Episode Grouper for Medicare - Approach B

The goal of this contract is to construct a new comprehensive public domain episode grouper. The grouping processes and logic shall be readily understandable, transparent, and comprehensible to the intended audience of physicians, policy makers, and health care administrators. It shall be valid and reliable, and have a reasonable number of homogenous episode groupings. Conceptually, episode grouping comprises three sub-systems or modules: clinical logic, episode construction logic, and the risk adjustment method. Each of these subsystems can stand on its own, or be integrated with the other components into a software program that groups claims into episodes. The Approach B is organized by these components. This contract is for only episode grouping software and its components. Elements of a profiling system--i.e., attribution rules, benchmarking, standardized costs, etc.--may be considered in the design of data items that will be part of the grouper software's output with input from CMS.