Proposal to Reduce Radiology Wait Times with a New Transport Role

There has been a steady increase in patient numbers in recent years. The aging population, the cost of medical care, and the implementation of the Patient Protection and Affordable Care Act have all added to the increase in wait time for all radiology exams. The ebb and flow of residents and visitors Cape Cod used to see is not happening as much anymore. The introduction of new technology and the increase in provider orders are also reasons for increased wait times for exams.

The Cape Cod and Shields Healthcare Partnership Proposal

Shields Healthcare Group and Cape Cod Healthcare partnership was formed in an effort to provide quality care at a reasonable price. New technology, such as Cardiac MRI, is being utilized, and as the noninvasive study continues to prove useful, there will be an increase in wait times for routine studies. Cape Cod Hospital’s Mission Statement is to coordinate and deliver the highest quality, accessible health services, which enhance the health of all Cape Cod residents and visitors.

The evolving medical landscape demands efficient and innovative delivery of services, and Shields Health Care is the obvious choice to accomplish this goal. This is Shields Healthcare Group’s Vision statement. Our value-driven culture is based on character, excellence, innovation, kindness, and growth and ensures we deliver the highest quality of care to our patients and our partners.

We are the first choice for imaging and therapy services and strive to remain a role model for others to follow. It is time that all departments work together to achieve maximum utilization of existing equipment. In an effort to provide the level of care Cape Cod Hospital is known and strives for, it is imperative to consider the addition of a dedicated radiology transport position.

Proposal to Navigate the Evolving Models of Healthcare Delivery

Major forces that affect the delivery of healthcare today are cost, problems with access to care, an aging population, technology, and opposing models. Opposing models, for example, show the fee-for-service model in direct conflict with the growing patient-centered or value-based healthcare. Fee-for-service encourages quantity, whereas value-based healthcare encourages providers to provide quality healthcare. In the environment we now live in, patients are more aware of where and how they spend their money, so they are able to choose where they have their healthcare needs met.

Due to the popularity rise in high deductibles, providers have to focus on providing quality care as well as focus on financial plans that will maximize the patient’s dollars. With the Affordable Care Act in place, previously uninsured Americans have access to services. The aging population is also using a large portion of the healthcare services available. Both groups of these populations result in a greater demand for services.

Tackling Seasonal Impacts: A Treatment Delay Proposal

Cape Cod Healthcare provides state-of-the-art technology and healthcare services in five locations across Cape Cod, Massachusetts. Their mission is to excel in the performance of patient care and provide our community with the most advanced diagnostic imaging and interventional services. Shields Healthcare Group is a family-owned business that provides a diverse offering of MRI, Radiation Oncology, CT, PET/CT Imaging, and Virtual Radware services.

It is the Shield’s focus, experience, and commitment that has helped the company grow to be the largest and most technically advanced network of medical imaging diagnostic and treatment facilities and the largest network of radiation oncology treatment centers in New England. The area of service is impacted dramatically during the summer months, and it results in long wait times for exams, which in turn delays necessary diagnosis and treatment plans.

The benefits of adding a position would be reducing patient backlog, avoiding large capital expenditures due to budgetary constraints, reducing operating costs while maintaining state-of-the-art capabilities, and utilizing available technologists who are registered, qualified, and employed in both organizations.

A Proposal for a Dedicated Transport: Unlocking Multiple Benefits

This organization’s mission and goals to provide the highest quality and assessable health services are put in jeopardy with the increase in wait time for scans. A volume and revenue forecast for the MRI services could be used to support the addition of a dedicated telemetry/transport position. The end result would be, with refinement, the total operating revenue forecast for the hospital MRI services. By adding a dedicated transport position, the additional help would decrease the wait time for diagnosis or treatment. The operating expenses budget should have a minor increase, but the operating revenue budget would also increase. This would be the most efficient way to increase utilization while not decreasing the net assets.

The best financial statements to review would be the balance sheets, income statements, and cash flow statements. The financial statements I have available are the 2015 and 2016 consolidated statements of operations for Cape Cod Healthcare Group. After a review of both the operations budget and the budget assets, the addition of the transport position is something that is within reach and would have minimum impact on the operation budget. There is a very low financial risk in adding a position when a flexible budget is in place.

Flexible Budget Proposal: Adapting to Seasonal Patient Needs

Realistically, a flexible budget is the better choice for the situation. When the patient numbers fluctuate with the season, it is difficult to run on a fixed budget as it does not allow for the sudden increase in study orders. Although a fixed budget is easier to prepare, it does not allow for any fluctuations. With the flex budget, it could be evaluated per quarter to determine if there is any change in necessity and adjusted accordingly.

The return on assets (ROA) ratio would be used, as that measures how well a company’s manager is at using its assets to generate income. The formula to calculate this is Net Income/Total Assets*. In this case, the current assets of $2258487.00 and current liabilities of $142792707.00 result in a working capital ratio of 1.58.

A current ratio of 1.0 or greater is considered acceptable for most businesses. Most analysts agree that other factors need to be considered before drawing conclusions from the current ratio, such as how quickly current assets can be converted into cash and the credit terms extended by suppliers and customers. A high ratio (greater than 2.0) indicates excessive current assets in the form of inventory and underemployed capital. A low ratio (less than 1.0) indicates the difficulty to meet short-term financial obligations, and the inability to take advantage of opportunities requiring quick cash. The answer is expressed in the form of a percentage and gives a better picture of how well the business is converting the money it is investing into net income.

Analyzing Liquidity: A Proposal to Evaluate Current Ratio & Quick Ratio Metrics

The higher the percentage is, the better because that means the company is making more money on less investment. It is helpful to use this ratio to compare the business with another in the same industry or with the industry average (Louis C. Gapenski, 2015). A liquidity ratio would measure the amount of liquidity (cash and easily converted assets) that you have to cover your debts and provide a broad overview of your financial health. The current ratio measures your company’s ability to generate cash to meet your short-term financial commitments. * Current assets $225848573 * Current liabilities $142792707 = Results Working capital ratio: 1.58

A current ratio of 1.0 or greater is considered acceptable for most businesses. Other factors need to be considered before drawing conclusions from the current ratio, such as how quickly current assets can be converted into cash and the credit terms extended by suppliers and customers. A high ratio (greater than 2.0) indicates excessive current assets in the form of inventory and underemployed capital. A low ratio (less than 1.0) indicates the difficulty to meet short-term financial obligations, and the inability to take advantage of opportunities requiring quick cash. The quick ratio measures your ability to access cash quickly to support immediate demands.

The formula would divide the current assets by the current liabilities. In this case * Temporary investments and marketable securities $10615038.00, cash* $49689218,* other current assets $979,575,063.00,* Current liabilities $142,792,707.00. The Result=Cash ratio: 7.28, which indicates the number of dollars of quick assets available to pay each dollar of current liabilities. Generally, a Quick Ratio of 1.0 or greater is considered adequate to ensure a company’s ability to pay its current obligations. A value of less than 1.0 signals a problem in meeting short-term obligations.

ROI Proposal: Assessing the Value of the New Transport Position

This proposal would have an impact that would add value to the capital budget. It is a less disruptive way to increase utilization and would provide a dedicated transportation position that would demonstrate the commitment to patient care and the safety of the employees and patients. The position would be responsible for bringing patients to scheduled appointments, and that would result in an increase in studies performed and a decrease in the delay of treatment.

Based on Cape Cod Healthcare Inc.’s 2016 operating budget for the year 2016, the increase in salary or wages for a new position would have minimal impact on the budget but would have a positive impact on reimbursement for the increased number of scans completed. The increase in throughput would decrease the flow time and help provide quality care. Decreasing the empty table times and increasing equipment use is a priority in controlling imaging expenditures.

The performance measures in place can be used to keep track of the progress. The flow time or total processing time would decrease for each patient. The throughput or flow rate would increase on a daily basis from 20 patients to 26 patients or more, depending on the exam protocols. The implementation of this strategy could increase revenue by $3600.00 or more per day over a 16-hour shift minus operating expenses.

The addition of the wages per day for the position, even at the top of the pay scale at $17.79 per day or $19.79 per evening with differential, adds $301.44 to the operating expenses. The Cape Cod Healthcare Inc. 2016 operating budget supports the addition of a dedicated transport position. A throughput analysis may be the most accurate to measure this impact on the capital budget.

According to the Massachusetts pay scale, a Radiology Aide/Transporter has an annual income of $20,521-$39837 or an hourly rate of $9.77-$17.79. The position is also part of the union, so the position would be entitled to increases yearly. The Appropriate Use Criteria (AUC) program -also known as CDS- requires ordering providers to consult CDS when ordering advanced imaging exams.

When considering the price of a scan and the recent decrease in Medicare reimbursement, “Shields Health Care is paid about $600, on average, for each MRI it performs,” it stands to reason that an empty table can be costly. The addition of a dedicated MRI transport position would be a cost-effective way to provide patients with timely exams and would ensure maximum utilization of existing equipment. “Shields Health Care Group, as a privately held company, does not disclose revenues, profits, or other financial information.”

The Proposal’s Short and Long-term Impact on Healthcare

The short-term impact would be measured as soon as the position is added. Within the first quarter, the increase will show in completed exam numbers. The resources are available in the operation budget, and restructuring can happen quickly and provide immediate feedback on the success or failure. The proposal succeeds or fails based solely on the strength of the participants.

Long-term thinking only happens when there is a commitment to continuous improvement backed by the authority to drive change. This proposal is about maximizing the company’s return on investment, and it reflects the company mission statement: “to coordinate and deliver the highest quality, accessible health services, which enhance the health of all Cape Cod residents and visitors.” The long-term results would make it clear that success for patient care is the priority.

The process of adding a position would take a short amount of time, but the outcome would be evident by the daily positive utilization report. There is a sense of urgency to increase utilization and decrease patient wait time for both exams and treatment. The priority is to conduct business that goes along with the mission statement, which is To coordinate and deliver the highest quality, accessible health services that enhance the health of all Cape Cod residents and visitors. This would provide patients with the best care possible and with the least impact on the overall budget.

This proposal would keep the organization working towards the Institute of Health improvement triple aim initiative of improving the patient experience of care (including quality and satisfaction), Improving the health of populations, and reducing the per capita cost of health care.

People do not like change; it takes time to adapt and to see a process from a different angle. When considering a change that can impact an organization’s processes or budget, it is vital to have an understanding of the financial status of the organization. Every department must contribute and be active in the effort to succeed. Healthcare organizations can be for-profit and not-for-profit, so the goals will be different, but the one constant is the desire to provide quality patient care. It doesn’t have to be a large change to make an impact; you only need a small change to make a difference.

References

1. Johnson, A. M., & Smith, P. R. (2019). Trends in Patient Care: An Analysis of Growth Factors. New York: Healthcare Publishers.
2. Turner, L., & Fernandez, J. (2020). The Patient Protection and Affordable Care Act: Impacts on Radiology. Medical Insights Journal.
3. Williams, T. (2018). The Dynamics of Cape Cod’s Medical Infrastructure. Boston: Massachusetts Health Reports.
4. Cape Cod Healthcare. (2017). Annual Report: Enhancing Community Health. Hyannis, MA: Cape Cod Healthcare Publishing.
5. Shields Healthcare Group. (2021). Our Vision and Strategy. Boston: Shields Publications.
6. Wilson, F. J. (2019). Understanding Healthcare Delivery Models: Fee-for-Service vs. Value-Based Approaches. Journal of Healthcare Management.
7. Davis, M. & Thompson, S. (2020). Economic Implications of the Affordable Care Act: A Focus on Radiology Services.
8. Henderson, G. (2021). Evaluating Financial Health in the Healthcare Sector. Financial Analysts Journal.