Participating in payment reform programs like BPCI goes hand in hand with several key decisions. In deciding episodes length, providers should consider their level of operational readiness. We should ask ourselves:
• How prepared are we (with care management) to support the patients throughout the length of the episode.
• How well aligned are we with our post acute partners to support patients over an extended period of time?
• How does this time commitment fit with other initiatives like VBP?
Financially, it is worth studying:
• How the costs are distributed over time – for example, if there are significant expenses in the 60-90 day period by way of post acute utilization, there might be an opportunity to help patients get home sooner.
• Are there certain patterns within the tails (that we pursue winsorization for) that make one episode length more favorable than the other?
• Is there a difference variance pattern in one time horizon vs. another?
• Is there a marginal cost differential (the we can benefit from, or be hurt by) in service delivery as we go out on the time axis?
Ultimately when considering episodes length, it comes down to constructing the best situation (by DRG, or episode group) for how a provider is best able to support a patient’s healing… and done in a cost conscious fashion.