Executive Summary

Rural Urgent Care (RUC) units are essential in providing emergency and other services to patients. The paper presented a business plan for the next five years for approval and funding for its implementation as the new project. Oftentimes, not all patients need services of emergency department. In this case, they may be better served by inpatient unit. However, due to that enough beds are not available, they are forced to board in the emergency department. Therefore, a non-profit community hospital, Lakeview Hospital, located in Mississippi considered adding an urgent facility of care in the rural region. Urgent care incorporates facilitating ambulatory care in a committed service provider for delivery of walk-in-care that is not scheduled outside the hospital emergency department. Setting up of the center of RUC will focus on the facilitation of access across the care service providers by prolonged hours of service in a closer geographic reach to caregivers, victims and families. RUC will enable the lowering of pressure for services of emergency department in order to move the patients with less severe health conditions to an environment of less intensive resource. This project responds to the shift from volume-based healthcare to value-based healthcare.

All the beneficiaries show great interest in the advancement of economic efficiency by utilizing the emergency department at settings of reduced cost, like RUC. There will be set up and staffing of the center with the physicians and inclusion of a radiology suite, laboratory suits, and other ventures related to healthcare for assisting in the advancement of the hospital service.

Program Overview

Lakeview Hospital is a non-profit community hospital located in Columbus, Mississippi. It is planning to start up a Rural Urgent Center. It will offer services such as, nursing triage and lab test. In addition, for Lakeview Hospital achieve its goal for meeting the needs of the community and provide the essential standard of care without unnecessary replication of a capital-in-depth hospital department of emergency, the RUC will provide necessary emergency strategy, analysis, and treatments, such as, imaging the basic diagnostic, doctor assessments, minor steps, basic lab services, signs which are vital, and care of the wound.

Other professional services that Lakeview Hospital will offer are family support services, house ambulance services which are opportunities and requirements as well. There will be also the stocking of the supplies which will reduce the cost because the warehouse will facilitate storage. In addition, the Lakeview Hospital Rural Urgency Centre will be part of disaster management, that is, strategic disaster-planning by facilitating easy access to the required equipment and supplies during the cases of emergency. Additionally, the RUC could offer opportunities to leverage the suitable retail environment to facilitate additional income-generating clinical services. There is safety testing of occupational which is an example that could avail using a safe bathroom to provide basic drug testing. Currently, the service is offered at the facility, but is much better suited for an independent unit. Lakeview Hospital Rural Urgency Centre’s lab tests and x-ray services could also be offered on a basis that is referral for community, availing a more favorable environment for various services than the hospital and enabling larger access to care.

The staffing needs are very high. The new set up will require a team of qualified staff to run the organization to prevent work-to-family conflicts and maintain the quality service (Tement & Korunka, 2015). There will be need for physicians, nurse practitioners, nurse, radiologic technician, and an assistant/receptionist.

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Operational Model

The Lakeview Hospital operational model 2019?2023 shows a structure through which the Rural Urgent Centers will be operated and the procedures to be followed in delivering services to the community in Columbus, Mississippi. The set strategies will be of great help because after achieving the goal of establishing the urgent center, the community will be relieved the stress and pressure of travelling far to get the medication and first aid. The set operational model will help in attaining the set goals for the next five years. The set goals are; acme quality and affordable health services, stress free connection networks, creativity, innovation and research, staff development, and community development. The operational model will be based on the number of patients’ visit per year, percentage growth rate of the number, age of the community in the area, number of staffs required in the unit, size of the land required and, the software and hardware to be used. To achieve the mentioned goals, operational model or plan must be used, that is, all the requirements to be analyzed. In line with this, there will be requirement of land, maybe three acres, where the center will be built. In addition, there will be a requirement for the raw materials including the cost to be incurred in construction are $777.63 per square foot.

Moreover, after construction and establishment, there will be need for staffing and installation of the software. Staffing will cost $625,000.00 in the first year which will increase annually. Also, marketing strategy will be essential at the beginning to help the community know that there is urgent center in their land.

Market Profile

Market Overview

Lakeview Hospital is a non-profit community hospital located in Columbus, Mississippi. The service area where RUC will be located is well defined. Baptist Memorial Hospital is near. This will be of great help in collaboration to ensuring that the society is well served and satisfied. The area has a large population and the RUC will serve sufficient number of patients.

The population comprises of 50% Hispanics, 25% Caucasians, 12% African American, and 13% recent immigrants from Northern Africa. Over 50% of the population is living within 200% or below of the poverty level. This population requires a lot of service and attention to ensure they are healthy. The map below shows the location of the hospital (see Figure 1).

Demand Forecasting

Demand forecasting shows that the number of patients that visit the center in the first year is projected as 4,882. This number increases with the rate of 5%. Therefore, the patients that visit the center within the given five years will total to 26,976 patients. The demand of the service is very high as predicted by Table 1 below.

Table 1

Demand Forecasting

Yr I Yr II Yr III Yr IV Yr V
Year 4,882 5,126 5,382 5,652 5,934
Month 406.8333333 427.1666667 448.5 471 494.5
Week 101.7083333 106.7916667 112.125 117.75 123.625
Day 3.390277778 3.559722222 3.7375 3.925 4.120833333

Financial Analysis

Capital Requirements

Capital requirement is the amount or capital that the institution has to have as a legal requirement for regulatory agencies. Lakeview Hospital will need to hire physicians of emergency department, particularly as the strategy of collaboration for taking part in an agreement of Accountable Care Organizations (ACO). The Lakeview Hospital is at a crucial season requiring immediate response for the competitive situation to make clear and healthy analysis for investment in the unit of RUC addressing both economic and financial circumstances (Kettaneh, Kinyanjui, Slevin, Slevin, & Harley, 2015). There will be staffing of the unit with the doctors and the center will comprise of various sections, such as a laboratory suit, and radiology flat among others. For the service provider of RUC, the project will be considered as the “Critical Access Hospital” (CAH). This selection will be established for reducing the vulnerability of finance across rural facilities, such as Lakeview Hospital, while facilitating the accessibility across the healthcare by controlling appropriate services across the non-urban community. The achievement of this goal will be ensured by means of the model of cost-based managed care reimbursement. The various limitations of holding the eligibility for designation of CAH might exist. For this reason, the RUC will be having utmost 30 inpatient beds for severe care. There will be an interval of 36 miles from a different hospital in its location. There will be preservation of annual average length of lasting for 96 hours or lower than that for patients of severe care.

In the healthcare sector, service providers have a number of objectives. There is a need to serve the community and stop experiencing the long queues and time wastages. A material value of attentiveness and incorporation has already taken place in the healthcare market, and there is likely to be a progress of this trend (Anthony & Mizock, 2013). This is due to the fact that healthcare providers have been responding to the Affordable Care Act along with other factors motivating collaboration.

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Reimbursement Model

The capital requirements will be achieved by considering the cost- based model of managed care reimbursement. For this reason, the RUC will make the value-based purchases that are essential for enhancing the experience of the patient and clinical quality with a low inflation of cost (Kossek, Hammer, Kelly, & Moen, 2014). This type of reimbursement will provide inducement for the advancement of patients’ experience and clinical standard with a lowered inflation of cost. In addition, benefit can be taken from the regulation of scale within a surrounding of fee-for-service payment not becoming a compounding limitation while engaging in the particular project. The declaration of quality care will be the key policy objective developing the distinctive necessity of non-urban areas and accessibility of health care system for people that is appreciated as both cost efficient and having high standard.

Cost per Patient Visit

The Lakeview Hospital aims at adding an urgent facility of care in the rural region. RUC incorporates providing the ambulatory care in a committed service provider for delivery walk-in-care, not- scheduled outside the hospital emergency department. In line with this goal, there will be a flat rate on the charges per visit. The Lakeview RUC Center will have its rate constant each visit, that is, a fee of $450 and this rate will not change with time. This means that every time the patient comes in will pay $450 without adjustments, unless the policy changes. Contractual discount, also known as contractual allowance, is the difference between what the hospital bill and what they are paid by the scheme administrators. Contractual discounts for insurance is 30% of gross patient revenue.

Table 2 shows the income statement for five years. This is the analysis of the expected revenue and expense. The analysis shows that there will be an increase of the income every year for the five years.

Table 2

Pro Forma Income Statement

Pro Forma Income Statement
Yr I Yr II Yr III Yr IV Yr V
Total Visits 4,882 5,126 5,382 5,652 5,934
Revenue Generated Per Visit $450 $450 $450 $450 $450
Gross Revenue
Patient Revenue 2,196,900 2,306,700 2,421,900 2,543,400 2,670,300
Gross Patient Revenue $2,196,900 $2,306,700 $2,421,900 $2,543,400 $2,670,300
Deductions from Patient Revenue
Contractual $659,070 $692,010 $726,570 $763,020 $801,090
Total Deductions from Revenue ($659,070) ($692,010) ($726,570) ($763,020) ($801,090)
Net Patient Revenue $1,537,830 $1,614,690 $1,695,330 $1,780,380 $1,869,210
Operating Expenses
Salaries and Wages $625,000.00 $643,750.00 $663,062.50 $682,954.38 $703,443.01
Employee Benefits $156,250 $160,938 $165,766 $170,739 $175,861
Utilities $208,750 $215,013 $221,463 $228,107 $234,950
Repair/Maintenance $40,500 $41,715 $42,966 $44,255 $45,583
Housekeeping $20,000 $20,600 $21,218 $21,855 $22,510
Telephone Service $16,806 $17,310 $17,829 $18,364 $18,915
Depreciation $32,000 $32,960 $33,949 $34,967 $36,016
Malpractice $50,000 $51,500 $53,045 $54,636 $56,275
Miscellaneous/Other $20,000 $20,600 $21,218 $21,855 $22,510
Variable Medical Supply Costs $65,767 $67,740 $69,772 $71,865 $74,021
Other Non-Personnel Costs $95,351 $98,212 $101,158 $104,193 $107,318
Total Operating Expenses $1,330,424 $1,370,337 $1,411,447 $1,453,790 $1,497,404
Excess of Rev over Exp. From Operations $207,406 $244,353 $283,883 $326,590 $371,806
Cumulative Income $207,406 $451,759 $735,642 $1,062,232 $1,434,038
Net Cash from Excess Rev (excl Depreciation) $866,476 $936,363 $1,010,453 $1,089,610 $1,172,896
Cumulative Income Net Cash $866,476 $1,802,839 $2,813,292 $3,902,902 $5,075,798


Lakeview RUC Center will be a great benefit to the community in Mississippi. It will serve the community and reduce the sufficient pressure of the demand for the emergency care. In addition, it will be advancement valuable care setting in this area because it will be effective in service delivery and cost cutting. This is because the distance from the hospital will be 36 miles. This is not far as compared to the emergency department overcrowded in the urban areas. In line with the regulations, the ACO is considered as a group of traders and services providers concurred for working together for coordination of care among the patients based on fee-for-service. The main goals are provision of high-quality care rather than fragmented care leading towards a payment system of fee-for-service within which various service providers will be acquiring detached and different settlements. The objective will be reached by means of well-planned funding, providing the necessary resources for care delivery, as well as relevant staffing of the facility.

Under the Medicare regulations, the RUC Center will be making value-based purchases that are essential for enhancing the experience of the patient and the clinical standard with a low inflation. This type of settlement will be availing inducement for the improvement of patient experience and clinical quality in a cost-efficient way. The promise of high-standard care by the service provider will be the key policy objective establishing the accessibility of high-quality and cost-efficient healthcare system in the rural areas.

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