Assumptions Total Cost $100,000 Total Volume 1,000 Average cost $100 Payer volumes Medicare (payment rate = $95) 400 Medicaid (payment rate = $75) 100 Managed Care #1 (payment rate = $110) 300 Managed...

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Assumptions


Total Cost



$100,000



Total Volume



1,000



Average cost



$100



Payer volumes



Medicare (payment rate = $95)



400



Medicaid (payment rate = $75)



100



Managed Care #1 (payment rate = $110)



300



Managed Care #2 (pay 80% of charges)



100



Uninsured (pay 10% of charges)



100



Total all payers



1,000



Desired net income



$5,000




A. Medicare and Medicaid presently account for 50 percent 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 the managed-care plan #2 increases to 110 patients. Thus, total volume is unchanged at 1,000 visits. What must the new price be, assuming all other factors are unchanged?

B. Start with the original assumptions. The hospital is facing pressure from public interest groups to control the prices it charges to the uninsured. Assume that, through various efficiencies, the hospital is able to cut its per-visit cost by five percent. It also negotiates a seven percent increase with managed-care plan #1. Assuming all other factors are unchanged, what is the new required price?


C. Start with the original assumptions. Notice that managed care plan #1 receives a much lower price in return for sending a larger volume of patients. Managed care plan #2 (MC#2) wants to pay a lower cost per case and is willing to send 250 more patients (350 total from MC#2) to the clinic in return for a rate of $110 per case. Assume that the average cost per case drops to $90, due to the economies of scale. All other assumptions are unchanged. What is the new required price?


D. Start with the assumptions in problem (c). Now, assume that the additional volume does not enable enough economies-of-scale to reduce the average cost per case as much as originally anticipated. Assume now that the average cost per case drops to only $95. What is the new required price?

Answered Same DayDec 26, 2021

Answer To: Assumptions Total Cost $100,000 Total Volume 1,000 Average cost $100 Payer volumes Medicare (payment...

David answered on Dec 26 2021
121 Votes
a) Average Cost (AC) = $ 100
Total Volume (Q) = 1,000
Calculation of average price paid by FP payers:

Price = [(380/790)*95] + [(90/790)*75] + [ (320/790)*110]
Price = $98.80
Calculation of Unadjusted Price:
AC + [Net Income] + [(AC – average price paid by FP payers) * (FP)]
CH
100 + [5000] + [ (100- 98.80) * ( 790)]
210
100 + 28.32 =$128.32
Calculation of Write- off Proportion .
[ (110 /210) * 20%] + [(100/210) * 90%] = 0.53
Adjusted price = $128.32 / 1-0.5333
Adjusted price = $128.32 / 1-0.5333 =$274.96 or $275
Thus new price is $275
Payer Type Volume
A) Fixed Payers (FP)
Medicare ($95/ case) 380
Medicaid ($75/ case) 90
MCO #1 ($110/ Case) 320
Total Fixed payers 790
B) Charge Payers (CH)
MCO #2 (pay 80% charges) 110
Uninsured (10% of charges) 100
Total Charge Payers 210
b) Calculation / Change in Average Cost
= Average Cost – (5% * Average Cost)
= 100 – (5%*100)
= $95
Change In payment under MCO #plan 1
= Amount + (Amount * 7%)
=$110 + (110 *7%)...
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