How does CMS define an 'episode of care' for bundles like BPCI?

• A. A defined period during which all related services for a clinical condition are paid as a single bundle across care settings.
• B. A single hospital stay.
• C. The duration of the patient’s illness.
• D. The calendar year.

Answer: (A)

CMS defines an episode of care as a defined time window during which all services related to treating a specific clinical condition are paid as a single bundled payment across care settings. This typically starts with the index hospitalization or procedure and ends after a fixed post-discharge period (commonly 30, 60, or 90 days, depending on the model), bringing together hospital care, physician services, post-acute care, home health, and other related services. The goal is to capture the total cost of care for that episode and incentivize providers to coordinate care and avoid unnecessary variation, since one payment covers the entire episode rather than paying separately for each service. It is not limited to a single hospital stay, nor is it simply the duration of the illness, nor the calendar year.