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					Assessment of Albany’s Current Medical Needs




                Prepared for

              Dr. Paul Ploutz
                PO Box 38
               LEAD Group
             Albany, OH 45710

                    and

             Dr. Frank Barone
             Dr. Christine Yost
             Dr. Raymond Frost
            Dr. Arthur Marinelli
           Professor Larry Rogers




               Prepared by

                   Team 7
               Julie Dickman
               Amie Meczka
                Evan Peres
               Jason Ziegler

              October 30, 2000
14 University Terrace
Athens, OH 45701
October 30, 2000

Dr. Paul Ploutz
PO Box 38
Albany, OH 45710

Dear Dr. Ploutz:

Here is the report you asked the Business Cluster to prepare for you on Albany’s need for
health care following the retirement of Dr. William Baumgaertel. We evaluated several
alternatives and after evaluation came to the conclusion that the best option for you and the
greater Albany area is to establish a community health center.

The set of criteria that we used to select the best option include affordability, convenience,
implementation, and desirability. We felt that the best alternative for you and the greater
Albany area should be one that meets all of these criteria.

One alternative is to open a local doctor’s office. However, this alternative leaves full
responsibility of the cost to the residents of Albany or the doctor(s) because of the lack of
government funding available.

A new transit system could be set up to give residents access or advice on how to deal
with medical problems. Once again, government funding has gone down in regards to
transportation services. A transit system also does not give the close, personal care of a
doctor’s office or health center.

A mobile clinic would serve citizens at their home and provide basic medical needs, but
would be difficult and costly to set up. The costs of this option are way too high to be
honestly considered as a true solution.

Another alternative is opening a local clinic or community center, providing Albany
residents with an outlet to receive acute and preventative health care. Dr. Smith’s existing
building can be used for the facility. Government funding is readily available making the
option affordable. Since the facility will be brought to Albany, access to medical care
will be very convenient to all citizens. It is also easy to implement because the building
and necessary space are already available. Finally, as showed by the survey, the
community health center is desirable to the citizens of Albany.

After evaluating all of the alternatives Albany has available, we have determined that
building a community health center is the best option for you, Dr. Ploutz, and the greater
Albany area. Thank you for giving my teammates and I the great opportunity of learning
about the Albany area. We hope our information can assist you in your decisions.

Sincerely,



Amie Meczka

                                              i
                                                      Table of Contents

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

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

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

Background of Albany....................................................................................................1

                        Demographics ........................................................................................1

                        Funding sources ....................................................................................1

                        Attracting doctors .................................................................................2

Criteria .............................................................................................................................2

Alternatives ......................................................................................................................3

                     Local doctor’s office ..................................................................................3

                     Local clinic or community health center ................................................5

                     Establishment of new transit system .......................................................6

                     Establishment of mobile clinic .................................................................7

Recommendation/conclusion .........................................................................................8

References ........................................................................................................................9

Appendix A: Funding Sources .....................................................................................11

Appendix B: Necessary Components ..........................................................................12

Appendix C: Background of Albany ...........................................................................15

Appendix D: Qualifications of Medical Positions ......................................................16

Appendix E: Dr. Smith’s Clinic ...................................................................................18

Appendix F: Zoning Regulations.................................................................................20




                                                                   ii
                                  Executive Summary

Problem Statement
Due to the recent loss of Dr. Baumgaertel and the bankruptcy of Dr. Smith’s clinic,
Albany does not have a convenient and practical means of health care. The Albany
community is currently searching for a new way to meet their health care needs.

                                          Criteria
In order to evaluate the possible solutions for the community, a standard criterion was
established to determine which alternative would be the best fit for Albany.

      Affordability
      Convenience
      Implementation
      Desirability

                                        Alternatives
Several alternatives exist for Albany to deal with health care problem. These options
include opening a local doctor’s office, building a local clinic or health care center,
creating a new transit system, or implementing a mobile clinic.

      Open a local doctor’s office. A doctor’s office could include a single doctor
       brought in to care for basic preventative needs.

      Build a local clinic or community health center. This option could be handled by
       expanding the branch of OU-COM to Albany, using faculty as doctors. Another
       way to implement the community health center is by using an existing facility.

      Establishment of a new transit system. A new transit system will give citizens
       access to outside medical care in Athens.

      Mobile Clinic. A mobile clinic provides health services while making house calls.

                                    Recommendation

The best alternative for the Greater Albany Area is to launch a community health center
using Dr. Smith’s existing building for the facility. A health center provides the most
benefit to the to the residents while still being affordable to the community. A
community health center is easy to implement and provides a convenient medical care
facility that meets the wishes of the community.




                                            iii
                                                                              Albany Assessment     1


Due to the recent loss of Dr. Baumgaertel, and the recent bankruptcy, from bad bill collecting,
of Dr. Smith’s clinic, the village of Albany is left without a convenient and practical means of
health care. Residents are faced with various obstacles such as the rural, isolated nature of the
region of Appalachia and its poor, aging population. The Albany community is currently
searching for a new way to meet their health care needs.

This assessment outlines various alternatives available, including establishing a local doctor’s
office, health clinic or community health center, setting up a new local transit system, and
implementing a mobile clinic. Each alternative is weighed against the established criteria and
a recommendation is given as to the best possible solution.

                                    Background of Albany

The village of Albany is located in Athens County of Southeast Ohio. Albany is part of the
greater region known as Appalachia, known for high poverty rates and high health care needs.

Demographics

Albany has a small population of around 900, but the greater Albany area encompasses
regions such as Lee, population 2,404, and Alexander Township, population 2,483, for a total
of 5,787 residents (Census Homepage, 2000). The population of Athens County is 61,490
people (Ohio County Profiles, 1999). The greater Albany area represents nine percent of the
county’s total population.

The poverty rate in Athens County is estimated to include 20.1percent of the population, and
the median household income is only $26,020 (Census Homepage, 2000). In a sample of the
Albany population, 39 percent of the people were either ages 65 and over or 18 and under
(Class Survey, 2000). These two age groups represent the section of the entire population that
uses medical care most often, proving the need for a more convenient medical facility.

Funding Sources

As of October 1999 Athens County was designated a Health Professional Shortage Area
(HPSA) in the area of primary health care (Health Resources and Services Administration
homepage, 2000). This designation is used by the Health Care Financing Administration
in determining grant/loan eligibility as well as qualifications for increased levels of
Medicare and Medicaid reimbursement.

The village of Albany is eligible for several types of financial assistance from both the
state and federal governments. These types of programs include loan repayment for
physicians serving in shortage areas, state and federal grants for funding of new clinics,
assistance in recruiting new physicians, and increased government reimbursement plans.
See Appendix A for a description of several programs available to the village of Albany.



Attracting Doctors
                                                                               Albany Assessment   2


One problem that the Greater Albany Area has to consider is attracting physicians to the
area. Albany is a small town, in rural Southeastern Ohio. The town may have trouble
attracting a doctor to come to practice medicine, no matter what type of facility it is.
There are federal grants that aid an underserved area like Albany in recruiting doctors.
Some offer to pay off a part of a doctor’s medical school debt in exchange for a set
number of years of service in the area. For a listing of these grants refer to Appendix A.

There are attractive qualities in practicing medicine in the Greater Albany area. The class
survey showed that over 81 percent of the persons polled have some form of medical
insurance, and only 16 percent of these are covered by Medicare (Class Survey, 2000).
Therefore, a physician can be guaranteed payment from at least 81 percent of the patients
for services rendered under some form of an insurance plan.

Another attractive quality is if the medical facility becomes a part of a Health
Maintenance Organization (HMO) or Preferred Provider Organization (PPO). This will
ensure a definite client base for a new doctor in town. The doctor will not have to go out
and recruit clients.

Ohio University employees belong to Unicare/DCA. If the facility in Albany belongs to
DCA, then many of the University’s employees will attend this facility for medical care.
In a DCA approved office, the patient is only required to pay 20 percent of the cost, while
the HMO will pay 80 percent with no deductible (University, 2000).

The Albany area has much strength, most lying in its location. Albany village is located
within reasonable driving distance of two major hospitals, O’Bleness and Holzer. It is
also positioned in close proximity to Ohio University on the Appalachian Highway.

Potential for growth in this region exists through the expansion of the Ohio University
airport and the Hocking College eco-tourism program at Lake Snowden. Such future
growth could provide the financial opportunity for bringing better health care to Albany’s
citizens. Several solutions exist to take advantage of this opportunity and provide health
care for the entire community.


                                            Criteria

In evaluating the various potential solutions, the following criteria were established to
determine which alternative would be most beneficial to the people of Albany.

       Affordability. The best alternative would be one that could be financed mostly from
        the outside, without placing much of an extra tax burden on the residents of Albany.

       Convenience. A survey taken of the Albany population shows that only 5 percent of
        residents do not currently travel for health care or seek medical care at all (Class
        Survey, 2000). This survey also shows that 75 percent of the population would see a
        doctor more often if it were more accessible. With this information in mind, it is
                                                                               Albany Assessment     3


        important to consider whether or not any alternative is accessible to 100 percent of the
        residents and convenient for anyone who should choose to take advantage of it.

       Implementation. The need for medical care in Albany is immediate. A solution must
        be found now and quickly implemented. Each alternative needs to be weighed
        according to the length of time necessary to actually implement.

       Desirability. Is the alternative something that the residents desire to have and will it
        benefit the community?



                                          Alternatives

Several alternatives are available to the residents and have been evaluated based on the above
criteria. The alternatives include opening a local doctor’s office, building a local clinic or
community health center, setting up a new local transit system, and implementing a mobile
clinic.

Open a local doctor’s office

A local doctor’s office could be set up within the village of Albany. It would operate with
business hours from 8am-5pm on weekdays, and an emergency number would be available
for after-hours medical needs. It is unnecessary for an office in Albany to feature a lab or an
X-Ray room. Lab work can be outsourced and those in need of x-rays can refer to another
facility like O’Bleness or Holzer.

Dr. Larry Spoljaric owns his own solo medical practice (Spoljaric, 2000). In an interview he
discussed all of the various necessities for running a practice. He said that a solo practice in a
rural area only needs to contain a business area, including a waiting room and receptionist’s
office, an office for the doctor’s and nurses to use, a procedure room, and three exam rooms.
The following are the variations of a doctor’s office.

       Single doctor brought in to care for basic preventative needs.

        A single doctor’s office would keep costs as low as possible. There would only be
        one physician, one receptionist, and one nurse needed, reducing the number of salaries
        that have to be paid. Another advantage of this option is the individuality that the
        physician will be able to keep. The practice will be run exactly how the physician
        likes. Having just one doctor in town also allows for close contact with the
        community, building a sense of loyalty and trust.

        The drawbacks to a solo practice include difficulties in attracting a doctor who is
        willing to move to rural Ohio and accept such great responsibility for a community.
        This doctor would be the one relied upon for all diagnosis and would feel pressured to
        always be “on-call” for patients and neighbors.
                                                                                Albany Assessment    4


       Rotating Staff of Doctors.

        Several doctors would rotate through a part time position of caring for the people of
        Albany. A less pressured environment would result from this option. The physicians
        would have others to consult with and share the burden of time and commitment. The
        staff could alternate nights of being on-call and would be able to take necessary time
        off.

        However, having a rotating staff of doctors will increase the costs for the facility.
        Three physicians, one receptionist, and two nurses will be needed to aid when the
        doctor’s shifts overlap.

The average cost of running a single doctor’s practice is $80,000-100,000 per year (Spoljaric,
2000). This does not include the rent paid monthly depending on the property, and also the
remodeling that would need to be done to set up the office including around $20,000 for the
furniture. See Appendix B for more information on the costs involved in setting up a medical
practice.

Affordability is where the problem occurs. Setting up an office involves serious costs. As
shown in their recent problems passing school levies, the citizens of Albany do not have extra
money to spend on higher taxes for a medical facility (Progress, 2000). The most logical way
that this option could be financially feasible is if the doctor(s) who were brought in invested
their own money to start up the office. For a further description of Albany refer to Appendix
C.

Seventy-five percent of the residents surveyed informed us that they would go to a medical
facility or office more often if it was more accessible (Class Survey, 2000). A doctor’s office
in Albany would be a great convenience to the citizens because it will cut down on driving
time to other cities for medical care and make it more likely for citizens to see a doctor.

The implementation would not be difficult as long as the funds are there to support the facility.
Implementation would include setting up the practice, in a new or old structure, hiring the
staff, acquiring equipment and supplies, and finding new patients. This would be able to be
done in a reasonable amount of time.

Currently, the majority of residents in Albany travel to another city for preventative healthcare
(Class Survey, 2000). There is not a need for a hospital in town because O’Bleness Hospital is
located only ten miles from Albany with Rt. 32 East connecting the two cities. However,
there has been a desire expressed by certain citizens, including Paul Ploutz, for a general
practitioner in the Albany area.

A doctor’s office may be what the town of Albany is looking for, but it is not the best
alternative available. The costs will be left to the citizens of the greater Albany area or to the
doctor who begins a practice. There are other options available to Albany that are more
affordable and beneficial.
                                                                              Albany Assessment    5


Build a local clinic or community health center

A clinic or community health center would be a place where families could receive acute and
preventative health care from doctors with a variety of areas of expertise. Doctors would be
able to provide for the specific needs of the young and older population. A location within the
Albany area would fulfill the desire to have convenient access to primary health care in a
familiar setting.

Health centers and clinics such as this have already been established in several other rural
communities. One example is in Lincoln County, West Virginia, where citizens renovated an
old grocery store to provide a place for primary health care services for their community.
They saved money in renovating the structure by using community volunteers, but funding
from the Appalachian Regional Commission and National Health Service Corps also
supported construction costs and partial physician salaries. The clinic is currently open 92
hours a week, 364 days a year. Fees are based on a sliding scale with no one being turned
away due to lack of money (Rural Development Administration, 2000).

This type of facility can best be implemented in one of two ways:

       Expand the branch of OU-COM to Albany, using faculty as doctors.

        A branch of OU-COM would offer the opportunity for OU faculty to serve the local
        community at the same time as having a place where medical students can have more
        first-hand experience with patients and apply their knowledge.

        This type of facility currently exists in Cooleville, Ohio and has been successful in
        meeting both the needs of the community and OU’s Osteopathic Medical Center. The
        College of Osteopathic Medicine (COM) is currently exploring the possibility of an
        Albany expansion, but such a move is unlikely due to a lack of funding (Marazon, D.
        personal communication, 2000).

       Use existing facilities to open a community health center.

        The difference between a clinic and health center exists mostly in the services and type
        of staffing used. A community health center could provide for basic needs of the
        community such as medical, dental and prenatal care in one location. Primarily
        physicians’ assistants could staff the office, as long a regular physician is on-call at
        least one day per week. Costs are lower due to salaries for physicians’ assistants being
        less than half that of physicians. See Appendix D for a further description of
        qualifications.

Several government programs exist with the sole purpose of funding such endeavors within
rural communities making it an affordable option. A clinic established by COM would be
financed by Ohio University and both the state and federal governments would support a
community health center.

Location within the greater Albany area fits the criteria of being accessible to 100 percent of
the targeted population. Other clinics in a similar setting have even offered shuttle service to
                                                                            Albany Assessment     6


more isolated members of the community. This is a possibility for the future in order to
ensure easy access to health care for all. This option offers long-term practicality for the
community as it can be readily expanded to meet the growing needs of the developing Albany
area.

Such a clinic could be quickly put into operation because there is no need to construct a new
facility and funds can be obtained without difficulty through government funding. Dr.
Smith’s clinic, currently up for sale, is located just off of the Appalachian Highway in Albany
(McDaniel, J. personal communication, October 23, 2000). This facility would have sufficient
space to house the basic services needed to provide primary health care to the greater Albany
area. See Appendix E for more information on Dr. Smith’s clinic.

The drawbacks in this option include lack of trust and loyalty built up in the community for
one doctor. Residents would begin to trust the clinic as a whole over time. A desire has been
expressed to see primary health care brought to this growing area and this option would be one
that would grow along with the community.


Establishment of a New Transit System

The current situation in Albany shows that citizens are relying on Athens to provide
health care. In the class survey of Albany, 67 percent of poll participants stated that they
go to Athens for at least some sort of medical treatment (2000). While this may give the
inclination that bringing health care to Albany is unnecessary, the fact is that 75 percent
of Albany citizens surveyed said they would go more often to a clinic that is more
accessible. The survey shows that while most citizens are able to adjust to the current
situation, a closer medical facility is something they desire.

Albany could set up a transportation system to deliver people to Athens to receive
necessary check-ups or medication. Since senior citizens take up such a large proportion
of the population and the low per capita has resulted in a lack of cars, many people in the
Albany community need the availability of transportation (Ohio County Profiles, 1999).

A new transportation system is more affordable than establishing a clinic or doctor’s
office, but is still expensive. Funding for transit has been steadily decreased because
Congress is attempting to eventually cut it completely. The following shows the cuts in
funding of Ohio transit systems from 1995 to 1996 (Transit, 2000).

      Transit funding in rural areas cut 16 percent from $6 million to $5 million.

      Specialized transit systems serving elderly and disabled cut from $2.4 million to $2.1
       million.

These numbers indicate that funding is dropping quickly and steadily, which will make it
difficult for Albany to be able to conjure enough funds from the government to start a whole
new transit system. Even if they were able to start a transit system, the quality of service
                                                                              Albany Assessment     7


would be low, and fares would be extremely high. In an area such as Albany, citizens will be
unable to afford such steep costs.

The plan also lacks convenience. Without a local doctor’s office or clinic, it presents major
accessibility problems for citizens. If transportation is provided, only a small, rotating staff
would be necessary to be on call, and arrival and departure times could be set for citizens to be
picked up and taken home after receiving necessary treatment. Although this plan is feasible,
it will be very difficult to satisfy each citizen’s demands and time constraints.

Acquiring a new transit system will take a great deal of time and effort to organize. It is also
unknown whether or not the community will use the transit system. The time and expense is a
risky investment serving only a small portion of the population.

The desirability level will not be high with fares increasing while service is decreasing. The
residents of Albany have also expressed a desire for more personalized care and this option
does not offer the doctor-patient relationship many would like to have.



Mobile Clinic

The purpose of a mobile clinic is to provide quality health services while making house calls
like an old-fashioned doctor. They are accessible for all types of needs, including calls for
medical advice or on-site visits to patients.

Despite the positive aspects mobile clinics provide, Albany is not likely able to afford it.
Doctors are paid 30 percent more for house visits than in an office (Uzelac, 1999). Since
doctors already obtain high salaries, this option is out of the payable range for Albany. Also, a
large staff is necessary to make the mobile clinic work, making the rates even higher.

Mobile clinics are a convenient alternative, but would not be able to serve as many people that
would be able to visit a clinic within a day. Patients can call for advice or request a visit, so
accessibility is not a problem. Since it is so expensive, residents are unlikely to be willing to
pay for it.

Implementation is an aspect that could present a problem. The details of the system would be
hard to organize and the large staff will be difficult to acquire and integrate. A mobile clinic
staff requires the following (Homeless, 2000):

       Two physicians (pediatrician and internist)

       Three nurse practitioners

       Three drivers
                                                                             Albany Assessment    8


The following services will be available for Albany citizens through a mobile clinic
(Homeless, 2000):

    Pediatric and Adult services:

        o Well-child check-ups

        o Immunizations

        o Acute (sick) care

        o Health maintenance evaluations

        o Immunizations

        o STD and HIV screening

        o Acute and chronic disease clinics

        o Diabetes Education Program



                                      Recommendation

The best alternative for the Greater Albany Area is to launch a community health center using
Dr. Smith’s existing building for the facility. This option provides the most benefit to the
residents while still being affordable to the community. A community health center is easy to
implement and provides a convenient medical care facility that meets the desires of the
community.

The class survey proved that the citizens of Albany would go to a medical facility more often
if it were more accessible to them. The convenience of a community health center has the
chance to improve the greater Albany area’s overall health by preventing and treating disease
early. Those who are not currently seeing a physician will now have medical care close at
hand.

Long range plans for such a facility include recruitment of staff through specialized
government programs designed to aid in that process. Government grants and loans will
provide the health center with the financing necessary to get up and running, at which point it
will function independently of the Village of Albany, operating off of its own revenues.
Specific services can be outsourced and patients needing specialized treatments can be
referred to larger clinics or hospitals in surrounding areas.

The Village of Albany is currently beginning to grow and improve. The expansion of the
Ohio University airport and the eco-tourism program through Hocking College will make
Albany a more desirable place to live. If all aspects of the community are improving, from the
expansion of the airport to the new sewer system, health care facilities need to keep pace with
the changes. Bringing a community health center to the area is a step in the right direction of
creating a higher standard of living in the Albany area.
                                                                     Albany Assessment   9


                                     References


American Medical Association (1996). Starting a Medical Practice: the Physician’s
      Handbook for Successful Practice Startup. Norcross, GA: The Coker Group.

Census homepage (2000). Retrieved on October 18, 2000 from the World Wide
      Web: http://www.census.gov

City of Athens Code Enforcement (2000). Retrieved on October 18, 2000 from the
        World Wide Web: http://ci.athens.oh.us.

Class Survey (2000, October 27). Retrieved on October 27, 2000 from the World Wide
       Web: http://intranet.cob.ohiou.edu/cluster/bus202ia01/.

Conference of American College of Healthcare Executives (September 2000).
       Charleston, South Carolina.

Grants to Rural Providers. Retrieved on October18, 2000 from the World Wide Web:
       http://www.ruralhealth.hrsa.gov/funding.htm.

Health Professional Shortage Areas and Medically Underserved Areas (2000). Retrieved
       on October 20, 2000 from the World Wide Web:
       http://www.med.und.nodak.edu/depts/rural/hpsa.htm.

Health Resources and Services Administration Homepage (2000). Retrieved on October
25, 2000 from the World Wide Web:
       http://www.bphc.hrsa.dhhs.gov/databases/newhpsa/newhpsa.cfm.

Homeless Outreach Medical Services (Homes). Retrieved on October 27, 2000 from
      The World Wide Web:
      wysiwyg://46http://www3.utsouthwestern.edu/parkland/homes.

Loan Repayment/Forgiveness Fact Sheet. Retrieved on October 18, 2000 from the World
      Web Web: http://www.aamc.org/about/gsa/stloan/oh.htm.

Malecki, Donald S. (1996). Commercial Liability Insurance and Risk Management.
      Third Edition. Volume 2. Malvern, PA: American Institute for CPCU.

Medical Waste Considerations (2000). Retrieved on October 25, 2000 from the World
      Wide Web: http://www.deg.state.la.us/permits/sw/swbiohaz.htm.

Occupational Outlook Handbook (2000). Retrieved on October 23, 2000 from the World
      Wide Web: http://stats.bls.gov/oco/ocos074.htm.
                                                                     Albany Assessment   10


Ohio County Profiles: Ohio department of Development office of Strategic
      Research. (1999).

Progress Report (2000, October 23). The Post, pp. 2.

Rural Development Administration. Case Study: Lincoln County, West Virginia.
       Retrieved on October 20, 2000 from the World Wide Web:
       http://www.rurdev.usda.gov/ideas/case 37.html.

Salary.com homepage (2000). Retrieved on October 25, 2000 from the World Wide
       Web: http://www.salary.com.

Sole & Bloom Realtors homepage (2000). Retrieved on October 28, 2000 from the
       World Wide Web: http://www.soleandbloom.com/todays_message.html.

Spoljaric, Dr. Larry (2000, October 21). Personal interview with Brian Roach.

Transit in Ohio. Retrieved on October 26, 2000 from the World Wide Web:
       http://www.fta.dot.gov/library/money/fy96cut/OH7.HTM.

University Human Resources (2000, February 23). Retrieved on October 27, 2000 from
       the World Wide Web: http://www.uhr.ohiou.edu/benefits/Providers/default.htm.

Uzelac, Ellen (1999, July). The Doctor’s in the House. USA Weekend. Retrieved from
       The World Wide Web: http://www.mobiledoctors.com/news.htm.
                                                                            Albany Assessment   11


                                        Appendix A
       Funding and Assistance for Health Professional Shortage Areas
Several state and federal programs have been established for the sole purpose of providing
support to rural communities (Grants, 2000). The following is a partial list of grants, loan, and
other programs that are available to the village of Albany in assistance to establishing a means
for health care.


The Rural Health Clinic Act allows for Medicare and Medicaid cost-based
reimbursement of services provided in rural HPSAs.

National Health Service Corps is in charge of recruiting health care professionals for
areas that do not have sufficient access to primary care services (Loan, 2000).
 Loan Repayment Program provides the opportunity for primary health care
    professionals in HPSAs to receive educational loan repayment.

Health Resources and Services Administration is dedicated to seeing 100percent
access to primary health care services where no disparities exist in shortage areas.
 Community and Migrant Health Centers Grant promote the development of
   Community Health Centers in medically underserved areas. 250 grants are awarded
   to support this promotion.

Public Health Service Act established programs designed specifically to support
Community Health Centers and Health Care for the Homeless.

J-1 Visa Waiver Program is for foreign medical graduates who wish to pursue a
medical education in the United States. Obtaining this waiver allows the physician to
continue their education in the US without needing the traditional two-year home
residency rule. Instead, physicians will be required to practice primary health care in
HPSAs.

Rural Health Network Development Program is designed to support the planning and
development of rural health care networks. These networks must be composed of three
different types of providers dedicated to providing local delivery systems to meet the
health care needs of the rural community.

Community Facilities Loans are available through the Rural Development Administration
(division of the USDA) to fund construction or other improvement to community facilities
providing vital services to rural area residents.
                                                                               Albany Assessment   12


                                          Appendix B
             Necessary Components of Setting Up a Medical Facility
Involved in planning a medical office includes the cost of the facility, equipment, salaries, and
malpractice insurance. The costs of the equipment does not change due to region, however,
the salaries do vary (salary.com).

Facility

In Albany there is already a clinic that has been built but has not yet been used. Dr. Smith, a
former physician in Albany, built this clinic before he had the funds to pay for it. It still stands
empty in Albany today. The purchase price for Dr. Smith’s clinic is $600,000. This would be
cheaper than constructing a brand new building. (McDaniel J. personal communication,
October 23, 2000).

Equipment

A doctor’s office or clinic needs the same medical equipment. The price is steep for the
various items needed, but they are a necessity in a medical facility. Dr. Larry Spoljaric owns
his own single doctor practice, and listed below are the approximate costs for the equipment
he needs (Spoljaric, 2000).

           Computer system for billing-$6100

           Phone system (multiple lines)-$1200 for set up plus monthly charges

           Table-$1200

           Lamp-$200

           Otophthalmoscope-$400

           BP cuff and wall unit-$100

           Suture supplies, swabs, bandaids, etc.-$2000 a year

These supplies are one per room, except the supplies, phone system, and billing computer, so
the price will increase depending on the number of exam rooms. Not included in the above
list is the cost of office supplies, including paper, pens, etc., which would be approximately
1.5-2.3 percent of the total cost (Conference, 2000).

Salaries

The salaries for the staff that would need to be attained for a medical facility vary. There are
ways to cut costs by hiring staff with different titles. Here are the average salaries for most
positions needed in a medical facility (Salary.com homepage):

           Physician-$132,454
                                                                               Albany Assessment      13


           Physician’s Assistant-$62,200

           Registered Nurse-$40,690

           LPN-$32,985

           Receptionist-$22,429

           Billing consultant-$24,773

The necessary staff includes a physician and a receptionist, but after these the choices vary
depending on the physician’s preference (Spoljaric, 2000).

Malpractice Insurance

Medical malpractice insurance is a type of professional liability insurance designed for
physicians. The law is well established in that physicians can be held liable under negligence
principles for injuries to their patients (Malecki, 2000). A physician’s basic duty is to use
reasonable care to avoid injury to their patients.

Medical malpractice claims against physicians are often based on improper diagnoses,
improper tests, lack of informed consent and improper administration of drugs (Malecki,
2000). Informed consent means that the physician must disclose to the patient the nature of
their problem, the purpose of the treatment that the physician is suggesting, the risks
associated with the treatment, the anticipated benefits of the treatment, and any alternative
treatments. If the doctor fails to inform the patient of any of the information listed, the patient
is able to sue the doctor.

Medical malpractice insurance is used to insure physicians against these types of
allegations (Malecki, 2000). This type of insurance can also be adapted to cover nurses as
well. The insurance covers the damages the physician is legally obligated to pay because
of their negligent acts or omissions. The average cost for medical malpractice per year
for a general practitioner is $5000 (Joel Kaiser, personal communication, October 26,
2000).

There are some things a physician can do to avoid being sued (Malecki, 2000). They should
make sure they know the patient well; make sure they communicate with the patient; keep
thorough and accurate records; diagnose and test thoroughly; don’t take on too many patients;
and make sure they know what their staff is doing as well.

OSHA Regulations on Exposure to Blood borne Pathogens

A medical facility in Athens, or anywhere, must abide by the OSHA Regulations on exposure
to blood borne pathogens. Failure to do so could result in the harm of others or personal harm,
and also in strict fines from the OSHA.

Under the OSHA rule, exposure includes skin, eye, mucous membrane (mouth and nasal)
contact with blood or other potentially infectious materials (Medical Waste, 2000). Blood
                                                                             Albany Assessment   14


means human blood, blood products, or blood components. Other potentially infectious
materials include all body fluids in situations where it is difficult or impossible to distinguish
between body fluids. If the circumstances are such that different body fluids cannot be
distinguished from each other, all should be treated as potentially infectious.

Employers must prepare an “Exposure Control Plan” (Medical Waste, 2000). This plan must
contain separate lists of job classifications where some or all of the employees may be
exposed and a list of job tasks in which exposure may occur. The Exposure Plan must also
contain a timetable for implementing various provisions of the regulations and a description of
the procedure that will be followed if in fact exposure occurs. The plan must be made
accessible to all employees.

Employers are required to employ “engineering and workplace controls” wherever possible to
minimize or even eliminate employee exposure (Medical Waste, 2000). Engineering controls
either remove the hazard or isolate the worker from exposure. Employers are required to
examine, maintain, and replace engineering controls on a regular basis to ensure effectiveness.

Appropriate personal protective equipment must be used to reduce the risk of worker exposure
(Medical Waste, 2000). Employers are required to provide this equipment at no cost to the
employee. Protective equipment must prevent such materials from passing through an
employee’s work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous
membranes under normal conditions of use and for the duration of time that the equipment is
in use.

Personal Protective Equipment consists of gloves, face shields, masks, and eye protection,
gowns, aprons, and similar items (Medical Waste, 2000). Employers must ensure that
appropriate personal protective equipment is used and used in the correct manner. Employers
must also make sure that the equipment used is cleaned, laundered, repaired, replaced, or
disposed of as needed, at no cost to the employee.

Employers must provide handwashing facilities that are readily accessible to all employees
(Medical Waste, 2000). When this is not feasible, they must provide antiseptic towlettes.
Employers must ensure that employees wash their hands as soon as possible after removing
gloves and other personal protective equipment, or after contact with potentially infectious
material.

The disposal of medical wastes must be in accordance with all applicable federal, state, and
local regulations (Medical Waste, 2000). There are services that will dispose of medical
waste, including biohazardous material for a fairly cheap price (Spoljaric, 2000).

Training all persons with a potential for exposure must be provided (Medical Waste, 2000).
Training must include a general explanation of the modes of transmission, symptoms, warning
signals relating to possible exposure, and procedures to follow if exposure occurs.

The employer must also keep medical records and records of training sessions (Medical
Waste, 2000). Records must be kept confidential, however an employee may see a copy of
his/her records upon request, and must be maintained for thirty years after employment has
ended.
                                                                           Albany Assessment   15


                                        Appendix C
                             Background of Albany, Ohio


The Greater Albany area is experiencing other needs besides the one for local medical care.
The Alexander school system, which includes Albany village, has been unsuccessful several
times in trying to pass a levy to build a new campus for the schools (Ploutz, P. personal
communication, October 17,2000). The school system would receive $17-19 million from the
government if they could pass the levy to raise $5 million from the cities. The levy will be
voted on in the election on November 7 again to determine if Alexander School Systems has a
chance to improve (Progress, 2000).

Another issue important to the village of Albany is the EPA’s requirement to install a sewer
line in the city (Ploutz, P. personal communication, October 17,2000). Albany currently uses
a septic system, but the health issues with the system have become too large to ignore. The
cost of this sewer line will cost residents $38 a month, which many may not be able to afford.
The ground breaking for this project will begin in three to six months.
                                                                           Albany Assessment    16


                                        Appendix D
                         Qualifications of Medical Positions


A medical facility has different options available to them when staffing the facility. There are
ways to cut costs by hiring a more qualified person, or by hiring a person with a lower average
salary.

Physicians

There are two types of physicians available: the Doctor of Medicine (MD) and the Doctor of
Osteopathic Medicine (DO). DOs are the likely fit for Albany because they provide more
primary care than MDs.

Physicians must go through a heavy load of education and training in order to become
certified (Occupational, 2000). Four years of undergraduate school, four years of medical
school, and three to eight years of internship and residency are required before someone can
go into practice as a physician. This makes it more unlikely for a physician to be willing to
start out in an unstable environment like Albany and take on the initial high debt levels.

Education costs are increasing, while student financial aid is not (Occupational, 2000). With
this fact in mind, Albany could create an option for a student to have their entire education
paid for if they commit to serving Albany after their school tenure is concluded.

Another problem with acquiring a physician revolves around the annual salary. The average
annual salary of a physician was $164,000 in 1997 (Occupational, 2000). This cost is a lot to
bear for such a poor community. However, since the cost of living is not high in Albany, the
salary of a physician may become significantly less.

Physician Assistants

Physician assistants provide a lot of the same services as physicians, except they are not as
qualified, making physician supervision necessary (Occupational, 2000). Despite this
limitation, they may provide care in rural and inner city clinics where a physician must only be
present one or two days per week. Since Albany is so close to Ohio University, the
supervision of a physician is not hard to find.

A physician assistant’s educational requirements are also less time consuming and less costly.
Most PAs graduate with a bachelor’s degree; while others may receive a certificate, associate
degree, or master’s degree (Occupational, 2000). PA programs normally last two years.

Another significant factor is that physician assistants have a much lower average income than
physicians (Occupational, 2000). The average salary for physician assistants in 1998 was
$62,200. The overall cost of training and compensating a physician’s assistant is much lower
than that of a physician, and the discrepancy between the qualification levels of physicians and
physician assistants is not very high
                                                                           Albany Assessment   17


Registered Nurses

Registered nurses provide more basic primary health care than physicians and physician
assistants (Occupational, 2000). They are trained to diagnose and treat common illnesses and
injuries. RNs are also qualified to prescribe medications.

In order to become a registered nurse, students must graduate from a nursing program and
pass a national licensing examination to earn a license (Occupational, 2000). The associate
degree in nursing takes two years, the Bachelor of Science degree in nursing takes four to five
years, and hospital diploma programs take two to three years. The cost of sending a registered
nurse through school is lower than both physicians and physician assistants, however the
qualifications extended to an RN are far lower.

The average annual income of registered nurses was $40,690 in 1998, just over $20,000 less
than the average salary of a physician assistant (Occupational, 2000). While costs of acquiring
a registered nurse are lower than other related occupations, they are not capable of providing a
great deal of primary health care services.
                                                                            Albany Assessment   18


                                        Appendix E
                                    Dr. Smith’s Clinic


In Albany there is already a clinic that has been built but has not yet been used. Dr. Smith, a
former physician in Albany, built this clinic before he had the funds to pay for it (McDaniel, J.
personal communication, October 23, 2000). He had problems keeping track of the books and
was not getting paid by his patients, therefore causing his bankruptcy. He never even began to
practice in his new clinic. It still stands empty in Albany today. The clinic’s total area is
approximately 9600 square feet and includes the following (Sole & Bloom, 2000):

           All furnishings, excluding medical equipment

           Mini-lab

           Fifty acres of land

The clinic is located at the intersection of SR 50/32 and SR 143 (Sole & Bloom, 2000). The
clinic can be purchased with the land or by itself, and the land can be purchased by itself. Sole
and Bloom Realtors have the site listed on their webpage if more information is desired (Sole
& Bloom, 2000). The purchase price for Dr. Smith’s clinic is $600,000. This would be
cheaper than constructing a brand new building. (Jeff McDaniel personal communication,
October 23, 2000).
                                                  Albany Assessment   19




Here are pictures of Dr. Smith’s Albany clinic:
                                                                           Albany Assessment   20


                                        Appendix F

                             Zoning Regulations in Athens

It has been decided to build a medical facility at 385 Richland Avenue, which is located
in the B-2 Downtown Business District area (City, 2000). The property includes three
bedrooms and a full bath with a new roof. The property will have to be remodeled to be
suitable for a medical facility. This location was chosen due to the close proximity of
Highway 33, providing easy access to the facility from surrounding areas.

It is essential that the medical providers of the facility obtain a state license to provide
healthcare in the city of Athens, Ohio (City, 2000). This is the first step that must be
taken before any types of medical services are provided to patients.

There are two alternatives in establishing a medical facility in Athens; buy an existing
building, or construct a medical facility from scratch. The two alternatives are discussed
below.

In buying out an existing building, an occupancy permit must first be obtained from the
Zoning office (see 23.08.01. Enforcement (E) Occupancy permits). An occupancy
permit is attained through a zoning certificate by the zoning inspector (City, 2000). The
zoning inspector must first approve such a certificate before commencement of the
medical facility can take place (see 23.08.01. Enforcement). If the development is
approved, then the construction may take place and the required fees must be paid (see
23.08.01. Enforcement (2) Fees). However, if disapproved, the medical facility team
may appeal the decision, and possibly undergo a trial in the Court of Common Pleas

The other alternative is building a medical facility from scratch. This requires a more in
depth analysis because constructing a building requires an architect. First, a building
permit must be obtained by getting a zoning certificate through the zoning inspector
(City, 2000). The licensed architect must submit his construction plans to the state.
Commencement of the building starts lawfully within a one year period of obtaining the
zoning certificate (see 23.03.22. Construction commencement period).

The zones are ranked in order of restrictiveness starting from the B-1 Neighborhood
business zone, which is the most restrictive (City, 2000). The B- General business district
zone is less restrictive, and any uses in the B-2 General business district are permitted if it
is allowed in a more restrictive zone, like the B-1 district (see 23.02.04. Degree of
restrictiveness).

There are certain types of permitted uses that are entailed when beginning a business,
whether pre-built or not. The first permitted use is the principal building permitted uses.
The principal building permitted uses include any local retail business or service
establishment supplying products or services primarily for residents of the neighborhood.
                                                                           Albany Assessment   21


This states that the business, including the medical facility, must be within an enclosed
building.


It is necessary for the medical facility to obtain signs in recognition of the business (City,
2000). First, however, a sign permit must be attained (see 23.03.13. Sign regulations).
There are many regulations and many different types of signs that are allowed in the B-2
district, but it must meet zoning regulations.

Our proposed medical facility would have to include off-street parking to accommodate those
in need of medical care (City, 2000). There are certain provisions of a parking lot that must be
complied with, such as being enclosed by a fence, the proximity of the parking lot with
adjacent dwellings and others listed in 23.10.05., development and maintenance of parking
areas and structures and loading areas.

The structure located on Richland Avenue does not have to abide by Zoning restrictions
that pertain to height and yard restrictions since it is an existing structure (see 23.07.01.
Existing non-conforming uses; “Grandfather Clause”). The Grandfather clause does not
apply to parking, however. For every 200 feet of floor space of the building, one parking
space is permitted. If not, variances must be acquired.

23.08.01. Enforcement

   D) Use prohibited without zoning certificate.

       It shall be unlawful for an owner to use or to permit the use of any structure,
       building or land, or part thereof, hereafter created, erected, changed, converted or
       enlarged wholly or partly, until a zoning certificate, which may be part of the
       building permit, shall have been issued by the zoning inspector. Such zoning
       certificate shall show that such building or premises or a part thereof, and the
       proposed use thereof, are in conformity with the provisions of this code. It shall
       be the duty of the zoning inspector to issue a zoning certificate, provided he is
       satisfied that the structure, building or premises, and the proposed use thereof, and
       the proposed methods of water supply and disposal of sanitary
       wastes conform with all applicable requirements of this code.

   E) Occupancy permits

       The purpose of an occupancy permit is to certify that the premises comply with
       the provisions of this and all other local codes and ordinances and is being used
       for the purposes set forth in the occupancy permit. Prior to the use or occupancy
       of any land or building for which a zoning certificate is required, or for any
       change of use of any existing building or for any change of use of land, an
       occupancy permit shall be secured from the zoning inspector. A copy of the
       occupancy permit shall be kept upon the premises and shall be displayed upon
       request made by any officer of the city. All applications for occupancy permits
       shall be in writing on forms to be furnished by the zoning inspector
                                                                           Albany Assessment   22



       (2) Fees - No fee shall be charged for an original zoning certificate applied for
       with the application for a building permit, where such permit is required and
       issued prior to commencement of construction or remodeling under the building
       code of the city.




For all other zoning certificates, there shall be a fee and the charge thereof, shall be as
follows:

         (a) Remodeling
         Minimum fee $15 where a permit is issued prior to commencement of
         construction or $115 where a permit is issued after commencement of
         construction for the first $1,000 or under remodeling cost, plus a $1.50 charge
         for each $1,000 additional cost or fraction thereof.

         (b) New construction
         Minimum fee $20 where a permit is issued prior to commencement of
         construction or $120 where a permit is issued after commencement of
         construction, plus $.02 per square foot of building area. The higher minimum
         fee charged where a permit is issued after commencement of construction is
         intended to compensate the city for additional administrative expense.

   3) Fee exemptions--Local, state or federal government agencies, and churches shall
   be exempt from the payment of fees required in paragraph (D) (2) above.

23.03.22. Construction commencement period.

Construction of a new building, repair, alteration or addition to an existing building shall
commence within a year period from the date of issuance of the zoning certificate.
Failure to start construction within this one year period shall void the zoning certificate.
(Ord. 0-30-69, passed 4/7/69)

23.02.04. Degree of restrictiveness

Where a use is specifically enumerated in a less restrictive zone, such use shall not be
permitted in a more restrictive zone, unless it is specifically enumerated as a permitted
use therein

23.03.13. Sign regulations

*Sign Application and Permit: A sign permit shall be required for all signs, other than
real estate and political signs, in any zoning district.
                                                                         Albany Assessment   23


(L) STANDARDS FOR SIGNS IN B-2, B-3, AND M DISTRICTS

Unless otherwise permitted in this section, no off-site signs shall be
permitted in the B-2 Business District.

The following signs shall be permitted:

(1) Building Signs.

       (a) Business Identification Sign - Multiple Use. In a business
       area containing more than one building, designed and developed as a
       coordinated unit, or where a business building contains more than one business
       unit, an individual store identification sign for each business unit may be
       attached to the building or unit thereof.

       (3) Free-Standing Signs: Placement. Free-standing signs shall be not
       less than ten (10) feet from another business lot and not less than fifty (50) feet
       from any residential district line. The pole or sign structure of a free-standing
       sign shall be set back a minimum of five (5) feet from the street right-of-way line.
       The horizontal clearance between the sign's outer dimension and the curb line
       shall not be less than two (2) feet. No free-standing sign shall be allowed within a
       triangle formed between points on the front and side street right-of-way lines
       within ten (10) feet from their intersection.

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, about, 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.
                                                                        Albany Assessment   24


   (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

   (E) Any off-street parking area and off-street loading area shall be graded and drained
   so as to dispose of all surface water without detriment to surrounding uses.

   (F) Parking shall be permitted on the roof of any structure, provided a 4 foot wall is
   constructed around the perimeter of the roof.

23.07.01. Existing non-conforming uses

Except as hereinafter specified, the lawful use of a building or premises existing at the
time of the adoption or amendment of this code may be continued, although such use,
building or structure does not conform with the provisions of this code for the district in
which it is located.


            Dimension Requirements for a B-2 Downtown Business Zone


Minimum Lot Area per Dwelling unit (sq. ft.): No minimum lot area restrictions apply.

Minimum Lot Width: No minimum lot width applies.

Maximum Height (feet/story): Maximum height is 75/6.

Minimum Front Yard (feet): There is no minimum front yard restriction that applies.

Side Yard one/both (feet): No side yard restrictions apply.

Minimum Rear Yard (feet): No minimum rear yard restrictions apply.

Maximum Lot Coverage (percent): No maximum lot coverage percentage applies.

				
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