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 ?