Analyze cost drivers for surgeons performing the same procedure at multiple facilities

Challenge:

Surgeons performing the same procedure at multiple facilities are generally unaware of the reimbursement rates that each facility has negotiated with individual health plans. While the surgeon is generally reimbursed the same amount no matter where they perform the procedure, the facility’s reimbursement rates can vary greatly. This causes wide price variances that can range as much as 400%-500% amongst in-network providers for the same procedure.

Solution:

Health Plans need the ability to identify surgeons utilizing multiple facilities as well as the cost variances among them. Using a fairly light-handed approach, health plans can realize significant cost savings by educating and incentivizing surgeons performing the same procedure at multiple facilities.

“The savings opportunity identified for this specific procedure averaged $1.8 million for each state involved in the analysis.”

RemitDATA’s comparative analytics provide health plans with actionable information on their top surgical procedures by surgeon. With the ability to identify which surgeons are practicing at multiple facilities during the pre-authorization process, health plans can direct or incentivize surgeons to conduct the service at 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.

Case Example:

Working with a large national carrier, RemitDATA presented the carrier with Surgeon Site of Service data based on in-network pricing for colonoscopies conducted in mid-western states. Leveraging this data, RemitDATA was able to identify the financial impact of redirecting surgeons from a high-cost to a lower-cost facility.The surgeons are only redirected to facilities where they are actively practicing.

The savings opportunity identified for this specific procedure averaged $1.8 million for each state involved in the analysis. RemitDATA also provided the savings potential by surgeon, giving the health plan a clear road map for achieving these savings.

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