There's the ability to generate a global episodic case rate for that specific disease entity by efficient management, thereby lowering the cost. The costs have to come from some part of the health care dollar in order to result in savings to the payer and improved reimbursement to the physicians, unless the health care dollar were to become larger, which over the past many years it has not. Therefore, you have to look at where the streamlining is going to take place. If you decrease a clinical component, you have to substitute an appropriate alternative that results in the same outcome. Pennsylvania Orthopaedic Society and the payers are both concerned that the outcomes remain unchanged, that the patient doesn't suffer because of any change in reimbursement methodology.
Payers save under a single price that covers the entire continuum for that surgical procedure.
That single price would be less than their historical experience. Where this has significant value in workers comp is the ability to price the frequency of injuries at a specific number which can be slightly lower or even identical to what the self-insured company is presently experiencing, but it remains stable. They understand that the re-operation that might take place within that defined period of time doesn't get reimbursed the second time. The provider is responsible for the patient completely from the trigger event to the conclusion event. It's better for physicians because, for the first time, they have the opportunity to regain control over the process.