[Federal Register Volume 74, Number 185 (Friday, September 25, 2009)]
[Notices]
[Pages 48979-48981]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-22959]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

[CMS-1814-N]


Medicare Program; Listening Session Regarding: Defining an 
Episode Logic for the Medicare Physician Resource Use Measurement 
Program; November 10, 2009

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Notice of meeting.

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[[Page 48980]]

SUMMARY: This notice announces a listening session being conducted as 
part of the proposal to further the Medicare program's ability to 
assess the relative resources used for beneficiary care using episodes 
of care as the unit of measurement. This listening session will solicit 
comments on the range of issues in the analysis of the applicability of 
currently available tools to identify discrete episodes of care for 
Medicare beneficiaries. Physicians, physician associations, and all 
other interested parties are invited to participate. The meeting is 
open to the public, but attendance is limited to space and 
teleconference lines available.

DATES: Meeting Date: The listening session will be held on November 10, 
2009 from 9 a.m. until 1 p.m. Eastern standard time (e.s.t.).
    Meeting Registration and Request for Special Accommodations 
Deadline: Registration opens on September 25, 2009. For security 
reasons, registration must be completed no later than 5 p.m. e.s.t. on 
November 3, 2009. Requests for special accommodations must be received 
by 5 p.m. e.s.t. on November 3, 2009.
    Deadline for Submission of Written Comments or Statements: Written 
comments or statements on the issues paper may be sent via mail, fax or 
electronically to the address specified in the ADDRESSES section of 
this notice and must be received by 5 p.m. e.s.t. on November 17, 2009.

ADDRESSES: Meeting Location: The listening session will be held in the 
main auditorium of the Central Building of the Centers for Medicare & 
Medicaid Services, 7500 Security Boulevard, Baltimore, MD 21244-1850.
    Registration and Special Accommodations: Persons interested in 
attending the meeting or participating by teleconference must register 
by completing the online registration via the Web site at http://www2.eventsvc.com/stage/palmettogba/111009. Individuals who require 
special accommodations should send an e-mail request or via regular 
mail to as specified in the FOR FURTHER INFORMATION CONTACT of this 
notice.
    Written Comments or Statements: Written comments or statements may 
be mailed to Mail stop C4-03-06, Centers for Medicare & Medicaid 
Services, 7500 Security Boulevard, Baltimore, MD 21244-1850; e-mail to 
<a href="/cdn-cgi/l/email-protection#dc8cb4a5afb5bfb5bdb28a9e8c9cbfb1aff2b4b4aff2bbb3aa"><span class="__cf_email__" data-cfemail="386850414b515b5159566e7a68785b554b1650504b165f574e">[email protected]</span></a>,; or faxed to 410-786-8005.

FOR FURTHER INFORMATION CONTACT: Colleen Bruce, 410-786-5529. You may 
also send inquiries about this listening session via e-mail to 
<a href="/cdn-cgi/l/email-protection#4f2c2023232a2a21612d3d3a2c2a0f2c223c6127273c61282039"><span class="__cf_email__" data-cfemail="82e1edeeeee7e7ecace0f0f7e1e7c2e1eff1aceaeaf1ace5edf4">[email protected]</span></a> or via regular mail as specified in the 
ADDRESSES section of this notice.

I. Background

    Section 131(c) of the Medicare Improvements for Patients and 
Providers Act of 2008 (MIPPA) establishes the Physician Resource Use 
Measurement Reporting Program that requires the Secretary to provide 
confidential feedback reports to physicians on resource use. Section 
131 (d) of MIPPA requires the Secretary to develop a plan for the 
transition to a value-based purchasing program for physician and other 
professional services for which these measurements could also be used. 
We have established the Physician Resource Use Measurement and 
Reporting Program and provided reports to physicians in Phase I of the 
program using currently available methods for defining episodes and 
creating reports on relative resource use based on those episodes. 
Findings from these efforts and several years of research of the 
applicability of currently available grouper tools to Medicare 
beneficiaries and data suggest there may be some benefit to further 
refinement of our approach to defining episodes of care. We have 
established the program and provided reports (http://rurinfo.mathematica-mpr.com/) to physicians in several geographic 
areas. Several units of measurement have been utilized in an effort to 
determine the most useful unit of measurement. Comparing the relative 
resources used to deliver care for an episode of care is one of the 
methods used in the Medicare Physician Resource Use Measurement and 
Reporting Program. (For more detail information, see the Calendar Year 
(CY) 2009 Physician Fee Schedule final rule with comment period in the 
November 19, 2008 Federal Register (73 FR 69867).)
    Currently, an episode of care is created through the use of a 
software program that identifies claims that are clinically related and 
then groups them into an episode. These episodes usually include costs 
of care for an individual beneficiary across settings of care. In 
addition to providing reports to individual practitioners under the 
Medicare Physician Resource use Measurement and Reporting Program, the 
Congress has given the Secretary authority to create reports for 
physician groups. In the CY 2010 Medicare Physician Fee Schedule 
proposed rule (July 13, 2009, (74 FR 33589)), we have proposed 
reporting to groups of physicians. Reporting to groups of physicians 
would allow these episodes to be used to compare costs for episodes 
across regions or systems of care, or across beneficiary populations.
    We have solicited feedback from physicians and physician groups on 
the reports. Furthermore, we have been conducting research on the 
applicability of the commonly used grouper tools that create the 
episodes. Through these efforts we have identified potential areas for 
further refinement of our approach to defining episodes of care. We are 
specifically concerned that the tool be designed to address the unique 
attributes of the Medicare population, settings of care and payment 
system.
    We have also determined that for all involved: physicians, other 
providers, beneficiaries, and policymakers, a tool that is used to 
determine what costs should be included in an episode of care needs to 
be in the public domain so it can be fully transparent.
    At the listening session, CMS staff will present findings from 
research on the key attributes of a grouper logic for Medicare 
beneficiaries and seek input on other strategies for improving the 
manner in which episodes for Medicare beneficiaries are designed. 
Issues to be considered include the challenges associated with--
    <bullet> Beneficiaries with multiple co-morbidities,
    <bullet> Post-acute care diagnoses not matching with inpatient 
diagnoses,
    <bullet> Whether physician services delivered in a hospital stay 
should be grouped to the same episode as the hospitalization, and
    <bullet> Risk-adjustment.
    We recognize that to use this type of grouper logic other 
significant issues, such as attribution and benchmarking methods will 
also need to be addressed, but we do not intend on discussing these at 
this session.
    We intend on using the input from this session, the comments 
received in writing and our research findings to write a request for 
proposal for interested applicants to develop a logic and software that 
are specific to Medicare beneficiaries.

II. Listening Session Format

    The listening session will be held on November 10, 2009 to consider 
the key issues related to drafting the request for proposal. The 
session will begin at 9 a.m. e.s.t. with an overview of the objectives 
for the session and a brief summary of the Medicare Physician Resource 
Use Measurement and Reporting Program. Beginning at approximately 9:30 
a.m. e.s.t. the remainder of the meeting will be devoted to receiving 
public comments. The agenda will provide opportunities for brief 2-
minute comments on each of

[[Page 48981]]

the key issues from on-site session attendees. As time allows, 
telephone participants will also have the opportunity to provide brief 
2-minute comments. The meeting will conclude by 1 p.m. e.s.t. with 
brief comments on next steps.

III. Registration Instructions

    For security reasons, any persons wishing to attend this meeting 
must register by the date listed in the DATES section of this notice. 
Persons interested in attending the meeting or participating by 
teleconference must register by completing the on-line registration via 
the Web site at http://www2.eventsvc.com/stage/palmettogba/111009. The 
on-line registration system will generate a confirmation page to 
indicate the completion of your registration. Please print this page as 
your registration receipt.
    Individuals may also participate in the listening session by 
teleconference. Registration is required as the number of call-in lines 
will be limited. The call-in number will be provided upon confirmation 
of registration.
    An audio download of the listening session will be available 
through the CMS Resource Use Web site within 72 hours after completion 
of the listening session. Use Web site at http://www.cms.hhs.gov/center/physician.asp.

IV. Security, Building, and Parking Guidelines

    This meeting will be held in a Federal government building; 
therefore, Federal security measures are applicable. In planning your 
arrival time, we recommend you to arrive to the central building by 8 
a.m so that you will have enough time to check-in before the session 
begins. The on-site check-in for visitors will begin at 8:15 a.m. 
e.s.t.
    Security measures will include inspection of vehicles, inside and 
out, at the entrance to the grounds. In addition, all persons entering 
the building must check in by name with Security, provide a government-
issued ID, and pass through a metal detector. All items brought to the 
building, whether personal or for the purpose of demonstration or to 
support a presentation, including items such as laptops, cell phones, 
and palm pilots, are subject to physical inspection.

    Authority: Section 131(d) The Medicare Improvements for Patients 
and Providers Act of 2008.

    Dated: September 17, 2009.
Charlene Frizzera,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. E9-22959 Filed 9-24-09; 8:45 am]
BILLING CODE 4120-01-P


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