CHAPTER 2: FEASIBILITY ANALYSIS
Clearview House is a not-for-profit organization that provides transitional mental health services to individuals with severe mental illnesses. Because the organization is not-for-profit, funding will come from grants, donations, and billing from Medicare and Medicaid. In order to reach the mentally ill population, funding will be needed to start and sustain the business. Startup costs for Clearview House will come solely from non-loan sources and will include the cost of the building, furniture and supplies, and personnel. Estimated startup costs will be approximately $800,000, most of which is the cost of the location of Clearview House (which will be discussed further in distribution management and personnel which will be discussed in management and control). A large portion of the initial funding will come from grants from the Substance Abuse and Mental Health Services Administration (SAMHSA). Clearview House will apply for a block grant from SAMHSA which is a non-competitive grant from the government that can be applied for yearly (“Applying | SAMHSA”, 2017). Because we only offer mental health services, the block grant we will apply for is the Community Mental Health Services Block Grant (MHBG). Clearview House will also apply for smaller grants such as the Peter and Elizabeth C. Tower Foundation mental health grant for startup funding. We will also continuously take donations from individuals and organizations on our website or in person once the facility opens.
Once services begin at Clearview House, we will bill to Medicare and Medicaid as most of our patients will be eligible for state and federally sponsored coverage. The approximate cost per inpatient day that will be billed to Medicare is $250 per patient, (“Physician Fee Schedule Search”, 2017). This reimbursement rate is based on the physician fee schedule for Centers for Medicare and Medicaid Services (CMS) CPT code 99236 and could vary depending on the type of treatment the patient is receiving and how long they stay at Clearview House. The average length of stay will vary widely per patient; therefore, it is unreasonable to assume the revenue from each patient. As previously mentioned, at full capacity, Clearview House can treat 26 patients a day. If all patients are enrolled in Medicare or Medicaid, income per day will be approximately $6,500. Because our income will rely heavily on CMS, one staff member will be dedicated to enrollment and management of Medicare or Medicaid eligibility and billing. Because there is a large demand for this service in Long Beach, we expect full capacity at all times and will work diligently to bring new patients in as soon as one get discharged. If Clearview House is at full capacity, we can make 2.3 million dollars of income a year off CMS payments alone. This income will allow us to offer an exceptional quality of services to the Long Beach community by investing money back into the organization.
The first location of Clearview House will be in Long Beach at 3918 Long Beach Blvd. The building is 18,000 square feet and has large parking lot for employees and visitors. The building is $530,000 a year and will be leased at the start of the business and will be purchased once we have positive cash flow. The large space will allow 10 patient rooms, a large kitchen, one medical examination room, administrative offices, as well as recreational space for the patients and a large dining area. Hours of operation of Clearview House will be 24 hours a day, 7 days a week. Patient care will be around the clock and walk in visiting hours will be from 8 a.m. to 8 p.m. 7 days a week. Visitors will also be able to visit patients on all holidays.
Patients will come to Clearview House by referral from an outside physician or from admittance from the onsite physician. Once they arrive at Clearview House, the psychiatrist will do a full evaluation of the patient and review their medical charts. The patient will then be assigned to a room and will be given time to settle in. During this time, the care team at Clearview House will establish a plan of care for the patient and determine an estimated discharge date. The care plan will then be discussed with the patient and family member if present. The psychiatrist will prescribe medication to the patient and they will begin medication treatment right away. Throughout their stay, the patient will participate in daily activities and treatments based on their specific needs. The care team will assess the progress of the patient weekly to ensure they are on track to recovery and adjust the treatment plan as needed. Once the patient’s illness becomes stabilized, the patient will work with the social worker to find a job and housing. Once the patient’s job and housing are secured, they will be discharged from Clearview House. After discharge, the care team will check-in with the patient once a month for 6 months to ensure the patient is on a successful path. The process is displayed in Figure 2.
Figure 2. Patient flow chart
Communication between all employees at Clearview House will be instrumental to the success of the business and the health of the patients. As in other organizations that provide healthcare services, communication about the patients’ health status will need to be communicated with clinical staff daily. All clinical information regarding the patients will be communicated between nurses during their shift and at change of shift. If there is a complicated case, information will be communicated to the nurse manager who can then seek guidance from the on-site psychiatrist if necessary. All orders and major decisions about the patients will be made by the psychiatrist who will communicate the order to the nursing staff in charge of the patient. The clinical staff will be responsible for communicating with the social worker when the patient is stable so the social worker can begin working with them to find a job and housing. The social worker and clinical team will constantly be in contact to facilitate patients discharge. For any non-clinical decision making, the director and the administrative support will communicate to facilitate business decisions.
Every day communication is necessary when providing inpatient care. Aside from the daily communication between nurses and the psychiatrist, once a week there will be Interdisciplinary Team (IDT) meetings with the nurses, psychiatrist, and social worker. Each week at the IDT meeting, they will discuss the current state of each patient, how they are progressing, and if their discharge date is the same. This will give the care team time to sit down and discuss any issues with care when the patient is not present and ensure all team members are up to date on their condition. Once the patient is almost ready to be discharged, the IDT will sit down with the patient and discuss their plans post-discharge and ensure they are ready to be in the community on their own. Weekly meetings will also be held with the director, social worker, nurse manager, administrative staff, and the psychiatrist to discuss how the week went and if there are any issues that need to be resolved. As the director, I will be on-site Monday through Friday and will walk all areas of Clearview House to give the staff the opportunity to openly communicate with me and ensure their opinion is heard and they know they are a valued part of the team.
MANAGEMENT & CONTROL
A visual display of the organizational structure (Figure 3) will be shown following the description of each position at Clearview House. The chart represents the organization in year one.
The director of Clearview House (myself) will require a Master’s Degree in healthcare administration and will need to have at least 5 years of healthcare experience. The salary of the director will be $100,000 annually, with options for an annual increase. At the start of business, I will take a lower salary to ensure the business has enough cash flow to operate. The responsibility of the director will be to oversee daily operations, set the budget for the facility, create and manage the strategic plan, and ensure the facility is up to code with all California regulations. The director will also manage all teams and lead weekly meetings with reports about how the facility is doing and if any changes need to be made. Another responsibility of the director will be to assist in the hiring process and make the final decision to onboard a new employee.
The psychiatrist will be a Doctor of Medicine (M.D.) with a specialty in psychiatry. The psychiatrist will be responsible for diagnosing, prescribing, and placing all orders for patients Monday through Friday. The psychiatrist must have an expertise in treating schizophrenia, depression, and bipolar disorder which is what most patients at Clearview House will likely have. The psychiatrist will have admitting privileges at the facility and will evaluate patients records before they are admitted to Clearview House to ensure he/she is able to treat them. The psychiatrist must accept all patients and be present for them to be admitted. The annual salary of the psychiatrist will be $200,000 and they will be one of the most important members of Clearview House.
The social worker at Clearview House will facilitate housing and job placement for all patients. They must have a minimum of a Bachelor’s Degree in social work and have at least two years of previous work experience. The role of the social worker will also be to facilitate referral requests from physicians and hospitals, and arrange transportation for patients if necessary. The social worker will also help patients get enrolled in Medicare or Medicaid if necessary. The annual salary for this position will be $50,000 to start.
The administrative support person will oversee all non-clinical record keeping and other daily operations. They will be responsible for sending and receive invoices to vendors and other companies, doing payroll for the staff at Clearview House, and billing to insurance companies. The administrative support will also oversee the housekeeping and cooking staff and will make their work schedule. The administrative support and social worker will work closely to set up activities and learning sessions for the residents. This position is a very important part of the organization and will aid in general support for all staff. The administrative support will have a minimum of a Bachelor’s Degree in healthcare administration or business and the annual salary will be $76,000.
Registered Nurse (RN)
At Clearview House, there will be three RN positions. The first will be the nurse manager, who will oversee and be responsible for all nursing staff. They will be responsible for making the schedule for nurses and LVN’s and will be their resource for any questions. The nurse manager will have a Bachelor’s Degree in nursing and will make $75,000 annually. The other two nurses will work under the nurse manager and will have an Associate’s Degree in nursing. They will make $65,000 a year and will be required to work some evenings and weekends. All nursing staff is responsible for daily care of the patients and completing physician orders and must have experience working with mentally ill patients.
Licensed Vocational Nurse (LVN)
Clearview House will have two LVN’s that will work directly under a RN and assist them with any patient care. All LVN’s must have the practical training and experience working with mentally ill patients. LVN’s will also be required to work overnight and weekends and they will make $45,000 annually.
There will be a lead cook and cook position at Clearview House. They will be responsible for preparing all meals for the patients and following any dietary restricts they may have. The cooks will also serve the food to residents in the dining area or their room depending on the patient’s needs. Cooks must have some experience working in a hospital style kitchen. The lead cook will make $35,000 annually and the cook will make $28,000.
There will be two housekeepers at Clearview House. The lead housekeeper will oversee the other housekeeper and ensure they are doing their job well. The housekeeping team will be responsible for keeping all areas of the facility clean and washing bed linen. They will do a deep clean of each room before a new resident comes in. The lead housekeeper will make $35,000 annually and the housekeeper will make $27,000.
Figure 3. Clearview House Organizational Chart
A SWOT analysis is a tool organizations use to help make important decisions. The acronym stands for strengths, weaknesses, opportunities, and threats provides a framework that helps companies face challenges (“SWOT Analysis: What It Is and When to Use It”, 2017). This tool is important in helping users be fully aware of all factors involved in a decision. A SWOT analysis should always be used when enduring a new business venture, below is the SWOT analysis for Clearview House.
There are many strengths that Clearview House has that differentiates them from others in the market. First, each patient gets a personalized care plan that is developed for them upon admittance by the on-site psychiatrist. This ensures that each patient is getting the exact care they need to have a full recovery. Another major feature Clearview House offers is job and housing placement. It is vital for patients to have somewhere to go once they are discharged and can support themselves financially. Clearview House will not discharge patients until housing and a job are secured for them. We also provide a home-like environment for patients that helps them feel comfortable and enables them to receive treatment at ease. By having a small patient population, the care team at Clearview House is able to spend more time with each patient and tends to their needs. Many patients will be low income, therefore accepting Medicare and Medicaid is a strength of Clearview House because we will be able to reach more patients and will also get reimbursed accordingly.
Along with the strengths, Clearview House has identified some weaknesses that should be considered as well. At the start of business, there will be limited staffing due to the cost of hiring nurses and other support staff. Cash flow will be one of the main challenges during the early days of the business because of the large start-up costs. It also might take CMS a while to reimburse so there won’t be consistent cash flow in the beginning. Another weakness is the lack of credibility we have as a new small business. We are not well known by people and providers in the community which could lead to empty beds at our facility. The most significant weaknesses of Clearview House are the high operating costs. The facility is very large and is a 24-hour operation which leads to large expenses. Many employees of the facilities have large salaries as well.
Clearview House has many opportunities to be successful in this market. Most importantly, there is a large demand and dire need for mental health services. There is a large mentally ill population in the Long Beach area and there are no other facilities in the city that provider this exact service. Other facilities that are similar in surrounding areas are very busy and often at full capacity. There is a definite need for these services and many government agencies and charities are willing to fund mental health programs.
There are a few factors that pose a threat to Clearview House. First, with the probable changes in the Affordable Care Act, many people insured by Medicaid may lose their insurance coverage. Many other changes may come with new healthcare legislation that could affect Clearview House. Another threat is the ability of large and established organizations to start offering the same services. It would be easy for a large hospital to start their own transitional house that they could send their patients to. Another threat is other organizations taking our employees. Because we are a new business, we won’t be able to pay our employees as much as other organizations. Therefore, it could be difficult to recruit and retain employees.
|S· Personalized care plan· Offer job and housing placement· Home-like environment· Life skills and training courses offered· Smaller patient population/ more time spent with each patient· Accept insurance||W· Limited staffing at start up· Funding/ Cash flow· Small business with limited resources· New/ Not well known· Large operating cost|
|O· Large mentally ill population· No other facility in Long Beach· Other similar facilities are at capacity· Many government entities fund mental health programs||T· Affordable Care Act may go away· Other large organizations/hospitals can offer same service· Employee’s may leave to more established organizations|
Table 1. SWOT Analysis