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Utilization Review Price Comparison Chart


This is a price comparison GSG did for a California TPA, comparing GSG's price for service to their current vendor. This comparison validates GSG's position that many vendors utilize their nurse consultants as loss leaders to make higher margins on Physician Advisor services. GSG has always believed that we should be part of the solution not part of the problem. We are a NURSE consulting company and we do our business as such. We maintain our viability as a company by making a fair margin on the services of our nurse consultants and not misrepresenting our costs to our clients.


Month
Sample		 Total
Reviews
Billed		 Flat Rate
Per Unit
(Nurse Review)		 Total Cost
for
Nurse
Review		 Total Physician Advisor Reviews Percent of Reviews
to P.A.		 Total Advisor Costs Average Cost
Per Advisor Review		 Total
Review Costs		 Average Cost
per Review
(All Reviews)
GSG Client 269 $125.00 $33,625.00 94 35% $8,816.20 $93.64 $42,441.20 $157.77
TPA Totals 579 $60.00 $34,740.00 343 59% $79,739.14 $232.48 $114,479.14 $197.72
 
5000 Reviews @ GSG Rate, based on above figures:
 $788,869.89  
5000 Reviews @ Client's old Vendor (Vendor A) Rate:
$988,593.61
Savings per 5000 Reviews at GSG's Per Unit Rate:
$199,723.72
 
 
Add $20 per review since UR Vendor's price went up to $80 since this evaluation was originally done
add $20 X 5000 reviews:
$100,000.00
 
5000 Reviews @ Client's old Vendor rate:
$1,088,593.61
 
Savings per 5000 Reviews at GSG's Rate: $299,723.72  
 
Vendor A Model: $95 per RN Review/ $175 per MD Review  
5000 Reviews at $95 $475,000.00  
2950 MD Reviews at $175
$516,250.00
 
Total for 5000 Reviews in Vendor A Model
$991,250.00
 
Savings per 5000 Reviews at GSG's Rate:
$202,380.11
 
 
Vendor B Model: $90 per RN Review/ $250 per MD Review  
5000 Reviews at $90
$470,000.00
 
2400 MD Reviews at $250
$600,000.00
 
Total for 5000 Reviews in Vendor B Model $1,070,000.00  
Savings per 5000 Reviews at GSG's Rate: $281,130.11  
 
Flat Rate for 5000 Cases (in GSG Model about 3 Nurses @ $85/hour)  
Three Years of UR at Flat Rate for Nurse
$694,270.00
(includes Flat Rate Nurse cost & est. Physician costs )
Savings over three Years at Flat Rate: $394,323.61  
 
GSG Rates  
First Level RN Review $125.00 This flat rate fee includes follow-up on a review. For example: RN preparation of appealed UR decision before sending to Appeal Physician
Physician Advisor Review $175/hr billed in 15 minute increments
2nd Level PA/Appeals $175/hr same as above
Chiro Peer Review $150/hr RN does first level chiro review, only peer reviews go to chiro
Specialty Physicians $225-$300/hr Used with Client's consent when Specialty Match is most appropriate.

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