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Removing Red Tape from America's Surgical System
Date:10/23/2013

CHICAGO, Oct. 23, 2013 /PRNewswire/ -- Surgeons, insurance payers and patients all face uncertainty when a surgery occurs.  Predictability is the major missing piece of the medical equation that Rising Medical Solutions' Surgical Care Program (SCP) promises for workers' compensation, auto, liability and group health-related surgeries, as outlined in a recent Risk & Insurance article spotlighting surgical shopping.

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This new concept of "surgical shopping," follows a headline flurry pointing to a sharp increase in demand for joint replacements over the past decade and implant costs also on the rise. Earlier this year a New York Times article featured a patient who traveled to Germany for a hip replacement because surgery in the US would cost more than $100,000. He received his hip replacement abroad for nearly one-tenth of that price.

While traveling overseas to go under the knife isn't an option for everyone, removing the surgery sticker shock is. Rising's SCP fast tracks a patient's surgical care at a fair, upfront price. In Illinois, an arthroscopic knee surgery would cost approximately $32,000 in a hospital-setting. By using an Ambulatory Surgery Center (ASC) and Rising's Orthopedic Surgeons Affiliation, that arthroscopic knee surgery cost gets cut in half.

"The benefits extend far beyond sheer cost savings," says Robert Evans, Rising's Director of National Network Solutions. "Rising's SCP dramatically helps everyone in the surgical picture."

Benefits for the Patient include:

  • Provides faster care through a concierge service that links the patient with an orthopedic surgeon immediately and opens up access to more flexible scheduling through an ASC
  • Achieves better outcomes by using board-certified surgeons and Medicare-certified ASCs, which pose substantially less risk for infection than hospital settings
  • Boasts greater satisfaction with less hassle, no hospital overnights, better results and recovery

For the Medical Provider:

  • Ensures faster payment within five days of surgery
  • Guarantees set payment with pre-negotiated rates
  • Gives single-point of contact for referral process and administrative aspects of surgery

For the Insurance Payer:

  • Saves time by deploying clinical care coordination to determine medical necessity and provide prompt patient scheduling with a high-quality, credentialed surgeons
  • Sets predictable reserving by guaranteeing a pre-determined rate covering chief cost drivers (surgery to 90-days postoperative)
  • Cuts cost by moving surgical procedure from a hospital setting to an ASC

"You go into a store for jeans, you know exactly how much you'll pay. You walk down the grocery aisle, you see every product's price. You go into a restaurant, the menu displays the cost. In no other area of our lives, but healthcare, are prices so unclear and arbitrary," says Jason Beans, Rising's Founder and CEO. "SCP changes that game."

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

Media Contact
Leslie Yeransian – 617.733.1225 / leslie.yeransian@risingms.com


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SOURCE Rising Medical Solutions
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