Chicago, IL – The merits of value-based care in workers’ compensation have been long recognized as a viable concept. Adoption, however, has been another story. The industry has flirted with the idea over the years, but sustained models are rare.
The traditional “fee-for-service” system, predominant in workers’ compensation and healthcare as a whole, provides payment based on volume of services, often leaving the concepts of quality and improved outcomes out of the equation. “Value-based care,” on the other hand, places a central focus on realizing the lowest cost while also achieving optimal quality and outcomes.
“We are at a tipping point with value-based care as an industry and as a nation,” says Rising Medical Solutions CEO Jason Beans. “With Florida, we saw an opportunity to not only help our customers utilize value-based care in one of the most costly expense categories – surgical care – but also address it in one of the most challenging workers’ compensation states in the U.S.”
WCRI reports that Florida has the fourth costliest hospital outpatient surgeries in their Hospital Outpatient Cost Index for Workers’ Compensation, Fourth Edition, a 33-state study representing 86% of the workers’ compensation benefits paid in the U.S. WCRI studies also verify that ambulatory surgery centers (ASCs) are significantly less expensive than hospitals as a surgical setting, as most recently noted in their Comparing Payments to Ambulatory Surgery Centers and Hospital Outpatient Departments 2014 report.
To address these issues, Rising’s Surgical Care Program (SCP) first moves treatment away from the costly hospital outpatient setting. Second, Rising applies pre-negotiated case rates with surgeons and ASCs for bundled episodes-of-care, allowing deeper levels of savings. Rising’s SCP realizes an average discount of 35-50% off the normal cost to payers for these services.
The SCP single case rate includes the cost of surgeon(s), anesthesia, implants, facility and post-operative care, with treatment provided by highly credentialed orthopedic surgeons and ASCs for prompt access to top quality care. In the world of workers’ compensation, speed and quality are critical to ensuring better patient outcomes, faster returns to work, and quicker claim resolutions. In Florida, SCP patients typically have an appointment scheduled in 48 hours or less through SCP’s clinical coordination.
Major Florida markets where Rising’s SCP provides access to its orthopedic network include: the Florida Panhandle (Pensacola, Fort Walton Beach, Panama City), Northeast Florida (Jacksonville), Central Florida (Gainesville, Ocala, Orlando), South Florida (Palm Beach, Coral Gables, Miami), and the Florida West Coast (Tampa, Sarasota, Fort Myers, Cape Coral).
SCP’s value-based surgical care not only provides cost predictability for Florida payers, it also provides payment predictability for providers. Jeanetta Lawrence, COO of Florida-based Jewett Orthopaedic Clinic, says that specialists often experience extended collection periods. “Predictable and timely reimbursements for services rendered gives our practice an opportunity to budget accordingly and ultimately offer even better service to those seeking care.”
In additional to workers’ compensation patients, Rising’s SCP is available to auto, liability and group health patients. The program is also currently available in Illinois and is being expanded to other key states nationally.