Student Fee Advisory Board
2
Mandatory Student Fees
3
“Your Campus Clinic and Pharmacy”
Our mission - to provide access to quality and effective healthcare
4
About us
• Student Health Service (SHS)
includes primary healthcare,
urgent care, and walk-in clinic
services (depending on
symptoms and availability)
• Integrated services include:
–
–
–
–
–
–
Physician
Nurse Practitioners
Nurses (RNs & LPNs)
Medical Technologists
Pharmacists
Radiologic Technologists
5
Overview
• NDSU enrolled students are eligible for services
– Utilization has increased approximately 20% since 2010
• Funded by student health fee:
– No extra charge for unlimited office visits
– Reasonable charges for the following:
•
•
•
•
•
Laboratory Services
X-rays
Treatments & Procedures
Immunizations & Injections
Prescriptions & Medications
– One-time summer user fee of $40
• For those enrolled in Spring and Fall but NOT enrolled in summer classes
• No charge for students enrolled for summer session
6
Services Offered
Primary Health Care:
• Allergy injections &
maintenance
• Asthma, hypertension, elevated
cholesterol, & other common
chronic health conditions
• Contraception & birth control
• Depression, anxiety & ADHD
• Immunizations
• Orthopedic injuries & other
sports related problems
• Physical examinations
• Respiratory, urinary tract &
other common infections
• Gynecological problems
• Sexually transmitted infection
screening & treatment
• Gastrointestinal problems
• Simple laceration repair
7
Services Offered
Medical Laboratory:
• CLIA Certified (Clinical
Laboratory Improvement
Amendments)
– Federal survey process with zero
deficiencies since 1995
• Staffed by licensed laboratory
professionals
8
Services Offered
Pharmacy:
• Students do NOT need to be SHS
patient to use pharmacy
• Prescription transfers
• Diabetic supplies
• Non-prescription medications &
supplies
• Reasonable charges for
prescriptions with ability to process
claims with most insurance carriers
• Staffed by licensed pharmacists and
pharmacy interns
9
Services Offered
Radiology:
•
Computed radiography technology
•
Images professionally read by a
licensed radiologist
•
Staffed by licensed radiologic
technologists
•
MRIs, CT scans, mammograms or
sonograms are referred to an
outside provider in the community
http://www.youtube.com/watch?v=Rqt
h7Q5kP1E&feature=youtu.be
10
Student Health Portal
•
•
•
•
Schedule an appointment
View and upload immunization records
Complete pre-visit health forms
Receive and send secure patientprovider messages
• Print statements
• Input insurance information
– For assisting with outside referrals
• Accessible through Student Health
Service website
Click picture to go to link
11
Payment for Services
• Health insurance NOT required to utilize services at SHS
• Charges posted to students’ accounts by Customer Account
Services and can be paid through Bison Connection
• SHS provides itemized statements for students choosing to
file an insurance claim. Statements available through:
•
•
Student Health Portal
Printout at Student Health Service
• Students responsible for filing clinic charges with insurance
carriers
12
Accreditation & Membership
• Accredited by Accreditation
Association for Ambulatory Heath
Care, Inc.
• Member of the American
College Health Association
13
Student Focused Care
• Operate with a student focus philosophy rather than a production
model, which allows time for individualized, patient centered care
• Full service clinic that offers primary care, urgent care, and walk-in
all under one roof conveniently located on campus
• High functioning clinicians with vast experience in the young adult
population
• Providers personally contact students of concern the next day to
follow up on symptoms which helps build a trusting relationship
• Nurses return phone calls to patients within 1-2 hours that same day
• Very reasonable charges for services
14
Survey Results
User Survey
Fall 2011
User Survey
Fall 2012
User Survey
Fall 2013
User Survey
Fall 2014
Friendliness of reception staff
83%
83%
86%
Friendliness of providers, nurses, lab and x-ray
95%
90%
94%
Quality of explanations and advice
98%
98%
NA
Explanation of costs for services
88%
85%
89%
Information gathered on:
Importance of Issues
Satisfaction with Services
Professional, caring staff
95%
95%
Amount of time with provider
89%
93%
NA
Explanation of costs for services
88%
68%
73%
Availability of appointments
78%
Likely to return in future
96%
87%
94%
Likely to refer a friend
97%
89%
96%
Overall satisfaction
91%
Friendliness of reception staff
96%
80%
92%
Friendliness of providers, nurses, lab and x-ray
95%
92%
98%
Quality of explanations and advice
98%
87%
94%
Amount of time needed to complete appointment
87%
88%
81%
67%
62%
69%
Providers
Increased my ability to advocate for myself
63%
15
Student Testimonials
“Provider seemed genuinely concerned about my welfare.
Her concern and care really showed. I got the sense she is
very competent and enjoys her job. What a great service. I
feel better already! Everyone I interacted with in the clinic
and pharmacy was very nice. That is one of the things I
absolutely love about being at NDSU. Thank you for having
wonderful people on your staff and for helping make NDSU
truly great!”
16
Student Testimonials
“I have been in several times this year for different things
and have had excellent service every time. Everyone cares
and does whatever they can to make you feel comfortable.”
(also commented on how amazing her provider was)
17
Student Testimonials
“I just want to thank Student Health Service and Jean
Seltvedt for the help I received this semester because it
helped me from leaving school this semester and passing
my classes.”
18
SHS Revenue
• SHS does not receive appropriated funding or
funding from any sources other than:
– Student Fee (mandatory health fee):
• Over 50% of SHS revenue generated from the health fee
• Fee not adjusted annually with inflation
• Fee increase in 2010 projected to sustain operations for 5 years, but has sustained
operations for 6 years.
– Charges/fees for Services:
•
•
•
•
•
Immunizations / injections
Treatments / procedures
Laboratory exams
Radiology exams
Prescriptions / medications
19
SHS Expenses
•
•
•
•
•
•
•
•
•
•
Staff salaries and benefits
Technology (computers, EHR updates, etc.)
Medical supplies and pharmaceuticals/medications
Immunization compliance (staff time) (NDUS & SBHE P&P)
Custodial services and supplies
Equipment and supplies
Accreditation costs
Repair & replacement
Capital improvements
Wellness Education Coordinator and programs
– (i.e., Healthy Herd Champions take health and well-being topics out to the
campus community)
• Administrative overhead (beyond SHS)
20
Cost Reduction &
Containment Efforts
• External review of Business Office operations, resulted
in reorganization & reduction of .75 FTE
• Collaborate with Purchasing to procure all supplies and
equipment at best possible pricing
• Continue to work with Medicat (electronic health record)
to ensure software is utilized at highest functionality and
documentation is aligned with best practices
21
Cost Reduction &
Containment Efforts
• Streamlined immunization process & moved to paperless
• Extended hours one day per week to meet students’
needs using a budget neutral approach
– Tuesdays until 7 pm
• Cross-trained staff: nurses do phlebotomy; rad tech does
phlebotomy, assists with nursing & administrative tasks;
LPN to do X-rays
• Reduce staff during summer session to align with
decrease in enrollment and student demand
• Utilize per-diem (non-benefitted) providers & staff
22
Regional Student Fee Comparison
$30
$25
21.25
$20
18.25
$15
10.64
9.41
$10
6.66
$5
4.75
5.42
5.42
St. Cloud
State
University
of
Northern
Iowa
$NDSU
UND
Western
Illinois
University
Illinois
State
University
Southern
Illinois
University
Missouri
State
University
$ Per Credit
23
Peer Institutions Student Fee Comparison
$30
26.92
$25
20.67
$20
18.92
14.58
$15
13.33
11.83
$10
7.25
7.75
8.17
8.25
8.92
5.83
$5
4.75
$NDSU
University University University
Iowa
University University University Clemson University University University University
of
of
of
State
of
of
of
University
of
of
of
of
Alaska
Arkansas
Nevada University Tennessee Wyoming Nebraska
Kentucky Delaware
Rhode
Vermont
Fairbanks
- Reno
- Lincoln
Island
$ Per Credit
https://www.ndsu.edu/oira/ndsu_peer_institutions/
24
2010 – 2016
Projected Budget
19301 - Student Health Fee
2010-2011
Beginning Balance
$142,720.79
Fee Revenue
$1,482,318.52
Other Services
$624,191.24
Expenses
($1,510,889.35)
Transfer Out
for Pharmacist
($123,791.15)
Admin Overhead
($25,000.00)
Dean’s office support
($75,000.00)
WC Payback $497,228 begins 2011 *see below
WC from SHS for custodial service
SHS R&R
Facilities Improvement 19306
Expansion costs 2010
Ending Balance
$514,550.05
19309 -Sales & Service
Beginning Balance
Other Services
Expenses
Transfer Out
Transfer-AdminOvrhd
Transfer -Dean’s office
WC Payback last payment 2015-16*
Facilities Improvement 19306
Pharmacy
Ending Balance
Ending Balance Total funds
2010-2011
$114/per academic year
2011-2012
2012-2013
2013-2014
$514,550.05
$591,379.23
$375,917.37
$1,479,480.50
$1,486,993.47
$1,483,639.12
$671,491.73
$0.00
($1,523,577.50)
($1,308,031.03) ($1,261,256.14)
2015-2016
$325,494.06
$1,425,000.00
($1,386,357.86)
($1,638,001.00)
($124,565.55)
($20,000.00)
($76,000.00)
($180,000.00)
($144,434.30)
($25,000.00)
($166,918.68)
($75,000.00)
($72,058.75)
($75,000.00)
($150,000.00)
($150,000.00)
($40,000.00)
($34,100.00)
($93,620.00)
($20,725.00)
($208,760.00)
$591,379.23
$375,907.37
$285,222.92
$231,874.06
($300,339.94)
2012-2013
$0.00
$755,092.51
($382,643.52)
2013-2014
$262,448.99
$755,906.55
($389,523.43)
($1,310.90)
($100,000.00)
($90,000.00)
2014-2015
$437,521.21
$761,049.46
($359,651.81)
2011-2012
($20,000.00)
($90,000.00)
$514,550.05
2014-2015
$285,212.92
$1,501,639.00
$591,379.23
$262,448.99
$437,521.21
$638,356.36
$722,744.13
($183,348.00)
($100,000.00)
($100,000.00)
($80,000.00)
($176,276.44)
$382,642.42
$614,516.48
Projected Budget
2015-2016
$382,642.42
$697,665.00
($364,160.00)
($100,000.00)
($65,000.00)
($92,227.00)
($60,000.00)
$398,920.42
$98,580.48
25
Without a Fee Increase
Projections if fee remains at $114/per academic year
19301 - Student Health Fee
2016-2017
Beginning Balance
($300,339.94)
Fee Revenue
$1,425,000
Other Services
Expenses
($1,703,521.04)
Transfer Out
for Pharmacist
($190,681.92)
Admin Overhead
Dean’s office support
WC Payback $497,228 begins 2011 *see below
WC from SHS for custodial service
($21,554.00)
SHS R&R
($138,150)
Facilities Improvement 19306
Expansion costs 2010
Ending Balance
($929,246.90)
19309 -Sales & Service
Beginning Balance
Other Services
Expenses
Transfer Out
Transfer-AdminOvrhd
Transfer -Dean’s office
WC Payback last payment 2015-16*
Facilities Improvement 19306
Pharmacy
Ending Balance
Ending Balance Total funds
Projections [estimated 4% increase in expenses]
Projections
2018-2019
2019-2020
2020-2021
2021-2022
($1,541,159.14)
($2,220,291.87)
($2,961,857.90)
($3,886,547.58)
$1,425,000
$1,425,000
$1,425,000
$1,425,000
2022-2023
($4,820,458.85)
$1,425,000
2023-2024
($5,830,302.56)
$1,425,000
($1,771,661.88)
($1,842,528.36)
($1,916,229.49)
($1,992,878.67)
($2,072,593.82)
($2,155,497.57)
($2,241,717.47)
($198,309.20)
($206,241.56)
($214,491.23)
($223,070.88)
($231,993.71)
($241,273.46)
($250,924.40)
($22,416.16)
($44,525)
($23,312.81)
($32,050)
($24,245.32)
($11,600)
($25,215.13)
($108,525)
($26,223.74)
($28,100)
($27,272.69)
($10,800)
($28,363.59)
($10,325)
($1,541,159.14)
($2,220,291.87)
($2,961,857.90)
($3,886,547.58)
($4,820,458.85)
($5,830,302.56)
($6,936,633.03)
2017-2018
($929,246.90)
$1,425,000
Projections [estimated 4% increase in expenses and other services, 4% Transfer Dean's office, and 2% increase in AdminOverhead]
2016-2017
2017-2018
2018-2019
2019-2020
2020-2021
2021-2022
2022-2023
2023-2024
$398,920.42
$513,765.62
$635,244.63
$763,663.60
$899,341.74
$1,042,611.87
$1,193,820.97
$1,353,330.76
$725,571.60
$754,594.46
$784,778.24
$816,169.37
$848,816.15
$882,768.79
$918,079.54
$954,802.73
($378,726.40)
($393,875.46)
($409,630.47)
($426,015.69)
($443,056.32)
($460,778.57)
($479,209.72)
($498,378.11)
($102,000.00)
($67,600.00)
($104,040.00)
($70,304.00)
($106,120.80)
($73,116.16)
($108,243.22)
($76,040.81)
($110,408.08)
($79,082.44)
($112,616.24)
($82,245.74)
($114,868.57)
($85,535.57)
($117,165.94)
($88,956.99)
($62,400.00)
($64,896.00)
($67,491.84)
($70,191.51)
($72,999.17)
($75,919.14)
($78,955.91)
($82,114.14)
$513,765.62
$635,244.63
$763,663.60
$899,341.74
$1,042,611.87
$1,193,820.97
$1,353,330.76
$1,521,518.31
($905,914.51) ($1,456,628.27) ($2,062,516.16)
($2,843,935.71)
($3,626,637.88)
($4,476,971.80)
($5,415,114.72)
($415,481.28)
26
Impact of Not Increasing Fee
•
•
•
•
•
Staff reductions
Decreased hours of service
Decreased appointment availability
Longer waits for appointments
More referrals to off campus entities
– More costly and less convenient for students
• Potential decrease in services on campus (i.e., lab, radiology,
pharmacy)
• Discontinue walk-in appointment availability
• Potential for additional charges for:
– Office visits
– No shows
– Fees for services
27
Fee Increase to Sustain
Current Operations ($2.33/credit)
$
19301 - Student Health Fee
Beginning Balance
Fee Revenue
Other Services
Expenses
Transfer Out
for Pharmacist
Admin Overhead
Dean’s office support
WC Payback $497,228 begins 2011 *see
below
WC from SHS for custodial service
SHS R&R
Facilities Improvement 19306
Expansion costs 2010
Ending Balance
19309 -Sales & Service
Beginning Balance
Other Services
Expenses
Transfer Out
Transfer-AdminOvrhd
Transfer -Dean’s office
WC Payback last payment 2015-16*
Facilities Improvement 19306
Pharmacy
Ending Balance
Ending Balance Total funds
2016-2017
12,000
170.00
$
2017-2018
12,100
170.00
$
2018-2019
12,200
170.00
$
2019-2020
12,300
170.00
$
2020-2021
12,400
170.00
$
Projections [estimated 4% increase in expenses and transfers]
Projections
2018-2019
2019-2020
2020-2021
2021-2022
($432,879.14)
($536,560.67)
($688,617.46)
($1,009,857.52)
2016-2017
($300,339.94)
2017-2018
($382,246.90)
$2,040,000
$2,057,000
$2,074,000
$2,091,000
$2,108,000
($1,771,521.04)
($1,842,381.88)
($1,916,077.16)
($1,992,720.24)
($190,681.92)
($198,309.20)
($206,241.56)
($21,554.00)
($138,150)
($22,416.16)
($44,525)
($382,246.90)
($432,879.14)
2016-2017
$398,920.42
$725,571.60
($378,726.40)
2021-2022
12,500
170.00
$
2022-2023
12,600
170.00
$
2023-2024
12,700
170.00
2022-2023
($1,326,501.18)
2023-2024
($1,705,386.59)
$2,125,000
$2,142,000
$2,159,000
($2,072,429.05)
($2,155,326.21)
($2,241,539.26)
($2,331,200.83)
($214,491.23)
($223,070.88)
($231,993.71)
($241,273.46)
($250,924.40)
($23,312.81)
($32,050)
($24,245.32)
($11,600)
($25,215.13)
($108,525)
($26,223.74)
($28,100)
($27,272.69)
($10,800)
($28,363.59)
($10,325)
($536,560.67)
($688,617.46)
($1,009,857.52)
($1,326,501.18)
($1,705,386.59)
($2,167,200.41)
Projections [estimated 4% increase in expenses and other services, 4% Transfers, and 2% increase in AdminOverhead]
2017-2018
2018-2019
2019-2020
2020-2021
2021-2022
2022-2023
$513,765.62
$635,244.63
$763,663.60
$899,341.74
$1,042,611.87
$1,193,820.97
$754,594.46
$784,778.24
$816,169.37
$848,816.15
$882,768.79
$918,079.54
($393,875.46)
($409,630.47)
($426,015.69)
($443,056.32)
($460,778.57)
($479,209.72)
2023-2024
$1,353,330.76
$954,802.73
($498,378.11)
($102,000.00)
($67,600.00)
($104,040.00)
($70,304.00)
($106,120.80)
($73,116.16)
($108,243.22)
($76,040.81)
($110,408.08)
($79,082.44)
($112,616.24)
($82,245.74)
($114,868.57)
($85,535.57)
($117,165.94)
($88,956.99)
($62,400.00)
($64,896.00)
($67,491.84)
($70,191.51)
($72,999.17)
($75,919.14)
($78,955.91)
($82,114.14)
$513,765.62
$635,244.63
$763,663.60
$899,341.74
$1,042,611.87
$1,193,820.97
$1,353,330.76
$1,521,518.31
$131,518.72
$202,365.49
$227,102.93
$210,724.28
$32,754.36
($132,680.21)
($352,055.83)
($645,682.10)
28
Impact of Fee Increase of to Sustain
Current Operations ($2.33/Credit )
•
•
•
•
Inability to add staff to meet increased student utilization
Inability to grow wellness education outreach efforts
Continued dissatisfaction in wait times for appointments
Inability to replace/repair needed equipment (i.e. lab,
radiology, pharmacy) resulting in fewer services
available
• Short term ability to sustain current operations
• No growth potential
29
Fee Increase to Accommodate Growing
Enrollment & Student Needs ($3.33/Credit)
2016-2017
12,000
$
194.00
19301 - Student Health Fee
Beginning Balance
2016-2017
($300,339.94)
Fee Revenue
$2,328,000
Other Services
Expenses
($2,025,521.04)
Transfer Out
for Pharmacist
($190,681.92)
Admin Overhead
Dean’s office support
WC Payback $497,228 begins 2011 *see below
WC from SHS for custodial service
($21,554.00)
SHS R&R
($138,150)
Facilities Improvement 19306
Expansion costs 2010
Ending Balance
($348,246.90)
19309 -Sales & Service
Beginning Balance
Other Services
Expenses
Transfer Out
Transfer-AdminOvrhd
Transfer -Dean’s office
WC Payback last payment 2015-16*
Facilities Improvement 19306
Pharmacy
Ending Balance
Ending Balance Total funds
2016-2017
$398,920.42
$725,571.60
($378,726.40)
2017-2018
12,100
$
194.00
2017-2018
($348,246.90)
2018-2019
12,200
$
194.00
2019-2020
12,300
$
194.00
2020-2021
12,400
$
194.00
2021-2022
12,500
$
194.00
Projections [estimated 4% increase in expenses and transfers]
Projections
2018-2019
2019-2020
2020-2021
2021-2022
($372,639.14)
($458,247.07)
($600,819.31)
($921,603.45)
2022-2023
12,600
$
194.00
2023-2024
12,700
$
194.00
2022-2023
($1,247,276.95)
2023-2024
($1,645,153.39)
$2,347,400
$2,366,800
$2,386,200
$2,405,600
$2,425,000
$2,444,400
$2,463,800
($2,106,541.88)
($2,190,803.56)
($2,278,435.70)
($2,369,573.13)
($2,464,356.05)
($2,562,930.29)
($2,665,447.51)
($198,309.20)
($206,241.56)
($214,491.23)
($223,070.88)
($231,993.71)
($241,273.46)
($250,924.40)
($22,416.16)
($44,525)
($23,312.81)
($32,050)
($24,245.32)
($11,600)
($25,215.13)
($108,525)
($26,223.74)
($28,100)
($27,272.69)
($10,800)
($28,363.59)
($10,325)
($372,639.14)
($458,247.07)
($600,819.31)
($921,603.45)
($1,247,276.95)
($1,645,153.39)
($2,136,413.88)
Projections [estimated 4% increase in expenses and other services, 4% Transfers, and 2% increase in AdminOverhead]
2017-2018
2018-2019
2019-2020
2020-2021
2021-2022
2022-2023
$513,765.62
$635,244.63
$763,663.60
$899,341.74
$1,042,611.87
$1,193,820.97
$754,594.46
$784,778.24
$816,169.37
$848,816.15
$882,768.79
$918,079.54
($393,875.46)
($409,630.47)
($426,015.69)
($443,056.32)
($460,778.57)
($479,209.72)
2023-2024
$1,353,330.76
$954,802.73
($498,378.11)
($102,000.00)
($67,600.00)
($104,040.00)
($70,304.00)
($106,120.80)
($73,116.16)
($108,243.22)
($76,040.81)
($110,408.08)
($79,082.44)
($112,616.24)
($82,245.74)
($114,868.57)
($85,535.57)
($117,165.94)
($88,956.99)
($62,400.00)
($64,896.00)
($67,491.84)
($70,191.51)
($72,999.17)
($75,919.14)
($78,955.91)
($82,114.14)
$513,765.62
$635,244.63
$763,663.60
$899,341.74
$1,042,611.87
$165,518.72
$262,605.49
$305,416.53
$298,522.43
$121,008.43
$1,193,820.97
($53,455.97)
$1,353,330.76
$1,521,518.31
($291,822.63)
($614,895.57)
30
Impact of Health Fee Increase to
Support Managed Growth ($3.33/Credit)
• Additional provider (MD/NP) & nurse
• Improved access
• More appointment availability, including same day/walkin appointments
• Maintain facilities and keep up with utilization growth
• Continuous technology improvements
• Add services / procedures based on student needs
• Health fee fund remains in red even with increase
• NDSU will be in bottom third of peer institutions with the
$194/year increase
31
Summary
Current
Fee:
Proposed Fee
Option 1:
Proposed Fee
Option 2:
•
•
•
•
•
•
•
•
•
$114.00/academic year
$57.00/semester
$4.75/credit
$170.00/academic year
$85.00/semester
$7.08/credit ($2.33 increase)
Impact:
Impact:
•
•
•
•
Staff reductions
Decrease in services
Decrease in appointment
availability
•
•
Maintain current
operations only
Inability to address
appointment availability
Inability to keep facility,
equipment, & technology
up-to-date
$194.00/academic year
$97.00/semester
$8.08/credit ($3.33 increase)
Impact:
•
•
•
•
Better positioned to meet
growing student needs
Ability to add staff as
demand increases
Improved appointment
availability
Add services/programs to
align with NDSU goal to
grow enrollment to 18,000
32
Dedicated to the
well-being of
NDSU students
33
Questions?
34