The Clinical Episode-Based Payment (CEBP) Program is a Centers for Medicare & Medicaid Services (CMS) initiative that rewards acute-care hospitals with incentive payments for the quality of care they provide to Medicare beneficiaries.
CMS rewards hospitals based on:
– The quality of care provided to Medicare patients.
– How closely best clinical practices are followed; and
– How well hospitals enhance patients’ experiences of care during hospital stays.
Episode-based payment will change the way that healthcare is provided by bundling a single payment around a defined healthcare event, or episode, such as knee replacement or an acute stroke. A care episode may be a brief event or a period of up to a year, during which time a patient may see multiple providers for episode-related problems. Provider service fees are paid from the bundled payment in an episode-based model. Episode-based payment is a pilot project of the Patient Protection and Affordable Care Act.
The six Clinical Episode-Based Payment (CEBP) Measures show whether Medicare spends more, less, or about the same on an episode of care for a Medicare patient treated in a specific inpatient hospital compared to how much Medicare spends on an episode of care for the respective condition or procedure across all inpatient hospitals nationally. This measure takes into account important factors like patient age and health status (risk adjustment) and geographic payment differences (payment-standardization). Example of episode-based payment, such as with Medicare-related diagnosis-related groups (DRGs). However, episode-based payment can be much more complex than DRG payments for hospitalization. The DRG system pays for acute hospitalization as a bundle. The DRG system does not provide professional payments to physicians.
The DRG payment system does not bundle acute and posthospitalization care. Episode-based payment would pay for acute and postacute care together, possibly increasing the likelihood of appropriate timing of care transitions. When payments for healthcare are based on the care delivered in a clinical episode, the result is increased coordination of care, enhanced quality of care, and less fragmentation in the medical system. This leads to better experience and health for patients and lower costs for payers and providers.
The start and end measure dates for clinical episode based payment measures by hospital covers the period from 1st January, 2017 to 31st December, 2017.