Clinician Feedback on Using Episode Groupers with Medicare Claims Data
Fred Thomas, Ph.D.
Date of Pub
Fred Thomas, Ph.D., Craig Caplan, M.A., Jesse M. Levy, Ph.D., Marty Cohen, M.P.A., James Leonard, M.P.H., Todd Caldis, Ph.D.,
and Curt Mueller, Ph.D.
CMS is investigating techniques that might help identify costly physician practice patterns. One method presently under evaluation
is to compare resource use for certain episodes of care using commercially available episode grouping software. Although this
software has been used by the private sector to classify insured individuals' medical claims into episodes of care, it has
never been used with fee-for-service Medicare claims except in the studies by the Medicare Payment Advisory Commission (MedPAC)
and CMS. This study reviews and reports on clinician feedback on the most obvious and important decisions that must be faced
by Medicare to use grouped claims data as the foundation for a physician performance measurement system. The panel reactions
show the importance of bringing persons with clinical knowledge into the development process. The clinician feedback confirms
that additional research is needed.