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eQHealth Blog

Analytics Help Payers Take a More Surgical Approach to Reimbursement

By Ila Sarkar, Vice President of Analytics, eQHealth Solutions 

While the nation’s eyes seem to be obsessively fixed on the high cost of prescription medications, the reality is they only comprise just under 10% of the total cost of healthcare. The real high-cost area is surgery, which accounts for roughly 40% of hospital and physician expenditures.

Surgery also tends to compete with obstetrics for the highest-risk department in any hospital. That’s doubly bad news—surgical complications can drive that already-high cost up 93% on average. And just to bring things full circle, surgeons often prescribe opioidsafter surgery, which is viewed in many circles as a contributor not just to high burden of prescription medications in healthcare, but also to the opioid epidemic.

It’s not that surgery is bad in and of itself. In many cases the health and wellbeing of the member/patient depends on it. The question remains, however, whether all of the surgeries being performed are necessary. In other words, are there other, non-invasive treatments that should be considered before sending a member/patient under the knife? And what can health payers do to encourage providers to take a more surgical approach to recommending a course of treatment?

Click here to read more on Managed Healthcare Executive 

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