Healthcare Finance Case 2
Description
Health Care Services Reimbursement
Case Assignment
Pearland Medical Center owns a small satellite clinic, specializing
in General Practice, located at nearby Pearland airport. General
Practice Clinics sole payor is Air Health, a health care plan that
covers the airport employee population. Air Health has been paying on a
fee-for-service basis; however, recently, its covered population
increased and it proposed a capitation contract for the next year with
an annual capitation payment of $150 for each of its 20,000 covered
members.
Previous experience indicates that the covered population will
average 2 visits per year to General Practice Clinic. General Practice
Clinic generates annually $1,150,000 fixed cost, which includes $550,000
in direct cost and $600,000 in allocated overhead. Each visit to
General Practice Clinic generates $45 in variable costs.
- Construct the base pro forma profit and loss statement on the capitation contract based on the number of visits for the clinic.
- What is the clinics contribution margin on the contract? What is
the clinics breakeven point under this capitation contract in the
number of visits? - Construct the base pro forma profit and loss statement on the capitation contract based on the number of members for the clinic.
- What is the clinics breakeven point under this capitation contract in the number of members?
- Should the clinic accept the contract terms?
- What elements of CVP analysis change when a clinic moves from a fee-for-service to a capitated environment?
- How do provider incentives change when it moves from a fee-for-service to a capitated contract?
Length: 34 pages, excluding title page and references.
Assignment Expectations
Assessment and Grading: Your paper will be assessed based on the
performance assessment rubric that is linked within the course. Review
it before you begin working on the assignment.
Your submission should meet the guidelines on file format, in-text
citations and references, scholarly sources, scholarly writing, and use
of direct quotes noted under Module 1 Assignment Expectations.
Required Reading
Berenson, R. A., & Rich, E. C. (2010). U.S. approaches to physician payment: The deconstruction of primary care. Journal of General Internal Medicine, 25(6), 613-618.
Chang, K. & Said, A.A. (2014). The impact of outsourcing on hospital performance. International Journal of Management Accounting Research, suppl. Special Issue. Health Care Costs and Performance, 4(1), 7-26.
Hennig-Schmidt, H., Selten, R., & Wiesen, D. (2011). How payment
systems affect physicians provision behavior – An experimental
investigation. Journal of Health Economics, 30(4), 637-646.
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References:
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Clinical Guidelines
Guideline Adaption Committee. (2016). Clinical practice guidelines and principles of care for people with dementia. NHMRC Partnership Centre for Dealing with Cognitive and Related Function Decline in Older People. https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/CDPC-Dementia-Guidelines_WEB.pdf
Living Guideline
Stroke Foundation. (2022). Australian and New Zealand living clinical guidelines for stroke management – chapter 1 of 8: Pre-hospital care. https://app.magicapp.org/#/guideline/NnV76E
Evidence-based practice
BMJ Best Practice
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Beyea, S. C., & Slattery, M. J. (2006). Evidence-based practice in nursing: A guide to successful implementation. http://www.hcmarketplace.com/supplemental/3737_browse.pdf
JBI: Evidence summary
Swe, K. K. (2022). Blood glucose levels: Self-monitoring [Evidence summary]. JBI EBP Database. https://jbi.global
JBI: Best practice information sheet
Bellman, S. (2022). Experiences of living with juvenile idiopathic arthritis [Best practice information sheet]. JBI EBP Database, 24(1), 1-4.
Cochrane Database of Systematic Reviews
Srijithesh, P. R., Aghoram, R., Goel, A., & Dhanya, J. (2019). Positional therapy for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD010990.pub2
Drug Information
Codeine. (2023, January). In Australian medicines handbook. Retrieved February 2, 2023, from https://amhonline.amh.net.au
Colorado State University. (2011). Why assign WID tasks? http://wac.colostate.edu/intro/com6a1.cfm
Dartmouth Writing Program. (2005). Writing in the social sciences. http://www.dartmouth.edu/~writing/materials/student/soc_sciences/write.shtml
Rutherford, M. (2008). Standardized nursing language: What does it mean for nursing practice? [Abstract]. Online Journal of Issues in Nursing, 13(1). http://ojin.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Health-IT/StandardizedNursingLanguage.html
Wagner, D. (n.d.). Why writing matters in nursing. https://www.svsu.edu/nursing/programs/bsn/programrequirements/whywritingmatters/
Writing in nursing: Examples. (n.d.). http://www.technorhetoric.net/7.2/sectionone/inman/examples.html
Perth Children’s Hospital. (2022, April). Appendicitis [Emergency Department Guidelines]. Child and Adolescent Health Service. https://www.pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Appendicitis
Department of Health. (n.d.). Who is being active in Western Australia? https://ww2.health.wa.gov.au/Articles/U_Z/Who-is-being-active-in-Western-Australia
Donaldson, L. (Ed.). (2017, May 1). Healthier, fairer, safer: The global health journey 2007-2017. World Health Organisation. https://www.who.int/publications/i/item/9789241512367
NCBI Bookshelf
Rodriguez Ziccardi, M., Goyal, G., & Maani, C. V. (2020, August 10). Atrial flutter. In Statpearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK540985/
Royal Perth Hospital. (2016). Procedural management: Pre and post (24-48 hours) NPS. Canvas. https://courses.ecu.edu.au
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