Making the Case: Fellowship Financials

Britney Broyhill, DNP, ACNP-BC

CHS NP Fellowship Director

Objectives

• Participants will name 5 key motives for creating a post-graduate education program for Nurse Practitioners for healthcare administrators.

• Participants will create a business model to provide financial support for a NP post-graduate education program

• Participants will calculate a potential ROI for a NP post-graduate education program.

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Current State of Post Graduate

Programs

Subspecialty Break-out

….to create value for patients.

Objective Problem/Opportunity @ CHS

Clinical Outcomes

● ACPs in acute care settings are often hired from non-acute settings

● ACPs receive on-the-job training with their supervising physicians

● ACPs often find themselves ill prepared for many clinical situations

The Need for Advanced Clinical Practitioners…

Satisfaction

● CHS lacks strong reputation as a best place to work for ACPs

● Fragmented communication with ACPs across the System

● Provider dissatisfaction with ACP/MD clinical partnerships

● Underutilization leads to ACP disengagement (not practicing at top of license)

● Physician frustration with increasing work load and patient demands

Costs

● High MD/ACP ratio = Higher cost provider workforce

● Vacant ACP positions yield lost revenue, decreased patient satisfaction & decreased access to care

● Length of time to recruit skilled providers contributing to increased costs

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Key Drivers

• Employee Engagement Scores

• Turnover Rates

• Recruitment Costs

• Lower Workforce Costs

• ACP Productivity Differential

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Components of Business Plan

• Executive Summary

• Project Overview

• Situation Assessment

• Management and Operations

• Alternatives and Recommendations

• Financial Projections

• Management Action Plan

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Costs to Consider

• Administrative costs

– Licensure

– Interview Expenses

– Food/Beverage

– Marketing

• Salaries and Benefits

– CE

– Directors/Staff

– Mentors/Lecturers

– Simulation Costs

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Leadership Approval & Funding

• Management Company

– Business Plan

– ROI

• Executive Vice President Sponsorship

• Funding Approval

• Board approval

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Return on Investment

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Value CreatedImproved clinical outcomes with ACPs obtaining the clinical knowledge and

expertise needed to practice at top of license,

Increased physician & patient satisfaction

Higher ACP satisfaction = leads to increased retention; decreased vacancies

Lower turnover cost, including recruitment, training/orientation, lost productivity, new hire costs

Lower recruitment costs = due to fewer vacancies; enhanced pipeline shortens recruitment cycle

Lower provider workforce cost = sufficient quality and quantity of providers allows shift of the ACP to MD ratio

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The “Ask”• $14.1 million over 5 years ($18.4 m with expan.)

– Included CAP, Fellowship and Collaborative

– Did not include expansion (32 Fellows v. 56 Fellows)

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ROI

• Proj. BE 18 mo. ($27.4 million in 12 mo.)

– Lower provider workforce cost ($18.2 m) (141 ACPs)

– Revenue generated by Fellows ($3.5 m)

– Decreased Open Position time ($2.1 m) 141 – 92 days

– Decreased turnover rate ($2.9 m) (18 ACPs) 12 – 8%

– Lower recruitment costs ($0.7 m) (218 ACPs)

– Increased patient access (days to first new patient appt. and days to established patient appt.)

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Other ROIs?

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How is this scalable?

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Benefits to Fellowship Programs

• Protected time to learn

• Social support during transformative year

• Ease into independence

• Organized approach to key topics to be successful in a specialty

• Proctoring for procedures completed

• Ready to be productive on day 1 of permanent practice when being compensated at full salary

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Questions

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