Episode-of-Care Payment

2021 Measure Reporting Year

Measurement Period: April 2017 - June 2020

Thirty-day Episodes of Care Payments are Medicare fee-for-service reimbursements that have been standardized to remove factors unrelated to clinical care, such as differences in geographic location and support for medical student education. Thus, payments are a dollar-value reflection of the care choices hospitals make for their patients. While not a measure of quality, variation in payments within and between the index and post-acute care settings may be influenced by a hospital's unique practice patterns. Understanding which care settings are accounting for the greatest proportions of payments and which are driving differences in payments can inform efforts to reduce spending and improve efficiencies in care.

To begin exploring the data: 

  1. Click the magnifying glass to view the breakdown of payments made for the index admission or post-acute care. 

  2. Check the boxes on the right side of the graph to view payments for each care setting. 

  3. Toggle the x-axis (horizontal axis) to view "Proportion of Payment" OR "Average Standardized Dollars per Patient". 

Years:

2023 2022 2021 2020 2019 2018
Index Admission Payments
Post-Acute Care Payments
0%
25%
50%
75%
100%

{[{condition.label}]}

Breakdown 
{[{breakdown.label}]}
Breakdown 
{[{breakdown.label}]}

{[{condition.label}]}: Index Admission Payments ({[{condition.index.percent}]}%)

Post-Acute Care Payment ({[{condition.acute.percent}]}%)
Number of Hospitals
Proportion of Payment Average Standardized Dollars per Patient

{[{condition.label}]}: Post-Acute Care Payment ({[{condition.acute.percent}]}%)

Index Admission Payments ({[{condition.index.percent}]}%)
Number of Hospitals
Proportion of Payment Average Standardized Dollars per Patient

Table View

Measure Type of Payment {[{condition.label}]}

Index Admission Payments
Index Admission Payments
  • Proportion of total payments
  • {[{condition.index.percent}]}%
empty Proportion of index admission payments (%) Average payment per patient ($)
  • {[{breakdown.label}]}
  • {[{breakdown.percent}]}%
  • {[{breakdown.payment}]}

Post-Acute Care Payment
Post-Acute Care Payment
  • Proportion of total payments
  • {[{condition.acute.percent}]}%
empty Proportion of post-acute care payments (%) Average payment per patient ($)
  • {[{breakdown.label}]}
  • {[{formatPercentage(breakdown)}]}
  • {[{formatPayment(breakdown)}]}

How do we determine episode of care payment?

Episode of Care

 

Standardizing Payment

To calculate standardized payments that reflect differences in care provided for patients, payments based on geography (i.e. cost of living and wage index) or policy adjustments (i.e indirect medical education and disproportionate share) are removed from the payment calculation.

 

Breakdown of the Types of Payment

 

Notes

For the publicly reported results by hospital, please visit HospitalCompare.

MEASUREMENT PERIOD

The measures included in this visualization have the following measurement period:

Table 1. Included Measures

Outcome 

Condition/Procedure

Measurement Period

Payment

Acute Myocardial Infarction

7/2019 - 6/2022

Heart Failure

7/2019 - 6/2022

Pneumonia

7/2019 - 6/2022

Total hip arthroplasty and/or total knee arthroplasty

4/2019 - 3/2022
 

DATA NOTES

Only hospitals with at least 25 qualifying hospitalizations for a given measure are included in the visualization.

DEFINITIONS

Table 2. Key Definitions

Term

Definition

Histogram

A graphical representation of the distribution of numerical data. Please see “Figure Explanations” in Related Research for more information.

Episode of Care

Starting with the index admission, the 30-day (for AMI, heart failure and pneumonia patients) or 90-day (Hip/Knee arthroplasty) window in which the patient receives care across multiple care settings.

Index Admission Payments

All payments related to the initial admission for an episode of AMI, heart failure, pneumonia, or hip/knee replacement care and evaluated for the outcome.

Post-Acute Care Payments

All payments related to care received after being discharged from the index admission.
Non-Acute Inpatient Settings

All payments related to long-term care in inpatient settings, including inpatient psychiatric facilities, inpatient psychiatric physician visits, inpatient rehabilitation facilities, inpatient rehabilitation physician visits, and long-term care hospital (LTCH) facilities.

Standardized Dollars

Payments are standardized for each care setting using the CMS Standardization Methodology for Allowed Amount. Geographic differences and policy adjustments in payment rates for individual services are removed from the total payment for that service. Where geographic differences in payments cannot be removed, they are averaged across geographic areas.

Miscellaneous

The miscellaneous category includes ambulance, medical supplies, and other costs.

Stacked bar chart

A stacked bar chart shows a sum of values as a column or bar, including the individual subgroups within the sum. Subgroups of data within the bar allow for comparisons of the relative contribution of each subgroup to the bar and the overall chart. Please see “Figure Explanations” in Research Briefs for more information.

 

Methodology Sources

AMI, COPD, Heart Failure, and Pneumonia Readmission Measures Methodology: DeBuhr J, McDowell K, Grady J, et al. 2023 Condition-Specific Measures Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Readmission Measures: Acute Myocardial Infarction – Version 16.0, Chronic Obstructive Pulmonary Disease – Version 12.0, Heart Failure – Version 16.0, Pneumonia – Version 16.0. https://qualitynet.cms.gov/inpatient/measures/readmission/resources Available as of Spring 2023.

 

CABG and Hip/Knee Arthroplasty Readmission Measures Methodology: DeBuhr J, McDowell K, Grady J, et al. 2023 Procedure-Specific Measures Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Readmission Measures: Isolated Coronary Artery Bypass Graft (CABG) Surgery – Version 10.0, Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) – Version 12.0. https://qualitynet.cms.gov/inpatient/measures/readmission/methodology  Available as of Spring 2023.

 

AMI, COPD, Heart Failure, Pneumonia, and Stroke Mortality Measures Methodology: DeBuhr J, McDowell K, Grady J, et al. 2023 Condition-Specific Measures Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Mortality Measures: Acute Myocardial Infarction – Version 17.0, Chronic Obstructive Pulmonary Disease – Version 12.0, Heart Failure – Version 17.0, Pneumonia – Version 17.0, Stroke – Version 12.0. https://qualitynet.cms.gov/inpatient/measures/mortality/resources.  Available as of Spring 2023.

 

CABG Mortality Measure Methodology: DeBuhr J, McDowell K, Grady J, et al. 2023 Procedure-Specific Measure Updates and Specifications Report Hospital-Level 30-Day Risk-Standardized Mortality Measure: Isolated Coronary Artery Bypass Graft (CABG) Surgery – Version 10.0. https://qualitynet.cms.gov/inpatient/measures/mortality/methodology. Available as of Spring 2023.

 

Hip/Knee Arthroplasty Complication Measure Methodology: DeBuhr J, McDowell K, Grady J, et al. 2023 Procedure-Specific Measure Updates and Specifications Report Hospital-Level Risk-Standardized Complication Measure: Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) – Version 12.0. https://qualitynet.cms.gov/inpatient/measures/complication/resources Available as of Spring 2023.

 

AMI, Heart Failure, Pneumonia, and Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) Payment Measures Methodology: DeBuhr J, McDowell K, Grady J, et al. 2023 Measure Updates and Specifications Report Hospital-Level Risk-Standardized Payment Measures: Acute Myocardial Infarction – Version 12.0, Heart Failure – Version 10.0, Pneumonia – Version 10.0, Elective Primary Total Hip Arthroplasty (THA) and/or Total Knee Arthroplasty (TKA) – Version 9.0. https://qualitynet.cms.gov/inpatient/measures/payment/resources Available as of Spring 2023.

 

AMI, Heart Failure, Pneumonia Excess Days in Acute Care Measure Methodology: DeBuhr J, McDowell K, Grady J, et al. 2023 Condition-Specific Measures Updates and Specification Report Hospital-Level 30-Day Risk-Standardized Excess Days in Acute Care Measures: Acute Myocardial Infarction – Version 8.0, Heart Failure – Version 8.0, Pneumonia – Version 7.0. https://qualitynet.cms.gov/inpatient/measures/edac/resources Available as of Spring 2023.

 

Hospital-Wide Readmission Measure Methodology: DeBuhr J, McDowell K, Grady J, et al. 2020 All-Cause Hospital-Wide Measure Updates and Specifications Report: Hospital-Level 30-Day Risk-Standardized Readmission Measure – Version 12.0 https://qualitynet.cms.gov/inpatient/measures/readmission/methodology Available as of Spring 2023.

 

 

Related Research

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