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									Providing Health Care to the Citizens

          Of Albany, Ohio




              Prepared for

               Paul Ploutz
         The L.E.A.D.E.R. Team
         Albany Village Council
          Albany, Ohio 45710




              Prepared by

  Rural Health Care Consultants: Team 1
               Jessica Beck
             David Benseler
               Nicole Hutto
               Ryan Rieger
             Holly Seckinger
              Copeland Hall
           Athens, Ohio 45701




            February 1, 2010




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                                                               Health Care in Albany   ii



Nicole Hutto
Copeland Hall
Athens, Ohio 45701

October 30, 2000

The L.E.A.D.E.R. Team
Albany Village Council
Albany, Ohio 45710

Dear Mr. Ploutz:

Here is the copy of the report you requested on the best way to provide health care to meet the
needs of the Albany community. Our report is based on extensive research over the last two
weeks of many different alternatives. We narrowed our alternatives by using four criteria:

      Effectiveness
      Cost
      Desirability
      Time

Based on our research, we believe the best alternative for providing health care to the community
of Albany is to continue to utilize existing medical facilities around the area. The reason we
believe this is the best alternative is because it meets the above specific criteria.

The citizens of Albany need to focus their time and energy on improving other aspects of the
community. These include developing a better school system and implementing a sewage
system.

A health care facility is not necessary at this time. Athens is only eleven miles away and
provides many needed health care services. Retired physician Dr. Baumgaertel has had very few
patients over the last two years. Since then the citizens of Albany are traveling to surrounding
areas for healthcare needs. Only approximately half of the people surveyed in the Albany area
said they would use a new facility if one was started.

We hope you find our recommendation helpful and would like to thank you for giving us the
opportunity to help challenge ourselves.

Sincerely,




Nicole Hutto, Team 1
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                                                                                                Health Care in Albany                iii



                                                        Table of Contents


Letter of Transmittal ............................................................................................................ i

Executive Summary ........................................................................................................... iii

List of Illustrations ............................................................................................................. iv

Introduction ..........................................................................................................................1

    Purpose............................................................................................................................1

    Criteria ............................................................................................................................1

    Alternatives .....................................................................................................................1

Clinic ....................................................................................................................................2

Private Practice ....................................................................................................................4

Transportation Service .........................................................................................................7

Status Quo ............................................................................................................................9

Recommendation ...............................................................................................................10

Conclusion .........................................................................................................................10

References ..........................................................................................................................11

Appendix A: Zoning Laws and Regulations ......................................................................13

Appendix B: Chart of Revenues for Clinic ........................................................................19

Appendix C: Survey Results ..............................................................................................20

Appendix D: Chart of Expenses for Family Practice ........................................................23




                                                                          ii
                                                                Health Care in Albany    iv


                                       Executive Summary

Albany, Ohio is currently facing the loss of their sole medical practitioner. This leaves the
citizens of city with a health care dilemma. What should be done to provide a physician to the
area?

Four different criteria have been established in order to find a solution to this problem.

      Effectiveness- Is this solution effective for the city?
      Cost- Is the cost of the solution feasible for the community and doctors?
      Desirability- Is the solution desirable for the citizens and the investors?
      Time- Will the solution take too long to implement?

Utilizing these criteria, alternatives have been assessed and evaluated using the above criteria.
Following is a chart and a brief explanation as to why it is a good or bad solution:

      Clinic- very effective, too expensive, desirable to the people of Albany, and somewhat
       timely
      Private Practice- effective, too expensive, desirable to about half of the population, and
       timely
      Transportation- not completely effective, fairly inexpensive, not extremely desirable,
       and timely
      Status Quo- very effective, costs no money, desirable to community, timely

In evaluation of the alternatives, status quo sticks out as the most effective solution to the
problem. This is the most effective solution because the Albany area has been without a doctor
for the past couple of years. Dr. Baumgaertel has only seen a select number of patients with in
that amount of time. The phone survey showed that many citizens of Albany saw the same
doctor every time they needed physician care and they would not switch if one were more
convenient.

The citizens of Albany need to focus their time and energy on improving other aspects of the
community. Some of these factors include a better school and sewer system. Keeping their
energies out of health care issues will give them time to work on these issues.




                                                 iii
Health Care in Albany   v
                                                List of Illustrations

Tables

Table 1: Time Table for a Transportation System ........................................................................8

Table 2: Where Albany is Receiving Health Care ........................................................................9




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Health Care in Albany   ii
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                                                               Health Care in Albany   1


                                       INTRODUCTION

What is the best way to provide healthcare that meets the needs of the Albany community? This
is the problem facing the citizens of the community. After Dr. William Baumgartael retired, it
left the city with out a family practitioner. This is not a new problem, since Dr. Baumgaertel had
not been practicing medicine for quite a while due to his age. During the past few years, he had
only been treating long time patients with whom he had built a reputation (Kaiser 2000).

Joel Kaiser, chief operating officer at Doctor’s Hospital in Nelsonville, believes that the real
problem lies beyond the doctor leaving. He maintains that Dr. Baumgaertel had not kept up a
strong practice for several years. This left residents without a physician nearby, and forced them
to travel great distances for quality health care. Perhaps, the citizens of Albany desire a
convenient facility in their own community.

                                              Purpose
The L.E.A.D.E.R. Team, a select group of citizens from the village of Albany, has contracted
Rural Health Care Consultants to research health care in Albany. The L.E.A.D.E.R Team
believes that Albany has a great potential for growth. Because of this growth potential, it is
necessary to analyze the health care options of the Albany community.

                                             Criteria
These criteria are based on relevant health care issues. Utilizing these criteria, the
recommendation benefits both the village of Albany and the investors of the health care option.
The criteria mentioned below are ranked in descending order of importance:

      Effectiveness- Does the alternative effectively solve the health care problem in Albany?
      Cost- Does the cost of the alternative outweigh the risk for the investor and does it keep
       the cost of health care reasonable for the citizens of Albany?
      Desirability- Do the people of Albany want the health care option?
      Time- How long will the implementation process take?

In analyzing the alternatives with this set of criteria, Rural Health Care Consultants recommend
that Albany, Ohio stay with the status quo and the citizens should keep going to surrounding
areas for health care.

                                          Alternatives
Four workable alternatives exist as a means to provide health care in Albany. They include:

      Clinic- Using the existing clinic building and bring in several doctors to practice
       medicine
      Private Practice- Bringing a family doctor into town and setting up a small practice
      Transportation Service- Establishing a shuttle van service by OU-COM
      Status Quo- Keeping health care as it is in the town; sending patients to other areas of the
       county
                                                                 Health Care in Albany    2


                                              CLINIC

The Albany area currently has an abandoned doctors office formally owned by Dr. Scott Smith.
While in practice, Dr. Smith acquired nearly 30 patients a day (Seckinger 2000). After Dr. Smith
practice closed, these patients all found alternatives to his health care facility. The building and
ground, which includes forty-seven acres, is currently for sale for $600,000, a price that is
negotiable (Bloom 2000).

The building itself has three floors. The first is where Dr. Smith’s actual practice was located,
with a receptionist area and examining rooms. It is also equipped with an x-ray room containing
lead walls and doors for the safety of the patients. The second floor was mainly used for staff
during their leisure time. The basement, which is not yet finished, was to be a physical therapy
and childcare facility. Contractors have estimated that it would cost between $75,000 to
$150,000 to finish (Bloom 2000).

Staffing a clinic of three to five doctors in this building to some extent fits into the criteria of
cost, time, effectiveness, and desirability. However, there are also many possibilities as to why
this building has been abandoned since the physician left.

                                            Effectiveness
The use of a clinic is an effective way of adhering to the needs of the community’s patients. A
clinic would provide a wide range of services to area. Furthermore, they would no longer have
to travel far for emergencies or drive miles out of their way for a diagnosis of the common cold
or flu. A clinic would cater to many areas of medicine for all age groups.

                                                Cost
Existing conditions, as well as the numerous options as to who is going to be financially
responsible for a clinic will have to be well thought out.

Some of the renovation expenses will include a second floor exit, a laundry room and cleaning
kitchen, an decorating to bring the facility to an updated look, and an evaluation done by an
architect or other building professional to assess the conditions of the key building elements.
This professional will be looking at elements such as the roof, walls, doors, windows,
foundation, stairs, plumbing, and electrical systems (Making your Clinic Building Work, 2000).

After the building passes inspection laws, it will need to be equipped with all the essential
physician tools and a budget for fixed cost expenses. Some of these expenses include basic such
as electric, water, sewer, fuel for generator, light bulbs, cleaning supplies, garbage, and a phone
system.

With all of these one time and monthly expenses in is clear that Albany themselves as a village
cannot afford a clinic at this time, though, they have a few options as to who can fund this clinic.
                                                                 Health Care in Albany    3


One option is to link it to an already existing, well-established health care facility. Such as one
of the following:

      OU-COM
      Holzer
      Rotating Doctors

UOMC
UOMC, also known as University Osteopathic Medical Center, has grown to become one of the
leading health-care providers in Southeastern Ohio, in only 21 years of existence (Caring for
your Community, 2000). It is a multi-specialty, outpatient clinic made up of more than 60
physicians who also serve as the faculty for the Ohio University College of Osteopathic
Medicine, giving them up-to-date medical knowledge (Patient Information).

Physicians at UOMC practice a variety of specialties including arthritis services, cardiovascular
services, ear nose and throat, family, geriatric, and internal, obstetrics/gynecology, orthopedics,
osteopathic manipulation, pathology, pediatrics, and surgery (Caring for your Community,
2000).

UOMC is already located in numerous locations throughout Athens County, including Parks Hall
Clinic and O’Bleness in Athens, the Coolville Clinic, Doctors Hospital in Nelsonville,
Nelsonville Square, and Ohio University’s College of Osteopathic Medicine (Caring for your
Community, 2000).

This alternative may sound great on the outside, but if you take a closer look at the colleges
financial troubles, another story is told. OU-COM has indeed looked to expand numerous times
to the Albany area, however funding has never been able to be obtained. Starts up costs,
including staff and building, were too much for the school. If this were financially viable, it
would have already been implemented (Marazon, D., 2000)

Holzer Clinic
Holzer Clinics are a chain of clinics throughout Ohio and West Virginia. The clinics are
physician owned. They have their own board, staff, and are completely independent of Holzer
Medical Center (Neal, 2000).

A recent survey of the Athens citizens concluded that Athens needed a basic clinic, consisting of
a family practice, pediatrics, a laboratory and x-ray (Neal, 2000).

Holzer Clinic operates 7 locations in South Charleston, West Virginia, Pt. Pleasant, West
Virginia, 2 in Gallipolis, Ohio, Jackson, Ohio, Proctorville, Ohio, Pomeroy, Ohio, and a “sleep
lab” already in Athens County. The newest clinic is in Jackson, and staffs about 65 people
(Neal, 2000).

Holzer is currently very interested in locating their services in the city of Athens. Therefore, it is
doubtful that Holzer would consider locating in Albany, when they are already very set on
moving the facilities to another location already in Athens.
                                                                 Health Care in Albany    4



Rotating Doctors
Another option Albany has is to bring in several doctors throughout the area to take turns serving
clients. A concern that may be voiced is that citizens of Albany feel comfortable seeing the same
physician each time they visit a doctor.

Another concern might be obtaining doctors that would be willing to agree to this. Being in a
physician shortage area, implies that the physicians reach their capacity the amount of patients
they see each day.

                                             Desirability
Possibly most important in this decision is to find out weather the people of Albany would
actually want or use this type of facility. As stated before, the want for a facility in the area is
not in great demand. To use this facility the people of Albany need to be educated about it, and
be able to afford it.

Many of the citizens of Albany have either no insurance, Medicare, or Medicaid, which pays
only a percentage of the total bill. It would be up to the facility and those financially responsible
to make a clinic a profitable alternative.

                                                Time
Only a little over half the residents of Albany have said that they would be willing to use the
facility if it was available to them. This could be because many have already relocated and are
comfortable with their current physicians or arrangement. Albany currently needs to be involved
financially with other projects before considering locating a physician in their area. Some of
these expenses include improving their school system, obtaining a sewer system, concentrating
on their Snowden Lake project, and expanding the OU airport to increase tourism to their village.

Looking at all the criteria as a whole going into producing an effective clinic might not be the
best option for the people of Albany.

                                     PRIVATE PRACTICE

Establishing a private practice in the Albany community is an attractive alternative when
considering time, effectiveness, and desirability, but Rural Health Care Consultants believes cost
is the problem. Attracting a highly qualified physician to the Albany area is necessary in the
creation of a private practice, and that would be hard to do (Carl, 2000).

 An individual physician in the Albany area would need to have the capabilities of a family
practice doctor. These capabilities include (Salary.com, 2000):

      Having a degree in medicine from an accredited medical school, and a license to practice
       medicine.
      2-4 years of family practice experience
      The experience and ability to make sound decisions in judgment
                                                                Health Care in Albany   5


A family practice physician in the Albany community must also have experience in many other
fields of medicine including geriatric medicine, obstetrics, internal medicine, etc. (Benseler,
2000). Dr. Baumgaertel filled the niche of the Albany community because he was able to
perform many of the tasks necessary in these fields.

                                         Effectiveness
Dr. Baumgaertel and his private practice on Washington Street filled a niche in Albany’s health
care system (Cross, 2000). Baumgaertel was available until as late as midnight, delivered babies
in farmhouses, and often made house calls. By establishing himself in the Albany community
and developing a “family-like” relationship with his patients, Dr. Baumgaertel could cover many
of Albany’s health care needs.

It has been proven by the citizens that 5-10 minutes is an acceptable amount of time to travel for
health care in Albany. People without means of transportation are much more likely to be able to
find temporary transportation to a facility which is in Albany than in any other city in Athens
county (Abel, 2000). Even though it may seem old-fashioned to some people, the house call is
still welcomed and appreciated by many people (Uzelac, 2000).

Having a small, close facility will make health care accessible to the whole community. This
will include everyone, including people who have transportation, people who can find
transportation occasionally, and people who cannot leave their homes.

The most important health care need of the citizens of Albany is primary health care (Marazon,
M., 2000). Other area hospitals and clinics have the ability to perform procedures that private
practice facilities do not generally provide. Though they are not able to provide a large variety
of procedures, they are often known for having personable physicians such as Dr. Baumgaertel.
The quality of the physician in a private practice determines the quality of the health care.

                                               Cost
The cost for developing a private practice could be covered by the physician, the government, or
a private health care group. A private practice would have to consider facility, staffing salaries,
and equipment.

In order provide adequate health care to the citizens of Albany, an adequate primary care facility
must be available. The former office of Dr. Baumgaertel has been transformed into a building,
which is currently being used for apartments (Ploutz, 2000). An office in the village of Albany
would cost about $500 a month in rental fees, or about $6,000 annually (Abel, 2000). This cost
for a health care facility is more reasonable than that of a clinic.

Attracting quality physicians to a rural area can be a challenge. The Ohio University College of
Osteopathic Medicine works to recruit the following types of students (Marazon, M., 2000):

        Those who are interested in primary care
        Those who are interested in practicing medicine in Ohio’s rural communities
                                                                Health Care in Albany    6


This commitment to the community is a major benefit for attracting high quality physicians to
the Albany community. Since Albany is located in a Special Health Physician Shortage Area,
funding to repay student loans is available. This option is very attractive to Ohio University
osteopathic medical students.

In an October 2000 survey of these students, 77% of OU-COM medical students said they would
consider a family practice position in a small town for a $75,000 loan repayment (See Appendix
C). The National Health Service Corps (NHSC) and the Ohio Physician Loan Repayment
Program are two such loan repayment programs
(http://www.aamc.org/about/gsa/stloan/oh.htm, 2000). This funding would cut costs for a
physician working in Albany.

In order to be completely effective, a single physician practice must have adequate support.
According to Mr. Kaiser, a single practice physician should employ two nurse/secretaries. They
would be in charge of all secretarial duties, the billing process, and assisting the physician.

Equipment needed would be a table, a lamp, an ophthalmoscope, a blood pressure cuff, and
furniture. For detailed monthly costs see Appendix D.

                                            Desirability
Although many people wish that their health care provider were located closer to their homes,
these same people would not change physicians if a private practice opened in Albany. In a
survey of the greater Albany area, only 1% the citizens specified that they would travel only 5-10
minutes for health care. Of these same citizens, 81% see the same doctor regularly. These two
factors demonstrate that there is not a great demand for an in-city health care center.

                                               Time
The time frame for finding a physician and implementing the health care system is dependent on
several factors. The largest of these factors is the ability to find a doctor who is willing to work
in a rural area. Albany would be extremely lucky to find a physician within six months.
Realistically, it would take about one year. This is because a search would have to be made to
find the right doctor and then they would have to move from where they are located (Marizon,
D., 2000).

Although many students are interested in loan repayment programs, the truth is that the
distribution of graduating physicians to areas with a population of 25,000 or fewer has decreased
from 49% in 1980 to 39.3% in 1998. For the most part, physicians aren’t interested in working
longer hours for lower pay, fewer social and educational amenities and less peer support
(Greene, 1999).

Mayor Richard Abel of Athens city believes that the priority of the Albany community should be
to pass their education levy on November 7. Other issues that could affect the growth of the
Albany community, and therefore, the effectiveness of a private practice include the expansion
of the Ohio University airport and OSHA sewage regulations (Abel, 2000). The expansion
potential of Albany could make a small private practice obsolete by the time a doctor is found
and a client base is established.
                                                                Health Care in Albany   7



From applying the criteria to this alternative, costs would be too much for a single physician in
the Albany area. The physician would not be able to see enough patients to cover these costs.

                                     TRANSPORTATION

Another alternative for Albany is a transportation service. UOMC would provide a shuttle for
the Albany residents. With this, residents of the community would be able to get a ride to Parks
Hall and O’Bleness medical facilities in Athens. There would be a bus that picks the citizens up
and takes them to and from appointments. The service would be used for those going to
regularly scheduled appointments, not emergencies.

A person would first make an appointment with the doctor’s office. After the appointment had
been made, the receptionist would ask if the person needed a ride. UOMC would make it simple
for their patients by then automatically taking care of signing the patient up for the shuttle
service. This makes the shuttle service very user friendly.

                                             Effectiveness
By providing transportation, it gives all the residents of the Albany community the same
opportunity to seek medical treatment. If a medical facility were brought to the community of
Albany, it still would not solve the problem of transportation. If a person has the problem of
fining a ride to their current medical facility, they would have the same problem finding a ride to
one in Albany. With this shuttle service, a person could not use the excuse of not having a
dependable ride to the doctor. As shown by the phone survey, 57% said they would go to a
medical facility more often if t were more accessible.

                                             Costs
There are many alternatives as to who could finance this service, but the most reasonable one
would be by UOMC. The village of Albany does not have the money to maintain a service and
Athens is the next closest location.

While there are many fixed and variable costs in obtaining and maintaining a vehicle, most costs
involved are be based on the amount of usage. The more the shuttle is used, the more variable
costs (repairs, gas, replacement parts, etc,) will be needed. See Appendix E for cost chart.

The Chevrolet 2001 2500 Express Passenger Van is one choice to use for the shuttle. As shown
above, after paying for a destination charge of $665, the lowest package you can get is 27,635
while the most expensive is around $29,000 (Chevrolet Vehicle Detailed). Since OU-COM is a
private non-profit, they are eligible to apply for a van through the specialized transportation
program. If they get accepted, the government will pay 80% of the costs of a handicap accessible
van. If OU-COM participates in the program, it is required that 30% of their vehicles are
handicap accessible. Right now, The United Seniors of Athens provides rides for those over 60
to doctors’ appointments (Turner 2000).

OU-COM won’t be making money on this from the beginning. Where they would hope to make
their money is in those who do not regularly go to a medical facility because they do not have a
                                                                Health Care in Albany    8


ride. It must also be taken into consideration that those who need a ride to go to a medical
facility or any place else are already able to find one. As shown in Appendix E, it would take a
lot of extra/repeat patients to make up for the money being spent.

                                           Desirability
This option would be particularly helpful for senior citizens who are unable to drive anymore.
The older a person is, the more health problems can arise. This service would also provide for
another group of citizens who only have one vehicle for the family. The provider for the
household has to take the vehicle to work, therefore leaving the ones that stay at home with no
means of transportation. Therefore, this alternative caters to different groups of people.

                                             Time
To implement a shuttle service would not take long at all. All you would need to do is to find a
10-15-passenger van. Below is a timetable on how long it would take to implement.

Table 1: Time Table for a Transportation System
What is needed to be done                  How long it would take
Choosing the right automobile and           2-8 weeks
receiving it
Getting insurance                           Less than 1 week
Finding drivers                             Less than 3 weeks

When looking at the amount of time, it should not take much longer than a total of 8 weeks
because all of these tasks could be preformed simultaneously. The greatest time variable is
getting a van. There is a big time difference if you choose to buy a van that is already on the lot
at a big dealership than if one is specially ordered. If a van is specially ordered it takes between
four to eight weeks depending on the time of year (Fritz 2000). After ordering a van from a
dealership and waiting for it to arrive, one can be comparing different insurance rates and putting
an ad out for drivers to save time.

If they are accepted into the program though, they would apply by March, and they would find
out if they were accepted around June. Their vehicle would be sent to them around August.

This alternative is one of the quickest to implement because it makes fewer changes than the
others, except do nothing.
                                           STATUS QUO

Currently, the citizens of Albany go to surrounding areas for their medical care. There are four
hospitals nearby which are located in Athens, Columbus, Jackson, and Nelsonville. The
following table shows the percent of Albany population that travels to the listed cities for health
care according to the phone survey:
                                                                 Health Care in Albany    9


                       Table 2: Where Albany Is Receiving Health Care
                         City                        Percent of Albany
                                                     Population
                         Albany                      .57%
                         Athens                      67%
                         Jackson                     11%
                         Nelsonville                 5.7%
                         Chillicothe                 3.2%
                         Lancaster                   11%
                         Gallipolis                  9.5%
                         Columbus                    19%
                         Other                       11%

While 57% of the people surveyed said they would switch doctors if one was more available and
as credible as their current doctor, but 43% stated they would still stay with their current doctor.

                                           Effectiveness
This method of health care is effective. While the citizens of Albany do not have immediate
health care available, doctors and hospitals can be at their service in as little as ten to fifteen
minutes. Going to surrounding cities is effective because the people of the Albany area are able
to choose where they want to go for medical treatment. In doing so, they have more of a variety
of health care providers.

                                                Cost
This alternative to Albany’s health care method is free for the community. Where the money
will come from is one of the biggest questions. The office would have to be paid for either by
the doctor him/herself or subsidized by a hospital or Ohio University. The doctors’ office would
have to be a free enterprise. A school or hospital cannot subsidize it because the doctor will not
work as hard under a permanent salary (Seckinger 2000). As shown in appendix C and D, it is
virtually impossible for a doctor to finance a clinic or private practice in Albany.

                                            Desirability
Switching costs is another problem that comes with changing to a doctor that is more convenient.
This term describes all the hassles that come with moving to a new doctor, such as transferring
records, insurance and the like. This is the reason that almost half of the population would stay
with their current doctor and not switch to a more convenient one in town.

                                                Time
This method is also very time effective. While the other alternatives take time to implement, this
plan is already in effect. According to the phone survey, the 57% of the population that would
switch doctors said they would only if the one in town was as, or more credible than the one they
currently attend. Unfortunately, this status is not going to happen over night.

As one can see, the status quo alternative does indeed fulfill all of the criteria requirements.
                                                                Health Care in Albany   10


                                     RECOMMENDATION

After assessing all options, it has been decided that Albany should keep the status quo and keep
outsourcing their citizens to other parts of Athens County for health care. The citizens have
already been doing this for many years due to Dr. Baumgaertel’s practice deterioration and
retirement. This method best fits the needs of the village because it is effective, timely,
desirable, and cheap.

In review of the alternatives, keeping the status quo is clearly the best option.

      Clinic- Whether building a new clinic or using Scott Smith’s existing clinic, this option is
       also too costly. The old Smith clinic would cost too much money to fix up and the
       mortgage payments would be impossible for any doctor to pay. Albany currently cannot
       pass a levy to build a new school that they are desperately in need of, so any levy to pass
       more money would be out of the question, especially to build a new clinic building.
      Private Practice- Establishing a private practice would be too expensive for the physician
       and the town. The expenses would overweight the income and the doctor would need to
       see 847 patients a month just to break even. This means he would need to see almost
       every citizen of Albany every month (See Appendix C for details).
      Transportation Service- This option has been tried in numerous cities and failed every
       time. Currently Albany has a transportation service for citizens over age 65, but is not
       utilized well.

According to the phone survey, almost 50% of the citizens said they would not use a health care
facility if it were closer because they were comfortable going to the doctor they had previously
been going to. It would more beneficial for the town to concentrate on passing school levies and
working on the sewer system than worrying about health care options.

                                            Conclusion

Rural Health Care Consultants has concluded that the health care options available to the citizens
of Albany are adequate. No further health care options are needed in Albany for the time being.
Driving distances to adjacent cities are not unreasonable. All basic and some advanced
procedures are practiced at Athens County hospitals. It is not financial advantageous for OU-
COM, Holzer, or a private physician to operate a health care facility in Albany. Further growth
of the 798-person village and its surrounding townships is needed to make a health care venture
in Albany profitable and effective.
                                                          Health Care in Albany       13


                                          References

Abel, R. (October 2000). Personal communication.

ADA Accessibility Guidelines. (2000). Access Board [Online].
  <http://www.access-board.gov/adaag/html/aaag.htm> [2000, October 27].

Benseler, J. (October 2000). Personal communication.

Bloom, J. (October 2000). Personal communication.

Bloomberg Mortgage Calculator. (2000). Loan Center Calculators [Online].
   <http://www.bloomberg.com/cgi-bin/ilpc.cgi> [2000, October 29].

Caring for your Community. Athens: OH: The Health Care Corridor.

Carl, J. (October 2000). Personal communication.

Chevrolet Vehicle Detailed. Athens, OH: Larry Schey Chevrolet Inc.

Code Titles. (2000). Law Directory [Online].
  <http://www.frognet.net/~ghunter/lawdirectory/city_code_titles_21-25.htm>
  [2000, October 27].

Cross, J. (October 2000). Personal communication.

Greene, J. (1999, September 13). Prescribing a cure for the shortage of rural physicians
  [Online]. <http://www.ama-assn.org> [2000, October 18].

Fritz, S. (October 2000). Personal communication.

Kaiser, J. (October 2000). Personal communication.

Loan Repayment/Forgiviness Programs Fact Sheet. (2000, August 29). About the AAMC
  [Online]. <http://www.aamc.org/about/gsa/stloan/oh.htm> [2000, October 18].

Making Your Clinic Building Work. (2000). ERC – Clinical [Online].
  <http://erc.msh.org/clinical/tools/building.htm> [2000, October 23].

Marazon, D. (October 2000). Personal communication.

Marazon, M. (October 2000). Personal communication.

Neal, J. (October 2000). Personal communication.

Patient Information. Athens, OH: University Osteopathic Medical Center.
                                                        Health Care in Albany   23



Pierson, S. (October 2000). Personal communication.

Ploutz, P. (October 2000). Personal communication.

Salary Wizard. (2000). What are you Worth? [Online]. <www.salary.com>
   [2000, October 20].

Seckinger, M. (October 2000). Personal communication.

Turner, M. (October 2000). Personal communication.

Uzelac, E. (1998). Mobile Doctors [Online]. <http://www.mobiledoctors.com/news.htm>
  [2000, October 24].
                                                                       Health Care in Albany      24


                          Appendix B: Chart of Revenues for Clinic
           Below is a chart showing the revenues needed for a clinic of three doctors, two nurses and one
           secretary to break even. The mortgage payment, were amortized over thirty years at 7.00%
           interest (Bloomberg.com).

           Equipment is calculated by adding $30,000 of used equipment and $50,000 x-ray equipment, and
           depreciating them over ten years with no salvage value (Seckinger 2000).

           Other expenses and benefits are calculated by taking 25% of total expenses (Kaiser 2000).

           According to our expenses, 2,435 are needed for a clinic to breakeven. This figure is
           unreasonable in a village as small as Albany. For this amount to be obtained, three times the
           population in the village of Albany would have to visit the clinic per month.


Expenses                                        Revenue Needed to break even

Monthly                                         Doctor visit charges                                Number of patients
Mortgage Payment               $3,992           $50                                                              1,169
Physician salary (3)          $37,500           Collect 48% of charges due to Medicaid and Medicare
Nurse/secretary (3)            $3,900           $24 collected from original bill                                 2,435
Utilities                       $300
Equipment                       $667
Liabilities – Insurance         $400
Other expenses and benefits   $11,690
Total monthly expenses        $58,449           Total monthly income                                          $58,449
                                                           Health Care in Albany      24


                          Appendix C: Survey Results
A survey was administered to 48 first and second year medical students at OU-COM. Questions
were asked relevant to the project to get a feel for their thoughts on the situation in Albany.
Following are the questions and their answers:

1. How big is your hometown?

      Population           Percent of
                            Students
Less than 3,000           12.5%
3,000-7,500               10.42%
7,500-15,000              6.25%
15,000-30,000             18.75%
30,000-50,000             10.42%
50,000-100,000            6.25%
100,000-500,000           14.58%
500,000-1,000,000         14.58%
1,000,000-5,000,000       4.17%
More than 5,000,000       2.08%

2. What size city do you want to live and practice medicine in?

      Population           Percent of
                            Students
Less than 3,000           2.17%
3,000-7,500               8.70%
7,500-15,000              2.17%
15,000-30,000             10.87%
30,000-50,000             13.04%
50,000-100,000            13.04%
100,000-500,000           17.39%
500,000-1,000,000         21.74%
1,000,000-5,000,000       8.70%
More than 5,000,000       0.00%
                                                           Health Care in Albany       24


3. Realistically, what do you expect your annual income to be after finishing your residency?

Annual Income           Percent of
                        Students
Less than $50,000       4.26%
$50,000-70,000          8.51%
$70,000-90,000          10.64%
$90,000-110,000         14.89%
$110,000-130,000        23.40%
$130,000-150,000        14.89%
$150,000-170,000        10.64%
$170,000-190,000        4.26%
$190,000-210,000        4.26%
More than $210,000      6.38%

4. How much do you expect your student loan debt to be?

Loan Debt Amount        Percent of
                        Students
$0                      2.08%
Less than $10,000       8.33%
$10,000-25,000          0.00%
$25,000-40,000          6.25%
$40,000-55,000          2.08%
$55,000-70,000          4.17%
$70,000-85,000          14.58%
$85,000-100,000         18.75%
More than $100,000      43.75%
                                                                Health Care in Albany         24


5.   Please evaluate the following situation and respond to the related questions.

     You are a doctor who has just finished your internship and residency. You are faced with the
     challenge of finding a place to happily live and work. Currently, you have a $75,000 student
     loan debt. A small town has offered you the opportunity to open up your own family practice
     facility. The town will provide your building and all equipment. In addition, the town will
     completely repay your student loans. Your contract requires you to practice medicine in the
     town for at least 5 years. You will be the only doctor in town and will earn a salary typical of
     a small town family practice doctor.

     Would you consider this position?
     Yes = 77.08%
     No = 22.92%

     What is the most attractive benefit of this opportunity?

  $75,000          Small Town Atmosphere              Stability              Running Own
    Loan                                                                    Family Practice
 Repayment
   62.5%                    6.25%                      16.67%                   14.58%
                                                                      Health Care in Albany     24


                  Appendix D: Chart of Expenses for Family Practice
           Below is a chart that shows the expenses needed to keep up a family practice with one doctor.
           The figures were estimated and provided by Dr. Joel Kaiser, Chief Operating Officer of Doctors’
           Hospital in Nelsonville, Ohio.

           Equipment is calculated by adding $10,000 of used equipment and $50,000 x-ray equipment, and
           depreciating it over ten years with no salvage value.

           Other expenses and benefits are calculated by taking 25% of total expenses. Such expenses
           consist of cotton swabs, syringes, and other daily used items.

Expenses                              Revenue Needed to break even

Monthly                               Doctor visit charges                                       Number of patients
Rent                            $500 $50                                                                        420
Physician salary (1)          $12,500 Collect 48% of charges due to Medicaid and Medicare
Nurse/secretary (2)            $2,600 $24 collected from original bill                                          875
Utilities                       $300
Equipment                       $500
Liabilities – Insurance         $400
Other expenses and benefits    $4,200
Total monthly expenses        $21,000 Total monthly income                                                   $21,000
                                                             Health Care in Albany         24


            Appendix E: Costs of Transportation Service
Below is a chart figuring up the amount it would cost yearly for 10 years to support a shuttle
service.


Yearly Fixed Costs                        Yearly Variable Costs
12 Passenger Van         $2,800           Gas (15 miles per gal.) at $1.55/gallon          $2,700.00
Insurance                $1,400           Oil Change at $30 each                             $210.00
Handicap Accessible        $800           Repairs (warranty covers 3 yrs.)                         0
                                          Drivers at $6.00/hour each                      $12,480.00
Total                    $5,000           Total                                           $15,390.00

                                                     Combined Total                       $20,390.00



We based these variable numbers on driving 100 miles per day, five days a week, 52 weeks a
year.

To be able to break even from the costs of this service, UCOM would have to serve an extra 850
patients with an average amount collected from them being $24 a person.

This team does not think that the costs outweigh the benefits this service would bring.




DISCLAIMER: The financial information provided in this paper is based on the information we
were able to obtain in such a short amount of time.

								
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