Evaluation the Functionality of the Symmetry ETG and Medstat MEG Software in Forming Episodes of Care Using Medicare Data

摘要

This report focuses on understanding the properties of the grouper algorithms in forming episodes out of Medicare claims data and in assigning costs to these episodes. Such an analysis provides key insights into the challenges that must be overcome to realize the potential put forth by advocates of using the groupers to evaluate Medicare providers. The study does not explore how the ETG and MEG groupers might be used to profile physicians, nor does it examine the clinical logic underlying the groupers in their allocation of claims into meaningful clinical events.