Did you know that the cost for some surgical procedures can vary by as much as
400%-500% amongst in-network providers for the same procedure? A close look at three years of independent Blue Cross and Blue Shield companies’ claims data found that the cost for a total knee replacement (without complications) varied nationally, from a low in Montgomery, Alabama of $11,317 to as high as $69,654 in New York City. And costs can vary widely within the same market too. In Dallas, the study found a 267 percent cost variation for total knee replacement ranging from $16,772 to $61,585 depending on the hospital.

Surgeons are typically reimbursed the same amount no matter where they perform their procedure. However, the facility’s reimbursement rates can vary greatly, costing health plans millions. 

Using comparative analytics, health plans can identify which surgeons are practicing at multiple facilities during the pre-authorization process, and then guide or incentivize surgeons to conduct the service at the lower cost facilities where they currently practice. As a result, health plans and their patients will both realize cost savings without reducing the surgeon’s reimbursement. Talk to us to learn more about leveraging comparative data to reduce site of surgeon costs.

Read this article to learn more.