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Gary Bentham, CFO of Bartlett Community Hospital, is preparing for contract negotiation with his largest nongovernmental payer, Antrim Healthcare. Antrim currently accounts for approximately 30% of all patient-care revenue at Bartlett and this percentage is growing. The current contract has been in force for 3 years and expires on June 30 of this year. Gary has given Antrim the required 180-day notification of his intent to terminate but is alarmed by the position taken by Antrim's chief negotiator, Alice Mullins. Alice has told Gary that Antrim is unwilling to increase its present payment schedule beyond 5%. Currently Antrim pays for inpatient care on a diagnosis-related group (DRG) basis using the relative weights employed by the centers for Medicare and Medicaid Services (CMS). The base payment for a case with weight of 1.0 is $4,800. Gary knows that Medicare currently pays the hospital $6,500 for a case with a weight of 1.0. While the outpatient payment from Antrim is more reasonable, Gary is concerned about the hospital's long-term financial position if the Antrim inpatient rate cannot be increased substantially.
Problem 1: Gary is attempting to answer the following questions before his next scheduled meeting with Alice. What is his marginal or incremental cost for the Antrim book of business?
Problem 2: Could his competitor handle his present Antrim volume and at what cost?
Problem 3: If Gary's system were not in Antrim's network, what percentage of his present Antrim volume would he retain? These issues and others are central to his negotiation posture with Alice and have profound implications for his hospital system.
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