FINANCIAL MANAGEMENT OF HEALTH SYSTEMS

HSA 6175 FINANCIAL MANAGEMENT OF HEALTH SYSTEMS

ASSIGNMENT1

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:

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?

Rubrics:

Submission of both problems 50%

Problem 1A 10%

Problem 1B 15%

Problem 2A 10%

Problem 2B 15%

 

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