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Middleboro Community Hospital has been contacted by a regional employer to negotiate a contract for providing health services to a group of 50,000 employees. You

  1. Middleboro Community Hospital has been contacted by a regional employer to negotiate a contract for providing health services to a group of 50,000 employees. You have been asked to evaluate the terms of the contract and determine if the PMPM (per member, per month) payment is acceptable.

    Category Inpatient Days per 1,000 enrollees Average Cost per Day
    Medical 387 $1,450
    Surgical 295 $2,400
    OB 68 $975
    Newborn 39 $875
    Other Pediatric 34 $750
    ICU/CCU 71 $3,650
    Psychological 18 $1,250
    Substance Abuse 36 $900

    Answer the following questions:

    1. Using the table provided, calculate the minimum PMPM that is acceptable to Middleboro based upon a 20% load factor (administrative costs and profit).
    2. The regional employer has proposed a PMPM amount of $165.00. Is this acceptable? Why or why not?
    3. What potential risk does Middleboro Community Hospital have in participating in the program?

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