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CMS-1403-FC
magnetic resonance imaging and computerized tomography
imaging. For stage II, the RURs were modified to
incorporate clinical guidelines into the reports. The
construct of the RURs included in stages I and II of the
study is similar to the RURs that are described, in detail,
in section 6.c. of this final rule.
Building on its March 2005 recommendation, MedPAC
subsequently released an additional report on the topic of
measuring physician resource use. In its June 2006 Report
to Congress, MedPAC focused on commercial episode grouper
products. In that report, MedPAC addressed such issues as:
risk adjustment, attribution (assignment) of cost per
episode to individual physicians, and variation in resource
use across geographic areas. MedPAC tested two
commercially available episode grouper products, Episode
Treatment Groups (ETGs) and Medical Episode Groups (MEGs),
using Medicare fee-for-service claims data. 4 The ETG
product is owned by Ingenix and “identifies and classifies
an entire episode of care regardless of whether the patient
has received medical treatment as an outpatient, inpatient,
or both.” 5 The MEG product is owned by Thomson and “groups
inpatient, outpatient, and pharmaceutical claims into
4 Increasing the Value of Medicare. Medicare Payment Advisory Commission Report to Congress. June
2006. Chapter 1. http://www.medpac.gov/documents/Jun06_EntireReport.pdf.
5 Ingenix Product Sheet. http://www.ingenix.com/content/attachments/ETG_ProductSheet.pdf.
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