Comparative Analytics Saves Payers Millions with Surgeon Site of Service Data

Cost savings for payers is more important than ever. Yet, in a typical fee-for-service pricing model, surgeons performing the same procedure at multiple facilities are generally unaware of the reimbursement rates negotiated between the facility and the individual health plan.

Surgeons are generally reimbursed the same amount no matter where they perform the procedure. Since most facilities’ reimbursement rates can vary greatly, there are wide price variances that can range as much as 400%-500% amongst in-network providers for the same procedure.

In order for health plans to manage these cost variances, they need transparency to understand the complete costs associated with a procedure and the ability to identify the surgeons practicing at multiple facilities.

Increased transparency can be achieved through the use of comparative analytics.

In this case, RemitDATA’s Surgeon Site of Service comparative data reveals detailed and actionable information allowing payers to identify top surgical procedures by surgeon, and the healthcare facilities where they are practicing.

Now, during the pre-authorization process, the payer can easily identify which surgeons are practicing at multiple facilities. This level of information allows the health plan to direct or incentivize surgeons to conduct the medical procedure at a lower cost facility where they currently practice.

The end result creates a ripple effect of value across all parties – health plans and their members both achieve cost savings without reducing the surgeon’s reimbursement.

See how a large national carrier is realizing savings of approximately $1.8 million for a specific procedure leveraging RemitDATA’s Surgeon Site of Service data.