STUDENT HEALTH SERVICE

1. STUDENT HEALTH SERVICE

2. STUDENT HEALTH SERVICE How we serve students: • The mission of the Student Health Service is to provide access to quality and effective healthcare. • SHS is a primary care health service providing preventative, acute and chronic care to NDSU students. Services include dietitian, health and wellness promotion, medical laboratory, pharmacy, radiology services, and immunization management. • Provide precepting and shadowing opportunities for NP and pharmacy students • Support and participate in Academic Affairs research projects • Healthy Herd Champions – peer to peer health promotion and wellness education

3. Current State of Student Health SHS does not receive appropriated funding or funding from any sources other than: • Student Fee (mandatory health fee): • Over 50% of SHS revenue generated from the current health fee • Fee not adjusted annually with inflation • Fee increase in 2010 projected to sustain operations for 5 years, but sustained operations for 6 years with a $0.54 increase in FY17 • Charges/fees for Services: • Immunizations / injections • Treatments / procedures • Laboratory tests • Radiology exams • Prescriptions / medications

4. Current State of Student Health SHS Expenses: • Accreditation costs • Administrative overhead (beyond SHS) • Building maintenance • Capital improvements • Custodial services and supplies • Equipment and supplies • Immunization compliance • Staff time • NDUS & SBHE P&P/requirement • Electronic Health Record module/ICM • Medical supplies and pharmaceuticals/medications • Repair & replacement • Staff salaries and benefits • Technology • Computers • EHR updates • Etc.

5. Current State of Student Health Cost Reduction and Containment Efforts: • External review of Business Office operations, resulted in reorganization & reduction of .75 FTE • Utilize work-study students • Collaborate with Purchasing to procure all supplies and equipment at best possible pricing (6.8% reduction in costs) • Continue to work with Medicat (electronic health record) to ensure software is utilized at highest functionality and documentation is aligned with best practices

6. Current State of Student Health Cost Reduction and Containment Efforts continued • Streamlined immunization process & moved to paperless • Cross-trained staff: nurses do phlebotomy; rad tech does phlebotomy, assists with nursing & administrative tasks; LPN does X-rays • Reduce staff during summer session to align with decrease in enrollment and student demand • Utilize per-diem (non-benefitted) providers & staff (this also creates challenges)

7. Statistics (current state of SHS)

8. Current State of Student Health Student Focused Care: • Operate with a student focused philosophy rather than a production model, which allows time for individualized, patient centered care • High functioning clinicians with vast experience in the young adult population • Providers personally contact students of concern the next day to follow up on symptoms which helps build a trusting relationship • Nurses return phone calls to patients within 1-2 hours that same day • Very reasonable charges for services

9. Current State of Student Health Accreditation: • Student Health Service received a three-year certificate of accreditation in June 2016 (maximum award) which reflects the high quality of care being provided to the students of NDSU. Some comments from surveyors: • Exceeded our expectations! • Robust quality assurance program! • Surveyors said they would send their own children to NDSU SHS knowing they would be well taken care of.

10. Current State of Student Health

11. Current State of Student Health Survey Comments (Fall 2015) • I love the clinic at the wellness center! The nurses are so kind and helpful - like a mom away from home. I would chose to go there over another clinic any day, and always recommend to my friends. Have not had a better experience any where else. • I really appreciate everything they do and that I was being taken care of. • I really enjoy this service provided to students! • I use the pharmacy once a month and have been to the clinic multiple times in my time here at NDSU and have never had a negative experience. The staff is always wonderful and they work to get me an appointment as quickly as I need one. • It has been my best experience with healthcare.

12. Current State of Student Health Student Testimonials • Not only do I feel welcome every time I come here, I am enlightened by the care from the nurses, doctors, and the front desk angels. Thank you so much for making my days easier and a special thanks to Dr. Hordvik for giving me hope from her compassionate service.” • I am a third year student and I am 39 years old. I have been a regular customer of pharmacies and clinics for at least 20 years. The staff at both the NDSU pharmacy and clinic have been the best I have experienced. They are polite, knowledgeable and willing to go the extra mile for their patients.”

13. Future Potential for Student Impact • As enrollment grows, the services will need to grow to continue to support students in their health and wellbeing, which is a fundamental base for student success. • Additional provider (MD/NP) & nurse • Add services / procedures based on student needs • Continuous technology improvements • Improved access • Increase health and wellness promotion, including expanding peer to peer mentor program and adding student employment opportunities • Maintain facilities and keep up with utilization growth • More appointment availability, including same day/walk-in appointments • Expand Dietitian position to full time to meet student needs • Add Case Manager to efficiently manage high-risk patients

14. Current Student Fees Funding • HOW MUCH SHS RECEIVES FROM STUDENT FEES? • $5.29 per credit; $63.48 per semester or $126.96 per academic year full-time student; equates to ~$1,617,851, which is approximately 50% of SHS total revenue • WHAT PERCENT OF THE STUDENT ACTIVITY FEE SHS RECEIVES • 0% • CURRENT EVENTS, ACTIVITIES, OR SERVICES FUNDED BY STUDENT FEES • Approximately 50% of total operation of SHS is funded by student fees (in addition to operational expenses, includes salaries and fringes)

15. Student Fee Comparison (current state) * School charges additional office visit fee

16. Reason for Fee Increase Request • SUMMARY OF REASON FOR INCREASE PROPOSAL • FY16 - operated at a loss of $30,092 • FY17 - budgeted to operate at loss of $217,531 • Carryover funds will be depleted in the short term • FEE INCREASE AMOUNT REQUESTED • Primary request - $1.20 per credit; $14.40 per semester or $28.80 per academic year for full-time student. For a total fee of $6.49 per credit; $77.88 per semester or $155.76 per academic year for full-time student • Secondary request – $1.00 per credit; $12.00 per semester or $24.00 per academic year for a full-time student. For a total fee of $6.29 per credit; $75.48 per semester or $150.96 per academic year for a full-time student

17. Student Fee Comparison (Primary proposed fee $1.20/credit) * School charges additional office visit fee

18. Reason for Fee Increase Request • “CURRENT DEFICIENCIES IN EVENTS, ACTIVITIES, AND SERVICES (IF ANY)” • Over utilization of temporary non-benefited staff causes challenges in recruitment, communication, consistent staffing (can cause patient care issues in continuum of care), inefficient use of management time trying to staff clinic/scheduling • Insufficient staffing causes access issues • Staff morale and burnout, which can increase errors (staff sometimes working up to 12 hours with very limited breaks) • Inability to grow current services and essential outreach programs

19. Reason for Fee Increase Request • “SPECIFIC CHALLENGES THAT REQUIRE ADDITIONAL FUNDING” • Increased enrollment and/or utilization requires increased staffing and services • Since implementation of an electronic health record the patient flow has dramatically changed and traffic patterns in facility should be studied • Pharmacy utilization continues to increase and layout of the pharmacy should be re-evaluated • SHS has delayed computer replacement plans and a number of computers are very slow or no longer supported by ITS • SHS often utilizes furniture from surplus, which may cause ergonomic/health issues for staff; appropriate furnishings (i.e., chairs) may need to be purchased

20. Reason for Fee Increase Request • “EXTERNAL FACTORS REQUIRING CONSIDERATION OF A FEE INCREASE” • Accreditation and state regulatory requirements • Shortage of healthcare workers creates a very competitive recruitment environment • ACA (Affordable Care Act) changes could impact access for students • Increased need to bill 3rd party payers • Immunization requirements and management • Acuity of student health issues • Increase in or identification of mental health issues with students, including but not limited to eating disorders

21. Impact of Student Fees • “WHY THE STUDENT FEE IS ESSENTIAL TO STUDENT HEALTH” • It provides over 50% of the current revenue for SHS operations • “WHAT ARE OTHER SOURCES OF REVENUE SHS RECEIVES” • Fees for services such as immunizations, injections, lab tests, medications, prescriptions, procedures, treatments, and x-ray exams • “WHY THIS OUTSIDE REVENUE (IF ANY) IS INSUFFICIENT FOR EXPENSES” • Fees for services provides less than 50% of the SHS current revenue for operations • Since the establishment of the SHS in 1940, the philosophy has been to provide affordable services to students to ensure they have access to quality healthcare, which is critical to their academic success

22. Historical Context of Student Fees • “TIME SINCE LAST FEE INCREASE” • Fee increase in 2010 projected to sustain operations for 5 years, but sustained operations for 6 years. An increase of $0.54 was approved for FY17 with an understanding SHS would be requesting an additional fee increase in FY18 • “CURRENT PERFORMANCE INCREASES ASSISTED BY PREVIOUS FEE INCREASE” • Ability to sustain operations at current level • “STUDENT RESPONSE AS A RESULT OF PERFORMANCE INCREASE” • 73% of students reported SHS is important to their academic success • Continuous positive feedback through customer satisfaction results and comments via suggestion box

23. Contingency Plan“SUMMARY OF CONTINGENCY PLAN SHOULD PARTIAL OR NO FEE INCREASE BE APPROVED” • Utilize carry over until it is depleted • Possible staff reductions • Possible decrease in appointment availability • Possible decrease in programs / services • ???

24. How We Plan to Improve • “HOW DO YOU PLAN TO IMPROVE YOUR ORGANIZATION/DEPARTMENT” • “WHAT PROGRAMS, PROJECTS, and/or INITIATIVES DO YOU PLAN ON ROLLING OUT IN THE FUTURE” • “HOW DO YOU PLAN TO FURTHER SERVE STUDENTS” • Additional provider (MD/NP) & nurse • Add services / procedures based on student needs • Continuous technology improvements • Improved access • Increase health and wellness promotion, including expanding peer to peer mentor program and adding student employment opportunities • Maintain facilities and keep up with utilization growth • More appointment availability, including same day/walk-in appointments • Expand Dietitian position to full time to meet student needs • Add Case Manager to more effectively manage high-risk patients

25. Questions?