For Pancreas Transplant, DRG code is 010. For DRG 010, Medicare pays fixed amount of $21,313.50. Outlier threshold for Medicare is $25,800. (a) John admitted hospital A for pancreas transplant. The charges for John’s treatment was 128,000. Cost to charge ratio for Hospital A was 0.10. How much payment hospital A would get from Medicare? (b) Bryan admitted hospital B for pancreas transplant. The charges for Bryan’s treatment was same as John, $128,000, but cost to charge ratio for Hospital B was 0.25. How much payment hospital B would get from Medicare?

For Pancreas Transplant, DRG code is 010. For DRG 010, Medicare pays fixed amount of $21,313.50. Outlier threshold for Medicare is $25,800. (a) John admitted hospital A for pancreas transplant. The charges for John’s treatment was 128,000. Cost to charge ratio for Hospital A was 0.10. How much payment hospital A would get from Medicare? (b) Bryan admitted hospital B for pancreas transplant. The charges for Bryan’s treatment was same as John, $128,000, but cost to charge ratio for Hospital B was 0.25. How much payment hospital B would get from Medicare?

EBK HEALTH ECONOMICS AND POLICY

7th Edition

ISBN:9781337668279

Author:Henderson

Publisher:Henderson

Chapter4: Economic Evaluation In Health Care

Section: Chapter Questions

Problem 4QAP

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For Pancreas Transplant, DRG code is 010. For DRG 010, Medicare pays fixed amountof $21,313.50. Outlier threshold for Medicare is $25,800.(a) John admitted hospital A for pancreas transplant. The charges for John'streatment was 128,000. Cost to charge ratio for Hospital A was 0.10. How muchpayment hospital A would get from Medicare?(b) Bryan admitted hospital B for pancreas transplant. The charges for Bryan'streatment was same as John, $128,000, but cost to charge ratio for Hospital Bwas 0.25. How much payment hospital B would get from Medicare?
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. The health authorities are considering the treatmentalternatives for three types of diseases: heart disease,cancer, and infectious disease. Each year there are10,000 new cases of heart disease, 10,000 new casesof cancer, and 5,000 new cases of infectious disease.For each diagnosis, there are a number of mutuallyindependent treatment alternatives (including notreatment) as shown in the following table. a. Identify all dominant treatment alternatives.Explain why each is dominant.b. Calculate the incremental cost, incrementalQALYs, and ICERs for all economicallyrational strategies (ICER 5 incremental cost/incremental QALYs). Why are these consideredeconomically rational?c. Using separate graphs for heart disease, cancer,and infectious disease, show the alternativetreatment options, label the dominant options,and show the economically feasible alternatives.(Place QALYs on the vertical axis and cost pertreatment on the horizontal axis.)d. The local health district has asked your opinion…
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