Episode Care Improvement Program (ECIP)

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:

1. 1. Congestive Heart Failure, selected by 10 hospitals.
   2. Sepsis, selected by 9 hospitals.
   3. Stroke, selected by 9 hospitals.
   4. Cervical spinal fusion/combined anterior posterior spinal fusion/spinal fusion (non-cervical), selected by 8 hospitals.
   5. Major joint replacement of the lower extremity/Double joint replacement of the lower extremity, selected by 8 hospitals.

• Seventeen hospitals are participating in ECIP in CY 2023:

• ECIP earned incentives have increased over time. The table below shows results for each six-month reconciliation period since ECIP launched in January 2019:

Episodic Payment Approach

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 Track Implementation Protocol

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.

ECIP Case Study

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.

Key deadlines are set by the CRP Calendar. The calendar is provided below. Please contact care.redesign@crisphealth.org with questions.