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CMS-1403-FC
clinically homogenous units of analysis called episodes
that describe a patient’s complete course of care for a
single illness or condition.” 6
In 2006, we awarded a contract to Acumen LLC, to
explore how the ETGs and MEGs handle Medicare FFS claims
data. In addition to Acumen’s technical episode grouper
analysis, we are also pursuing a contract with Kennell, LLC
to analyze selected claims grouping algorithms within each
of these commercial episode grouper products. Both of
these research contracts are currently underway.
The Government Accountability Office (GAO) has also
addressed physician resource use. In their April 2007
report, GAO compared the resource use of physician
practices with that of their peers and specifically focused
on outliers. In their report, GAO recommended that CMS
develop a system to identify physicians with inefficient
practice patterns and provide confidential feedback to
improve efficiency. 7
A number of other entities have also been developing
approaches to measuring and reporting on physician resource
use, including the National Quality Forum, the National
6 Thomson Product Sheet.
http://home.thomsonhealthcare.com/uploadedFiles/docs/MEG_HP_TH10002.pdf.
7 Focus on Physician Practice Patterns Can Lead to Greater Program Efficiency. April 2007.
http://www.gao.gov/new.items/d07307.pdf.
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