Diabetic Skin Solutions:

A SKIN, FOOT, AND WOUND CLINIC

BY: NICOLE CORY, LISA MARTINEZ

JUDY SPOOR, AND JENNIFER WILLIAMS
 Diabetic Skin Solutions: The Beginning

While working with a Nurse Practitioner at her place of employment,

Lisa Martinez, RN, identified a need in the Mecosta County area for a
diabetic clinic. This project may someday become a reality with her efforts.
The clinic will provide diabetic education, wound care, and basic skin
care. The goal of the clinic is to decrease or eliminate long-term
complications of diabetes through the provision of education and to help
patients deal with skin and wound related complications of the disease. The
belief is that a clinic can provide diabetic patients with the right tools and
education to help improve their quality of life.
 Assessment of the internal and
Diabetic Skin
Solutions external environments
demonstrates a need for this
clinic due to the high obesity rate,
and advanced age of area
residents. External and Internal
forces against/for the service are
explained in two parts.
 Capability of the environment to support service of
diabetic foot clinic

Rural community - closest major health system is approximately 60

miles away from Mecosta/Osceola County.

Many smaller communities around Reed City/Big Rapids travel here

for medical care.

High obesity rate and, in turn, increased risk for diabetes.

Statistics show increased number of children with diabetes due to

obesity

Retirement community of older residents in Great Lakes means

increased health problems due to aging.

 Forces For or Against the Clinic

Forces For Forces Against

No other clinic in the area for specified DM

wound/skin care.
Funding for initiation of the

Office space readily available clinic/organization would be need to be

The area services multiple counties with provided through grants.
medical necessities ensuring a large client
Difficulty with Certification for private
base. insurance/Medicare.

Low advertising rates in the local paper
Most likely would not accept Medicaid.

Group of physicians in our practice have
This would be a new service, and would be
stated plans to support the clinic with unfamiliar to members of the community.
referrals .

Would have space available for the clinic in
two locations - Reed City and Big Rapids.

Convenient location near the local hospital.

Would be overseen by Internal Med

Would provide charity/pay scale care to
uninsured or underinsured clients.
 Health Trends in the Mecosta County Area

According to the Michigan Department of

Community Health (MDCH, 2007), it is estimated
that 1300 adults in Osceola County have diabetes.
Diabetes affects approximately 700 males and 600
females in Osceola County. Diabetes related deaths
have increased from 14.8 to 20.2 per 100,000
population since 1989 (MDCH, 2009). There are no
free clinics listed for Osceola County (TIPDON,
2009).
 Our Mission and Philosophy
Mission Statement

To improve the quality of life of
patients diagnosed with Diabetes
through education and treatment,
with a focus on diabetic skin and
foot care.
Philosophy

Making a difference by
empowering diabetic patients with
exceptional education, innovative
treatments, continuous
improvement, and compassionate
care by maintaining a trusting
relationship while involving
patients and families in the
prevention of complications
related to Diabetes and skin care
issues.
 Goals

To improve our patients’ knowledge base of diabetes by providing inclusive, individualized, one-on-one

diabetic education to patients/families with a focus on diabetic compliance.

Implement creative approaches to caring for the diabetic patient.

Provide comprehensive care with a diabetic care team consisting of a physician, certified nurse educator, and

registered nurse.

Implement creative approaches to caring for the diabetic patient.

Enhance the diabetic patient’s understanding/knowledge of the importance of skin and foot care with an

emphasis on those at higher risk.

Empower diabetic patients to be involved in skin disorder prevention.

Develop and enhance support systems for those affected by diabetes

through collaboration with other caregivers.

 Objectives

Provide a one hour initial assessment

Annual comprehensive skin/foot exam with continued education about the diabetic effects on skin/feet.

Educate all patients on self skin/foot evaluation.

Motivate the diabetic patient to incorporate physical activity into their lifestyle.

Provide inclusive, individualized, one-on-one diabetic education to patients/families with a focus on diabetic
compliance.

Motivate the diabetic patient to incorporate physical activity into their lifestyle.

Communicate effectively with patients and families in a patient centered manner to improve the
understanding of diabetes and compliance.

Develop appropriate strategies that encourage newly diagnosed patients to participate in continued education
and medical evaluation.

Provide emotional support and resources to assist patients and families in dealing with a diabetes diagnosis.

Continually improve organizational strategy including confidentiality and communication with patients,
patients’ families, and other health care providers
Diabetic Skin
Solutions: A Skin ,
Foot, and Wound
Clinic, will employ a
Medical Director,
Nurse Practitioner, a
Clinic Coordinator, a
Medical Assistant,
and a Secretary who
also performs the
duty of Medical Job Descriptions
Billing.
 Medical Director

Job Description

Must be able to ensure compliance with policies and regulatory requirements, coordinating with other
department heads to ensure the organization's goals and objectives are met facility wide. Create and
implement a best practice program, maintaining a consistent level of quality of care offered to patients.

Must possess excellent interpersonal and management skills, as he/she is responsible for the entire
clinical team. Additionally, organizational and reporting skills are imperative. Should also have
exceptional research and writing skills, as he/she must constantly seek out new procedures to assist
his/her facility in running as efficiently as possible.

Educational Requirements

Required to be a medical doctor, with at least 5 years of professional experience in diabetic or related
treatment. Additionally, he/she must be board-certified within this area of specialty. Preferred
certified medical director through the American Medical Directors Association, although this is not
required.
 Nurse Practitioner

Job Description

Will provide diagnosis, treatment, consultation, and follow-up under the supervision of a physician.
Must possess extensive knowledge of diabetes management as well as pathophysiology, nursing
theory, and process. Must possess excellent interpersonal and management skills. Responsible for the
assessment and care of diabetic patients with emphasis on skin and foot care, provide patients with
appropriate specialty referrals, prescribe medications appropriately, provide accurate diabetic
education on an individual basis, ordering of treatments, providing direction regarding appropriate
follow-up care. Must be able to directly supervise 2 to 4 employees.

Educational Requirements

Masters of Nursing Degree with at least one year Nurse Practitioner experience. Additional experience
in clinical nursing or treatment with diabetic patients preferred. Current professional license and
certification in the state of Michigan.
 RN, Clinic Coordinator

Job Description
Must possess extensive knowledge of diabetes management as well as pathophysiology, nursing
theory, and process. Clinical and technical skills to assess patients recommend treatment plans and
manage community resources in relation to diabetic skin/foot care. Must possess excellent
interpersonal and management skills. Must be capable of collaboration with patients and other
caregivers to create a patient centered plan of care. Will also be responsible for evaluation of the
effectiveness and compliance of the plan of care. Must be able to directly supervise 2 to 4 employees.

Educational Requirements

The clinic coordinator must be currently licensed as a registered nurse in the state of Michigan.
Current certification in diabetic education or willingness to obtain within 90 days of employment.
 Medical Assistant

Job Description

Must function as a member of the medical team, working under the supervision of a licensed provider. Will provide
safe, knowledgeable, compassionate, and individualized care to patients and their families. Must possess excellent
written and interpersonal skills.
Must have the ability to work well with physicians, employees, patients, and others. Required mobility, walking and
standing for extended periods. Job tasks include but are not limited too; interviewing patients to obtain medical history
and their chief complaint. Measuring and recording patient vital signs. Showing patients to the examination rooms and
preparing them for the provider. Collecting blood, tissue or other laboratory specimens and preparing them for testing.
Assisting the provider with exams. Additional training in ordering, stocking, and sterilization of instruments will be
provided. Any additional tasks delegated by manager.

Education Requirements
Must have completed a medical assistant degree or be a certified medical assistant.
Preferably one year of experience in a related position preferred, although not required. Must have current CPR
training. Must have basic understanding and some advanced knowledge in medical terminology. Past education in
medical terminology field preferred, although not required.
 Receptionist/Biller

Job Description

Responsible for patient reception, obtaining insurance and basic patient information, filing and chart
compilation, perform basic monetary transactions, answering telephones and scheduling
appointments, assistance with ordering of supplies, billing and insurance, data processing, use of basic
office equipment including copier and fax machines. Must be familiar with basic computer systems.

Education Requirements

High school diploma or equivalent. Certified Billing & Coding Specialist or CPC Certified Professional
Coder. Two plus years in similar position, preferably in medical environment preferred. Must have
basic understanding and some advanced knowledge in medical terminology.
 Organizational Chart

MEDICAL
DIRECTOR

NURSE RN
PRACTITIONER CLINICAL MANAGER

RECEPTIONIST MEDICAL
ASSISTANT

Our organization will be a flat or decentralized organization. Decision making will be spread commonly
among many people. Additionally, there will be encouraged autonomy and independence.
Referral Source Diagram

Diabetic
Solutions: A
Physician’s
Skin, Foot,
offices
and Wound
Clinic

Patient and
Local
Family
Hospitals
Education

Diabetic
Support
Groups
 Advertisement
THE CLINIC WILL PLACE TWO ADS FOR THE
CLINIC COORDINATOR.
ONE AD WILL BE PLACED IN THE BIG RAPIDS
PIONEER NEWSPAPER
THE SECOND AD WILL BE POSTED IN THE
PROFESSIONAL JOURNAL
TITLED DIABETIC CARE
 Professional Journal Ad

This ad will run in the professional journal titled Diabetic Care. The
cost of this advertisement will be $1510.00. This will be a one time ad
in one Journal. The ad would run as a ¼ page advertisement. In the
interest of cost effectiveness we would not re-run this ad if the position
was not filled.
 RN CLINIC COORDINATOR
Diabetic Skin Solutions: A Skin Foot & Would Clinic
We are a new innovative clinic, located in Michigan, that is looking for the
appropriate individual interested in improving the care of the Diabetic patient.
Job Requirements
Needed individuals must possess extensive knowledge of diabetes management
as well as pathophysiology, nursing theory, and process. Clinical and technical
skills to assess patients recommend treatment plans and manage community
resources in relation to diabetic skin/foot care. Must possess excellent
interpersonal and management skills. Must be capable of collaboration with
patients and other caregivers to create a patient centered plan of care. Will also be
responsible for evaluation of the effectiveness and compliance of the plan of care.
Must be able to directly supervise 2 to 4 employees.
Educational Requirements
The clinic coordinator must be currently licensed as a registered nurse in the state
of Michigan. Current certification in diabetic education or willingness to obtain
within one year of employment.
Send Resumes to: 20095 Gilbert Road, Big Rapids, Michigan 49307
@ For questions and Benefit information go to:
www.medicalspecialists.com
 Diabetic Skin Solutions: A skin, foot, and
wound clinic
Newspaper Ad We are a new innovative clinic in Big Rapids, looking

This ad will run in for the appropriate individual interested in

improving the care of the Diabetic patient. We are
the Big Rapids
seeking a Registered Nurse, licensed in the State of
Pioneer Newspaper,
Michigan, to provide patient care, patient teaching,
the ad will run in the
and supervision in a clinic setting. Preferred
classifieds help
certification as a Diabetic Educator, or willingness
wanted section in
to obtain within one year of hire. Competitive
black and white for 7 salary and benefits. Please submit resume to: Neita
days and will cost Dorais @ 20095 Gilbert Road, Big Rapids,
$123.35. Michigan 49307 or www.medicalspecialists.com
 Budget Proposal
Budget Summary

The excel document on the next slide includes our initial budget for the start
up of our organization. We have decided to recruit a physician on a consult-
ation basis only, as our nurse practitioner will be able to see and treat patients. In addition,
we have made an organizational decision to not provide benefits to our staff related to the
part-time status of the clinic.

We have researched and found that many of our initial needs will be provided by our
sponsor company that will be allowing us to lease our office space. Much of the needed
equipment for office set up is already existent within the office space. We have set aside
additional budgets for supplies and miscellaneous needs that may be unexpected.

Calculations show that we will run somewhat in the red with our reimbursements; however
the plan is to apply for a yearly grant to supplement our establishment. Grants are approved
according to need; therefore we will be requesting a set amount per year. We will also be
implementing relationship for cash donations as well as patient equipment supplies.
Additional revenue will be rolled into the organization for additional needs and new
equipment. Yearly budgets will be created and adjusted in comparison to the previous years
profits/losses.
 Diabetic Skin Solutions: A foot, skin, and wound
clinic

Expenses
Annual salaries: Nurse Practitioner 75,000, RN
47,000. Biller/Sec 38,000. Clinic will be open 20
Salaries and Wages 80,000 hours a week.
Contract with a physician for oversight at 5,000
Physician Fees 5,000 annually
Purchased Services (cleaning "Completely Clean" charges 35/hr for services. Staff
crew) 5,250 clean up during week. Service on Sat. 3 hours.
Office supplies, File Cabinets $270, Paper $45, File
Supplies (office) 580 folders 400=$265

Supplies(equip) 200 Diascan Machine

Supplies (medical)
Occupancy (building rent,
utilities, etc.)
Insurance (general liability,
and professional liability)
basins, nailclippers, soap, lotion, saline wash, 4x4's,
roll gauze, mirros, nail files. (BP cuff, thermometer,
750 pens, clipboards, exam chairs) already available.
10,400 200 per week to include rent and utilities.
12,000

Other(misc.) 500

114,680
Diabetic Skin Solutions: A foot, skin, and wound care
clinic

Income

NP bills for an office visit

(level 99213) then
Medicare will pay
$65.00. 20 hours
week=35 visits x 50
Insurance/patient pay. 113,750 weeks/yr.

grants
50,000

Johnson/Johnson, Robert
donations 0 Wood,

163,750
 References

Michigan Department of Community Health, (2007). Estimated Number of Adults with Diabetes-
Michigan. Retrieved from http://www.michigan.gov
/documents/mdch/EstDMPrevByCountyRegion_2007_283609_7.pdf

Michigan Department of Community Health, (2009) Diabetes-related Deaths and Death Rates
Osceola County Residents, 1989-2007. Retrieved from
http://www.mdch.state.mi.us/pha/osr/chi/CRI/CriticalInd/Crico.asp?TableType=Diabetes-
related&CoName=Osceola&CoCode=67

Northern Michigan’s Diabetes Outreach network. (TIPDON) (2009). Retrieved from

http://www.diabetesinmichigan.org/PDF/ pdfTIPDON/ResDirTIPDON.pdf