For Independent Medical Practices In Central Ohio Sponsored by: Central Ohio Trauma System Ohio Department of Health Colum...
CME & Disclosures <ul><li>Ohio State Medical Association </li></ul><ul><li>1.5  AMA PRA Category 1 Credits ™ </li></ul><ul...
It’s Coming <ul><li>“ One of the most important public health issues our Nation and the world faces is the threat of a glo...
Experience Shows Number of Episodes of Illness, Healthcare Utilization, and Death Associated with Moderate and Sever Pande...
Impact in Central Ohio <ul><li>2000 Census for Franklin County  1,068,978* </li></ul><ul><ul><li>30% infection rate  320,6...
From Outbreak to Pandemic <ul><li>Outbreak </li></ul><ul><ul><li>Sudden onset of a virus that spreads rapidly </li></ul></...
MGMA Connexion, January 2009, Pg 13
Focus for Medical Practices <ul><li>Pandemic Response Plan Includes: </li></ul><ul><ul><li>Clinical Care Plan </li></ul></...
<ul><li>For Medical Offices </li></ul>
Necessary Components <ul><li>Create an internal flu monitoring system </li></ul><ul><li>Diagnosing Influenza-Like-Illness ...
Flu Monitoring System <ul><li>Use various methods for diagnosing influenza cases </li></ul><ul><ul><li>Rapid testing </li>...
Flu Monitoring System  (continued) <ul><li>Signs & Symptoms of Seasonal Flu </li></ul><ul><ul><ul><li>Acute infection of r...
Diagnosing ILI  (Influenza-Like-Illness) History of  Recent Exposure Potential Occupational Exposure and  either/both Curr...
Diagnosing ILI  I.  Clinical Criteria <ul><li>Temperature > 101 o F – 102 o F </li></ul><ul><li>Cough, sore throat, or dys...
Diagnosing ILI II . History of Recent Exposure <ul><li>Recent travel to an affected area </li></ul><ul><li>Close contact w...
Diagnosing ILI III . Employment in an Occupation at Risk <ul><li>Healthcare worker in direct contact with  </li></ul><ul><...
Diagnosing ILI Collecting Lab Specimen <ul><li>Collect ALL of the following: </li></ul><ul><ul><li>Nasopharyngeal swab </l...
Responding to Suspected Cases <ul><li>If “YES” to either Recent or Occupational exposure: </li></ul><ul><ul><li>Initiate s...
Infection Control <ul><li>“ The period when an infected person is contagious depends on the age of the person. Adults may ...
Infection Control  (Continued) <ul><li>Goal: Care for the sick and do not expose the healthy </li></ul><ul><li>Practices n...
Infection Control  (Continued) Personal Protective Equipment (PPE) <ul><li>OSHA has outlined the following PPE to be used:...
Antiviral Medications and Vaccinations <ul><li>Antiviral medications for a novel influenza strain require 6 months to prep...
Other Considerations <ul><li>Dual Medical Responsibility </li></ul><ul><li>Additional space needs </li></ul><ul><li>Increa...
<ul><li>For Medical Offices </li></ul>
Necessary Components <ul><li>Budgeting and stockpiling of medical supplies </li></ul><ul><li>Purchasing and storage of med...
Budgeting and Stockpiling  <ul><li>Access to Supplies </li></ul><ul><ul><li>Stockpile necessary medical supplies </li></ul...
Purchasing and Storage of Disposable Medical Supplies <ul><li>CMA will maintain an emergency stockpile of limited supplies...
Antivirals & Vaccines <ul><li>HHS recommends against offices stockpiling antivirals </li></ul><ul><ul><ul><li>Individual p...
Education and Training <ul><li>“ to ensure that all personnel understand  </li></ul><ul><li>the implications of, and contr...
Budgeting for Temporary  Reduction in Cash Flow <ul><li>Anticipate a disruption in the billing & revenue cycle </li></ul><...
Anticipate Significant Loss of Available Personnel <ul><li>In the worst scenarios, as much as 25% of the population could ...
Sick-Leave Policy <ul><li>Consider modifications to address: </li></ul><ul><ul><li>Onset of ILI symptoms in the workplace ...
Temporary Office Closure <ul><ul><li>Practice size matters </li></ul></ul><ul><ul><li>Who will decide to close the office ...
<ul><li>For Medical Offices </li></ul>
Necessary Components <ul><li>Practice personnel should consider how to address: </li></ul><ul><ul><li>School and daycare c...
<ul><li>Questions and Answers </li></ul>
<ul><li>For Medical Offices </li></ul>
Reporting Form for ILI Cases <ul><li>http://www.ncid.cdc.gov/flu/H5Forms/H5CSF_Revised27Feb04.pdf   </li></ul>
Supplies U/M Order Qty* Cost/Unit Total Cost Antimicrobial Soap 12/case 4 $40.80 $163.20 Anti-bacterial lotion (waterless)...
Education and Training Programs  for Pandemic Influenza <ul><ul><li>CDC   http://www.cdc.gov/flu/professionals/training/  ...
Necessary Cash On-Hand Required to Stay Open Per FTE Physician 25% Impact    Projection 1 Projection 2 Projection 3 Day's ...
Upcoming SlideShare
Loading in …5
×

For Independent Medical Practices In Central Ohio

441 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
441
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
4
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • The number of illnesses in both Severe and Moderate pandemics reached 30% of the then current population. The illness rate of 90 million listed here is 30% of the 2005 estimated population as provided by US Census Dept. The moderate pandemic saw only 8.74% as many patients hospitalized over its Severe pandemic counterpart. This means there were many more people sick with influenza, but they were much less likely to be hospitalized. Likewise, only 8.67% received ICU care, 8.74% used a mechanical ventilation, and only 10.98% of the number of deaths.
  • Percentage of death rates uses the same ratio as listed on the last slide for each pandemic size
  • Tracking possible cases Consider using a unique $ 0 code posted to the account Consider using the CDC form to capture necessary data, rather than creating your own
  • Clinical criteria: Accute infection of the respiratory tract characterized by fever (101 0 -102 0 F, usually abrupt onset), chills, headache, myalgia, prostration, coryza, sore throat and cough GI symptoms (nausea, vomiting, diarrhea) sometimes occur in children Most uncomplicated infections subside in 3-7 days Complications associated with
  • Local employers who pose a potential for False Positives -Happy Chicken Farms: Lewis Center Ohio
  • For Independent Medical Practices In Central Ohio

    1. 1. For Independent Medical Practices In Central Ohio Sponsored by: Central Ohio Trauma System Ohio Department of Health Columbus Medical Association
    2. 2. CME & Disclosures <ul><li>Ohio State Medical Association </li></ul><ul><li>1.5 AMA PRA Category 1 Credits ™ </li></ul><ul><li>As a provider accredited by the Accreditation Council for Continuing Medical Education, the Ohio State Medical Association, who is certifying this activity for CME credit, requires planning members and faculty to disclose if they have any financial relationships with commercial interests that would be considered in conflict with this presentation. The content of this presentation does not relate to any product of a commercial interest. Neither the speakers nor any planning committee member has any financial relationships with commercial interests to disclose. </li></ul><ul><li>MGMA / ACMPE </li></ul><ul><li>2.0 Continuing Education Units </li></ul>
    3. 3. It’s Coming <ul><li>“ One of the most important public health issues our Nation and the world faces is the threat of a global disease outbreak called a pandemic. </li></ul><ul><li>No one in the world today is fully prepared for a pandemic – but we are better prepared today than we were yesterday - and we will be better prepared tomorrow than we are today.” </li></ul><ul><li>Mike Leavitt, Health & Human Services Secretary </li></ul>
    4. 4. Experience Shows Number of Episodes of Illness, Healthcare Utilization, and Death Associated with Moderate and Sever Pandemic Influenza Scenarios* Source: 2006 HHS Pandemic Influenza Plan
    5. 5. Impact in Central Ohio <ul><li>2000 Census for Franklin County 1,068,978* </li></ul><ul><ul><li>30% infection rate 320,693 </li></ul></ul><ul><ul><li>50% seeking outpatient medical care 160,347 </li></ul></ul><ul><ul><li>Potential death rate </li></ul></ul><ul><ul><li>Moderate impact (0.23%) 2,459 </li></ul></ul><ul><ul><li>Severe impact (2.1%) 22,449 </li></ul></ul><ul><ul><li>*2000 Ohio County Profiles: Franklin County </li></ul></ul>
    6. 6. From Outbreak to Pandemic <ul><li>Outbreak </li></ul><ul><ul><li>Sudden onset of a virus that spreads rapidly </li></ul></ul><ul><ul><li>Localized to a community or region </li></ul></ul><ul><ul><li>High mortality rate </li></ul></ul><ul><ul><li>Those infected are asymptomatic during initial onset (show no evidence of the disease) </li></ul></ul><ul><li>Pandemic </li></ul><ul><ul><li>An outbreak that spreads worldwide </li></ul></ul><ul><ul><li>Near-simultaneous outbreaks in communities across the US </li></ul></ul><ul><ul><li>Enormous demand on healthcare system </li></ul></ul><ul><ul><li>Delays & shortage of vaccines </li></ul></ul><ul><ul><li>Disruption of community and national infrastructures </li></ul></ul>
    7. 7. MGMA Connexion, January 2009, Pg 13
    8. 8. Focus for Medical Practices <ul><li>Pandemic Response Plan Includes: </li></ul><ul><ul><li>Clinical Care Plan </li></ul></ul><ul><ul><li>Business Continuity Plan </li></ul></ul><ul><ul><li>Personal and Family Response Plan </li></ul></ul>
    9. 9. <ul><li>For Medical Offices </li></ul>
    10. 10. Necessary Components <ul><li>Create an internal flu monitoring system </li></ul><ul><li>Diagnosing Influenza-Like-Illness (ILI) </li></ul><ul><li>Responding to suspected cases </li></ul><ul><li>Infection control </li></ul><ul><li>Antiviral medications and vaccines </li></ul><ul><li>Other considerations </li></ul>
    11. 11. Flu Monitoring System <ul><li>Use various methods for diagnosing influenza cases </li></ul><ul><ul><li>Rapid testing </li></ul></ul><ul><ul><li>Culturing by an appropriate lab </li></ul></ul><ul><ul><li>Watch for signs and symptoms of </li></ul></ul><ul><ul><li>seasonal influenza </li></ul></ul><ul><li>Track possible cases </li></ul><ul><ul><li>Consider monitoring all seasonal flu cases for experience </li></ul></ul><ul><ul><li>Necessary information to track for the CDC form </li></ul></ul><ul><ul><ul><li>Demographics, Onset & duration, Related past medical history, Treatment regimen, Travel, Contacts potentially exposed, etc. </li></ul></ul></ul>
    12. 12. Flu Monitoring System (continued) <ul><li>Signs & Symptoms of Seasonal Flu </li></ul><ul><ul><ul><li>Acute infection of respiratory tract </li></ul></ul></ul><ul><ul><ul><li>Fever (101 o F – 102 o F), usually with an abrupt onset </li></ul></ul></ul><ul><ul><ul><li>GI symptoms (nausea, vomiting, diarrhea) </li></ul></ul></ul><ul><ul><ul><li>Generally subside in 3-7 days </li></ul></ul></ul><ul><ul><ul><li>Watch for complications </li></ul></ul></ul><ul><ul><ul><ul><li>Febrile convulsions </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Viral pneumonia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Bacterial pneumonia </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Otitis media </li></ul></ul></ul></ul>
    13. 13. Diagnosing ILI (Influenza-Like-Illness) History of Recent Exposure Potential Occupational Exposure and either/both Current Signs of Illness I II III CLINICAL CRITERIA EPIDEMIOLOGIC CRITERIA
    14. 14. Diagnosing ILI I. Clinical Criteria <ul><li>Temperature > 101 o F – 102 o F </li></ul><ul><li>Cough, sore throat, or dyspnea (labored breathing) </li></ul><ul><li>Requires hospitalization, or has a strong epidemiologic link </li></ul><ul><li>AND </li></ul>
    15. 15. Diagnosing ILI II . History of Recent Exposure <ul><li>Recent travel to an affected area </li></ul><ul><li>Close contact with a person with suspected or confirmed novel influenza </li></ul><ul><li>Close contact with a person who died or was hospitalized due to a severe respiratory illness </li></ul>
    16. 16. Diagnosing ILI III . Employment in an Occupation at Risk <ul><li>Healthcare worker in direct contact with </li></ul><ul><li>suspected or confirmed novel influenza case </li></ul><ul><li>Worker in a Lab that contains live novel influenza viruses </li></ul><ul><li>Worker in a poultry farm, live poultry market, or poultry processing operation with a known or suspected avian flu infection </li></ul>
    17. 17. Diagnosing ILI Collecting Lab Specimen <ul><li>Collect ALL of the following: </li></ul><ul><ul><li>Nasopharyngeal swab </li></ul></ul><ul><ul><li>Nasal swab </li></ul></ul><ul><ul><li>Throat swab </li></ul></ul><ul><ul><li>Tracheal aspirate (if intubated) </li></ul></ul><ul><li>Storing specimen: </li></ul><ul><ul><li>Place into viral transport media </li></ul></ul><ul><ul><li>Refrigerate at 4 o C </li></ul></ul>
    18. 18. Responding to Suspected Cases <ul><li>If “YES” to either Recent or Occupational exposure: </li></ul><ul><ul><li>Initiate standard and droplet precautions </li></ul></ul><ul><ul><li>Treat as clinically indicated </li></ul></ul><ul><ul><li>Notify Communicable Disease Response System </li></ul></ul><ul><ul><li>CDRS (614) 719-8888 ext 1 (24 hours) </li></ul></ul><ul><ul><li>Initiate general work-up as clinically indicated </li></ul></ul><ul><ul><li>Collect and submit specimen for Novel Influenza virus testing to the practice’s preferred laboratory </li></ul></ul><ul><ul><li>Begin empiric antiviral treatment </li></ul></ul><ul><ul><li>Help identify all contacts, including healthcare workers </li></ul></ul>
    19. 19. Infection Control <ul><li>“ The period when an infected person is contagious depends on the age of the person. Adults may be contagious from one day before becoming sick and for three to seven days after symptoms develop. Some children may be contagious for longer than a week” </li></ul><ul><li>Source: “Influenza Fact Sheet”, Ohio Dept of Health, 2005 </li></ul>Pre-Symptom Onset of Symptoms 0 1 2 3 4 5 6 7 8 9 10 Potential Contagious Duration for an Adult Potential Contagious Duration for a Child
    20. 20. Infection Control (Continued) <ul><li>Goal: Care for the sick and do not expose the healthy </li></ul><ul><li>Practices need an alternate plan </li></ul><ul><li>for patient flow during a Pandemic: </li></ul><ul><ul><li>Reschedule non-urgent office visits </li></ul></ul><ul><ul><li>Triage appointments by phone before visit and redirect ILI cases </li></ul></ul><ul><ul><li>Require appropriate infection control measures for all patients, family, transport, vendors, personnel, etc: </li></ul></ul><ul><ul><ul><li>Hand Hygiene/Cough Etiquette & Appropriate use of PPE </li></ul></ul></ul><ul><ul><ul><li>Separation of ILI-patients from others </li></ul></ul></ul>
    21. 21. Infection Control (Continued) Personal Protective Equipment (PPE) <ul><li>OSHA has outlined the following PPE to be used: </li></ul><ul><ul><li>Contact Precautions </li></ul></ul><ul><ul><ul><li>Gloves and Gowns - New gloves and gown for each patient </li></ul></ul></ul><ul><ul><ul><li>Use disposal equipment if possible (Thermometers, BP Cuffs) </li></ul></ul></ul><ul><ul><ul><li>Disinfect other equipment between each patient (stethoscope) </li></ul></ul></ul><ul><ul><li>Droplet Precautions </li></ul></ul><ul><ul><ul><li>Goggles when within 3 feet of the patient </li></ul></ul></ul><ul><ul><li>Airborne Precautions </li></ul></ul><ul><ul><ul><li>Face Masks for patients and visitors </li></ul></ul></ul><ul><ul><ul><li>N95 Respirators for personnel </li></ul></ul></ul><ul><ul><ul><li>(requires fit testing) </li></ul></ul></ul>
    22. 22. Antiviral Medications and Vaccinations <ul><li>Antiviral medications for a novel influenza strain require 6 months to prepare </li></ul><ul><li>HHS will distribute vaccines from the national stockpile, coordinated by local health authorities </li></ul><ul><li>Healthcare workers are among the first to receive the vaccine, followed by high-risk individuals </li></ul>
    23. 23. Other Considerations <ul><li>Dual Medical Responsibility </li></ul><ul><li>Additional space needs </li></ul><ul><li>Increased hours of operation </li></ul><ul><li>Staff communications outside the office </li></ul><ul><li>Security considerations </li></ul><ul><li>Patient transport </li></ul><ul><li>Handling patient deaths in the office </li></ul><ul><li>Monitoring stress indicators of personnel </li></ul>
    24. 24. <ul><li>For Medical Offices </li></ul>
    25. 25. Necessary Components <ul><li>Budgeting and stockpiling of medical supplies </li></ul><ul><li>Purchasing and storage of medical supplies </li></ul><ul><li>Antivirals and Vaccines </li></ul><ul><li>Education and training of personnel </li></ul><ul><li>Budgeting for temporary reduction in cash flow </li></ul><ul><li>Anticipate significant loss of available personnel </li></ul><ul><li>Potential changes to sick-leave policy </li></ul><ul><li>Temporary closure of the practice </li></ul>
    26. 26. Budgeting and Stockpiling <ul><li>Access to Supplies </li></ul><ul><ul><li>Stockpile necessary medical supplies </li></ul></ul><ul><ul><li>Determine need & purchase over time </li></ul></ul><ul><ul><li>Employ FIFO rule </li></ul></ul><ul><ul><li>Consider warehousing and security needs </li></ul></ul><ul><li>Disposable Supplies </li></ul><ul><ul><li>Hand hygiene supplies </li></ul></ul><ul><ul><li>Face masks and respirators </li></ul></ul><ul><ul><li>Face shields, gowns, gloves </li></ul></ul><ul><ul><li>Blood pressure cuffs </li></ul></ul><ul><ul><li>Thermometers </li></ul></ul><ul><ul><li>Facial tissue paper </li></ul></ul>
    27. 27. Purchasing and Storage of Disposable Medical Supplies <ul><li>CMA will maintain an emergency stockpile of limited supplies for 20 days for the region </li></ul><ul><ul><ul><li>N95 Respirators, Gloves, Gowns, & Face Masks </li></ul></ul></ul><ul><li>Practices should accumulate a 10 day stockpile </li></ul><ul><ul><ul><li>Above items plus hand cleaners, BP cuffs, thermometers, tissue </li></ul></ul></ul><ul><ul><ul><li>Store in a safe and secure space to protect from: </li></ul></ul></ul><ul><ul><ul><ul><li>Unintended Use </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Accidental Damage or Theft </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Consider impact from natural environment (temperature, light, moisture, etc) </li></ul></ul></ul></ul><ul><ul><ul><li>Rotate supplies to reduce waste from expiring </li></ul></ul></ul>
    28. 28. Antivirals & Vaccines <ul><li>HHS recommends against offices stockpiling antivirals </li></ul><ul><ul><ul><li>Individual purchases require prescription </li></ul></ul></ul><ul><ul><ul><li>Expensive with Rx (Per dose: Tamiflu® $7-$8/ Relenza® $90-$105)* </li></ul></ul></ul><ul><ul><ul><ul><li>3-5 times more expensive without Rx, authorized purchasers only </li></ul></ul></ul></ul><ul><ul><ul><li>Shelf Life (Tamiflu® – 36 mo / Relenza® – 60 mo) </li></ul></ul></ul><ul><li>National Stockpile Activities </li></ul><ul><ul><ul><li>Ohio is ahead of its accumulation target: </li></ul></ul></ul><ul><ul><ul><ul><li>25% of population by 2010, enough to cover Tier 1 individuals </li></ul></ul></ul></ul><ul><ul><ul><ul><li>In 2010, set new stockpile target </li></ul></ul></ul></ul><ul><ul><ul><li>Distribution will be conducted by HHS and carried out by Ohio DOH </li></ul></ul></ul><ul><ul><ul><li>*Current pricing as of December 2008 </li></ul></ul></ul>
    29. 29. Education and Training <ul><li>“ to ensure that all personnel understand </li></ul><ul><li>the implications of, and control measures </li></ul><ul><li>for pandemic flu” –CDC, 2006 </li></ul><ul><ul><li>Identify a person with appropriate authority to coordinate training </li></ul></ul><ul><ul><li>Identify medical training programs (web-based & local) </li></ul></ul><ul><ul><li>Educate on infection control measures to prevent spread </li></ul></ul><ul><ul><li>Conduct an annual disaster drill which includes response to pandemic flu </li></ul></ul>
    30. 30. Budgeting for Temporary Reduction in Cash Flow <ul><li>Anticipate a disruption in the billing & revenue cycle </li></ul><ul><li>Establish a Rainy Day Fund </li></ul><ul><ul><li>Discuss specific options with your accountant </li></ul></ul><ul><ul><li>How much the practice spends on average each day </li></ul></ul><ul><ul><li>How many days the disruption will last (6-8 wks) </li></ul></ul><ul><ul><li>How much disruption to expect (25%-35%) </li></ul></ul>
    31. 31. Anticipate Significant Loss of Available Personnel <ul><li>In the worst scenarios, as much as 25% of the population could be impacted </li></ul><ul><li>Practices should prepare for a temporary reduction in their workforce </li></ul><ul><ul><ul><li>Cross-train personnel to perform critical tasks </li></ul></ul></ul><ul><ul><ul><li>Focus on episodic care, avoiding unnecessary clinical steps </li></ul></ul></ul><ul><ul><ul><li>Change workflow to accommodate critical needs </li></ul></ul></ul><ul><ul><ul><li>Cancel unrelated or non-critical patient appointments </li></ul></ul></ul><ul><ul><ul><li>Eliminate unnecessary business office tasks </li></ul></ul></ul>
    32. 32. Sick-Leave Policy <ul><li>Consider modifications to address: </li></ul><ul><ul><li>Onset of ILI symptoms in the workplace </li></ul></ul><ul><ul><li>Care for family members </li></ul></ul><ul><ul><li>Access to, or leave for counseling services </li></ul></ul><ul><li>Healthcare facilities must prepare to: </li></ul><ul><ul><li>Protect healthy personnel from exposure </li></ul></ul><ul><ul><li>Evaluate and manage symptomatic and ill personnel </li></ul></ul>
    33. 33. Temporary Office Closure <ul><ul><li>Practice size matters </li></ul></ul><ul><ul><li>Who will decide to close the office </li></ul></ul><ul><ul><li>What triggers will be included </li></ul></ul><ul><ul><ul><li>Space limitations </li></ul></ul></ul><ul><ul><ul><li>Overwhelming reduction in staff </li></ul></ul></ul><ul><ul><ul><li>Lack of necessary medical supplies </li></ul></ul></ul><ul><ul><li>What resources may be reassigned </li></ul></ul><ul><ul><ul><li>Healthy personnel, medical supplies, available office space </li></ul></ul></ul><ul><ul><li>Who will reassign available resources </li></ul></ul><ul><ul><ul><li>Potential support from a local Incident Command Center </li></ul></ul></ul>
    34. 34. <ul><li>For Medical Offices </li></ul>
    35. 35. Necessary Components <ul><li>Practice personnel should consider how to address: </li></ul><ul><ul><li>School and daycare center closings </li></ul></ul><ul><ul><li>Medical care for chronically ill </li></ul></ul><ul><ul><li>Essential services may be disrupted </li></ul></ul><ul><ul><ul><ul><li>Banks, restaurants, post offices, telephone companies, etc </li></ul></ul></ul></ul><ul><ul><li>Preparing a written family response plan </li></ul></ul><ul><ul><li>Family food storage </li></ul></ul><ul><ul><li>Rainy day fund for each family member </li></ul></ul>
    36. 36. <ul><li>Questions and Answers </li></ul>
    37. 37. <ul><li>For Medical Offices </li></ul>
    38. 38. Reporting Form for ILI Cases <ul><li>http://www.ncid.cdc.gov/flu/H5Forms/H5CSF_Revised27Feb04.pdf </li></ul>
    39. 39. Supplies U/M Order Qty* Cost/Unit Total Cost Antimicrobial Soap 12/case 4 $40.80 $163.20 Anti-bacterial lotion (waterless) 12/case 4 $181.32 $725.28 Disposable Face Masks 50/box 160 $12.95 $2,072.00 Disposable (N95 Compliant) Respirators 30/box 60 $10.93 $655.80 Face Shields, Disposable 24/box 75 $35.49 $2,661.75 Gowns 50/case 29 $34.99 $1,007.71 Gloves 1000/case 13 $68.90 $909.48 Disposable BP Cuffs 5/box 320 $36.19 $11,580.80 Disposable thermometers 100/box 16 $15.75 $252.00 Facial Tissues 30/case 4 $21.65 $86.60 Subtotal Costs $20,114.62 Taxes and shipping not included * Staffing assumes 2 physicians, 4 clinical assistants and 3 administrative staff. Patient volume assumes 40 ILI patients per day, 5 days per week, 8 weeks
    40. 40. Education and Training Programs for Pandemic Influenza <ul><ul><li>CDC http://www.cdc.gov/flu/professionals/training/ </li></ul></ul><ul><ul><li>HHS http://www.hhs.gov/pandemicflu/plan/sup4.htm </li></ul></ul><ul><ul><li>Ohio Dept of Health https://oh.train.org/DesktopShell.aspx?tabid=1 </li></ul></ul>
    41. 41. Necessary Cash On-Hand Required to Stay Open Per FTE Physician 25% Impact   Projection 1 Projection 2 Projection 3 Day's Cash On-Hand 45 60 90 Anticipated Impact 25% 25% 25% Avg Daily Operating Cost * $1,625 $1,625 $1,625 Required Cash On-Hand $18,276 $24,368 $36,552 35% Impact   Projection 4 Projection 5 Projection 6 Day's Cash On-Hand 45 60 90 Anticipated Impact 35% 35% 35% Avg Daily Operating Cost * $1,625 $1,625 $1,625 Required Cash On-Hand $25,586 $34,115 $51,173             *Median Total Operating Cost from 2007 MGMA Cost Survey; Table 1.4c Operating Cost per FTE Physician All Multispecialty; TC/NPP excluded; Adjusted to 1/250 of total median figure (50 weeks x 5 days per week).

    ×