Chicago, IL – Rising Medical Solutions is broadening its bundled payment, surgical program in the southeast with the addition of North Carolina and Georgia. The states join Florida, as well as New Jersey and Illinois in Rising’s Surgical Care Program (SCP) – one of the first value-based, bundled reimbursement programs in workers’ compensation that has provided all-inclusive case rates for orthopedic surgical procedures since 2013.
Both North Carolina and Georgia face an evolving provider landscape and changes to their fee schedules that create an environment in need of value-based, quality care that is delivered by SCP.
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.