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6. Using the information below, determine the actual cost for each case for each hospital as well as the MS-DRG payment, and the profit/loss for

6. Using the information below, determine the actual cost for each case for each hospital as well as the MS-DRG payment, and the profit/loss for each case. Based on an evaluation of the results, what would you tell your hospital CFO about the cost effectiveness of treating these types of cases. Keep in mind that these two claims may qualify as high-cost outliers. Based on an evaluation of the results, what would you tell your hospital CFO about the cost effectiveness of treating these types of cases. [Taxonomy level 5 (evaluate)]

20XX Threshold amount = $27,545.00

Hospital Information
Hospital CCR Base Rate
Hospital A 0.547 $7,300.00
Claim Information
Claim MS-DRG MS-DRG Description RW Total Charges
1 469 Major joint replacement or reattachment of lower extremity with MCC 3.2011 $139,995.00
2 003 ECMO or Tracheostomy with MV 96+ hours or PDX excluding face, moth & neck with major OR procedure 17.6331 $434,546.55

Hospital A
Claim Cost MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Profit/Loss
1
2

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