Patient-Centered Episodes of Care System (PACES)

After extensive analysis and meetings with specialty stakeholders, the HSCRC will move forward with utilizing Patient-Centered Episodes of Care System (PACES) as the EQIP episode grouper, starting in PY4 (CY2025).

• While many PACES episodes are undergoing final clinical review and updates, the system offers much more complete coverage than PROMETHEUS and paves the way for easier, more seamless program expansion in future years. Current EQIP episode categories are well-covered by finalized PACES categories and overall, a high degree of alignment has been found for episodes currently available under EQIP

PACES Background in Brief:

• The PACES Center for Value in Healthcare, Inc. was incorporated in 2019, as a not-for profit organization, to further update and enhance earlier groupers developed for CMS and make them available to the market as a transparent offering
• The PACES team consists of a wide range of seasoned experts, many of whom were directly involved in the development of other major episode groupers, including Prometheus
• There currently are 1,090 PACES procedural, chronic condition, and acute condition episodes in various stages of refinement. PACES episodes will be reviewed and updated on a regular basis by expert clinicians in each relevant specialty.
• The sole focus of the PACES Center is on developing a clinically sound episode grouper in collaboration with the clinical community and market stakeholders and keeping it up to date over time
• The PACES Center is committed to transparency of the value sets that define each episode and the business rules that determine how those episode definitions are applied. In contrast commercially available groupers are “black boxes” (i.e., the underlying codes and rules are not available to users), which undermines users’ and stakeholders’ ability to understand what drove results.

Episode Playbooks:

• PY4 Playbook
  • Please note, the full Excel workbooks for the PACES episodes are linked in the Enrollment group title slide
• PACES Transition Guide