Rising Brings Surgical Case Rates to New Jersey

January 13, 2016 — Chicago, IL — Rising Medical Solutions announces the arrival of value-based surgical care in New Jersey, with the introduction of its Surgical Care Program in key markets.

The New Jersey workers’ compensation landscape is one of the toughest in the nation, with:

  • No fee schedule controls over medical costs
  • The second-highest surgical costs in the U.S., averaging 115% more than a typical state*
  • Billed charges 700% greater than Medicare rates**
  • Increased provider consolidation, including major systems
  • Decreased market competition amongst providers

To address these issues, Rising’s Surgical Care Program (SCP) helps New Jersey payers fast-track quality care at a fair, upfront price. Through pre-negotiated case rates with orthopedic surgeons and ASCs for bundled episodes-of-care, Rising allows deeper levels of savings, predictable costs, and better outcomes. Rising’s SCP delivers case rates at 40 to 60 percent below usual and customary charges in New Jersey.

Rising adds New Jersey to its existing surgical programs in Florida and Illinois as part of the company’s continued efforts to bring value-based purchasing to workers’ compensation. At their core, value-based models reward high quality and cost effective patient care – aspects which are not supported by volume-based fee-for-service reimbursement. Tying payments to patient and financial outcomes is what makes value-driven healthcare the logical future standard in workers’ comp.

“Given New Jersey’s challenging environment, it made sense as the next state for SCP,” says Bob Evans, Vice President of Repricing Solutions. “Our customers and industry colleagues have been eager for us to bring the program to New Jersey, and we’re now pleased to launch and expand SCP in the state.”

The program’s single case rates include the cost of surgeon(s), anesthesia, implants, facility and post-operative care, with treatment provided by highly credentialed orthopedic surgeons and ASCs for prompt access to top care.  For a brief program overview, download New Jersey SCP information here.

About Rising Medical Solutions
Rising Medical Solutions is a national medical-financial solutions firm that provides medical care management and medical cost containment services to the workers’ compensation, auto, liability and group health markets.

**Rising claims data