Assumption for Part 1		Assumption for Part 2
Table A: Assumptions for PCP FFS Revenue per Visit				Table D: Assumptions for Mt. St. Heaven's Gate Hospital's Existing Charge Code-Based Commercial Payment and Utilization Data
Average FFS revenue per visit:	$83.79				Type of Medical Service	Pct. of Admissions	ALOS	Average Payment Per Day for Type of Service
Average number of visits per patient per year:	4.6				Maternity	15%	2.6	$1,823
					Surgical	25%	5.6	$4,160
Table B: Assumptions for Net PMPM Capitation Payments		Medical	60%	4.6	$2,037
HMO Product	Copay/Visit	% Withhold	Average # of Members/Month
Diamond Select Premium Plus	$20.00	20%	23		Table E: Assumptions for Flat Per Diems by Type of Service
Select Choice Plus	$30.00	20%	32		Type of Service	Payment per Day
Premium Omega ValueNet	$40.00	20%	45		Maternity	$1,750.00
					Surgical	$4,225.00
Table C: Assumptions for the Year-End PCP Withhold Distribution			Medical	$2,000.00
Percent of Aggregate Withhold, Meaning the Total of All Withholds for All PCPs, Used by the HMO for Cost Overruns.	20%
Percent of Network PCP's Eligible to Receive a Withhold Distribution of any remaining dollars in the withhold pool.	70%			Table F: Assumptions for Front Loaded Per Diems by Type of Service
					Type of Service	Payment 1st Day	Payment After 1st Day
					Maternity	$3,100.00	$925.00
					Surgical	$13,250.00	$2,200.00
					Medical	$5,200.00	$1,450.00

Part 1 Answer Sheet
Capitation Revenue for Dr. Maquis Welby
1: Capitation Rate Equivalent to Existing FFS Revenue
Starting with the average FFS revenue per visit assumptions, calculate the equivalent base capitation rate, the average FFS revenue per patient per year, and the average total FFS revenue per 100 patients per year.
Base Equivalent PMPM Capitation Payment Rate:	$385.43
Total FFS Revenue per Patient per Year (Dollars):	$385.43
Total FFS Revenue per 100 Patients per Year (Dollars):	$38,543.00
2: Net PMPM and Dollar Capitation Payment Rates for Each Product
Starting with the base capitation rate that you calculated above, calculate the net PMPM payment rates after any deductions, and total dollars of payment per month under capitation for each product; and the total dollar amount per month for all products combined.
HMO Product	$ PMPM	Dollars per Month
Net Cash HMO Pmt.	Amt. Withheld	Net HMO Cash Pmt.	Amt. Withheld
Diamond Select Premium Plus	$	$	$	$
Select Choice Plus	$	$	$	$
Premium Omega ValueNet	$	$	$	$
Total for All Products, (Dollars):	$	$
3: Dollars Collected by PCP Each Year from Copays for Each Product
Calculate how much, in dollars per year, a PCP collects in copays from HMO members, for each product, and in total.
HMO Product	Dollars/Year in Collected Copays
Diamond Select Premium Plus	$
Select Choice Plus	$
Premium Omega ValueNet	$
Total for All HMO Products (Dollars):	$
4: Aggregate Dollars in Withhold, Used for Cost Overruns, Available for Distribution for PCP Distribution, and Amount Distributed to Dr. Welby.
Calculate the year-end total dollar amount of withhold money in the aggregate risk pool, the amount used for cost overruns, the amount remaining for distribution to eligible PCPs, and the amount distributed to Dr. Welby.
	Amount in Dollars
Total Amount the Aggregate PCP Withhold Risk Pool:	$
Total Amount of the Aggregate Withhold Used for Cost Overruns:	$
Total Aggregate Amount Remaining for Distribution to All Eligible PCPs:	$
Amount of Withhold Distribution to Dr. Welby:	$
5: Put It All Together and Compare it to FFS
Calculate the total dollar amount paid to Dr. Welby at the end of the year, including total net capitation payments plus Dr. Welby's withhold distribution amount; and compare Dr. Welby's annual revenue under this example of capitation to Dr. Welby's annual FFS revenue.
For Dr. Welby Only, in Dollars
Total Annual Net HMO Capitation Payment:	$
Total Annual Amount of Collected Copayments:	$
Year-End HMO Withhold Distribution to PCP:	$
Total Annual Revenue Under This Capitation Method:	$
Amount Over or Under Compared to FFS Revenue	$

Part 2 Answer Sheet
Revenue under Per Diems for Mt. St. Heaven's Gate Hospital
1: Existing Charge Code-Based Commercial Payment Per Day
Fill in the Blank Cells for Existing Payment Per Day by Type of Service
Type of Service	Weighted Payment Per Day
Medical/Surgical	$
Maternity	$
ICU	$
Overall Average Hospital Payment Per Day:	$
2: Payment Under Flat Per Diems by Type of Service Methodology
Fill in the Blank Cells for Payment Under a Flat Per Diem by Type of Service Methodology
Type of Service	Average Payment Per Day	Weighted Payment Per Day
Medical/Surgical	$	$
Maternity	$	$
ICU	$	$
Overall Average Hospital Payment Per Day:	$
Dollar Comparison to Charges-Based Payment:	$
3: Payment Under Front Loaded Per Diem by Type of Service
Fill in the Blank Cells for Payment Under Front Loaded Per Diem by Type of Service
Type of Service	Average Payment Per Day	Weighted Payment Per Day
Medical/Surgical	$	$
Maternity	$	$
ICU	$	$
Overall Average Hospital Payment Per Day:	$
Dollar Comparison to Charges-Based Payment:	$