Role of the Internet in Physician-Patient Relationships: The Issue of Trust Net Present Value (NPV) / MBA Resources

Introduction to Net Present Value (NPV) - What is Net Present Value (NPV) ? How it impacts financial decisions regarding project management?

NPV solution for Role of the Internet in Physician-Patient Relationships: The Issue of Trust case study

At Oak Spring University, we provide corporate level professional Net Present Value (NPV) case study solution. Role of the Internet in Physician-Patient Relationships: The Issue of Trust case study is a Harvard Business School (HBR) case study written by S. Altan Erdem, L. Jean Harrison-Walker. The Role of the Internet in Physician-Patient Relationships: The Issue of Trust (referred as “Physician Patient” from here on) case study provides evaluation & decision scenario in field of Technology & Operations. It also touches upon business topics such as - Value proposition, Leadership, Marketing.

The net present value (NPV) of an investment proposal is the present value of the proposal’s net cash flows less the proposal’s initial cash outflow. If a project’s NPV is greater than or equal to zero, the project should be accepted.

NPV = Present Value of Future Cash Flows LESS Project’s Initial Investment

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Case Description of Role of the Internet in Physician-Patient Relationships: The Issue of Trust Case Study

The Internet has proven to be a powerful and very popular vehicle for distributing health information to millions of individuals; it is interactive, user-controlled, and provides an effective means for communicating detailed information. While there has been increasing use of the Internet in healthcare, little research has been conducted to examine what, if any, impact the availability and integrity of healthcare information on the Internet has on the physician-patient relationship. Importantly, several studies show that Web-based health information frequently contains inaccurate or incomplete information. Patients who retain such information go so far as to suggest approaches to their physicians and express disappointment when the physicians refuse to prescribe as expected. For their part, doctors are concerned about the physician-patient relationship when they have to explain to patients that their Internet-based information is less than accurate; consequently, the physician-patient relationship is often affected. While many issues bear upon the physician-patient relationship, the central one is trust. Examines consumer use of the Internet for healthcare information, considers the problems caused by inaccuracies or omissions from third-party websites, and sets forth recommendations regarding how the Internet can be used to improve the physician-patient relationship. It is hoped that these suggestions provide a better understanding of the required components of upcoming healthcare strategies.

Case Authors : S. Altan Erdem, L. Jean Harrison-Walker

Topic : Technology & Operations

Related Areas : Leadership, Marketing

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Calculating Net Present Value (NPV) at 6% for Role of the Internet in Physician-Patient Relationships: The Issue of Trust Case Study

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 6 %	Discounted Cash Flows
Year 0	(10009493)	-10009493	-	-
Year 1	3447177	-6562316	3447177	0.9434	3252054
Year 2	3954055	-2608261	7401232	0.89	3519095
Year 3	3952348	1344087	11353580	0.8396	3318468
Year 4	3235599	4579686	14589179	0.7921	2562897
TOTAL			14589179		12652514

The Net Present Value at 6% discount rate is 2643021

In isolation the NPV number doesn't mean much but put in right context then it is one of the best method to evaluate project returns. In this article we will cover -

Different methods of capital budgeting

What is NPV & Formula of NPV,
How it is calculated,
How to use NPV number for project evaluation, and
Scenario Planning given risks and management priorities.

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Capital Budgeting Approaches

Methods of Capital Budgeting

There are four types of capital budgeting techniques that are widely used in the corporate world –

1. Profitability Index
2. Internal Rate of Return
3. Payback Period
4. Net Present Value

Apart from the Payback period method which is an additive method, rest of the methods are based on Discounted Cash Flow technique. Even though cash flow can be calculated based on the nature of the project, for the simplicity of the article we are assuming that all the expected cash flows are realized at the end of the year.

Discounted Cash Flow approaches provide a more objective basis for evaluating and selecting investment projects. They take into consideration both –

1. Timing of the expected cash flows – stockholders of Physician Patient have higher preference for cash returns over 4-5 years rather than 10-15 years given the nature of the volatility in the industry.
2. Magnitude of both incoming and outgoing cash flows – Projects can be capital intensive, time intensive, or both. Physician Patient shareholders have preference for diversified projects investment rather than prospective high income from a single capital intensive project.

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Formula and Steps to Calculate Net Present Value (NPV) of Role of the Internet in Physician-Patient Relationships: The Issue of Trust

NPV = Net Cash In Flowt1 / (1+r)t1 + Net Cash In Flowt2 / (1+r)t2 + … Net Cash In Flowtn / (1+r)tn
Less Net Cash Out Flowt0 / (1+r)t0

Where t = time period, in this case year 1, year 2 and so on.
r = discount rate or return that could be earned using other safe proposition such as fixed deposit or treasury bond rate. Net Cash In Flow – What the firm will get each year.
Net Cash Out Flow – What the firm needs to invest initially in the project.

Step 1 – Understand the nature of the project and calculate cash flow for each year.
Step 2 – Discount those cash flow based on the discount rate.
Step 3 – Add all the discounted cash flow.
Step 4 – Selection of the project

Why Technology & Operations Managers need to know Financial Tools such as Net Present Value (NPV)?

In our daily workplace we often come across people and colleagues who are just focused on their core competency and targets they have to deliver. For example marketing managers at Physician Patient often design programs whose objective is to drive brand awareness and customer reach. But how that 30 point increase in brand awareness or 10 point increase in customer touch points will result into shareholders’ value is not specified.

To overcome such scenarios managers at Physician Patient needs to not only know the financial aspect of project management but also needs to have tools to integrate them into part of the project development and monitoring plan.

Calculating Net Present Value (NPV) at 15%

After working through various assumptions we reached a conclusion that risk is far higher than 6%. In a reasonably stable industry with weak competition - 15% discount rate can be a good benchmark.

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 15 %	Discounted Cash Flows
Year 0	(10009493)	-10009493	-	-
Year 1	3447177	-6562316	3447177	0.8696	2997545
Year 2	3954055	-2608261	7401232	0.7561	2989834
Year 3	3952348	1344087	11353580	0.6575	2598733
Year 4	3235599	4579686	14589179	0.5718	1849964
TOTAL					10436076

The Net NPV after 4 years is 426583

(10436076 - 10009493 )

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Calculating Net Present Value (NPV) at 20%

If the risk component is high in the industry then we should go for a higher hurdle rate / discount rate of 20%.

Years	Cash Flow	Net Cash Flow	Cumulative     Cash Flow	Discount Rate @ 20 %	Discounted Cash Flows
Year 0	(10009493)	-10009493	-	-
Year 1	3447177	-6562316	3447177	0.8333	2872648
Year 2	3954055	-2608261	7401232	0.6944	2745872
Year 3	3952348	1344087	11353580	0.5787	2287238
Year 4	3235599	4579686	14589179	0.4823	1560378
TOTAL					9466135

The Net NPV after 4 years is -543358

At 20% discount rate the NPV is negative (9466135 - 10009493 ) so ideally we can't select the project if macro and micro factors don't allow financial managers of Physician Patient to discount cash flow at lower discount rates such as 15%.

Acceptance Criteria of a Project based on NPV

Simplest Approach – If the investment project of Physician Patient has a NPV value higher than Zero then finance managers at Physician Patient can ACCEPT the project, otherwise they can reject the project. This means that project will deliver higher returns over the period of time than any alternate investment strategy.

In theory if the required rate of return or discount rate is chosen correctly by finance managers at Physician Patient, then the stock price of the Physician Patient should change by same amount of the NPV. In real world we know that share price also reflects various other factors that can be related to both macro and micro environment.

In the same vein – accepting the project with zero NPV should result in stagnant share price. Finance managers use discount rates as a measure of risk components in the project execution process.

Sensitivity Analysis

Project selection is often a far more complex decision than just choosing it based on the NPV number. Finance managers at Physician Patient should conduct a sensitivity analysis to better understand not only the inherent risk of the projects but also how those risks can be either factored in or mitigated during the project execution. Sensitivity analysis helps in –

What will be a multi year spillover effect of various taxation regulations.

What are the key aspects of the projects that need to be monitored, refined, and retuned for continuous delivery of projected cash flows.

What can impact the cash flow of the project.

What are the uncertainties surrounding the project Initial Cash Outlay (ICO’s). ICO’s often have several different components such as land, machinery, building, and other equipment.

Understanding of risks involved in the project.

Some of the assumptions while using the Discounted Cash Flow Methods –

Projects are assumed to be Mutually Exclusive – This is seldom the came in modern day giant organizations where projects are often inter-related and rejecting a project solely based on NPV can result in sunk cost from a related project.

Independent projects have independent cash flows – As explained in the marketing project – though the project may look independent but in reality it is not as the brand awareness project can be closely associated with the spending on sales promotions and product specific advertising.

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Negotiation Strategy of Role of the Internet in Physician-Patient Relationships: The Issue of Trust

References & Further Readings

S. Altan Erdem, L. Jean Harrison-Walker (2018), "Role of the Internet in Physician-Patient Relationships: The Issue of Trust Harvard Business Review Case Study. Published by HBR Publications.