About our Program

The Orthopedic and Neurological Surgeon Quality Project is a pay-for-quality initiative designed to improve injured workers’ outcomes through access to high quality surgical care.

Participation in this project is currently restricted to orthopedic, neurologic, or plastic surgeons who perform hand surgery. At this time, we are only enrolling surgeons who practice within participating clinics.

Refer to our Project Manual to learn more.

Surgical Best Practices Pilot

A small subset of surgeons in the Orthopedic and Neurological Surgeon Quality Project are helping us test new best practices related to transition of care and return to work planning.

We are working to merge these two efforts into a future surgical quality care program.

Best Practices

The Orthopedic and Neurological Surgeons Quality Project uses each of the following quality best practices:

  • Complete Activity Prescription Form before and after surgery.
  • Document and track rehabilitation plans and goals.
  • Only write "dispense as written" prescriptions when formulary alternatives are unavailable or clinically inappropriate.
  • Offer injured workers timely access to care.
  • Offer injured workers timely surgery.
  • Maintain and report continuing education units.
Health Services Coordination

The Surgical Best Practices Pilot has developed care coordination standard work that allows health services coordinators to collaborate with surgeons to reduce transition times and improve return-to-work planning.

Provider Incentives

Ortho-Neuro surgeons participating in this project use the following codes and limits to bill for services provided:

Code: 1071M

Service: Quality indicator incentive pay

Description: Billed and payable when an Activity Prescription Form (APF) is also paid for the same date of service.

Maximum fee: Payment level based on assigned tier for each provider. Fees effective October 1, 2020.

  • Tier 3: $115.58
  • Tier 2: $86.67
  • Tier 1: $57.79
  • No Tier: $0

Comments:

  • Not Payable to PA-C or ARNP.
  • Still payable during global surgery period.

Know the bill payment cutoff dates

Bills are processed every other Friday. See cutoff and payment dates. Payments are mailed during the week of the payment date (beginning on Tuesday).

Self-insured employers participation

The following self-insured employers are currently participating in the project*:

  • City of Longview.
  • City of Vancouver.
  • Clark County.
  • Clark County PUD #1.
  • Cowlitz County.
  • ESD 112.
  • Great Western Malting.
  • JH Kelly, LLC.
  • Legacy Health System.
  • PeaceHealth Southwest Medical Center.
  • RSG Forest Products.
  • Safeway.
  • Vancouver Public School District #37.
  • Wafer Tech.
  • Walmart.
  • WinCo Holdings.

*Last updated June 29, 2020.

Surgical Quality Care Program

The Surgical Quality Care Program (SQCP) is an L&I pay-for-quality initiative. This program rewards participating musculoskeletal surgeons for consistently adhering to established administrative best practices designed to improve the outcomes of workers injured on the job.

Who may participate?

Initially, enrollment is restricted to surgeons who are active participants in the Orthopedic and Neurological Surgeon Quality Project (Ortho/Neuro) as of March 1, 2021, and who:

  • Are credentialed as an L&I provider, with an active provider ID number.
  • Practice in Washington or an adjacent community of Oregon/Idaho and regularly treat workers, be it State Fund or Self-Insured (collectively referred to as “payors”).
  • Have no active adverse findings from L&I’s Provider Quality and Credentialing unit.
  • Complete the orientation for the Surgical Quality Care Program, and
  • Know and comply with these L&I guidelines:

Administrative Best Practices and Rewards

While the participant incentive calculation has changed from Ortho/Neuro’s, the earning potential has remained the same.

The SQCP program is easy to understand with these four quality indicators:

  1. Complete Activity Prescription Form (APF) for workers undergoing surgery.
  2. Timely surgery following authorization.
  3. Create release-to-work (RTW) plans and goals with the injured worker.
  4. Review/integrate communications from ancillary providers into the rehab plan.

Subject to how participants meet these quality indicators, one of four (4) adoption levels are assigned. The higher the adoption status, the more desirable the incentive fee. These are: Low, at 10% of the maximum payment level, Medium, at 50% payment level, High Adopter, at 65%, to Sustaining High Adopter, at 100% of the maximum payment level.

Surgical Health Services Coordinators (SHSCs)

This program encourages participants to engage Surgical Health Services Coordinators (SHSCs) as collaborators with all parties to the claim. Their role is meant to help:

  • Reduce transition times to and from surgical care.
  • Assist workers, employers and health care providers navigate L&I processes.
  • Identify and mitigate barriers to treatment, recovery and return to work.
  • Improve release/return-to-work planning.

Comments or Questions:

For more information: (360) 902-6060 or mailto:SQCProgram@Lni.wa.gov

Frequently Asked Questions

    Can a provider submit the APF or ROA electronically?

    Yes, the APF and ROA can be completed and submitted through My L&I on the provider dashboard. In addition, both are also available as a Health Information Exchange (HIE) transactions.