Sports Medicine & Orthopaedic Center

In their own words, “While staying on the cutting edge of modern medicine and surgical techniques, we found many of our contracts were extremely outdated, and we lacked the internal expertise to adequately address renegotiation.”

In short, SMOC recognized their need to renegotiate decades-old contracts that hamstrung their payor revenue streams with outdated rates and non-competitive terms. Not having the time or expertise to handle this in-house, they turned to PayrHealth for their contract negotiation and re-negotiation needs.

Under their Payor Portfolio Management contract with PayrHealth, SMOC and PayrHealth worked with five contracts at a time to renegotiate their most valuable contracts to obtain competitive rates and terms with large insurance providers.

Under their new UHC contract, SMOC obtained an average 5% increase on their top codes for Commercial Options PPO rates and an average 10% increase on top codes for Commercial All Other LOBS. Their new Optima offer moved from 2008 Medicare reimbursement rates to 130% of 2021 CMS rates. Cigna’s new offer resulted in a 5% increase on top codes.

In particular, due to the competitiveness of the client’s market, PayrHealth’s negotiation tactics utilized escalation clauses, including a 2% escalator for a three-year contract with Aetna. Currently, 25% of client’s contracts include a multi-year escalator.

All told, SMOC obtained 5-10% increase in revenue for their top-performing codes.

According to the client, by using relationship building, escalations, and financial modeling, PayrHealth “successfully renegotiated every contract we targeted for improvement.” In proving PayrHealth’s success and building a trusting relationship with the team, SMOC continues to negotiate other strategic contracts to help them stay consistent with the rising costs of doing business in the sports and orthopedic medicine market.