Thesis Nurs. 1997 T475g
c.2
Thompson, Paul.

Grant proposal to fund a
nurse pratitioner
1997.

Grant Proposal to Fund a Nurse Practitioner Practice

in a Rural Setting

by
Paul Thompson

Submitted in Partial Fulfillment of the Requirements
for the Master of Science in Nursing Degree

Approved by:

bate

/Judith S. Schilling, CRNP, Ph.Dz.
Committee Chairperson
Edinboro University of Pennsylvania

J

'

/;

Uy 1U'// / 99 7

__________________

x^^JJanet Geisel, Ph.D., RN
1
Committee Member
Edinboro University of Pennsylvania

J

Date

C '

Table of Contents

Page
Request

5

Ashtabula County Primary Practice Mission Statement

6

Background of the Problem: A National Perspective

7

Health Status of the Rural Population

7

Health Insurance

8

Access to Health Care

9

Barriers to Rural Practice

9

Private and Government Involvement in Rural Health Care.

10

Controlling Health Care Costs

11

Summary
Background of the Problem: A County Perspective

12
14

Poverty

14

Health Issues

16

Vital Statistics

17

Summary

18
19

Business Plan Outline
Purpose of Business

Business Location .

19

Total Market

19

Target Market

19

Industry Trends

20

Competing Services

20

ii

Organizational Structure and Membership

21

Legal Organization

22

Operational Plan

22

Charges for Services

23

Advertising

24

Facility

25

Project Evaluation

26

Budget, First Year

.

27

Other Funding Sources

31

Budget, Second Year

32

Budget, Third Year

36

Budget, Fourth Year

39

References

43

Appendixes

45

Appendix A - Objectives

46

Appendix B - Causes of Death for Ashtabula County-1995

49

Appendix C - Board Member Job Description

50

Appendix D - Clinic Manager Job Description

51

Appendix E - Nurse Practitioner Job Description

52

Appendix F - Nurse Practitioner Intern Job Description ..

53

Appendix G - Qualifications of Board Members

54

Appendix H - Qualifications of Clinic Manager and
Nurse Practitioner

Appendix I - Sliding Fee Scale

iii

62
65

List of Tables

Table

Page

1

Projected Income First Year

28

2

Expenses Covered by Grant First Year

29

3

Projected Statement of Operations First Year

30

4

Projected Income Second Year

33

5

Projected Expenses Second Year

34

6

Projected Statement of Operations Second Year ....

35

7

Projected Income Third Year

36

8

Projected Expenses Third Year

37

9

Projected Statement of Operations Third Year

38

10

Projected Income Fourth Year

39

11

Projected Expenses Fourth Year

40

12

Projected Statement of Operations Fourth Year ....

41

13

Balance Sheet

42

iv

Request
A grant of $42,510 is requested from the Ashtabula Foundation for
initial financing and creation of Ashtabula County Primary Practice

(ACPP). This grant money will be used to enhance and expand the

availability of essential health services to rural southern Ashtabula
County, Ohio. Emphasis will be placed on quailty, accessibility, and

affordability of services. The outcome will be improved quality of life for

the county's medically indigent population and overall cost savings for the
health care system.

5

Ashtabula County Primary Practice

Mission Statement
The best hope for the future of our county is the well-being of our
families. No child, teenager, adult, or senior citizen should fear the future
as a result of lack of health care.

The purpose of the Ashtabula County Primary Practice is to assure the
availability and accessibility of quality primary care to rural residents of

our county regardless of their ability to pay. The service is patient­

centered. Through education, guidance and medical management patients

are provided primary care service. Primary care is integrated, accessible

health care services provided by clinicians who are accountable for
addressing a large majority of personal health care needs, developing a
sustained partnership with patients, and practicing in the context of family

and community (Institute of Medicine, 1994). The Practice asserts, as

basic to its mission, that primary care services are neither denied nor
abridged on the basis of race, color, religion, ancestry, age, or ability to

pay.

The Practice will cooperate with other community organizations to

assure the maximum service opportunities for its patients. The
effectiveness of the Practice will be evaluated in terms of objectives

accomplished, patient satisfaction, and achievement of internal quality

control standards, Appendix A. The target patient population is the rural,
medically indigent: those persons who cannot afford to pay for primary
care, or are unable to access primary care as it now exists in Ashtabula
County.

6

Background of the Problem: A National Perspective
During America's history as a nation, the composition of the

population has changed from one that was almost totally rural to one that
is now predominantly urban. The United States Census Bureau (1990)

estimates that 95% of the population in 1790 was rural; today only 25%
live in rural areas. In recent years, the size of the rural population has not

declined overall, but is growing more slowly than the suburban

population.
The Office of Technology Assessment (OTA, 1991) found that, in
general, rural residents tend to be white, native-born, and living in a

family headed by a married couple. Rural residents are less likely than
urban residents to be employed and to have completed high school. Rural

residents have lower incomes than their urban counterparts. Nearly one
in four rural citizens lives in poverty, but this rate approaches one out of
every two for black families living in rural areas. The 1991 OTA study
also showed most rural employment stems from agriculture. This same

study found there is a recent trend of locating small manufacturing

facilities and other types of light industry in rural areas to take advantage
of nonunion environments. However, these companies do not pay much

over minimum wage, and benefits such as health insurance are often
nonexistent.
Health Status of the RuraUPopulatjon

Chronic disease is a significant problem in rural areas. In five of
the six chronic condition groupings used by the National Health Interview
Survey (1988) rural persons experienced higher rates. Infant mortality is

7

8

slightly higher in rural areas. Deaths resulting from accidents are a

striking 40 /o higher in rural than urban areas. Rural residents in general

rate their overall health as poorer than do urban residents (OTA, 1991):
1. Rural residents are much less likely than urban residents to use
seatbelts, a characteristic that is consistent with higher fatality rates.

2. Rural residents are less likely to exercise regularly, and are more

likely to be obese.
3. Fewer rural residents smoke but, those who do, smoke more

heavily than their urban counterparts.
4. Rural residents use preventive screening services less often than do

urban residents.
Health Insurance

The OTA (1990) found that rural residents were less likely than
urban residents to have either private health insurance or employment-

related health insurance. As stated above, rural residents have lower
average incomes than urban residents and these lower incomes are

associated with lower rates of private insurance coverage. Poor rural
residents are much less likely than poor urban residents to be covered by
Medicaid. In their report the OTA (1990) noted that for farm workers the
lack of Medicaid coverage was striking. Fewer than 6% of farm residents

with incomes below the Federal Poverty Threshold were covered by

Medicaid compared with over 44% of below poverty urban residents. A

likely explanation is that poor farm families tend to be two-parent
households who are often ineligible for Medicaid.

9

Access to Health Care
In their report the OTA (1990) noted that physicians have
historically been in control of the health care system, and the physician

supply has been increasing for many years. Despite the overall increase,

rural areas have fewer than one-half as many physicians providing patient
care as do urban areas. According to the U.S. Health and Human Services
Office of Data Analysis (1990) there were 91 physicians per 100,000

population in rural areas as opposed to 216 physicians per 100,000

population in urban areas. In the least populated counties with fewer than
10,000 people this rate dropped to 48 physicians for every 100,000
people, and over 100 U.S. counties had no practicing physicians at all.
Access to health care in the rural setting is also limited by distance.

In rural areas the lack of public transportation makes it difficult for many
residents to reach health care facilities. The OTA (1990) found that there

may be fewer places to receive health care because rural hospitals have
been closing or consolidating since the 1980s. This trend has been
spurred by the fact that rural hospitals generally have higher operating

costs and lower occupancy rates than larger urban facilities (OTA, 1990).

Barriers to Rural Practice.
In its study the OTA (1990) found that physicians have historically
chosen to practice in metropolitan areas which offer more professional

and personal amenities. Rural areas have populations too sparse or

dispersed to support many specialty physicians. Although the national
supply of physicians has grown in the past two decades, most of this
growth has been in the specialty areas. Primary care providers are what is

10

needed for rural areas. Primary care providers can supply a wide array of

basic health services to small communities that cannot support a full
complement of specialists. Perceived lower financial rewards,

professional isolation, and lack of preparation for rural practice may
prevent primary care physicians from locating or staying in rural areas.

Private and Government Involvement in Rural Health Care
There is little direct involvement in solving rural health problems

by private companies, health maintainence organizations, or various
health insurers. County health departments are very involved with their
communities, promote preventive health activities, and offer clinic
services as they can afford them. The federal government plays a large
role in rural health and states depend on federal financing for almost one-

half of their resources for rural health programs (OTA, 1990).

Federal programs such as Medicare and Medicaid pay directly for
medical services. Federal block grants give states money that can be used

for rural health services. There are additional federal programs to enhance
rural health resources such as the National Health Service Corps (NHSC)

(1996). This program works by paying the tuition of medical school

students in exchange for practicing in a Health Profession Shortage Area
(HPSA) at the rate of one year of service for each year of tuition paid.
However, representatives of the NHSC have stated that the biggest

problem is with the retention of physicians. The majority of physicians
leave the HPSA when their debt is paid off and relocate to urban areas.

The goal of the NHSC is that while working in the HPSA,usually rural
areas,the physician would establish community ties and stay after the

11

service obligation is up, but this appears not to be the case. This in turn

fosters distrust of the medical system as people in these communities

come to realize that each new provider is only going to be temporary.
This makes it difficult to build client-practitioner rapport.

Controlling Health Care Cost
Painting a bleak picture of the state of health care in America, John

A. Kitzhaber, M.D. (1996) the Governor of Oregon and a former
emergency department physician, said the country must continue to
debate health care or face dire consequences. Dr. Kitzhaber believes that

the problem of the uninsured is largely responsible for the continuing
crisis in health care costs and access in general. Kitzhaber states that the
problems of uninsured and uncompensated care are as acute now as when
they were the hottest topic of the day, referring to the debate initiated by

the Clinton administration 4 years ago.
National health care expenditures have risen from about $ 1 billion

a month in 1950 to around $1 billion a day in 1991 (Kitzhaber, 1996).
This, in turn, has caused health care to be driven by economic rather than

social policy. Third-party payers, businesses, and governments look for
ways to protect themselves from serious financial liability. In the name of

cost containment, they have taken a variety of actions. Although none,
according to Kitzhaber (1996), have controlled costs, they have managed

to shift costs to somewhere else in the system.

Because more and more costs have fallen on providers, what was
once subsidized care has become uncompensated care. When institutions

and providers are no longer able to provide charity care, they may begin

12

to require that individuals make payments up front. This results in those
without insurance or private resources losing access to the health care
system because they cannot pay. More importantly, it causes patients to

delay seeking treatment until their conditions become emergencies.

Dr. Kitzhaber (1996) wrote that the rationing of health care in this
country is insidious, and that the consequences are seen every day in

medical practice. Emergency departments and the emergency physicians
are becoming the providers of last resort for the victims of social
rationing.

In the emergency department, we see the consequences of this
failed system in infants with respiratory distress syndrome because their

mothers had no access to prenatal care, and in patients with strokes who
could not afford to manage their high blood pressure because of poor

access to primary and preventive care.
Summary
In general, the picture of rural population over the past 20 years has

been one of sluggish and erratic economic and population growth.
Improvements in the standard of living of rural residents have lagged

behind those of urban residents. Rural populations are characterized by

chronic illness and poor self-perceptions of health as compared to urban
dwellers. The prevalence of chronic illness and decreased knowledge of
preventive medical care and healthy lifestyles suggest that addressing

these issues would be appropriate for rural populations.
Lower rural incomes, combined with decreased insurance

coverage, may lead to rural residents making low overall use of hospitals

13

or health care providers. The very low rates of Medicaid coverage among
poor rural farm families is a concern. Access to health care may be

diminished due to long distances and lack of public transportation.
Attitudes or prejudices of both physicians and rural residents toward each

other may also be a barrier to health care delivery in these areas.

Background of the Problem: A County Perspective

Ashtabula County is unique in that it is the largest and most rural
county m the state of Ohio, covering 1,368 square miles (Ohio

Department of Development, 1996). The 1990 U.S. Bureau of Census
figures show 100,924 residents, 60% of whom reside north of Interstate

90 in a geographic corridor that covers only about 20% of the county's

total acreage. The remaining 40% of the population is spread over the
southern 80% of the county. This dispersed south county population

presents challenges to delivering health care to people in an efficient and
effective manner.

An estimated 15,000 Ashtabula County residents are thought to be
medically indigent and cannot afford to pay for health care services.
Unfortunately, these people also do not qualify for Medicaid because

their incomes exceed eligibility limitations. This estimate is derived from

applying national statistics and data to Ashtabula County. Nationally, the

Centers for Disease Control, (1989) estimated that 15.3% of people under
age 65 are medically indigent. Hence, using this percentage, Ashtabula
County's medically indigent population is estimated to include at least

15,000 people.
Poverty
The Ohio Department of Development (1996) found that a large

portion of our county's poverty is due to the loss of good paying jobs from
the industrial sector in the 1970s. These jobs have been replaced with
lower paying service-related jobs (seasonal, fast food, temporaty agency

jobs, etc.) which do not provide health insurance benefits. A state-wide

14

15

poverty study prepared by the Ohio Department of Development (1996)
revealed that Ashtabula County's overall poverty rate was 22.5%.
Moreover, this report indicated that the poverty rate of Ashtabula County

increased 152.8% between 1980 and 1990. In fact, the increase in
Ashtabula County's poverty rate between 1980 and 1990 was second only
to Harrison County in its magnitude.
The poverty statistics for townships in the rural southern portion of
our county, the area ACPP intends to serve, are quite dramatic. The 1990
census revealed Windsor Township to have a poverty rate for persons

ages 0-18 of 37.8%. This compared to a county-wide average for the

same age group of 23.5%. In Windsor Township, poverty rates for all
ages far exceeded the county averages. In Hartsgrove Township, 23.1%
of people 65 years or older lived in poverty as compared to the county

average of 16.1 %. Children there fared no better with 27.3% of them
living in poverty.
Overall, when computing averages for the southern rural portion of

Ashtabula County, poverty levels of all townships scored consistently
higher (are economically worse off) than the northern or urban areas of

the county. Consistent with these findings, in 1990 the U. S. Bureau of
the Census reported overall median family income county-wide to be

$28,610 per year. But, south county average was lower at $25,953.
Most striking was the median self-employed farm income of only $8,055
per year; 1,587 persons list their occupation as farmers according to the

1990 census. This farm income was 3.5 times lower than county
average. Most fanners reside in the southern half of the county.

16

Health Issues

Ashtabula County Health Department conducted the Maternal,

Child and Family Health Survey (DePascale, 1996). It found that drug
and alcohol abuse, teen pregnancy, and cigarette smoking were high on

the list of greatest perceived health problems. Respondents listed the
three main causes of these problems as peer pressure, lack of information,

and limited or low income/no health insurance. Parents who do not take
their children to a doctor for routine health care were asked why. The
majority responded with these three answers: "I cannot afford to pay for a

doctor visit," "I have no health insurance," or "I do not know where to go
for health care".

The Community Leader Health Survey (DePascale, 1993), a survey
sent to Ashtabula County leaders in health care, business, education,
agriculture, and the clergy elicited interesting responses. Leaders thought

the most important health problems facing women in our county were
teen pregnancy, lack of affordable health care, and domestic violence.
Survey respondents concluded that the most serious barriers to women

having a healthy pregnancy were use of cigarettes, drugs, and alcohol
during pregnancy, little or no health insurance coverage, the need for

more education about pregnancy, and the lack of doctors to provide
prenatal care.
A consumer health care survey done by the Ashtabula County

Health Department (DePascale, 1993) found that 17% of the county's
population went to hospital emergency departments to receive routine

17

h care. This figure corresponded closely with the percentage of

medically indigent population in our county. In another question, when

people were asked why they did not go to a doctor for regular health care,

the majority (55%) cited no health insurance or said they could not afford
to pay for health care. Of the respondents, only 36% had private health
insurance; 30% paid for health care themselves; 27% had

Medicaid/Medicare.

Vital Statistics

The annual report for 1995 published by the Ashtabula County
Health Department shows the county rate of fetal deaths (stillbirths) to be
13.1 per 1000 live births. This figure is almost 25% higher than the state

rate of 9.7 fetal deaths per 1000 live births. This may relate to concerns

which were reflected on the health surveys regarding teen pregnancy, lack

of prenatal education, low income, lack of health insurance, and limited
access to prenatal care.

Other leading causes of death for Ashtabula County follow national

trends. Appendix B shows that cancer, heart disease, and stroke are the

leading causes of death. According to the U. S. Preventives Services
Task Force (1994) many of these leading causes of mortality and

morbidity are amenable to primary and secondary preventive medical
interventions. Prevention or early intervention allows for increased health

and productivity for these individuals, and at the same time costs less for
society and the health care system. These health promoting interventions
such as education about diet, weight control, smoking secession, or the

ability to obtain prescriptions for drugs that lower blood pressure or

18

cholesterol are currently not being accessed by a large percentage of our

county's population, the medically indigent.
Summary

The poor economic conditions of southern Ashtabula County
coupled with its large medically indigent population and long distance in

terms of miles to health care facilities, make the provision of a primary

care practice important to the economically disadvantaged of our county.

Having a Medicaid card does not automatically mean a person has access
to appropriate health care. Location and availability of transportation are
important factors when you look at a large rural county such as

Ashtabula. Mandatory managed care has not come into Ashtabula
County. The majority of primary care practitioners will not take on the

medically indigent as new patients (Thompson, 1997). Persons without

health insurance, or who are financially unable to pay for medical care,

are not seeking help for health conditions, some of which are potentially
life threatening. Therefore, if current conditions continue, the health and
health care needs of those in southern Ashtabula County will continue to

be poorly served.

Business Plan Outline
Purpose of Business

The purpose of Ashtabula County Primary Practice (ACPP) is to
provide primary care to the rural medically underserved population of
Ashtabula County. The intent of this business will be to provide health
care to rural persons currently unable to obtain care through the

traditional health care delivery system. This will be done by removing the

barriers of cost (by using a sliding fee scale, acceptance of
Medicaid/Medicare, or free care), and accessibility (eventually centrally

located in the HPSA) to quality primary care for the targeted population.
Business Location

Ashtabula County Primary Practice (ACPP)
38 Dorset Street
Jefferson Ohio 44047
216-576-4455

Total Market
The total market is all persons living in Ashtabula County: 100,924
according to the 1990 census.
Target Market
The target market will focus on the rural population of Ashtabula
County from Interstate 90 south to the county line. The townships that

will benefit most from primary care services are Trumbull, Morgan,
Lenox, Hartsgrove, Rome, New Lyme, Cherry Valley, Dorset, Rock

Creek Village, Orwell Village, Windsor, Orwell Township and
Colebrook. These townships had a combined 1990 population of 15,917

19

20

and most are designated by the U.S. Department of Health and Human
Services as being located within a Health Profession Shortage Area.

Industry Trends
No current system is in place in Ashtabula County to adequately

serve the following groups:
1.

The working poor, defined as persons working at or close to

the minimum wage and not receiving health insurance benefits.
2.

Persons self employed, such as farmers, without health

insurance coverage.
3.

The unemployed without health insurance coverage.

4.

People receiving Medicare/Medicaid who are unable to find a

provider willing to take them as patients. As of January 13, 1997, a

telephone survey found that only two of the twelve primary care providers
in the county were willing to take new patients with Medicaid
(Thompson, 1997).

Competing Services
No serious competition exists as no local comparable services are
currently provided or available to this identified target market/population.
Current providers for the medically indigent are the emergency

departments at our county hospitals. Emergency services, however, are
expensive in terms of overall cost to society and the target population

must drive a minimum of 20 miles each way to access this care.

21

Organizational Structure and Membership
A Board of Directors consisting of three persons will meet
quarterly to provide guidance, review policies and procedures, and
receive financial and operating reports from the clinic manager. The

professional job description of board members appear in Appendix C.
Board members will serve on a voluntary basis and without monetary

compensation.

The Clinic Manager will be responsible for daily operations of the
practice, as noted in Appendix D. This includes, but is not limited to,

managing cash flow, paying bills and wages, and billing for services. The
manager will also prepare financial statements, develop and maintain

advertising strategies, and interface with other agencies both public and
private.

The Primary Care Provider will be a board certified family nurse
practitioner. He or she will be in charge of providing primary care for
patients, as outlined in Appendix E. This will include, but not be limited

to, patient education, medical management of acute or chronic conditions,
and referrals as needed. The primary care provider will also serve as a
clinical instructor/mentor for family nurse practitioner students who may

work at the clinic or rotate through the clinic as part of their internship.
The Nurse Practitioner Intern will be a student currently enrolled in

a family nurse practitioner master's degree program who has completed

an initial course in physical assessment. The intern will collaborate with
the

22

practitioner by obtaining vital signs, history and physical examinations,

and presenting differential diagnoses and treatment plans for patients to

the primary care provider (Appendix F).
Legal Organization
Ashtabula County Primary Care will be incorporated as a non­
profit entity under the IRS rules governing it as a 501(C) 3 tax exempt
organization. The board of directors will consist of Robert Malinowski,

D.O., Judith Schilling, CRNP, Ph.D., and Raymond Saporito, MPH,

qualifications of board members listed in Appendix G. Initially, both the
clinic manager and primary care practitioner will be Paul Thompson,

FNP, qualifications listed in Appendix I.
Operational Plan
Initially, Ashtabula County Primary Practice will rent completely
furnished medical facilities from Pamela Lancaster, D.O. This will be

advantageous for at least three reasons:
1. Large initial capital expenses will be avoided by using an

existing and fully equipped physicians office.
2. Present office staff will be available 5 days a week, during
regular business hours, to take appointments for patients of Ashtabula

County Primary Practice.
3. The location in Jefferson, which is geographically almost
centered in the county, makes access realistic for people in the target

area.
Office hours will be Monday and Wednesday evenings horn 6:00

p.m. to 9:00 p.m. and Saturdays from noon to 6:00 p.m. Being open

23

twelve hours each week, and allowing 20 minutes time for each patient
visit, Ashtabula County Primary practice wili have the capacity (0 see 36

patients per week or 144 each month.

Care provided will be primary family practice ambulatory care.
This includes teaching healthy lifestyle practices that help prevent

disease, screening for early detection of health problems, management of
chronic diseases, and interventions for acute episodic illnesses. Ashtabula

County Primary Practice will provide services for all age groups.
Conditions unable to be appropriately managed in the family practice

setting will be referred to other agencies or specialists for follow-up.
Patients requiring hospital admission will be admitted to Ashtabula

County Medical Center. This facility grants admitting privileges to nurse
practitioners, thus fostering continuity of care for ACPP's patients.
Serious conditions or life threatening emergencies identified during the

course of treatment while at ACPP will be delt with by calling 911 to

summon an ambulance for immediate transport to the hospital.
Charges for Services
Anyone with Medicaid or Medicare will be accepted and payments

received from these agencies will constitute full payment for services.

Persons without health insurance who have the ability to pay will be
charged based on a sliding fee scale adjusted for family size and income,
Appendix I. People who are unable to pay, for whatever reason, will not

be discriminated against and service will be provided free of charge.
Patients who can only afford to pay for office care may still need
prescription medicines to complete their treatment. These patients have

24

traditionally hit the next road block in health care as it exists today,
trying to fill a prescription which may cost up to $100. For many it
comes down to getting the medicine, buying food, or paying a utility bill.
Ashtabula County Primary Practice intends to overcome this obstacle for

its patients by providing the medicines needed in these cases. This will be

determined by simply asking the patient if he or she will be able to

purchase the required medicine without sacrificing other basic needs. A
stock of basic medications will be kept. These will be sold at cost to
those who can pay for them or be given free to those unable to pay. For
example, Amoxicillin 250 mg/5ml, which would be used to treat a child’s

ear infection, costs the Ashtabula County Primary Practice $2.65 for 10
days of treatment and would be provided at this price if the parent could

afford it or, if not, given free. In checking the price of the same amount

of this drug at a local drug store, it would cost the parents $13.25, or five

times the wholesale price, and this is one of the least expensive routinely
used prescription medications.
Advertising
Ashtabula County Primary Practice will purchase space to

advertise its services each week in the EffiLtas, a weekly paper
delivered via mail boxes free of charge to all of Ashtabula County.
Advertising will also be done weekly in the Jefferson Gazette.. Being a
non-profit Organization. Ashtabula County Primary Practice will submit to

these publications and the SttrBeamn, «> be published without charge,
periodic public service announcements describing the benefits of primaiy

care and the accessibility of Ashtabula County Pomary Pract.ee to

25

Ashtabula County residents. The director of Ashtabula County Primary

Practice will also offer to speak at local Chamber of Commerce, Kiwanis,
Ruritan, and Grange meetings to help spread the word of our services.
ACPP will have informational pamphlets printed and ask local agencies

or businesses for permission to leave them for distribution.

Facility
Through the generosity and progressive vision of Dr. Pamela

Lancaster, Ashtabula County Primary Practice will rent and utilize her
fully furnished office space in Jefferson, Ohio. This facility consists of

adequate parking; large waiting room; three exam rooms; and the ability

to perform on site urinalysis, pregnancy test, rapid strep test, blood
glucose, gynecological exams, and other diagnostic tests. Supplies

associated with routine care such as otoscopes, opthalmoscopes, exam

tables, gloves, telephones, office supplies, housekeeping services,
security, and appointment schedules will all be provided and included in

the monthly lease.
Project Evaluation

Evaluation of this project will be based on the degree to which the
eight objectives listed in Appendix A have been achieved. A

comprehensive evaluation will be submitted to the Board of Directors
annually.
The goal of increasing the public's awareness of ACPP activities,

Objective 1, will be judged on the basis that: (a) At least one public

service announcement is being published in appropriate newspapers each
month, (b) at least one

public speaking presentation is accomplished per

26

month, (c) brochures are being circulated to the public as evidenced by
having to restock distribution sites, and (d) advertisements are run weekly

in selected newspapers.

To verify the establishment of relationships with other agencies,
Objective 2, we will analyze the responses on new patient

questionnaires concerning their source of referral to ACPP. This will
indicate what percentage have been referred from other agencies.
A random audit of 10% of patient charts will be done quarterly to

ensure the provision of complete primary care, Objective 3. One outcome
measure for complete pediatric care will be to see that all children in the

practice are fully immunized by the age of two. This same 10% audit
would also be used to evaluate Objective 4 concerning appropriate and
timely patient referrals.

Statistical analysis will be used to identify the number of patients seen
each month. This will be an on-going process and used as the means of
evaluating Objective 5. Ensuring that the practice is run in a cost effective
manner, Objective 6, will be assessed via quarterly and yearly reviews of
budgets by the office manager, practitioner, and board members.

Auditing 10% of patient charts in a random manner will be done
quarterly to evaluate accurate and timely documentation, as stated in

Objective 7. The maintainence of confidentiality, Objective 8, will be
evaluated by a 10% chart audit to check that no records have been

released without a signed release of information form. Also to comply

with Objective 8, all files will be fireproof and kept locked unless the
office is open with ACPP staff present.

27

Budget, First Year
Projected income is based on providing services 12 hours per

week, treating two patients per hour. This would be 24 patients per
week, approximately 100 per month, or 1,200 the first year. Of the 1,200

patients, we project that 50% or 600 will have Medicaid/Medicare

coverage with an office reimbursement of $33 per visit. It is estimated
thirty percent or 180 will not be able to pay for care. This figure of 30%
non-pay patients was arrived at after discussion with the office manager
of Dr. Lancaster's office. The remaining 420 patients will pay for care

using a sliding fee scale built on a basic office charge of $33 per visit.
Table 1 shows the projections for income and total patient visits.

Expenses to be covered by Ashtabula Foundation's grant are listed in

Table 2. The projected statement of operations for the first year is shown
in Table 3.

28

Table 1

Projected Income First Year

Insurance

Number of
Visits

Amount
Collected

Total

Medicaid/
Medicare

600

$33 each

$19,800

Self-Pay
Sliding Fee
Scale

420

Average
Fee $16

6,720

Free Care

180

0

0

TOTAL

1200

$26,520

29

Table 2
Expenses Covered by Grant First Year

Personnel

Expenditures

Clinic Manager

$ 6,000

Primary Care Provider

Nurse Practitioner Intern

Ashtabula
Foundation

ACPP
Income

0

$ 6,000

24,000

11,680

12,300

12,000

12,000

0

6,300

0

6,300

2,880

2,880

0

Brochures and Cards

350

350

0

Speaking Expenses

200

200

0

1,000

1,000

0

Lease fully equiped medical
14,000
office @ $1,200 per month
i—

14,000

0

0

1,600

_____ 0
$42,510

300
$26,500

Payroll Taxes

$

Advertising

Newspapers - 3x5 ad @
$30 ea. x 8 per month

Medications

Rent

Insurance

Business insurance forACPP 1,600
Liability insurance for
board of directors
TOTAL

___30Q
$69,030

30

Table 3
Projected Statement of Operations First Year

Income

Revenue from 1,200 visits
Ashtabula Foundation Grant
Total Income

$26,500
42,510
69,030

Expenses

Wages

48,300

Operating expenses

20,730

Total Expenses

$69,030

31

Other Funding Sources
During this first year of operation, Ashtabula County Primary

Practice plans to submit requests for additional funds to Wal-Mart Stores,
3551 North Ridge East, Ashtabula, Ohio. An additional fund request will

be submitted to USA Waste Services, Inc, 2581 Tuttle Road, Geneva,

Ohio. Both corporations have provisions to provide grants for projects
that enhance the quality of life in communities where they are located.

The funds from these corporations will be used for 3 purposes:
1. The purchase of a building that will become the future location

of ACPP. This facility will be located in Rome or Morgan township, thus
placing the practice geographically in the center of the HPSA.
2. Renovation of the purchased building enabling compliance with
Section 504 of the Rehabilitaion Act of 1973 pertaining to handicap

access, and renovations that will result in a safe and efficient primary
care facility.
3. To contract with a grant writing specialist who will put together
a grant proposal to help fund ACPP expansion and operations for a 3 year

period. This grant will be written for the Rural Outreach Grant Program
#93.912 of the U.S. Department of Health and Human Services.

ACPP is also exploring options with other agencies, organizations,

and individuals for possibie funding in the event that we do not recieve

the federal grant. We are confident in the ability to continue with

expansion plans with or without the federal monies.

32

Budget, Second Year
second year of operation, Ashtabula County Primary Practice

will open a full-time rural health clinic (RHC). The clinic will be located

in Rome or Morgan Township, centered in the Health Profession
Shortage Area of the county.
Initial funding for the first 3 years of operation of this RHC will

come from Grant #93.912 to be obtained from the Department of Health

and Human Services. This funding decreases each of the years and by the

fourth year the RHC will be self-supporting. The clinic, along with
meeting the medical needs of our County's rural population, will also
serve as a learning site for nurse practitioners and physicians interested in

rural health care. The RHC will also be made available to the Ashtabula

County Health Department for its well-child clinics.
Proposed second year income from patient visits, detailed on Table 4,
is based on providing services 40 hours per week. Treating five patients
per hour, this would be 200 visits per week, 800 per month, or 9,600

patient visits per year. Expenses for the second year are shown in Table
5, with the projected second year statement of operations in Table 6.

33

Table 4

Projected Income Second Year

Insurance

Number of
Visits

Amount
Collected

Total

Medicaid/
Medicare

4,800

$55 each

$264,000

Self Pay
Sliding Fee
Scale

3,360

Average
Fee $20

Free
Care

1,440

TOTAL

9,600

0

67,200

0

$331,200

34

Table 5

Projected Expenses Second Year

Job Title

Annual
Expense

Clinic Manager

$40,000

Practitioner

90,000

Practitioner

60,000

Nurse Practitioner Intern

20,000

Nurse Practitioner Intern

20,000

Office Secretary
Fringe Benefits & Payroll Taxes
Mortgage

Utilities

Insurance

Office supplies
To equip three exam rooms

Medications
Lab supplies
Advertising

TOTAL

18,000

74,400
12,000
4,800

1,500
30,000

9,000
4,000

10,000
4,800
$455,000

35

Table 6

Projected Statement ofOperations Second Year
Income
Revenue from 9,600 visits
Rural Health Grant

Total Income

$331,200

123,800
455,000

Expenses
Wages

332,400

Operating expenses

132,600

Total Expenses

$455,000

36

Budget, Third Year

Income is based on providing patient services 40 hours per week,
Table 7 details these figures. Expenses are listed in Table 8, and the
projected statement of operations for the third year is in Table 9.

In the third year, Ashtabula County Primary Practice hopes to
employ a Certified Nurse Midwife full-time to enhance our capability to
provide women's health and obstetrical and gyenecological care for our
patients.

Table 7

Projected Income Third Year

Insurance

Number of
Visits

Amount
Collected

Total

Medicaid/
Medicare

5,760

$55 each

$316,800

Self Pay
Sliding Fee
Scale

4,032

Average
Fee $20

80,640

Free
Care

1,728

0

0

TOTAL

11,520

$397,440

37

Table 8

Projected Expenses Third Year

Job Title

Annual
Expense

Clinic Manager

$42,000

Practitioner

94,500

Practitioner

63,000

Nurse Midwife

60,000

Nurse Practitioner Intern

20,000

Nurse Practitioner Intern

20,000

Office Secretary

19,000

Fringe Benefits & Payroll Taxes

95,550

Mortgage

12,000

Utilities

4,800

Insurance

1,500

Office supplies
Medications

Lab supplies
Advertising
TOTAL

10,000

5,000
5,000

4,800
$457,150

38

Table 9
Projected Statement of Operations Third Year

Income
Revenue from 11,520 visits

Rural Health Grant

Total Income

$397,440
59,710

457,150

Expenses

Wages
Operating expenses
Total Expenses

414,000

43,150
$457,150

39

Budget, Fourth Year
Income projections, Table 10, are based on providing patient services

40 hours per week and treating seven patients per hour. Table 11 shows
projected expenses and Table 12 shows the fourth year projected

statement of operations. Note that projected expenses for ACPP are
starting to plateau while projected income continues to rise. Grant
funding in this fourth year is negligible and the practice is predicted to be

self-supporting in the fifth year of operation. The balance sheet, Table

13, shows this trend along with a steady increase in the number of patient
visits. This projected increasing number of visits each year will make a
significant improvement in the lives of our county's rural medically

indigent population.
Table 10
Projected Income Fourth Year

Insurance

Number of
Visits

Amount
Collected

Medicaid/
Medicare

6,720

$55 each

$369,600

Self Pay/
Sliding Fee

4,704

Average
Fee $20

94,080

Free Care

2,016

0

0

TOTAL

13,440

Total

$463,680

40

Table 11

Projected Expenses Fourth Year

Job Title

Annual
Expense

Clinic Manager

$44,100

Practitioner

99,225

Practitioner

66,150

Nurse Midwife

63,000

Nurse Practitioner Intern

20,000

Nurse Practitioner Intern

20,000

Office Secretary

20,000

Fringe Benefits & Payroll Taxes

99,742

Mortgage

12,000

Utilities

4,800

Insurance

1,500

Office supplies

10,000

Medications

6,000

Lab supplies

7,000

Advertising

4,800

TOTAL

$478,317

41

Table 12
Projected Statement of Operations Fourth Year

Income
Revenue from 13,440 visits

Rural Health Grant
Total Income

$463,680
14,637
478,317

Expenses

Wages
Operational expenses
Total Expenses

432,000

46,100

$478,317

42

Table 13

Balance Sheet

Number
Projected
Patient Visits Income

Projected
Expenses

Grant Money
Requested

Year 1

1,200

$ 26,520

$ 69,030

$ 42,510

Year 2

9,600

$331,200

$455,000

$123,800

Year 3

11,520

$397,440

$457,150

$ 59,710

Year 4

13,440

$463,680

$478,317

$ 14,637

References

Centers for Disease Control, U. S. Health and Human Services.
(1989). Public Health Service Publication, 89-12.32 Washington, DC:
U. S. Government Printing Office.
DePascale,V. (1993). [Community leader survey]. Unpublished
raw data.

DePascale,V. (1993). [Consumer health care survey]. Unpublished
raw data.
DePascale,V. (1996). [Maternal child and family health survey].

Unpublished raw data.

Institute of Medicine. (1994). Defining primary care: An interim
report. Washington, DC: National Academy Press.

Kitzhaber, J. (1996, December). A dismal but hopeful view of
America's health care system. Emergency Medicine News, 18, 3-5.

National Health Interview Survey (1988). Vital and health
statistics series 10, number 166, DHHS publication N. (PHS) 88-1594.
Washington, DC: U. S. Government Printing Office.

National Health Service Corps. (1996). Loan repayment program
McLean, VA: Author.

Office of Technology Assessment, U. S. Congress. (1990). Health
care in rural America, OTA-H-434. Washington, DC: U. S. Government
Printing Office.

Office of Technology Assessment, U. S. Congress. (1991). Rural
America at the crossroads, OTA-TCT-471. Washington, DC: U. S.

Government Printing Office.

43

44

Ohio Department of Development. (1996). Ohio county profiles.

Columbus: State Printing Office.
Thompson, P. (1997). [Telephone survey to determine the number
of primary care practitioners in Ashtabula County willing to take new
patients with Medicaid]. Unpublished raw data.

U. S. Bureau of the Census. (1990). Summary social, economic,

population characteristics for Ohio. Washington, DC: U. S. Government
Printing Office.

U. S. Department of Health and Human Services Office of Data
Analysis. (1990). Health professions resource file 1989-90. Washington,

DC: U. S. Government Printing Office.
U. S. Preventive Services Task Force. (1994). Guide to clinical

preventive services. Baltimore, MD: Williams & Wilkins.

Appendixes

46

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Cause

Appendix B
Causes of Death for Ashtabula Co
'unty-1995
Number
Percent

Cancer

143

29.0

139

28.3

Stroke

38

7.7

COPD

35

7.1

Pneumonia

28

5.7

Neurological

23

4.7

Accidents

21

4.3

Diabetes Mellitus

20

4.0

Kidneys

16

3.3

Digestive System

13

2.6

Suicides

7

1.4

Other Respiratory Diseases

6

1.2

Homicides

2

0.4

AIDS

1

0.2

Heart and Arteries

Ashtabula County Department of Health 1995 Annual Report

50

Appendix C
Board Member Job Description

Board of Directors
The board will be composed of persons with knowledge or
professional experience relating to health care or health care issues.

Board members will agree with ACPP's mission that quality primary care
should be made available and affordable to rural medically indigent
people in Ashtabula County. Members of the board will serve without
monetary compensation.

Job Description
Members of the board will:

1. Review and approve all policies and procedures of ACPP.
2. Review and approve all contracts, grants, or agreements entered

into by ACPP.
3. Meet quarterly with the clinic manager and practitioner to

receive financial and operational reports.
4. Offer guidance or ideas enabling ACPP to fulfill and maintain

its mission.
5 Participate in regular evaluation of practice objectives.

51

Appendix D
Clinic Manager Job Description

Clinic Manager

A person skilled in managing all aspects of a medical office. This includes

but is not limited to accounting, computer skills, public speaking, and
understanding Medicaid/Medicare, ICD.9 and CPT codes and rules.

Job Description
The office manager will:
1. Submit fees for services rendered.

2. Pay bills and salaries and keep all accounts current.
j.

Prepare quarterly statements for the Board of Directors.

4. Oversee all advertising, printing and distribution of brochures.

5. Engage in public speaking to promote ACPP services, and
network with other agencies.

6. Carry out other duties to assist in the efficient operation of
ACPP.

52

Appendix E

Nurse Practitioner Job Description

Certified Nurse Practitioner (CNP)
A certified nurse practitioner is a registered nurse with advanced

education and clinical competency necessary for delivery of primary
medical care. A master's degree and national certification are needed for
entry level practitioners.

Job Description
The CNP will:

1. Identify the physical, social, educational, and emotional health
needs of individuals and families.

2. Obtain a health history, perform a physical evaluation, and use
laboratory and other diagnostic tools to develop patient diagnoses and

treatment plans.
3. Implement patient treatment plans, making referrals as needed.

4. Counsel all patients on healthy lifestyles, disease prevention, and
health screenings based on age and health history.
5. Provide instruction, guidance, and positive reinforcement for

intern students working at ACPP.
6. Participate in evaluating the achievement of ACPP objectives.

53

Appendix F

Nurse Practitioner Intern Job Description
Nurse Practitioner Intern

A registered nurse currently enrolled in a masters or doctoral program
preparing the person as an advance practice nurse. The intern shall have
completed a course in advanced physical assessment.

Job Description
The nurse practitioner intern will:
1. Obtain vital signs, weights, and heights for all patients.

2. Record patients' progress.
3. Complete a physical examination and formulate differential

diagnoses.
4. Collaborate with the primary care practitioner in arriving at

diagnoses and treatment plans for patients.
5. Assist the primary care provider with other patient care
activities as needed.

APPENDIX G
.Qualifications of Board Members

CURRICULUM VITAE

ROBERTA. MALINOWSKI, D. O.
2578 Route 46 North
Jefferson, Ohio 44047
(216) 997-7688

PERSONAL INFORMATION

Birthdate:
Health:
Married:
Hobbies:

09/15/36
Good
7 children; 3 stepchildren; 14 grandchildren
Model ship building; reading; carpentry; gardening

PROFESSIONAL EXPERIENCE
1996 -

Present

President, Ashtabula County Medical Society

1992

Present

Director, Center for Occupational Health and Wellness
Memorial Hospital of Geneva

1984 -

1992 '

Director, Occupational Health Services of Ashtabula County

1981

1989

President, Ashtabula County Board of Health

1979

1988

Medical Director, Ashtabula County Justice Center

1979

1982

Director, Emergency Services Department
Ashtabula County Medical Center

1975

1979

Staff Physician
Ashtabula County Medical Center Emergency Services

1975

Present

County Coroner, Ashtabula County

1970 -

1975

Director, Anesthesia Services
Memorial Hospital of Geneva

1966

1972

Director, Anesthesia Services
Northeastern Ohio General Hospital

EDUCATION
Medical Review Officer Training Course

1991
1985

1986

University of Cincinnati, College of Medicine
Occupational Medicine - Mini Residency

1964 -

1966

Chicago Osteopathic Hospital
Two-year Residency - Anesthesiology

1963

1964

Garden City Osteopathic Hospital
Internship

1958

1963

Chicago College of Osteopathic Medicine
Doctorate in Osteopathic Medicine

1954

1958

Wayne State University, Detroit, Michigan

54

55
Curriculum Vitae
Robert A. Malinowski, D. O.
Page 2

CONTINUING EDUCATION

•
•
•
•
•

Tri-State Occupational Medicine; annual meetings
American College of Occupational and Environmental Medicine; annual meetings
American Academy of Forensic Sciences; annual meetings
American Society of Toxicologists; seminar on toxicology and drug screens
Ohio State Coroners Association; annual meetings

PROFESSIONAL ACTIVITIES
• Wrote policy and procedure manual for Ashtabula County Justice Center Jail, Medical Facilities.
Necessary for A.M.A. Jail, Medical Facilities Accreditation.
• Initiated hospital-based Occupational Medical Clinic. Developed policies and procedures and
directed operation of the Clinic.
• Presentation of scientific papers for American Academy of Forensic Sciences:
1982, 1983, 1984 and 1985
Elected Fellow, 1982
• Developed and directed toxicol gy laboratory, Ashtabula County Coroner’s Office.
• Developed and directed Forens Medical Investigative Agency for Ashtabula County.

MEMBERSHIPS
•
•
•
•
•
•
•
•
•
•

American college of Occupation .1 and Environmental Medicine
Tri-State Occupational Medical association
American Academy of Forensic Sciences
Ohio State Medical Association
Ohio State Coroners Association
Ashtabula County Medical Ass<:-iation
Ashtabula County Board of Her Saint John High School Board of Directors
Western Reserve Medical Directors Association
International Association of Me iical Examiners

Board Eligible: Occupational Medicine, 1989
Fellow: American Academy of Forensic Sciences

PUBLICATIONS
Emergency Service Policy and Procedure Manual
Ashtabula County Medical Center 1979 - 1980
Approved by Joint Commission on Accreditation of Hospitals Accreditation Committee
Policy and Procedure Manual - Ashtabula County Justice Center
Justice Center Jail approved by American Medical Association Committee for Jail, Medical
Facility Accreditation

56

VITA
Raymond J. Saoorito
4324 Arrowhead Court
Conneaut, Ohio 44030

Education: (1981 - 1984)

Doctoral Coursework (Ph. D.)
SUNY at Buffalo, School of Management
Thirty-six hours of managerial coursework completed in Health Care Policv

‘-““‘E,P?1IC

Septemper 1978 - Septemoer, 1979
B.S. (Health Science) State University of New York College at
Brockport, September, 1975 - June, 1977. Certification: pennanent
certification, State of New York, Health Education (K-12). Issued
September, 1977.
A.S. (General Studies/Social Services) Genesee Community College, Batavia
N.Y. September 1973 - June 1975.
Registered Sanitarian, State of Ohio #1176
Experience

1984 - present
Chief .Administrator and Director of Environmental Health of Ashtabula County
Health Department. Responsible for the overall management of all county
public health department programs.
Adjunct Instructor, Kent State University - Ashtabula Teaching Area includes
Community Health 1990 - present.

Instructor of Health Science, State University of New York, College at
Cortland. Teaching areas included Environmental Health, Health Care
Administration and°Community Health September, 1980 - June, 1984.
Health Education Consultant, State Health Department of Ohio. Served as
consultant to local health agencies, private schools and universities,
communitv croups and private individuals, to identify and list existing health
education - risk reduction activities and to help set up and evaluate programs
to me°t their problems and needs. Responsibilities also included the
provision of g?ant writing assistance to interested local health agencies
January, 1980°- September, 1980.

Publications
Saporito, Raymond and Goldberg, Raymond, "The Changing Image of Prescription
Drug Advertisements, "Journal of Drug Education” Volume 12, No. 4, 1982.
Saporito, Raymond and Goldberg, Raymond, ’’Superfund: Promises versus
Performance”, New York State Journal of Environmental Sanitarians Volume 1,
No. 1, 1984.
Saporito, Raymond, "An Expensive Lesson: The Misuse of a Pesticide In a
School Setting”, Ohio Journal of Environmental Health Volume 43, No. 3,
May/June, 1993.

Professional Organizations

American Public Health Association
Ohio Environmental Health Association
Association of Ohio Health Commissioners

58

JUDITH S. SCHILLING

411 Waterford Street #107, Edinboro, PA 16412 (814) 734-4669
304 Fernledge Drive, New Kensington, PA 15068 (412) 339-4415
EDUCATION:

University of Pittsburgh, Pittsburgh, PA
Family Nurse Practitioner Program
Management of common acute/chronic illnesses and
health promotion for persons of all ages. Nationally
board certified as a FNP. Graduated with QPA of 4.00.
University of Pittsburgh, Pittsburgh, PA
Ph.D. in Higher Education Administration
Dissertation was national study of long-range strategic
planning.

University of Pittsburgh, Pittsburgh, PA
Master of Nursing
Major in medical-surgical nursing and a concentration
in oncology clinical specialist. Graduated 1st in class.
Duke University, Durham, NC
Bachelor of Science in Nursing

EXPERIENCE:
Jan., 1991
to
Present

July, 1984
to
Dec., 1990

Associate Professor, Member of the Graduate Faculty,
and Director of the Master of Science Family Nurse
Practitioner Graduate Program
Edinboro University of PA, Edinboro, PA
With faculty, responsible for all aspects of a 48-credit
MSN FNP program including curriculum development/
implementation/evaluation, and student admissions.
Teach a variety of FNP courses, supervise students’
clinical practicums, and advise students’ thesis
research. Practice one day per week as a FNP. Also
teach pathophysiology, and both the class and clinical
components of medical-surgical nursing and community
health nursing, in BSN program. Serve on many
department and University committees.

Professor and Dean of Institutional Advancement and
Executive Director of the College Foundation
Butler County Community College, Butler, PA is a
comprehensive community college with a full-time
equivalent credit enrollment of 3,400 students. Served
as chief grants officer and fundraiser. Responsible
for all institutional research studies and external
reporting, as well as long-range strategic planning.
Participated in economic development and legislative
efforts. Served as accreditation liaison officer.

• 59

i ember of College’s budget committee; negotiated
acuity and secretarial collective bargaining
agreements. Coordinated the academic program review
process. Supervised the Computer Center and all
Title IX/EEO activities. Also served as Acting Director
of Continuing Education from August of 1988 to April
1989 with responsibility for the College’s entire
noncredits division and three major off-campus sites..

Sept, 1976
to
June, 1984

PjCQfgssor._a_nd .Chairperson, Nursing Division
Butler County Community College, Butler, PA
Administrator of PN/ADN career ladder program.
Responsible for all activities of the Nursing Division
including curriculum development, evaluation,
admissions, all scheduling, budgeting, coordination
with clinical agencies, student advising, and CE
offerings. Averaged 145 nursing students and 15
full-time and part-time faculty/staff. Taught nursing
history and trends course. Served on many Division
and College committees.

Jan., 1375
to
Aug., 1976

Instructor of Nursing
Carlow College, Pittsburgh, PA
Taught all aspects of a 12 credit course in medicalsurgical nursing, and portions of nursing
fundamentals course, in BSN program.

ADDITIONAL EXPERIENCE:
Family Nurse Practitioner, Part-time in family
medical practice in Corry, PA, 1994-Present.
Oncology Clinical Specialist, Mercy Hospital,
Pittsburgh, PA, 1974.

Medical-^Surgical.Nursing Coordinator, Citizens General
Hospital School of Nursing, New Kensington, PA, 19671972.
PROFESSIONAL ME^Corpor^t^on^o^rd^^Member,' PA Blue Shield, 1993-1996.
National League for Nursing
National Organization of Nurse Practitioner Faculty
Si<*ma Theta Tau, International Honor Society of Nsg
American Academy of Nurse Practitioners
Northwestern PA Association of Nurse Practitioners
PA Coalition of Nurse Practitioners, NW PA Rep.
Womens Health Connection, Erie, PA
AIDS Council of Erie, PA
Erie County Tuberculosis Task Force
rh^ir Lon°--Range Planning Council, Butler County
Community College, 1985-1990

• 60

Chair, Middle States Steering Committee, Butler County
Community College, 1983-1985
Chair, Middle States Follow-Up Committee, Butler
County Community College, 1987
Chair, Middle States Steering Committee for Periodic
Review Report, Butler County Community College,
1990.
Member, Middle States Accreditation Evaluation Teams:
Allegheny Community College, MD, 1985
Wor-Wic Technical College, MD, 1985
Gloucester Community College, NJ, 1987
Schenectady Community College, NY, 1989
Member, National Coucil for Resource Development,
Federal Funding Task Force, 1989 and 1990
Member, Western PA Community College Council for
Advanced Technology, 1986-1989; Chair, 1989-90
Member, PA Board of Directors, American Council on
Education National Identification Program for Women
in Higher Education Administration (PACE-NIP),
1988-1991.
Member, EUP Commission on the Status of Women,
1993- Present
Member, EUP Institutional Advancement Committee,
1994- Present
Chair, EUP Graduate Nursing Program Committee
Member, EUP Graduate Council
PUBLICATIONS/PRESENTATIONS:
Schilling, J. S. (Scheduled, July 1997).
Hyperthyroidism: Update On Diagnosis and
Management. Nurs e P.rac ti tio ner.
Schilling, J. S. (December, 1987). Studying the
Costs of Nursing Education: Seven Decades of
Effort. Nursing & Health Care, 8, pp. 575-586.
Schilling, J. S. (February, 1989). Butler County High
School Survey, 1988. Butler, PA: Butler County
Community College. (ERIC Document Number
ED 303 230).
Schilling, J- S. (March, 1988). Butler County
Community CollegeLs^^ngzRan^^^
System. Butler PA: Butler County Community
College. (ERIC Document Number ED 287 534)
Schilling, J. S. (October, 1987). Fact Sheets: A Useful
Way to Disseminate,Community College Institutional
Research. Butler PA: Butler County Community
College. (ERIC Document Number ED 282 617)
Schilling, J. S., & Freedman, F. (Ed). (FebruaryMarch, 1987). The Successful Planning System.
AACJC Journal, 57(4), pp. 48-49.
Guest lecturer, "Regional College/University
Accreditation,"University of Pittsburgh Doctoral
Program in Higher Education, 1984, 1986, and 1990.

61

Consultant, Regional Accreditation, Thaddeus Stevens
Technical College, Lancaster, PA, January, 1988.
Workshop presenter, "Successful Grant-Writing,"
Lawrence County Adult Literacy Project, April 8,
1988.
Roundtable discussion leader, "Regional Economic
Development," Northeast Regional Meeting of the
Association of Community College Trustees,
Annapolis, MD, May 12, 1988.
Presented testimony, PA Senate Committee on
Community and Economic Development, July 19, 1988.
Roundtable discussion leader, "Writing Winning
Grants," Northeast Regional Meeting of National
Council for Resource Development, Baltimore, MD,
May 31, 1990.
Consultant in strategic planning, Community College of
Beaver County, PA, October 9, 1990.

GRANTS:

August, 1996

Wrote and administered more than 60 state, federal
and foundation grants worth over $2 million including
a Title III Strengthening Programs Planning Grant,
projects in adult literacy, economic development,
instructional equipment, job training, and curriculum
development. Experienced in private fundraising.

62

Appendix H
Qualifications of Office Manager and Nurse Practitioner

Curriculum Vitae

Paul E. Thompson, FNP, MSN
4268 Route 167

Jefferson, Ohio 44047
(216) 858-2588
Education

1975 Associate Science Degree AAS

Kalamazoo Valley Community College

Kalamazoo, Michigan

1989 Bachelor Science Degree BSN

Kent State University
Kent, Ohio
1997 Master Science Degree MSN, FNP

Edinboro University
Edinboro, Pennsylvania

Health Care Experience
1991-Present

Nursing Supervisor, Ashtabula County Medical
Center, Ashtabula, Ohio. Duties include

63

maintaining effective operation of a 120 bed
community hospital. Responsible for staffing,
public relations, and acting as on-site
administrator during evening/night shifts.

1992-1996

Emergency Department Nurse, St. Vincent

Hospital, Erie, Pennsylvania. Charge/trauma
nurse and clinical instructor for EMT

students.

1989-1992

Emergency Department Nurse, St. Luke's

Hospital, Cleveland, Ohio. Charge nurse at an
inner city Level I trauma center.

Business Experience

1990-1995

Owner/Operator of Gordon's Gardens, A Retail
Greenhouse Operation, Jefferson, Ohio.

Personally involved with the start-up and day to

day operations of a sucessful business venture

that achieved an average 25% net annunal
growth.

1975-1988

Owner/Operator of Double "T" Farm, Orwell,

Ohio. Duties included all aspects of operation
such as economic forcasting, budgets,

personnel, and negotiating contracts.

1982-1992

Board Member, Ashtabula County Board of

Health.

64

1992-Present

President, Ashtabula County Board of Health

Duties include formulating county health
regulations, enforcement of county and state

codes, labor negotiations, setting budgets and
fees, public speaking on health issues, and

interacting with government and private
agencies.

APPENDIX I - Sliding Fee Scale

65

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