An episode of care includes all the services provided to a patient to treat a clinical condition or procedure. A group of one or more health care encounters, in which a health care subject receives health care services for one or more health problems or disorders from a health care provider. Attention episodes are sets of encounters or revenues with a common purpose. Often, it is a patient's condition that encompasses several encounters, such as pregnancy, back pain, or workers' compensation.
Encounters can be linked to a care episode for easy review and notification. Providers responsible for episodes of chronic diseases would assume responsibility for treating patients on an outpatient basis and avoiding hospitalization to the extent possible. One of the ways that MVC provides information about health care episodes is with data about payments for professional health care services and health facilities. Specific applications of the episodes being discussed include profiling providers to provide comparative feedback to improve quality, public reporting, pay-per-performance and “combined payments” by service groups.
For these reasons, episodic approaches to chronic care should be evaluated in conjunction with patient-based approaches. The period from the beginning of an episode to the initial discharge is called an index event, and MVC aggregates the requests submitted by the centers and the payments associated with the centers with standardized prices for the base payment, as well as atypical and transfer payments, if applicable. The recommendations contained in this document serve as a starting point for developing a more robust program for evaluating the applications of attention episodes. The most recent proposals, which emphasize creating shared responsibilities for quality and cost among the broadest set of providers involved in patient care, advocate the development of responsible care organizations (ACO) 19 or responsible care systems (ACS), 20: groups of providers who would assume responsibility for episodes or patients.
The CV ranged from 72 for episodes related to hip fracture, indicating lower variability, and 269 for diabetes-related episodes, indicating great variability within episodes of the same type of condition. For 30 or 90 days following discharge, requests for assistance to centers for that patient's episode follow a standardized price and are classified into post-acute care and hospital readmission components. Prometheus Payment has performed this type of analysis to analyze several conditions of a national business population and has found that 40% of the costs of episodes, on average, correspond to services classified as “potentially avoidable complications”. A series of recent proposals for health system reform advocates using care episodes as a basis for payment and the measurement of performance.
