Reference no: EM13321893
For the past fifteen years or so, health plans and group practices have been involved in “profiling” physicians’ practices to identify high cost services or high cost patients, and/or to reward physician performance. CMS is now also investigating methods that compare resource use for certain episodes of care using commer¬cially available episode grouping software.
“…findings from the Institute of Medicine (IOM) regarding rewarding provider performance: “numerous chal¬lenges must be faced in the development, implementation, and ongoing evaluation of performance measures. Multiple meth-odological considerations—risk adjust¬ment reflecting patient populations of varying acuity, small sample sizes at the individual practitioner level, … and attribu¬tion of responsibility among multiple pro¬viders … have already been identified as high priority areas for further research…” (IOM, 2006). HCFRev Fall 2009 Vol 31(1).
a) Review the most common profiling methods and tools in use;
b) Summarize the episode groupers’ methodologies for constructing an episode and note the data required;
c) Share any evidence that the episode groupers are superior to the per-visit or per-procedure measures;
d) Note the costs and benefits of using the episode approach for Medicare and for the private sector providers
I'm stuck on parts a-d. Our teacher kind of ambushed us with this question.
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: For the past fifteen years or so, health plans and group practices have been involved in “profiling” physicians’ practices to identify high cost services or high cost patients, and/or to reward physician performance.
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