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Details for Application of Episode Groupers to Medicare
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Shown below are the details for the item you selected from the list.
| Title |
Application of Episode Groupers to Medicare |
| Project Number |
HHSM-500-2006-00006I/05 |
| Project Officr(s) |
Fred Thomas |
| Start Date |
August 2007 |
| End Date |
March 2009 |
| Funding |
$444,398.00 |
| Award |
Task Order (XRAD) |
| Principal Investigator(s) |
Thomas MaCurdy |
| Awardee Name |
Acumen, LLC |
| Awardee Street |
500 Airport Blvd. Suite 365 |
| Awardee City/State/Zip |
Burlingame, CA 94010 |
| Description |
CMS's episode grouper software evaluation began in 2006. Over the last year, there has been a notable evolution in the policy environment related to episodic grouping. In particular, MEDPAC has issued two reports that suggest that episode grouping techniques have the potentital to be developed into tools for profiling physician efficiency by identifying physicians whose costs per episode are outside a reasonable range. Various umbrella organizations, such as the Alliance for Quality Activity (AQWA) and the National Quality Forum (NQF), are working to define a set of conceptual standards that can be used in constructing physician profiles. Recently, a GAO study showed that there is substantial cost variation across patients within disease types using annual claims data. An extension of this work is that physician profiles may be generated from claims data to identify those responsible for higher care costs, and then use financial incentives to change this behavior. In light of the continuing policy debate, and to test the application of these concepts in Medicare, this task order will continue the work performed under the Episodic Grouper Evaluation contract by writing a design report for a pilot study; construct physician efficiency profiles; write a report on profiling and result of the modified groupers; and provide programming/analytic support to a complementary clinical logic contract. |
| Status |
Work to date has included review of the clinical logic of two commercial groupers. Preparation for expert panel meetings with physicians to review grouper-based resource profiles is underway. |
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Last Modified Date : 03/25/2009
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