Worksheet 1. Estimating Number of Current (Prevalent) Hemodialysis Patients for StudyArea: Example County.

Category2014 County PopulationCoefficient based on 2010 data per 100000 populationEstimated 2014Number of coefficients in country (prevalence data)

By race

Malay

Chinese

Indian

Other

Total

By age

0-19

20-44

45-64

65-74

75+

Total

By population

Total

Worksheet 2. Estimating Number of New (Incident) Hemodialysis Patients for Study Area:Example County.

Category2014 County PopulationCoefficient based on 2010 data per 100000 populationEstimated 2014Number of patients in country (incidence data)

By race

Malay

Chinese

Indian

Other

Total

By age

0-19

20-44

45-64

65-74

75+

Total

By population

Total

Worksheet 3. Estimating Number of Stations and Annual Treatments.

3-day week6-day week

Number of Stations

A. Number of prevalent patients estimated from coefficients

B. Expected number of new patients estimated from coefficients

C. Number of daily treatments per M.W.F. rotation per station

D. Number of daily treatments per T. Th. Sat. rotation per station

E. Total number of possible treatments per day per station (C + D)

F. Number of stations required ((A + B)/E)

G. Actual number of stations (round up to whole number)

Number of Annual Treatments

H. Number of annual treatments from prevalent patients (A x 3 x 52)

I. Number of annual treatments from new patients (B x 3 x 52)

J. Total number of annual treatments (H + I)

K. Number of annual treatments expected (90%)

L. Maximum number of patients (G x E)

M. Maximum number of annual treatments (K x 3 x 52)

Worksheet 4. Estimating Capital Costs for Example County Case Study Adjusted for 8-Station Facility

Cost/unit# of unitsTotal cost

Clinical equipment

dialysis machines

patient lift

wheelchair/standup scales

lab refrigerator

lab freezer

meds refrigerator (tx)

EPO refrigerator

Ice machine

Ambu bag

Oxygen equipment

Infusion pump

IV pole

Glucometer

Thermometer

Stethoscope

Ultrasonic mini Doppler

Mobile BP modules

Infectious waste hampers

Emergency evacuation kit

Miscellaneous clinical

Bed pan

Trash can

SUBTOTAL Clinical Equipment

Clinical Furniture

Dialysis chair

Task stool

Privacy screen

Chart rack

Wheelchair

Computer system

SUBTOTAL Clinical furniture

Worksheet 4 Continued (p. 2). Estimating Capital Costs for Example County CaseAdjusted for 8-Station Facility

Cost/unit# of unitsTotal cost

Staff lounge

Refrigerator

Microwave

Coffee machine

Toaster oven

Lockers (3/unit)

Table

chair

SUBTOTAL staff lounge

Storage fixtures

Supply cart

Shelving

Hand dolly

Flatbed truck (hand)

Utility cart

Floor pallets

SUBTOTAL storage fixtures

Business office

Copier machine

Facsimile

Time clock

Answering machine

Desk

Chairs

Filing cabinets with locks

Computer system/printer/scanner

SUBTOTAL business office

Reception/ Waiting area

Chairs

Side tables

Television

Lamps

Artwork/plants

Clock

Coffee machine/maker

SUBTOTAL reception/waiting area

Worksheet 4 Continued (p. 3). Estimating Capital Costs for Example County Case Adjusted for 8-Station Facility

Cost/unit# of unitsTotal cost

Signage

interior

exterior

SUBTOTAL signage

TOTAL Capital costs

Worksheet 5. Estimating Annual Personnel Costs for Example County Case Study

TypeRate/HrHours/weekTotal costs

Salaried Personnel

Registered Nurse (RN)

Patient Care Tech (PCT)

Chief Technician

Housekeeper

Financial manager

TOTAL Salaried Personnel

Benefits @ 35%

SUBTOTAL Salaried Personnel

Staff Development

Staff training/continuing education

SUBTOTAL staff development

Contract personnel (no benefits)

Medical Director/Nephrologist

Renal social worker

Hemodialysis dietitian

Renal councilor

Renal pharmacist

SUBTOTAL contract personnel

TOTAL personnel costs

* Benefits includes medical insurance, workers compensation, EPF and SOCSCO.

Worksheet 6. Estimating Annual Operating Costs for Example County Case Study Adjusted for 8 Stations and Based on 3,089 Annual Dialysis Treatments.

Cost/treatmentCost

Personnel

Maintenance

housekeeping/cleaning supplies

lawn/yard maintenance (local rate)

physical plant maintenance

equipment maintenance

SUBTOTAL Maintenance

Supplies

paper/office supplies

advertisement/ literature

SUBTOTAL Supplies

Medical supplies

dialysis supplies

medications EPO, Vitamin D

biomedical hazardous material disposal

SUBTOTAL Medical Supplies

Utilities

water

sewer

electricity

natural gas/heating

SUBTOTAL Utilities

Building (2,800 square feet)

lease

SUBTOTAL Building

Worksheet 6 Continued (p. 2). Estimating Annual Operating Costs for Example County Case Study Adjusted for 8 Stations and Based on 3,089 Annual Dialysis Treatments.

Cost/treatmentCost

Communications

telephone

security system

cable/satellite

Pagers for MD and staff

SUBTOTAL Communications

Insurance

fire and theft

SUBTOTAL Insurance

TOTAL Annual Operating Costs

*Will need cash flow available for first six month until begin receive reimbursement from JPA claims.

Worksheet 7. Estimating Revenue

A. Expected number of prevalent patients (Worksheet 3 A)

B. Number of JPA reimbursed patients

C. Number private pay patients

D. Number of new patient (Worksheet 3 B)

E. Number Medicare reimbursed patients

F. Number of private pay patients

Number of annual treatments by reimbursement

G. Number of annual Medicare treatments

[(B + E) x 3 treatments/week x 52 weeks x 90% participation]

H. Number of annual private pay treatments

[(C + F) x 3 treatments/week x 52 weeks x 90% participation]

Revenue Projections

I. JPA Revenues (G x RM____________________________)

J. Private pay (H x RM______________________________ )

K. TOTAL Gross Revenues (I + J)

Revenue adjustment for new Medicare Patients (First 3 months or 39 treatments)

L. (E x 39 x $233 x 90%)

M. TOTAL Annual Net Revenues (K L)

Worksheet 8. Summary of Annual Costs and Revenue for Example County Case Study: Revenue Less Costs.

Total capital costsPer treatmentTotal annual costs

Capital Costs (Worksheet 4)

Construction (10 years @ 7%)

Dialysis machines (7 years @ 7%)

Remainder of equipment (10 years @ 7%)

TOTAL Capital Costs

TOTAL Annual Capital Costs

TOTAL Annual Operating Costs (Worksheet 6)

TOTAL Annual Capital and Operating Costs

TOTAL Net Revenue (Worksheet 7)

REVENUE LESS COSTS

Worksheet 4. Estimating Capital Costs for Example County Case Study Adjusted for 8-Station Facility

Cost/unit# of unitsTotal cost

Clinical equipment

dialysis machines

patient lift

wheelchair/standup scales

lab refrigerator

lab freezer

meds refrigerator (tx)

EPO refrigerator

Ice machine

Ambu bag

Oxygen equipment

Infusion pump

IV pole

Glucometer

Thermometer

Stethoscope

Ultrasonic mini Doppler

Mobile BP modules

Infectious waste hampers

Emergency evacuation kit

Miscellaneous clinical

Bed pan

Trash can

SUBTOTAL Clinical Equipment

Clinical Furniture

Dialysis chair

Task stool

Privacy screen

Chart rack

Wheelchair

Computer system

SUBTOTAL Clinical furniture

Worksheet 4 Continued (p. 2). Estimating Capital Costs for Example County CaseAdjusted for 8-Station Facility

Cost/unit# of unitsTotal cost

Staff lounge

Refrigerator

Microwave

Coffee machine

Toaster oven

Lockers (3/unit)

Table

chair

SUBTOTAL staff lounge

Storage fixtures

Supply cart

Shelving

Hand dolly

Flatbed truck (hand)

Utility cart

Floor pallets

SUBTOTAL storage fixtures

Business office

Copier machine

Facsimile

Time clock

Answering machine

Desk

Chairs

Filing cabinets with locks

Computer system/printer/scanner

SUBTOTAL business office

Worksheet 4 Continued (p. 3). Estimating Capital Costs for Example County CaseAdjusted for 8-Station Facility

Reception/ Waiting area

Chairs

Side tables

Television

Lamps

Artwork/plants

Clock

Coffee machine/maker

SUBTOTAL reception/waiting area

Worksheet 4 Continued (p. 3). Estimating Capital Costs for Example County Case Adjusted for 8-Station Facility

Cost/unit# of unitsTotal cost

Signage

interior

exterior

SUBTOTAL signage

TOTAL Capital costs