Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment Final Report. Key Findings and Implications


This study identifies a number of important issues that need to be examined in more depth, should Medicare decide to pursue any of the possible paths towards using episodes of care as a basis for performance measurement, accountability, or payment.  We highlight seven important findings and consider their implications with respect to constructing and applying episodes of care for various purposes.  We remind readers of this report that the observed results are, in part, related to how the commercial episode grouper tools define what claims get assigned to an episode (i.e., the underlying grouper logic used to construct an episode) as well as variations in coding practices among providers in what diagnosis they code as primary versus secondary and the completeness of this coding. - Alternative types of episode constructions could yield different results.

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