CMS Solicits Comments on Episode Groups

CMS released an initial set of 34 episode groups on October 15, 2015. The agency designated the methodology used to construct these episodes as Method A. Method A was developed to fulfill certain requirements of section 3003 of the Affordable Care Act. Method B was developed to complement those efforts and provide a more robust measure set for the Supplemental Quality Resource Use Reports (sQRURs). In November 2015, CMS released a Request for Comment on how to define “episode groups.”   The recently posted proposed episode groups reflect input received by CMS since then.


CMS developed these episode groups using Episode Grouper for Medicare (EGM), a software application developed to read Medicare administrative claims data chronologically by beneficiary, and assign services and their associated Medicare payments to an episodes of care. In addition to a workbook which includes the background data used to develop these episode groups, CMS also released a report describing the methodology used to design the episodes.


In all, CMS seeks comments on 57 episode groups. Comments are due by August 25, 2016.


Notice requesting comments is available here.


Episode workbook is available here.


Report is available here.


More information on MACRA can be found at the McDermottPlus MACRA Resource Center.