Exhibit 8. Setting-Specific Total and PMPM Payments Using Both Actual and Standardized Payments.
| Actual | Standardized | Difference | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Setting | Total Payments | PMPM | Total Payments | PMPM | Payment Difference | PMPM Difference | %Change | |||||||
| Institutional Part A | ||||||||||||||
| IP | $4,224,071,357.43 | $3,368.26 | $3,617,279,899.81 | $2,884.40 | $606,791,457.62 | $483.85 | 14.37% | |||||||
| SNF | $768,795,645.54 | $1,878.70 | $790,291,493.13 | $1,931.23 | ($21,495,847.59) | ($52.53) | –2.80% | |||||||
| HOS | $141,645,320.18 | $1,381.03 | $140,898,448.27 | $1,373.75 | $746,871.91 | $7.28 | 0.53% | |||||||
| HH | $250,762,719.41 | $495.55 | $259,875,143.29 | $513.56 | ($9,112,423.88) | ($18.01) | –3.63% | |||||||
| Institutional Part B | ||||||||||||||
| HOP | $433,099,076.96 | $388.84 | $443,050,955.45 | $397.77 | ($9,951,878.49) | ($8.93) | –2.30% | |||||||
| Non-Institutional Part B1 | ||||||||||||||
| PHYS | $863,702,333.86 | $689.25 | $868,497,398.97 | $693.08 | ($4,795,065.11) | ($3.83) | –0.56% | |||||||
| OPTB | $390,192,762.94 | $312.30 | $391,953,563.62 | $313.71 | ($1,760,800.68) | ($1.41) | –0.45% | |||||||
1
NOTE: The PHYS category includes physician E & M, procedures and imaging; the Other Part B (OPTB) includes all other Part B claims, such as ASC, labs, DME, Part B drugs, etc.
SOURCE: Calculations based on CCW Medicare enrollment and Part A and B fee-for-service claims, 2007–2008, Dartmouth Atlas HRRs 2007, and other data sources.