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WORKING PAPER
Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment
Final ReportCheryl l. Damberg, Melony E. Sorbero, Peter S. Hussey, Susan Lovejoy, hangsheng liu, and ateev mehrotra
WR-633-ASPE
February 2009
Assistant Secretary for Planning and Evaluation
U.S. Department of Health and Human ServicesThe report was prepared by the contractor (RAND). The findings and conclusions are those of the authors and do not necessarily reflect the views of ASPE or HHS.
This report is available on the Internet at:
http://aspe.hhs.gov/health/reports/09/mcperform/index.shtml
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This project is taking a building block approach to examine alternative episode definitions to better align performance measures, incentives, payments and accountability within Medicare fee-for service in the near term and examining options for moving toward broader episode-based reforms to encourage high quality, efficient and coordinated care. The episode is used as the unit of analysis. The project includes an environmental scan, a technical expert panel for review and input of deliverables in the project, analyses of grouped Medicare claims data using two commercial grouper software products and the development of a conceptual analytic piece.
This product is part of the RAND Health working paper series. RAND working papers are intended to share researchers’latest findings and to solicit informal peer review. They have been approved for circulation by RAND Health but have not been formally edited or peer reviewed. Unless otherwise indicated, working paper scan be quoted and cited without permission of the author, provided the source is clearly referred to as a working paper. RAND’s publications do not necessarily reflect the opinions of its research clients and sponsors. RAND® is a registered trademark. Material contained in this publication is in the public domain and may be reproduced, fully or partially, without permission of the Federal Government. The courtesy of attribution is requested. The recommended citation follows: Office of Health Policy, ASPE(2008) Exploring Episode-Based Approaches for Medicare Performance Measurement, Accountability and Payment. Washington, DC: U.S. Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. |
3. PERFORMANCE MEASURES REPORTED TO MEDICARE
4. LITERATURE REVIEW AND EXPERT DISCUSSIONS
5. ANALYSIS OF EPISODES OF CARE
APPENDIX A. DIAGNOSIS AND PROCEDURE CODES TO IDENTIFY CONDITIONS OF FOCUS
APPENDIX B. SPECIFICATIONS USED TO CREATE EPISODES
APPENDIX C. EPISODES RELATED TO CONDITIONS OF FOCUS
APPENDIX D. STANDARDIZED PAYMENT METHODOLOGY
APPENDIX F. DEFINING PROFESSIONAL COSTS AND EVALUATION AND MANAGEMENT (E&M) VISITS
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Last Updated: 03/15/2010