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Acute Medical ECRs

An Evidence informed case rate (ECR®) is a risk-adjusted budget for an entire care episode which includes all covered services across all providers that would typically treat a patient for that condition.

Acute ECRs are designed to promote coordination of care by having the entire range of services associated with the condition being derived from one bundled payment with a reward incentive built in for physicians who deliver superior care.

PROMETHEUS Payment currently has three acute medical ECRs for the following conditions: Acute Myocardial Infarction (AMI), Pneumonia (PNE), and Stroke (STR).  The acute medical ECRs are designed to span a thirty day period.

ECRs are patient-specific, in that the patient's characteristics are analyzed and a payment amount is calculated based on factors such as a patient's age, risk factors, and co-morbidities. 

Outpatient facility, professional and pharmacy claims are analyzed to determine a patient's conditions and risk factors.  These claims are then sorted into two types: typical claims and claims associated with Potentially Avoidable Complications (PACs). PACs are any events that negatively impact the patient and are potentially controllable by all of the clinicians who manage and co-manage the patient. Each ECR has an allowance to cover the cost for any PACs that occur. If PACs are reduced or eliminated, the leftover allowance is distributed amongst all providers for the patient as a bonus.

To read an example scenario of PROMETHEUS Payment in Practice relating to an Acute Procedural ECR, click here.

Version 3.5 Acute ECR freeware is available here for clinicians and practices who are interested in learning the number of eligible patients they have for any of the given acute conditions, the breakdown of claims associated with the condition into typical services and PAC-related services, and their PAC rates.

The Acute ECR playbooks are also available below to provide detailed information regarding the outputs of the test dataset and how the ECRs are constructed.

Acute ECR Playbooks:

1. AMI
2. Pneumonia
3. Stroke