Dialysis center business plan

Please try , there was a not available forcolor:How to start a dialysis center plus business the first to review this 2 left in stock - order , nov. 3 when you choose two-day shipping at from and sold by hing you need to know about starting a dialysis get a 425+ page sba approved lender directory! 7, mac os x16 offers from $ to start a barber school plus business ss plan for how to start hot dog stand meat cart ss plan pro premier v 12 [download]. Vista / 7 / xp5 offers from $ truck business plan - ms word/l offers and product answers in product info, q&as, make sure that you are posting in the form of a 't see what you're looking for? Please try your search again how to start a dialysis center will provide you with all of the necessary steps and information that you need in order to launch your business. You will learn how to how to raise capital, manage startup, how to establish a location, how to market your dialysis center, and how to maintain your day to day operations. Additionally, you will receive a complete ms word/ms excel business plan that you can use if you need capital from an investor, bank, or grant company. The ms word and ms excel documents feature a completely automated table of contents, industry research, and specific marketing plans that are for a dialysis center. Software > business & office > business & marketing plans > business t warranty: for warranty information about this product, please click you like to tell us about a lower price? 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Please try , there was a not available forcolor:Dialysis center business plan - ms word/ the first to review this 1 left in stock - order , nov. In order to navigate out of this carousel please use your heading shortcut key to navigate to the next or previous 424529 turbotax premier 2014 federal plus state plus federal e-file al kit professional - business proposals, plans, legal contracts, templates, samples and software s 8 / 7 / vista / xp, mac, linux1 offer from $ to start a barber school plus business to start a dialysis center plus business ss plan pro 15th anniversary edition [old version]. Vista / 7 / xp5 offers from $ truck business plan - ms word/ other items do customers buy after viewing this item? To start a dialysis center plus business l offers and product answers in product info, q&as, make sure that you are posting in the form of a 't see what you're looking for? Please try your search again dialysis center business plan is a comprehensive document that you can use for raising capital from a bank or an investor. The template also features full documentation that will help you through the business planning process. This is a full and complete business plan with original research, financial models, and marketing/advertising plans that are specific for a dialysis center. Since 2005, bizplandb and its parent company have helped raise more than $100,000,000 through its developed ng weight: 2. Related slideshares at an group_final business hed on feb 7, you sure you want message goes the first to the first to like an group_final business future of ne business ment of health policy and gillings school of global public health. Public health & meeting community need ix 1: example of hemodialysis equipment ix 2: outpatient revenue growth, 2009 to 2012 ix 3: industry distribution of dialysis patients ix 4: economic sensitivity analysis of outpatient dialysis industry ix 5: dialysis patients admissions per patient-year ix 6: nephrology market share map ix 7: value based purchasing initiative ix 8: porter’s five forces ix 9: stakeholder analysis ix 10: con law in north carolina ix 11: evaluation of alternatives ix 12: distribution mechanisms of awareness campaign ix 13: staffing model calculations & assumptions ix 14: example of staff work schedule ix 15: example of nurse job description ix 16: detailed npv comparison ix 17: net income without contract ix 18: net income with contract ix 19: gross margin comparison ix 20: sensitivity analysis ix 21: scenario analysis ix 22: performance goals ce regional medical center (armc) is a non-profit community hospital located gton north carolina. Since the unit opened in 2009, management ions has been outsourced to davita, a large outpatient dialysis provider, who provides the necessary staff and equipment to run the to 2009, residents in alamance county who required inpatient dialysis treatment had to distances to receive acute dialysis care. In its first month of operation, it received nearly 23 then, the need for inpatient dialysis services has continued to help armc expand its operations to better meet the growing need for inpatient dialysis services,The meridian group was asked to develop an expansion strategy. Armc should increase the size of its inpatient dialysis unit by 416 square feet and add onal dialysis bay. Armc should follow the implementation plan outlined by the meridian group to sful expansion and in-housing of its inpatient dialysis t capacity & patient ’s three-bay inpatient dialysis unit receives an average of three to five patients per day. Higher than expected patient resulted in the unit operating at overcapacity approximately 15% of the time, or day in every growth & patient target market is alamance county, home to 85% of armc’s inpatient dialysis patients. Inpatient dialysis has grown considerably in this target market over the past several ts with end-stage renal disease (esrd) average approximately two hospitalizations number of alamance residents with esrd grew from 177 patients in 2001 to 288 patients in. Looking forward,The number of esrd patients requiring inpatient services is expected to grow by 6% currently holds 58% of the inpatient all-discharge dialysis market.

Dialysis business plan

While unc and duke itive advantages in size and brand-recognition, armc has the advantage of location ion & ’s dialysis unit will be expanded into the four office spaces adjacent and to the west of . Armc will ate its current outsourcing contract and staff the newly expanded inpatient dialysis unit own employees and meet projected demand, armc will need to hire three full-time registered dialysis nurses, -time nurses, and one nurse manager to oversee operations. Armc will also need to contract with a ical technician to provide maintenance and support to its dialysis ing of the newly expanded, in-housed unit will consist of an awareness campaign. It will ant for former hospitalized dialysis patients and community residents with impaired ons to know that armc is a viable option if they need to be hospitalized. Primary care physicians, nephrologists,Cardiologist, and vascular surgeons, ambulance services/emergency medical technicians, and ient dialysis centers. The campaign will employ brochures, informational letters, direct mailings, ch, internal emails/newsletters, and physician to physician mobilization to build ial ically, inpatient dialysis services provided at armc have produced a net loss to the a result, the net present value (npv) of expanding and bringing services in house is projected negative. However, when compared to the npv of expanding and continuing to outsource,Armc is projected to save approximately $1 million by in-housing its dialysis services. In order to affirm this mission statement, armc must ensure that it capacity to continue to meet the rising community need for dialysis services. Is removed, the purified blood is pumped back into the ts can receive either hemodialysis or peritoneal alysis involves stationary treatment in four hour peritoneal dialysis is mobile and can be done during the day or while the patient is sleeping. Treatment can be performed in ent setting, in an outpatient facility, or at ient facilities treat patients with chronic kidney problems while inpatient dialysis es more severe cases. Patients requiring inpatient dialysis care are very sick ents requiring acute dialysis treatment are typically admitted through the ment (ed), often for non-kidney related ailments such as shortness of breadth or , and later on in the course of treatment, a determination is made that dialysis treatment . Patients receiving inpatient dialysis treatment often receive dialyiss on a regular basis ient settings and have a history of chronic kidney problems that require maintenance three to four times a week. The most prevalent primary diagnosis for patients admitted for inpatient es altered mental status, anemia, shortness of breath, nausea and vomiting, and prevalence of chronic kidney and end-stage renal disease has spurred large growth in the dialysis treatment. This represents a 40% increase from 2000 ents the largest increase in point prevalence of esrd in over a in patient demand for dialysis services has been coupled with large increases in outpatient services and medicare spending. Future estimates project the dialysis industry by another billion dollars in 2012, representing an 8% increase in annual revenue ted growth in gdp. Both providers are vertically integrated, resulting in a robust but consolidated for dialysis equipment, supplies, and clinical expertise. Braun, althin and consolidation of distribution and supply suggests that the dialysis industry as a whole ng the maturity stage of market development. As it reaches peak maturity, the industry to see more entrenched competition among fixed market leaders (davita and fresenius) ing customer loyalty as market share is environmental trends will likely impact the dialysis industry include hospital outsourcing ent services, medicare bundling and reimbursement, an aging population, and idation of both outpatient and supplier r utilization of state-of-the-art hemodialysis machines that offer automated monitoring -time processing capability is expected to continue as costs associated with automation competition on service quality among hospitals increases. Advances in hemodialysis logy will also ensure continued preference for hemodialysis over peritoneal in gs in the near - total medicare expenditures on esrd population by type e provider, 1991 - ent dialysis services are outsourced more than service-line. As of 2006, 31% als reported outsourcing dialysis services due cost pressures and perceived expertise ient market outsourcing is expected to remain relatively larger hospitals, mounting cost pressures to result in greater outsourcing of dialysis smaller community u. The aging of the american population will likely result in ses in demand for dialysis re there was no net change in the 2012 medicare fee schedule for nephrology-related service, ions in bundled payments through productivity offsets and value-based purchasing can ed in the near term as the federal government attempts to reign in medicare / political r consolidation within the outpatient dialysis market can be expected as fresenius and e for market share. Consolidation may also result in limited peritoneal and home dialysis as large providers limit the range of therapies to strictly an effort to boost outsourcing trends. Target market & patient ’s target market is defined as patients who are expected to require inpatient dialysis live within the primary service area from which armc receives acute dialysis on 2010 admission data provided by armc, approximately 85% of armc’s dialysis in alamance county, followed by guilford county with 10%. Based on this admission data,Alamance county was identified as armc’s primary service area within its target patient target patient population is comprised of esrd patients currently residing in alamance whose kidney-disease will eventually result in the need for inpatient dialysis treatment. As of population health trends suggest ar health problems will continue to drive up prevalence rates of kidney-related illness for both outpatient and inpatient dialysis alization rates: patients receiving inpatient dialysis treatment are very sick most common admitting drgs among dialysis patients at armc over the past two e heart failure and shock, septicemia, renal failure, and other circulatory system al admissions are highest among women, african americans, older patients, and esrd is caused by /ethnicity: the racial and ethnic makeup ent dialysis patients at armc closely of alamance county and north carolina as (see figure 4). Although in alamance county, native americans represent the n of dialysis patients, state-wide, they represent 1. Ent a young and growing population in north carolina and armc should therefore expect more latino dialysis patients in the future. Based on these demographic trends, armc to see an increasing proportion of minority patients requiring inpatient dialysis / gender: alamance county dialysis patients are older than the statewide average (62 versus.

5 future growth are two principal drivers of growth in the need for inpatient dialysis services within : 1) rising prevalence of chronic and end-stage renal disease among alamance nts, and 2) what we have coined the “awareness effect” on ambulance in prevalence of in inpatient dialysis patient volume is driven primarily by growth in the prevalence of end-. Of the availability of inpatient dialysis treatment among ambulatory providers is a driver of increased inpatient volume. Unlike in outpatient settings, within acute care, ncy department (ed) is the primary entrance into the hospital for dialysis patients. The like a feeder-system for inpatient treatment and the process begins with ambulance awareness ent dialysis capability. At armc, the inpatient dialysis service is entering into its third year,Growth associated with this “awareness effect” is expected to taper-off as the availability of ent becomes common ce county age distribution. Number of competitors currently compete for inpatient dialysis patients within alamance competitors include unc health care, duke university health system, and moses - map showing location of key competitors. Unc currently owns and operates a 10 bay inpatient dialysis unit at hospital in chapel hill. Unc also has a two-thirds ownership stake in carolina dialysis, llc,A multi-facility outpatient dialysis provider comprised of carolina dialysis-carrboro, pittsboro,Sanford, siler city, fmc burling kidney center, and burlington dialysis ute owns the remaining one-third unc’s inpatient and outpatient dialysis units are staffed and operated by the large is organization fresenius. Despite its size, unc continues to face difficulties in recruiting ding dialysis nurses for its inpatient unit. The “all discharge” market refers to the market comprised of patients across all service-lines regardless of - all-discharge market share, r, it takes up to 9 months to fill a dialysis position. Still, unc intends to provide t to the program as it expects the program to continue to grow given rising patient university health university health system (duhs) is a three-hospital academic medical center located 34 of armc in durham, north carolina. Duhs’s nephrology department is ed and currently ranks as one of the best nephrology training programs in the ent services provided by duke include nephrology consultation, on-going dialysis treatments,And kidney / pancreas transplants. Duke also has an active home dialysis program and is emergency dialysis as well as pediatric nephrology services provided through its children’r to unc, duhs has a strong outpatient component and provides maintenance dialysis its chronically-ill patients at a number of davita-operated outpatient dialysis facilities son, roxboro, louisburg and durham. While cone health has historically been a itor within the inpatient dialysis market in alamance county, as of 2011, cone health the process of merging with armc. 3 barriers to rs to entering and successfully competing in the inpatient dialysis market include proximity -party organizations, an increasing target market, specialized knowledge, high degrees ity, and strong brand-recognition. As stated earlier, the primary population for inpatient those that receive dialysis in outpatient dialysis facilities. To promote continuity of care,Inpatient dialysis services must stay in frequent communication with the outpatient maintain access to outpatient resources and expertise in areas such as improving quality,Lowering cost, and increasing employee satisfaction. Access properly trained in providing and supporting dialysis care is therefore crucial sfully competing in the inpatient dialysis market. Ial dialysis patients come to the hospital for emergent conditions, they will mostly ed (or request to be directed) to the nearest hospital. Less opportunity for relationships with ties and referrals relative to other organizations large dialysis organizations in alamance population prevalence of esrd. Lacks competitive edge in providing in home ion and transplant armc’s primary competitors duke and unc have a competitive advantage in size -recognition, armc has the advantage of location and convenience. Should armc decide its dialysis service, it should assume a “defender” competitive strategy, protecting its is service-line and seek to gain more traction within its primary service area. 4 level of conducting a porter’s five forces analysis (see appendix 8), the overall level of the inpatient dialysis market within alamance county appears to be low-to-medium. Threats of substitutes are also low as there are few low-cost acute alternatives alysis patient bargaining power remains low given the emergent nature of inpatient dialysis care, held by payers and suppliers appears to be high as medicare remains the dominant payer treatment. Armc ed unc’s con, however, market penetration from large academic medical centers like duke should be . 1 nt to north carolina state law regarding certificate-of need (con), the expansion of armc’is unit will not require armc to file a con application because con requirements do to expansion of dialysis services in inpatient settings. Although the “bundled” payment system may have a on improving quality of care and efficiency, it may result in financial losses to es such as inpatient dialysis. Beginning in 2013, medicare payments will be reduced for excess 30-day ssions for patients suffering from heart attacks, heart failure, and , it will be important that armc maintains high quality outcomes among its ts, especially those with high co-morbidities and receiving inpatient dialysis treatment.

1 strengths, weaknesses, opportunities & identify internal strengths, weaknesses, external opportunities and threats associated ent dialysis service, a “swot” analysis was conducted (see table 2). Fortunately, the market for dialysis service is relatively difficult without the support of a third-party (i. Threats facing ed potential damage to armc’s ability to provided dialysis services if it loses its another organization and future cuts in medicare reimbursement due to productivity off-sets -based - swot analysis. However,As armc plans for expansion, dialysis has been identified as that has reserved logists high high both nephrologists at armc provide the clinical expertise l knowledge that is required to successful operate ent dialysis unit. Davita may also try to of armc’s business by serving as a vendor for m’s equipment and g staff high moderate should armc discontinue its contract, the success of m is highly dependent on the number of nurses that g and able to be complete dialysis care training. Stakeholder map was also developed to identify the relationship between important their level of support for in-housing armc’s dialysis service. 4 capacity & patient ’s current dialysis unit has three bays and provides alysis and peritoneal dialysis services. Due to greater than expected patient volumes, over three years, approximately 15% of the time (or one day in every seven), they operated at max order to meet this excess demand, nurses have to adjust s of treatment and dialyze patients at later times,Lowering the quality of the unit’s inception in 2009, the number of patients requiring dialysis treatment has ically. 5 patient mix & is is a unique inpatient service because insurers do not specifically reimburse for the inpatient dialysis treatments. Instead, payment for dialysis treatments are lumped within a based on the primary admission the past two years, the most ing drgs for armc’s dialysis been heart failure and shock, septicemia,Renal failure, and other circulatory ses. Annual fluctuations in drg prevalence,Average reimbursement also changes yearly the acuity of the patients being mix for inpatient dialysis services is heavily skewed towards public payers with medicare. This to the fact that the majority of dialysis patients seen at armc fall into the special category stage renal disease (esrd) patients who are automatically medicare-eligible regardless of . 514 545 578 613 – dialysis patient volume projections at armc, 2009 through 2011, 82% of the patient population was medicare patients, a decrease from 90. In e of government payers, the other major payer was managed care plans which represent. 7 capacity projections given current random sampling and of daily census distributions, we estimate that if the dialysis area is ed, the percentage of time that the dialysis area operates at maximum capacity will 17. Recommended ’s vision is to be “desired and chosen by the community for healthcare services based on tion of excellent services, modern facilities and equipment, [and] skilled and meridian group has developed the following recommendations to help e its vision for meeting the community’s inpatient dialysis need. On market trends, current capacity, and projected demand, it is recommended that its unit’s capacity by one additional dialysis bay, and increase the size of the unit imately 416 on financial projections, anticipated cost-savings, and internal administrative and st, armc should dissolve its contract with davita and bring inpatient dialysis services in-. Ensure that the recommendations are successful, the meridian has developed an gy for expanding and in-housing armc’s inpatient dialysis unit. Since armc’s contract with not end until july 2014, it is recommended that expansion occur first followed entation of in-housing dialysis services. The minimal tly allotted for dialysis treatments hinders operational efficiency, and only two of the bays conveniently used due to an obstruction in the middle of the dialysis is also limited space for storage which has forced staff to store both dirty and clean supplies same room and in close proximity to one another. Limited storage space also requires es to be kept elsewhere which further hinders operational are four offices next to the current location containing 416 square feet that could ted to provide additional space for dialysis services, including space for adding is bays beyond the recommended expansion. Due to the water system that is currently to the dialysis area, moving the area to another location is impractical and would be - current layout & future the four offices next door are currently in use, armc is adding space elsewhere in al which should help facilitate the relocation of those employees currently residing in these. Phase 1 will consist zational planning efforts including organizing a steering committee to oversee the project ping a transition plan to guide expansion efforts. In phase 2, construction will tion of the adjacent office rooms and hallway should be completed first before tearing remaining wall that divides the dialysis area from the office area. While this will onal labor and the use of portable dialysis machines, the financial impact is expected to l as davita charges per encounter rather than per hour for staffing and - timeline for expansion. Begin dialysis treatments with armc - three-step implementation process for in-housing addition to implementation, the meridian group has developed the following operations plan armc’s operation of the expanded, in-housed dialysis is patients are a unique patient require specialized clinical personnel to them. The nurses administering dialysis must ered dialysis nurses (rdns), which requires d amount of supervised experience and ng. As armc currently treats this t population, they must be able to is service at all armc to move forward with bringing -house, it will be necessary to recruit a full staff ered dialysis nurses.

Armc will also need to hire g supervisor who will take responsibility for overseeing all dialysis related activities, uing education, regulatory and compliance issues, conference attendance and . Professional judgment method calculates total hours needed to staff a particular unit and takes into account a tage to adjust for pto and unplanned absences and then converts them into ftes needed. Sundays historically have the lowest volume of dialysis treatments, thus one nurse on staff will g staff break down. 3 nurse floating & -to-day demand for inpatient dialysis treatment varies significantly making it difficult, if ible, to accurately predict volume in advance. To combat this unpredictability, end that armc float its registered dialysis nurses to the medical and surgery unit. Under this float model, the salary cost of each nurse split between the dialysis unit and med/surg based on the amount of time rdns spend in would significantly improve the financial viability of the dialysis unit, because armc s floating schedules in other units, and there would be minimal cultural data from the past two years on the time davita rdns staffed at armc spend not ent; we determined that 85% of the time rdns can treat approximately four patients over a. After year one, nurse float time in med/surg is projected to approximately 40% by year 5 due to increases in dialysis volume (see figure 11). 5 recruitment & armc’s relative inexperience operating an inpatient dialysis area, it is recommended should not initially self-train and certify its own rdns. Instead, armc should focus s on recruiting already trained registered dialysis nurses with previous experience in gs. Recruitment should focus first on the professional networks of armc’s current staff down any available internal referrals prior to branching out to external to external recruitment, in order to stay competitive with local outpatient dialysis centers,Full-time nurses should receive armc’s benefits package worth 24% of their total salary to include te medical insurance package, disability and life insurance, wellness program benefits itive retirement benefits. This generous benefits plan, particularly for part-time nurses, should to be competitive in the full-time rdn market and highly preferred in part-time meridian group recommends that armc include a sign-on and retention bonus worth 10% total salary. Awareness the emergent nature of inpatient dialysis treatment, patient demand is predicated less -recognition and external referrals and more on local availability, internal referrals, and a result, we recommend that armc’s marketing efforts consist of an awareness ing armc’s five major stakeholders: community residents, former dialysis patients, ians and physicians, ambulance services/emergency medical technicians, and local is centers. Armc’s commitment to high quality emergency medicine and inpatient dialysis services rated by the hospital’s recent decision to invest in the expansion of inpatient dialysis services”,Will be the message that is communicated to the alamance county community. This message be coupled with patient outreach post-patient discharge to reinforce armc’s dedication to ts, ensure patient satisfaction, and strengthen patient tion to patients and reinforce armc’s dedication to its patients receiving dialysis treatments, short ghting armc’s commitment to high-quality dialysis care and the breadth of its staff’s ise will be distributed to patients and families admitted through the ed. These pamphlets be sent via direct mail to alamance county - awareness campaign ensure patient satisfaction, dialysis patients recently discharged from armc’s will be asked to a satisfaction survey. To necessitate maximum compliance, the survey will also be a phone call that addresses the patient experience and reinforces armc’s commitment to t-centered care. 2 increase internal al staff and physicians assess patient needs during the triage process, and play a large role ining whether patients need and can receive dialysis treatment during their stay. As a result, it will important for the expansion of the inpatient dialysis unit to ghly communicated to clinical staff and physicians, notably cardiologists and al outreach & effectively communicate the expansion to clinicians and physicians within armc, the s will be taken:1. The expansion of the inpatient dialysis unit will be announced in the employee newsletter,Wavelengths; the medical staff newsletter, physicians’ quarterly; the community health magazine,2. Armc’s chief medical officer and other unit administrators will be asked to inform al/medical staff and primary care physicians about the expansion of the dialysis to encourage patient referrals to the unit; and,3. Eight weeks before and one month after the expansion of the dialysis unit, a biweekly al email to all clinical and medical staff will be disseminated with information ion and the importance of patient referrals to the unit. 3 external mentioned earlier, the vast majority of dialysis patients treated at armc are admitted ed. Furthermore, armc will need to promote awareness of local outpatient dialysis service centers and al outreach & ensure awareness of expanded inpatient capacity at armc, the following actions will take place: information on expansion efforts will be disseminated to emts and ambulance services via. Brochures will be disseminated to outpatient dialysis centers in alamance county (bma gton, and burlington dialysis center) outlining the services and d by armc’s newly expanded inpatient dialysis unit. Informational letters and phone calls will be directed to outpatient dialysis centers ce county (bma of burlington, and burlington dialysis center) about expansion ’s inpatient dialysis unit. Financial the provision of inpatient dialysis services at armc is based on meeting community need, ial performance of the expanded unit will be crucial to successful implementation and future. 1 past and present began serving the dialysis patient population of alamance county region in 2009 due g community need. Although the net operating margin was negative, the gross the patient population needing dialysis services available was $1,488,117, suggesting that e generated from dialysis patients covers the direct costs of treating them.

Under the expanded four dialysis bays, armc will need to dialysis machines and two portable water new equipment will cost approximately $95,onal costs including marketing (~$13,500) retention bonuses (~$10,050) must also will also need maintenance support for its dialysis equipment which will not contribute start-up costs of expansion and in-housing but will need to be added to annual es. 3 projected net income & cost per currently pays a contracted fee to davita per treatment administered to a patient at fee starts as a flat rate with additional fees added for items such as wait times, number ts monitored at one time, and a premium for administering dialysis at certain hours of the ending its contract with davita and providing services with its own staff and equipment, reduce its cost per treatment by 33% in the unit’s first year operating in-house, increasing 44% in projected savings in cost per treatment by year 5. 4 net present value & sensitivity bringing inpatient dialysis services in-house, armc ted to save approximately $1,120,941 in net (npv) of 5 year projected cash a more detailed breakdown of npv, see appendix ivity & scenario meridian group also performed sensitivity and scenario analyses to determine how s in npv are to changes in the unit’s growth rate and number of treatments per inpatient s from the analysis show that savings in npv were highly sensitive to the number of ents per inpatient stay but less sensitive to growth rate (see appendix 19 for more details ivity analysis). Sensitivity analysis was not expanded to include fluctuation in patient drg mix or payer e there is minimal range in contribution margins and no single drg comprises a n of the patient l, in-housing armc’s dialysis services consistently illustrated a more attractive npv ining its existing contract. Measuring performance & exit on market trends, the competitive environment, and the overarching mission of armc, ing critical success factors were identified: recruit and retain dialysis staff / nephrologists. Number of dialysis treatments per patient is less than ically, dialysis patients at armc received an average of 2. Treatments per ing to our sensitivity analysis, the savings associated with the program is dialysis patients receiving fewer treatments than expected. However, based on the disease profile of our target patient population, we do not anticipate dramatic patients’ lengths of stay and number of dialysis treatments received. Dialysis program is not compliant with regulatory all esrd patients are categorically eligible for medicare part a, dialysis treatment y regulated by cms. In-housing dialysis services will shift this responsibility and failure to comply with regulatory standards could jeopardize in-housing hedge this risk, it is important that armc have a full-time nurse supervisor on staff responsible for ensuring the in-housed dialysis unit is fully compliant with rds and competencies. Unsuccessful recruitment of dialysis ion of the program is dependent on recruiting and retaining qualified, g staff and any inability to do so would hinder plans to in-house services. Armc should also consider expanding ient relationships to increase its access to qualified pools of registered dialysis nurses. 2 performance evaluate the success of this recommended strategy, we aligned the critical success ated with expansion and in-housing with the armc’s mission and strategic plan. A more detailed breakdown mance measures which includes strategic goal, success factors, success metrics, and be found in appendix armc find that an expanded, in-housed dialysis unit is no longer feasible, the developed an exit strategy for transitioning the unit back to its original size and re-. Phase 1 will consist of the phasing out current ions and reassessing expansion and spatial needs given lower than expected treatment the rdns will have spent time providing care on other units, given their expertise, ance of maintaining competency, and the cost premium of specialization, it is unlikely would stay at armc if the dialysis area was no longer staffed with in-house stration in conjunction with human resources would have to deliberate with each rdn career options and opportunities. This will include making decisions regarding whether or should keep or sell its dialysis equipment. While this option would result in - performance metrics for expansion & in-housing of inpatient dialysis , the tax loss from the sale would have to be considered when comparing this option g the equipment and negotiating a lower price from outsource y, in phase 3 of the exit strategy, armc would finalize its contract with an outsource ble options would include renewing its contract with davita or signing a new contract r dialysis provider, such as fresenius. Public health & meeting community the heart of meridian group’s recommendations is the firm belief that armc will be better meet the local community’s health needs by increasing its inpatient dialysis capacity solely accountable for the operations of the area. When armc’s dialysis area operates at ty, the nurses must limit treatment length and dialyze patients late into the night to meet demand. Instead, armc must have the capacity, staff, and expertise in place tee that it is the hospital of choice for all community ix 1: example of hemodialysis ix 2: outpatient revenue growth, 2009 to e growth among ix 3: industry distribution of dialysis bution of dialysis ix 4: economic sensitivity analysis ient dialysis industry. 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 dialysis: admissions per ix 6: nephrology market share ix 7: value based purchasing new quality performance program included in the health reform bill, all esrd payments reduced by up to 2% for failure to meet or exceed performance standards. The majority of dialysis services offered in ce county region are outpatient have been major consolidations and entrants into the outpatient dialysis service. Pricing for the provision of inpatient dialysis bundled under the patient’s drg for alization resulting in minimal pricing armc and its y is low in this market holds almost the nt market share for ing dialysis within the area are not many providers in a ity to armc vying for dialysis needs. There are low to moderate capital requirements inpatient dialysis service line if it is staffed by e contractor like fresenius or davita- e contractors provide the equipment, l, and expertise. There is a correlation ient and inpatient dialysis services; therefore be assumed that inpatient dialysis services will. Inpatient dialysis service lines are not tors for facilities; however, they meet ity’s public health needs. Barriers to entry- a) licensing of facilities (sion); b) certificate of need (con) laws is services; c) medicare- limits entrant into ent dialysis service market through its high. Dialysis equipment and machines are becoming ed and specialized- facilities with ial leverage may be able to acquire ed dialysis equipment and machinery.

Wak) may eliminate the need ent dialysis are not many low cost, atives to dialysis machines ent on the market that tute inpatient care. Medicare reimbursements for dialysis services d under the patient’s primary encounter bargaining power of is service customers is e the main buyer of is service is medicare. Ng of inpatient dialysis the primary encounter s in the facility having ning power and reduced profits. Additionally, most is is the result of emergent is unplanned- patients have ation prior to encounter to gain. The major inpatient dialysis service contractors, and fresenius, hold major intellectual expertise within the bargaining power of suppliers to high because a low suppliers (equipment, material, nel) hold the majority ent dialysis service market ore, they have ning leverage in the service onally, they have a high personnel with expertise in the lowers armc’s training and ix 9: stakeholder ance influence stration high high. Will require a sizable initial investment in supplies, equipment, high priority: dialysis has been identified as an area that logists high high  highly important and highly influential in the direction of. Health reform legislation and greater emphasis on cost cutting will highly influence expansion and efforts services g staff high medium  recruiting experienced dialysis nurses is critical to the. Nursing buy-in will be highly important to ensuring t quality of care and floating effectively to other regulators high medium  the discontinuation of the contract implicates armc for tory and reporting acquirements for dialysis tly, many of these reports are davita’s ts medium low  ability to choose what emergency department they go to is. Negotiated prices as well as the maintenance services will be moderately important to expansion efforts zing cost will maintain low  other armc physicians’ sickest patients who will ing dialysis services at low  feel more confident that their patients are receiving ary care at the hospital closest to low  already have established inpatient units and will exert competitive pressures on armc’s inpatient ix 10: con law in north carolina. The law restricts unnecessary increases in health care limits unnecessary health services and facilities based on geographic, demographic ic considerations… all new hospitals, psychiatric facilities, chemical dependency ties, nursing home facilities, adult care homes, kidney disease treatment centers, facilities for mentally retarded, rehabilitation facilities, home health agencies, hospices,Diagnostic centers, and ambulatory surgical facilities must first obtain a con before pment. Expenditure by any person for health service in excess of $2 million dollars requires ing to the con law, "kidney disease treatment center" refers to a facility that is certified end‑stage renal disease facility by the centers for medicare and medicaid services, health and human services... Con law applies to the following activities of outpatient dialysis facilities:1) change in bed capacity. Relocation of health service facility beds or dialysis ) change of health service facility beds from one category to ) increase in dialysis stations or health service facility beds. Change in project that includes cost overrun of 15% of the capital expenditure amount of ed con project or addition of a health service to an approved ce regional medical center’s dialysis service does not fall under the con law because it offered to inpatients. Furthermore, the expansion of the dialysis bays at armc is not exceed the capital expenditure amount of $2 million ix 11: evaluation of gic alternative pros cons. Physician liaison provides outreach to the management nce services about the expansion and armc’s ability more patients that may require dialysis treatments. Provide outpatient dialysis centers in alamance county (bma gton, and burlington dialysis center) with brochures disseminated to their patients ---outlines the services ise offered by armc’s expanded inpatient dialysis mailings  inform former dialysis inpatients and alamance olds about armc’s commitment to patients and to meet the public health needs of the community ing its inpatient dialysis unit. Announce the expansion of the inpatient dialysis unit in al newsletters, wavelengths, physicians’ quarterly, and , the community health magazine. Inform outpatient dialysis centers in alamance county (bma gton, and burlington dialysis center) about the ix 13: staffing model calculations &. Required (based on a 36 ix 14: example of staff work of nurse sun mon tue wed thu fri ix 15: example of nurse job dialysis nurses (rdns) play a vital role in caring for patients that are undergoing dialysis treatment. Additionally, renal are required to implement the course of care for patients, generate thorough care plans, and monitor ents. The areas of practice for rdns can vary widely, including, but not limited to, hemodialysis, is, continuous renal replacement therapies, and apheresis. Assesses patients’ responses to treatment therapy making appropriate adjustments and modifications to ent plan as indicated by the appropriately credentialed physician. Collaborates and communicates with physicians and other members of the healthcare team to interpret, adjust,And coordinate daily patient care plan to ensure continuity of care. Cleans and disinfects dialysis machine surface, chair, equipment, and surrounding areas between ing to inpatient renal services policies and procedures. Present value of cash flows at 5 present value of cash flows at 5 ts from a college career course - linkedin aesthetics for course - linkedin ication in the 21st century course - linkedin renal care taiwan business 's thesis - diabetes center of m4 q (the common technical document for the registration of pharmaceutica... Meihaus, thomas berne, and eugenia orrellana copyright and license information ►copyright notice abstractthe southern california region has available a renal-dialysis center at the university of southern california school of medicine and the los angeles county general hospital. The center is prepared to carry out dialysis, transplantation, research and education in t selection for dialysis will be randomized among optimum high cost of dialysis per patient might be reduced through home dialysis and by successful homotransplantation.

The center plans to arrange transplantation of cadaver kidneys matched by tissue typing to a recipient undergoing hemodialysis.