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).
When the episode of care
ends, Medicare will compare its total outlay to all providers to the pre-determined bundle price that naviHealth set in its contract with Medicare.
In addition to the options of prospective or retrospective payment, providers could choose how long the episode of care
will be and what conditions they want to bundle payment for, and what services would be included in the payment.
For example, CMS currently is developing the Medicare Acute Care Episode (ACE) demonstration that bundles services (both hospital and physician) into a single episode of care
with a negotiated payment amount.
A global fee is the price the payer reimburses an integrated specialty care team for an entire episode of care
Differences in the numbers of episodes and of encounters per patient per year were small compared with differences in utilization per episode of care
, including diagnostic and therapeutic interventions.
Costs related to the episode of care
include the length of stay in the special care unit or hospital, nursing care costs in the hospital, professional and technical services, physician services, respiratory therapy, pharmaceuticals, IV therapy, and collateral diseases and complications.
Payments can be set prospectively for each visit provided, each month of care, each episode of care
, or each month of program enrollment, for example.
Under this model, the episode of care
will include the hospital inpatient stay and all related services during an episode up to 90 days post hospital discharge.
With CMS' recent announcement of its Comprehensive Care for Joint Replacement (CCJR) payment model and its plan to implement in seventy-five geographic areas, hospitals must be prepared to manage the entire episode of care
from the time of surgery through ninety days after discharge.
Arkansas Medicaid has initiated payment reform by explicitly rewarding those physicians and hospitals that achieve quality outcomes at lower total resource utilization for a given episode of care
Bundled payments, in which providers are reimbursed a set fee for an episode of care
, will enable UC to compete for regional and national employer-based contracts for these procedures.