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Inpatient Procedural 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.

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

PROMETHEUS Payment currently has five inpatient procedural ECRs for the following procedures: hip replacement, knee replacement, bariatric surgery, coronary artery bypass graft, and colon resection.  The inpatient procedural care bundles are designed to span a 210 day period, a 180 day look forward, and a 30 day look back.

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

Example scenarios of PROMETHEUS Payment in Practice relating to an Inpatient Procedural ECR:
Ron's Bypass Surgery
Karen's Knee Replacement

Version 3.5 Inpatient Procedural 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 inpatient procedures, the breakdown of claims associated with the procedure into typical services and PAC-related services, and their PAC rates.

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

Inpatient Procedural Playbooks:

2. Bariatric Surgery
3. Hip Replacement
4. Knee Replacement
5. Colon Resection