Worksheet 1.

Estimating Number of Current (Prevalent) Hemodialysis Patients for Study

Area: Example County.
Category
2014 County
Coefficient based on Estimated 2014
Population
2010 data per
Number of
100000 population
coefficients in
country (prevalence
data)
By race
Malay
Chinese
Indian
Other
Total
By age
0-19
20-44
45-64
65-74
75+
Total
By population
Total

Worksheet 2. Estimating Number of New (Incident) Hemodialysis Patients for Study Area:
Example County.
Category
2014 County
Coefficient based on Estimated 2014
Population
2010 data per
Number of patients
100000 population
in country (incidence
data)
By race
Malay
Chinese
Indian
Other
Total
By age
0-19
20-44
45-64
65-74
75+
Total
By population
Total

Worksheet 3. Estimating Number of Stations and Annual Treatments.

3-day week
Number of Stations
A. Number of prevalent patients estimated from coefficients
B. Expected number of new patients estimated from coefficients
C. Number of daily treatments per M.W.F. rotation per station
D. Number of daily treatments per T. Th. Sat. rotation per station
E. Total number of possible treatments per day per station (C + D)
F. Number of stations required ((A + B)/E)
G. Actual number of stations (round up to whole number)
Number of Annual Treatments
H. Number of annual treatments from prevalent patients
(A x 3 x 52)
I. Number of annual treatments from new patients (B x 3 x 52)
J. Total number of annual treatments (H + I)
K. Number of annual treatments expected (90%)
L. Maximum number of patients (G x E)
M. Maximum number of annual treatments (K x 3 x 52)

6-day week

Worksheet 4. Estimating Capital Costs for Example County Case Study Adjusted for 8Station Facility
Cost/unit
# of units
Total cost
Clinical equipment
dialysis machines
patient lift
wheelchair/standup scales
lab refrigerator
lab freezer
meds refrigerator (tx)
EPO refrigerator
Ice machine
Ambu bag
Oxygen equipment
Infusion pump
IV pole
Glucometer
Thermometer
Stethoscope
Ultrasonic mini Doppler
Mobile BP modules
Infectious waste hampers
Emergency evacuation kit
Miscellaneous clinical
Bed pan
Trash can
SUBTOTAL Clinical Equipment
Clinical Furniture
Dialysis chair
Task stool
Privacy screen
Chart rack
Wheelchair
Computer system
SUBTOTAL Clinical furniture

Worksheet 4 Continued (p. 2). Estimating Capital Costs for Example County Case
Adjusted for 8-Station Facility
Cost/unit
# of units
Total cost
Staff lounge
Refrigerator
Microwave
Coffee machine
Toaster oven
Lockers (3/unit)
Table
chair
SUBTOTAL staff lounge
Storage fixtures
Supply cart
Shelving
Hand dolly
Flatbed truck (hand)
Utility cart
Floor pallets
SUBTOTAL storage fixtures
Business office
Copier machine
Facsimile
Time clock
Answering machine
Desk
Chairs
Filing cabinets with locks
Computer system/printer/scanner
SUBTOTAL business office
Reception/ Waiting area
Chairs
Side tables
Television
Lamps
Artwork/plants
Clock
Coffee machine/maker

SUBTOTAL reception/waiting area

Worksheet 4 Continued (p. 3). Estimating Capital Costs for Example County Case
Adjusted for 8-Station Facility
Cost/unit
# of units
Total cost
Signage
interior
exterior
SUBTOTAL signage
TOTAL Capital costs

Worksheet 5. Estimating Annual Personnel Costs for Example County Case Study
Type
Rate/Hr
Hours/week
Total costs
Salaried Personnel
Registered Nurse (RN)
Patient Care Tech (PCT)
Chief Technician
Housekeeper
Financial manager
TOTAL Salaried Personnel
Benefits @ 35%
SUBTOTAL Salaried Personnel
Staff Development
Staff training/continuing education
SUBTOTAL staff development
Contract personnel (no benefits)
Medical Director/Nephrologist
Renal social worker
Hemodialysis dietitian
Renal councilor
Renal pharmacist
SUBTOTAL contract personnel
TOTAL personnel costs
*
Benefits includes medical insurance, workers compensation, EPF and SOCSCO.

Worksheet 6. Estimating Annual Operating Costs for Example County Case Study
Adjusted for 8 Stations and Based on 3,089 Annual Dialysis Treatments.
Cost/treatment Cost
Personnel
Maintenance
housekeeping/cleaning supplies
lawn/yard maintenance (local rate)
physical plant maintenance
equipment maintenance
SUBTOTAL Maintenance
Supplies
paper/office supplies
advertisement/ literature
SUBTOTAL Supplies
Medical supplies
dialysis supplies
medications EPO, Vitamin D
biomedical hazardous material disposal
SUBTOTAL Medical Supplies
Utilities
water
sewer
electricity
natural gas/heating
SUBTOTAL Utilities
Building (2,800 square feet)
lease
SUBTOTAL Building

Worksheet 6 Continued (p. 2). Estimating Annual Operating Costs for Example County
Case Study Adjusted for 8 Stations and Based on 3,089 Annual Dialysis Treatments.
Cost/treatment Cost
Communications
telephone
security system
cable/satellite
Pagers for MD and staff
SUBTOTAL Communications
Insurance
fire and theft
SUBTOTAL Insurance
TOTAL Annual Operating Costs
*
Will need cash flow available for first six month until begin receive reimbursement from JPA
claims.

Worksheet 7. Estimating Revenue

A. Expected number of prevalent patients (Worksheet 3 A)
B. Number of JPA reimbursed patients
C. Number private pay patients
D. Number of new patient (Worksheet 3 B)
E. Number Medicare reimbursed patients
F. Number of private pay patients
Number of annual treatments by reimbursement
G. Number of annual Medicare treatments
[(B + E) x 3 treatments/week x 52 weeks x 90% participation]
H. Number of annual private pay treatments
[(C + F) x 3 treatments/week x 52 weeks x 90% participation]
Revenue Projections
I. JPA Revenues (G x RM____________________________)
J. Private pay (H x RM______________________________ )
K. TOTAL Gross Revenues (I + J)
Revenue adjustment for new Medicare Patients (First 3 months or 39 treatments)
L. (E x 39 x $233 x 90%)
M. TOTAL Annual Net Revenues (K L)

Worksheet 8. Summary of Annual Costs and Revenue for Example County Case Study:
Revenue Less Costs.
Total capital
Per
Total annual
costs
treatment
costs
Capital Costs (Worksheet 4)
Construction (10 years @ 7%)
Dialysis machines (7 years @ 7%)
Remainder of equipment (10 years @
7%)
TOTAL Capital Costs
TOTAL Annual Capital Costs
TOTAL Annual Operating Costs (Worksheet 6)
TOTAL Annual Capital and Operating Costs
TOTAL Net Revenue (Worksheet 7)
REVENUE LESS COSTS

Worksheet 4. Estimating Capital Costs for Example County Case

Study Adjusted for 8Station Facility
Cost/unit
# of
Total cost
units
Clinical equipment
dialysis machines
patient lift
wheelchair/standup scales
lab refrigerator
lab freezer
meds refrigerator (tx)
EPO refrigerator
Ice machine
Ambu bag
Oxygen equipment
Infusion pump
IV pole
Glucometer
Thermometer
Stethoscope
Ultrasonic mini Doppler
Mobile BP modules
Infectious waste hampers
Emergency evacuation kit
Miscellaneous clinical
Bed pan
Trash can
SUBTOTAL Clinical Equipment
Clinical Furniture
Dialysis chair
Task stool
Privacy screen
Chart rack
Wheelchair
Computer system
SUBTOTAL Clinical furniture

Worksheet 4 Continued (p. 2). Estimating Capital Costs for

Example County Case
Adjusted for 8-Station Facility
Cost/unit
# of
Total
units
cost
Staff lounge
Refrigerator
Microwave
Coffee machine
Toaster oven
Lockers (3/unit)
Table
chair
SUBTOTAL staff lounge
Storage fixtures
Supply cart
Shelving
Hand dolly
Flatbed truck (hand)
Utility cart
Floor pallets
SUBTOTAL storage fixtures
Business office
Copier machine
Facsimile
Time clock
Answering machine
Desk
Chairs
Filing cabinets with locks
Computer system/printer/scanner
SUBTOTAL business office

Worksheet 4 Continued (p. 3). Estimating Capital Costs for

Example County Case
Adjusted for 8-Station Facility
Reception/ Waiting area
Chairs
Side tables
Television
Lamps
Artwork/plants
Clock
Coffee machine/maker
SUBTOTAL reception/waiting
area
Worksheet 4 Continued (p. 3). Estimating Capital Costs for
Example County Case Adjusted for 8-Station Facility
Cost/unit
# of
Total cost
units
Signage
interior
exterior
SUBTOTAL signage
TOTAL Capital costs