Module 4 1. Based on your proposed organization and structure for the GAH and the Community Clinic, we will now focus on financing and budgeting issues.
2. In order to do so, we will need to define the following requirements and assumptions:
a. Cost of facility construction, initial medical equipment, and instrumentation, will not be calculated – as they will be fully paid by the state as a grant.
b. All senior patients will be above the age of 65, and will have only the Federal Medicare health insurance. Research the major constructs of Medicare health coverage as defined by the “Medicare Prospective Payment System.”
c. The hospital and clinic will be financially balanced, that is, income from Medicare payments will cover in full all operating costs.
3. “Medicare Prospective Payment System”
a. The hospital is reimbursed by the government per procedure and/or treatment by a predefined sum and not by the actual expenses performed for and on a particular patient.
b. For example – a patient requiring open heart surgery will utilize the services of physicians, nurses, OR, laboratory, pharmacy, and occupies a hospital bed on average for six days. If a certain patient is discharged after four days, the hospital will still be paid the six-day amount. Hence, the incentive to operate efficiently and effectively, enabling the hospital to “save money.”
4. Based on the services you have decided to provide - at least six (see Module 3 – item 2d), complete the table:
a. Input services/treatments in column A.
b. Input estimated and rounded Medicare reimbursement to GAH (in thousands of dollars) for each treatment in column B (assign for each a figure between $10,000 to $60,000).
c. Your instructor has inputted the projected number of procedures/treatments performed annually at GAH in column C.
d. Calculate the total income for GAH by multiplying columns B*C in column D.
e. Your instructor has inputted the GAH Projected Performance percentage, relative to the Federal standard (100%) in column E.
f. Calculate the total GAH gain or loss by D-(D*E) in column F.
5. Assume a $250,000 annual miscellaneous expense.
6. Prepare (based on the table), a forecast of profit or loss for GAH for the first year of operation.
7. Conclusions and Recommendations.
8. Your instructor will comment on your table in his feedback to you, on the basis of which you will be able to further develop your project plan.
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