Stream: implementers
Topic: Total cost of care over full medical episode
Lee Surprenant (Mar 10 2020 at 20:44):
Is there a resource we could use to track overall cost / utilization for a given episode of care (potentially across providers/organizations)?
Lee Surprenant (Mar 10 2020 at 21:02):
Or at least something to group the Encounters over time to make that possible?
Lee Surprenant (Mar 10 2020 at 21:02):
We were thinking to use EpisodeOfCare (with extensions), but were scared away by its Scope statement which says that if multiple organizations are involved in the EpisodeOfCare, then each will have its own instance. (and note there is only a single managingOrganization in the resource body)
Lee Surprenant (Mar 10 2020 at 21:03):
What makes it tricky is the mix of clinical and financial data. But even ignoring the financial aspect, is use of EpisodeOfCare to track a full episode (across organizations) out of scope?
Jose Costa Teixeira (Mar 10 2020 at 21:15):
Cost for whom? For patient? For payers?
Jose Costa Teixeira (Mar 10 2020 at 21:16):
In any case, for grouping - CarePlan? Or just for collecting info - composition?
Lee Surprenant (Mar 10 2020 at 21:19):
Lets say payers. Lots of utility to this type of info. Usually a result of analytics I presume. Wondering how to package that up in the case of FHIR. Perhaps Composition is the right answer (and one we're considering). Basically composing the related Encounters/Claims into a coherent whole. Any other options we should be considering?
Jose Costa Teixeira (Mar 10 2020 at 21:52):
did you look at measure / measureReport?
Jose Costa Teixeira (Mar 10 2020 at 21:53):
and you can also use Task which, despite its name, is a pretty powerful way of tracking a series of activities - I had to do cost tracking in v2 and I wish I had a Task resource at a time - to track all activities (clinical or administrative e.g. reschedules) that have a cost associated with it.
Jose Costa Teixeira (Mar 10 2020 at 22:01):
oh and pinging @Paul Knapp
John Timm (Mar 12 2020 at 16:24):
@Paul Knapp we like EpisodeOfCare as a way to organize encounters but we'd like to do it across organizations. Has the financial management working group thought about this use case? The current documentation states that each org would have a new instance of EoC but if an external entity is tracking an EoC it would be nice to do it in a way that is cross-organizational. Thoughts?
Lloyd McKenzie (Mar 12 2020 at 19:46):
@Michelle (Moseman) Miller
Michelle (Moseman) Miller (Mar 12 2020 at 20:24):
Patient Admin owns EpisodeOfCare, so tagging @Brian Postlethwaite for this thoughts
Lee Surprenant (Mar 18 2020 at 14:17):
@Brian Postlethwaite have you had a chance to read this topic yet? Do you think using EpisodeOfCare in a cross-organization way to record a full medical episode is an abuse of EoC?
Lloyd McKenzie (Mar 18 2020 at 15:07):
I don't think the notion of a distinct Episode per Organization is a hard requirement - just what's typical. If you actually have an ability to coordinate episodes across organizations, congratulations :)
John Timm (Mar 18 2020 at 17:47):
@Lloyd McKenzie
I think one of the issues stems from EpisodeOfCare.managingOrganization being [0..1] indicating the expectation of a single org and also this blurb from the docs:
"Many organizations can be involved in an EpisodeOfCare; however each organization will have its own EpisodeOfCare resource instance that tracks its responsibility with the patient.
When an Organization completes their involvement with the patient and transfers care to another Organization. This is often in the form of a referral to another Organization (or Organizations)."
I think what we are looking for is a way for a single EoC instance to reference multiple different organizations and that can be used to group multiple Encounters (that are also coming from different organizations).
Lloyd McKenzie (Mar 18 2020 at 19:10):
If you've got a group of organizations that are sharing an EpisodeOfCare, presumably there's some overarching group that defines that collection of organizations - that becomes the managingOrganization - if you want to declare one at all. Keep in mind that Organization doesn't have to be a legal entity, it's just a collection of people (or sub-organizations) that can take on responsibility.
Lloyd McKenzie (Mar 18 2020 at 19:12):
The hierarchy of organizations is handled by the children pointing to the parent. Though there is a challenge that an organization can't currently be part of multiple organizations. @Brian Postlethwaite ?
Paul Knapp (Mar 19 2020 at 01:00):
@Lee Surprenant Short answer, no there isn't. Currently you would need to aggregate costs across providers, whether it be costs to them for costs analysis or by accounts to determine amounts billed and recovered by insurance, patient etc. Several claims analytics firms are using ExplantionOfBenefits from the insurers to support analytics.
Lee Surprenant (Mar 20 2020 at 18:09):
Thanks for the input all. I think we're going to attempt the EpisodeOfCare + financial extensions for this and see where we get to. Would anyone be opposed to loosening the wording in the summary and scope sections to make it clear that this can be used to group encounters that span multiple organizations (while retaining the words that make it clear it typically is just the view from a single organization's perspective)?
Lee Surprenant (Mar 20 2020 at 18:10):
For example:
An association between a patient and an organization / healthcare provider(s) during which time encounters may occur. The managing organization assumes a level of responsibility for the patient during this time.
could become
An association between a patient and organization(s) / healthcare provider(s) during which time encounters may occur. The managing organization (if present) assumes a level of responsibility for the patient during this time.
Last updated: Apr 12 2022 at 19:14 UTC
