HA520 Unit 2 Assignment
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HA520Unit2spreadsheetInstructions.xlsxExhibit 2.1
| EXHIBIT 2.1 Tulsa Healthcare: Physician PHO Members and Estimated Needs for 50,000 Enrollees : Kent - what is this for and where should it be placed? -Sandy Cobb These are the data for Case Study 1 in U2 -Kent Acheson | Specialty | No. in PHO | Est. need per 50,000 Enrollees |
| General medicine | 42 | 21 | |
| Pediatrics | 15 | 4 | |
| Total primary care | 57 | 25 | |
| Anesthesiology | 9 | 3 | |
| Cardiology | 12 | 1 | |
| Emergency Medicine | 10 | 3 | |
| General Surgery | 13 | 3 | |
| Neurosurgery | 3 | 1 | |
| Obstetrics/gynecology | 27 | 5 | |
| Orthopedics | 11 | 3 | |
| Psychiatry | 19 | 2 | |
| Radiology | 8 | 3 | |
| Thoracic Surgery | 0 | 1 | |
| Urology | 5 | 1 | |
| Other Specialties | 75 | 10 | |
| Total Specialists | 192 | 36 | |
| Grand Total | 249 | 61 | |
Exhibit 2.2
| EXHIBIT 2.2 Tulsa Healthcare: Hospital Costs for Three Common DRGs by Physician | DRG | Description | Minimum | Maximum | Average |
| 470 | Major joint replacement or reattachment of lower extremity without MCC | $12,872 | $24,638 | $14,999 | |
| 871 | Septicemia or severe sepsis without MV; 96+ hours with MCC | $4,271 | $17,394 | $13,729 | |
| 291 | Heart failure and shock with MCC | $6,498 | $18,015 | $10,849 | |
| MCC: major complication or comorbidity; MV: mechanical ventilation | |||||
| Note: | This exhibit is based on historical costs related to the old severity-unadjusted DRGs. In the future, the cost data will be related to the new severity-adjusted Medicare severity diagnosis-related groups (MS-DRGs) | ||||
Exhibit 2.3
| EXHIBIT 2.3 Tulsa Healthcare: Proposed Allocation of Premium Dollars | Category | Percentage |
| PHO administration/overhead | 13% | |
| Paid to in-system physicians | ||
| Primary Care | 10% | |
| Specialists | 18% | |
| Ancillary Services | 5% | |
| Administration/profit | 1% | |
| Paid to in-system hospital | 38% | |
| Paid for prescription drugs | 10% | |
| Paid to out-of-system providers | 5% | |
| Total premium dollars | 100% | |
