Cost Analysis Comparing CHAMPUS to Treatment Provided Within Ireland ArmyCommunity Hospital

摘要

This graduate management project identified high cost CHAMPUS claims by diagnosisin the Fort Knox catchment area and calculated the cost of providing care to treat these same diagnoses within the medical treatment facility. In order for Fort Knox's Gateway to Care program to be successful and negotiate fees with civilian providers, customary and reasonable charges within the catchment area must be known first. Once determined these comparisons can serve as valuable tools in negotiating treatment fees with civilian providers. First, the project consisted of a thorough examination of the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) claims by diagnosis submitted to the government during FY90 in the Fort Knox catchment area. Six of the most expensive diagnoses that were reimbursed to civilian providers by the government were identified. Next, the costs of providing treatment at Ireland Army Community Hospital for these diagnoses were calculated through the use of the Medical Expense and Performance Reporting System (MEPRS). By comparing the two cost amounts it could be determined which method of providing treatment was more economical for the government, treatment within the medical treatment facility or through CHAMPUS.