You are the manager of a Family Practice clinic in a healthcare system that utilizes productivity benchmarks to monitor staffing efficiency. Your clinic has consistently been at or very near benchmark productivity levels. The physicians in your clinic have requested that you hire two additional support staff to make the clinic run smoother. The process for approval requires a pro forma analysis be done with Finance and shared with your Vice President to garner her support. Use the below information to answer the below questions.

Benchmark:	2.20 productive hours per clinic visit
Annual budgeted clinic visits:	20,000
Average hourly wage of clinic staff:	$25.00
Productive FTE/Total FTE:	88%
Average net reimbursement per visit:	$65.00

Please respond to the following questions:

1. How many additional clinic visits are required to keep your clinic at benchmark if you hire two additional 1.0 FTE support staff?
2. Is adding the number of visits you calculated above positive or negative financially? Assume all variable costs other than staffing costs are negligible.
3. How might a payor mix shift to more Medicare/Medicaid patients at your clinic change the calculation in part 2? Cite at least one external reference.