Your hospital has been approached by a major HMO
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
Routine Charge
$3,600
Cost/Charge 0.80
Variable Cost % 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
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?
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