ASSIGNMENT: FINANCIAL MANAGEMENT OF HEALTH SYSTEMS
Problem 1
OVERVIEW:
John Rossi, MD is an Internal Medicine Physician. For the year 2016 he had the following Payor Mix:
|
Insurance
|
Patient Type
|
Contract Type
|
Contract Rate Per Visit* or PMPM**
|
Patients
|
Monthly Utilization
|
Visits
|
|
HMO A
|
Commercial
|
Fee for Service
|
$ 85.00
|
1,100
|
10%
|
1,320
|
|
HMOB
|
Medicare
|
Capitation
|
$ 45.00
|
500
|
31%
|
1,860
|
|
HMOB
|
Medicaid
|
Capitation
|
$ 15.00
|
350
|
9%
|
378
|
|
Medicare
|
Medicare
|
Fee for Service
|
$ 65.00
|
400
|
34%
|
1,632
|
|
Medicaid
|
Medicaid
|
Fee for Service
|
$ 35.00
|
435
|
11%
|
574
|
|
None
|
Self Pay
|
Fee for Service
|
$ 85.00
|
320
|
8%
|
307
|
|
|
|
|
|
|
|
|
Total
|
|
|
3,105
|
|
6,071
|
* Average rate per visit
** Per member per month
REQUIRED:
A. Using an Excel Worksheet, calculate Dr. Rossi's revenues for 2016.
B. HMO A has offered Dr. Rossi $11 PMPM capitation rate. Should he accept this offer? Why or why not?
Problem 2
OVERVIEW:
The Orthopedic Unit at Collins General Hospital had the following cases, excluding outliers:
Medicare cases: 300
Average MS-DRG payment by Medicare $ 3,500.00
Average MS-DRG Length of stay 2.6
Average actual Length of stay 2.9
REQUIRED:
A. What is the average Per Diem paid by Medicare and the actual average Per Diem the hospital realized?
B. State at least two reasons why the actual ALOS was higher than the average MS-DRG LOS?
Format your assignment according to the following formatting requirements:
1. The answer should be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides.
2. The response also includes a cover page containing the title of the assignment, the student's name, the course title, and the date. The cover page is not included in the required page length.
3. Also include a reference page. The Citations and references should follow APA format. The reference page is not included in the required page length.