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The Episode Care Improvement Program (ECIP) is a voluntary track under the Care Redesign Program (CRP). ECIP allows a hospital to link payments across providers during an episode of care. Maryland based ECIP on CMS’s Bundled Payments for Care Improvement Advanced (BPCI Advanced) program. To participate in ECIP, hospitals must sign a CRP Participation Agreement with the State of Maryland and the Centers for Medicare and Medicaid Services (CMS). CRP provides fraud and abuse waivers—relating to Federal physician self-referral law and Federal anti-kickback statute—to a hospital that has signed a CRP Participation Agreement. The HSCRC made policy changes to ECIP effective for CY 2023, requiring hospitals to share incentives with care partners and/or provide significant resource sharing to care partners. The new requirement ensures hospitals are leveraging the fraud and abuse waivers central to the Care Redesign Program. Close to half of participating hospitals are opting to share incentives with care partners in CY 2023.
The eligible providers for ECIP certification include general or specialist physicians, clinical nurse specialists, nurse practitioners, physician assistants, physical therapists, skilled nursing facilities, home health agencies, long-term care hospitals, hospices, and inpatient rehabilitation facilities. ECIP emphasizes post-acute care coordination and outcome improvements after discharge, involving not only physicians and advanced practice nurses but also engaging post-acute care facilities like physical therapists.
ECIP offers hospitals a choice of participating in 23 clinical episode categories. In CY 2023, hospitals selected approximately 5.8 clinical episode categories on average. The most commonly selected clinical episode categories are:
|Anne Arundel Medical Center||University of Maryland Baltimore Washington Medical Center|
|Doctors Community Hospital||University of Maryland Capital Region Medical Center|
|Garrett Regional Medical Center||University of Maryland Charles Regional Medical Center|
|Greater Baltimore Medical Center||University of Maryland St. Joseph Medical Center|
|Holy Cross Hospital||University of Maryland Upper Chesapeake Medical Center|
|Meritus Medical Center||University of Maryland Shore Regional Health Chestertown|
|University Of Maryland Medical Center||University of Maryland Shore Regional Health Easton|
|University of Maryland Medical Center Midtown||University of Maryland Rehabilitation and Orthopaedic Institution|
|UPMC Western Maryland Health Systems|
|2019 P1||2019 P2||2020 P1||2020 P2||2021 P1||2021 P2||2022 P1||2022 P2|
The Episode Care Improvement Program (ECIP) allows a hospital to link payments across providers during an episode of care. Maryland modeled ECIP on CMS’s Bundled Payments for Care Improvement Program Advanced. ECIP’s bundled payment approach is designed to align incentives across hospitals, physicians, and post-acute care facilities to generate savings and improve quality through better care management during episodes, eliminating unnecessary care, and reducing post-discharge emergency department visits and hospital readmissions. ECIP provides hospitals with the opportunity to provide incentive payments to care partners that help achieve these goals.
ECIP requires hospitals to share earned incentive payments with their care partners or provide a significant amount of care management resources or other intervention resources to their care partners.
The ECIP Track Implementation Protocol (ECIP 2024 Track Template) outlines the parameters of the program. Hospitals have a high degree of flexibility to design their initiatives within those parameters.
The Greater Baltimore Medical Center (GBMC) showcased in their ECIP Case Study and GBMC ECIP Summary a significant success in cost reduction and quality improvement for joint replacement and fracture patients through Maryland’s Episode Care Improvement Program (ECIP). Key factors included early interdisciplinary collaboration, stakeholder engagement, leveraging quality metrics, and having a dedicated ECIP manager. Challenges involved initial staff buy-in and data availability, but GBMC’s achievements offer valuable insights for hospitals implementing the ECIP program.
|4/3/23||Care Partner Vetting to determine eligibility for participate (provider participation July through December 2023)|
|8/31/23||Care Partner Vetting to determine eligibility for participate (provider participation CY 2024)|
|12/15/23||Care Partner Certification to identify participating care partners who will have a care partner agreement with hospital (provider participation January through June 2023)|
|6/15/23||Care Partner Certification to identify participating care partners who will have a care partner agreement with hospital (provider participation July through December 2023)|
|3/15/23||CRP Report (Q1–Q2 2023)|
|10/31/23||Implementation Protocols for CY 2024 (Performance Period 9)|
|10/31/23||Participation Agreements for hospitals new to CRP|
|11/2/23||Hospitals Begin to Make Incentive Payments to Care Partners for CY 2022 (PP7)|