Class: Financial Management of Healthcare Organizations

Text-book: Healthcare Finance: An Introduction to Accounting and Financial Management

This weeks readings:

·  Cost Behavior & Profit Analysis

·  Cost Allocation

·  Pricing & Service Decisions

·  Planning & Budgeting

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?

Submission Details:

• Present your analysis as a 3-page report in a Microsoft Word document formatted in APA style.
• On a separate page, cite all sources using APA format.
• Name your document SU_MHC6305_W3_A2_LastName_FirstInitial.doc.
• By Tuesday, June 9, 2015, submit your assignment to the W3 Assignment 2 Dropbox.

Assignment 2 Grading Criteria	Maximum Points
Calculated the PMPM rate to cover medical and administrative costs.	40
Calculated utilization rates reduced by 10 percent.	36
Calculated utilization rates reduced by 20 percent.	36
Calculated the rate with the average service cost reduced by 10 percent.	40
Calculated the PMPM premium after utilization and cost reductions.	40
Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and APA style attribution of sources; displayed accurate spelling, grammar, and punctuation.	8
Total:	200

Additional Rubric

Criteria

Unsatisfactory

Emerging

Proficient

Exemplary

Score

Assignment Components:

Calculated the PMPM rate to cover medical and administrative costs

0-14 Points

The calculation of the PMPM rate is unclear and inaccurate.

15-24 Points

The calculation of the PMPM rate is somewhat clear and accurate.

25-35 Points

The calculation of the PMPM rate is clear and mostly accurate.

36-40 Points

The calculation of the PMPM rate is clear and accurate and is supported by a peer reviewed reference.

__of 40

Calculated 10% reduced utilization rates

0-12 Points

The calculation of the PMPM rate is unclear and inaccurate.

13-25 Points

The calculation of the PMPM rate is somewhat clear and accurate.

26-32 Points

The calculation of the PMPM rate is clear and mostly accurate.

33-36 Points

The calculation of the PMPM rate is clear and accurate and is supported by a peer reviewed reference.

__of 36

Calculated 20% reduced utilization rates

0-12 Points

The calculation of the PMPM rate is unclear and inaccurate.

13-25 Points

The calculation of the PMPM rate is somewhat clear and accurate.

26-32 Points

The calculation of the PMPM rate is clear and mostly accurate.

33-36 Points

The calculation of the PMPM rate is clear and accurate and is supported by a peer reviewed reference.

__of 36

Calculated the rate with reduced average service cost by 10%.

0-14 Points

The calculation of the PMPM rate is unclear and inaccurate.

15-24 Points

The calculation of the PMPM rate is somewhat clear and accurate.

25-35 Points

The calculation of the PMPM rate is clear and mostly accurate.

36-40 Points

The calculation of the PMPM rate is clear and accurate and is supported by a peer reviewed reference.

__of 40

Calculated the PMPM premium after utilization and cost reductions

0-14 Points

The calculation of the PMPM rate is unclear and inaccurate.

15-24 Points

The calculation of the PMPM rate is somewhat clear and accurate.

25-35 Points

The calculation of the PMPM rate is clear and mostly accurate.

36-40 Points

The calculation of the PMPM rate is clear and accurate and is supported by a peer reviewed reference.

__of 40

Presentation and Writing Components:

Organization

Introduction

Transitions

Conclusion

0 Points

Introduction is limited or missing entirely.

Transitions between ideas are infrequent, illogical, or missing entirely.

Conclusion is limited or missing entirely.

0.5 Point

Introduction is present but incomplete or underdeveloped.

Transitions between ideas are sporadic.

Conclusion is recognizable, but incomplete or underdeveloped.

1 Point

Introduction has an opening, provides some background information, and states the topic.

Transitions between ideas are present.

Conclusion summarizes main argument and has a clear ending.

2 Points

Introduction catches the audiences’ attention, provides compelling and appropriate background information, and clearly states the topic.

Thoughtful transitions between ideas are appropriate and help the flow of ideas.

Conclusion leaves the audience with a sense of closure and provides concluding insights.

__of 2

Style

Tone

Audience

Word Choice

0 Points

Presentation (including background images, text, choice of words, and appropriateness of tone) is lacking or completely overpowers the presentation to the point of interfering with comprehension, or design is inappropriate for the assignment.

0.5 Point

Presentation (such as background images, text, choice of words, and appropriateness of tone) upstages the writing, or design is too understated at points, or design is inconsistent.

1 Point

Presentation (such as background images, text, choice of words, and appropriateness of tone) is clear, appropriate for the assignment, balanced, and compliments the writing.

2 Points

Presentation (such as background images, text, choice of words, and appropriateness of tone) is clear, appropriate for the assignment, balanced, and compliments the writing throughout the presentation. The design engages the audience and does not distract from information.

__of 2

Usage and Mechanics

Grammar

Spelling

Sentence structure

0 Points

Any written portion contains numerous errors in spelling, grammar, and/or has sentence structure that severely interferes with readability and comprehension.

0.5 Point

Any written portion contains errors in spelling and grammar that somewhat interfere with comprehension.

1 Point

Any written portion follows conventions of spelling and grammar throughout. Errors are infrequent and do not interfere with comprehension.

2 Points

The presentation is basically error free in terms of mechanics. In any written portion, grammar and mechanics help establish a clear idea and aid the reader in following the writer’s logic.

__of 2

APA Elements

Attribution

Paraphrasing

Quotations

When appropriate or assigned

0 Points

No attempt at APA formatting in presentation.

0.5 Point

APA format is attempted to paraphrase, quote, and cite, but errors are significant.

1 Point

Used APA format, accurately paraphrased, quoted, and cited in most areas throughout when appropriate or called for. Errors present are mostly minor.

2 Points

Used APA format, accurately paraphrased, quoted, and cited throughout when appropriate or called for. Only a few minor errors present.

__of 2

Comments  Total Score ___200