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Fort Bliss Outpatient Physical Therapy Final Business Case Analysis

This business case analysis evaluates the feasibility of recapturing physical therapy workload at the William Beaumont Army Medical Center (WBAMC) Physical Therapy Clinics at Fort Bliss. The analysis includes financial projections, assessment of contingencies, and risks to determine the potential benefits of increasing staffing levels.

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Fort Bliss Outpatient Physical Therapy Final Business Case Analysis

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  1. Fort Bliss Outpatient Physical TherapyFinal Business Case Analysis Army-Baylor University Graduate Program in Health and Business Administration Physical Therapy Workload Recapture CPT Eun S. Choi, USA, MSC CPT Jon M. Eppes, USA, MSC CPT Maxwell H. Smith, USA, MSC (FOUO – Pre-decisional) CPT Jon M. Eppes jon_eppes@baylor.edu (901) 626-7661 Date Prepared: 09 February 2015 Date Presented: 10 February 2015

  2. Business Case Analysis DISCLAIMER The views expressed in this research are those of the authors and do not reflect the official policy or position of Baylor University, the Department of Defense, or the U.S. Government. This report provides approximations of important financial consequences that should be considered in decisions involving the feasibility of physical therapy workload recapture at William Beaumont Army Medical Center (WBAMC) Physical Therapy Clinics. The analysis is based on information provided by those individuals listed on the title slide, as well as information believed by WBAMC staff to be accurate. We recommend that you use this analysis only as an aid to develop your own cost and benefit analysis. POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 2

  3. A. Introduction B. Methods C. Projections D. Risks & Sensitivity E. Recommendations & Conclusions Business Case Analysis AGENDA A. Introduction • Purpose • Background B. Business Case Methods • Scope and Boundaries of the Case • Course of Action Analyzed • Cost Model • Cost and Benefit Projections, 2016 – 2020 • COAs 1-4 D. Risk and Sensitivity Analysis E. Recommendations & Conclusions POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 3

  4. A. Introduction Business Case Analysis Purpose • Problem: Internal demand for outpatient physical therapy exceeds the current resources and capacity at WBAMC PT Clinics. In FY14, $4.709 million was spent on avoidable physical therapy purchased care; $392,474.65 per month; 6.7% of MEDCOM’s total private sector outpatient physical therapy costs. • Business Case Objective: The purpose of this brief is to evaluate the current staffing levels, financial metrics, assessment of contingencies, and risks to recapture physical therapy workload at WBAMC PT Clinics that are currently lost to the network. POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Information provided by LTC Gregg using M2 data MHS Review Final Report Appendix 3. Access to Care Page 4

  5. A. Introduction Business Case Analysis Background • Fort Bliss, TX • The U.S. Army’s Second-Largest installation (1.12 M Acres) • FORSCOM installation, home to 1st AD • 167,348 Pop. of Fort Bliss, TX (Supported) • El Paso Area Pop. 827,718 in 2013 • William Beaumont Army • Medical Center (FY 2014) • Over 1 M Sq. Ft. of floor Space • Level 3 Trauma Center • 136 Beds • 2,548 Daily Patient Visits • 8,395 Inpatient Admissions • 10,585 Inpatient Surgeries • 97,352 Eligible Beneficiaries in Catchment Area http://www.wbamc.amedd.army.mil/NewPersonnel/WBAMCHistory.aspx Unite States Census Bureau http://www.militaryinstallations.dod.mil/pls/psgprod/f?p=132:CONTENT:0::NO::P4_INST_ID,P4_INST_TYPE:4375%2CINSTALLATION POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 5

  6. A. Introduction Business Case Analysis Background • William Beaumont Army Medical Center Physical Therapy (PT) 8 facilities: • WBAMC Clinic • Traumatic Brain Injury Clinic • Pain Clinic • Soldier Family Medical Center • Mendoza Clinic • East Bliss Clinic • White Sands Missile Range Clinic • Inpatient at WBAMC (not included) • WBAMC Physical Therapy Current Staffing (OIC: MAJ Charles Blake) • PT Civilians: 7 (6 GS, 1 Contract) • PT Civilians Vacancy: 2 • PTA Civilians: 7 (should be 16 for a 2:1 ratio) • PTA Civilians Vacancy: 6 • Administrative Secretary (GS-5) Vacant: 1 • 68F NCO’s: 6 (of that, 3 NCOIC’s) • 65B Officers: 9 ; BDE PT: 4 (4 BCT’s in 1AD) Photos from http://www.armylive.dodlive Staffing Levels Provided by MAJ Blake POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 6

  7. A. Introduction Business Case Analysis Proposed Action/Financial Metrics • Action: Hire Four General Schedule (GS-12) Physical Therapists and Eight (GS-7) Physical Therapist Assistants to increase physical therapy workload • Financial Metrics: The MEDCOM and MTF require financial projections and financial metrics: • Annual net cash flow (NCF) • Break even analysis • Risk and sensitivity analysis will identify: • Critical success factors and contingencies • Risk factors that might change results POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Information provided by LTC Gregg using M2 data Page 4

  8. B. Methods Business Case Analysis Data Sources • WBAMC Business Plan & FY14 Market Share Analysis • WBAMC: PT • MEDCOM Draft OPORD 15-XX (Private Sector Physical Therapy Recapture) • MEDCOM Performance Planning Guidance • TRICARE Operations Center • MHS Management Analysis & Reporting Tool (M2) • PASBA data analysts, WBAMC: DBO, and Baylor student data pulls • Expense Accounting System Four (EAS IV) • WAMC: DBO • WBAMC Program Analysis and Evaluation (PAE) • WBAMC PT OIC, MAJ Charles Blake • Indeed.com Physical Therapy (Assistant) Salary in El Paso, TX Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil ; www. Health.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 9

  9. B. Methods Business Case Analysis MethodDemand 15% Historical Growth • Retrieved historical RVU data from M2 • Used the rate of 2.05% to project inflation for next five years Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 12

  10. B. Methods Business Case Analysis Scope • Time Period • -Historical Data Analyzed: FY09-FY14 • -Projections: 01 October 2016-30 September 2020 • Organizations • -WBAMC Physical Therapy Clinics (7 Effected) • -Ft. Bliss Catchment Area Enrollees (71,493) • Geography • -Ft. Bliss, TX; White Sands Missile Range, NM; • and El Paso, TX Catchment Area POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 7

  11. B. Methods Business Case Analysis Scope Scope: • Examine the current staffing levels and workload at WBAMC PT Clinics • Assess financial projections and metrics • Determine strategic and tactical priorities • Establish a plan that incorporates departmental strengths, organizational needs, and financial implications • Provide recommendations to recapture PT workload Assessment: • Complex patient population referrals • PT/PTA shortages • Unique PT/PTA hiring challenges POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 8

  12. B. Methods Business Case Analysis Analyzed Courses of Action COA #1: Continue with current operations (status quo) COA #2: Change current scheduling to optimize PT appointments (Recommended) COA #3: Hire additional mix of 4 PT/ 8 PTA staff to recapture workload lost to the network COA #4: Hire additional mix of 1 PT/8 PTA staff to recapture workload lost to the network POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 9

  13. Business Case Analysis COA # 1 Status Quo Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 19

  14. Business Case Analysis Status Quo C. Projections Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 13

  15. Business Case Analysis COA # 2Improve Appointment Utilization C. Projections 4.0% Unfilled Appointment Rate < MEDCOM Goal of 5% Frequent Same Day Cancelations Hamper Productivity NO Show Rate and Same Day Appointment Rate provided by MAJ Blake Utilization Rates Obtained from Tricare Operations Center POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 15

  16. Business Case Analysis COA # 2 Improve Appointment Utilization Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 19

  17. Business Case Analysis Improve Appointment Utilization C. Projections Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 17

  18. Business Case Analysis Recommended COA # 3Hire 4 PT’s/ 8 PTA’s Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 19

  19. Business Case Analysis Hire 4 PT’s/ 8 PTA’s C. Projections • Recommended Staff Hires from MEDCOM Draft OPORD 15-XX Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil MEDCOM Draft OPORD 15-XX POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 18

  20. Business Case Analysis COA # 4Hire 1 PT/ 8 PTA’s Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 19

  21. Business Case Analysis Hire 1 PT/ 8 PTA’s C. Projections Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 19

  22. Business Case Analysis COA Comparison Overview C. Projections Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 13

  23. D. Risks & Sensitivity Business Case Analysis Sensitivity of ResultsWhich Assumptions have the most impact on returns? C. Projections Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 19

  24. D. Risks & Sensitivity Business Case Analysis Sensitivity AnalysisWhich Assumptions have the most impact on returns? C. Projections Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 19

  25. D. Risks & Sensitivity Business Case Analysis Qualitative Analysis • Convenience • Patient morale • Provider skill set enhancement through increased volume and efficiency • Patient continuity of care • Uniformity of procedural documentation in patient Military Health System Electronic Health Records (EHR). C. Projections Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 19

  26. Business Case Analysis Other Courses of Action to Consider • Change patient acuity level of patients seen vs. patients referred • Lease off site building • Use group therapy to increase productivity/ capacity • Outsourcing- Contract MOA with civilian a rehabilitation center to benefit financially for the current overflow referrals • Partnership with VA • Contract vs. GS Hiring Source: MCF Operations Administrator; Military Health System (MHS) Management Analysis and Reporting Tool (MART)--- (M2) https://tma-bi.csd.disa.mil POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 23

  27. E. Recommendations & Conclusions Business Case Analysis Recommendations & Conclusions We recommend that the WBAMC Commander implements Course of Action #3 - Hire a mix of 4 Physical Therapists and 8 Physical Therapy Assistants prior to the start of FY16. This course of action will provide for a profitable recapture of physical therapy workload and the associated intangible benefits. POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 22

  28. E. Recommendations & Conclusions Business Case Analysis Recommendations & Conclusions • Review the BCA in order to (IOT) determine if the assumptions and calculations are appropriate for WBAMC • Review FY16 budget IOT determine the feasibility of paying for the ____ • Appoint a project manager responsible for ensuring that the project is completed on time without disruption • Determine if MEDCOM is willing to approve the recommended hiring actions associated with COA # -. • Write a statement of work for the PTA’s, and update the duty descriptions for the support staff & initiate hiring actions POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu Page 22

  29. Business Case Analysis Guidance/Questions POC: CPT Jon M. Eppes (901) 626-7661; jon_eppes@baylor.edu http://www.wbamc.amedd.army.mil/# Page 24

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