Analyzing Bay Pines Medical Center’s Financial Statement

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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:

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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.

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

 
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