Zero Based Budget

Proposal: Expanding the

Care-a-Van Service
Megumi Miyajima-Olguin RN
Nur4243: Business of Health Care in Complex Systems
Ashley Cavanna RN, MSN
04/29/2022
"I pledge..."
 Welcome, Shared Governance
Representatives!

We are all involved in patient care and we want to help our hospital save money, treat
patients efficiently, and get them home safely.  How can we do all that?
 Objective

By improving on
our Care-a-Van
transportation!

(Image360, 2022)
 Driving Forces:
How much does it cost to transport a patient that's discharged from
the ER?

• A typical discharge cab ride is about $30-$50 a patient (per

Roundtrip) 
• A wheelchair van or transport with oxygen: $60-150 a ride (per
Hospital to Home)
• An ambulance with stretcher: $500 (per Richmond Ambulance
Authority).
Richmond Community Hospital and Memorial Regional
pay out approximately $2,200 -4,000/week in discharge
rides home after hours! (Bon Secours Mercy, 2021)

That’s $114,400 – 208,000 per year!

Reasons we would have to pay for
discharge transport:
Medicaid pays for discharge rides home. If a patient has Medicare, other insurances, or
is uninsured the patient or the hospital must pay.
• Requiring regular Lyft ride: The patient does not have a ride home and not insured by
Medicaid. 
• Requiring wheelchair van or oxygen: The patient comes by EMS and their wheelchair or
portable oxygen tank is left at home
• Requiring an ambulance with stretcher: the patient is bed bound
 • Transporter must be BLS certified
Restraining • Transporter must be trained
Factors: Issues in patient transfers
with transport • Transport needs to be
wheelchair accessible
• Transport need oxygen tanks
Alternative 1
The unit leader can speak to our EMS provider's mangers to ensure they bring the patient's assistive
devices (wheelchairs and walkers) and portable oxygen tanks when a patient is brought into the ED.
Cost – Estimated $0 - $2,000/week
Advantages
• Possibility to save money
• Builds rapport with our EMS providers
Disadvantages:
• Large electric wheelchairs cannot fit in EMS transport
• Some patients still need assistance into the home
• People not insured by Medicaid will still need to pay or be paid for
Alternative 2
Eliminate all discharge transportation to those without Medicaid. Patient's can be referred to the bus
stop by the building. Refuse all requests for transport except for extreme cases reported to case
manager. Weekly transportation cost capped at $1,500/week.
Cost – Estimated $0-1,500/week
Advantages
• Potential to save money
• Discourages those who are not insured by Medicaid that come to the ED for cab rides
Disadvantages
• Not very caring
• Resource consuming contacting case manager for ride approval
Alternative 3
Have Care-a-Van services run 24/7 (2300-0600 on call status) include new van with
stretcher transport capabilities
Advantages Disadvantages
• Care-a-Van has BLS and patient mobility • Liability insurance goes up
trained individuals that transport during the • More trained, Care-a-Van drivers to fill night
day and then (proposed) on-call. needs
• Care-a-Van already has oxygen transport • Would need a stretcher compatible unit
capabilities.
• Help our patients get home safely
• Less costly to hospital (see next slide)
Alternative 3: Approximate Costs
Need Cost per year Cost per week
Extra 3 BLS and mobility trained $30,000 $576
drivers (On-call status)
Liability Insurance Increase (per $1,704 $33
Insureon)
New Care-a-Van with Stretcher $60,000 $1,154 (for one year)
Capability
Total $1,763
Alternative 3: Potential Savings
Per Week
Current Transportation - $2,200 – 4,000
Cost
Potential Savings + $437 – 2,237
Potential Savings (after + $1,591 – 3,391
new van paid off in a year)

After one year, potential savings could be $82,732 - 176,332!!!

Conclusion
Improving our Care-a-Van ride service not only saves our ministry money, but it reflects
our values of service, compassion, human dignity, and stewardship!
References 
Image 360. (2022). Bon secours suv [image]. https://richmondsouthva.image360.com/vehicle-lettering

Insureon.2022. What is the average cost of commercial auto insurance?

https://www.insureon.com/small-business-insurance/commercial-auto/cost#:~:text=For%20a%20policy%

20limit%20of,outlier%20high%20and%20low%20premiums

Bon Secours Mercy. (2021). Richmond community emergency department budget 2021. Accessed

04/20/2022.