Change in Payer Mix Model.xlsx (26.3 KB)
I created this change in payer mix model (if you want to use it fill in the grey fields with your actual data and then put whatever scenario you want to model in the yellow highlighted column; and NO, these are not our practice’s actual numbers, don’t want to get anyone in trouble). For our practice a 10% decrease in Blue Cross and a 10% increase in Medicaid would negatively impact our revenue by about 8%. That scenario is too simplistic. Has anyone given thought to how our payer mix might change due to mass unemployment?
This is a fascinating spreadsheet - a better version of one that I’ve whipped up many times. I have a question and a comment:
- If your BCBS drops by 10% and your Medicaid goes up and that leads to an 8% loss, the implication to me is that Medicaid pays 20% of what BCBS pays you? That seems extreme. Is my head-math not right?
- I presume you are using VFC vaccine for your Medicaid patients? That will knock ~25-30% off of the revenue right there. Although you may generate profit from your private vaccines, it’s not 100% profit, so the gap between your Medicaid program and BCBS is less than the gross revenue would indicate. Try comparing them without vaccine revenue. I’d be curious to see what you get!
Thanks! That is a helpful thought. Yes, we use VFC so you point out an important variable that is not included in the model. I will report back.
Change in Payer Mix Model (adjusted for vaccines).xlsx (20.6 KB)
I removed vaccine revenue for vaccines CPTs but left admin codes. For my practice (not our actual figures in the attached model) this changes the model to 5% overall gross revenue loss if MC+ increases by 10% and BCBS decreases by 10%.
That makes a lot more sense!
I created this model hoping others who are worried about changes in the their payer mix due to unemployment could use it too. Do you feel the math looks appropriate so others can use it?
The discussion I wanted to start was what we think will happen with our payer mix. I can create the model but I don’t know where to look for suggestions on how the payer mix might shift.
A QUICK glance tells me that it looks pretty good.
The vaccine part is tricky…you need to exclude them for comparing to
Medicaid but include them for everyone else.