Cost Benefit Analysis

This is assignment has 2 parts; Please refer to Chapter 19 The Case Manager's Handbook (6th) ISBN-13: 9781284102413 for guidance as you complete the assignment.

Part  1:  Complete the following Cost Benefit Analysis Report for the following scenario:    

The client is to be discharged from a skilled nursing care setting to home. This is a Michigan no fault auto and all reasonable and necessary cost are covered at 100%. It has already been determined the client will need a sip and puff wheelchair quoted at $17,000, a specialty bed quoted at $7,000 and ventilator supplies quoted at $500 a month from Lifestyles Equipment Company. Your assignment is to review the current costs and negotiate the lowest price for the identical equipment. Obtain two make believe quotes from two other equipment companies. You will need to estimate the case management time it would take to complete this assignment. Estimate case management time obtaining and negotiating costs to the nearest hour. You do not have to estimate any time for ordering or delivery of equipment. This assignment is specific to the cost of the equipment. Once you have identified your costs complete the following cost benefit analysis form.

Cost Benefit Analysis Form

Report Date:   March 9, 2018

Re:   Joe Smith

File #:  12345

Carrier:   American Insurance Co.  (No Fault Auto Carrier)

Date of Referral:  January 5, 2018

Total Weeks of Case Management:   Four Weeks

Diagnosis:   C4 Tetraplegia, TBI on a ventilator

Case Management Fees:

Summary of Interventions:     (Companies contacted, prices negotiated)

Avoidance of Potential Charges:   ( These are the individual charges that would have been incurred if you had paid the highest price)

Total of Potential Charges:    (This is the total amount of Potential Charges)

Total of actual costs:    (Includes the actual cost negotiated and paid)

Gross Savings:  (These are the avoided potential charges minus the actual charges

Net Savings:    (These are the gross savings minus case management fees)

Part 2: For this part of the assignment  you are to compare the alternate care settings of  discharge to home  vs. the cost of care in a skilled care facility over a 30 day period.   Once you have calculated your costs, complete the following Alternative Care Setting form.

Some costs have been provided and other costs you will have to obtain or estimate.    Do not add additional services for equipment .

Estimate case management services based on how much time you believe it will take to coordinate services.  For this assignment you do not have to provide specific detail regarding case management services such as how many phone calls or mileage.  Provide just a broad estimate of the number of case management hours and costs based on: Estimated Phone hours + Estimated personal contact hours + Estimated travel time = Total estimated case management time. Calculate time to the nearest hour.

Alternative Care Setting Form

Report Date:  March 9, 2018

Re:   Joe Smith

File #:  12345

Carrier:   American Insurance Co.  (No Fault Auto Carrier)

Date of Referral:  March 9, 2018

Diagnosis:   C4 Tetraplegia, TBI on a ventilator

Summary of Skilled Care Costs:

Daily rate:  $675 per day

Sip and Puff Wheel Chair not included:  $17,000

Specialty Bed not included: $7,000

Ventilator supplies included with no additional charge

Nursing, physician and therapy included with no additional charge

Case management services:  $100 hour. Calculate a charge based on an estimated time to coordinate equipment and services required to transition the client to the skilled care facility

Total Skilled Care Costs:

Alternative Discharge to Home Costs:   

For simplification of this assignment, Michigan No Fault coverage was chosen as charges are compensable 100% for 24/7 RN/LPN coverage when determined to be reasonable and necessary. Client is a ventilator dependent quadriplegic with a TBI and would require 24/7 skilled care by an RN/LPN.

Skilled Nursing /RN/LPN  24/7:

Therapy:  30 days of OT, PT, SPL

Sip and Puff W/C:  $17,000

Specialty Bed: $7,000

Ventilator Supplies $500 a week

Temporary Ramp at Front door:

Case Management Services:  $100 hour.  To include arrangement of equipment and services for discharge to home with follow up case management services over the first thirty days.

Total Alternative Discharge to Home Costs:

Total Costs of skilled care:

Total Alternative costs of Home Discharge:

Total savings or costs of Alternative Care:

Case Management Fees for Alternative Care Analysis:   $100 per  hour.    These are billable hours associated with determining the costs of an alternative care setting.   Please use the time that it took you to complete this assignment as your billable hours.

Please review the grading rubric for this assignment as it will provide you a guide in preparing you Cost Benefit Analysis.  It identifies key areas the assignment will be evaluated, and describes a range of outcomes to evaluate your success.