micro hospital - health - village living

| System | Initial Cost ($ + hrs) / unit | Annualized Cost ($ + hrs) / unit | sqft building | sqft land | Revenue | Market Cost | Benefits | |--------|-------------------------------|----------------------------------|---------------|-----------|----------|-------------|-----------| | Primary Care + Emergency | $750k + 2500 hrs | $175k + 6240 hrs | 2500 | 10000 | $0 | $2.19M | Healthcare access, emergency response, preventive care, community health integration | #### Assumptions - manage health of 1000 person community - 3 PCPs "generalist specialist" operating at top of their licenses - Healthier population due to micro society lifestyle - All providers are community members - Internal resources from community systems (power, water, waste, food) - [[pcp recruitment analysis - health - village living]] ##### Legal Frameworks | Model | Regulatory Burden | Medicare/Medicaid Billing | Scope Flexibility | Training Requirements | External Dependencies | Provider Recruitment Difficulty | Estimated Max % Internal Care | Key Advantages | Key Limitations | | -------------------------- | ------------------------------------------------------------------- | ------------------------- | -------------------------------------------------------------------- | ------------------------------------------------------------- | --------------------------------------------- | ---------------------------------------------- | ------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------- | | Rural Health Clinic (RHC) | High - Full CMS compliance, regular surveys, strict staffing ratios | Yes | Medium - Limited by RHC rules but broader than standard primary care | Standard residency + Rural certification + Ongoing compliance | Moderate - Required for complex cases only | High - Must meet federal staffing requirements | 85% - Can handle most primary + urgent care + many specialist needs | - Medicare/Medicaid reimbursement - Clear regulatory framework - Broader procedure scope | - Heavy compliance burden - Strict staffing rules - Higher operational costs | | Direct Primary Care | Low - Basic licensing only | No | High - Provider determines scope based on skills | Standard residency + Optional additional training | High - Need strong specialist network | Low - Attractive to providers seeking autonomy | 70% - Limited by provider skills and liability concerns | - Maximum flexibility - Low administrative burden - Direct patient relationships | - No insurance billing - Higher individual costs - Limited complex procedures | | Private Community Clinic | Medium - State licensing and basic certifications | Yes, with limitations | Medium-High - Based on provider credentials | Standard residency + Specific procedure certifications | Medium-High - Regular specialist coordination | Medium - Standard private practice model | 75% - Can expand capabilities but higher risk management | - More flexible than RHC - Can bill insurance - Customizable model | - Higher malpractice costs - More restricted procedures - Complex case limitations | | Collaborative Care Network | Low-Medium - Varies by partnership structure | Possible through partners | Medium - Enhanced by specialist support | Standard residency + Ongoing specialist mentorship | High - Dependent on network relationships | Medium-Low - Attractive learning environment | 80% - Access to specialist guidance expands capabilities | - Built-in specialist support - Gradual capability growth - Lower initial burden | - Complex coordination - Partner dependency - Variable availability | ##### Specialty Training Requirements | Specialty Area | Required Training | Certification/Credential | Typical Duration | Key Procedures Unlocked | Maintenance Requirements | | ------------------------ | --------------------------------------------------------------------- | ---------------------------------------- | ---------------- | ----------------------------------------------- | ------------------------------------------------------ | | Dermatology | CME course + supervised cases | Basic skin surgery certification | 2-3 weekends | Skin biopsy, lesion removal, cryotherapy | 10 cases/year documented | | Women's Health | ALSO course + hands-on training | ALSO certification | 2-4 weeks | IUD placement, Nexplanon, basic prenatal | Renewal every 4 years | | Sports Medicine | Injection techniques workshop | Individual procedure credentials | 1-2 weeks | Joint injections, casting, splinting | 5 procedures/type/year | | Emergency Medicine | ATLS + procedure workshop | ATLS certification | 1 week + cases | Suturing, I&D, foreign body removal | Renewal every 4 years | | Point-of-Care Ultrasound | Basic + advanced courses | POCUS certification | 2-4 weeks | Basic diagnostic ultrasound | 50 scans/year logged | | Office Surgery | Basic surgical skills course | State surgical privileges | 1-2 weeks | Lipomas, cysts, ingrown nails | 10 cases/year documented | | Colonoscopy | Hands-on course + 50 supervised | Endoscopy certification | 8-12 weeks | Diagnostic colonoscopy | 50 procedures/year | | Aesthetic Medicine | Injectable training course | Product-specific certificates | 1-2 weeks | Botox, basic fillers | 20 cases/year logged | | Mental Health | Psychopharmacology course | None required* | 1 week | Basic medication management | 15 CME hours/year | | Pain Management | Controlled substance course | State pain management cert | 1 week | Basic chronic pain management | 10 CME hours/year | | Obstetrics | Advanced Life Support in Obstetrics (ALSO) + 20 supervised deliveries | ALSO certification + Hospital privileges | 3-6 months | Uncomplicated vaginal deliveries, prenatal care | 10 deliveries/year minimum, ALSO renewal every 4 years | ##### AI-Integrated Patient Experience maximize PCP effectiveness and improve patient experience - Appointment Screen: AI prompts symptom analysis through community health app. preliminary care recommendations - Pre-Visit Prep: patient record updated after Community vital station check-in, concerns flagged for PCP, Suggests relevant tests - Visit Options: AI-supported documentation, Real-time specialist AI consultation - Care Planning: care plan creation through doctor, patient, and AI collaboration, built-in follow-up scheduling - Ongoing Management: automated symptom tracking prompts (check-ins) - Enhanced Specialist Support: AI diagnostic assistance, Real-time research updates, Treatment protocol guidance, Remote specialist consultation - Community Integration: AI suggests nutrition planning, task preference updates, Social support connections #### Market Solutions Analysis | Service Type | Annual Volume | Market Cost/Visit | Annual Market Cost | Notes | |--------------|---------------|-------------------|-------------------|--------| | Routine Checkups | 1000 | $200 | $200,000 | Basic preventive visits | | Chronic Care | 1000 | $250 | $250,000 | Ongoing condition management | | Acute Care | 600 | $300 | $180,000 | Immediate health issues | | Level 1 Emergency | 200 | $1,000 | $200,000 | Urgent care level | | Level 2 Emergency | 100 | $3,500 | $350,000 | ER visit equivalent | | Level 3 (Transfer) | 50 | $10,000 | $500,000 | Major emergency care | | Minor Surgery | 100 | $4,000 | $400,000 | Outpatient procedures | | Diagnostic Procedures | 100 | $800 | $80,000 | Testing and imaging | | Preventive Programs | 52 | $500 | $26,000 | Group sessions | | **Total Market Cost** | - | - | **$2,186,000** | Per year | #### System Outputs & Labor 1937 | Service Type | Annual Volume | Per Week | Time Per Case | Annual Hours | Provider Split | |--------------|---------------|-----------|---------------|--------------|----------------| | Routine Checkups | 1000 | 19 | 20 min | 333 | PCPs 1&2 | | Chronic Care | 1000 | 19 | 30 min | 500 | PCPs 1&2 | | Acute Care | 600 | 12 | 30 min | 300 | All PCPs | | Level 1 Emergency | 200 | 4 | 60 min | 200 | PCP 3 primary | | Level 2 Emergency | 100 | 2 | 120 min | 200 | PCP 3 + backup | | Level 3 (Transfer) | 50 | 1 | 60 min | 50 | All PCPs | | Minor Surgery | 100 | 2 | 90 min | 150 | Rotating | | Diagnostic Procedures | 100 | 2 | 60 min | 100 | All PCPs | | Preventive Programs | 52 | 1 | 120 min | 104 | Rotating | | **Total Hours** | - | - | - | 1937 | 3 PCPs | #### Operating Costs $175k/year | Component | External Cost ($) | Internal Cost ($) | Notes | |-----------|------------------|-------------------|--------| | Medical Supplies | $80k | 0 | Disposables, medications | | Equipment Maintenance | $35k | 0 | Required external certifications | | Technology Systems | $25k | 0 | AI/software subscriptions | | Emergency Supplies | $20k | 0 | Regular restocking | | Diagnostic Materials | $15k | 0 | Lab supplies, testing materials | | **Total Annual Cost** | $175k | 0 | | #### Initial Costs $750k + 2500 hrs -> $89.7k + 311 hrs/year | Equipment Category | Initial Cost ($ + hrs) | Lifespan (Years) | Amortized Cost/Year ($ + hrs) | Notes | |-------------------|------------------------|------------------|------------------------------|--------| | Diagnostic Suite | $200k + 500 hrs | 10 | $20k + 50 hrs | X-ray, ultrasound, lab | | Emergency/Surgical | $250k + 700 hrs | 10 | $25k + 70 hrs | Level 2 capability | | Clinical Equipment | $150k + 500 hrs | 7 | $21.4k + 71 hrs | Basic care needs | | Technology Infrastructure | $100k + 500 hrs | 5 | $20k + 100 hrs | AI/automation systems | | Facility Setup | $50k + 300 hrs | 15 | $3.3k + 20 hrs | Space configuration | | **Total** | **$750k + 2500 hrs** | - | **$89.7k + 311 hrs** | Annual amortized | #### Detailed Equipment Analysis | Equipment | Initial Cost | Annual Maint. $ | Annual Maint. Hrs | Internal/External | Usage Rate | Certifications | Life Span | Notes | |-----------|--------------|-----------------|-------------------|-------------------|-------------|----------------|-----------|--------| | **Diagnostic Suite** | | Digital X-ray | $85,000 | $8,000 | 100 hrs | External cert | 2-3/day | Radiation safety | 10 years | Core imaging | | Ultrasound | $45,000 | $4,000 | 50 hrs | Internal | 3-4/day | Basic training | 8 years | Versatile | | Chemistry Analyzer | $30,000 | $5,000 | 100 hrs | External cal | 5-6/day | Lab cert | 7 years | Daily labs | | CBC Analyzer | $20,000 | $3,000 | 50 hrs | External cal | 4-5/day | Lab cert | 7 years | Blood counts | | Blood Gas Analyzer | $25,000 | $4,000 | 50 hrs | External cal | 1-2/day | Lab cert | 7 years | Critical care | | **Emergency/Surgical** | | Surgical Table | $40,000 | $2,000 | 40 hrs | Internal | 2-3/week | Basic training | 15 years | Procedures | | Anesthesia Machine | $65,000 | $6,000 | 100 hrs | External cert | 2-3/week | Advanced cert | 10 years | Level 2 care | | Ventilator | $35,000 | $3,500 | 80 hrs | External cal | 1-2/month | Advanced cert | 8 years | Critical support | | Defibrillator | $25,000 | $2,000 | 40 hrs | External cert | 1-2/month | ACLS cert | 8 years | Emergency | | Surgical Lights | $20,000 | $1,000 | 20 hrs | Internal | 2-3/week | Basic training | 15 years | Procedures | | **Clinical Equipment** | | Vital Stations (2) | $6,000 | $600 | 40 hrs | Internal | 15-20/day | Basic training | 5 years | Regular use | | ECG Machine | $15,000 | $1,000 | 30 hrs | Internal cal | 2-3/day | Basic training | 8 years | Cardiac | | Exam Tables (4) | $20,000 | $500 | 20 hrs | Internal | Daily | None | 10 years | Basic care | | Point-of-Care Testing | $25,000 | $3,000 | 60 hrs | External cal | 5-6/day | Lab cert | 5 years | Rapid tests | | Sterilization System | $20,000 | $2,000 | 100 hrs | Internal | Daily | Basic training | 10 years | Critical support | | **Technology** | | AI System Servers | $30,000 | $5,000 | 100 hrs | Internal | Continuous | IT cert | 5 years | Core processing | | Workstations (6) | $18,000 | $2,000 | 50 hrs | Internal | Daily | Basic training | 5 years | Documentation | | Network Infrastructure | $25,000 | $3,000 | 80 hrs | Internal | Continuous | IT cert | 5 years | Connectivity | | Backup Systems | $15,000 | $1,000 | 40 hrs | Internal | As needed | IT cert | 5 years | Data security | **Key Maintenance Notes:** 1. Internal Maintenance: Requires community member certification 2. External Calibration: Annual or semi-annual professional service 3. External Certification: Required for critical equipment 4. Usage Rates: Based on projected patient volume 5. Training Requirements: Integrated with task system #### Space Allocation (2500 sqft) | Space Type | Size (sqft) | Key Equipment | Purpose | |------------|-------------|---------------|----------| | Reception/Vitals | 200 | Automated stations | Initial assessment | | Exam Rooms | 4 × 150 = 600 | Basic diagnostic | Primary care | | Procedure Room | 400 | Surgical capability | Level 2 emergency | | Diagnostic Suite | 300 | Imaging & lab | Testing | | Supply Storage | 200 | Inventory systems | Materials | | Staff Area | 200 | Documentation | Provider space | | Emergency Bay | 400 | Critical care | Emergency response | | Support Spaces | 200 | Utilities | Infrastructure | #### Critical Success Factors 1. Provider Integration - All PCPs as community members - Sustainable workload - Clear emergency rotation 2. Technology Support - AI-augmented care - Automated documentation - Remote monitoring 3. Community Integration - Emergency response team - Task system alignment - Health education 4. Quality Metrics - Outcome tracking - Patient satisfaction - Emergency response times - Prevention success #### Emergency Care Levels | Level | Description | Examples | Resources Needed | Time Sensitivity | |-------|-------------|----------|------------------|------------------| | Level 1 (Handle Here) | Can be fully treated with available resources. Low to moderate risk. | - Simple fractures/sprains - Cuts needing stitches - Asthma attacks - Minor burns - Allergic reactions - Uncomplicated childbirth | - Basic imaging - Suture supplies - IV fluids - Basic medications | Hours | | Level 2 (Stabilize & Transfer) | Need initial treatment here but require transfer. Moderate risk but stable enough for transport. | - Complex fractures - Moderate burns - Appendicitis - Non-severe heart attacks - Early labor complications | - Stabilization equipment - Transfer protocols - Emergency transport arrangements | Within hours | | Level 3 (Immediate Transfer) | Beyond local capabilities. High risk requiring immediate specialist care. | - Severe trauma - Major heart attacks - Severe burns - Brain injuries - Stroke symptoms | - Emergency transport - Life support equipment - Direct line to receiving facility | Minutes |