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%