Clinician Feedback on Using Episode Groupers with
Medicare Claims Data

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.