Your hospital has been approached by a major HMO to perform all their MS-DRG 470
ID: 2806127 • Letter: Y
Question
Your hospital has been approached by a major HMO to perform all their MS-DRG 470 cases (major joint procedures). They have offered a flat price of $10,000 per case. You have reviewed your charges for MS-DRG 470 during the last year and found the following profile:
Average Charge $15,000 Average LOS 5 Days
C o s t / C h a r g e V a ria ble C o s t %
Routine Charge $3,600 0.80 60
Operating Room 2,657 0.80 80
Anesthesiology 293 0.80 80
Lab 1,035 0.70 30
Radiology 345 0.75 50
Medical Supplies 4,524 0.50 90
Pharmacy 1,230 0.50 90
Other Ancillary 1,316 0.80 60
Total Ancillary $11,400 0.75 50
1. In the above data set, assume that the hospital’s cost to charge ratio is 0.80 for routine services and 0.75 for all other ancillary services. Using this information, what would the average cost of MS-DRG 470 be.
Explanation / Answer
Solution :- Average cost of MS-DRG 470 = (3600 + 11400) * 0.80
= 15000 * 0.80 (Variable cost percentage = 80 % i.e., 0.80).
= $ 12,000.
Conclusion :- Average cost of MS-DRG 470 = $ 12,000.
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