The additional reimbursement is conditional upon a favorable QIP profile. There's no one insurance company that covers all orthopaedists across the state. Within a given insurer, unless the insurer has cut a separate contract with a given group, which to date is not very common, the professional fee should be the same across a given area in which an insurer has responsibility. But the episodic case rate for a given procedure varies enormously for a payer according to the geographic region. Hospitals have different contracts.
Hospitals have different costs.
Some hospitals' charges for a given procedure are significantly higher than others' for various reasons. Where episodic case rates do lend themselves well on a primary care level is as a disease management tool. Episodic case rates and disease management have many things in common. You can look at the costs that are inherent, for example, in diabetes and asthma as specific diseases within the continuum of health care. You can create a carve out for asthma or diabetes with a given payer.