Episode Grouper Listening Session

The Centers for Medicare & Medicaid Services (CMS) is hosting a listening session on Defining an Episode Logic for the Medicare Physician Resource Use Measurement Program. We are considering developing a transparent grouper logic for the Medicare program. The purpose of the listening session is to solicit comments on identifying and defining discrete episodes of care for Medicare beneficiaries for the development of the grouper logic.

CMS has previously used available methods to define episodes of care for Medicare beneficiaries and created reports on relative resource use based on these episodes. However, these efforts and other research suggest that further refinement is needed in defining episodes of care. Several tools currently exist to construct episodes of care from claims, but are not focused specifically on the Medicare population and the complexities that Medicare beneficiaries bring to the effort to define discrete episodes of care. In addition, it is essential that any logic that is developed for use in identifying and defining an episode of care be publicly available so it can be fully transparent. CMS intends on using the input from this session as well as other comments and research to write a request for proposal on developing a transparent grouper logic and software for episodes of care that are specific to Medicare beneficiaries.

At the Listening Session, we would be interested in your comments regarding, but not limited to, the following topics:

• Multiple Chronic Conditions. How should multiple chronic conditions treated at the same time or as a co-morbid condition of the primary diagnosis be grouped in an episode of care?
• Post-acute Care (PAC). Should PAC be grouped in the same episode as the previous hospitalization and if so, for how long after the hospitalization?
• Length of Chronic Episode. Is a year-long definition for chronic episodes appropriate and should it include flare-ups of the chronic disease or flare-ups for other potential related chronic conditions?
• Physician Services. Should physician services that occur during a hospital stay or institutional setting always be grouped with the same episode regardless of the diagnosis?
• Risk Adjustment. What is the best way to risk adjust for patient severity without relying too heavily on types of services, such as hospitalizations, to determine severity?

The listening session will be held on November 10, 2009, from 9 am to 1 pm (EST). The listening session will be held in the main auditorium of the Central Building of the Centers for Medicare & Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244-1850. Anyone interested in attending the meeting or participating by teleconference must register by completing the online registration at http://www2.eventsvc.com/palmettogba/register/c9f3ebcf-8487-4cfb-b883-8a00502dcfb7 . In order to participate in the meeting, registration must be completed no later than 5 pm EST on November 3, 2009. For more information, please see the Federal Register meeting notice posted at http://www.cms.hhs.gov/center/physician.asp .

If you have any questions, please contact Colleen Bruce at colleen.bruce@cms.hhs.gov.

Page Last Updated: Thursday, 18-Mar-2010 05:55:41 CDT