Conservative Estimation68
When preparing a budget, try to be as accurate as possible. Always use actual figures if you have them, and when you don't, estimate conservatively, meaning high for expenses and low for income.
When you estimate expenses, guess high. For instance, take your highest monthly phone bill and multiply it by 12 rather than taking an average. By the same token, when you estimate income, guess low, using the smallest number realistically possible. Estimating conservatively when you plan your budget will make it more likely that you stay within it over the course of the year.
One of the most important steps in starting a SANE program is creating an operating budget. The budget provides the overview, encourages finding effective ways to address money issues, fills the need for required information (funding proposal, rationale, and reports), and facilitates discussion of the financial realities of the program or organization.
If the program is hospital-based, the office of the chief financial officer may create the budget, but the program manager should have input on what is included. The budget should be defined as either a stand-alone cost center or part of a larger department’s budget (e.g., the ED). If starting a community-based, free standing, or entrepreneurial SANE program, budget creation is a critical step in the feasibility evaluation of the project.
The budget should include both startup and annual costs and revenue. Many startup expenses, such as capital equipment, occur initially and then not again for several years. One option is to include the startup expenses in the first year’s budget. In this instance, note which expenses fall into the one-time-only versus annual category.
Budget creation is typically based on “conservative estimation.” When creating the startup budget, establish your available capital. Available capital may be in the form of grants, donations, and upfront money promised by the institution. In many instances, reimbursement may already be established and ongoing, but if the program is truly just beginning, it may take some time before it begins to receive reimbursement for services.
Identify all of the anticipated startup costs, as well as ongoing expenses. These figures may be estimates or based on actual numbers from previous years.
Startup Expenses
Initial purchase of durable equipment is reflected in the initial startup costs. All equipment over capital budget in cost will require replacement planning in future year budgets based on the anticipated lifespan of the equipment. Additionally, maintenance costs for capital equipment should be reflected in subsequent budgets. The following is a list of possible equipment to anticipate:
Not all of the equipment listed is required in a program. Some programs may choose to begin on a smaller scale with regard to equipment, setting specific annual equipment goals.
Ongoing Annual Expenses
Personnel
Salaries for part- or full-time, on-call, and per diem staff, including benefits at the appropriately designated rate for the institution, should be identified. Salaries should be based on formulas utilized institution-wide for other specialty nursing services (e.g., call rate). Benefits for part- and full-time employees range from 25–40 percent of the annual salary and should be figured in to overall expenses for personnel. Malpractice insurance would typically be provided by institutions hiring full-time, part-time, or per diem SANEs, whereas institutions contracting out for SANE services would typically expect the SANE contractor to carry her/his own insurance. Court preparation and testimony time would generally be considered paid time by the institution.
Disposable Equipment
Equipment that is considered disposable, but is required on a routine basis in order to provide services effectively, should be calculated into the budget expenses. This would include supplies such as disposable speculums, lubricant, toluidine blue dye, urinary catheters, bags for evidence, labels, swabs, evidence collection kits, urine collection kits, blood drawing equipment, rulers or measuring tapes, CDs for giving photographs to law enforcement, medications, sheets, blankets, and patient clothing.
Facility Expenses
Facility expenses include rent/mortgage for office space and examination space, utilities (electricity, phone, Internet, TV), office supplies, cleaning services and supplies, security services, general facility insurance, and maintenance.
Expenses Related to Providing Accessibility to Patients With Disabilities
In hospital programs, equipment related to items such as adaptive aids or American Sign Language (ASL) interpreters may be part of the overall hospital budget. For community-based programs, budgets should consider interpreter costs and possibly structural changes to a facility to make it accessible for all patients. According to the Vera Institute of Justice Center on Victimization and Safety, the average cost for an ASL interpreter is between $55 and $65 per hour, with a minimum of two interpreters required in a team-interpreting format.
Expenses Related to Providing Interpreters to Patients With Low English Proficiency
All programs should include the costs of providing interpretation services for patients with low English proficiency (LEP). It is important to always use certified interpreters and to never rely on family members to interpret. Language lines and video conferencing services can provide interpretation when in-person interpretation is not possible.
Educational Expenses
If the program covers educational expenses, they may include training for SANEs, ongoing continuing education, and certification costs, plus travel, lodging, and per diem.
Determining Program Revenue
The revenue should be based on realistic projections of patient volume and expected reimbursement rates. This is often estimated from historical data on the number of cases and number of patients served. This is where to include startup money, annual stipends/donations, revenue from benefits/donors, and grant awards. Revenue should be estimated using insurance or crime victims’ compensation reimbursement based on expected census and other sources of potential revenue/income.
It is important to understand that there may be a delay from the time a program starts seeing patients until it begins receiving revenue. Having adequate funds to operate for 3 to 6 months until revenue is available is an essential part of program development. Once a program is established, it is advisable to create a reserve account containing 3 to 12 months of funds to pay operating expenses to keep a program from closing in case of an emergency. For example, cuts or freezes in the budget may stop or limit sources of payment for a period of time.
Reducing Need for Revenue With In-Kind Donations
For community-based programs, in-kind donations may be an alternative for funding program expenses other than salaries. For example, community businesses may be willing to donate office supplies, clothing for victims, or food for patients or staff meetings. Programs may be able to receive donated office or examination space from another organization. Hospitals may be willing for community-based SANE programs to obtain equipment, such as examination beds, from a surplus facility.
When creating projected subsequent year budgets, try to include a 2–4 percent cost of living increase for all expenses. The key to any budget is that it is realistic and appropriately represents all potential expenses and income for the program.