KATHIE KNOBLE-IVERSON: We have a bunch of questions that we want to respond to.

One question was, could we get a sample of the form that I used, or our agency uses to determine hourly costs and rates for staff.

I called our accountant and she's at the doctor this morning.

I can't get it.

But, if we have a form, if she has something that is a format we will post it on the WIKI.

But I wanted to talk a little bit about that.

It's so simple.

If you know how to use Excel, you put the staff names at the top and list every benefit.

And that is why, you can look at ours, we don't have very many benefits for our staff.

You know, we have disability insurance and health insurance.

And that is it.

You individualize that.

You put the wages, FICA and all the benefits you have down the side.

Because they will be individualized.

They will be different for every person.

And then below that line, I take our IL budget and divide all the expenses by the number of staff I have.

So if I am paying $60,000, if that program is paying, this is a lot, we don't pay that much, but $60,000 for rent and I have 12 employees that costs me $5,000 per person per year for rent.

That all gets factored in.

Training is different for different people.

If I have somebody that I know needs 20 hours and somebody who doesn't or have a new staff person that we're going to invest money in, that training budget will be bigger for that person than somebody else.

You have to think individually.

You should be able to have your entire budget allocated to all your staff.

When you're done, it should be zero.

You shouldn't have anything hanging out there that's not allocated and then you add all those up and divide that by how many hours they work in a year and that's how much it costs you to have a staff person around.

Okay?

And if you still don't get it, we'll talk about it.

I did a little sample.

I wrote it out.

I used to do all of that and I now have an accountant who does it for me.

Another question was about private pay.

In personal care we do private pay and because we get such a horrible rate, for what we do.

We charge more for private pay, but we're still the cheapest private pay in our service area.

We don't do private pay, I don't think we have ever had a request in IL for private pay.

If someone comes in and they don't have a funding source if it's a core service, we don't charge them.

Doesn't matter if they have money or not.

Even our benefits specialist and stuff that are all, it's fee-for-service, if someone doesn't have a source, we just provide the service, we don't charge them for it.

Because it gets sticky trying to help people identify, what's your income?

Especially if it's an I&R.

You are starting out, that's not, you might ask that question later on if you're going to open a file.

It can get awkward in the beginning.

So we just don't charge for any service.

Now when you talk about private pay and you talk about 504 assessments, no individual is going to ask you to come and do a 504 assessment in their house.

They're going to ask you to take a look and make sure it's accessible and safe.

We wouldn't do the same kind of report that we would do if we went to a township and did their courthouse.

It that would be different.

The service to the individual would be free.

The service to the courthouse certainly would be paid for.

I consider that private pay.

It's a fee-for-service service.

But it's service to an entity, service, not an individual.

That get answered for whoever asked that?

And then the last one, they wanted examples, this is of both of us, examples of fee-for-service programs that are being currently used and if you go back to day one, both of us listed all the current fees-for-service programs we have and the contracts we have.

And listed, on mine, I listed how much I charge, how long we had it, how we accessed it, whether it was through an RFP or contract, or fee-for, or an hourly unit rate.

I believe that was off day one.

AUDIENCE MEMBER:  That was my question, and what I was looking for in addition to what you have shared is there a place, WIKI or something like that, I came from a culture where best practices were always posted and it would so be cool to have a place where you could look and say, so-and-so in whatever state is running this kind of a fee-for-service.

And it either has been successful or hasn't been successful.

I would like to have examples of what not to do as well as things to do.

We sit around our office and try to dream things up.

It would be very helpful to know thing's that are already out there.

There are really smart people in this room that are doing inventive things and then rather than me trying to exhaust what little gray cell I have left, I'd love to just steal something.

KATHIE KNOBLE-IVERSON:  I guess we would ask the table over there.

Richard, is there such a site?

RICHARD PETTY: No, not to my knowledge.

And it's not something that we at ILRU have developed.

I would draw your attention to the sheet of funding options that was presented on day one.

And somebody can give me the exact title of that sheet, several pages I think.

KATHIE KNOBLE-IVERSON:  I think it was titled buyers, where's the money?

RICHARD PETTY:  Where's the money.

Thank you.

That would be a good example of that.

And we certainly would entertain creating a page like that.

I would tell you that it would take some time resources and if any one or ones of you would be interested in taking a lead on that and doing it and see if you could encourage peers to submit their ideas, we would be happy to work with a group on that.

DENNIS FITZGIBBONS:  I see a grant opportunity out there for somebody in this room.

KATHIE KNOBLE-IVERSON: In Wisconsin, because we have a really state association, Maureen, who is our staff person, has collected all that information.

So that she is aware when she is going going out and doing lobbying and whatever else and, wanting to figure that out, she has a list of everything everybody in our state does.

Because there is a lot of things we all do.

That's the beauty of Wisconsin for us.

If someone is doing a really good job, they got this insight, they share it with everybody and then Maureen goes to that source and tries to lock that in for 
everybody in the state.

Which is really a nice practice.

And I told you what the children's waivers services right now, we are the only resource for social workers to get accessibility assessments done in people's homes.

It's keeping us busy.

It's those sorts of things that in your own state, because things are unique to your state that you might want to do something with.

Yes, Is there a question?

AUDIENCE MEMBER:  Would you be willing to share that with the group?

Although it may be pertinent to just Wisconsin, there are some way that might fit for some of the rest of us.

I concur with the lady's question about getting more information about program income type programs that are actually working.

That's the struggle that I'm having in my center is trying to see what would work in my area.

It's really difficult because we're just limited with our resources.

But if we could just get a lead on maybe some of the, maybe ten programs that are working.

So...

KATHIE KNOBLE-IVERSON: I am going to tell you-even in Wisconsin, you will see that we all do lot of the same things and it works better in some regions than others and it all depends on your VR office or in Wisconsin we do a self-directed model of managed care.

And some counties they are getting 50 or 60 referrals a month.

And in our region, we get 2 or 3 a month.

And it also depends on your population base and other things that are going on in your region.

Yeah, Richard?

RICHARD PETTY:  Darrell just had a great idea and that is we can, from ILRU can do a SurveyMonkey or another survey tool and ask centers around the country to give us that kind of information and we can post the results.

As, I think it will be dependent on how well the field responds, but often we get several good responses and our rate is typically around 75 to 100 or so.

That is a possibility.

KATHIE KNOBLE-IVERSON:  It would be really nice if you would also include, if they would be willing, to take calls from people who are interested.

So that you knew if you had a resource.

AUDIENCE MEMBER:  I think that's a great idea.

Thank you.

DENNIS FITZGIBBONS:  More questions here.

This one is what does an IL assessment look like at your CIL and is it possible to get a copy of your standards for that.

The answer is yes.

We will send it to ILRU to go on the WIKI regarding this conference.

May take a few days to get that done.

Another question is, can you give a basic explanation of a unit cost for non-business majors?

I like the way that was phrased.

Of course, the answer is no.

Actually, see if I can make this work.

A unit cost is the cost for a business such as your CIL to produce and deliver one unit of service.

And it ties into what Kathie was talking about before with looking at that formula for what it costs to employee each person.

But it goes further than that.

You have a unit cost, you have two pieces that go to that.

One are your fixed cost, which I think we did talk about, but to go over that again.

Fixed costs are costs that don't change.

Like rent on your building, utilities and things like that.

And then you have variable costs as well.

Those variable costs might include the cost of employing people, so you have your wages and benefits, things like that.

Might have travel costs, et cetera.

So they can vary.

Then you add your fixed costs to your variable costs and divide by the number of units that you want to sell or provide.

And that would give you your unit cost.

A real world example might be, you leave here today, and you say I've had enough of IL.

I was in Denver, smelled the funny stuff in the air.

I'm going to make brownies now.

So now your fixed costs are, again your rent and things like that, the variable costs are the flour, the sugar, the packaging, the shipping things like that and you add those things together and calculate how many units you want to sell to start out, and divide that into your cost and gives you your unit cost.

Now you know what your unit cost is, you have to mark it up in order to make a profit.

I don't know, does that explain it or not?

Best I can do without a business major.

KATHIE KNOBLE-IVERSON: I heard some comments

DENNIS FITZGIBBONS: Wait a minute-question, Richard?

RICHARD PETTY:  Let me add another way of looking at that.

Think about how your lawyer bills you.

And as painful as that may be, still probably a good example.

Your lawyer may decide that their unit of time that they bill is, say, 15 minutes, they may bill in a tenth of an hour, six minutes.

But lets say that their unit, they determined that their unit cost is $75 for 15 minutes of time that they offer their rates.

$300 an hour and they bill every 15 minutes.

When they pick up the phone, from the time they say hello and how are your kids, their clock is running and they'll bill for any part of that 15 minute time that they had contact with you.

That's their unit of service and you get billed for that time.

That gets negotiated in different ways with different funding sources.

But Dennis has talked about how you calculate that.

A unit can be a period of time.

It can be 15 minutes, an hour, it can be a day, a unit can be a contact.

For example, information and referral in most of our centers is probably just a contact.

A unit could be any number of other things that you might choose it to be, but you have to decide what works in your circumstances.

But in most cases, I think it is safe to say that it's a period of time.

Would that be correct?

DENNIS FITZGIBBONS:  Yes.

KATHIE KNOBLE-IVERSON:  And I want to go back, because I have heard a lot of comments, that there's no way we can charge this amount of money in our region or VR is never going to pay that rate.

If you can't get what it costs you to provide that service, you have to make a decision about whether you can you can afford to do that.

Because then you're supplementing that service out of your IL contracts.

And things start to get complicated then.

Or you start to show a loss every month because you're providing the service.

You have to decide, is that good business or not?

I continue to look for something where somebody sees the value and they're willing to pay for that service.

Tim, can you come up and bump us to the next one?

DENNIS FITZGIBBONS:  One more question.

Three sticky note question.

Both Maine and Wisconsin presenters discussed some programs that have ended or that they are ending.

However, they did not discuss how they to sustain or replace those revenues.

Would like to hear more about that and the impact it would have on their CILs.

And the answer for that, for me, from Alpha One perspective, for a good example, was when we shut down Alpha One Medical, the DME provider.

Certainly it had revenue every year, but we were losing money on a regular basis.

When we made the call to do that, we were down to the final days before we made the decision and we were contacted by a person of, a company that also does sell other DME products that weren't the necessarily the same as we sold, but we had been talking about collaborating for some time.

And, we already made the decision we would close, but fortuitously, this person showed up and wanted to talk about how things were going.

At first, we decided we're not going to play our cards here we're not going to let them know what's going on.

And five minutes later, I said, oh, yes, we are.

Let's just get it all on the table and let him know what's happening and see what comes of it.

And it worked out extremely well.

Because we, on January 1st of a few years ago, we closed the business and this person agreed to hire one of our key employees who had a license to install elevators; he was really happy to get that person on board.

He bought much of our inventory that was left over.

So we were able to recoup some of the cost that way.

We had two vans we used for deliveries.

He paid full value for.

So we had some quick recoupment cash came in, which was good for cash flow and it turned out, and then, within a month, he decided he wanted to rent the service space that we had for the business and a month later, 
he wanted half of the showroom as well.

So now, instead of losing money on a regular basis, we have someone paying rent, which goes right to the bottom line and reduce some of our own fixed costs by doing that.

So it really was a very big positive and made for a quick turnaround in the bottom line for us as a whole.

I would say that's one of the reasons not too wait long.

We waited too long but the end result actually was beneficial to the CIL as a whole.

And we're happy we did it and wished we had done it sooner.

Even though we had revenue, we didn't have the payroll cost, we didn't have the insurance cost, we didn't have the bad debt that was accumulated in a business like that.

Lots and lots of benefits.

KATHIE KNOBLE-IVERSON:  And at our center, the only program that is the home care, the in-home care program.

And I'm guessing that it's just going to naturally ease out of our agency.

And we'll have a decision to make at some point.

Because we have probably about 50 or 60 consumers that have been with us for 12 years and they want to stay with us.

So as an organization, I have whittled down now.

I had to lay off a full-time care manager and not any direct service staff, but we are mean and lean now.

I have one person and 10 percent of another one managing our home care agency.

And we're starting to make money.

And what we're doing with that money is erasing the $5,000 we've lost year to date and we will break even by the end of the year.

And then we'll monitor that very closely.

And as it slowly dies, we will make sure that I ease staff out of that and allocate them to a different program so that we don't lose any money.

And it's a really valuable service.

If the 60 people want to stay with us, we'll keep them and we'll try to maintain that program for as long as we can.

And we are looking.

That's one of the things I put in one of the presentations.

That's why I'm excited about this.

I am looking.

We are looking for all kinds of new ways to take, used to cover 65 percent of our admin.

Now it costs, it covers 28.

So we're, I'm looking for other things and we're going to talk about expansion this morning about what we're going to do to replace personal care.

All your questions answered?

SPEAKER:  All the questions are answered.

SPEAKER:  Great.

SPEAKER:  Super.