How would you like to solve the health care crisis?
Yes?
Well, you might get your chance. It's called the Episode of Care and its coming to your town soon.
I've spoken about the Episode of Care before on this blog.
In theory, the Episode of Care sounds neat and tidy.
In fact, the Episode of Care is messy and scary.
The American Physical Therapy Association (APTA) has some serious concerns about a 'post-acute care bundling policy' that bundles all payments for a basket of defined health services, like inpatient, surgery, imaging, lab, PT and skilled nursing, into one payment.
The Episode of Care has a 'risk chain' that passes risk down to the last provider on the chain.
| Provider | Cost/Payment | Risk |
|---|---|---|
| US Gov't/Medicare | $18-26 billion | rising per capita health costs |
| Acute Care Hospitals | Episode of Care payment | re-hospitalizations |
| Rehab Agency, PTPP, CORF, SNF | Case Rate | 'Outliers' with chronic and psychosocial conditions (eg: LBP, depression & anxiety) |
The APTA, in a Statement for the Record to Senator Max Baucus(D-MT), recommended that any health care reforms...
"...implement programs that include care coordination payments for patients with high-cost, chronic illnesses..."Psst!
Wanna know what an Episode of Care payment looks like?
| Episode Level | Payment |
|---|---|
| Level 1 | $55 |
| Level 2 | $135 |
| Level 3 | $225 |
| Level 4 | $300 |
| Level 5 | $530 |
Remember, you take on the risk that the patient, instead of the average 8-10 visits to PT, goes 40-50 visits.
Oh, and by the way, higher episode levels are based on prior surgery within 30 days, not true drivers of chronicity like elevated fear-avoidance beliefs and depression.
Most initial episode levels come in at a Level 2 ($135).
Is it just me?
I don't know - I may have some difficulty solving the health care crisis on $135.
Oh, and by the way, if you're curious where I got the data on episode levels just send me an e-mail.
I may pick your brain on how to solve the health care crisis in PT, as well.
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