The states have seen massive consolidation and acquisition of independent surgical centers in recent years, which increases cost while decreasing customer choice. In January 2016, North Carolina shifted from a payment system based on a percent of billed charges to a percentage mark-up of Medicare rates in order to reduce costs. Georgia's workers' compensation fee schedule increased to over three times Medicare rates in April.
Payers using SCP in the two states can expect surgical savings ranging from 15 to 50 percent. The program's upfront, value-driven rates for the most common workers' compensation orthopedic procedures allow accurate financial reserving on surgical claims for payers, predictable revenue for providers, and high-quality care for patients.
According to Jeff Rivkin, author of IDC Health Insights' June report on value-based initiatives, payers anticipate that payments associated with value-based methodologies will increase from 32 percent to 52 percent in the next five years. He writes, "value-based reimbursement…is coming out of the pilot phase, the experimenting is over."
Says Bob Evans, Rising's Vice President of Repricing Solutions, "Early adopters in workers' compensation know that staying ahead of the curve will involve implementing alternative payment models that move away from fee-for-service. We've been providing this program since 2013 and understand how to help payers operationally execute as the majority of healthcare payments progress rapidly towards value-driven arrangements."
SCP's single rate for an entire orthopedic episode includes the initial consultation, facility, surgeon(s), implant, anesthesia, and post-op services. Additional key states are targeted for expansion later in 2016.
Visit Rising's website for a brief overview of the Surgical Care Program.
About Rising Medical Solutions
Rising Medical Solutions (www.risingms.com) is a national medical-financial solutions firm that provides medical cost containment and medical care management services to the workers' compensation, auto, liability, and group health markets.
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SOURCE Rising Medical Solutions