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A nursing home contracts with an HMO for skilled nursing care at $2.00 PMPM. If costs are expected to average $120 per day, what is the maximum utilization of days per 1,000 members that the nursing home can experience before it begins to lose money?

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Answer:

To find out the maximum utilization of days per 1,000 members before the nursing home begins to lose money, we need to compare the revenue from the HMO contract to the expected costs.

Given:

- Revenue per member per month (PMPM) = $2.00

- Average cost per day = $120

First, let's convert the revenue to a daily rate:

Revenue per day per member = Revenue PMPM / 30 days

\(= \frac{2}{30} = \frac{1}{15} \) dollars

Next, we need to find out how many days a member can stay before the nursing home begins to lose money:

\( \text{Max days} = \frac{\text{Total Revenue}}{\text{Average Cost per Day}} \)

\( \text{Max days} = \frac{\frac{1}{15} \text{ dollars}}{120 \text{ dollars}} \)

\( \text{Max days} \approx 0.111 \)

To convert this to days per 1,000 members, we multiply by 1,000:

\( \text{Max days per 1,000 members} = 0.111 \times 1000 \approx 111 \)

So, the nursing home can experience a maximum utilization of 111 days per 1,000 members before it begins to lose money.

Explanation:

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