Gulf Coast

Health Care

ACUTE GERIATRIC
CARE CENTER (AGCC)
BUSINESS PLAN PROJECT
Joseph Hall
Terry Ray
Sherri White

King University
TABLE OF CONTENTS
BUSINESS PLAN PROPOSAL…………………………………………………………………….

………………...3

EXECUTIVE

SUMMARY…………………………………………………………………………………………….5

ABSTRACT………………………………………………………………………………………………….………..7

Service Defined………………………………………………………………………………………….7

Market Analysis………………………………………………………………………………………….7

Marketing Plan……………………………………………………………………………………….….8

Potential Risks/Regulations……………………………………………………………………………8

Timeline……………………………………………………………………………………………………9

S.W.O.T. Analysis...………………………………………………………………………………………9

FINANCIAL PLAN…………………………………………………………………………………………………10

Start Up Overview……………………………………………………………………………………...10

Capital Budget………………………………………………………………………………………….11

Break Even Analysis…………………………………………………………………………………...14

Proforma…………………………………………………………………………………………………15

REFERENCES……………………………………………………………………………………………………….1
7

APPENDIX

i……………………………………………………………………………………………………………18

ii…………………………………………………………………………………………………………...19

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PROJECT PROPOSAL
Dr. Rhonda Morgan, DNP, RN, CEO along with the Emergency Department Associate Nursing
Officer Terry Sellstrom, MSN, CCNE of Gulf Coast Health Care Center, the area’s premiere Level One
Trauma Center Emergency Department and tertiary care facility is proposing an Emergency Department
expansion. This will include a state-of-the-art Acute Geriatric Care Center (AGCC) to serve the growing,
aging population of the Gulf Coast Region. Gulf Coast Health Care Center Emergency Department is a
65-bed facility with continuous operations 24/7/365, serving 90,000 patients annually, while also offering
an additional daily fast track operation, open noon to midnight.
Florida’s Gulf Coast population demographics indicate a growing number of residents age 65
years and greater. As baby boomers continue to progress toward retirement age this region is inviting to
seniors desiring retirement relocation to this area. Gulf Coast Health Care Center is in a unique situation
to offer this growing senior citizen population specialized ED care. The AGCC will allow for a
conversion of six existing treatment rooms to create this specialized and specific care area. The initial
conversion cost will be minimal and there are funds currently earmarked for this project from a generous
philanthropic donation as well as matching hospital budgeted funds.
The implementation of the AGCC presents Gulf Coast Health Care with an opportunity to
improve hospital outcomes for this increasing demographic by catering to the specific needs of this
community’s senior population. The AGCC will follow existing ED operations and meet all regulatory
requirements for this proposal along with anticipation of being profitable within the first year of
existence.
The AGCC staff will consist of physicians, registered nurses, social workers, pharmacist,
physical therapists and patient navigators. All will have specialty training in geriatric care to meet the
precise needs for this population. The six AGCC suites will have appropriate environmental aesthetics to
include suitable lighting, walls and floors with noticeable complementary yet contrasting coloring as well
as non-slip flooring. These contemporary suites will provide geriatric specialty equipment, larger print,
easily readable signage, and clocks to improve visual communication and increased cognition. The
lavatory facilities will be designed with geriatric accesses and mobility options to increase patient
independence and safety.
This proposed project will be an essential service for this patient demographic and will be a great
accomplishment for the Emergency Department, Gulf Coast Health Care, and the surrounding
community. This will be a welcome opportunity to further provide specialized services to this growing

3
patient population and improve their hospital outcomes, to return them safely back to their home
environment.

(WestHealth.org, 2018, p. 42).

EXECUTIVE SUMMARY
Gulf Coast Health Care is the premier tertiary care facility of Walton County FL and the
surrounding Gulf Coast region. We have a 70 year history of providing exceptional care in this
community and hold the distinguished status as a not-for-profit, Magnet recognized medical center. Gulf
Coast Health Care supports and nurtures educational opportunities including evidenced based research
projects and curricula to ensure our team is prepared with current clinical education and training, state of
the art equipment, and the latest technology to provide compassionate and supportive care to the

4
surrounding community. We have distinction in the state of Florida as the provider of excellent care in
the Panhandle Region and adjoining states of coastal Alabama and Georgia.

Mission:
The commitment of compassion to an extraordinary community, investment in our employees
along with effectiveness and efficiency in the delivery of excellent clinical care will sustain the healthcare
of this region to provide and support the health and well-being of our employees and the great citizens
living and visiting the Gulf Coast area of Florida. This project to renovate six emergency care suites to
establish the Acute Geriatric Care Center will continue the innovative work which is the strength of this
institution.

Markets, Products and Services:

Operational Structure:
The project management oversight team members Terry Ray, RN BSN, Sherri White, RN, BSN
and project manager Joseph Hall, RN, BSN have deliberated with the executive board, conducted clinical
research and market analysis to make this profitable recommendation of need for the AGCC along with
sponsorship of our executive leadership supported by Dr. Rhonda Morgan, DNP, RN, CEO and Terry
Sellstrom, MSN, ANO, Adult ED.
This specialized unit will have 24/7/365 operations as part of the Adult ED. It will provide
services by a clinical staff with specialty training in geriatric care including physicians, registered nurses,
social workers, pharmacists, physical therapists, and patient navigators.

Financial Goals:
This project has the financial support to meet the budgeted start up needs of $3 million through a
generous philanthropic donor supplying half of the needed funds and Gulf Coast Health Care has
budgeted the additional funds needed. The anticipated startup funding is projected under budget at $2.25
million. First year projections are to treat 13,140 patients with increasing volumes of 10% annually. The
breakeven point is projected to be within 8 to 10 months.

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6
ABSTRACT
Service Defined:

According to the United States Census Bureau, the average life expectancy of Americans has
increased from 69.7 years in 1960, to 79.7 years in 2017 (Medina, Sabo, & Vespa, 2020, p. 25). This
trend is expected to continue with the average projected life expectancy reaching 85.6 years in 2060
(Medina et al., 2020, p. 26). Likewise, in 2012, there were an estimated 43 million persons living in the
United States (US) over the age of 65 and that total is expected to reach 83 million by 2050 (American
College of Emergency Physicians, 2013)
Of note, elderly adults comprise approximately 18% of all emergency department visits annually
(American College of Emergency Physicians, 2013, p. 3). To meet the healthcare needs of seniors, the
American College of Emergency Physicians (ACEP) has outlined the requirements of those seeking
“Senior-Friendly” or “Geriatric Emergency Designation” (GED). This evidence-based approach seeks to
“standardize senior-friendly emergency care across multiple settings through an accreditation program
based on objective measurable criteria” (American College of Emergency Physicians, 2013, p. 4). By
utilizing these criteria, GEDs can safely and efficiently differentiate those individuals needing inpatient
versus outpatient care, and tailor their healthcare plan accordingly.

Market Analysis:
According to the United States Census Bureau (2019), Walton County, Florida has an estimated
population of more than 74,000 people. Of this population, an estimated 20.2%, or approximately
15,000, are persons over the age of 65 (United States Census Bureau, 2019). Walton County has also
seen a 34% increase in population growth since 2010, when the population estimate was 55,000 (United
States Census Bureau, 2019). Likewise, Walton County’s tourism industry cannot be overlooked. In
2018, an estimated 4.1 million people visited Walton County, a 4% increase since 2017, with an
estimated total economic impact of nearly $4.7 billion, a 6.6% increase since 2017 (Visit South Walton,
2018). When one considers the county demographics, the need for an Acute Geriatric Care Center,
AGCC is apparent. When factoring in the financial stability of the region, the prospects for economic
success are appreciable.
Florida currently has only four accredited GEDs, none of which are in the Florida panhandle
region, neither are there any accredited GEDs in Alabama nor Georgia. The closest GEDs in Florida are
in the Tampa Bay area which is approximately 450 miles driving distance from Gulf Coast Health Care.
Given the overall benefit to the community, the proposal of converting six Emergency Department (ED)

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suites for geriatric treatment is strongly recommended. ACEP estimates the cost of converting a typical
ED room into a GED compatible room to be approximately $1,500 per room. Based on these estimates,
the total conversion cost is estimated to be $10,000. The return on this minimal investment would be
evident within the first year, with a breakeven at eight to ten months. Likewise, the seeking of formal
GED accreditation is strongly encouraged from both a marketing and quality of care perspective.

Marketing Plan:
The approval by our Board of Directors will initiate a marketing campaign strategy for the
AGCC, to consist of multiple approaches and modalities. The Gulf Coast Health Care marketing team
would operate within the requirements of Walton County Commission and County Codes. Informing the
senior community will involve the Marketing Department designing a marketing campaign involving
outreach to senior centers, community centers, churches, and civic organizations. Contingent upon the
budgeted marketing allocation, billboards, social media, radio, and television advertising will be
considered. Partnering with our hospital physicians and their office staffs, particularly, geriatricians and
internists will be crucial for the success of this project. Discussions between primary care physicians and
hospitalists for inpatient management will be aided by participation from our ED Medical Director. In
addition, developing relationships with local urgent care clinics will increase patient referrals for both our
AGCC, and ED proper.

Potential Risks/Regulations:
Risks to consider with this initiative include potential misallocation of our current ED resources,
such as staffing or equipment which is under the purview of our current ED Director. Avoidance of any
compliance concerns, i.e. State of Florida, Centers for Medicare and Medicaid (CMS), or Joint
Commission regulations will be facilitated by our compliance team. Reimbursement concerns will be
addressed by a task force of revenue cycle personnel working in conjunction with our ED Director. Staff
education and development will ensure the ED team members are professionally trained in the area of age
appropriate geriatric care specialty.
Indications project this venture will prove successful; however, our competitors may seek to
proceed with their own geriatric emergency departments. Our strategy will be to continue promoting our
services as the community’s visionary leader in outstanding geriatric care. This will be accomplished by
the Vice President of Patient Care Services and his or her team. Furthermore, he or she will be charged

8
 with ensuring adequate staffing throughout the hospital as we anticipate a steady increase in
hospitalizations from our AGCC.

Timeline:
Upon approval by our Board of Directors, our AGCC can be opened within six months. The
construction needs are minimal, and easily achieved within this timeline by our facilities team and
subcontractors. Staff recruitment and training will begin within 90 days of the planned AGCC opening.
The Marketing Department team will begin a concentrated effort 60-90 days from anticipated opening,
with initial media reports occurring once the project is approved. Our goal of becoming an accredited
GED will coincide with all aspects of this project and a consultant will be retained to ensure progress with
the accreditation standards.

SWOT ANALYSIS

SWOT Analysis: The strengths will offset the threats as the initial business venture and utilization is
anticipated to be justified by the need identified by data indicating senior patients are 30% of the
population utilizing and visiting our ED. The construction impact will initially be a concern due to
the time to convert 6 rooms to geriatric suites as well as the need to purchase geriatric specialty
equipment. This however is projected to be a financially sound investment with return on investment
within one year of operation.

STRENGTHS WEAKNESSES
 Necessary service to  Utilization of 6 ED rooms
specific population  Specialty training required
 Addresses underserved  Initial start-up costs until
community fully productive
 Financially sound  Need to provide specialty
investment equipment and
 New concept will own the environment
initial market share
 Growing clinical trend

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 nationwide

OPPORTUNITIES
THREATS
 Serve senior community
 Marketing to increasing  Initial business venture
population and ensuring utilization
 Proven as an expanding  Construction impact
healthcare trend  Competitor duplicating
 Partnership with service
community outreach

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 FINANCIAL PLAN
STARTUP OVERVIEW Budget Actual (Under) / Over

Total Expenses $ - $ 2,257,209.20 $ 2,257,209.20

Administrative / General $ 15,000.00 $ 15,000.00

Location / Office $ - $ 21,000.00 $ 21,000.00

Marketing $ 25,000.00 $ 25,000.00

Labor $ 2,191,209.20 $ 2,191,209.20

Other $ 5,000.00 $ 5,000.00

Total Funding $ 3,000,000.00 $ - $ (3,000,000.00)

Hospital $ 1,500,000.00

Additional Funding $ 1,500,000.00

Funding Less Expenses $ 3,000,000.00 $ (2,257,209.20) $ 742,790.80

STARTUP FUNDING Budget Actual (Under) / Over

Investors    

Hospital $ 1,500,000.00  

Owner 2    

Owner 3  

Other    

Total    

Additional Funding    

Grant $ 1,500,000.00  

Other    

Total    

Total Startup Funding $ 3,000,000.00    

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 STARTUP EXPENSES Date Due Budget Actual (Under) / Over
Administrative / General
Application Fee 03/01/2021 $ 5,000.00

Insurance $ -

Legal $ -

Training/Education

Consultant 03/01/2021 $ 10,000.00

Total $ 15,000.00

Location / Office
Space Rental / Lease $ -

Utility Costs $ -

Telephone Set-Up & Annual Cost $ -

Furniture 05/01/2021 $ 2,500.00

Medical Equipment 05/01/2021 $ 5,000.00

Hardware 05/01/2021 $ 2,500.00

Software (CRM, etc.) $ -

Installation Fees $ -

Start Up Inventory (Pharma) $ -

Medical Supplies (Gloves, etc.) 07/01/2021 $ 10,000.00

Miscellaneous

Nutrition 08/01/2021 $ 1,000.00

Total $ 21,000.00

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Marketing
Logo Design 04/01/2021 $ 2,500.00
Branding / Identity Development 04/01/2021 $ 2,500.00
Launch Advertising 06/01/2021 $ 2,500.00
Website 04/01/2021 $ 2,500.00
Printed Marketing Pieces 04/01/2021 $ 2,500.00
Promo Materials 04/01/2021 $ 2,500.00
Listing Fees 04/01/2021 $ 2,500.00
Internet Marketing 04/01/2021 $ 2,500.00
Trade Shows 05/01/2021 $ 2,500.00
Networking Events 06/01/2021 $ 2,500.00
Other
Total $ 25,000.00
Labor Expenses
Payroll 09/15/2021 $ 1,018,318.00
Training 08/01/2021 $ 51,611.20
Physician 09/15/2021 $ 1,121,280.00
Other
Other
Total $ 2,191,209.20
Other
Contingencies Reserve
Launch Party/Celebration 09/01/2021 $ 5,000.00
Other
Other
Other
Total $ - $ 5,000.00
Total Startup Expenses $ - $ 2,257,209.20 $ 2,257,209.20

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Projected Profit and Loss Model: This model indicates the projections forecasted for 36 months and divided by Year 1 through Year 3. The top
portion projects annual operating revenues. The second section projects operating expenses with recurring expenses annually. These numbers are
consistent with the projected start-up costs. The bottom portion projects anticipated net income with projections to be profitable during Year 1 of
operations based on the 25% CMS collection rate.

PROFIT AND LOSS SHEET

OPERATING REVENUE Year 1 Year 2 Year 3

Total Gross $ 52,190,011.69 $ 57,408,924.77 $ 63,148,228.51

Revenue Deductions $ 49,140,292.40 $ 54,084,198.56 $ 59,509,495.93

Service Revenue

Ave Collection Rate of 25% $ 13,047,502.92 $ 14,352,231.19 $ 15,787,057.13 25%

Net CMS Revenue $ 3,049,719.29 $ 3,324,726.21 $ 3,638,732.58

Volume 13140 14454 15899

OPERATING EXPENSES      

Administrative General $ 64,711.00 $ 10,448.00 $ 10,572.00

Marketing $ 25,000.00 $ 25,000.00 $ 25,000.00

Salary and Wages $ 2,139,598.00 $ 2,185,630.72 $ 2,625,425.92

Employee Benefits (non-productive time) $ 460,543.40 $ 625,031.80 $ 734,979.88

Supplies $ 21,000.00 $ 11,000.00 $ 11,000.00

Depreciation Expense $ 250.00 $ 250.00 $ 250.00

Total Expenses $ 2,711,102.40 $ 2,857,360.52 $ 3,407,227.80

NET INCOME
Based CMS NET $ 338,616.89 $ 467,365.69 $ 231,504.78

Based on 25% $ 10,336,400.52 $ 11,494,870.67 $ 12,379,829.33

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Labor Specific Startup Expense Projections Years One through Three
  Y1 Y1 Y1 Y1
Hours Productive Productive Non-Productive Non-Productive
Total Physician Hours 8,760 $ 1,121,280.00 1,752 $ 224,256.00
Total Registered Nurse Hours 19,698 $ 610,638.00 4,992 $ 154,752.00
Total Social Worker Hours 2,912 $ 69,888.00 582.4 $ 13,977.60
Total Pharmacist Hours 2,912 $ 145,600.00 582.4 $ 29,120.00
Total Physical Therapist Hours 2,912 $ 113,568.00 582.4 $ 22,713.00
Total patient navigator (RN or SW) 2,912 $ 78,624.00 582.4 $ 15,724.80
Total hours 40,106 $ 2,139,598.00 9,074 $ 460,543.40 $2,600,141.40

Y2 Y2 Y2 Y2
Hours Productive Productive Non-Productive Non-Productive
Total Physician Hours 11,664.64 $1,493,073.92 2,916.16 $373,268.48
Total Registered Nurse Hours 21,964.80 $680,908.80 5,491.20 $170,227.20
Total Social Worker Hours 2,912 $2,912.00 582.4 $13,977.60
Total Pharmacist Hours 2,912 $2,912.00 582.4 $29,120.00
Total Physical Therapist Hours 2,912 $2,912.00 582.4 $22,713.00
Total patient navigator (RN or SW) 2,912 $2,912.00 582.4 $15,724.80
Total hours 45,277.44 $2,185,630.72 10736.96 $625,031.08 $2,810,661.80

Y3 Y3 Y3 Y3
Hours Productive Productive Non-Productive Non-Productive
Total Physician Hours 14,576.64 $1,865,809.92 3,644.16 $466,452.48
Total Registered Nurse Hours 24,128.00 $747,968.00 6,032 $186,992.00
Total Social Worker Hours 2,912 $2,912.00 582.4 $13,977.60
Total Pharmacist Hours 2,912 $2,912.00 582.4 $29,120.00
Total Physical Therapist Hours 2,912 $2,912.00 582.4 $22,713.00
Total patient navigator (RN or SW) 2,912 $2,912.00 582.4 $15,724.80
Total hours 50,352.64 $2,625,425.92 12,005.76 734,979.88 $3,360,405.80

PROFORMA

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 Y1 Y2 Y3
Total Expected Care Hours 52,560 57,816 63,556
Total Volume (4 hour LOS) 13,140 14,454 15,889
FTEs Y1 Y2 Y3
Total Physician FTE 5.26 7.01 8.76
Total Registered Nurse FTE 12 13.2 14.5
Total Social Work FTE 1.75 1.75 1.75
Total Pharmacist FTE 1.75 1.75 1.75
Total Physical Therapist FTE 1.75 1.75 1.75
Total patient navigator (RN or SW) 1.75 1.75 1.75
Total FTEs 24.26 27.21 30.26
Hourly Rate [CITATION 20ht \l
1033 ]
ER MD $128.00
ER RN $31.00
Social Worker $24.00
Pharmacist $50.00
Physical Therapist $39.00
Patient navigator $27.00
Education Hours (40) Y1 Y2 Y3
ER MD $26,931.20 $8,960.00 $8,960.00
ER RN $14,880.00 $1,488.00 $1,612.00
Social Worker $1,680.00 $- $-
Pharmacist $3,500.00 $- $-
Physical Therapist $2,730.00 $- $-
Patient Navigator $1,890.00 $- $-
Total $51,611.20 $10,448.00 $10,572.00
Not considered:
Pay rate increase
Turnover Orientation
Additional Education for Turnover

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 REFERENCES
American College of Emergency Physicians. (2013). ACEP geriatric emergency department accreditation. Retrieved from

American College of Emergency Physicians (ACEP): https://www.acep.org/by-medical-focus/geriatrics/

American College of Emergency Physicians. (2013). Geriatric Emergency Department Guidelines. Retrieved from American

College of Emergency Physicians:

https://www.acep.org/globalassets/sites/geda/documnets/geri_ed_guidelines_policy_final.pdf

EP Monthly. (2019). Building a better emergency department: An architect's perspective. Emergency Physicians Monthly.

Retrieved from https://epmonthly.com/article/building-a-better-emergency-department-an-architects-perspective/

Medina, L., Sabo, S., & Vespa, J. (2020). Living Longer: Historical and Projected Life Expectancy in the United States, 1960 to

2060. Retrieved from United States Census Bureau:

https://www.census.gov/content/dam/Census/library/publications/2020/demo/p25-1145.pdf

United States Census Bureau. (2019). QuickFacts: Walton County, Florida. Retrieved from United States Census Bureau:

https://www.census.gov/quickfacts/waltoncountyflorida

Visit South Walton. (2018). Visit South Walton: Economic impact of tourism calendar year 2018. Retrieved from Visit South

Walton: https://www.visitsouthwalton.com/userfiles/downloads/research/2018_Economic_Impact_Report_FINAL.pdf

WestHealth.org. (2018, September ). UC SanDiego Health: A Practical Guide to Implementing a Geriatric Emergency

Department. Retrieved from WestHealth.org: https://s8637.pcdn.co/wp-content/uploads/2018/09/GED-

Implementation-Guide.pdf

Zip Recruiter. (2020, November 01). Zip Recruiter salaries. Retrieved from Zip Recruiter:

https://www.ziprecruiter.com/Salaries/Registered-Nurse-Salary

17
Appendix i

(EP Monthly, 2019)

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 Appendix ii
Quality Dashboard
Global Measures January February March April May June July August September October November December YTD

Patient Volume >65 0

% of Total Admissions 0

Readmissions 0

72 hour ED return                         0

24 hour admission                         0

Geriatric Abuse                         0

Deaths                         0

Disease Specific                         YTD

Falls                         0

Hip Fractures 0

Traumatic ICH                         0

Blunt Abdominal Injury 0

Death                         0

Fall-risk Assessment 0

Physical Therapy Eval                         0

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Urinary Catheters                         YTD

Check list                         0

Catheter Days                         0

Automatic Discontinue 0

CAUTI Stay                         0

Medicine Management                         YTD

High Risk Meds Noted 0

ED High Risk Meds                         0

Adverse Reaction Return 0

Non-compliance Return                         0

Delirium                         YTD

Screening                         0

Restraints                         0

Chemical Restraint
0
Attempt

Behavior Physical
0
Restraint Used

(American College of Emergency Physicians, 2013, p. 11)

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