Health Care in Albany

A Comprehensive Solution to Meet the Needs of Area Residents




                         Prepared ...
Group 4
Copeland Hall
Athens, OH 45701

October 30, 2000

L.E.A.D.E.R Group
Board of Trustees
Albany, OH

Dear Mr. Ploutz:...
Recommendation: Albany Health Care Problem

                                    Executive Summary

Recommendation
The comm...
Table of Contents
Transmittal Letter.........................................................................................
Introduction

Background

Albany is a rural Appalachian community located in Southeastern Ohio. According to a
1996 survey...
Alternatives

In evaluating the problem of health care in Albany there are four alternatives to consider.
The alternatives...
Alternatives

Open a Clinic

To address the lack of health care facilities and medical professionals in Albany, the
commun...
Holzer Clinic is very successful in Pt. Pleasant and would be opened at no cost to the
community, which would be very bene...
bill the patients based on their financial ability to pay and allow those without insurance
and with low income to receive...
while there are other counties in the southeastern Ohio region that have over 3,000
    patients per physician (Center for...
Complete interactive system       $50,000-$100,000
Teleradiology system              $40,000-$75,000
Telephone line access...
The above figures could prove very difficult for Albany citizens to pay. The difficulty
would stem from the fact that Medi...
Costs

Excluding private loans and donations, funding for including specialty services will come
from various government s...
Atoka Memorial Hospital in Oklahoma ran an operating loss of 500K in 1996 before
understanding the market in which it oper...
Sensitivity and defensive driver training
       First aid and CPR training for staff
       Vehicle Insurance

In additio...
We believe that the best alternative for Albany is that of expanding the existing facilities
by bringing specialists to th...
Health Care in Albany                   1

                                       References:

Bloom, J. Personal Communic...
Health Care in Albany                    2



Rollins, Scott MD. A Model for Successful Rural Practices. (2000, March) Ret...
Health Care in Albany    3

                                     Appendix A

Question #1
                                 ...
Health Care in Albany       4




Question#5
                            Distance to Healthcare Provider
                 ...
Health Care in Albany    5




Question#9
                    Health Concearns
             Have                          ...
Health Care in Albany                      6

                                         Appendix B.



                    ...
Health Care in Albany                        7

from State Route 33, a four-lane highway that passes not only through Athe...
Health Care in Albany                      8




                                 Building Considerations

The actual buil...
Health Care in Albany             9


23.10.05.Development and maintenance of parking areas and structures and
loading are...
Health Care in Albany                      10



27.03.02. Development requiring prior approval of
plans
       (C) Develo...
Health Care in Albany                       11

earth-disturbing activities shall proceed only in accordance with conditio...
Health Care in Albany                  12

order to comply to the property owner or the owner's agent by means of certifie...
Health Care in Albany                  13

                                      Appendix C

Costs of Opening a Clinic:

T...
Health Care in Albany                  14

                                       Appendix D

Costs of Opening a Private P...
Health Care in Albany                  15

                                      Appendix E


Amortization of Capital Inve...
Albany Healthcare in MS Word
Albany Healthcare in MS Word
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Albany Healthcare in MS Word

  1. 1. Health Care in Albany A Comprehensive Solution to Meet the Needs of Area Residents Prepared for L.E.A.D.E.R Group Albany Village Council Prepared by Team 4 Health Care Consultants Erin Connelly Drew Dunkle Jamie Klingler Stevan Stanic Jody Triplett July 22, 2010
  2. 2. Group 4 Copeland Hall Athens, OH 45701 October 30, 2000 L.E.A.D.E.R Group Board of Trustees Albany, OH Dear Mr. Ploutz: We would like to begin by offering you the report you asked us to prepare in regards to the problem of health care in Albany, Ohio. We feel that you will be pleased with the information we gathered and with our solution proposal. This is a serious issue and we hope that our suggestions will be helpful in solving the problem quickly and with great success. We began by determining what alternatives would be effective in solving the issue of no health care within the village of Albany, while meeting the needs of the community. After much research, an extensive survey of the citizens of Albany, and analysis of both, we came to the conclusion that the citizens should continue visiting area facilities for their health care needs, however, expansion of the existing facilities is necessary. Albany citizens are currently traveling to surrounding towns and cities to receive health care. 81% of these people are visiting a family doctor frequently. However, the citizens need better access to these facilities and better specialty care. Albany offers free transportation to area doctor offices, clinic, and hospitals; however, citizens are unaware of this service. The transportation service could be expanded to include more drives and better advertisement. Citizens also desire more specialized care. O’Bleness and other area hospitals could expand to offer more specialists in cardiology, orthopedics, obstetrics, etc. This alternative will meet citizen’s needs at a low cost to the community. In closing, we would like to thank you for the opportunity to participate in a project that allows us to give our support to a community that needs so much. With best regards, Jamie Klingler Representative of Group 4 i
  3. 3. Recommendation: Albany Health Care Problem Executive Summary Recommendation The community of Albany, Ohio could best solve their health care problem through continued use of existing facilities. However, it is essential to quality care that these facilities be improved by including specialist care and developing a transportation system. Analysis The rural community of Albany, Ohio is facing a problem. The problem is that the citizens recently lost their only health care provider within the village limits. Now a decision must be made regarding what new form of health care should be implemented. When choosing a new form of health care, there are four alternatives that deserve consideration. These alternatives are as follows:  Open a clinic  Recruit private solo practice  Offer telemedicine services  Build upon existing services The above-mentioned alternatives were evaluated against the following criteria:  Costs  Ease of implementation  Community needs The possible alternative of opening a clinic can quickly be ruled out by analyzing the high costs and low profits. The possibility of finding doctors to run a private practice is eliminated due to problems with recruitment and also because of high costs to the practicing physicians. Telemedicine is not a viable solution for Albany because it is too expensive for the patients to afford and private insurers are reluctant to pay for these services. The final option of expanding existing services is the best solution to Albany’s health care situation. Bringing specialists to existing facilities would eliminate lack of specialty care, a major citizen concern. The issue of transportation difficulties would also be solved by further developing transportation systems that are already in use. By implementing these changes, the health care concern of Albany could be dissolved inexpensively and efficiently. ii
  4. 4. Table of Contents Transmittal Letter.................................................................................................................i Executive Summary.............................................................................................................ii Introduction..........................................................................................................................1 Background.....................................................................................................................1 Problem...........................................................................................................................1 Current Status..................................................................................................................1 Alternatives.....................................................................................................................2 Criteria............................................................................................................................2 Open A Clinic......................................................................................................................2 Costs................................................................................................................................2 Ease of Implementation..................................................................................................2 Community Needs..........................................................................................................3 Private Practice....................................................................................................................5 Costs................................................................................................................................5 Ease of Implementation..................................................................................................5 Community Needs.........................................................................................................6 Telemedicine........................................................................................................................6 Costs................................................................................................................................6 Ease of Implementation..........................................................................................7 Community Needs..........................................................................................................7 Build Upon Existing Services..............................................................................................8 Costs................................................................................................................................8 Ease of Implementation..........................................................................................9 Community Needs..........................................................................................................9 Improving Transportation....................................................................................................9 Costs..............................................................................................................................10 Ease of Implementation................................................................................................10 Community Needs........................................................................................................11 Conclusion.........................................................................................................................11 Recommendation...............................................................................................................11 References..........................................................................................................................12 Appendix A........................................................................................................................14 Appendix B........................................................................................................................17 Appendix C........................................................................................................................24 Appendix D........................................................................................................................25 Appendix E........................................................................................................................26 iii
  5. 5. Introduction Background Albany is a rural Appalachian community located in Southeastern Ohio. According to a 1996 survey conducted by the Census Bureau, the village has a population of 865. The community is part of both Lee and Alexander Townships within Athens County. Albany is located along Rte. 50, “the Appalachian Highway,” ten miles west of Athens. Current Status In a 1996 survey, the Census Bureau estimated Albany’s mean per capita income to be $14,799. This was well below the Ohio average of $23,493. The poverty rate is at 32.5 percent, meaning that more than 30 percent of Albany’s residents live at or below the federally defined poverty level of $15,600 for a 4-person family. The town’s rural setting impedes its development, causing problems such as poor school districts and inadequate sewage. This weighs heavily on Albany as it seeks healthcare professionals. To receive health care services, area residents must travel outside of their community. The following chart illustrates where Albany residents currently receive medical treatment. Location Approximate Distance Major Facility(s) Name From Albany Athens 10 miles O’Bleness Hospital School of Osteopathic Medicine Jackson 30 miles Holzer Clinic Gallipolis 35 miles Holzer Hospital Nelsonville 20 miles The Doctors Hospital Problem The Albany Village area has no health care facility. The village’s only health care provider, Dr. Baumgaertel recently retired after serving the community for the last 45 years. Because of Baumgaertel’s retirement, the community now faces the problem of finding the best way to solve the healthcare needs of the Albany citizens. iv
  6. 6. Alternatives In evaluating the problem of health care in Albany there are four alternatives to consider. The alternatives are as follows: • Open a clinic o Purchase facility on Rte. 143 o Bring a branch of Holzer to the area o Bring a branch of the Ohio University Medical Center to Albany • Recruit private practice doctors • Offer telemedicine services • Build upon Existing Services o Include Specialist Care o Develop Transportation system Criteria In deciding which alternative is best the following criteria must be applied. Cost. In order to evaluate each alternative the costs of implementation and sustaining the business must be examined. The costs of each alternative will be discussed along with an in depth cost analysis of each in an Appendix. Ease of Implementation. In order to make each of these alternatives successful there must be support of the citizens, it must be implemented in a timely manner, and there must be willingness by the health care provider Compatibility with Community’s Needs. In order for the alternative to be successful it must meet the needs of the citizens of Albany. Albany citizens are looking for the following:  In a survey taken of 903 Albany residents, in which 376 responded, 57 percent responded that they would visit the doctor more if there were better access.  In a different survey taken by Jennifer Neal, a total of 100 surveys were collected and 84 were applicable, 50 females and 34 males. The citizens asked most for more specialty based care. 76 percent were unsatisfied with their current number of choices of cardiology specialists, followed by surgery at 65 percent, and orthopedics with 62 percent unsatisfied. For a further analysis of each survey see Appendix C. Analysis of each alternative needs to be made using all of the criteria. This analysis will allow an educated decision to be made on how to solve the problem of health care in Albany. v
  7. 7. Alternatives Open a Clinic To address the lack of health care facilities and medical professionals in Albany, the community could create a health care clinic. This clinic would offer a facility with rotating doctors, examination rooms, a trauma room, a specialty room, a library, and several physicians’ offices (see Appendix B to examine zoning laws and steps to implementation if the facility were to be opened). Costs In analyzing this alternative, the first step is to determine what the costs will be to implement the clinic. Costs must be determined for each of the following types of clinics that could be opened  Purchase Clinic on Rt 143  Bring a branch of the Holzer Clinic  Bring branch of Ohio University Medical Clinic to Albany Purchase Clinic on Rt.143 One available option is to purchase Dr. Smith’s old clinic on Rt.143. The 9000 square-foot building costs approximately $600,000, and includes fifty acres of land (Jim Bloom, 2000). Other costs would include:  $13,800/month in salaries  $300/month in utilities  $400/month for liability insurance  $60,000 for equipment For a further description of costs see Appendix C. This building is an excellent choice because of its location, and because it is already set up for a clinic. However, this is a large building for such a small area. Albany might benefit more from a smaller facility. Holzer Clinic. Holzer Clinic is a large facility that operates in seven locations in Ohio and West Virginia. Holzer’s newest branch in Jackson staffs approximately 65 people. Holzer has been looking to open a clinic in Athens County (www.holzerclinic.com). Jennifer Neal, an associate from the marketing department of Holzer Clinic, suggested the clinic be comparable to the Pt. Pleasant location offering services in Pediatrics, Family Practice, Laboratory, and X-ray. Ms. Neal estimated that it would cost approximately $1,000,000 to build such a facility. The facility would need to include one family practitioner, one or two specialists, a registered nurse, two nurses aides, a lab technician, and one X-ray technician. (For further break down of the costs see Appendix C) vi
  8. 8. Holzer Clinic is very successful in Pt. Pleasant and would be opened at no cost to the community, which would be very beneficial. Holzer Clinics are physician-owned. The clinic has its own staff, board, and is independent of the Holzer Medical Center in Gallipolis. The University Osteopathic Medical Center (UOMC). The UOMC is an outpatient medical center made up of approximately 60 physicians. UOMC offers specialties including cardiovascular medicine, obstetrics, pediatrics, and much more. UOMC is located in Athens and could move a branch to the Albany area with no cost to the community. This seems like a good alternative, and UOMC was actually looking to buy the clinic on Rt. 143 (Jim Bloom, October 2000). However, the UOMC is currently suffering financial difficulties. The UOMC is close to $1,000,000 in debt and cannot afford to expand at this time. Ease of implementation If a clinic is built in Albany we need to know if the clinic will be supported. 81 percent of citizens surveyed in the Albany survey, say that they already have a family doctor and would not change if one were more accessible. To determine the effectiveness of this alternative it would be beneficial to look at a similar example. This type of clinic proved to be very successful in Lincoln County, WV. Lincoln County, like the Albany area, suffers from a high poverty rate and low per capita income. In 1977, it opened a Primary Care Center, which became the first rural Health Clinic in the nation. The clinic was opened with money from the National Health Service Corps ($25,000), the Appalachian Regional Commission ($59,000), community donations ($60,000), and a Farmers Home Administration Loan ($400,000). The clinic offered 16 examining rooms, two trauma rooms, and several physicians’ offices. The clinic provided a sliding schedule of fees based on patients’ ability to pay. The clinic is open 364 days a year and serves approximately 30,000 patients annually (www.holzerclinic.com). Community Needs The last criterion that needs to be assessed is whether or not the facility meets the community’s needs. Due to the fact that the clinic will service a relatively poor area, the clinic could institute a sliding schedule of fees that would be based on the patient’s ability to pay. Albany citizens have a high poverty rate with only 8.6 percent covered by Medicaid insurance. This is where the clinic could be very beneficial. The clinic would vii
  9. 9. bill the patients based on their financial ability to pay and allow those without insurance and with low income to receive medical treatment. The community is also looking for accessibility and specialty care. Building a clinic would meet both of these needs by placing a health are facility within the village limits and offering a clinic that provides specialist in surgery, obstetrics and pediatrics. Overall the idea of building a clinic seems like a good alternative. However, its main downfall is cost. The area citizens cannot support the cost of opening such a large clinic. As seen in Appendix C, the clinic will not be profitable Private Solo Practice Another alternative is to open a private practice in the Albany area where a physician can provide the primary health care needs of the community. Dr. Baumgaertel held a private practice for 45 years in Albany until recently retiring and leaving Albany with no health care. Costs In order to implement this private practice, the physician will need to open an office, which will hold a receptionist’s area, procedure room, a minimum of three exam rooms, and an office for the nurses and doctor. The doctor will need a staff of three to four people minimum. This would include a receptionist, an in-house billing expert, and a nurse costing a total of $50,000 a year for all three. In order to run a solo practice, the costs would be approximately $80,000 to $100,000 per year. For a more in depth look on the costs, see Appendix D. Ease of Implementation In order for the implementation of a private practice, a physician must be willing to locate a private practice in Albany. Ohio University College of Osteopathic Medicine (OU- COM) is a national leader in the training of primary care physicians for underserved areas. Of the graduates from OU-COM, 22 percent practice in communities of less than 10,000 people. Many of these communities were previously without a primary care provider for many years (OU-COM, 2000). With the interest that OU-COM students have with underserved areas, Albany can try to recruit one of these graduates. There are problems that prove it will be difficult to recruit a doctor for the area: • Physicians that are interested in locating in underserved areas may look at places that are more in need. Athens County has approximately 589 patients per physician, viii
  10. 10. while there are other counties in the southeastern Ohio region that have over 3,000 patients per physician (Center for Appalachian Research, 2000). • The young physicians will be hesitant to begin such a practice with the amount of debt they have already incurred to pay for their education. The average physician has over a $100,000 debt (Marazon, 2000). • Having his or her own practice means there will be unlimited liability for the practitioner. The individual practitioner is legally liable for all the debts of the business (Johntson, 2000). Community Needs The community is going to want a doctor that is affordable and accessible. Affordability will not be a problem because 72 percent of Albany’s citizens have some form of health insurance, whether it is employer sponsored or private. Accessibility is key to provide to the citizen’s needs. In a successful rural practice located in Collbran, Colorado, with a service area that encompasses about 2,000 people, the doctor averages 15 patient visits per day and sees about 20 patients with after-hour emergencies per month (Rollins, 2000). This is what a physician in Albany will expect. To make the practice accessible the doctor should work different hours on different days (Kelsey-Mendez, 2000). For example, a doctor could have a normal schedule three days a week (9am-5pm) and start at noon and work into the evening on the other two days. In the survey of Albany citizens, 81 percent regularly use the same doctor. If most of the citizens already see a specific doctor, they will be less likely to change if a doctor does come into the area. Telemedicine Another alternative form of health care for Albany to consider is that of telemedicine. Telemedicine is the delivery of health care through interactive audio, video, or data communications. Satellites and telephone lines transmit radiology images, pathology slides, echocardiogram readings, and basically almost any form of clinical information, along with the sight and sound of patients and physicians. Telemedicine has only recently been studied in terms of actual usage, although experiments have been performed since the 1950’s (Scott, 1994). Cost One aspect of implementing telemedicine that must be considered is that of cost. Some basic costs of implementation are as follows (Scott,1994) : ix
  11. 11. Complete interactive system $50,000-$100,000 Teleradiology system $40,000-$75,000 Telephone line access $100-$8,000 depending on location and volume Telephone line access charges Approximately $25/hour Training Costs vary Maintenance Costs vary depending on needs For further financial information on telemedicine, see Appendix E. Ease of Implementation The second criteria that should be applied to the possibility of telemedicine is ease of execution and implementation of the alternative. For example, Ohio University’s College of Osteopathic Medicine (OU-COM) already has a videoconferencing system that is currently being used to link students, interns, and residents to 13 Centers for Osteopathic Research an Education (CORE) hospitals and one affiliate hospital (OU-COM, 2000). This system could possibly be used to link Albany patients to doctors. Although using OU-COM’s existing videoconferencing equipment to provide teleconsultations may seem like a viable solution for the Albany health care situation, it would be more difficult than it may sound. OU-COM would first have to agree to use their educational videoconferencing system as a medium to provide health care. OU- COM would have to be convinced that this solution makes financial sense, which could prove to be challenging. Although using OU-COM’s existing system could save money, many additional costs would be incurred by having to set up equipment to connect Albany to that system. Telemedicine equipment is expensive and according to T. Trivison (2000), setting up a system to connect Albany to other health care facilities would require a staff of trained clinicians and a building in which the system could be installed. Another potential obstacle of using telemedicine is that of citizens’ apprehension to a “virtual doctor.” Many patients do not feel comfortable seeing a doctor merely on a video screen (Siwicki, 2000). The people in the village of Albany would need to be persuaded to use telemedicine in place of conventional doctor visits. Needs of the Community Telemedicine must also be evaluated in terms of whether or not the citizens of Albany could afford such a service and if it meets the community’s need for accessibility. When combined with start up costs and transmission fees, the fact that telemedicine is used at a low volume makes for an expensive teleconsultation. The average cost per consultation is $1,181 for a central “hub” site and $476 for a connected “spoke” site. Payment to clinicians is not included in these figures (Morrissey, 2000). x
  12. 12. The above figures could prove very difficult for Albany citizens to pay. The difficulty would stem from the fact that Medicare and many private insurers are wary to reimburse health care providers for telemedicine services. Insurers are apprehensive of telemedicine because many are concerned teleconsultations will performed too often without really proving to be necessary. In other words, insurers will be paying expensive bills for services that do not “clearly improve patients’ health” (Scott, 2000). As for the need of accessibility, it would be accessible to the people in the community because it could be set up within the village limits. However, if it only meets the need of accessibility and not that of affordability, telemedicine is clearly not the best alternative form of health care for Albany residents. Build Upon Existing Services Many argue that a doctor’s office, clinic, or other health facility is needed in Albany to meet the health care needs of residents. To see the pitfalls in this analysis, one needs to look no further than the abandoned facility located off of Rte. 50. The following is a cost effective alternative that focuses on two principles. • Improve Existing Facilities • Expand Transportation By improving specialty care and available transportation into Albany, we can meet the health care needs of village residents. According to a survey of 84 residents near Albany, 92 percent were satisfied with the primary care available to them in the city of Athens, based on quality of care and location. Overall, 86 percent were satisfied with their current primary care providers. (Neal 2000) While most are satisfied with the level of primary care, many agree they are “not satisfied” with the level of specialty care available to them. The following chart highlights areas of dissatisfaction uncovered by the survey’s findings. (Neal 2000) Not Satisfied With Availability of Specialists Pediatrics Surgery Orthopedics Cardiology Ophthalmology Primary 27% 65% 62% 76% 28% 35% To meet the needs of Athens residents and people of New Albany area service providers will have to improve and develop their specialty care. xi
  13. 13. Costs Excluding private loans and donations, funding for including specialty services will come from various government sources. The Rural development Agency (RDA) has funded expansion of rural hospitals in the past. When expanding providers in Athens, it will be a likely source of funding. For instance, the RDA allocated 1.7 million dollars to fund improvements at a rural Hospital in Hoisington, Kansas. Based on the data gathered in our survey of Albany residents in conjunction with Jennifer Neal’s Survey of Athens we feel that expansion into Specialty care will be supported with a patient base within Athens and the Albany area. (Neal 2000) According to the survey of Albany residents, 19.8 percent go to Columbus for various types of treatment. For many, Columbus is the closest provider of specialist care. These individuals would be the primary source of revenue for expansion into specialty care. (Neal 2000). Based on mean physician salaries, the annual cost to acquire trained and qualified specialists in Pediatrics, Surgery, and Cardiology would be $405,000 (College of Healthcare, 2000). This amount would be offset by annual revenue of $500,000. This figure was the derived from Atoka Memorial Hospital in Oklahoma after it expanded its services (Jaklevich, 2000). Ease of Implementation Another approach that area health providers must consider when implementing specialty care is better marketing their services. Many subscribe to the stigma that certain facilities in the community do not meet the standards of providers in other areas. In essence, these institutions must launch a public relations program aimed at townspeople who hold the “Suffering Arms” view of Athens County healthcare. With existing facilities, this alternative can be carried out in a timely manner. Thus, existing institutions make the implementation process a matter of weeks as opposed to the many months it would take to carry out other options. Community Needs Not only does this plan meet the needs and expectations of residents it exceeds them. Nearly 70 percent of Albany residents use facilities in the city of Athens. Of these, 43 percent said they would not go to a facility that was closer. This puts a deep cut in what proponents of a clinic or other facility can expect. (Albany Survey, 2000) xii
  14. 14. Atoka Memorial Hospital in Oklahoma ran an operating loss of 500K in 1996 before understanding the market in which it operated. After using federal grant money to conduct area surveys, the hospital was able to determine community needs. As a result, “Atoka Memorial has become a national model for critical-access hospitals, thanks to its aggressive efforts to reshape services (Jaklevich, 2000).” According to Forrest Calico, who heads the Health and Human Service’s Office of Rural policy, Atoka is a “picture postcard of what we aspire to accomplish.” By 1999, the Hospital had met community expectations. Its operating loss became an operating profit of 300K. (Jaklevich, 2000) Improving Transportation As patients in rural areas become “poorer and more elderly” the need for transportation to health facilities becomes important. (NHRA website). According to Elizabeth Woodkock, director of Knowledge Management Physicians practice, “ten minutes [to Athens] is actually not very far- there are many communities in America that are hours away from the next hospital.” Nevertheless, elderly patients must contend with treacherous roads during winter months causing many to forgo care only minutes away. (Lewis, 2000) In Athens, there are many government funded organizations designed to meet the transportation needs of disadvantaged Albany residents or those unable to get transportation through a network of friends, neighbors, or family members (Lewis, 2000). Existing non-profit Services: Organization Services Provided Requirements United Seniors of Athens General Transportation Over 60 Doctor Appointments Helping Hands Long Distance Service - Over 60 OR (specialist care in places like Medicaid Columbus) V.F.W. Volunteer healthcare Veteran transportation Costs According to staff at United Seniors, the cost of transporting rural patients is seventy-five cents per mile or 30,000 dollars a year. This figure covers the following: Vehicle cost Vehicle repair / maintenance Gas costs at their present level xiii
  15. 15. Sensitivity and defensive driver training First aid and CPR training for staff Vehicle Insurance In addition to non-profit providers, Albany residents can arrange for transportation with Healthpro Ambulance, in Athens. Healthpro offers to take patients wherever they need to go at a price for $2.25 an hour (Healthpro, 2000). Another alternative is to call a taxi. According to the local taxi company, a round trip from Albany to Athens would be 24 dollars. Ease of Implementation Joyce Lewis, head of United Seniors of Athens County, says the problem of accessible transportation arises from an inability to advertise their service (Lewis, 2000). According to J. Lewis, those most in need of transportation services (the poor and elderly) are not aware that the service exists. In essence, non-profit groups like United Seniors and Helping Hands are faced with a trade off. Either allocate the resources provided to them to help residents or use the money for advertising. A lack of funds mandates that transportation only be provided to people over age 60 (Lewis, 2000). For Helping Hands, the service is geared for the elderly or those currently on the Medicaid program. J. Lewis recalled how a couple that saved ten thousand dollars for funeral costs was forced to spend the money, in order to become eligible for the service (Lewis, 2000). Community Needs Ideally, groups like United Seniors and Helping Hands should consolidate their services to better serve the people in the area. By working together they can offer greater flexibility in their scheduling to better service the Albany area. Presently, United Seniors provides services to transport seniors in Albany for general purposes on Wednesdays. The rest of the week is designated specifically for medical purposes. United Seniors takes the elderly to doctors appointments and to pharmacies. Recommendation/Conclusion Albany, Ohio is faced with an important decision. The rural community must choose a form of health care that will meet the citizens’ needs of affordability and accessibility, while remaining cost efficient and successful for the health care provider. xiv
  16. 16. We believe that the best alternative for Albany is that of expanding the existing facilities by bringing specialists to the area and developing a better transportation system. We arrived at this conclusion only after careful analysis of all four alternatives. The alternatives that we researched are:  Open a clinic  Recruit private practice doctors  Offer telemedicine services  Build upon existing services The criteria we based our decisions on are:  Costs  Ease of Implementation  Compatibility of community’s needs When the four alternatives were weighed against the criteria, it became obvious that the best solution for Albany is the expansion of existing facilities. Opening a clinic would not be profitable to the health care provider. Doctors for a private practice would be difficult to recruit because of the rural area. A physician with a private practice would also have to operate with low profits. Telemedicine consultations are simply not affordable for the residents of Albany, because insurers are hesitant to pay for the teleconsultations. Expanding existing facilities would adhere to the needs of Albany citizens, while proving to be affordable to care givers and patients. This alternative would also be the simplest to implement. The citizens’ desire for specialty care would be addressed and problems stemming from lack of transportation would be eliminated. Based on careful analysis of the situation, expanding existing facilities is clearly the best solution to the problem. xv
  17. 17. Health Care in Albany 1 References: Bloom, J. Personal Communication. (October 24, 2000)Center for Appalachian and Rural. Health Homepage. (2000). Retrieved on October 18, From the World Wide Web: http://main.chem.ohiou.edu. Cross, Roy. The Doctors is Out. The Messenger. (2000, June 28). Damiano, Peter. Transportation of Rural Elders and Access to Health Care. (1995, February). Retrieved on the World Wide Web: http://lime.weeg/edu/nppc/elders.html. Holzer Hospital homepage. (2000). Retrieved on October 21, 2000 from the World Wide Web: http://www.holzerclinic.com. Ideas That Work. (2000). Retrieved on October 22, 2000 from the World Wide Web: http://www.vurdev.usda.gov/ideas/case37. html. Jaklevic C. Mary, For Small Hospital, Critical-access designation has been a financial lifesaver, Modern Healthcare. Lewis, J. Personal Communication. (October 26, 2000). Lord, Peter J. and Johnston. (1982). Your Private Practice. Floria: Peter J. Lord And Associates. Marazon, D. MD. Personal Communication. (October 2000). Morrissey, John. A Fuzzy Picture. (2000, April 7) Retrieved on October 22, 2000 on the World Wide Web: http://web.lexus-nexis.com/univers. Neal, J. Personal Communication. (October 26 and 23, 2000). Ohio University College of Osteopathic Medicine. (2000). Retrieved on October 26,2000 From the World Wide Web: http://www.oucom.ohiou.edu. Operational Telemedicine System. (2000). Retrieved on October 21, 2000 on the World Wide Web: http://www.ncjrs.org/telemedicine/appe.html. Patient Information. Athens, Ohio: University Osteopathic Medical Center. Providing Services for Senior Citizens. Athens Ohio: United Seniors of Athens County.
  18. 18. Health Care in Albany 2 Rollins, Scott MD. A Model for Successful Rural Practices. (2000, March) Retrieved on October 27, 2000 from the World Wide Web: http://www.aafp.org. Scott, Lisa. Will Healthcare Accept the Virtual Doctor? (1994, November 28). Retrieved On October 22, 2000 on the World Wide Web: http://web.lexisnexis.com/univers. Siwicki, Bill. Is There a Doctor in the House? (March 1999) Retrieved on October 21, 2000 from the World Wide Web: http://web.lexis-nexis.com/univers. Spoljaric, Dr. L. Personal Communication (October 23, 2000). Trivison, T. Personal Communication. (October 2000).
  19. 19. Health Care in Albany 3 Appendix A Question #1 Insurance Type Percentage Employer Sponsored 57.6% Private 14% Medicare 25.5% Medicaid 8.6% Question#2 Where Albany Residents Go Town Percentage Albany .57% Athens 67% Jacksonville 11% Nelsonville 5.7% Chillicothe 3.2% Lancaster 11% Gallipolis 9.5% Columbus 19% Other 11% Question#3 Doctor Visits How Often Percentage 1.4% Annually 23.8% Semi Annually 36.7% Monthly 28.4% Every Other Week 4.9% Weekly 0.9% Don’t Go 4.0% Question#4 Same Doctor See Same Dr. Percentage Yes 80.8% No 19.2%
  20. 20. Health Care in Albany 4 Question#5 Distance to Healthcare Provider Time Percentage 5-10 minutes 1.2% 10-20 minutes 8.6% 20-30 minutes 18.6% 30- 60 minutes 18.3% Over an hour 20.6% Question#6 If it Were Closer Will Use Percentage Yes 57% No 43% Question#7 Number in Household Number Percentage 1 0.86% 2 16.9% 3 42.7% 4 20.1% 5 16% 6 3.2% Question#8 Age Demographic Number Percentage 0 67% 1 17% Under 18 2 13% 3 2% 4 0.6% 0 68.8% Over 65 1 17.8% 2 13.5%
  21. 21. Health Care in Albany 5 Question#9 Health Concearns Have Percentage yes 61.89% no 38.11%
  22. 22. Health Care in Albany 6 Appendix B. Building a Medical Clinic In The City of Athens Introduction Building a medical clinic is a very complicated undertaking. A lot of time and thought must be put into the project before the doors can be opened for business. The following paragraphs will take you through this process, all the way from the beginning stages of looking for a good location, to the day the first patient walks through the doors of the facility. Zoning The best zone in which to build a clinic is a B-3(General Business) zone. A clinic could technically be built anywhere, except an open space zone, with approval of the Zoning Commission; However, A B-3 zone is by far the most suitable. A B-3 zone has all the requirements or lack of requirements that make building a clinic as painless as possible. These are: • No minimum lot size • Only a 30ft. minimum lot width • A maximum height of 45ft. or 3 ½ stories • No minimum front yard • Only a 10ft. side yard and 15ft. total width for both side yards • Only a 10ft. rear yard • No maximum lot coverage. For a further explanation of these requirements, see table A at the end of this appendix. Location The location we chose for building a clinic is 175 Columbus Road, which is for sale through Larry Conrath Realty at an asking price of $1,200,000. The lot consists of 33.16 acres. 3.22 of which is located right on Columbus Road. This parcel is where the clinic will be built. The other 29.94 acres is located behind and slightly to the right of the other parcel, this land will be used for two purposes. First, it will be used for fill dirt to raise the building sight above the flood plain. After this has been done the ground can then be made into lots and sold for residential use to reduce the loan payments. The plat map section containing this piece of ground is located at the end of this appendix. This location was chosen for several reasons. First, Columbus Road is located in a B-3 zone, which we already stated would be ideal for a clinic. Second, it is less than a mile
  23. 23. Health Care in Albany 7 from State Route 33, a four-lane highway that passes not only through Athens, but also many other small communities in the area. Third, The Plains a small community with no health care providers is located less than 5 miles away. Finally, this portion of Columbus road is growing rapidly, with new business moving in all the time. This growth will increase traffic and thus, improving public exposure and knowledge of the clinic. Another benefit of this site is the presence of utilities. This lot has city water and sewage hook up, this fact will save several thousand dollars, if not more. The cost of putting in a septic system for a medical clinic would be tremendous, if city sewage was not available at the site. Pre-Construction Considerations There are several things that need to be considered before construction can begin. Deciding how large your clinic will need to be is a logical first step. After a general size has been decided on, an Architect must be contacted. No building plan can be submitted to either the zoning office or the Department of Commerce, Industrial Compliance Division unless it drawn up by a licensed Architect. The plan should include this general information: 1) water and sewer receipt, 2) septic tank permit, 3) property deed, 4) building plans, 5) heating and air, plumbing and electrical permits. The details of these plans are in section 27 of the Athens Revised Code. The applicable sections can be seen at the end of this Appendix. After your plans have been approved by both sectors the site must then be prepared for construction. This is a very complicated procedure in regards to this particular piece of property. According to Steve Pierson, of the Athens County Zoning office, the lot where the clinic will be constructed lies approximately 3 to 4 feet below the 100-year flood plain, which is 657.7ft. above sea level in this particular area. The floor of a newly constructed building is to be one foot above this level. A licensed surveyor must be hired to determine the exact height that the building site needs to be raised. According to Phil Roberts of Phillip M. Roberts INC., a job of this size would cost around $2500-$3000. In addition to an elevation measurement, this survey would also include information on how much dirt would need to be removed from the adjacent hillside, as well as, where on that hillside it should be removed from. Removing the dirt from the hillside will create several other headaches. Whenever dirt is removed in this volume from a hillside in the City of Athens, more plans must be submitted. These plans must include soil test results and projected changes in drainage. They also musts include all aspects of the procedures your contractor intends to use in order to complete the project. The details of these plans can be seen at the end of this Appendix under section 27 of the Athens Revised Code.
  24. 24. Health Care in Albany 8 Building Considerations The actual building of the structure brings up a whole new realm of problems. Care must be taken when picking a contractor. A reputable contractor that knows and is in compliance with all OSHA(Occupational Safety and Health Administration) rules and regulations is a must for successful project. The Americans With Disabilities Act also must be taken into consideration in regard to the building and parking lot. These laws are far too extensive to be practically included in this paper, however they can be viewed in completion at http://www.access-board.gov/adaag/html/adaag.htm#purpose. The facility must have handicapped parking and be fully handicapped accessible. The most cost effective way to achieve this would be by making the structure only one story. The lot is plenty large for nearly any reasonably sized structure, and, making the building only one story would eliminate the added cost of an elevator. The parking lot brings in other Athens zoning regulations. There are several of these rules, such as size of the spaces and drainage of the lot. All of these regulations can be seen at the end of this Appendix under section 23 of the Athens Revised Code. Conclusion As you can see, constructing a medical clinic in the City of Athens is not a simple undertaking. There are numerous factors and regulations that must be taken into consideration before, during, and after construction. Some of these are extremely important and some are not so important, but each of them must carry some weight in your decision making process. While this may seem expensive and complicated right now, five years from now, when the profits are rolling in, it will all seem simple and well worth the effort. .
  25. 25. Health Care in Albany 9 23.10.05.Development and maintenance of parking areas and structures and loading areas. Every parcel of land hereafter used as a public or private parking area for three or more cars, or structure used as a parking garage, or loading area, including a commercial parking lot, shall be developed and maintained in accordance with the following requirements. Plans for such areas shall be reviewed by the city engineer to insure compliance with these regulations. (A) Off-street parking areas or structures and off-street loading areas shall be effectively screened by a fence or hedge. The screening shall be on the sides which adjoin, abut, are adjacent to, or face premises situated in any residential zone or institutional building. (B) No off-street loading area or parking area or part thereof shall be closer than 10 feet to any dwelling, school, hospital or institution for human care located on an adjoining or adjacent lot. (C) Any off-street parking area or off-street loading area shall be paved with asphalt, brick, or concrete to create a hard and durable surface. Crushed stone and gravel surfaces are prohibited. All areas shall be marked so as to provide for the orderly and safe loading, parking and storage of automobiles or trucks. (D) Any lighting used to illuminate any off-street parking or loading area shall be so arranged as to reflect the light away from adjoining premises. Off-street parking facilities for multi-family structures containing 4 or more families shall be adequately lighted.
  26. 26. Health Care in Albany 10 27.03.02. Development requiring prior approval of plans (C) Development Area of One or More Acres Whenever a proposed development area consists of one (1) or more acres, and earth disturbing activities are proposed for the whole area or any part thereof, the developer shall submit for approval a plan for slope stability maintenance, for water management, and for erosion and sediment pollution control. 27.03.03. Procedure for plan submission and review (A) In any situation in which, under Section 27.03.02, approval of plans is required prior to development, it shall be unlawful to perform any earth-disturbing activity until such plans shall have been approved by the City Service-Safety Director. Approval shall take the form of a statement that the plans for land development comply with the provisions of this Title. It shall be the duty of the service-safety director to approve the plans, provided the Director is satisfied that the proposed activities conform with all applicable requirements of this Title. (B) Land development plans shall be filed in duplicate with the Code Enforcement Department of the City of Athens. Upon final approval of the plans by the service-safety director of the City of Athens, one copy of the approved plans shall be returned to the applicant and one retained by the City. (C) All plans, except those prepared by a public entity or agency, shall be accompanied by a filing fee to help defray costs of administration and inspection. The filing fee shall be established by the City Council in separate legislation. (D) Within thirty (30) calendar days of the receipt of a complete land development plan that has been filed in full compliance with all applicable requirements of this Title, the service-safety director shall act to approve or disapprove the plan. The Director shall state approval or disapproval to the applicant in writing. Statement of disapproval shall include the reasons therefor and shall identify the plan deficiencies and shall state the procedures for filing a revised plan. Failure of the service-safety director to act within 30 days shall entitle the applicant to plan approval, unless the applicant consents to an extension of time. (E) Pending preparation and approval of a revised plan,
  27. 27. Health Care in Albany 11 earth-disturbing activities shall proceed only in accordance with conditions outlined by the service-safety director. (F) After the service-safety director has given final approval to a plan, any proposed substantive change shall be submitted in writing to the service-safety director and shall not be undertaken without the Director's written approval, based on the proposal's conformity with the requirements of this Title. 27.03.04. Plan content Plans for parcels of one (1) acre or more shall include the following, in addition to information required in Section 27.02.04(A) and (B), above: (1) Location of the area and its relation to its general surroundings, including: (a) A drainage analysis. (b) Identification and description of offsite areas susceptible to sediment deposits or to erosion caused by accelerated runoff. (c) Identification and description of offsite areas that may pose runoff and erosion problems for the development area. (2) Design computations and applicable assumptions for all structural measures for erosion and sediment pollution control and stormwater management. Volume and velocity of flow must be given for all surface water conveyances and outlets. (3) Certification by persons responsible for development that all earth disturbance, construction, and development will be done pursuant to the plan and to specifications set forth in Water Management and Sediment Control for Urbanizing Areas (Soil Conservation Service, USDA, March, 1987). 27.03.06. Inspection to ensure compliance (A) The City Service-Safety Director or the Director's representative shall inspect development areas, both those for which plan approval is required prior to commencement of development and those for which it is not required, in order to determine compliance with these regulations. If the City or its representative determines that a violation of these regulations exists, the responsible person will be notified of the deficiencies or noncompliance. (B) The inspector or inspecting agency shall also report the deficiency or noncompliance to the City of Athens. Upon determination that a person is not complying with these regulations, the City may issue an
  28. 28. Health Care in Albany 12 order to comply to the property owner or the owner's agent by means of certified mail or personal service. If the certified mail is returned unclaimed, such notice may be sent by regular mail. Such order shall describe the deficiency or noncompliance and shall specify a date by which compliance must be accomplished. If the noncompliance pertains to land development that is underway, the City may also issue to the responsible person a written order to cease and desist the non-complying activity.
  29. 29. Health Care in Albany 13 Appendix C Costs of Opening a Clinic: These are estimated figures Revenue: (46% on average see the doctor monthly 408 x $50/visit) $20,400 (Receive only 48% of medical charges due to Medicare Medicade ($10,608) $9792 Expenses: (interview with Joel Kaiser administrator at the Doctors hospital) Building Rent $500 Salaries: Physisian $12,500 Nurse/secretary $1,300 Benefits (40% of salaries) (Dr. Marinelli) $5,520 Utilites $300 Insurance $400 Equipment ($60,000/10 years no salvage value/12mos.) $500 Net Income ($11,228) Revenue: Data from survey 83 see the doctor annually = 7/mo 128 semi annually = 21/mo 99 month = 99/mo 17 bi weekly = 34/mo 3 weekly = 12 Total 173/376 respondents = 46% of the survey pool visit the doctor monthy 889 citizens in Albany x 46%=408 citizens of Albany who visit the doctor montly
  30. 30. Health Care in Albany 14 Appendix D Costs of Opening a Private Practice: These are estimated figures Revenue: (46% on average see the doctor monthly 408 x $50/visit) $20,400 (Receive only 48% of medical charges due to Medicare Medicaid) ($10,608) $9792 Expenses: (interview with Dr.Spoljaric) Phone System $1200 Room Equipment (32,900 5 year useful life no salvage value) $550 Supplies $165 Insurance $1250 Other $417 Biohazard Pick-up $50 Salaries $4,000 Benefits $1,700 Net Income $460 Revenue: Data from survey 83 see the doctor annually = 7/mo 128 semi annually = 21/mo 99 month = 99/mo 17 bi weekly = 34/mo 3 weekly = 12 Total 173/376 respondents = 46% of the survey pool visit the doctor monthly 889 citizens in Albany x 46%=408 citizens of Albany who visit the doctor monthly
  31. 31. Health Care in Albany 15 Appendix E Amortization of Capital Investment Cost Time Frame Salvage Value Amortized (years) Monthly Cost Installation (3 Systems) Labor $21,270 20 $89 Travel $13,464 20 $56 Equipment $11572 10 $1,875 $81 Material $20,594 20 $86 Rental $7,358 20 $31 Fixtures $21,135 10 $3,424 $148 Freight $1,883 10 $16 Total Installation $97,277 - $507 Cost Training $19,674 5 $328 Equipment (1 System) Baseline $64,500 10 $10,440 $450 Telemedicine System Digital Stethoscope $3,225 10 $522 $23 Intraoral Camera $5,375 10 $871 $38 Total Equipment $73,100 $11,833 $511 Cost Communications ISDN $1,800 10 $15 The above information was taken from Operational Telemedicine System, 2000. Funding information Funding for existing telemedicine systems has been provided by federal and state grants. For instance, according to the Center for Public Services Communication, federal telemedicine grants were approximately $25 million dollars in 1994. State governments have also provided money for telemedicine research. In 1994, Oklahoma planned to spend $4.3 million to put telemedicine systems into 39 rural hospitals (Scott, 1994). Another source of telemedicine funds is private industry. For example, BellSouth Communications and GTE funded a telemedicine project at the University of South Carolina. Raytheon Co. used telemedicine to connect different health care facilities to Houston’s Texas Medical Center (Scott, 1994).

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