Abstract:
This project tests the potential of profiling with patient-centered episodes (PCEs) using Clinical Risk Groups (CRGs) as the risk adjustor. The important findings from this study include: The PCEs have an R2 for post acute care services that is comparable to the MS-DRGs for Part A. This level of R2 performance of the PCEs implies that the financial risks associated with a bundled post acute care payment system should be manageable. The impact of the patient acuity during the admission that initiated the episode diminishes as the length of the post acute care window increases. The impact of the patient burden of chronic illness increases as the length of the post acute care window increases. It is feasible to include all post acute care services in the episode with the possible exception of readmissions. Including even potentially avoidable readmission will need to be done with some caution in order to avoid creating too much financial risk and potentially creating access problems for some subpopulations of beneficiaries. Generally, longer windows perform as well or better than shorter windows. This means that post acute care windows as long as 90 days are feasible.