Problem: The SLD Imaging Center is currently negotiating with an MCO to provide diagnostic imaging services to is 225,000 covered lives. SLD has fixed costs of $750,000 and capacity for an additional 75,000 patient encounters per year. They have two types of services MRI and CT Scans. MRI’s have a variable cost $495 and CT Scan’s have variable a variable cost $375. The MCO is currently offering $100 per covered life.
SLD has come up with the following utilization estimates:
- 4% of covered lives will need MRIs
- 6% of covered lives will need CT Scans
- Of those needing either service, 27% will require 3 encounters, 56% will require 2 encounters and the remaining 17% will require 1 encounter.
a. Based on SLD’s estimates, how much will they be making or losing if they accept the MCO’s offer of $100 per covered life?
b. How many total encounters from the covered lives can SLD take on before they start losing money?