Medicare and Medicaid presently account for 50 % of the volume. The hospital wishes to reduce its dependence on government payers. Assume that Medicare volume is reduced to 380 patients and Medicaid volume is reduced to 90 patients. The volume from managed-care plan # 1 rises to 320 patients from 300. The volume from managed-care plan # 2 increases to 110 patients. Thus, total volume is unchanged at 1,000 visits. What is the new price necessary assuming all other factors are unchanged?
4. You have been asked to develop a capitation rate for a primary care group based on the following projections: Service Annual Frequency / 1,000 Cost per Service Inpatient Visits 100 $ 7,000.00 Office Visits 3,000 $ 45.00 Lab / X-ray 500 $ 25.00
What per-member per-month( PMPM) rate would be required to break even, ignoring any copayments?
5. A hospital has contracted with an HMO to provide acute care inpatient services for $ 1,000 per day, subject to a 10 percent withhold. The proposed budget for inpatient services is based upon expected utilization of 600 days per 1,000 members at $ 1,000 per day, or $ 600,000 per 1,000 members. The hospital risk pool will be split equally between the hospital and a primary care physician group. If only 450 days per 1,000 members were utilized in the first year, how much would the hospital be paid per 1,000 members?