Answered step by step
Verified Expert Solution
Link Copied!

Question

00
1 Approved Answer

What is the PMPM rate that Bay Pines must set to cover medical costs plus administrative expenses? Analyzing Bay Pines Medical Center's Financial Statement After

image text in transcribed

What is the PMPM rate that Bay Pines must set to cover medical costs plus administrative expenses?

image text in transcribed Analyzing Bay Pines Medical Center's Financial Statement After gaining an understanding of the components of a financial statement, analyzing and applying what the components represent, in terms of future planning, are the most important aspects of working in healthcare finance. Consider the following data and make your best analysis of per member per month (PMPM) rates, considering reductions in utilization or pricing. Bay Pines Medical Center estimates that a capitated population of 50,000 would have the following base case utilization and total cost characteristics: Service Category Inpatient Days per 1,000 Enrollees Average Cost per Day General 150 $1,500 Surgical 125 $1,800 Psychiatric 70 $700 Alcohol/Drug Abuse 38 $500 Maternity 42 $1,500 Total 425 $1,367 In addition to medical costs, Bay Pines allocates 10 percent of the total premium for administration/reserves. Tasks: On the basis of your data analysis, respond to the following: What is the PMPM rate that Bay Pines must set to cover medical costs plus administrative expenses? What would be the rate if a utilization management program were to reduce utilization within each patient service category by 10 percent? And by 20 percent? Consider the initial base case utilization assumption. What rate would be set if the average cost on each service were reduced by 10 percent? Assume that both utilization and cost reductions were made. What would the premium be

Step by Step Solution

There are 3 Steps involved in it

Step: 1

blur-text-image

Get Instant Access with AI-Powered Solutions

See step-by-step solutions with expert insights and AI powered tools for academic success

Step: 2

blur-text-image

Step: 3

blur-text-image

Ace Your Homework with AI

Get the answers you need in no time with our AI-driven, step-by-step assistance

Get Started

Recommended Textbook for

Intermediate Accounting

Authors: Elizabeth A. Gordon, Jana S. Raedy, Alexander J. Sannella

1st edition

978-0133251579, 133251578, 013216230X, 978-0134102313, 134102312, 978-0132162302

Students also viewed these Finance questions

Question

Determine miller indices of plane X z 2/3 90% a/3

Answered: 1 week ago

Question

Who are creditors?

Answered: 1 week ago

Question

Why is the efficient-markets hypothesis being challenged?

Answered: 1 week ago