teaching micro hospital - health

| System | Initial Cost ($ + hrs) | Annual Cost ($ + hrs) | sqft building | sqft land | Revenue | Market Cost | Benefits | | ----------------------- | ---------------------- | --------------------- | ------------- | --------- | ------- | ----------- | ----------------------------------------------------------------------------------------- | | Teaching Micro Hospital | $1.2M + 4000 hrs | $280k + 12,140 hrs | 5000 | 20,000 | $1.2M | $2.5M | Healthcare access, medical education, community health integration, preventive care focus | - a hybrid model where the community handles most care internally, maintains catastrophic coverage for major events, and provides strong support systems for accessing external care when needed. - AI Pre-Visit Processing, Automated checkin, Automated Vitals Station, AI History Taking, Resident-Led Care Model, Automated care coordination and follow up, Continuous health monitoring, - questions - should there be a mental health focused individual or are the residents expected to fill that roll - should there be a pharmacy tech or does this need a full pharmacist? - can community specialize enough to maintain its own equipment? - what med equipment doesn't make sense to have here? #### Assumptions - 1000 person community healthcare needs - Internal resource unit costs: - Power: from community grid - Water: from community system - Waste management: integrated with community - Food service: from community kitchen ##### Staffing Model - 3-4 Residents (Primary Care Providers) - Medicare GME funding available (~$150k per resident) - Each resident: ~1500 clinical hours/year - Progressive responsibility over 3 years - rural training track focused on comprehensive community care - 1 Board-certified program director 10 hrs/week. - 2-3 Supervising Physician - 20 hrs/week direct supervision total - 10 hrs/week teaching/admin total - 1 Medical Student (Rotating) - 40 hrs/week for learning/assisting - Changes every 4-8 weeks ###### Likelihood of Attracting Medical Professionals | Stakeholder Group | Likelihood | attractive features | challenging features | Key Success Factors | | ------------------- | ------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Board-certified teaching physician | High | - Flexible 10 hours/week - low administrative burden, No insurance/billing paperwork - malpractice insurance covered by community - Reduced cost of living in retirement - Continued professional purpose - Opportunity to develop new care protocols - Research potential in community health outcomes | - Less prestige, Lower compensation than traditional practice - Rural/semi-rural location - Limited complex cases - Requires lifestyle change - Distance from major medical centers - Must adapt to technology-driven practice | - Target semi-retired physicians interested in work-life balance - Focus on those aligned with community values - Emphasize teaching without administrative burden - Market quality of life and community benefits | | Residents | Moderate-High | - Comprehensive primary care experience and Broad procedural experience - Early autonomy and decision-making - Direct mentor relationships - community pays student loans - Housing and basic needs provided - Work-life balance (regulated hours) - Community health focus and research opportunities | - Less exposure to complex cases - Limited specialty rotations - Rural/semi-rural location - Non-traditional training environment - Potentially less prestigious than urban programs - Smaller program size | - Partner with medical schools emphasizing primary care - Offer loan repayment/forgiveness - Guarantee future positions - Emphasize unique training opportunity | | Medical Students | High | - Unique community health experience - Direct patient care opportunities - Close mentorship - Exposure to sustainable healthcare model - Housing/meals provided during rotation - Less hierarchy than traditional settings - Focus on practical skills | - Limited complex cases - Distance from medical school - Less structured than traditional rotations - May not align with traditional curriculum - Limited specialty exposure - Rural/semi-rural setting - Different practice style than most will use | - Partner with schools wanting rural/community experience - Offer unique preventive care exposure - Provide strong mentorship - Create pipeline to residency program | ##### Key Efficiency Factors: 1. Residents handle majority of routine care 2. Medical students support basic tasks 3. Supervising physician focuses on teaching/oversight 4. Community health workers support prevention 5. Integrated with other community systems 6. Strong emphasis on preventive care reduces acute needs ##### Key Cost Reduction Factors - Internal care delivered at cost - healthy micro society living: physical and social engagement, lower stress from reduced burdens, healthier eating and more nutritious foods, interaction with nature - Preventive focus reduces costly interventions - Community arbitration reduces legal costs - Integrated records reduce admin overhead - Bulk purchasing power for external services ###### Improvements from These Factors - Chronic disease incidence by 40-60% - Mental health issues by 30-50% - Stress-related conditions by 40-70% - Recovery times by 20-40% ##### Medical Equipment Distribution and Costs | Equipment | Initial Cost | Annual Maintenance | Found in % of PCPs | % Urgent Care | % Hospitals | Main Purpose | Typical Markup | Est. Annual Uses (1000 people) | Equipment Utilization | | -------------------------------- | ------------ | ------------------ | ------------------ | ------------- | ----------- | --------------------------------------------- | -------------- | ------------------------------ | --------------------- | | Point-of-Care Lab Testing | $30,000 | $5,000 | 45% | 95% | 100% | Basic blood work, metabolic panels, strep/flu | 400-600% | 1500-2000 | 30-40% | | Digital X-Ray | $75,000 | $8,000 | 30% | 90% | 100% | Fractures, chest x-rays | 300-500% | 300-400 | 15-20% | | Ultrasound | $45,000 | $4,000 | 25% | 70% | 100% | Pregnancy, soft tissue | 200-400% | 200-300 | 10-15% | | EKG Machine | $10,000 | $1,000 | 80% | 100% | 100% | Heart monitoring | 200-300% | | | | Automated External Defibrillator | $2,000 | $200 | 90% | 100% | 100% | Emergency cardiac | N/A | | | | Basic Surgical Equipment | $75,000 | $10,000 | 20% | 85% | 100% | Minor procedures | 300-500% | | | | Vital Signs Monitors | $3,000 | $300 | 100% | 100% | 100% | Basic monitoring | 100-200% | | | ##### Micro Society Healthcare Delivery Scenarios | Model Level | Core Components | % Care Internal | Types of Care Handled Internally | | --------------- | ---------------------------------------------------------------------------------------------------------------- | --------------- | ------------------------------------------------------------------------------------------------------------- | | Basic Clinic | - Point-of-care lab - Basic imaging - Urgent care setup - Physical therapy | 60-70% | - Primary care - Basic urgent care - Chronic management - Prevention - PT/rehab | | Enhanced Clinic | Above plus: - Digital X-ray - Minor surgery suite - Mental health - Basic pharmacy | 75-85% | Above plus: - Minor procedures - Basic mental health - Medication management - Simple emergencies | | Micro Hospital | Above plus: - Emergency stabilization - Basic surgical suite - Advanced diagnostics - Labor/delivery | 85-95% | Above plus: - Basic surgery - Emergency stabilization - Uncomplicated births - Simple procedures | ##### Care Typically Requiring External Support | Care Type | % of Total Need | Notes | | ---------------- | --------------- | --------------------------------- | | Complex Surgery | 3-5% | Joint replacements, cardiac, etc. | | Advanced Imaging | 2-3% | MRI, CT scans | | Specialist Care | 5-7% | Complex conditions, rare diseases | | Critical Care | 1-2% | ICU level care | | Complex Birth | 2-3% | High-risk pregnancy | #### Insurance - Community pays for access to majority(~90%) of medical needs - self-insurance pool covers external care under `$100K` per incident - community buys reinsurance for external care events over `$100k` per incident ##### Administrative Cost Comparison | Cost Category | Traditional Insurance | Health Ministry | Micro Society | | ------------------ | --------------------- | --------------- | ------------- | | Admin Overhead | 25-30% | 8-10% | 3-5% | | Dispute Resolution | 2-5% | <1% | 0.5-1% | | Care Coordination | 5-8% | 2-3% | 1-2% | | Total Admin | 32-43% | 10-14% | 4.5-8% | #### Market Solutions $???/year out of pocket costs for this care in the market - Primary care visits ($500k) - Urgent care services ($400k) - Basic procedures ($600k) - Diagnostic testing ($400k) - Preventive care ($300k) - Mental health services ($300k) #### Labor ??? Hours/year #### Operating Costs $250k/year | Component | Cost ($) | Notes | | ------------------------ | ----------------- | ---------------------------------- | | Medical Supplies | $100k | Disposables, medications | | Equipment Maintenance | $??k | Regular service, repairs | | Educational Materials | $25k | Training resources | | Insurance/Legal | $??k | Malpractice, reinsurance liability | | Software/Tech | $25k | EMR, teaching platforms | | external operation costs | | | #### Initial Costs $1.2M + 4000 hrs -> $30K + 140 hrs/year | Component | Initial Cost ($ + hrs) | Lifespan (Years) | Annual Cost | Justification | | -------------------- | ---------------------- | ---------------- | -------------- | --------------------------- | | Diagnostic Equipment | $300k + 500 hrs | 10 | $30k + 50 hrs | Labs, X-ray, ultrasound | | Clinical Spaces | $400k + 1500 hrs | 15 | $27k + 100 hrs | Exam rooms, procedure areas | | Emergency Setup | $200k + 500 hrs | 10 | $20k + 50 hrs | Stabilization equipment | | Teaching Facilities | $150k + 800 hrs | 10 | $15k + 80 hrs | Classroom, simulation lab | | IT Infrastructure | $150k + 700 hrs | 5 | $30k + 140 hrs | EMR, teaching software | #### System Outputs ##### Primary Care (3600 visits/year) | Task Type | Visits/Year | Time/Visit | Annual Hours | Provider | | ----------------- | ----------- | ---------- | ------------ | ---------------- | | Routine Check-ups | 1800 | 30 min | 900 | Resident | | Chronic Care | 1200 | 45 min | 900 | Resident | | Acute Issues | 400 | 20 min | 133 | Resident | | Health Education | 200 (group) | 30 min | 100 | Resident/Student | | **Total** | **3600** | - | **2033** | - | ##### Urgent Care (800 visits/year) | Task Type | Visits/Year | Time/Visit | Annual Hours | Provider | | ---------------- | ----------- | ---------- | ------------ | ---------------- | | Assessment | 500 | 45 min | 375 | Resident | | Minor Procedures | 200 | 60 min | 200 | Resident | | Follow-up | 100 | 20 min | 33 | Resident/Student | | **Total** | **800** | - | **608** | - | ##### Procedures (400/year) | Task Type | Cases/Year | Time/Case | Annual Hours | Provider | | ------------- | ---------- | --------- | ------------ | --------------------- | | Minor Surgery | 200 | 90 min | 300 | Resident + Supervisor | | Diagnostic | 150 | 60 min | 150 | Resident | | Special | 50 | 120 min | 100 | Resident + Supervisor | | **Total** | **400** | - | **550** | - | ##### Births (12/year) | Task Type | Visits/Year | Time/Visit | Annual Hours | Provider | | ------------------------ | ----------- | ---------- | ------------ | --------------------- | | Prenatal (12 per birth) | 144 | 30 min | 72 | Resident | | Delivery | 12 | 12 hours | 144 | Resident + Supervisor | | Postpartum (3 per birth) | 36 | 45 min | 27 | Resident | | **Total** | **192** | - | **243** | - | #### Revenue $1.2M/year | Source | Annual Amount | Notes | | --------------------- | ------------- | ------------------------ | | Medicare GME | $900k-1.2M | Resident funding | | Training Partnerships | $200k | Medical school rotations | | External Patient Care | $100k | Non-community services | #### Notes ##### Key Implementation Requirements 1. Accreditation Standards - ACGME program requirements - State medical board compliance - Educational quality metrics - Clinical outcome tracking 2. Educational Components - Curriculum development - Competency tracking - Faculty development - Assessment systems 3. Clinical Integration - Hospital partnerships - Specialist networks - Emergency protocols - Transfer agreements 4. Quality Metrics - Clinical outcomes - Educational effectiveness - Community health impact - Cost efficiency 5. Research/Innovation - Educational outcomes - Healthcare delivery models - Community health studies - Cost effectiveness research ##### Bread and Butter Procedures List 1. Surgical - Appendectomy - C-section - Hernia repair - Basic fracture fixation - D&C procedures - Simple biopsies - Basic endoscopy - Skin lesion removal 2. Medical - Joint injections - Minor wound repair - Basic cardiac procedures - Simple respiratory interventions - Basic GI procedures - Women's health procedures - Basic psychiatric interventions ##### Critical Success Factors 1. Strong educational oversight 2. Clear clinical protocols 3. Effective community integration 4. Quality assurance systems 5. Strong external partnerships 6. Continuous improvement processes 7. Resource optimization 8. Outcome documentation