What Are Episodes of Care?

What are episodes of care? How will that change my child’s therapy or medical care? Is this a good thing? Does anyone have real life experience that can help inform the rest of us?

For starters, I do not know. This is a term I have heard about for several years, but know little about. Episodes of care, episodic care, bundled payments are one direction health care appears to be taking. From what I can tell it all started in the late 1980s in Texas and Michigan.

Episodic care seems to be about charging or receiving reimbursement for a set problem, say a broken arm; in one lump sum.   The facility bills and gets paid for all the potential care at one time. For example, you go in with a broken arm; the facility generates one bill or gets reimbursed for the entire problem with a set fee. One payment covers the physician, the casts, the x-rays, the follow-up visit, the cast removal and the rehabilitative therapy needed to get the arm back to 100%. Are you serious? One bill sounds amazing.  There has to be drawbacks.

How does this seem to apply to pediatric therapy?  Many insurance provider are already saying you get 30 visits or 20 visits or? Therapy is already supposed to be driven by improving function. I.e. you have a goal, and your therapist is supposed to be able to tell you if it is achievable. Right?

From what I can gather in therapy an episode of care will look something like this; depending on where you are receiving care and your coverage package. The therapists will work you to decide on specific goal. Yes, your goal is probably walking but would it not be nice to have specific goals to get to walking, say standing braced for 10 seconds without support. As parents we need to know the purpose and expected outcome.

The therapist gathers data from the physician, medical team, and a skilled evaluation that actually provides solid data. Not your child has weak hips but your child has a specific level of weakness with measurable numbers. The recommendation is then for an episode of care based on past data collected from others who have had similar problems.  Ie in 3 months your child will be able to do this and this. Very specific, very measurable, very mom can see change type of information.

With episodes of care, therapy is not supposed to be every day, forever. It appears to be short bursts of intensive care, followed by periods of monitoring. It seems to mean therapy at higher frequencies (weekly or several times per week) to help children achieve specific goals. It also may mean therapy visits once or twice a month so allow the parent and therapist to problem solve new difficulties, review exercises, update activities to do at home, and monitor the child’s progress. It appears the child will move in and out of various types of care; at different times in their lives. It seems to mean different goals at different times and different levels of intervention.

I would love information from families that have been involved in this process? Did you see progress? Where you, and are you satisfied with this type of programming? I can see so much potential for this to work and for this not to work.

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What do I think you can do to maximize your therapy time? Go to therapy with realistic, functional goals. Not, I want my child to write. Instead, I want my child to hold the pencil correctly. Or, I want my child to be able to write on a line. Or, I want my child to make readable letters? Also, ask the dreaded questions: Is this a good goal? Is this possible? And the most important, how long before I see change and what will the change be?

As parents, we need therapists and physicians to be honest with us and give us good solid information. As parents it means being willing to have open, meaningful discussions that may provide information that breaks our hearts. Not information that dashes all dreams and hopes but information that gives us some parameter expectations.

How is therapy structured in New York, in Germany, in Australia, in?

Comments PLEASE

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3 thoughts on “What Are Episodes of Care?

  1. In Canada, you initially receive treatment dependent on the condition. Several years in some cases. After that, it will depend on a change in condition, or in my daughter’s case, a transition to adult services. She received a whole new team, a whole new attitude, and two years of physical and occupational therapy. Yahoo!

    In England, my cousin acquired a severe brain injury about two months ago. The medical team has already stopped all therapies! Pathetic.

    I suppose you work with the tools you are given. Cheryl

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