Working with episodes
An episode is a series of medical encounters that address a specific medical condition or center around a specific set of medical services. Episodes have been used by organizations for some time, but until recently, they were of interest from a clinical or quality perspective. Episodes are now becoming more popular due to the potential of being a source of reimbursement.
Episodes are similar to and often synonymous with bundles, which is the process of bundling a set of services and paying one amount to allocate across providers. A bundled payment methodology involves combining the payments for a physician, hospital, and other health care provider services into a single bundled payment amount. This amount is calculated based on the expected costs of all items and services furnished to a beneficiary during an episode of care. Payment models that provide a single bundled payment to healthcare providers can motivate them to furnish services efficiently, to better coordinate care, and to improve the quality of care. Healthcare providers receiving a bundled payment may either realize a gain or loss, based on how successfully they manage resources and total costs throughout each episode of care. A bundled payment also creates an incentive for providers and suppliers to coordinate and deliver care more efficiently because a single bundled payment will often cover services furnished by various health care providers in multiple care delivery settings.
Episodes have a trigger event that are often (but not always) a pre-and/or a post-phase. Episodes and bundles often have very specific criteria with numerous inclusion and exclusion rules. These rules are generally interpreted to resemble the advanced filtering used to identify which encounters might be defined as having a triggering event and what encounters may be related to each other, thus defining the episode.
In Axiom Enterprise Decision Support, the Episode Builder utility provides an easy way to select patients and encounters for an episode of care or a bundled payment analysis. You can then comb through large amounts of data and reference lists to find the desired filters when building an episode definition. This includes the ability to define rules and reuse them where appropriate, and then use them to define an episode or bundle.
By defining an episode, you create or select a data filter, which narrows the scope of the Encounter table to match events to the criteria, called the Anchor. After further configuration of an optional pre-Anchor and post-Anchor, you can submit the Episode Definition to the Scheduler for processing. Processing generates records into the EpisodicGroupingEncounter table for reporting purposes.
The Episode Builder includes two main areas:
- Episode Browser - The page where you manage the episode definitions. From this page, you can:
- View a list of all the episodes definitions created by all users
- View only those episode definitions created by you
- View episode definitions that are not active
- View bundled episode definitions
- Manage filters
- Create episode definitions
- Episode Editor - The page used to configure the specific episode definition criteria. From this page, you can:
- General Setup tab - Configure the episode definition name, description, folder, activate/deactivate the definition, and set the parameter dates of the episode
- Anchor, Pre-Anchor, and Post- Anchor tabs - Configure the Anchor, Pre-Anchor, and Post-Anchor criterion.
Process tab - Process the definition to display a list of the episodes based on the criterion you configured.
TIP: When using the Episode Builder for the first time, we recommend that you first set up the filters you will mostly likely use to create the criterion for the episode definitions. To do this, click the Filters button in the top right corner of the Episode Browser page. For more information on how to create and save filters for future use, see Using the Import Wizard.
