric management. There will also be a certified nurses aid working in the office to assist the APRNs. At the initial start up visit, patients will have basic labs drawn, an electrocardiogram, and a comprehensive examination with BMI calculation. Patients on the weight loss program will be required to keep a daily record of their food intake, including keeping track of caloric and fat grams, as well as begin and maintain an exercise regimen. To help facilitate weight loss, anorexiant medications may be prescribed to those patients where the medications would be contraindicated. Patients will be evaluated on a monthly basis to monitor their weight loss progression. Upon each third monthly visit or quarterly visit, patient’s body composition will be re-measured and pictures taken to monitor weight loss. VISION, MISSION, VALUE STATEMENTVisionTo provide affordable, bariatric nutrition and weight loss services to citizens in Topeka and surrounding communities.MissionThe mission of TNY is to inspire hope and contribute to health and well-being by diminishing the devastation of obesity, decreasing its co-morbidities and improving lives. With an interdisciplinary patient-focused approach to the treatment of obesity, we will improve health, reduce life-threatening co-morbidities, increase self-esteem and improve quality of life. Value StatementService: We provide high quality, patient-centered, cost-effective, bariatric services in a safe and nurturing environment.Respect: We serve a diverse patient population, our community, families, and colleagues with dignity and culturally appropriate, competent passion: Provide the best care, treating patients, family members, and individuals in the community with sensitivity and empathy.Sustainability: We assure our mission by remaining a profitable business.Collaboration: We will form partnerships within the Topeka community to continually assess and improve health.MARKET ANALYSISTarget Market and DemographicsThose most likely to seek services desire to be more satisfied with their health and are seeking medical weight loss services. Services at this bariatric clinic will benefit those clients with a Body Mass Index (BMI) of 30 or greater wanting weight loss and nutritional counseling. Body Mass Index is calculated using an individual’s height and weight. A BMI greater than or equal to 30 is considered obese. Overweight and obese individuals are at an increased risk for developing many diseases and health conditions including, high blood pressure, Type 2 diabetes, heart disease, stroke, and some cancers (Centers for Disease Control and Prevention, n.d.).Individuals seeking services will primarily reside in Topeka/Shawnee county and surrounding rural areas including Jackson County, Osage County and Wabaunsee County. These counties have limited health care services available requiring individuals who live in them to seek specialty health care services in Topeka and Shawnee County. The population of Shawnee County is almost 178,000 and Jackson, Osage, and Wabaunsee counties provide approximately an additional 50,000 individuals (U.S. Census, 2010). Shawnee County consists of a primarily Caucasian population (81.2%) with a slightly higher percent being female (51.7%). Households vary in education levels but most consist of married couples with school age children and a median income of $47,464. According to County Health Rankings (2012), Jackson, Osage, Shawnee, and Wabaunsee County all have more than 30% of their populations with BMIs greater than 30, or approximately a total of 77,000 obese individuals in all counties combined. This facility will accept third party insurances, private pay, and will also provide services to Medicare, Medicaid and Children’s Health Insurance Program (SCHIP) recipients. Competitive AnalysisThere are two direct competitors located in Topeka who provide medical weight loss services. The first is Tague Nutrition located at 29th and Urish Rd. This business services approximately 100 clients per week with only one provider. The average wait time to get in for an initial appointment with Dr. Tague is two weeks and then he requires weekly appointments with a dietician and a monthly follow-up with him. An initial appointment with this provider will cost a patient $275 then each weekly appointment is an additional $30. Forms of payments accepted by Tague Nutrition are private pay or third party insurances (Tague Nutrition, 2012). The second competitor is Dr. Stacy Weeks whose practice is located at 8th and Mulvane. She offers an initial comprehensive examination, biweekly or monthly follow-up appointments and quarterly workups recalculating BMI and body composition. Her prices are respectively $265, $40, $80, and $115 for each of these appointments. There is approximately a three to four month waiting period to enter into the program for an initial appointment with Dr. Weeks. The current practice has only one physician, a part-time nurse practitioner (NP), and a total caseload of 366 patients. This clinic also only accepts private pay and third party insurances, additionally it is required that the initial appointment fee be paid 100% upfront at the time of the appointment and then a refund will be issued if the patient’s insurance provides coverage for the services being rendered (Stacy Weeks, 2012). Competitive EdgeShawnee County has 17.3% of its population and approximately 12% of Jackson, Osage, and Wabaunsee counties receive Medicaid or SCHIP services (Peter & Williams, 2011). Our direct competitors do not accept Medicaid patients giving our clinic and advantage to serve this population. Medicaid allows for two 30 minute initial evaluations and eleven follow-up sessions per year and does not cover bariatric surgeries (Stop Obesity Alliance, 2010). This will make TNY the only clinic available to Medicaid recipients allowing them to take advantage of these services provided under their coverage. According to (2012) Medicare part B will cover three, one hour sessions per year. Our clinic will modify the program to fit the billable coverage for Medicare patients and then if the patient desires to be seen more frequently they may pay out of pocket or use Medicare gap insurance to cover the additional services. Finally the two above mentioned competitors do not offer services to individuals under the age of 18. We will work with SCHIP, third party insurances, and private pay customers for children starting at 12 years of age. Nurse Practitioners (NPs) can produce high-quality care and achieve health outcomes as good as physicians (American College of Physicians, 2009). Patient satisfaction increases with holistic care, interviewing and therapeutic listening skills, and their open communication, making a NP practice more attractive than the physician run clinic/business (King & Hansen-Thurton, 2010). Sales Forecast (SWOT analysis)The SWOT analysis (Appendix A) lists strengths, weaknesses, opportunities, and threats providing a framework for identifying growth (Nagelkerk, 2006).mitment to provide quality careStrong collaborative relationship among providersProvide cost effective quality carePositive health outcomesHolistic, personalized careNo wait: patients can obtain initial services immediatelyKnowledge and access to state of the art technologiesNew APRNs: Positive outlook with excitement about job, not burnt out.Weaknesses.New programLimited budgedLack of capital/reserveNew APRNs without experience (as business owners)Hiring staffGeographical locationLocating a collaborating physician to oversee NP ran businessOpportunities.Large market: Approximately 77,000 obese individuals in counties of coverageNiche marketCompetitors have limited space for new customersGrowing marketIncreased awareness of insurances offering weight loss coverageThreats.Bariatrics not considered a specialty: lower reimbursement ratesInsurance companies limiting coverage or not providing any coveragePatients may not want to have to pay for services out of pocket.Two established competitors that are physician ranPatients may find they do not want to work for results: risk of losing patientsInitial low patient censusGovernment restricting NP practices and reimbursement ratesUnable to initially pay for high dollar marketing planMARKETING PLANPromotion StrategyThe goal of the marketing campaign is to let members of the community know about the opening of the clinic and the services which will be offered. This will be accomplished by printing brochures and business cards and distributing them strategically with physician offices, in the YMCAs, and YWCA, and also in businesses whose insurance plans will cover the services being offered. Advertisements will be ran in the Sunday paper, because it is the most widely distributed paper and it will effectively reach the older Medicare population. Social media outlets will be utilized such as facebook and twitter to reach a younger demographic. Approximately one month after opening a grand opening/open house event will be held inviting community members to check out the office and have BMI calculations performed, allowing communication and distribution of materials to interested community members that meet patient eligibility criteria. The clinic will be registered in the NP Clinics online directory. The practice will be listed in the local phone directory and yellow pages. Further marketing needs and strategies will be evaluated throughout the year to help TNY reach its financial goals. Pricing StrategyPrices for services will align with direct competitors. Initial visits will comprise of review of program, review of health history, baseline laboratory tests drawn, BMI and body composition measurements, nutritional and exercise program initiation, and discussion of weight loss medications. The price of the initial visit is $250. Monthly visits will be billed as $75 for follow-up and discussion of progression in the program. Quarterly patients will have body composition recalculated and fees for quarterly appointments are $125. We will require anyone paying out of pocket for services to pay $25 at the time of each visit to decrease bad debt. Distribution and SalesSales will be distributed over a diverse payer mix with 10% Medicare, 10% Medicaid, 30% cash/private pay, and 50% third party insurance. Children ages 12 to 18 will not be distributed any differently however those with SCHIP services will fall into the Medicaid distribution.Strategic AlliancesThe New You will be active in the community creating ties with doctor’s offices to make services known so that physician referrals can be made appropriately. A relationship will also be established with the YMCAs and YWCAs offering monthly blood pressure, weight checks, and BMI calculations for both members and non-members. Health fairs will also be attended to allow for communication with community members, answering questions about general health wellness and weight loss. Also up to date brochures and business cards will allow community members to get in touch with TNY when ready to obtain personal services or invite TNY to community events. Quality Improvement StrategyThe collaborative physician hired by TNY will come onsite at least twice a month to help assure best practices are in place to be able to provide patients with the highest quality of care to maximize positive outcomes. Patient satisfaction surveys will be developed and distributed to all new patients after first quarter of treatment and to established patients yearly to evaluate program and modify it where deficiencies are located through the evaluation process. By having an improvement plan in place it will maximize patient satisfaction improving the overall bottom line and create increase in patient census. FINANCIAL PLANStart-up Expenses.“A New You” business will be jointly owned by three nurse practitioners and we will employ ourselves part-time as well as one full-time certified nurse’s aide. The three owners will each bring $20,000 to the business to fund start-up expenses. With a total of $60,000 in start-up funds, it will be enough to cover all estimated start up expenses, which are approximately $39,855. This sum covers purchasing office equipment and covers payroll in the beginning. A loan will not be necessary, as we will have approximately $20,145 left after our start-up expenses.We will lease a 1,080 square foot space from Brookwood Office Park. Rent will be $900 per month, so we will need to pay a security deposit of $900. The largest amount of the start-up costs in the budget will be approximately $15,500 for office furniture and equipment including desks and chairs, bariatric chairs, a glucometer, electrocardiogram machine, and signage inside and outside the business. $17,000 will be spent on computers, examination furniture such as bariatric exam tables, stools, and scales and leasehold improvements. We will spend approximately $2,210 in office supplies such as: pens, pencils, stables, paper clips, tape, copy paper, patient education packets and educational forms, envelopes and toner and printing services for brochures, stationary and business cards. Finally, approximately $1,800 will be spent on legal and accounting services, incorporation fees and taxes, fictitious name cost, and advertising. The APRNs will reduce some necessary costs by working part-time for another provider where we will obtain our licenses, certifications and health insurance. We will train the certified nurses aid ourselves which will costs approximately $500. Cash Flow.Operating ExpensesMonthly operational expenses include payment of $198 for a weekly newspaper ad in the Sunday paper for the first two months of business. Then ads will be placed bi-weekly for the following two months. Additional ads will be placed once a month in the Sunday newspaper. Approximately $500 or $41 a month will be spent on market strategies and analysis. $10 a month will go to maintaining a checking account. Professional liability insurance will be purchased at $202 a month for all three practitioners. The practitioners will be covered up to $3,000,000 per NP. Property insurance will include a blanket policy for $150,000 in property coverage and $2,000,000 in liability coverage for the business. The cost will be $125 a month. Each practitioner will not require health insurance as it will be obtained through another place of employment or through the practitioner’s spouses. Nursing licenses and certifications will be purchased separately by each practitioner. CLIA certification will be upheld for laboratory purposes if needed, but laboratory services will be outsourced. A coding program will be purchased in the initial start-up. The certified nurse’s aide will be trained to assist with billing needs and an accountant will be retained each month for billing and tax purposes. Their monthly fee of $200 is noted under professional fees. $541 a month will go towards an electronic medical records program. $16.67 a month or approximately $200 a year will fund office expenses. Office supplies will cost $200 a month. $50 a month will go towards postage as the bulk of that cost will be in sending new patient packets to those first starting the program. A CNA will be employed full time at $10.50/hour for 40 hours/week. This will cost approximately $1680 a month. The overseeing physician will initially receive payment of $500 a month with intention to increase salary parallel to patient load increases. Nurse practitioners will receive an annual salary of $65,000 broken down by hour ($31.25) and only paid for hours worked. Initially, nurse practitioners will work a combined total of 20 hours per month and will increase by 10 hours each month. Practitioners will each continue employment at current registered nurse or part-time advanced practice registered nurse positions. Payroll taxes for federal and state were calculated based on the year-end wage total and applied evenly to each month. Rent for the business space is $900 per month and does cover repairs and maintenance in that cost. $30 a month will be used for telephone services through a local company. Utilities will cost $200 a month. Hazardous waste material disposal costs $250 a year for less than 5 tons of waste. Costs were divided equally among each month. RevenueAfter start-up costs there is $20,145 cash reserve to begin with. For the month of January the business will see 20 clients and increase by 20 clients each month. Revenue will come from new client’s charge of $250 for the first appointment, $75 for each monthly follow-up appointment, and $125 quarterly in place of that third monthly appointment. It is estimated that 10% of our clients will be Medicare patients with the business receiving 70% reimbursement. 10% of clients will be Medicaid or CHIP participants receiving 55% reimbursement. 30% of the clients will pay out of pocket for services rendered and $25 per visit will be required up-front to limit bad debt. The remaining 50% of clients will have insurance and reimbursement rates are estimated at 85%. Cash payments will be collected in the month of January. In February, insurance payments will begin to be seen. By March, Medicare and Medicaid payments for services rendered in January will begin to arrive. The operational expenses outweigh the revenue coming in for the first six months. In those first six months the business depends on the cash reserve to stay afloat. July however will begin to see more revenue coming in compared to operational expenses going out. Income StatementThe patient revenue is anticipated at $128,269 with an additional $29,873 in cash reserves for the first year of operation. The majority of the expenses the first year are from payroll expenses. By the end of the first year, each practitioner would average a little over 10 hours at the clinic each week. The CNA will be paid as a full-time employee and the collaborating physician will be paid $500 per month for a total of $6000 for the year. The bad debt is estimated at 10% of revenue as a $25 payment will be required at time of service for private pay clients to decrease this estimate. Depreciations for equipment are totaled at $3000. The other yearly expenses are listed on the cash flow sheet giving a total operational income of a little over $40,000. Year two continues to show an increase of 20 new clients per month with payer mix ratios continuing as the same. This gives us patient revenues totaling over $350,000. Our cash reserves for year two total a little over $195,000. In year two a full-time CNA will continue to be employed at the same pay rate. The collaborating physician will receive a pay increase to equal $1000 per month. By the end of year two, one practitioner will be working full time in the clinic with the other two practitioners only working 10 hours a week. The full-time practitioner will receive benefits through her spouse and the other two NPs will continue to hold other part-time positions for income and benefits. Less money is spent on advertising in year two and continued free social media outlets will continue to be utilized, newspaper ads will cease, but the business will continue to collaborate with other physicians and associations for referrals. No money will be spent in marketing as market analysis and product analysis will be completed again in year three. Bad debt is again estimated at 10% of revenue and depreciation of equipment is noted. Total expenses for year two are $207,899 yielding an operating income of $345,904. Future plans for the business are to keep expanding by 20 new clients each month. It will take almost 4 years for all 3 nurse practitioners to see a full load of clients in a day. In year 3 the business plans to hire a dietician part-time, another CNA full-time, and increase collaborating physician pay to $2000 per month. Once all 3 NPs are working full-time, benefits will be offered and an increase in pay for the NPs will be given.ReferencesAmerican College of Physicians. (2009). Nurse practitioners in primary care: a policy monograph of the American College of Physicians. Philadelphia: Author.Center for Disease Control and Prevention. (n.d.). Healthy weight-it’s not a diet, it’s a lifestyle!: about BMI for adults. Retrieved April 30, 2012 from /assessing/bmi/adult_bmi/index.htmlCounty Health Rankings. (2012). County health rankings and roadmaps. Retrieved from , E.S. & Hansen-Thurton, T. (2010). Nurse managed health centers. Nurse Practitioners Evolution and Future of Advanced Practice. New York: Springer Publishing Company. 183-198. Retrieved from . (2012). Obesity and weight loss coverage. Retrieved from .com/services-and-procedures/weight-loss/obesity-and-weight-loss-coverage.htmlNagelkerk, J. (2006). Starting your practice: a survival guide for nurse practitioners. St. Louis:Mosby Elsevier. Peter, R.F., & Williams, I.S. (2011). Kansas health institute: annual insurance update 2011. Retrieved from C:\Users\Amber\Documents\annual-insurance-update-2011.htmStop Obesity Alliance. (2010, October 1). Medicaid fee-for-service treatment of obesity interventions: 50 state & District of Columbia survey. Retrieved from . wp-content/themes/stoppobesityalliance/pdfs/Medicaid_Fee-For-Service_Treatment_of_Obesity_Intervention.pdfU.S. Census Bureau. (2010). State and county quickfacts. Retreived from . qfd/ ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download