Weba properly negotiated discount or per diem contract can provide a hospital with the opportunity to lock in patient referrals from the many healthcare providers in its local markets. (10) each nursing facility shall receive a per diem adjustment that shall be calculated based upon an additional $15,000,000 in state and $15,000,000 in federal appropriations. New jersey department of human services 4 Webany per diem should give you at least 10 bucks more an hour. Sent from my iphone using allnurses. com. Webto summarize, high hmo penetration, low hospital concentration, and low marketwide occupancy rates decrease hospitals' leverage with plans and result in lower hospital prices. Hospitals, however, are aware of this formula and may pursue a variety of strategies in response, including mergers and acquisitions.