Superstar Medical Clinic is comprised of 45 primary care practitioners located throughout the greater metropolitan area. The Superstar Medical Clinic is contracted (open panel) with Gold HMO to provide primary care services for the HMO’s members. Each of the practitioners sees on average 18 patients/day. Please note: the total visits do not represent unique patients (visits ≠ patients). Unique patients account for 29% of the total visits. Of the unique patients, 30% are Gold HMO members. The remainder are FFS patients.

Superstar has set an average charge of $145 for visits.

On average, Superstar collects 62% of charges on FFS visits. This includes copays and health plan reimbursement.

Gold HMO has set the target average revenue for a patient visit at $70.

The average times per year that a patient sees a practitioner is 3.45

GOLD HMO members are responsible for a $20 copay at each visit.

Assume 2080 annual work hours, 8 hour workdays.

Disregard vacation, sick time, etc. Although it occurs, it is accounted for in the average patients/day figure.

Assume zero changes to patient panel over the course of the year… no additions or deletions.

Do not round until your final answer. At that point, round to the nearest cent.

1. How many unique Gold HMO patients does Superstar Medical Clinic have on its patient panel?

2. What is the total PMPY amount (capitation payment + copays) that Superstar Medical Clinic should receive?

3. What is the capitated payment due each month from Gold HMO (excludes copay)?

4. What is the total annual gross revenue for Superstar Medical Clinic from the Gold HMO arrangement (capitation payment + copays)?

5. Assuming the target average payment for an office remains at $70, what would the new capitated payment (PMPM) be from GOLD HMO if the patient copays were increased to $25/visit?

6. How much revenue can Superstar expect to generate from FFS visits?

7. What is Superstar’s total gross revenue (all payers) for the above visits?