Your facility wants you to expand the navigator role in the institution from Oncology to also include specially trained Chronic Disease (CD) navigators for ALL CHRONIC DISEASES they treat for patients who are 65 and older and on Medicare. Review the navigator role in a new and expanded way in such a way as would benefit and inform your institution.

Build a 3-year plan for this project

Present a 12-month budget for the program

Build a Fixed (Static) or Flexible Budget (Put capital expenditures on this same budget if needed.)

Your project must work towards the following goals:

Cut all re-admissions rates for patients 65 and older for all chronic diseases from 15% to 13% in year one, and drop to 10% in future years.

Use nurse navigators to intervene and solve problems before there is a readmission. Historical data from other states indicates navigators have a 90% prevention for re-admission rate when using assessment tools for readmission risks for all chronic diseases patients who join the program.

Attempt to break even in the first year if possible. You have the freedom to adjust all FTE (full-time equivalents), PTE (part-time equivalents), or program structure, as you see fit.

Data:

Ages 65 and older CD cases per year = 1,500 hospitalized (IP) stays. Re-admissions in less than 30 days for both areas is at 15%, and these are not paid by Medicare if re-admitted in less than 30 days. Average cost for IP is $18,000 for the average three-day stay. In the first year, 20% of this entire population is willing to work with a nurse navigator currently based on interviews and they project this to grow to 25% after the first year.

You are 1 FTE, paid $44 per hour as the manager plus a 33% benefits package, with $100 phone stipend, and no car or travel coverage.

Space, office equipment, office phones, and office supplies will be provided by the hospital for free for three years.

The office has one staff assistant that takes messages and calls RN’s when needed. Staff assistant is paid $18 per hour, 33% benefit package, and works 2080 hours/yr.

Navigator on-going work load for one year is expected to be 100 clients.

One navigator will need 40 hours of classroom training on the program and practice model before starting the workloads. The trainer can be the manager or an outside agency that costs $1200 per nurse trained in a single week session and a minimum number of nurses per session of 4.

FT Navigators will be given a $100 phone stipend for using their own cell phones. PT get $50 monthly stipend.

Navigators are experienced RN’s who are paid $35 per hour plus a 33% benefit package for FT, and $42 per hour without benefits for PT (you decide the best mix).

Navigators work (FT) 2080 hours per year. PT is up to 1040 maximum hours per year.

Navigators need supplies for home visits that equal $40 per home visit.

Transportation has three options – you pick the option you want:

OPTION #1: Leased hybrid cars for $225 per month with maintenance included and insurance of $75 per month.

OPTION #2: Use their own vehicle. Pay $0.55 per mile, plus personal car usage fee of $50 per month. If there is a car crash using their own vehicle, there is a 100% car repair or payoff fee that is paid through underwriter insurance at $100/mo. per car.

OPTION #3: Purchase cars at $22,000 per car, $75 per month insurance,(not-for-profit institution). Depreciate at 10% per year for five years. (All options have the following: Fuel is expected to cost $3.10/gal., hybrids get 45 miles per gallon, and personal cars get 20 miles per gallon. Each navigator travels 250 miles per month on average.)

Questions:

Develop a three year plan from the data information. Include the following elements.

Vision, goals, objectives for each goal, actions to be taken to get there.