Hsa 6175 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%