Report: 'Episode of care' reimbursement model filled with promise, problems

Share this article:

Reimbursing physicians and providers using an "episode of care" model has been discussed as a way to potentially curb medical expenses and improve quality of care, but a number of logistical concerns stand in the way of implementing such a system, according to new research from the RAND Corporation.

Under an "episode of care" model, providers and physicians would receive one lump-sum payment for treating a patient's medical condition. Despite having been widely proposed as a potential cost saver, the system itself is still largely conceptual, according to the report.

By making a single payment for all physician or facility services related to treating conditions, such as implanting an artificial hip or managing a patient's diabetes, proponents of an "episode of care" approach hope to eliminate extraneous tests or procedures that the current fee-for-service model apparently encourages. But the model presents some serious problems to solve, according to researchers. Because many conditions are treated by a number of physicians or providers-especially chronic conditions, such as heart disease or diabetes, which affect up to 90% of seniors-it becomes difficult to discern which physician or facility is responsible for managing treatment. As a result, such a model might not be optimal for those types of patients, researchers note.

Other difficult issues to take into consideration include how best to define an episode of care, or whether or not certain types of providers would be put at an unfair financial risk by treating patients under this type of system. The study appears in the September/October edition of the journal Health Affairs.


Share this article:

More in News

CMS expands therapy payment research

The government is expanding its research into alternative therapy payments, to consider more holistic changes to the way Medicare reimburses skilled nursing facilities, the Centers for Medicare & Medicaid Services announced Tuesday.

CDC tightens Ebola guidelines for healthcare workers

The Centers for Disease Control and Prevention has issued more stringent guidelines for how healthcare workers should interact with Ebola patients, following an outcry from nurses and other professionals.

Nonprofit providers face alarming market forces, must rally, LeadingAge chairman says

Nonprofit providers face alarming market forces, must rally, ...

Nonprofit long-term care providers must work together to address alarming trends, or their market share could plummet and the sector as a whole could falter, LeadingAge Chairman David Gehm told ...