Fort St. John Long Term Healthcare Solutions Partnership Committee Research Study Final Report
May 2015
Table of Contents Page No. Project Drivers…………………………………………………………………………………………………………
3
Project Approach……………………………………………………………………………………………………...
6
Findings…………………………………………………………………………………………………………………
9
ABC & FSJ Family Medical Clinic Operating Expense Analysis……………………………………...
9
Other Clinics……………………………………………………………………………………………………
17
Physician Demand…………………………………………………………………………………………….
21
Closing the Gap………………………………………………………………………………………………………..
23
Clinic Model Options…………………………………………………………………………………………
23
Clinic Space…………………………………………………………………………………………….
24
Capital and Operating Financial Requirements………………………………………………….
25
Criteria Analysis………………………………………………………………………………………………
30
Other Vendors…………………………………………………………………………………………………
35
Conclusions…………………………………………………………………………………………………………....
36
Next Step Considerations……………………………………………………………………………………………
40 2
Project Drivers •
Increasing population in Fort St. John and surrounding area –
•
Forecast to continue increasing with significant economic development in area
Decreasing physician/population ratio –
Challenges with physician recruitment
•
Access to appropriate primary care increasingly challenging
•
Existing clinics in town –
Suitability for long-term solution uncertain • Clinic fee structures suspected to be impeding ability to recruit new physicians • Space availability
3
Project Drivers •
How to attract, recruit and retain family practitioner's?
Solutions Committee’s Role
–
Solution needs to address short and medium term need, but must also be sustainable in the long term
–
Requires valid and credible data upon which to base decisions
–
Solution needs to be developed collaboratively with all stakeholders:
MNP’s Role
• Northern Health • BC Ministry of Health • City of Fort St. John
Negotiation
• Physicians • Industry • Industry Associations (Doctors of BC) • etc…. 4
Project Work Plan Recommend Stopping Here Project Phases and Stages Understanding the Issues
Project Definition
Needs Research
Phase III Phase II Reporting Developing Solutions Developing Options Business Plan Reporting
Gap Analysis
Detailed Research
Option Analysis
Business Plan Development
Business Plan Validation
Negotiated decision required before business plan can/should be developed 5
Project Approach (General) •
MNP has completed multiple capital asset driven business planning projects in the health sector and have come to understand that there is a basic framework that if applied appropriately will result in valid and defensible data
Need
drives
Function
Form
drives
drives
Cost
6
Project Approach (Detail) 1.
Collected and completed analysis of operating expense financial data from both ABC Clinic and Fort St. John Family Medical practice
2.
Consulted and/or received information from representatives of: –
Northern Health
–
BC Ministry of Health
–
ABC Medical Clinic
–
Fort St. John Family Practice Clinic
–
Resident Physicians
–
MLA Pat Pimm
–
Private Health Service Providers/Vendors • • • •
Live Care IRIDIA MEDEO Ultima Medical
–
Long Term Solutions Committee (Meeting Minutes)
–
Agassiz Medical Clinic (rural Manitoba)
–
Kelowna based Medical Clinic
–
Ontario based Medical Clinics (urban and rural)
–
Ms. Elke Haggerty (Citizen)
7
Project Approach (Detail) 3.
Developed four (4) capital options
4.
Developed financial models to assess options
5.
Developed criteria to assess options against
6.
Documented assessment and findings
8
Findings – Operating Expense Analysis •
Each clinic provided detailed operating expense and revenue information
•
Overheads at both clinics cover similar elements including Legal Costs
Supplies
Insurance
Rent
Utilities
Office Supplies
Lab and nursing supplies
Computer Costs
Dues and Licenses
Common Costs
Food and Entertainment (staff events)
Repairs and Maintenance
Interest and Bank Fees
Miscellaneous
Reception
Medical Office Assistants
Stenography
Filing
Billing
Lab Assistants
Payroll
Office Administration
Bookkeeping 9
Findings – Operating Expense Analysis
Clinic Comparison
ABC Medical Clinic
Fort St John Family Practice
Non-Financial Details Personnel Physicians (Permanent) Locums/Other Support Staff FTEs Clinic Square Footage Square Feet Per Person Square Feet Per Perm Doctor
18 6 12
19 6 4 9
4,720 262 787
5,645 297 941
10
Findings – Operating Expense Analysis •
Both Clinics participate in the BCMA Rural Retention Program which provides a 23.3% fee premium on all billings, and a $22,922 flat annual supplement
•
All family physicians currently at ABC or FSJ Family Practice are participating in this program
Clinic Comparison Revenue Overhead Permanent Locum/Other
ABC Medical Fort St John Clinic Family Practice $ 897,959.83 $ 907,200.00 897,959.83 730,020.93 167,938.90
907,200.00 864,000.00 43,200.00
11
Findings – Operating Expense Analysis Clinic Comparison Expenses
ABC Medical Fort St John Clinic Family Practice $ 934,605.29 $ 759,794.00
Human Capital Payroll Legal & Accounting
704,892.10 704,892.10
440,858.00 432,110.00 8,748.00
Facilities Rent Utilities Property Taxes Lease Insurance Leasehold Improvements Repairs and Maintenace Janitorial Parking Lot Maintenance
108,174.13 61,020.00 11,477.02
194,100.00 113,400.00 9,960.00 38,400.00
3,780.00 1,860.00 7,407.11 24,490.00
4,200.00 22,680.00 3,600.00 12
Findings – Operating Expense Analysis Clinic Comparison Expenses Medical Medical Supplies Courier to Hospital Office Administration Computer Telephone New Telephone system Office Supplies Petty Cash/Misc Food and Entertainment Risk & Future Expenses Depreciation Professional Fees Bank Charges Dues & Licenses
ABC Medical Fort St John Clinic Family Practice $ 934,605.29 $ 759,794.00 29,322.58 27,396.00 29,322.58 24,996.00 2,400.00 91,376.93 41,016.87 4,172.69 14,152.93 29,684.89 2,349.55
81,084.00 37,920.00 15,960.00 19,104.00 5,460.00 2,640.00
-
10,800.00 10,800.00
839.55 839.55
5,556.00 4,800.00 756.00
13
Findings – Operating Expense Analysis Per Unit Analysis
Item Support staff FTE/Physician Average Payroll/FTE Rent/Sq. Foot Utilities/Sq. Foot Sum Rent & Utilities/Sq. Foot Janitorial/sq. ft. Supply/Service cost/physician Office admin/physician
ABC Medical Clinic 2 $58,741.01 $12.93 $2.43 $15.36 $5.19 $4,887.10 $15,229.49
FSJ Family Practice 1.5 $48,012.22 $20.09 $1.76 $21.85 $4.02 $4,566.00 $13,514.00
14
Findings – Operating Expense Analysis Overhead Analysis
Line Item
ABC Medical Clinic
Fort St John Family Practice
Overhead Collected (Revenue) Clinic Operating Expenses Excess (deficit) Overhead Collected
$ $ $
897,959.83 $ 934,605.29 $ (36,645.46) $
907,200.00 759,794.00 147,406.00
Revenue Available to Return to Physicians Number of Physician Physician Annual Return (extra $ call) Physician Monthly Return (extra $ call)
$
(36,645.46) $ 6 -$6,108 -$509
147,406.00 6 $24,568 $2,047
Monthly Reported F/T Physician Overheads Monthly Reported Locum Overheads
$
10,000.00 $ 13,994.91
12,000.00 3,600.00 15
Findings – Operating Expense Analysis Revenue Summary •
Revenues (overhead collected) essentially net the same for both clinics, however ABC’s F/T physicians are contributing less/month due to higher locum overhead contributions –
FSJ Family Practice has collected excess overheads from F/T physicians that equal approximately $2,047/month/physician
–
If this amount were distributed back to physicians both clinics would essentially be having their physicians contribute $10,000/month
Expense Summary •
ABC Clinic has significantly higher staff expenses due to higher staff numbers and higher average payroll/FTW (countered by higher locum revenue)
•
FSJ Family Practice has significantly higher rent and utilities expense on a per square foot basis (countered by lower staff expenses)
•
All other expense categories essentially equal to one another when netted
16
Findings – Other Clinics Other Clinic/Jurisdictions •
For comparison, we collected overhead data from four other clinics in BC, Manitoba and Ontario
•
All four of these clinics utilize a percentage based overhead calculation rather than a flat monthly amount
•
Three of the four clinics charge a monthly amount equal to between 30% - 40% of billings – –
•
In this model, a physician billing $300,000/year would pay between $7,500 - $10,000/month In this model, a physician billing $500,000/year would pay between $12,500 - $16,666/month
One of these clinics utilizes a tiered system – – –
27% ($0 - $299,999) = $6,750/month 24% ($300,000 - $499,999) = $4,000/month 10% ($500,000 +)
• In this model, a physician billing $300,000 would pay $6,750/month • In this model, a physician billing $499,999 would pay $10,750/month •
We calculated the monthly overhead a physician at each of the two clinics would pay using the 30%, 40% and tiered methods (utilized an average of physician billings) 17
Findings – Other Clinics Source: Medical Services Commission Financial Statement to March 31, 2014 ABC Clinic
Monthly Overhead @ 30%
Monthly Overhead @ 40%
FSJ Family Practice
Monthly Overhead @ 30%
Monthly Overhead @ 40%
$501,000
-
-
$464,000
-
-
$629,000
-
-
$435,000
-
-
$865,000
-
-
$432,000
-
-
$447,000
-
-
$603,000
-
-
$241,000
-
-
$607,000
-
-
$112,000
-
-
$391,000
-
-
Average
-
-
Average
-
-
$465,833
$11,645
$15,527
$488,666
$12,216
$16,288
•
Note, those physicians earning higher/lower than average would pay significantly more/less under this method than the current flat amount method
18
Findings – Other Clinics Source: Medical Services Commission Financial Statement to March 31, 2014 • • •
•
27% ($0 - $299,999) 24% ($300,000 - $499,999) 10% ($500,000+) ABC Clinic
Monthly Overhead (Tiered Method)
FSJ Family Practice
Monthly Overhead (Tiered Method)
$501,000
-
$464,000
-
$629,000
-
$435,000
-
$865,000
-
$432,000
-
$447,000
-
$603,000
-
$241,000
-
$607,000
-
$112,000
-
$391,000
-
Average
-
Average
-
$465,833
$10,066
$488,666
$10,523
Note, those physician earning higher/lower than average would pay significantly more/less under this method than the current flat amount method
19
Findings – Operating Expense Analysis Conclusions •
Overhead rates historically charged at both ABC and FSJ Family Practice clinics do not appear to be significantly higher than other clinics researched
•
FSJ Family Practice appears to have excess revenue collected from overheads that could be returned to physicians, effectively reducing monthly overhead to just under $10,000/month
•
ABC Clinic has successfully reduced monthly physician overhead to $10,000/month by reducing staffing levels and supplementing income with locum overhead revenue (note this practice is changing more recently with less locums being used)
•
Utilizing percentage based, or tiered percentage based methods to calculate overheads would result in higher overhead amounts for the majority of physicians practicing at both clinics (based on historical billing patterns), and significantly lower overhead amounts for a minority of physicians currently practicing at both clinics
•
Utilizing a percentage based, or tiered percentage based method to calculate overheads allocates more or less overhead based on the amount billed by each physician –
•
These methods attempt to allocate revenue based on amount of resources utilized (i.e. more billings, means more consumable used, more staff time utilized, etc.)
Utilizing a percentage based, or tiered percentage based method to calculate overheads allows for physicians to “slow down” or “speed up” their practices with a corresponding adjustment to their overheads 20
Physician Demand •
In January 2015 there were effectively 13 family physicians with active office practices in Fort St. John
– – –
6 ABC Clinic 6 FSJ Family Practice (2 leaving in July 2015) 1 Northern Health Unattached Clinic
•
There will be 4 IMG positions starting at the Northern Health Unattached Clinic in 2015 (1 in July and 3 in September). This physicians are participating in Northern Health’s Practice Readiness Assessment Program
•
By September 2015 there is expected to be 15 family physicians with office practices in Fort St. John
•
Northern Health’s Human Resources Master Plan approved by the Northern Health Board in 2006, projected a need for 31 general practice physicians in Fort St. John by 2010/2011
•
Northern Health is currently in the process of finalizing a Physician Human Resource Plan with updated general practice physician demand numbers, which are anticipated to be similar to that documented in the 2006 Northern Health Human Resources Master Plan
Projected September 2015
15
Current Demand
At Least 31
21
Physician Demand •
There is a projected immediate need for at least an additional 16 general practice physicians with office practices in Fort St. John to a total of 31
•
This projected demand for physicians formed the basis of the four options MNP developed models for
22
Closing the Gap – Clinic Model Options •
Identified 4 distinct clinic model space options 1. 2. 3. 4.
•
Developed financial models for each that allows for multiple variable manipulation – – – – – –
– – – – •
Build a new clinic(s) Purchase existing space (FSJ Family Clinic) Lease FSJ Family Clinic Lease other
Number of physicians Amount of space Amount of lease tenants Construction costs Land costs Clinic ownership • Equity contributions (non-repayable) • Equity contributions (investor) ROI Operating costs Lease rates Debt term and rate
Operating costs and associated physician overheads can then be assessed 23
Closing the Gap – Option Analysis •
Worksheet review
24
Closing the Gap – Option Analysis Summary Option 1 – Build New •
To accommodate 30 physicians and ‘campus of care’ model, 30,500 square feet of space is required
•
Capital development cost of $16M
•
Lease rate required to service debt is extremely high ($38.46/sq. ft.)
•
Non repayable equity contributions can reduce debt and accordingly lease rates, but requires contributions of $7M - $9M to reach lease rates comparable to existing clinic lease rates
•
Without equity contribution, results in monthly overhead of approximately $12,300/physician to cover operating costs without additional overhead subsidy
•
With equity contribution ($7M - $9M), results in monthly overhead of approximately $11,400 $11,200/physician to cover operating costs without additional overhead subsidy
25
Closing the Gap – Option Analysis Summary Option 2 – Purchase Existing (FSJ Clinic) •
Can accommodate 21 physicians and provides elements of a ‘campus of care’ model
•
Capital cost of $6M
•
Lease rate required to service debt are aligned with current and market rates ($20.72/sq. ft.)
•
Non repayable equity contributions can reduce debt and accordingly lease rates to below market rates
•
Without equity contribution, results in monthly overhead of approximately $11,225/physician to cover operating costs, without additional overhead subsidy
•
With equity contribution ($2M), results in monthly overhead of approximately $10,900/physician to cover operating costs, without additional overhead subsidy
26
Closing the Gap – Option Analysis Summary Option 3 – Lease FSJ Clinic •
Can accommodate 21 physicians and provides elements of a ‘campus of care’ model
•
Capital development cost of $700,000
•
Lease rate required to service debt are aligned with current and market rates ($22.56/sq. ft.)
•
Non repayable equity contributions can reduce debt and accordingly lease rates to below market rates
•
Without equity contribution, results in monthly overhead of approximately $11,350/physician to cover operating costs, without additional overhead subsidy
•
With equity contribution ($2M), results in monthly overhead of approximately $10,870/physician to cover operating costs, without additional overhead subsidy
27
Closing the Gap – Option Analysis Summary Option 4 – Lease Other Space •
To accommodate 30 physicians and ‘campus of care’ model, 30,500 square feet of space is required
•
Capital development cost of $3M
•
Lease rate required to service debt are aligned with current and market rates ($25.00/sq. ft.)
•
Non repayable equity contributions can reduce debt and accordingly lease rates to below market rates
•
Without equity contribution, results in monthly overhead of approximately $11,930/physician to cover operating costs, without additional overhead subsidy
•
With equity contribution ($2M), results in monthly overhead of approximately $11,600/physician to cover operating costs, without additional overhead subsidy
28
Closing the Gap – Option Analysis Summary Summary of Operational Costs for Each Scenario Scenario 1 30
Number of Physicians Practicing
Scenario 2 21
Operating Costs Building Rent Utilities Janitorial Medical Supplies/Services Office Administration Human Capital Bank Charges Accounting/Legal Fees Leasehold renos (Scenario 4) Total Expenses to Recover
$ $ $ $ $ $ $ $ $ $
Annual Overhead/Physician Monthly Overhead/Physician
$ $
147,757 $ 12,313 $
Forgiveable Equity Contribution Investor Contribution Annual Subsidy to Overhead
$ $ $
Reduced Annual Overhead/Physician Reduced Monthly Overhead/Physician
$ $
Annual Annual Annual Annual
$ $ $ $
subsidy subsidy subsidy subsidy
required for $11,000/month OH required for $10,000/month OH required for $9,000/month OH required for $6,000/month OH
908,027 35,415 94,912 137,100 405,000 2,782,500 27,750 42,000 4,432,704
590,250 41,554 94,912 137,100 405,000 2,782,500 27,750 42,000 175,168 4,296,234
134,685 $ 11,224 $
136,179 $ 11,348 $
143,208 11,934
- $ - $ - $
- $ - $ - $
- $ - $ - $
-
147,757 $ 12,313 $
134,685 $ 11,224 $
136,179 $ 11,348 $
143,208 11,934
$ $ $ $
353,683 30,043 68,621 95,970 283,500 1,947,750 19,425 29,400 2,828,392
56,392 308,392 560,392 1,316,392
$ $ $ $ $ $ $ $ $ $
Scenario 4 30
$ $ $ $ $ $ $ $ $ $
472,704 832,704 1,192,704 2,272,704
$ $ $ $ $ $ $ $ $ $
Scenario 3 21
$ $ $ $
385,041 30,043 68,621 95,970 283,500 1,947,750 19,425 29,400 2,859,750
87,750 339,750 591,750 1,347,750
$ $ $ $
336,234 696,234 1,056,234 2,136,234
29
Closing the Gap – Criteria Analysis •
In order to provide insight into what Clinic Model could be considered optimal, optimal must first be defined, quantified and qualified
•
As is the case with most decisions, multiple viewpoints and perspectives should be considered. It is rare that a single criterion is used to determine performance, rather it is more objective when a series of criteria are utilized
•
For the purpose of facilitating discussion and decision making, MNP developed seven performance criteria against which Clinic Model options could be measured
•
These criteria are felt to be representative of important elements the FSJ Long Term Healthcare Solutions Partnership Committee should consider in its decision making
•
MNP weighted each criteria
•
MNP recognizes that the FSJ Long Term Healthcare Solutions Partnership Committee may wish to modify these criteria, removing some or adding others, and may weight them differently, and has provided a model that allows for such changes
•
Using the criteria collectively is important as using any one criterion in isolation of the others limits the strength of conclusions that can be drawn
30
Closing the Gap – Criteria Analysis Weights Assigned
Criteria Minimizes monthly overhead for physicians Quickly meets physician demand requirements Minimizes capital investment required Recruitment and retention opportunies are maximized Presents a scalable solution Maximizes opportunity for 'campus of care' model Mimizes ongoing financial (operational) subsidy required Total
Criteria Scale
15.0% 5.0% 20.0% 20.0% 5.0% 15.0% 20.0% 100.0% Points
Strongly Meets
3
Partially Meets
2
Poorly Meets
1
31
Closing the Gap – Criteria Analysis Summary Option 1 Build New
Option 1 Build New
Points
Option 2 FSJ Clinic Own
Weighted Score
Option 2 Option 3 Option 3 Option 4 FSJ Clinic Own FSJ Clinic Lease FSJ Clinic Lease Lease Other
Minimizes monthly overhead for physicians
1
0.15
3
0.45
3
0.45
2
Quickly meets physician demand requirements
3
0.15
2
0.1
2
0.1
3
Minimizes capital investment required
1
0.2
2
0.4
3
0.6
2
Recruitment and retention opportunies are maximized
3
0.6
2
0.4
2
0.4
3
Presents a scalable solution
3
0.15
2
0.1
2
0.1
2
Maximizes opportunity for 'campus of care' model
3
0.45
2
0.3
2
0.3
3
Mimizes ongoing financial (operational) subsidy
1
0.2
3
0.6
2
0.4
1
Weighted Score 0.3 0.15 0.4 0.6 0.1 0.45 0.2
15
1.9
16
2.35
16
2.35
16
2.2
Total
Option 1 Build New
Points
Weighted Score Points
Option 2 FSJ Clinic Own
Weighted Score
Option 4 Lease Other
Option 3 FSJ Clinic Lease
Points
Option 4 Lease Other
Minimizes monthly overhead for physicians
0.15
0.45
0.45
0.3
Quickly meets physician demand requirements
0.15
0.1
0.1
0.15
Minimizes capital investment required
0.2
0.4
0.6
0.4
Recruitment and retention opportunies are maximized
0.6
0.4
0.4
0.6
Presents a scalable solution
0.15
0.1
0.1
0.1
Maximizes opportunity for 'campus of care' model
0.45
0.3
0.3
0.45
Mimizes ongoing financial (operational) subsidy Total
0.2
0.6
0.4
0.2
1.9
2.35
2.35
2.2
•
Option 1 has the lowest absolute and weighted score
•
Options 2,3, and 4 have equal absolute scores, however Options 2 and 3 have higher weighted scores
32
Closing the Gap – Criteria Analysis Detail Strongly Meets Criteria Scale
Partially Meets Poorly Meets
Performance Criteria
Assessment Option 1Build New
Option 2 – Purchase FSJ
Option 3 – Lease FSJ
Option 4 – Lease Other
1. Minimizes monthly overhead for physicians
Poorly meets – Overhead $12,313
Strongly meets – Overhead $11,224
Strongly meets – Overhead $11,348
Partially meets – Overhead $11,934
2. Quickly meets physician demand requirement
Strongly meets – Capacity for 30+ physicians
Partially meets – Capacity for 21 physicians
Partially meets – Capacity for 21 physicians
Strongly meets – Capacity for 30+ physicians
3. Minimizes capital investment required
Poorly meets - $16M investment required
Partially meets - $6M investment required
Strongly meets $700,000 investment required
Partially meets - $3M investment required
4. Recruitment and retention opportunities maximized
Strongly meets – ‘Campus of Care’ model possible
Partially meets – Scaled down ‘Campus of Care’
Partially meets – Scaled down ‘Campus of Care’
Strongly meets – ‘Campus of Care’ model possible 33
Closing the Gap – Criteria Analysis Detail Strongly Meets Criteria Scale
Partially Meets Poorly Meets
Performance Criteria
Assessment Option 1Build New
Option 2 – Purchase FSJ
Option 3 – Lease FSJ
Option 4 – Lease Other
5. Presents a scalable solution
Strongly meets – Can be built as large as required
Partially meets – Can be scaled within space limitations
Partially meets – Can be scaled within space limitations
Partially meets – Limited by leasable space available
6. Maximizes opportunity for ‘Campus of Care’ model
Strongly meets – ‘Campus of Care’ model possible
Partially meets – Scaled down ‘Campus of Care’
Partially meets – Scaled down ‘Campus of Care’
Strongly meets – ‘Campus of Care’ model possible
7. Minimizes ongoing financial (operational) subsidy
Poorly meets – Results in highest physician overhead ($12,313)
Strongly meets – Results in lowest physician overhead ($11,224)
Partially meets – Results in second lowest physician overhead ($11,348)
Poorly meets – Results in high physician overhead ($11,934)
34
Closing the Gap – Other Vendors •
MNP consulted with private health service providers/vendors to gain a general understanding of the solutions they could provide
– – – –
Live Care IRIDIA MEDEO Ultima Medical
•
MNP did not undertake detailed analysis of any one provider/vendors solution as it was beyond the scope of this engagement
•
The Long Term Healthcare Solutions Partnership Committee may want to consider more detailed discussion with these or other providers/vendors to help alleviate the challenges being experienced with the physician shortage in Fort St. John
35
Conclusions – Operating Expenses Based on the principal findings of the study, MNP has drawn the following conclusions that we believe are consequential to the Long Term Healthcare Solutions Partnership Committee’s decision making process Operating Expense Analysis •
Overhead rates historically charged at both ABC and FSJ Family Practice clinics do not appear to be significantly higher than other clinics researched
•
FSJ Family Practice appears to have excess revenue collected from overheads that could be returned to physicians, effectively reducing monthly overhead to just under $10,000/month
•
ABC Clinic has successfully reduced monthly physician overhead to $10,000/month by reducing staffing levels and supplementing income with locum overhead revenue
•
Utilizing percentage based, or tiered percentage based methods to calculate overheads would result in higher overhead amounts for the majority of physicians practicing at both clinics (based on historical billing patterns), and significantly lower overhead amounts for a minority of physicians currently practicing at both clinics
•
Utilizing a percentage based, or tiered percentage based method to calculate overheads allocates more or less overhead based on the amount billed by each physician
•
Utilizing a percentage based, or tiered percentage based method to calculate overheads allows for physicians to “slow down” or “speed up” their practices with a corresponding adjustment to their overheads 36
Conclusions – Demand & Options Based on the principal findings of the study, MNP has drawn the following conclusions that we believe are consequential to the Long Term Healthcare Solutions Partnership Committee’s decision making process Demand Analysis •
There is an immediate projected need for at least 31 general practice physicians for Fort St. John
Option Analysis •
There are four baseline options for clinic space that can be considered 1. 2. 3. 4.
Build a new clinic(s) Purchase existing space (FSJ Family Clinic) Lease FSJ Family Clinic Lease other
•
Using the weighted criteria Option 1 has the lowest absolute and weighted score
•
Using the weighted criteria Options 2,3, and 4 have equal absolute scores
•
Using the weighted criteria Options 2 and 3 have the highest weighted scores
•
Capital investment required for the four options ranges from a low of $700,000 to a high of $16M 37
Conclusions – Options Based on the principal findings of the study, MNP has drawn the following conclusions that we believe are consequential to the Long Term Healthcare Solutions Partnership Committee’s decision making process Option Analysis (cont’d) •
Initial capitalization required for the four options ranges from a low of $700,000 to a high of $16M
•
All four options require additional and ongoing subsidization of physician overheads should a meaningful reduction in physician overhead be desired/required –
Option 2 requires the lowest subsidy, followed by Option 3. 4 and 1
General •
There will be significant third party subsidization required to decrease physician overhead
•
There will be significant third party capital investment required to develop a ‘Campus of Care’ concept in Fort St. John
•
Philanthropy in the form of non-repayable equity, and/or annual subsidization is required to make any of the four options financially feasible
38
Project Drivers Reminder •
How to attract, recruit and retain family practitioner's?
Solutions Committee’s Role
–
Solution needs to address short and medium term need, but must also be sustainable in the long term
–
Requires valid and credible data upon which to base decisions
–
Solution needs to be developed collaboratively with all stakeholders:
MNP’s Role
• Northern Health • BC Ministry of Health • City of Fort St. John
Negotiation
• Physicians • Industry • Industry Associations (Doctors of BC) • etc…. 39
Next Step Considerations 1.
Determine the appetite for and feasibility of, the options presented based on the requirements presented for each option
–
Each potential collaborator (BC Ministry of Health, Northern Health, City of Fort St. John, FSJ and ABC Clinic physicians, and industry)
2.
Negotiate a chosen solution
3.
Specify the details of the solution –
Capital investment?
–
Operating investment?
–
1x investment?
–
Ongoing investment?
–
Governance of solution • Not-for-profit corporation? • Sole ownership?
–
Other? 40
Greg Lamothe, CMC National Director, Health Consulting office - 204.788.6095 cellular - 204.470.6152 e-mail - greg.lamothe@mnp.ca
41