Site of Service

Value Based Contracting

The healthcare reimbursement landscape is evolving as the government, employers and payers continue to pressure our industry to rein in healthcare costs which have spiraled out of control over the past few decades. Some of the most popular alternative contracting models are "site of service" agreements in which providers are incentivized to perform surgical cases in lower cost facilities. The typical hierarchy that payers are creating tiered bonus reimbursements:

The BCBS plans have been very progressive in some states and the national commercial payers have recently become more active. One of the national plans, UnitedHealthCare has begun rolling out their version of a "site of service" program called Quality-based Physician Incentive Program (QPIP). The program pays a set bonus amount per surgical groupers and/or CPT's to surgeons who perform those procedures within a QPIP qualified Ambulatory Surgery Center (ASC).

The goal is to reward high quality surgeons and ASCs for surgical cases already being performed in ASCs. Further, they want to incentivize and reward surgeons for disrupting their current practice workflow by rescheduling their operating room block times to move surgical cases to more appropriate facilities.

Since the United QPIP is a national program, we have received the Grouper and CPT level algorithms and performed an opportunity analysis for your practice based upon your actual utilization data. This information will allow you to determine the potential financial impact of entering into the QPIP program. It will also allow you to evaluate the degree of difficulty of shifting cases by providing detailed breakdown of QPIP cases by facility, by surgeon.

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