Business Plan

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Columbia Southern University *

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5301

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Medicine

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Feb 20, 2024

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Business Plan Greg Hunt Columbia Southern University HCA 5301: Health Care Financial Management Dr. Point-Johnson 22nd November 2022

Executive Summary: Progressive Sleep Medicine What Our Business Does: Progressive Sleep Medicine is going to be a clinic for those in need of sleep medicine in western NC with the focus on in home testing. While performing our obligations, the clinic will function as part of the local hospital to ensure that we comply with all of North Carolina's legal requirements and health standards. Due to their vast knowledge, our staff members are capable of meeting a vast array of medical requirements. Mission Statement: “The Mission of Progressive Sleep Medicine is to provide quality healthcare to our patients with compassion, professionalism and efficiency from advanced staff training as healthcare grows for a community that looks at a prosperous future.” Vision: In the next five years, we intend to become Western North Carolina's premier provider of home-based sleep medicine services. Become one of the top 10 Sleep medicine healthcare managers. The objective is to establish the first home Sleep medicine organization that will serve both wealthy and low-income clients awaiting sleep testing. Values: We believe in giving our patients our undivided attention. We provide sensitive treatment to our patients. We adhere to the highest ethical standards in the industry.

We are devoted to regularly updating our knowledge of the most recent breakthroughs in sleep medicine in order to discover new and more effective ways to help our patients. To deliver the greatest care, we believe in forming relationships with our patients and their families Products and Services: To ensure that our patients and clients receive top-notch care, Progressive Sleep medicine will work in the service sector to provide home a home study program. Professionally educated doctors, Respiratory team and receptionists educated in Insurance reimbursement who comprehend what it takes to give outstanding care to our valued clients will uphold our ideals and principles. Leadership Team: Chief Executive Officer and Respiratory Director • Leadership in the workplace is one of the responsibilities. • Developing, communicating, and implementing the organization's vision, mission, and overarching strategy. In other words, directing the development and execution of the entire strategy. • In charge of recruiting, educating, and managing staff. • You must arrange meetings with healthcare professionals. • Executing agreements Target Market:

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Who should undergo sleep apnea screening? Patients with a body mass index 30 kg/m2; who are obese, those with nocturnal dysrhythmias, pulmonary hypertension, or coronary artery disease, and those planning for bariatric surgery should also be tested for OSA. Typically, sleep investigations are conducted in a sleep lab during typical sleeping hours. The objective is to capture brain and body activity during sleep in order to diagnose and treat sleep disorders. Today’s technology will allow us to do these studies with an in-home program that will target more patients that cannot afford a traditional sleep lab ( Michaelson, 2015) Competitive Analysis: Strengths - Progressive Sleep medicine will be the only program in a 30-mile radius with other programs having 3 to 6 month wait times. Weaknesses - Progressive Sleep will be a new program and need to develop a working relationship with area physicians Opportunities - Progressive Sleep has the ability to provide a service that other Sleep centers are not providing at this time and develop a base that could lead to an in-patient sleep center Threats - Every company has the threat of another organization coming into the area, but that doesn’t seem to be a concern at this time. The demand for sleep medicine services has increased dramatically over the past decade and is projected to continue to rise. To date, the increase in demand has been addressed by the expansion of new sleep facilities. Increasing regulatory requirements, labor shortages, the integration of home sleep testing, changes in funding, a shift in emphasis from diagnosis to

treatment, and an increased consumer interest on sleep will influence the demand for more new centers. Our home sleep program will help meet this demand. Financing: Increasingly, obstructive sleep apnea is recognized as a comorbidity in numerous medical conditions. This has led to a growing demand for sleep testing, which is not totally met by the current sleep laboratory infrastructure. Home or out-of-center sleep testing is an alternative to tests conducted in a laboratory. However, billing and coding for home investigations are more complicated than for laboratory studies. Startup cost- $3,929.95 This includes the monitoring system, software program and initial patient set-up 25-piece kit- $1,042.95 This per patient kit for each set up will be $41.42 The total cost to begin with software set up on existing computers will be $4,972.90 This cost will be paid for by Foundation money. Reimbursement: CPT Code 95800 CPT Code 95806 HCPCS Code G0399 (CleveMed, 2022) Indication ICD-10 Code

Obstructive sleep apnea G47.33 Sleep-related hypoventilation/hypoxemia in conditions classified elsewhere G47.36 Insomnia with sleep apnea, unspecified G47.01 and G47.33 Hypersomnia with sleep apnea, unspecified G47.14 and G47.33 Unspecified sleep apnea G47.30 Each CPT code and ICD-10 code will have a different reimbursement rate which is contracted with insurance organizations. The lowest is the Medicare rate of $250 and the highest for this program is $500 With the beginning startup of $4,972.90 Goal of 12 patients per month- first month at lowest rate $250 x 12 = $3,000 Maintain this 12 per month for the year = $36,000 Minus the $41.42 per setup per case x 44 patients= -$1822.48 Total profit end of year with 1 unit $34,177.52 This small program sleep setup for Progressive Sleep medicine could lead the organization to a larger program. But the upstart cost on a full-scale lab is about $300,000 which the organization is set to absorb or staff. This home program can be fully functional with the staff the Hospital already employees.

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References CleveMed, (2022) Cleveland Medical Devices Home Sleep Testing Reimbursement, https://clevemed.com/home-sleep-testing/reimbursement-tips-and-icd-codes/ Michaelson, E.D. (2015) Should, would, or could providers do home sleep testing? Anthem Systems LLC , Sleep Review. 2015, Vol. 16, Issue 1, pages. 4 Nelson ME. Coding and billing for home (out-of-center) sleep testing. Chest . 2013 Feb 1;143(2):539-543. doi: 10.1378/chest.12-0425. PMID: 23381319. Sharma, A., & Das, S. (2021, March 12). Opportunities for hospitals to create new revenue streams. Aranca . https://www.aranca.com/knowledge-library/articles/ip-research/opportunities-for- hospitals-to-createnew-revenue-streams The U.S. sleep disorder clinics market is projected to grow from $9.20 billion in 2021 to $15.92 billion in 2028 at a CAGR of 8.2% in forecast period, 2021-2028 , Fortune Business Insight, (April 2022) https://www.fortunebusinessinsights.com/u-s-sleep- disorder-clinics-market-106600

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