Reference no: EM133302509
Sunshine Pediatrics employs 12 busy Pediatricians. Each physician sees an average of 25 patients per day (Please note: the total visits do not represent unique patients (visits ≠ patients)). The clinic is open for patient visits 300 days per year. The practice sees a combination of fee-for-service (FFS) patients and patients from Star HMO. Unique patients account for 24% of the total patient visits. Of the unique patients, 20% are Star HMO members - with the remainder being FFS patients.
Sunshine has an average visit charge of $150.
On average, Sunshine collects 65% of charges on FFS visits. This includes copays and health plan reimbursement.
Star HMO has set the target average revenue for a patient visit at $85.
The average times per year that a patient sees a practitioner is 4.
Star HMO members are responsible for a $20 copay at each visit.
Disregard vacation, sick time, etc. Although it occurs, it is accounted for in the average patients/day figure.
Assume zero changes to patient panel over the course of the year... no additions or deletions.
1. How many unique Star HMO patients does Sunshine Medical Clinic have on its patient panel?
2. What is the capitated payment due each month from Star HMO on a per member per month basis (excludes copays)?
3. What is the Per Member Per Year amount (capitation payment + copays) that Sunshine Medical Clinic should receive (for each HMO patient)?
4. What is the total annual gross revenue for Sunshine Medical Clinic from the Star HMO arrangement (capitation payment + copays)?
5. How many unique FFS patients does Sunshine Medical Clinic have on its panel?
6. How much revenue can Sunshine expect to generate from FFS visits annually?
7. What is Sunshine's annual total gross revenue (all payers)?