The study appraised two commercial software packages that allow the generation of episode treatment groups. The study was conducted using Medicare claims data, with a focus on understanding the properties of the grouper algorithms in forming episodes of care and in assigning costs to these episodes. Analyses were conducted with Medicare claims from samples of beneficiaries in several states.
Researchers found that each software package had its own approach for classifying medical care use into episodes of care, and episodes were not typically comparable across the groupers. Considerable variation in cost across episodes within episode type for the algorithms were observed, and there were challenges in using the grouping algorithms to handle common practice patterns under the Medicare payment system.
Report Title: Evaluating the Functionality of the Symmetry ETG and Medstat MEG Software in Forming Episodes of Care Using Medicare Data http://www.cms.hhs.gov/Reports/Downloads/MaCurdy.pdf
Agency Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Fred Thomas, 410-786-6675
PIC ID: 9009