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| Evaluation of episode grouper for Medicare | |
|---|---|
| Investigator (PI): | Thomas, Fred |
| Performing Organization (PO): |
(Current): Acumen, LLC / (650) 558-8882 |
| Supporting Agency (SA): | Centers for Medicare and Medicaid Services (CMS) |
| Initial Year: | 2014 |
| Final Year: | 2017 |
| Record Source/Award ID: | CMS/HHSM-500-2011-00012I/T0012 |
| Funding: | Total Award Amount: $1,986,703 |
| Award Type: | Contract |
| Award Information: | Reports resulting from this project |
| Abstract: | Authority: Section 3003 of the Affordable Care Act. Description: The goal of this procurement was to construct an episode grouper for Medicare that is understandable, transparent, and not encumbered by patents and copyrights. The project deliverables include documentation (conceptual design, software documentation, business rules, interface specifications, etc.) and software. Conceptually, episode grouping is comprised of three sub-systems or modules: clinical logic, episode construction logic, and the risk adjustment method. Clinical logic refers to the basic framework for clustering, the rationale for grouping of condition codes, grouping algorithms, co-morbidities, hierarchy of grouping codes, acute exacerbations, signs and symptom diagnosis, interactions, and possibly severity levels (depending on the structure of the system). Episode construction logic establishes the processes and rules by which claims are grouped using the clinical logic. A risk adjustment method can adjust episode costs for co-morbid conditions and other factors that may influence resource use, but which may or may not be captured in grouped claims. Project period: The project started in September 2010 and ended in May 2016. Publications: a. Reports posted in relation to the MACRA request for comment: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Episode-groups-summary.pdf; b. Design Report: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/EGM-Design-Report.pdf. |
| MeSH Terms: |
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| Country: | United States |
| State: | California |
| Zip Code: | 94010 |
| UI: | 20163111 |
| Project Status: | Completed |