Case 4 Questions. Vallejo
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Victoria Vallejo CASE 4 QUESTIONS
TULSA MEMORIAL HOSPITAL
Break-Even Analysis
Using the historical data as a guide, construct a pro forma (forecasted) profit and loss statement for the clinic's average month for all of 2022 assuming the status quo. With no change in volume (utilization), is the clinic projected to make a profit?
The below pro forma profit and loss statement states that the clinic is currently operating at a loss of $3,173 per month, considering the subtraction of fixed and variable costs. The contribution margin per month totals $54,888 or divided out equals $40.66 per visit. The hospital is not sustaining itself at this point or even paying for its fixed costs. Pro Forma Average Month:
Number of visits
1,350 Net revenue
$54,888 Salaries and wages
$13,542 Physicians fees
18,000 Malpractice insurance
3,215 Travel and education
602 General insurance
843 Subscriptions
0 Electricity
1,077 Water
139 Equipment rental
105 Building lease
12,500 Other operating expenses
8,038 Total operating expenses
$58,061 Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale.
Victoria Vallejo Operating income (loss)
($3,173)
Operating margin (%)
-5.8%
2.
Consider the clinic's situation without the new marketing program. How many additional daily visits must be generated to break even? Construct a break-even graph that can be included in your report.
Without the new marketing plan, the clinic will need an additional 22 patients
each day to break even. 1
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-40000
-20000
0
20000
40000
60000
80000
100000
120000
Without New Marketing Program
Incremental visits
Total monthly revenue
Total monthly costs
Series4
Operating income (loss)
Repeat the Question 2 analysis, but now assume that the new marketing program is implemented.
With the new marketing plan, the clinic will need an additional 29 patients each day to break even. Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale.
Victoria Vallejo 1
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-40000
-20000
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20000
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60000
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120000
With New Marketing Program
Incremental visits
Total monthly revenue
Total monthly costs
Series4
Operating income (loss)
Focus solely on the expected profitability of the proposed marketing program. How many incremental daily visits must the program generate to make it worthwhile? (That is, how many incremental visits would it take to pay for the marketing program, irrespective of overall clinic profitability?) Construct a break-even graph.
For the clinic to not operate at more of a loss than they were before the marking program, an additional 26 visits per day are needed. The marketing
costs of $7000 are paid for through the incremental analysis.
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-30000
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0
10000
20000
30000
40000
50000
60000
Expanded Marketing Program Incremental Analysis
Added daily visits
Incremental monthly rev
Incremental monthly costs
Series4
Incremental Operating income (loss)
5.
The analysis has considered the clinic's near-term profitability—that is, an average month in 2022. Recast the pro forma (forecasted) profit and loss Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale.
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Victoria Vallejo statement developed in Question 1 for an average month in 2027, five years hence, assuming that volume is constant over time. (Hint: You must consider likely changes in revenues and costs due to inflation and other factors. The idea here is to see if the clinic can "inflate" its way to profitability even if volume remains flat.)
Using a set 3.0% inflation rate over the next 5 years, the clinic is still losing money. The building lease was kept at a set price since it was a long-term lease and subscriptions were not changed.
6.
Although you are basically satisfied with the analysis thus far, you are concerned about the uncertainties inherent in the revenue and expense data supplied by the clinic's director. Assess each element in your Question 1 pro forma profit and loss statement. Are there any items that are more uncertain than the others? How could uncertainty be worked into the analysis? Is there any additional information that you might want to get from the clinic's director?
The more uncertain elements in the pro forma data are:
o
Baptist’s acquisition of healthcare facilities may impact TMH’s market share. With overworked employees in the clinic, they may seek out Baptist positions to have better work schedules.
o
What does the “other operating expense” category include? Knowing the composition of this category may allow for other financial adjustments.
o
Visit numbers may fluctuate with Baptists coming into the market to compete with TMH.
Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale.
Victoria Vallejo o
Due to staffing shortages, the facility may have the likelihood of having
more accidents in patient care; this may impact the cost of malpractice
insurance coverage.
Questions we would ask the clinic director.
o
What caused the other area clinics to go out of business? o
In the other markets that Health Services of America owns are any other the other urgent care clinics flourishing and what has made them
flourish?
7.
Suppose you just found out that the $3,215 monthly malpractice insurance charge is based on an accounting allocation scheme that divides the hospital’s total annual malpractice insurance costs by the total annual number of inpatient days and outpatient visits to obtain a per episode charge. Then, the per episode value is multiplied by each department's projected number of patient days or outpatient visits to obtain each department's malpractice cost allocation. Does this allocation scheme bias your break-even analysis? (No calculations are necessary.)
I do not see this creating a bias in my break-even analysis, as I am not analyzing an individual department but the clinic as a whole. 8.
After all the work thus far in the analysis, you suddenly realize that the hospital, as a for-profit corporation, must pay taxes. What effect does tax status have on your break-even analysis?
This does not have an impact at this time. The clinic is operating at a loss so
they would not have to pay taxes at this time. Taxes would come into factor once the facility starts operating at a profit. 9.
Does the clinic have any value to the hospital beyond that considered by the numerical analysis just conducted? Do the actions by Baptist Hospital have any bearing on the final decision regarding the clinic?
I believe that Baptist Hospital does have a substantial bearing on the Tulsa System and that’s why the break-even analysis is taking place. If our major competitor is planning to expand, we cannot afford to lose this market so we need to create a plan that will turn the profitable clinic.
10.
What is your final recommendation concerning the future of the walk-in clinic?
Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale.
Victoria Vallejo I recommend that the walk-in clinic remain open without the implementation of the marketing program. Additionally, I recommend the following steps:
Firstly, to identify areas of inefficiency and potential cost-saving measures. Implementing cost containment strategies, such as renegotiating supplier contracts, optimizing staffing levels, and streamlining administrative processes, can help reduce expenses without compromising the quality of care.
Secondly, exploring opportunities to increase revenue streams. This could involve expanding services or specialties that are in high demand, improving
billing and revenue cycle management processes to minimize revenue leakage, and enhancing marketing efforts to attract more patients to the hospital. Additionally, exploring partnerships or collaborations with other healthcare providers or organizations can help leverage resources and access new patient populations.
Thirdly, it's crucial to focus on enhancing operational efficiency and patient satisfaction. Improving throughput times, reducing wait times, and enhancing the overall patient experience can lead to higher patient satisfaction scores and increased patient loyalty. This, in turn, can positively impact the clinic's reputation and bottom line.
11.
In your opinion, what are three key learning points from this case?
Break-even analysis is a crucial tool in the healthcare industry, aiding in financial decision-making and strategic planning. Three key learning objectives associated with break-even analysis in this sector include understanding the concept of fixed and variable costs, calculating the break-
even point, and utilizing sensitivity analysis to assess the impact of changes in key variables. Firstly, grasping the difference between fixed costs (such as
facility overhead) and variable costs (like medical supplies) is fundamental to
accurately analyzing cost structures. Secondly, being able to calculate the break-even point, where total revenue equals total costs, helps healthcare organizations determine the minimum volume of services or patients needed
to cover expenses. Lastly, sensitivity analysis enables healthcare professionals to evaluate how variations in factors like patient volume, reimbursement rates, or service prices affect the break-even point, allowing for more informed decision-making amidst dynamic healthcare environments. Mastering these objectives empowers healthcare managers to
make strategic financial decisions that ensure sustainability and effective resource allocation within their organizations.
Copyright © 2022 Foundation of the American College of Healthcare Executives. Not for sale.
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