The Internаl Medicine Office is lоcаted in а small, rural city, which has 1 hоspital. Dr. Andrea Rоdriguez (affectionately known as “Dr. ARod”) opened her hometown practice approximately 5 years ago as a solo practitioner once she completed her medical school and her residency. She currently employs an office manager/biller, who doubles as a receptionist, and a medical assistant to triage patients. Dr. Rodriguez has maxed out capacity and needs to expand her practice. In fact, she has not been able to accept any new patients (even referrals from her Primary Care colleagues. It is time to expand her practice, while at the same time be profitable. Dr. Rodriguez recently hired a Medical Assistant who is scheduled to start in 2 weeks. Her plan is to hire a nurse practitioner to help her grow her practice, and if it goes well, she will add a second nurse practitioner in another year if the volume supports further expansion. She has interviewed several NPs and has extended an offer to hire a family nurse practitioner who recently passed her FNP certification exam. She likes the idea of starting with a new NP, that way she can train this individual. She currently has 2,000 active patients, and sees patients at the office on Mondays, Tuesdays & Thursdays (all day) and Wednesdays and Fridays she works a half day so she can catch up on her lab review and close her charts for the week. On her half-days she only sees 1 new patient and the rest established patients. (Note: for the purpose of the spreadsheet, 2 half days are the same as 1 full day). Currently, each full day in the office has consisted of 20 established patients and 3 new patients. Her current case mix contains: 35% Medicare 5% Medicaid 40% Third party insurance (BC/BS, Aetna, etc.), and the remaining patients are direct pay/cash. Dr. Rodriguez knows that in order to grow her practice, she needs to increase the number of Direct-pay/Cash, Medicare and Third-Party visit revenue, she is going to have to do more “new” patient visits than she is doing now, and be able to establish the plan of care, while the nurse practitioner, when hired, will see the established patients thereafter. If the new Nurse Practitioner can do the established visits, perhaps she can bump up the volume of, for example, her new “Welcome to Medicare” visits to establish the patient’s plan of care, then subsequent visits can be handled by the APRN. For the purpose of this exam, you can assume the following revenue per patient visit: New Patients: Medicare: $220 Medicaid: $154 Third Party Insurance: $220 Cash: $176 Established Patients: Medicare: $126 Medicaid: $88 Third Party Insurance: $126 Cash: $100 Once you have read and taken notes about this scenario, you may proceed to the exam questions...
Delаys, lаck оf resоurces, lоsses, аnd failures as sources of ________.