Thus, if the NHI model is the one which is selected, then it needs to be tested against a range of different scenarios. The following demonstrate some truly relevant what-ifs: what if the doctors only move half the projected volume; what if medicare slashes rates; what if competitors open a comparable program (dgapartners.com). There are a range of factors which can change or adjust once a healthcare facility opens their doors for business. And as much as this facility is attempting to engage in a solid humanitarian effort, at the end of the day, it's still a business and people need to get paid. Thus, before engaging in further developmental activities, one needs to determine in what ways the model is sensitive and how it's more open to variation for controlling uncertainty.

Thus, one of the most important aspects of financial modeling for this scenario will be in creating a "worst case scenario" idea and plans/strategies as to how the company will adequately deal with it. Creating a presentation in front of a test audience of colleagues is also a suitable idea; these are people who don't have a personal investment in the project and thus can afford to be more objective and more critical regarding the success of the project.

Legal Issues Involved

One of the most pertinent concerns are going to be the legal issues of the healthcare facility. Many of those legal issues are going to depend on precisely what niche of care the facility is going to fulfill. For instance, if it's a facility described in the Fort Brag article the public response is going to be largely positive, and it's not going to suffer from the legal issues and public controversy that a woman's clinic which offers abortions will have to face. The following are a range of legal issues which are specific to urgent care centers. These are relevant because other healthcare facilities which don't offer urgent care specifically can still sometimes have to deal with these issues or comparable ones. Furthermore, it will probably be likely that this facility will want to offer urgent care in some capacity. If this healthcare clinic is going to be an alternative to the hospitals and health centers which already exist in this city center, then it should provide some sort of affordable and accessible urgent care to patients, in order to provide a decent alternative to the overcrowding and long lines in the ER.

Even so, one such relevant issue is the corporate practice of medicine. "Some states prohibit the corporate practice of medicine. This doctrine, intended to protect the integrity of the medical profession by keeping it separate from the interest of corporations, prohibits employment of physicians by corporations. For example, in New York it is a felony for an unlicensed person to practice medicine, and corporations may not hold licenses to practice medicine. In practical terms, that means that an urgent care center in New York owned by a corporate entity may not employ physicians at the facility" (Burnstein et al., 2012). On the other hand, Florida is a place which has absolutely no prohibition on the coroporate practice of medicine or all comparable entities (Burnstein et al., 2012). Thus given the intensity of this issue, one needs to look into the state law immediately to figure out what the final word on the corporate proactice of medicine is, where this facility will be opening. Furthermore, if there is a ban or narrowing of provisions, one will need to figure out what all the necessary loopholes can be and what all potential alternatives are. Thus, when figuring out the structure of ownership for this facility, finding out once and for all whether the state bans the corporate practice of medicine is something that needs to be determined immediately. In this case, the group of doctors will most likely be treated as entrepreneurs, making the prohibition on corporate practice unimportant. However, there are many legal ways...

The PC receives a management fee to provide these services" (Burnstein, et al., 2012). Thus, this is truly a vital issue to present to all parties involved and to find a solution to once and for all before proceeding further with any organization, planning or development of the proposed facility. This absolutely cannot be underestimated. Before any more planning or development occurs, this particular legal matter -- how the facility will exist in the eyes of the law -- must be addressed.
In a similar fashion, the issue of state licensure needs to be address, mostly because the ways that healthcare facilities are licensed varies from state to state (Burnstein et al., 2012). "Currently, Arizona is the only state that specifically requires the licensure of urgent care centers. Florida licenses healthcare clinics, and urgent care centers may fall under the definition of healthcare clinics in that state" (Burnstein et al., 2012). Thus, as urgent care centers become more and more popular, states are becoming more and more likely to put state licensure requirements (and fess with it): this means that before moving forward, the team should absolutely check with the Department of Health in the town or another comparable agency so that they can determine if the center needs licensing (Burnstein et al., 2012). Another thing that needs consideration is whether or not the center will be engaging in CLIA certification or a CLIA certificate of waiver; this will be contingent on whether or not the center decides to engage in clinical laboratory testing (Burnstein et al., 2012). This will be another conversation that all stakeholders will need to have and to determine: things such as whether or not the facility will offer clinical lab testing or x-rays (which will require an x-ray permit) (Burnstein et al., 2012). Ultimately, once all decisions are made, a long conversation will have to be had with the state Department of Health about the necessary licences and permits needed.

Since it is highly likely that this facility will be providing some sort of emergency care, this means that the center must be aware of the requirements and necessities of EMTALA (the Emergency Medical Treatment and Labor Act). Basically, if this health care facility is going to be indpenedent of any hospital it probably won't be subject to EMTALA processes and procedures. However, if a hospital is involved as a partner in this joint venture, then this means that the neew facility will be obligated to comply with EMTALA obligations. Regardless, the new facility needs to determine where it stands with EMTALA; even if we discover that EMTALA regulations aren't applicable, it will still be worthwhile to determine how patients will pay for urgent care services.

Thus, as it's highly probable that this health care center will provide some sort of urgent care, there needs to be a solid and simple means of reimbursement, if the facility intends to sustain itself. "To be economically viable, most centers will likely want to accept reimbursement by insurance companies. The first step is to determine the payors from which the center will accept payment. Getting on a payor's approved list can be an extended process, so this process should be started as soon as possible" (Burnstein et al., 2012). This forms of contracts and agreements can get quite complex so it's important to start as soon as possible so that forward momentum is achieved. One also needs to keep in mind that different insurance companies reimburse different amounts; furthermore reimbursements can take time, thus creating a cash flow issue for some facilities. Furthermore, certain government payors can take a lot longer to deliver reimbursements; these are entities like Medicare and Medicaid (Burnstein, et al., 2012). These payments are also generally delivered retroactively.

Other Legal Considerations

There are of course, other legal considerations to bear in mind, though these generally have to do with the physical and visual aspects of the actual facility, once it is built. For instance, by law the facility needs to bear the following: "Accessible path-of-travel into and throughout the facility; wide and easy-to-open exterior and interior doors; accessible examination and/or treatment rooms and equipment; accessible office and examination room hardware; appropriate reach ranges; accessible toilet and dressing rooms" (in.gov). Thus, a facility has a legal obligation to create a space which allows all people access; if there are any barriers to access, then they must be removed (in.gov). Certain hotspots can be tricky in allowing access, so in the construction of the facility, special attention needs to be paid to: parking lots, doorways, waiting…