Reference no: EM13332454

Task -Payment for Services

When hospitals are paid for services, it is through payment structures. Payment structures include health maintenance organizations (HMOs), preferred provider organizations (PPOs), and capitation rates.

Develop a strategic plan for the hospital to begin managed care contract negotiations. You can use the SMH data file, which you had downloaded from the Doc Sharing area, to create your plan.

Based on your understanding of the costs, you will develop a plan for contract negotiations with a managed care provider. Include in the plan:

• A strategy for contract negotiation

• Details on each facility's costs and expected margins

• Comparisons between the three organizations, indicating which is in a stronger or weaker financial position Using the SMH data file, you will do the following:

• Calculate inpatient gross profit for the major payers at the hospital.

• Calculate GP and GP percentage by payer.

• Comment on the results of your GP calculations.

• In this example, we assumed that patients from each payer incurred costs at the same rate. Is this assumption correct? What level of detail in cost identification should the hospital attempt to obtain? Provide your comments.

• Based on your understanding of your costs, you will develop a plan for contract negotiations with a managed care provider. In your plan, outline a strategy for contract negotiation.

• Based on your comparative analysis of the SMH, FP, and NFP facilities, is SMH in a better or worse position when it comes to contract negotiations? Provide your comments.

• Payers always want to move procedures from an inpatient setting to an outpatient setting. Why might this not be the best strategy for your financial situation? Provide your comments.

Voluntary Discussion

You have the option of discussing your work with your classmates. To use this option, you need to submit your assignment to the Discussion Area below. Through the week, you can share your thoughts about your project and offer your review and comments to others who are also seeking input on their work.

Wrote in a clear, concise, and organized manner; demonstrated ethical scholarship in accurate representation and attribution of sources, displayed accurate spelling, grammar, and punctuation.