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[null,null,null,null,null,null,null,null,"John Snow, Incorporated"]
[]
[null,"Introduction:"]
[null,"The STAR² Center is a project of the Association of Clinicians for the Underserved (ACU).  In partnership with the federal Bureau of Primary Health Care, ACU created the STAR² Center to provide free resources, training, and technical assistance to the health centers facing high workforce need. ACU has contracted with John Snow, Inc. to provide support to the STAR² Center, including the development of this Financial Impact Tool."]
[]
[null,"Ensuring access to the full range of primary care services lies at the heart of the federal Health Center program. Health centers do much more than provide primary health care services, but all the other services depend on the ability to achieve this core mission – access to primary care providers. The STAR2 Center recognizes the need to assist health centers with clinical workforce issues. The inability to recruit and retain a qualified and appropriate primary care workforce creates ongoing difficulties for an organization and the community it serves."]
[]
[null,"Purpose:"]
[null,"The purpose of this Financial Impact Tool is assist you in realizing the actual costs of provider turnover. These costs can include direct costs, such as advertising and recruiting services, but also indirect costs, such as staff time dedicated to finding locum tenens and permanent providers. This tool attempts to quantify the \"tangible\" costs involved in provider turnover. While there are also intangible costs associated with the loss of a provider, such as the cost to have existing providers absorb patient visits while maintaining their own practices; these are difficult to calculate and are not included in the tool. Several of the National Estimates are based solely on physician data and may or may not be applicable for non-physician providers. These include salary, length of vacancy, locum tenens cost, malpractice tail coverage, among others. Please be aware that there are likely differences in these National Estimates as compared to actual figures for non-physician providers."]
[]
[null,"How to Use This Tool:"]
[null,"The workbook has four worksheets. The first worksheet is this Instructions page. The second worksheet is the Financial Impact Tool. The third worksheet (Details) includes the methodology, estimate calculations, and sources that have been used to create the Financial Impact Tool. The fourth worksheet (Notes) documents overall assumptions. "]
[]
[null,"The Financial Impact Tool worksheet includes two tables. The first table is the Data Input Table. The second table, Tangible Costs, will show the results of the Data Input Table.  In the Date Input Table, please enter your actual values for each item in the column labeled Input Value. If you do not know the actual value, you may use your best estimate. If you do not have an estimate, suggested estimates derived from national averages and other sources are included in the gray column labeled National Estimate. Enter this number into the Input Value or click the radio button beside each estimate you would like to use. Clicking the button at the top of the column will automatically input all of the National Estimates. There is a reset button available to remove all of the entries and begin again. If you do not expend costs in a given category, just input a \"0\". The sources and rationale for these estimates can be found in the Details worksheet. Once the Data Input Table is complete, scroll down to the Tangible Costs table to see the Total Financial Impact of provider turnover for your health center."]
[]
[null,"For more information and tools to assist in recruitment and retention, check out the  STAR2 Center website  found at http://www.chcworkforce.org . If you have any questions or suggestions, please contact Allison Abayasekara at 844-ACU-HIRE or using the contact form on the STAR2 Center website."]
[]
[null,"Disclaimer: This project is/was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under U30CS26934, Training and Technical Assistance National Cooperative Agreements for total award amount of $444,989.00. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government."]

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["Data Input Table"]
["Description","Input Value","National Estimate","Select Estimate"]
["Salary Information"]
["Business Office (Patient Accounts/Billing) Salary and Benefits per hour",null,31.73]
["CEO/Administrator Salary and Benefits per hour",null,59]
["Chief Medical Officer Salary and Benefits per hour",null,107.86]
["Human Resources Salary and Benefits per hour",null,31.73]
["IT Hourly Rate plus benefits",null,19.7]
["Leaving Provider Annual Salary plus benefits",null,160000]
["Nurse/MA Hourly Rate plus benefits",null,28.68]
["Other Providers Average Hourly Rate plus benefits",null,92.3]
["Support Staff Salary and Benefits per hour",null,19.46]
["Outside Recruiting Expenses"]
["Recruiting Service",null,26000]
["Advertising Costs (2 national journal print ads, 1 national online service x 3 mths)",null,4200]
["Leaving Provider Practice Information"]
["Average patient visits per day by leaving provider",null,15]
["Average revenue/collections per visit with leaving provider",null,152]
["Malpractice Tail Coverage (if any)",null,12000]
["Locum Tenens or Temporary Provider Arrangements"]
["Estimated length of vacancy in work days",null,120]
["Locum Tenens daily rate",null,1200]
["Housing Expense",null,1200]
["Travel ",null,500]
["Estimated patient visits per day by Locum Tenens",null,9]
["Interview Expense"]
["Number of in-person interviews",null,4]
["Hotel Expense per night per interview",null,137]
["Travel Expense per interview",null,500]
["All Staff breakfast with candidate per interview",null,150]
["CMO lunch with candidate per interview (incl. candidate and guest)",null,75]
["Number of people included in interview dinner per interview",null,10]
["Interview Dinner Cost per person per interview, including tax and gratuity",null,40]
["Cost of other interview items, such as gift baskets, baby sitting service",null,150]
["Hiring Expenses"]
["Relocation Costs",null,10000]
["Signing Bonus",null,8000]
["Publicity Costs",null,250]
["Other Costs, i.e. cell phone, lab coat",null,250]
[]
[]
["Tangible Costs","Cost"]
["A. Termination Costs"]
["1. Human Resources and/ or Business Office Expense for terminating benefits, COBRA adminstration (if applicable), notifying health plans of provider change in status.",{"$f":"B4*5.5","v":0}]
["2. Estimated cost of a Locums Tenens or other part time provider",{"$f":"((B22*B21)+(B23*(B21/20))+B24)-((B9/230)*B21)","v":0}]
["3. Malpractice tail coverage costs, if any ",{"$f":"B19","v":0}]
["A. Total Termination Costs",{"$f":"SUM(B44:B46)","v":0}]
["B. Replacement Costs"]
["4. Advertising Costs",{"$f":"B15","v":0}]
["5. Pre-Interview Staff Time -  to arrange advertising; accept, sort and document applications (written and electronic);  respond to telephone and written inquiries, arrange visits including logistics (hotel, travel, recruitment dinner), schedule telephone interviews and meetings with medical director, other staff involved in the decision process.",{"$f":"(B7*60)+(B12*40)+(B5*10)+(B6*24)","v":0}]
["6. Professional Recruiting Service Expenses",{"$f":"B14","v":0}]
["7. Interview Staff Expenses",{"$f":"(B7*80)+(B12*32)+(B5*32)+(B6*48)","v":0}]
["8. Interview Direct Costs (on-site face-to-face interview visits)",{"$f":"(B29+(B28*2)+B30+B31+(B32*B33)+B34)*B27","v":0}]
["9. Post Interview Expenses - staff time for negotiation, other hiring expenses (bonus, relocation)",{"$f":"(B7*16)+(B5*4)+(B6*4)+B36+B37","v":0}]
["B. Total Replacement Costs",{"$f":"SUM(B49:B54)","v":0}]
["C. Net Impact to Revenue"]
["10. Revenue Loss from Leaving Provider",{"$f":"B17*B18*B21","v":0}]
["11. Revenue Recovered from Locum Tenens",{"$f":"B25*(B18*0.75)*B21","v":0}]
["C. Total Net Impact to Revenue [Recovered - Loss]",{"$f":"B57-B58","v":0}]
["D.  New Hire/Onboarding Costs"]
["12. Payroll startup, Benefit Enrollment, establish passwords,email account ",{"$f":"B7*4.5","v":0}]
["13. Credentialing services cost (internal or Credentialing Verification Organization (CVO))",{"$f":"B4*16","v":0}]
["14. Internal and external publicity announcements ",{"$f":"B38","v":0}]
["15. Equipment and Uniform expense ",{"$f":"B39","v":0}]
["16. Orientation Costs",{"$f":"(B4*8)+(B8*8)+(B11*6)+(B10*20)+(B12*10)+(B5*4)+(B6*10)","v":0}]
["17. Cost of Productivity lost to startup",{"$f":"((B17*B18*5*0.75)*4)+((B17*B18*5*0.5)*8)+((B17*B18*5*0.3)*12)","v":0}]
["D.  Total New Hire/Onboarding Costs",{"$f":"SUM(B61:B66)","v":0}]
["Total Financial Impact",{"$f":"B47+B55+B59+B67","v":0}]

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["Methodology, estimates, and sources."]
["Tangible Costs","Inputs","National Estimate Provided for Convenience","Reference","Calculation","Assumptions"]
["A. Termination Costs"]
["1. Human Resources and/ or Business Office Expense for terminating benefits, COBRA adminstration (if applicable), notifying health plans of provider change in status.","HR/Business Office Hourly Rate plus benefits","$31.73 per hour","o","Hourly Salary/Benefit Rate X 5.5 hours","2.5 hrs benefits, 3 hrs health plan communication; Annual average business office staff salary of $55,000 plus 20% for benefits for all tasks with 2080 hrs per year = $31.73 per hour"]
["2. Estimated cost of a Locums Tenens or other part time provider","Locum Tenens Expense"]
[null,"Daily locum tenens rate","$1,200 per day","b, c","See below"]
[null,"Estimated length of vacancy","120 days","b  ","Locum daily rate X Length of Vacancy (Days)","180 calendar days or 120 working days at 5 days per week for 6 months"]
[null,"Travel Expense",500,"d","Equal to input"]
[null,"Housing Expense","$1,200 per month","e","Rate per month X Length of Vacancy (Months)"]
[null,"HR/Business Office Hourly Rate plus benefits","$31.73 per hour","o","Hourly Salary/Benefit Rate X 12 hours","12 hours staff time for arranging for locum tenens, including communication with firm, coordination of licensing and credentialing; Annual average business office staff salary of $55,000 plus 20% for benefits for all tasks with 2080 hrs per year = $31.73 per hour"]
[null,"Leaving Provider Total Annual Salary and Benefits",160000,"a, h","(Annual Salary + Benefits Divided by 230 days) x estimated length of vacancy"]
[null,"Total Locum Tenens Expense",null,null,"Sum Locum Expenses - Leaving Provider Expenses"]
["3. Malpractice tail coverage costs, if any ","Malpractice Tail Costs (if any)",12000,"f","Equal to input"]
["A. Total Termination Costs",null,null,null,"Sum of 1,2 and 3"]
["B. Replacement Costs"]
["4. Advertising Costs","Advertising Costs",4200,"g","Equal to input","2 national journal print ads X3 months each ($500 per journal/month X 3 months), 1 national online service ($400/month X 3 months)"]
["5. Pre-Interview Staff Time -  to arrange advertising; accept, sort and document applications (written and electronic);  respond to telephone and written inquiries, arrange visits including logistics (hotel, travel, recruitment dinner), schedule telephone interviews and meetings with medical director, other staff involved in the decision process.","Pre-Interview Staff Time"]
[null,"HR Staff Salary and Benefits per hour",31.73,"o","Hourly Salary/Benefit Rate X 60 hours","60 hours: Annual average human resources staff salary of $55,000 plus 20% for benefits for all tasks with 2080 hrs per year = $31.73 per hour"]
[null,"Support Staff Salary and Benefits per hour",19.46,"a","Hourly Salary/Benefit Rate X 40 hours","40 hours: Annual median Support Staff (Med Recept, Med Rec, Med Asst) salary of $33,732 plus 20% for benefits for all tasks with 2080 hrs per year = $19.46 per hour"]
[null,"CEO Salary and Benefits per hour",59,"a","Hourly Salary/Benefit Rate X 10 hours","10 hours: Annual median CEO salary of $102,270 plus 20% for benefits for all tasks with 2080 hrs per year = $59 per hour"]
[null,"CMO Salary and Benefits per hour",107.86,"a, h","Hourly Salary/Benefit Rate X 24 hours","24 hours: Annual average CMO salary of $186,000 plus 20% for benefits for all tasks with 2080 hrs per year = $107.86 per hour"]
[null,"Total Pre-Interview Staff Time",null,null,"Sum"]
["6. Professional Recruiting Service Expenses","Recruiting Service Cost",26000,"i","Equal to input"]
["7. Interview Staff Expenses","Interview Staff Expenses"]
[null,"HR Staff Salary and Benefits per hour",31.73,"o","Hourly Salary/Benefit Rate X 80 hours","20 hours per interview for 4 interviews: Annual average business office staff salary of $55,000 plus 20% for benefits for all tasks with 2080 hrs per year = $31.73 per hour"]
[null,"Support Staff Salary and Benefits per hour",19.46,"a","Hourly Salary/Benefit Rate X 32 hours","8 hours per interview for 4 interviews: Annual median Support Staff (Med Recept, Med Rec, Med Asst) salary of $33,732 plus 20% for benefits for all tasks with 2080 hrs per year = $19.46 per hour"]
[null,"CEO Salary and Benefits per hour",59,"a","Hourly Salary/Benefit Rate X 32 hours","8 hours per interview for 4 interviews - direct interview, staff breakfast, dinner: Annual median CEO salary of $102,270 plus 20% for benefits for all tasks with 2080 hrs per year = $59 per hour"]
[null,"CMO Salary and Benefits per hour",107.86,"a, h","Hourly Salary/Benefit Rate X 48 hours","12 hours per interview for 4 interviews - direct interview, staff breakfast, CMO lunch, tours (including hospital), dinner: Annual average CMO salary of $186,000 plus 20% for benefits for all tasks with 2080 hrs per year = $107.86 per hour"]
[null,"Total Interview Staff Expenses",null,null,"Sum"]
["8. Interview Direct Costs (on-site face-to-face interview visits)","Interview Direct Costs (Non-staff)"]
[null,"Travel Expense per interview","$500 per interview","d","Travel Expense per interview X 4","3 candidate face-to-face interviews; 1 repeat interview for final candidate; Total of 4 on-site interviews"]
[null,"Hotel Expense per night","$137 per night per interview","j","Hotel Expense per night X 8","2 nights per interview for 3 candidate face-to-face interviews; 1 repeat interview for final candidate; Total of 4 on-site interviews"]
[null,"Number of people included in interview dinner per interview",10,null,"Equal to input","CEO couple, CMO couple, MD in same specialty couple, HR/in-house recruiter couple, Candidate couple"]
[null,"Interview Dinner Cost per person per interview, including tax and gratuity","$40 per person","k","Dinner cost per person X # of people X 4 interviews"]
[null,"All Staff breakfast with candidate per interview",150,null,"Breakfaast cost X 4 interviews","Estimate"]
[null,"CMO lunch with candidate per interview","$75 per interview",null,"Lunch cost X 4 interviews","Estimate"]
[null,"Cost of other interview items, such as gift baskets, baby sitting service","$150 per interview",null,"Other costs X 4 interviews","Estimate"]
[null,"Total  Direct Costs (Non-staff)",null,null,"Sum"]
["9. Post Interview Expenses - staff time for negotiation, other hiring expenses","Post-Interview Expenses"]
[null,"HR Staff Salary and Benefits per hour",31.73,"o","Hourly Salary/Benefit Rate X 16 hours","16 hours negotiation, contracts, processing signing bonus & relocation expenses: Annual average business office staff salary of $55,000 plus 20% for benefits for all tasks with 2080 hrs per year = $31.73 per hour"]
[null,"CEO Salary and Benefits per hour",59,"a","Hourly Salary/Benefit Rate X 4 hours","4 hours negotiation and contracting: Annual median CEO salary of $102,270 plus 20% for benefits for all tasks with 2080 hrs per year = $59 per hour"]
[null,"CMO Salary and Benefits per hour",107.86,"a, h","Hourly Salary/Benefit Rate X 4 hours","4 hours Q&A, check-in: Annual average CMO salary of $186,000 plus 20% for benefits for all tasks with 2080 hrs per year = $107.86 per hour"]
[null,"Signing Bonus",8000,"h, l","Equal to input","5% of provider's antipated net pre-tax income ($160,000 for FP)"]
[null,"Relocation Costs",10000,"l","Equal to input"]
[null,"Total Post-Interview Expenses",null,null,"Sum"]
["B. Total Replacement Costs",null,null,null,"Sum of 4, 5, 6, 7, 8, and 9"]
["C.Net Impact to Revenue"]
["10. Revenue Loss from Leaving Provider","Revenue Lost"]
[null,"Estimated length of vacancy","120 days","b  ","Equal to input","180 calendar days or 120 working days at 5 days per week for 6 months"]
[null,"Average # patients per day by leaving provider","15 visits per day","m","Length of vacancy X patients per day","Gross Visits lost due to vacancy"]
[null,"Average revenue/collections per visit with leaving provider","$152 per visit","n","Gross visits X Collections per visit","Gross Revenue lost due to vacancy"]
[null,"Total Revenue Lost",null,null,"Gross visits X Collections per visit"]
["11. Revenue Recovered from Locum Tenens","Revenue Recovered"]
[null,"Estimated length of vacancy","120 days","b  ","Equal to input","180 calendar days or 120 working days at 5 days per week for 6 months"]
[null,"Visits per day by locum tenens","9 visits per day",null,"Locum visits per day X length of vacancy","Estimate between 1/2 and 3/4 productivity due to no marketing, patient choice and acclimation to practice; Total visits provided by locum tenens"]
[null,"Average revenue/collections per visit with Locum Tenens","$114 per visit",null,"Total Locum visits X 75% of Collections per visit","Recovered Revenue due to Locum Tenens; assume that visits may be lower intensity due to patient choices 75% of collections plus differences in billing"]
[null,"Total Revenue Recovered",null,null,"Total Locum visits X 75% of Collections per visit"]
["C. Total Net Impact to Revenue [Recovered - Loss]",null,null,null,"Total Revenue Recovered - Total Revenue Lost"]
["D.  New Hire/Onboarding Costs"]
["12. Payroll startup, Benefit Enrollment, establish passwords,email account ","HR Hourly Rate plus benefits","$31.73 per hour","o","Hourly Salary/Benefit Rate X 4.5 hours","4.5 hrs benefits; Annual average business office staff salary of $55,000 plus 20% for benefits for all tasks with 2080 hrs per year = $31.73 per hour"]
["13. Credentialing services cost (internal or Credentialing Verification Organization (CVO))","Business Office Hourly Rate plus benefits","$31.73 per hour","o","Hourly Salary/Benefit Rate X 16 hours","16 hrs average; Annual average business office staff salary of $55,000 plus 20% for benefits for all tasks with 2080 hrs per year = $31.73 per hour"]
["14. Internal and external publicity announcements ","Publicity Cost",250,null,"Equal to input","Estimate"]
["15. Equipment and Uniform expense ","Cell phone and lab coat cost",250,null,"Equal to input","Estimate"]
["16. Orientation Costs","Orientation Costs"]
[null,"HR Hourly Rate plus benefits","$31.73 per hour","o","Hourly Salary/Benefit Rate X 8 hours","8 hrs; Annual average business office staff salary of $55,000 plus 20% for benefits for all tasks with 2080 hrs per year = $31.73 per hour"]
[null,"IT Hourly Rate plus benefits",19.7,"a","Hourly Salary/Benefit Rate X 8 hours","8 hrs; Annual average health information technician salary of $34,160 plus 20% for benefits for all tasks with 2080 hrs per year = $19.70 per hour"]
[null,"Other Providers Average Hourly Rate plus benefits","$92.30 per hour","a, h","Hourly Salary/Benefit Rate X 6 hours","6 hrs average; Annual median FP salary of $160,000 plus 20% for benefits for all tasks with 2080 hrs per year = $92.30 per hour"]
[null,"Nurse/MA Hourly Rate plus benefits",28.68,"a","Hourly Salary/Benefit Rate X 20 hours","20 hours; Annual median Nurse/MA salary of $49,626 plus 20% for benefits for all tasks with 2080 hrs per year = $28.63 per hour"]
[null,"Support Staff  Hourly Rate plus benefits",19.46,"a","Hourly Salary/Benefit Rate X 10 hours","10 hours: Annual median Support Staff (Med Recept, Med Rec, Med Asst) salary of $33,732 plus 20% for benefits for all tasks with 2080 hrs per year = $19.46 per hour"]
[null,"CEO Salary and Benefits per hour",59,"a","Hourly Salary/Benefit Rate X 4 hours","Annual median CEO salary of $102,270 plus 20% for benefits for all tasks with 2080 hrs per year = $59 per hour"]
[null,"CMO Salary and Benefits per hour",107.86,"a, h","Hourly Salary/Benefit Rate X 10 hours","Annual average CMO salary of $186,000 plus 20% for benefits for all tasks with 2080 hrs per year = $107.86 per hour"]
[null,"Total Orientation Costs",null,null,"Sum"]
["17. Cost of Productivity lost to startup","Cost of Productivity lost to startup"]
[null,"Average # patients per day by leaving provider","15 visits per day","m","Equal to input","Expected average visits for fully integrated provider"]
[null,"Average revenue/collections per visit with leaving provider","$152 per visit","n","Equal to input","Expected average revenue for fully integrated provider"]
[null,"Month 1 reduction factor",0.75,null,"Equal to input","Estimate for Month 1 ramp up"]
[null,"Months 2 and 3 reduction factor",0.5,null,"Equal to input","Estimate for Months 2 and 3 ramp up"]
[null,"Months 4 - 6 reduction factor",0.3,null,"Equal to input","Estimate for Months 4 - 6 ramp up"]
[null,"Months 7 - 12 reduction factor",0.2,null,"Equal to input","Estimate for Months 7 - 12 ramp up"]
[null,"Cost of Lost Productivity - Month 1",null,null,"Visits per day X Revenue X 75%","Estimate for Month 1 ramp up"]
[null,"Cost of Lost Productivity - Months 2 and 3",null,null,"Visits per day X Revenue X 50%","Estimate for Months 2 and 3 ramp up"]
[null,"Cost of Lost Productivity - Months 4 - 6",null,null,"Visits per day X Revenue X 30%","Estimate for Months 4 - 6 ramp up"]
[null,"Total Cost of Productivity lost to startup",null,null,"Sum of Lost Productivity"]
["D.  Total New Hire/Onboarding Costs",null,null,null,"Sum 12, 13, 14, 15, 16 and 17"]
[]
["Sources: (All sources were accessed in October 2015)"]
["a.  MGMA Cost Survey for Single-Speciality Practices 2012 report based on 2011 Data; FP Physician Owned"]
["Median Operating Cost by Employee Type per FTE Physician / Median FTEs by Employee Type per FTE Physician"]
["Average benefit % for non-provider staff - 20%"]
["b. Data from Association of Staff Physician Recruiters (ASPR) cited in Society for Human Resource Management. Accessed at http://www.shrm.org/hrdisciplines/staffingmanagement/articles/pages/physician-recruitment.aspx"]
["c. Miller, Philip. Trend - The Growing Use of Locum  Tenens Providers as a Supplement To  Permanent Medical Staff. 2010. Accessed at http://www.staffcare.com/uploadedFiles/StaffCare/Content/Resource_Center/The%20Growing%20Use%20of%20Locum.pdf"]
["d. Tuttle, Brad. Average Airfare Soars Past $500! 5 Tips to Save on Flights. August 5, 2014. Accessed at http://time.com/money/3082797/how-to-save-cheap-flights-tips/"]
["e. Glink, Ilyce. Top 10 US Cities to Rent an Apartment. July 20, 2013. CBS Money Watch. Accessed at http://www.cbsnews.com/media/top-10-cheapest-us-cities-to-rent-an-apartment/"]
["f. Medical Economics. Accessed at http://medicaleconomics.modernmedicine.com/medical-economics/content/tags/2013-salary-survey/competition-driving-malpractice-premiums-down?page=full"]
["200% of median annual FP malpractice for 2012: $11,900 X 2=$23,800, IM: $12,800 X 2=$25,600"]
["g. New England Journal of Medicine and Journal of American Medical Association websites accessed at NEJM.org and JAMAnetwork.com"]
["Accessed October 2015: NEJM small print ad $500 per month, JAMA 1 column inch $500 per month, also can get membership $750-1,000 NEJM Physician Career Center for Employers 30 days online ad and physician profiles, similar service for JAMA -  $331 per month"]
["h. National Association of Community Health Centers (NACHC) 2013-2014 Provider Salary Survey"]
["i. Data from Association of Staff Physician Recruiters (ASPR) cited in Society for Human Resource Management. Accessed at http://www.shrm.org/hrdisciplines/staffingmanagement/articles/pages/physician-recruitment.aspx"]
["j. Domestic Hotel Price Index. Review of Global Hotel Prices, January - June 2014. Accessed at http://www.hotel-price-index.com/2014/fall/us/chapter-2/"]
["k. Meal for 2 People, Mid-range Restaurant, Three-course . Cost of Living in United States. Numbeo.   Accessed at http://www.numbeo.com/cost-of-living/country_result.jsp?country=United+States - $50"]
["l. Bonds, Roger G. As the Economy Improves, Medical Staff and Employee Recruitment Heat Up. Physician Recruitment. Physician Career Advisor. American Academy of Medical Management. June 12, 2014. Accessed at http://aammweb.com/economy-improves-medical-staff-employee-recruitment-heats/"]
["m. UDS National Health Center Data, 2013 - FP = 3,346 per year or 15 patients per day"]
["n. MGMA Physician Compensation and Production Survey for Single-Speciality Practices 2012 report based on 2011 Data (FP w/o OB Median figures used) - 2012 MGMA - $152 collections per visit"]
["o. United States Dept of Labor, Bureau of Labor Statistics, 2012 HR. Accessed at http://www.bls.gov/ooh/healthcare/home.htm (HR/Business office average annual salary $55,640, Health Information Technicians average annual salary $34,160)"]

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["Notes:"]
["This tool was developed by John Snow, Inc. for the STAR2 Center."]
["The final tool builds upon the work conducted by HoltonHealthcare Consulting, Raleigh, NC and  the National Association of Community Health Centers (Calculating the Cost of Turnover in Your Health Center: A Guide)."]
["The information provided in this worksheet is intended for making estimates of the costs related to the loss of an existing provider and the recruitment and onboarding of a new provider as a replacement."]
["The termination costs are for providers leaving of their own accord, not providers being terminated by the organization. In an instance of firing, there is unlikely a choice between increasing retention efforts to avoid recruitment of a new provider and losing the existing provider. In addition, the costs of firing a provider are extremely difficult to estimate since there could be legal action involved."]
["National Estimates are provided for convenience and do not differentiate by region, provider type or other variations; they are averages."]
["The National Estimates  assume previously budgeted items, such as accrued vacation and final retirement contributions, are not additional costs, but have already been accounted for in the existing CHC budget. Additional benefit extensions negotiated as part of the separation are also not included in these calculations."]
["Several of the National Estimates are based solely on physician data and may or may not be applicable for non-physician providers. These include salary, length of vacancy, locum tenens cost, malpractice tail coverage, among others. Please be aware that there are likely differences in these National Estimates as compared to actual figures for non-physician providers."]
["There are likely intangible costs associated with the loss of a provider, such as the cost to have existing providers absorb patient visits while maintaining their own practice. "]
["While staff time may already be included as part of the health center budget and does not appear to be an additional cost, frequent vacancies can increase the need for more staff. "]
["In addition, there are opportunity costs: Using staff for recruiting means that they are not available for other job functions. Additional stress on staff can cause more turnover."]