Module 1
Episode Design and Economics
Trigger, window, inclusions, and accountability are separate choices. How target prices are built, how reconciliation actually computes, and what the evidence says bundles achieve.
By the end of this module, you will be able to:
- Analyze an episode model by its four independent design levers
- Trace a reconciliation from spending through quality adjustment to the payment caps
- State what surgical bundles achieved and by what mechanism
- The Episode Design Space Trigger, window, inclusions, and accountability are four independent choices. Each one moves who wins and who loses more than the headline model name does. About 5 min
- Target Prices and Reconciliation The target price decides who wins before any care is delivered. TEAM's reconciliation sequence shows exactly how the money is calculated. About 6 min
- What Bundled Payment Achieved Surgical bundles produced real but modest savings from post-acute care, without the patient selection critics predicted. Medical episodes are a different story. About 5 min
Module quiz
Answer all questions to see your score.
1. What happens to a bundle when the procedure it targets migrates from inpatient to outpatient?
CMS changed the CJR episode definition beginning in PY6 to include outpatient procedures. Any trigger tied to a setting rather than to the clinical event carries this maintenance burden.
2. In TEAM's reconciliation sequence, what is subtracted at the end to prevent gaming?
The provision anticipates the most obvious way to beat a fixed window, which is shifting cost just past its end. A hospital that does so does not keep the savings.
3. Did bundled payment cause hospitals to avoid complex patients?
Among twenty demographic and clinical factors, participation was associated with a differential change in only one. The selection critique, though frequently repeated, was not borne out in joint replacement bundles.