Assignment: Looking Ahead: Application Assignment Net Revenue and Budgeting  

No one can predict the future, but accountants and financial managers must try and do exactly that!  By examining net revenue, costs, and cash flow, you can get a clearer picture of what to expect in your organization’s (or one with which you are familiar) fiscal future. Using these metrics to look forward will enable you to more effectively plan budgets that accomplish organizational goals.  When developing a budget, what variables do you have to take into account? In health care organizations, two of the largest groups of factors that you must consider are first, volume, and second, staffing and supply. The number of patients and tests performed each day, as well as employees and their pay rates are all crucial pieces of information when determining a budget.  In this Assignment, you address five scenarios: net revenue, fixed and variable costs, cash flow, volume budget, and staffing and supplies budget.   Note: For those Assignments in this course that require you to perform calculations you must:  •Use the Excel spreadsheet template for the Week 5 assignment. 

•Show all your calculations and formulas in the spreadsheet. •Answer any questions included with the problems (as text in the Excel spreadsheet).   A title and reference page are NOT needed in this assignment.  Put your name and assignment at the top of the Excel spreadsheet.  For those not comfortable with the use of Microsoft Excel, this week’s Optional Resources suggest several tutorials.  To prepare: •Review the information in this week’s Learning Resources regarding net revenue, fixed and variable costs, and cash flow, and how they are used in financial decision making.  •Review the budgeting information in Week 5 Learning Resources dealing with volume, staffing, and supplies budget.

Note: All the scenarios will be submitted as one document.  Each scenario will be on a different tab in the spreadsheet.  Scenario 1: Net Revenue Scenario  Your clinic provides four kinds of services: •Comprehensive initial medical consultation is priced at $250 •Established patient limited visit is priced at $75 •Established patient intermediate visit is priced at $125 •Established patient comprehensive visit is priced at $250  Question: The profile of your patients is such that the average collection rate is 75%. Assuming you have 100 visits of each type each month, what amount of new revenue will you generate in the next 12 months?  Scenario 2: Fixed/Variable Cost Scenario  You have performed a cost analysis of your health care organization and have determined the following: based on the latest three years of information, your annual cost of operations is $1,600,000 with annual volume of 10,000 procedures. You have determined that certain of your supply items are fixed in nature (those marked with an F) while others are variable (marked with a V).  Question: An insurance company that is considering directing its 1,000 units per year of procedure business to your organization has approached you. For the last three years, you have been charging a price of $165 per procedure (with a 100% collection rate). Your board has mandated that you make $5 of profit from each of the procedures. You obviously want the highest possible price, but as you enter the negotiations, what is the lowest possible price you would be willing to accept from this payer?  Hint: Calculate the variable cost.  Scenario 3: Cash Flow Scenario  Your new business venture will begin operation on July 1, 20X2. You will hire staff effective January 1, 20X2 with a cost of $40,000 per month. You know from experience that collections lag billing by 3 months (in other words, once you bill for a service, you must wait 90 days for the payment to be received.) Your business volume is projected to be as follows:   Question: If you have $380,000 of cash on hand on January 1, 20X2, how much cash will you have at the end of June 20X3?  Assume a 100% collection rate.  Scenario 4: Volume Budget Scenario  You manage lab services in a large hospital. You have the following data on both the hospital’s budgeted patient days and visits for budget year 20XX along with the ratio of lab tests to patient days or visits.  Question: Based on this raw data provided , how many lab tests would you anticipate for the coming budget year? If each test is priced at $20.00, how much gross revenue would you budget? Assuming each full-time lab technician (FTE) can perform 200,000 tests each year, how many full-time lab technicians would you plan for?  Example on Template: 2 North Bldg calculated.  You will need to complete 2 South Bldg, ICU and OPD  Scenario 5: Staffing and Supply Budget Scenario  Calculate the supplies budget necessary to operate your unit for the fiscal year beginning January 1, 20X8. It is your expectation that you will perform 24,820 procedures in the budget year. The following spending data is available for the period January 1 to March 31, 20X7 during which time procedure volume amounted to 3,240. Items marked (F) are considered fixed, those marked (V) are considered variable. Inflation is planned at 4%.  In reviewing performance to date, you note that in January, you purchased $150,000 of D5W fluid replacement charged to IV solutions, which represents an entire year’s supply. In addition, you returned $2,800 of office supplies for credit from the vendor in Febuary. These supplies were purchased in a previous fiscal year.  You also need to prepare the salary budget for the same fiscal year. You have determined that staff needs are for 6.5 FTEs.  A pay raise will be given to all staff on October 1st of each year at a rate of 8 percent. In making your calculations, always round to the nearest whole dollar for annual salary amounts, but keep pennies in the hourly pay rates. New staff begins the new fiscal year at $16.00 per hour.

 Be sure and include all of your calculations

Required Readings  Baker, J. J., Baker, R. W., & Dworkin, N. R.  (2018). Health care finance: Basic  tools for nonfinancial managers (5th ed.). Burlington, MA: Jones and  Bartlett Learning.  •Chapter 7, “Cost Classifications” (pp. 55-61)    In this chapter, you focus on the difference between direct and indirect costs and why it is crucial for financial managers to understand the difference.     •Chapter 8, “Cost Behavior and Break-Even Analysis” (pp. 65-78)    This chapter continues the discussion on costs. It describes the differences between fixed, variable, and semivariable costs. It demonstrates how to compute the cost-volume-profit (CVP) ratio and the profit-volume (PV) ratio.  Zelman, W., McCue, M., & Glick, N. (2009). Financial management of health care organizations: An introduction to fundamental tools, concepts, and applications (3rd ed.). Hoboken, NJ: Jossey-Bass.  Retrieved from the Walden Library databases.  •Chapter 3, “Principles and Practices of Health Care Accounting” (pp. 87–120)    Review: This chapter explores the accounting practices and principles of health care. The authors detail the rules for recording transactions and the process of recording and developing financial statements.     •Chapter 4, “Financial Statement Analysis” (pp. 121–186)

Question

Question 1 1 / 1 point

Up to 21% of Asians are ultra-rapid 2D6 metabolizers, leading to:

Question options:

A need to monitor drugs metabolized by 2D6 for toxicity

Increased dosages needed of drugs metabolized by 2D6, such as the selective serotonin reuptake inhibitors

Decreased conversion of codeine to morphine by CYP 2D6

The need for lowered dosages of drugs, such as beta blockers

Question 2 1 / 1 point

Rifampin is a nonspecific CYP450 inducer that may:

Question options:

Lead to toxic levels of rifampin and must be monitored closely

Cause toxic levels of drugs, such as oral contraceptives, when coadministered

Induce the metabolism of drugs, such as oral contraceptives, leading to therapeutic failure

Cause nonspecific changes in drug metabolism

Question 3 1 / 1 point

Inhibition of P-glycoprotein by a drug such as quinidine may lead to:

Question options:

Decreased therapeutic levels of quinidine

Increased therapeutic levels of quinidine

Decreased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

Increased levels of a coadministered drug, such as digoxin, that requires P-glycoprotein for absorption and elimination

Question 4 1 / 1 point

Warfarin resistance may be seen in patients with VCORC1 mutation, leading to:

Question options:

Toxic levels of warfarin building up

Decreased response to warfarin

Increased risk for significant drug interactions with warfarin

Less risk of drug interactions with warfarin

Question 5 1 / 1 point

Pharmacogenetic testing is required by the U.S. Food and Drug Administration prior to prescribing:

Question options:

Erythromycin

Digoxin

Cetuximab

Rifampin

Question 6 1 / 1 point

Carbamazepine has a Black Box Warning recommending testing for the HLA-B*1502 allele in patients with Asian ancestry prior to starting therapy due to:

Question options:

Decreased effectiveness of carbamazepine in treating seizures in Asian patients with the HLA-B*1502 allele

Increased risk for drug interactions in Asian patients with the HLA-B*1502 allele

Increased risk for Stevens-Johnson syndrome in Asian patients with HLA-B*1502 Allele

Patients who have the HLA-B*1502 allele being more likely to have a resistance to carbamazepine

Question 7 1 / 1 point

A genetic variation in how the metabolite of the cancer drug irinotecan SN-38 is inactivated by the body may lead to:

Question options:

Decreased effectiveness of irinotecan in the treatment of cancer

Increased adverse drug reactions, such as neutropenia

Delayed metabolism of the prodrug irinotecan into the active metabolite SN-38

Increased concerns for irinotecan being carcinogenic

Question 8 1 / 1 point

A good history of herb and supplement use is critical before prescribing because approximately ____ % of patients in the United States are using herbal products.

Question options:

10

5

38

70

Question 9 1 / 1 point

A potential harmful effect on patients who take some herbal medication is:

Question options:

Constipation

Lead poisoning

Diarrhea

Life-threatening rash

Question 10 1 / 1 point

A thorough understanding of herbs is critical to patient safety. An example is the use of cinnamon to treat type II diabetes. It is important the patient uses Ceylon cinnamon, as the commercially available cassia cinnamon contains:

Question options:

Coumadin, which may lead to bleeding problems

Coumarin, which can cause liver and kidney damage

Cinnamic aldehyde, which is toxic to the kidney

Cinnamate eugenol, which is toxic to the liver

Question 11 1 / 1 point

Traditional Chinese medicine utilizes yin (cooling) versus yang (warming) in assessing and treating disease. Menopause is considered a time of imbalance, therefore the Chinese herbalist would prescribe:

Question options:

Herbs which are yang in nature

Herbs that are yin in nature

Ginger

Golden seal

Question 12 1 / 1 point

According to traditional Chinese medicine, if a person who has a fever is given a herb that is yang in nature, such as golden seal, the patient’s illness will:

Question options:

Get worse

Get better

Not be adequately treated

Need additional herbs to treat the yang

Question 13 1 / 1 point

In Ayurvedic medicine, treatment is based on the patient’s dominant dosha, which is referred to as the person’s:

Question options:

Vata

Pitta

Kapha

Prakriti

Question 14 1 / 1 point

When melatonin is used to induce sleep, the recommendation is that the patient:

Question options:

Take 10 mg 30 minutes before bed nightly

Take 1 to 5 mg 30 minutes before bed nightly

Not take melatonin more than three nights a week

Combine melatonin with zolpidem (Ambien) for the greatest impact on sleep

Question 15 1 / 1 point

In the United States, over-the-counter drugs are regulated by:

Question options:

No one. There is no oversight for over-the-counter medications.

The U.S. Food and Drug Administration Center for Drug Evaluation and Research

The U.S. Drug Enforcement Administration

MedWatch

Question 16 1 / 1 point

As drugs near the end of their patent, pharmaceutical companies may apply for the drug to change to over-the-counter status in order to:

Question options:

Get a new patent for the over-the-counter form of the drug

Lower the costs because most prescription benefit plans do not cover generics

Market the drug to a whole new population, as they are able to market to patients instead of just providers

Continue to make large profits from their blockbuster brand-name drug

Question 17 1 / 1 point

The ailment that generates the greatest over-the-counter annual drug sales is:

Question options:

Constipation

Cough and colds

Heartburn

Acute and chronic pain

Question 18 1 / 1 point

Common over-the-counter pain relievers such as acetaminophen or ibuprofen:

Question options:

Are always safer for the patient than prescription pain medication

Are harmful if taken in higher than recommended amounts

Have minimal interaction with prescription medications

Should never be given to children unless recommended by their provider

Question 19 1 / 1 point

When obtaining a drug history from Harold, he gives you a complete list of his prescription medications. He denies taking any other drugs, but you find that he occasionally takes aspirin for his arthritis flare ups. This is an example of:

Question options:

His appropriately only telling you about his regularly prescribed medications

His hiding information regarding his inappropriate use of aspirin from you

A common misconception that intermittently taken over-the counter medications are not an important part of his drug history

A common misuse of over-the-counter aspirin

Question 20 1 / 1 point

Michael asks you about why some drugs are over-the-counter and some are prescription. You explain that in order for a drug to be approved for over-the-counter use the drug must:

Question options:

Be safe and labeled for appropriate use

Have a low potential for abuse or misuse

Be taken for a condition the patient can reliably self-diagnose

All of the above

In this assignment you will summarize and analyze the essential elements of the Christian worldview and reflect on implications for your own worldview.

 

Write a 1,250-1,500-word essay using at least two course resources (textbook, lectures, the Bible) and at least two other sources from the GCU Library to support your points. Remember, the Bible counts as one reference regardless of how many times you use it or how many verses you cite.

 

Begin your paper with an appropriate introduction, including a thesis statement to introduce the purpose of the paper.

 

Organize your paper with the following sections using the seven underlined titles for subheadings.

 

The Christian Worldview: Describe the beliefs of the Christian worldview with regard to the following components corresponding to Topics 2-5. Write at least one paragraph for each component using the underlined title for a subheading.

 

1. God: What is God like? What are God’s characteristics? What is His creation?
2. Humanity: What is human nature? What is human purpose? What is the root cause of human problems?
3. Jesus: What is Jesus’ true identity? What did Jesus do? Why is Jesus’ identity and work significant for the Christian worldview?
4. Restoration: What is the solution to human problems according to the Christian worldview? What role do grace and faith play in Christian salvation? How do Christians think that the transformation of self and society happens?

Analysis: Analyze the Christian worldview by addressing each of the following questions:

 

1. What are the benefits or strengths of Christian belief?
2. What is troublesome or confusing about Christianity?
3. How does Christianity influence a person’s thinking and behavior?

Reflection: Reflect on your worldview by answering one of the following questions:

 

1. If you are not a Christian, what similarities and differences are there between your worldview and the Christian worldview?
2. If you are a Christian, how specifically do you live out the beliefs of the Christian worldview?

Conclusion: Synthesize the main points, pulling the ideas of the paper together.

References

 

Prepare this assignment according to the guidelines found in the GCU Style Guide, located in the Student Success Center.

 

This assignment uses a rubric. Please review the rubric prior to beginning the assignment to become familiar with the expectations for successful completion.

 

You are required to submit this assignment to Turnitin. Please refer to the directions in the Student Success Center.

 

 

 

Diagnosis and Management of Respiratory, Cardiovascular, and Genetic Disorders:

 

Respiratory  disorders such as pneumonia and asthma are among the leading causes of hospitalization in pediatric patients (U.S. Department of Health and Human Services, 2011). With such severe implications associated with many respiratory disorders, advanced practice nurses (FAMILY NURSE PRACTITIONER) must be able to quickly identify symptoms, diagnose patients, and recommend appropriate treatment. For this Discussion, consider potential diagnoses and treatments for the patients in the following three case studies.

 

 

 

Case Study 1:

 

 A 14-month-old female presents with a 4-day history of nasal congestion and congested cough. This morning, the mother noted that her daughter was breathing quickly and “it sounds like she has rice cereal popping in her throat.” Oral intake is decreased. Physical examination reveals the following: respiratory rate is 58, lung sounds are diminished in the bases, she has pronounced intercostal and subcostal retractions, expiratory wheezes are heard in all lung fields, and her tympanic membranes are normal. There is moderate, thick, clear rhinorrhea and postnasal drip. Her capillary refill is less than 3 seconds, and she is alert and smiling. Her RSV rapid antigen test is positive

 

 

 

POST I TO 2 PAGES DISCUSSION PAPER ON:  An explanation of the differential diagnosis for the patient in the case study you selected.

 

Explain which is the most likely diagnosis for the patient and why.

 

Include an explanation of unique characteristics of the disorder you identified as the primary diagnosis.

 

Then, explain a treatment and management plan for the patient, including appropriate dosages for any recommended treatments.

 

Finally, explain strategies for educating patients and families on the treatment and management of the respiratory, cardiovascular, and/or genetic disorder.

 

 

 

Reference

 

Readings

 

•Burns, C. E., Dunn, A. M., Brady, M. A., Starr, N. B., & Blosser, C. G. (2013). Pediatric primary care (5th ed.). Philadelphia, PA: Elsevier.

 

◦Chapter 31, “Respiratory Disorders” (pp. 708–738)

 

•Chapter 40, “Genetic Disorders” (pp. 1032–1054)

 

National Heart, Lung, and Blood Institute. (2007). Expert panel report 3 (EPR3): Guidelines for the diagnosis and management of asthma. Retrieved from http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm

 

.

 

•Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis by  Ralston, S.L., Lieberthal ,A.S., Meissner, H.C., Alverson, B.K., Baley, J.E., Gadomski ,A.M., Johnson, D.W., Light, M.J., Maraqa, N.F., Mendonca ,E.A., Phelan, K.J., Zorc ,J.J., Stanko-Lopp, D., Brown, M.A., Nathanson ,I., Rosenblum, E., Sayles, S. 3rd, & Hernandez-Cancio, S. in Pediatrics, 134(5), 1474-1502.

 

Dexamethasone for Acute Asthma Exacerbations in Children: A Meta-analysis by Keeney, G.E., Gray, M.P., Morrison, A.K., Levas, M.N., Kessler, E.A., Hill, G.D., Gorelick, M.H., & Jackson J.L. in Pediatrics, 133(3): 493–499.

 

 

Purpose

The purpose of this assignment is to familiarize the student with the most recent guidelines and recommendations for vaccine-preventable illnesses in the United States.

Activity Learning Outcomes

Through this assignment, the student will demonstrate the ability to:

1. Identify vaccines available in the US market for vaccine-preventable disease and describe their features.
2. Identify contraindications and precautions for the use of vaccines available.
3. Use recommendations from the Advisory Committee on Immunization Practice (ACIP) to identify target groups for receipt of each vaccine.

Requirements

1. The Immunization assignment is worth 100 points and will … on the quality of the content, use of citations, use of Standard English grammar, sentence structure, and overall organization based on the required components as summarized in the directions and grading criteria/rubric.
2. Submit the paper as a Microsoft Word Document, which is the required format at Chamberlain University. You are encouraged to use the APA Academic Writer when creating your assignment.
3. Follow the directions below and the grading criteria located in the rubric closely. Any questions about this paper may be posted under the Q & A Forum or emailed to your faculty.
4. The length of the paper should be 2-3 pages, excluding title page and reference page(s). The title and reference pages should be in APA format.
5. Vaccination schedules should … directly from the Centers for Disease Control and Prevention: Resources for Healthcare Providers website and reflect the most current recommendations from the Advisory Committee on Immunization Practices (ACIP). Additional scholarly resources may be used and all sources must be cited appropriately.

Following the directions above, answer each of the following case scenario questions:

Case # 1

You are rotating in the newborn nursery. Your next admission is a term newborn born at 3.5 kg, and all maternal labs are negative. The infant’s exam is normal.

1. What vaccine(s) should she receive and why?
2. … would you do if the mother tested positive for Hepatitis B?
3. What would you do if the mother’s Hepatitis B status was unknown?

Case # 2

Your first patient in primary care clinic is a healthy 2-month-old. She received Hep B #1 in the nursery. She is a term infant and parents have no concerns. Her exam is normal and there are no contraindications to giving her vaccines.

1. Which vaccines should the child receive at this visit?
2. When should she return and which ones would you administer at the next visit?
3. Which vaccination combinations can … to minimize the number of needle injections, if available?

Case # 3

A healthy 5-year-old comes in with her mother for a well-child check in November. Her routine vaccines are up to date through 2 years old, but she has never received a vaccine for influenza. Her exam is normal.

1. Which vaccines do you recommend at this visit?
2. What anticipatory guidance should … given for a child receiving a flu vaccine at this age?
3. Are there any contraindications for the vaccines that you recommended today?

Case # 4

An 11-year-old girl presents for a routine well-child check. Her immunizations are up to date. Her exam is normal and there are no contraindications to giving her vaccines.

1. Which vaccine(s) do you recommend at this visit?
2. The mother is states that she only wants her daughter to have “the one … for school this year but not the others”. How should the Nurse Practitioner counsel the mother and the patient?
3. The mother is agreeable to proceed with vaccine administration today. Are additional doses needed? If yes, state which ones and when.