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Second Opinion

Learn about policy issues important to medical schools and teaching hospitals, with Executive Vice President Atul Grover, M.D., Ph.D.

Washington Highlights

NQF Releases Draft Report on Episode Groupers

April 18, 2014— The National Quality Forum (NQF) has released a draft report on evaluating episode groupers. The report was developed by a 21-member expert panel comprised of individuals representing various stakeholders, such as payers, providers, and clinicians.

Episode groupers are software tools that support episode-based performance and payment measurement by attributing care to condition-specific or procedure-specific episodes based on the relationship of the health care services to the care of a specific condition. Episode groupers have been developed and used in the commercial payer sector and the Centers for Medicare and Medicaid Services (CMS) intends to develop a publicly available episode grouper for Medicare beneficiaries.

The purpose of this NQF effort is to:

  • Define the characteristics and challenges of constructing episode groupers;

  • Determine the key elements of episode groupers;

  • Establish an initial set of criteria by which episode groupers should be evaluated for NQF endorsement; and

  • Identify implications and considerations for NQF-endorsement of episode groupers.

The panel focus is broad in nature so that the recommended criteria can be applied to any episode grouper submitted to NQF for endorsement. Comments are due by May 13.

Contact:

Evan Collins, MHA
Specialist, Clinical Operations and Policy
Telephone: 202-828-0552
Email: ecollins@aamc.org

Mary Patton Wheatley, M.S.
Director, Health Care Affairs
Telephone: 202-862-6297
Email: mwheatley@aamc.org

Scott Wetzel, M.P.P.
Lead, Quality Reporting
Telephone: 202-828-0495
Email: swetzel@aamc.org

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Jason Kleinman
Sr. Legislative Analyst, Govt. Relations
Telephone: 202-903-0806
Email: jkleinman@aamc.org