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%

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    HSA 6175 FINANCIAL MANAGEMENT OF HEALTH SYSTEMS

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      Finance

      HSA 6175 FINANCIAL MANAGEMENT OF HEALTH SYSTEMS

      ASSIGNMENT 1

      OVERVIEW:

      John Rossi, MD is an Internal Medicine Physician. For the year 2016 he had the following Payor Mix:


    • Please see attached