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Evidence-Informed Case Rates™ (ECR)

An Evidence-informed Case Rate, or ECR®, is a budget for an entire care episode that includes all covered services bundled across all providers that would typically treat a patient for a single illness or condition (hospital, physicians, laboratory, pharmacy, rehabilitation facility, etc.) ECRs are also patient-specific in that they are adjusted for the severity and complexity of each patient's condition. ECR® methodology was developed by the PROMETHEUS Payment design team.

ECRs are calculated by taking into account the following factors: covered services, practice pattern variation, severity-adjustment, a margin, and potentially avoidable complication (PAC) allowance.

Covered services are the foundation of an ECR budget. They are commonly accepted clinical guidelines or expert opinions that define the best methods for treating a given condition from beginning to end. The covered services are then adjusted to reflect local practice patterns.

An ECR is severity-adjusted based on both patient and provider characteristics.  The severity-adjustment is arrived at through a stepwise multi-variable regression model.  This adjustment takes multiple factors into account including patient demographics and co-morbidities, geographic location, and provider specialty.

An ECR also factors in a margin, which reflects the importance for any going concern to have a return on capital assets invested and a reason to reinvest in business operations. Currently a margin of zero percent is factored into the ECR, though this number can be adjusted by the user.

A substantial PAC allowance is included in each ECR. The allowance is determined by running claims data through the PROMETHEUS Payment system to measure PAC rates. This rate is the current deficit. Fifty percent of this deficit is added to the ECR as the PAC allowance. If PACs occur, the allowance is used to offset costs of corrective treatment. But if providers reduce or eliminate PACs, the unused portion of the allowance is distributed among the providers as a bonus, based on an algorithm agreed upon by the implementers. Click here to learn about how PACs were developed.

National Voluntary Consensus Standards for Patient Outcomes: The National Quality Forum's work on patient outcomes measures identifies and endorses measures for public reporting and quality improvement that specifically address patient outcomes of healthcare.