Type of care provided

Care in this capacity can range from a short-term to long-term based upon the changing needs of the patient. Patient age can range from pediatric to elderly. Care can be provided in the patients private home, group home, or assisted living setting. Medical homes fall into this category and are a new focus of Accountable Care Organizations through the Affordable Care Act of 2010.

Scenario

In home care, a patient is visited at home by a nurse or nursing assistants with activities of daily living (ADL), wound care, IV therapy, etc. These organizations can be nonprofit or for-profit. A physician super- vises the care with the assistance of RNs or LPNs and certified nursing assistants (CNAs).

You are a new administrator for a home health agency that is a national nonprofit organization that serves the surrounding Phoenix community. The agency has been recognized for the delivery of on-time qual- ity services for a number of years. It is known to employ only the top staff within the community, but in recent months staffing numbers have dropped dramatically and you, as the agencys administrator, have found yourself in a position where your facility is short staffed. You are unable to admit any additional patients unless you are able to have your staff work over time.

Question 1

Review your current budget. Taking this information into account, what are some strategies you would use to identify resources to focus on improving efficiency and meeting customer expectations during this time?

Question 2

What do you see as the biggest financial issues of your organization? Hint: You are a nonprofit organiza- tionso look at your means of funding and the relationship this has on your ability to treat patients and hire new staff. How will you address this financial issue?

Budget Considerations

Operational Budget This budget focuses on a broader view of the total operations of the organization in which all departments are reviewed for both their income potential and the costs associated with the work activities used to generate projected revenues. Each department will have its own budget for the managers to follow and on which to base the activities of the department in order to meet its contribution to the total revenues and the asso- ciated costs of the organization.

Dietary Services This is a departmental budget focused on the costs and potential reimbursement for the organization. The operation is overseen by a dietitian or nutritionist who is responsible for supplying the nutritional needs of the patients within their care. This department may utilize the services of several consultants or contract this service to an outside organization.

Medical Supplies This budget is focused specifically on the requirement-based services being delivered by the hospital professional, which are often referred to as nondurable disposable items. This budget includes specific items for the surgeon or professional performing the services. These may include such things as oxygen supplies, diabetic supplies, ostomy supplies, bandages, and related supportive items. These items are generally manu- factured for one-time use. They are not reused due the inability to sterilize them. The items that are reusable are classified under capital assets and have a use-time identified with the specific piece of equipment.

Human Resources This budget indicates the finances needed to support the organizations objectives, from a personnel perspective. Full-time equivalent (FTE) calculations are used to project the personnel budget. These individuals could include nonskilled labors to professional licensed physicians and various job descriptions within the categories. In addition to listing the FTEs, the associated benefits of the FTEs would be projected within this department for each FTE within the organization. This will generally include line items for consultants and tempo- rary positions based on the needs of the organization.

Maintenance/Facility Operations This departmental budget focuses on the overall upkeep of the building and the related equipment and machines to provide a safe and comfortable environment for both the patients and workers. This budget includes all FTEs and may also include line items for consultants and outside sources based on needs of the facility.

Vendor/External Suppliers Health service organizations have special needs and may require certain exter- nal items and/or services. Most organizations have projected budgets to include the purchase of supplies and services for outside contractors (vendors) who specialize in installation, monitoring, and the repair of specialized equipment or technology being utilized by the specific health care delivery system.

Departmental Costs This budget focuses on the specific department and its overall needs, costs, and po- tential revenue in relation to the overall goals of the organizations strategic plan. The managers primary responsi- bility is to monitor the operational efficiency of the department, including all areas that directly impact and support the generating of revenue for the organization. Managers may be required to present an analysis of the weekly or monthly operational analysis to the Chief Financial Officer of the organization or a lead manager.

Budget Spreadsheet

Revenue	2011	2012	2013
Donations	50,000	55,000	75,200
Grants and Foundations	100,000	80,500	125,780
Government Grants	947,280	878,000	695,120
Interest Expense	6,050	8,000	10,000
Total	1,103,330	1,021,500	906,100
Expenses	2011	2012	2013
Health Center	2,482,845	2,558,265	2,668,951
Administrative Staff	100,000	110,000	125,000
Professional Staff	80,000	100,000	150,000
Family/Youth Services	214,888	210,987	230,985
General Management/Administration	140,000	152,000	159,000
Total	3,017,733	3,131,252	3,333,936