Primary Care Options Assessment
Purpose:
Quantify the financial impact to the hospital and the practice if the primary care practice were to convert to either provider-based rural health clinic (PB RHC) status or provider-based outpatient department (PB OPD) status. This analysis would delineate impact to both the hospital's CAH reimbursement and the practice's reimbursement that would result from a change in the practice's status.
Objectives:
- To project the future operating performance of the practice using historic and projected operating and utilization assumptions
- To model strategic direction for the practice based on the Centers for Medicare and Medicaid Services (CMS) programmatic requirements and reimbursement methodology (the set up of the financial model would follow cost reporting principles as laid out in the Federal regulations)
- To project the impact to the current levels of CAH reimbursement and primary care practice reimbursement that are associated with a change in status to PB RHC or PB OPD status
The financial feasibility study will include a detailed analysis of the primary care practice's revenue calculations and a description of the assumptions used to develop the revenue projections, including changes in costs, utilization, payer mix, and annual increases associated with PB RHC and PB OPD status. A thorough review will be facilitated by a consultant on a variety of operating assumptions, including any anticipated change in the practice's capacity, operating revenues, and expenses. The consultant will recommend a specific change in the programmatic status for the practice based upon the financial and operational impact of each of the two programs examined.
The process of preparing the financial feasibility analysis will involve interaction with hospital and practice staff, as necessary, to verify that appropriate and reasonable assumptions are being used to prepare the impact analysis. The expected final product will be a report that quantifies the financial impacts to the practice and the hospital resulting from conversion of the primary care practice to PB RHC and to PB OPD status. The report would also present key operational considerations associated with each program status.
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