We find the similar pattern among patients on their third or later
episode of care, but the size of discrepancy in the likelihood of discontinuation between 2008 and 2010 was smaller and less significant (see Appendix Figure S4a).
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.
Through repricing, the related claims are paid as a single bundled payment to an administrative provider, who then reimburses all practitioners involved in the
episode of care.
Providence Health & Services, based in Oregon, is among the first MedAssets customers to deploy the
episode of care (EOC) solution and is scheduled to begin monthly reporting on an EOC budget to actual experience in July 2011.
Bundled payments offer another mechanism to help align financial incentives for all providers involved in treating a patient during a discrete
episode of care for a specific condition.
Instead, payers designate a single caregiver or entity to serve as the principal accountable provider, or PAP, with responsibility for managing the cost and quality for an
episode of care.
A claims data approach to defining an
episode of care.
The patient is with the same therapist throughout any given
episode of care.
Instead of paying hospitals, physicians, and other providers separately, this initiative would combine the payment over an
episode of care for a specific condition.
An
episode of care may refer to all services, including hospital, physician, and other services related to a health condition with a given diagnosis from a patient's first admission, including any readmissions, through the last encounter for the condition, including postacute services such as home health, skilled nursing facility, and rehabilitation.
Another proposal would encourage greater cooperation by bundling payments to hospitals to cover all costs associated with a particular
episode of care for a patient.
While clinical coding is not the sole axis for private hospital invoicing, private sector coders need to be aware of the basic tenets of the contracts in order to ensure that the coding accurately reflects the
episode of care to be billed.
