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A B E F Total Benchmark Minus Aligned Beneficiary Expenditures at % of Total Benchmark (Indicates amount of savings; positive-savings; negative=loses) YEAR 1 YEAR 2 YEAR 3 YEAR 4 YEAR 5 ACO Allina Health Atrius Health Banner Health Network Fairview Health Services Michigan Pioneer ACO Monarch Health Care Montefiore ACO Partners Health Care H K L M N O P Q A B D E F G 2 Instructions: Calculate the MS-DRG reimbursment rate for each case. 3 Notice the changes in base rate for each facility. Remember the 4 hospital specific base rate includes adjustments for IME, DSH and 5 wage index. 6 Once you have completed the calculations, answer the questions in 7 7 the Student Workbook. 8 9 Hospital Community Hopsital Base Rate $6,200 10 MS-DRG 192 Chronic obstructive pulmonary disease w/o CC/MCC 11 RW 0.7092 12 Charges $ 15,000.00 13 CCR 0.429 14 LOS 3 15 16 MS-DRG Reimbursment 17 Cost of the encounter 18 Profit/Loss 19 20 21 Hospital Community Hopsital Base Rate $6,200 22 MS-DRG 190 Chronic obstructive pulmonary disease w MCC 23 RW 1.144 24 Charges $ 14,975.24 25 CCR 0.429 26 LOS 4 Hospital Memorial Hospital Base Rate $7,300 MS-DRG 192 Chronic obstructive pulmonary disease w/o CC/MCC RW 0.7092 $17,500.00 CCR 0.531 LOS 4 Charges MS-DRG Reimbursment Cost of the encounter Profit/Loss Hospital Memorial Hospital Base Rate $7,300 MS-DRG 190 Chronic obstructive pulmonary disease w MCC RW 1.144 Charges $16,578.24 CCR 0.531 LOS 5 MS-DRG Calculation Example MS-DRG Calculations + A B C D E F G H 1 K L M N O MS-DRG Reimbursment Cost of the encounter Profit/Loss MS-DRG Reimbursment Cost of the encounter Profit/Loss Hospital Community Hopsital Base Rate $6,200 MS-DRG 473 Cervical spinal fusion w/o CC/MCC RW 2.5124 Charges $ 30,245.87 CCR 0.429 LOS 2 Hospital Memorial Hospital Base Rate $7,300 MS-DRG 473 Cervical spinal fusion w/o CC/MCC RW 2.5124 Charges $31,674.10 CCR 0.531 LOS 2 MS-DRG Reimbursment Cost of the encounter Profit/Loss MS-DRG Reimbursment Cost of the encounter Profit/Loss $7,300 Hospital Community Hopsital Base Rate $6,200 MS-DRG 472 Cervical spinal fusion w CC RW 3.0415 Charges $ 30,384.64 CCR 0.429 LOS 3 Hospital Memorial Hospital Base Rate MS-DRG 472 Cervical spinal fusion w CC RW 3.0415 Charges $35,384.57 CCR 0.531 LOS 3 MA Daluations and MS DRG Caulai MAC DCC Profit/Loss Profit/Loss $7,300 Hospital Community Hopsital Base Rate $6,200 MS-DRG 472 Cervical spinal fusion w CC RW 3.0415 Charges $ 30,384.64 CCR 0.429 LOS 3 Hospital Memorial Hospital Base Rate MS-DRG 472 Cervical spinal fusion w CC RW 3.0415 Charges $35,384.57 CCR 0.531 LOS 3 MS-DRG Reimbursment Cost of the encounter Profit/Loss MS-DRG Reimbursment Cost of the encounter Profit/Loss Hospital Community Hopsital Base Rate $6,200 MS-DRG 001 Heart transplant or implant of heart assist system w/MCC RW 27.6339 Charges $315,258.74 CCR 0.429 LOS 35 Hospital Memorial Hospital Base Rate $7,300 MS-DRG 001 Heart transplant or implant of heart assist system w/MCC RW 27.6339 Charges $330,879.54 CCR 0.531 LOS 38 MS-DRG Reimbursment Cost of the encounter Profit/Loss MS-DRG Reimbursment Cost of the encounter Profit/Loss
