2. Lisa Whitlatch

3.  Michigan Neurology Associates, P.C., ASC is located in Clinton Township MI http://michiganneurologyassociates.com/  We specialize in only pain management procedures in the ASC  Currently only one operating room (OR) and opened in 2011.

4.  Open five to six sometimes six days a week  Offer anesthesia services for procedures  Have seven practicing pain management physicians that share the ASC; limits physician time and ASC days  We meets Michigan’s certificate of need (CON) requirements for a second OR room to expand.

5.  Key historical and forecasted data: Year to date MNASC has performed 2750 procedures with one OR. Each CON requires you to have a minimum of 1216 reported cases each year.

6.  Mission: MNASC Mission does fit the organizational strategic plan: “MNASC is a freestanding outpatient facility committed to providing the highest quality of patient care and to delivering this care in the most caring and professional manner. We strive to act with integrity and honesty in all our interactions, doing what us right for our patients, our employees and our providers. We seek through on our commitments in a timely fashion, demonstrating personal responsibility and accountability in all matters. The strengths of the MNASC physicians, nurses and administrative and clerical staff who provide services to those coming to our center. We comply with all applicable accreditation and certification standards to ensure we meet city, state, and federal healthcare requirements. We believe that the safety, well- being, and dignity of our patients are our highest priorities as we strive to meet their healthcare needs (MNASC, 2015).”

7.  Service Line: Therapeutic pain management surgery procedures  Financial Objectives:  Volume and revenue growth  Improved efficiency  Net margin over 10%

8.  Internal and External:  Internal – Physicians, employees, and capacity  External – Competitors, demographics, and market area.  Defined Service Area: Clinton Township, Utica, and St. Clair Shores, and Macomb Township

9.  Population demographics: Targeting patients that in chronic pain  Market Share: Clinton Township market share is 10%

10.  Number of active physicians:  Surgeons: 7  Anesthesiologists: 2  Medical Staff Age Assessment : 36 – 55 year range  Supply and Demand  Office Locations: 3; Utica, Clinton Township, and St. Clair Shores  ASC Location: Clinton Township  Practice Patterns: All full-time staff; one day a week in the ASC  Referral Patterns: All actively refer weekly to the ASC.  Incident Rates: None to Report  Recruitment recommendations: All physician requirement comes directly from the ASC board members only.

11.  Strengths  Operate 5 days a week – Full-time  Onsite separate ASC suite  Share the same EMR as the practice; obtaining clinical records is convenient  Long hours of operation; open some Saturday’s  Offer anesthesia and non-anesthesia options

12.  Weaknesses  The doctors don’t get enough OR time, only once a week  Limited ASC staff who really know the ASC operations  Pending AAAHC Deemed status inspection; billing as an office based procedure currently  Anesthesia only limited to certain days a week.

13.  Opportunities  We have the room to expand to a second OR  We have the space to accommodate more patients and longer work hours  With a second OR we could potentially gain new doctors and additional revenue

14.  Threats  Other local ASC that specialize in pain management  Don’t get granted deemed status by Medicare  Payer/Mix Population is a lot of Medicaid  If we don’t expand sooner than later, physicians are taking their patients elsewhere.

15.  Volume projections:  2014 –Last year 2100 Surgery Cases Performed  2015- YTD 2750 Surgery Cases Performed  2016– Projected volume: 20 % 3300

16.  2014 Historical Revenue/Collections $687,200  Expenses: Direct Wages:  Physicians $270,000  Support staff $35,800  Taxes and Benefits $45,900 $352,000  Medical Supplies $88,600  Licenses and Fees $16,700  Uniforms and Laundry $1,500  Allocated Cost  Administrative Staff $51,100  Fixed Expenses $25,100  Variable Expenses $75,500 $147,700  Total Cost $ 606,500  Projected Net Income 80,700

18.  Capital requirements: Total project cost $500,000 ($300,000 construction and $200,000 equipment)  Five year financial pro Forma (Economic justification: The return on the capital investment is 27% with a payback of 2.82 years.

19.  General focus remains on quality of care, customer satisfaction, volume, utilization management, and cost control.

20.  Plan outlines efforts needed to reach the population segment that will generate more volume. The marketing plan involves all three office locations; Utica, Clinton Township, and St. Clair Shores to capture those patients especially in the Utica and St. Clair Shores offices as potential growth for our Clinton Township ASC. By marketing at both offices this puts the center at a 21.4 mile radius to capture outside volume in need of the center’s services.

21.  Implementation of this plan will have a kick off meeting next week to draft a new floor plan to see and evaluate all potential options. Once a plan is agreed upon with all appropriate parties, then weekly monitoring phone conference calls will be made to keep the project on track to discuss performance indicators. Twice a month; every two weeks face to face meetings will be held on top of weekly conference calls.

22.  This plan will affect the cooperation overall by generating additional revenue for the organization. This plan will provide the patients with more choices regarding their scheduled surgeries. This expansion will open up additional surgery time for our practicing physicians to help treat their patients quicker and new physicians who’s surgery time is limited elsewhere.

23.  This plan offers more flexibility with our scheduling. The risk factors is that the additional room will not be occupied all five days of the week since volume always changes. The risk is hiring additional full-time staff to accommodate the second room and not being able to provide them with their 40 hours. Overall our organization believes the benefits outweigh the risks and by expanding our ASC will expand our services to our patients.

24. References  (2015). Retrieved from http://michiganneurologyassociates.com/contact- us/  (2015). Retrieved from http://www.michigan.gov/  (2015). Retrieved from http://www.painclinicmi.com/  (2015). Retrieved from http://www.stjohnprovidence.org/locationfinde r/details.aspx?location=121