Although an episode of care
was defined to encompass only one diagnostic category for both the data collection and the comparative norms, individuals often present more than one diagnosis at a time.
The episode of care
project will test the feasibility of a reformed payment structure that establishes a single budget or fee for a procedure that involves multiple providers.
The Bundled Payments initiative is seeking applications for four broadly defined models of care, three of which would involve a retrospective bundled payment arrangement, with a target price (target payment amount) for a defined episode of care
In order to successfully launch this initiative, CaroMont Health partnered with GE Healthcare and Sg2 analytic experts to assess the cost of a full knee replacement episode of care
, including the pre-surgical period, surgery and post-surgical period.
In addition, services determined to be related to patient comorbidities (which may or may not be exacerbated by the clinical condition under consideration) and to routine care in the absence of illness often have been excluded from analysis of an episode of care
Not all doctors will benefit, even if they provide a portion of the treatment for a particular episode of care
in these areas.
Yet that same medical director, using that same judgement, could as easily be said to be exercising her fiduciary responsibility by declaring that her company will not pay for that episode of care
due to specifications of the contract that governs the encounter.
Through the initiative, the Centers for Medicare & Medicaid Services would link payments for multiple services patients receive during an episode of care
under a single fee or agreed upon payment.
But another critical observation to make is that the episode of care
forms the most natural unit of analysis for arriving at a common outcomes metric.
BlueCross' bundled payments will provide a set payment amount for the entire episode of care
for total knee and hip replacements, including the surgery, post care and physical therapy.
Sound's patient-centered approach, web-based workflow platform, experienced leadership team, and more than 2,000 hospitalist, intensivist and transitional care providers drive breakthrough results throughout the acute episode of care
for nearly 300 hospitals and post-acute facilities in 35 states across the nation.
Payment bundling is a form of "value-based reimbursement" in which a group of clinicians and facilities agrees to receive a single prospective payment for all medical services for a well-defined episode of care