Medicare Grouper Evaluation and Physician Profiling Issues

During a recent Government Accountability Office (GAO) study it was found that there is substantial cost variation across patients within disease types using annual claims data. An extension of this work is that physician profiles may be generated from claims data to identify those responsible for higher care costs, and possibly used with financial incentives to change this behavior. In light of the continuing policy debate, and to test the application of these concepts in Medicare, CMS desired a contractor to continue the work performed under the Episodic Grouper Evaluation contract. Under this contract, Acumen will provide analytical support to help assess the various episode grouping projects that end on December 31, 2011. The project will then continue to support the development of an episode grouper.