The episode groupers build episodes of care using all of a beneficiarys health care claims that are filed between two points in time for a specific health problem. The purpose of an episode of care grouper is to link together all of the claims that pertain to the treatment of a particular condition for a particular patient. Episode treatment groups etg, developed by ingenix. Business health care industry health care costs management medical care quality management medical care quality medical care, cost of medical practice software usage prospective payment systems medical care. Check here for information, history, and evolution of truven. The study is based on data contained in the 20062007 marketscan commercial claims and encounters database. All thomson reuters websites use cookies to improve your online experience. Using multipayer data from the marketscan commercial database, we applied the two most widely used commercial episode groupers. The episode treatment group and medical episode group episodes. Episode treatment groups how is episode treatment groups abbreviated. Our thanks go as well to ingenix and thomson medstat. Comparing commercial systems for characterizing episodes of care pdf payers are increasingly using episodes of care to measure and reward efficiency in health care. Need for risk adjustment in adapting episode grouping software to.
Each of these grouper methodologies utilizes an anchoring event, such as an admission into an acute care hospital for a specific. This allows them to calculate payment rates, adjust for health risk, apply cms edits, validate codes and support valuebased purchasing programs. Provides episodebased analysis of physician cost, including all costs associated with a. During the study period, all distinct episodes of care of any type and. Thomson reuters medical episode grouper, and the 3mtm clinical risk grouping software packages to develop episodebased rates. Barnett, phd february 23, 2011 presentation has some valuable info about sfa, dea differences, limitations and two other health care efficiency measurement methods. Episode treatment groups how is episode treatment groups. An episode of care considers all care for one medical condition for one patient. View jennifer ranlys profile on linkedin, the worlds largest professional community. Measurement of and reward for efficiency in californias pay.
Table 2 summarizes the features of datasets available for calculating medical care expenditure indexes for medicare beneficiaries. Evaluating the functionality of the symmetry etg and medstat. Measurementofandreward forefficiencyincalifornias payfor. Symmetry episode treatment groups etgs, developed by ingenix, inc. An episode of care begins with the first physician visit or hospitalization for a given.
Pdf need for risk adjustment in adapting episode grouping. Thomson reuters medical episode grouper, and the 3mtm clinical each drg from the medicare lds file is the starting point in the analysis package is free of charge, however, the applicant. Clinician feedback on using episode groupers with medicare. Episode treatment groups etg and the thomson reuters medstat medical episode grouper. Thomson reuters december 2009 september 2011 1 year 10 months. Meg was developed and is maintained according to the following core principles. Meg allows for the analysis of a particular patients complete episode of care for a single illness or condition. Episodes of care provide a useful unit of analysis for evaluating healthcare utilization and cost. Thomson reuters will sell its health care business line. The episode groupers build episodes of care using all of a beneiciarys health care claims that are iled between two points in time for a speciic health problem. Where the identification is being done now the technologies being used to identify fraud thomson reuters applications and technical solutions in fighting fraud results of payandchase efforts. The cost efficiency methodology uses thomson reuters medical episode grouper meg. Episodes of care the milliman healthcare analytics blog. Both use software algorithms which sift through and organize claims data chronologically into.
Michelle mcallister, consulting manager, thomson reuters 2009 thomson reuters. Mathematica assisted the centers for medicare and medicaid services with designing a system to implement physician valuebased purchasing for medicare beneficiaries, which includes development and distribution of confidential physician feedback reports that inform physicians of their performance on quality and cost. Vendor notebook picis signs six north american deals. The grouper evaluates every ancillary and pharmaceutical service nonanchor records against all. Medical episode grouper meg, developed by thomson reuters. Although this is the largest p4p program in the nation, it amounts to less than 2% of california physicians income. This methodology results in one hierarchical level of coding. Need for risk adjustment in adapting episode grouping. Overview of health efficiency methods ppt portfolio. Episodic treatment groups and thomsonreuters medstat medical episode grouper software packages. We focused on patients with one of nine clinical conditions. The new yorkbased vendor announced in june 2011 it would divest its health operations and. Jul 03, 20 overview of health efficiency methods ppt 030720 leave a comment overview of research on health care efficiency paul g. Medical episode grouper meg can be used within plan analytics to.
The software also analyzes actual costs and determines expected resource use during an episode. Truven health analytics history and information ibm. Developing resource use reports for medicare feeforservice. Episode of care groupers are available from a variety of vendors and while each notes the unique features of their software, the general concept across all of them is the same. Patients with bipolar disorder at increased risk for wide. Using medical groups rather than individual physicians has a number of advantages.
Episode treatment groups etgs by symmetry and medical episode groups megs by thomson reuters medstat. We would like to show you a description here but the site wont allow us. Thomson reuters staying in health care, for now health data. Provide better accounting for differences in inpatient health status medicare. Comparing commercial systems for characterizing episodes of care. Episode treatment groups etgs and the thomson medical episode groups megs. Managing provider vulnerabilities in government healthcare programs. Citing economic conditions, thomson reuters has suspended efforts to sell its health care business lines. Program uses per capita and per episode measurement based on two commercially available software packages the same ones we have used in our analysis. Developing resource use reports for medicare feefor.
Episode treatment groups etgs by symmetry and medical episode groups megs by thomsonreuters medstat. Need for risk adjustment in adapting episode grouping software to medicare data. This webbased medical episode grouper provides current patient information logically organized, at the point of care to help physicians make sound medical decisions and enhance disease. Apr 23, 2012 thomson reuters will sell its health care business line. Thomson medstat medical episode grouper system aspe. Medical episode grouper what is an episode of care. Final 2009 criteria for practitioner profile 081109 mc. The medical episode grouper assigns each claim to one of 570 episode types based on primary and secondary diagnosis rather than procedure codes. Dec 22, 2011 citing economic conditions, thomson reuters has suspended efforts to sell its health care business lines. Medical episode grouper meg an episode is all care for a course of treatment of a disease primary and secondary diagnosis codes grouped into one of 560 disease categories stratified by severity of illness disease categories and clinical criteria specified by physicians at jefferson medical college. My focus was on research and development of healthcare analytic. Groupers definition of groupers by medical dictionary.
Policy analysis national institute for health care reform. I joined thomson reuters after their acquisition of profsoft. Meg incorporates demographic and diagnosis data from claims to link inpatient, outpatient, and pharmacy services into diseaserelated episodes of care and classifies the severity of. Using predictive models to move medicaid providers toward. Thomson reuters and careevolution collaborate to empower.
Etgs by symmetry and medical episode groups megs by thomsonreuters medstat. Thomson reuters and careevolution are working together to deliver an alternative an application that groups patient data by disease or medical episode. Comparing commercial systems for characterizing episodes of. The truven health medical episode grouper meg is the proprietary episode. The thomson reuters medical episode grouper was used to group each enrollees claims into distinct episodes of care based on the disease for which treatment was received. What is the abbreviation for medical episode grouper. Medical episode grouper meg, developed by thomsonreuters. These grouper tools define conditionspecific episodes of care. The groupers varied in their ability to allocate spending to episodes. Episode groupers are proprietary software programs that organize claims data into a set of clinically coherent episodes, usually linked by diagnosis.
Groups etg and the thomson reuters medical episode grouper meg. Overview of research on health care efficiency paul g. Etgs by symmetry and medical episode groups megs by thomson reuters medstat. The two commercial episode groupers in most widespread use. She gives her insights into being a medical negligence solicitor and talks about why she questioned whether the legal system was designed to deliver the kind of justice that her clients really wanted.
Thomson reuters has identified five top compliance concerns to plan and prioritize the. In this weeks episode, joe raczynski is joined by the pre. Most episode groupers are proprietary software designed to assign raw medical claims into sets of clinically coherent episodes. Meg abbreviation stands for medical episode grouper. The aggregate dollar amount of claims payment constitutes the cost of an episode. Truven health medical episode grouper semantic scholar. Using predictive models to move medicaid providers toward best practices and reduce waste predictive modeling summit gary redding, vice president and practice leader, thomson reuters. Comparing commercial systems for characterizing episodes. Within each stratum, healthcare utilization measures were grouped into episodes of care using thomson reuters medical episode grouper software, 20 which combines all inpatient, outpatient, andor prescription treatments related to a single discrete occurrence of illness. Meg incorporates demographic and diagnosis data from claims to link inpatient, outpatient, and pharmacy services into diseaserelated episodes of care and classifies the severity of disease within an episode.
The chfp program is now available online, allowing. Healthcare analytics utilizing episodes of care the. The healthcare business of thomson reuters offers a physician performance assessment module based on clinically sound, wellestablished. Measurement of and reward for efficiency in californias.
Mathematica assisted the centers for medicare and medicaid services with designing a system to implement physician valuebased purchasing for medicare beneficiaries, which includes development and distribution of confidential physician feedback reports that. The thomson medstata medical episode grouper meg is a grouping system that creates clinically homogenous and meaningful units episodes for analysis using inpatient, outpatient and pharmaceutical claims data. Evaluating the functionality of the symmetry etg and. Ingenix episode treatment grouper, thomson reuters medical episode grouper, sql server and mysql. Grouping classification solutions 3m health information.
Measurementofandreward forefficiencyincalifornias pay. The software also analyzes actual costs and determines expected resource use. Jean macquarrie, vice president july 16, 2010 2009 thomson reuters agenda. This study presents findings constructed from two major commercial episode groupers. Ingenix symmetrys episode treatment groups etg and the thomson reuters medical episode grouper meg. Thomson reuters staying in health care, for now health. Whether you seek to reduce the variability of care across a large health system, or you simply want to bring precision medicine to your community practice, ibm watson health is ready to work with you. Challenges in the risk adjustment of episode costs cms. Within each stratum, healthcare utilization measures were grouped into episodes of care using thomson reuters medical episode grouper software,20 which combines all inpatient, outpatient, andor prescription treatments related to a single discrete occurrence of illness. Physician market power and medicalcare expenditures.
115 130 940 560 1293 388 289 1464 593 109 293 1062 916 529 1293 529 364 1331 1342 991 1554 150 1504 1512 155 832 780 269 695 893 637 1210 1127 1233 1333 834 630 948 238