Case Study #1 will require you to refer to the New Day Health and…

Case Study #1 will require you to refer to the New Day Health and… Case Study #1 will require you to refer to the New Day Health and Associates case study.  Read the case thoroughly and you will need to perform OUTSIDE research and reading to adequately answer the s below. Number your s. Please answer the following s posed below.  You are an experienced family nurse practitioner, and you have decided to join with three colleagues to open a primary-care practice called New Day Health and Associates. The practice will focus on health rather than acute care. You and your colleagues strongly believe that patient teaching, health promotion, and careful attention to families and individuals with chronic health problems can decrease the cost of care and increase quality of life for your clients. You have incorporated your practice as a 501(3) organization so that you could invest your net revenue in a public health cause, for example to support the Healthy People 2020 activities in your state. This implies that you must be particularly budget-conscious because you will not carry over funds to cushion your practice in difficult times. When selecting a location for the practice, be sure to review demographic data, and do not select a location for which there is none available. The more demographic and provider data you have, the easier it will be for a good case analysis. 1. How will you determine the market area that you are going to serve? List at least three strategic considerations in picking a location.2. Describe at least two major payers in your market. They can be public or private payers. Then provide a reimbursement analysis on the two payers in a table format and include the following sections:Beneficiary base (the types of beneficiaries the contract with your payer type would bring to your practice)Reimbursable services under the payer contract (you would want to enter a contract with a payer that would cover the services you will be offering at your practice (i.e. this practice is interested in health promotion and counseling, you should present payer research on the reimbursement policies for these services)How will care be reimbursed? (i.e. fee-for-service, capitation, discounted fee-for-service, value-based models, etc.)         *****Refer to page 64 for more information on conducting a reimbursement analysis on the 2 payers types. The following excerpt is the requested page 64. Reimbursement Analysis  A reimbursement analysis should gather information from each prospective payer in the following areas: What is the beneficiary base?Information should be provided on the number of covered beneficiaries the provider can expect. In the case of public payers such as Medicare and Medicaid, population data may be required as well as data on other providers in the region. It is also important to understand the restrictions on switching from one primary care provider to another once the beneficiary enrolls.  What services are reimbursed? The covered services and exclusions for the beneficiaries should be clearly defined. If there are second-opinion requirements, waiting periods, or other qualifying events, they need to be clearly stipulated. The procedures for appeal of denied reimbursement also need to be clearly understood. Particular attention should be paid to clinical services such as patient education, counseling, and consultation. Many payers reimburse for these services, but providers do not always know that they can recover payment. All billable services should be clearly understood. How is reimbursement requested and received?Provider enrollment requirements, billing formats and coding, information system linkages and requirements, arrangements for payment transmittal, and the basis for reimbursement requests should all be defined. For example, if a fee schedule is the basis for reimbursement, the provider needs to understand if any deviation from this schedule will be allowed. If the basis for reimbursement is cost or discounted cost, then the documentation required to establish the cost base needs to be clear, as does the effective period for the cost schedule. What is the payer’s incentive and penalty structure? In addition to payments for services, many payers make bonus payments if service or quality targets are achieved. Conditions for these bonus payments and penalties for undesired events should be clear. Who qualifies for payment?Group practices frequently comprise physicians, advanced practice nurses, and other health professionals such as clinical psychologists, physical therapists, or registered dietitians. A reimbursement analysis should clearly define who may bill directly for services and who must bill under another professional’s billing authorization. The services that are billable under each professional’s billing authorization also need to be clear. The time required and the procedures for credentialing a provider to enable him or her to bill should also be clearly understood. 3. Discuss the linkage between strategic planning and budgeting for your first year of practice. How will you link your budget to your care-delivery strategy?Sample Revenue BudgetPayerService/product offeringProjected VolumeRevenue/Unit (I.e. cost per unit)Total Revenue               4. Discuss your service or product offering (at least 2) for the practice to promote health as indicated in the case study.  Then, provide a sample revenue budget for your product offerings and base it on the payer mix as well. Remember to include the revenue budget period and use the following table for the revenue budget:** Remember the revenue generated needs to coincide with what was indicated in #2. 5. Present an expense budget for the service or product offering you indicated in #4. Remember to include expenses consistent with your strategic plan for patient care.  Refer to chapter 6 (table 6.1 on page 70) about costs in managing a healthcare practice.   You can make-up the numbers. But it does need to be realistic. For example, a monthly lease for the practice should be around $4,000- $8,000 depending on your location and not like $500/month). This should also be in table format, with an explanation of tying the revenue and expense budget together. Will you make a profit or will there be a deficit Table 6.1 Main Characteristics of Practice Costs – This is the table found on page 70Cost CategoryContract VehicleTypical Minimum Outlay HorizonCost Duration & TerminationPractice partner laborPartnership agreementMonthlyContract TermsFixed employee labor costsAnnual salary contractMonthlyTwo-weeks to one-month noticeVariable employee labor costsContractualAs specified in contractContract TermsPractice spaceRent contract or mortgage contractMonthly or as specified in contractTerms of lease, Terms of mortgagePurchased patient care technologyPurchase termsMonthly paymentRepayment cycleLeased patient care technologyLease termsMonthly paymentTerms of leaseFixed practice assets such as furniture and office equipmentPurchase termsMonthly paymentRepayment cycleSuppliesInvoice termsInvoice terms upon receipt of invoicePayment in full of invoice against payment termsUtilitiesContract termsMonthly paymentTerms of contract   The textbook used and referenced is Healthcare Finance and Financial Management DEStech Publications, Inc., Feb. 2014ISBN-10: 9781605950624ISBN-13: 1605950629 Health Science Science Nursing NGR 7891 Share EmailCopy link Comments (0)

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