General Question for the Week of April 24, 2017

Question:

I have read that CMS will be developing “episode groups.” What are these?

Answer:

As explained by the Centers for Medicare & Medicaid Services (CMS), the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) of 2015 mandates that it collaborate with clinician and other stakeholder communities in the development of resource use (i.e., cost) measures for implementation in the new Merit-based Incentive Payment System (MIPS). Section 101(f) of MACRA requires CMS to develop care episode groups and patient condition groups (hereafter “episode groups”) to classify similar patients.