Nominations for Panels Developing Medicare Cost Episodes

Date of Publication February 16, 2018

CMS has issued a call for nominations of physicians and other practitioners interested in providing clinical input to develop new Medicare cost measures based on episodes of care, The measures will be used to calculate and compare physician resource use in the cost component of the Merit-based Incentive Payment System (MIPS) established under MACRA. Nominations for participation in the panels that will choose which episodes to focus on are due by March 20 but there will also be opportunities for additional participants once the episodes have been selected. The nomination form and more information on the project and expectations of the panel can be found here.

Work on the cost episodes is being conducted under contract with Acumen LLC. Previously, Acumen created a large Clinical Committee comprised of more than 70 clinicians from 50 physician and other practitioner organizations to put together a list of possible episodes and make general recommendations on various aspects of episode development. Seven Clinical Subcommittees tied to specific organ systems then selected and developed eight episodes that are expected to be proposed for use in MIPS as of 2019. Six of the original Clinical Subcommittees plus four new ones now will develop a second wave of potential cost episode measures.

In response to feedback from the original subcommittees, during this wave, once the larger subcommittee of 20 to 40 members has chosen an episode, work on its details will then be transferred to a smaller group comprised of five to 10 clinicians (15 maximum) with expertise directly relevant to the procedure or condition involved in the selected episode. To participate on the larger Clinical Subcommittee, it is necessary to complete and submit a nomination by the March 20 deadline. After this date, there will be an ongoing nomination period and these nominees will enter a standing pool that will be drawn upon for the measure-specific work groups. Together with the AMA, IMS believes that with appropriate clinical input, episode-based cost measures would be a significant improvement over the current cost measures. Therefore, we highly encourage physicians to volunteer for these panels.

The six original Clinical Subcommittees that are being reconvened cover: cardiovascular, gastrointestinal. neuropsychiatric, peripheral vascular, pulmonary, and non-spine musculoskeletal disease. Current members of these subcommittees must submit a new abbreviated nomination form. The four new clinical areas are spine, oncology, renal and urological.

CMS is specifically looking for specialists in allergy/immunology, anesthesiology, cardiac electrophysiology, general and interventional cardiology, colorectal surgery, critical care, dermatology, diagnostic and interventional radiology, emergency medicine, family medicine, gastroenterology, general surgery, geriatric medicine, hand surgery, hospitalists, infectious disease, internal medicine, nephrology, neurosurgery, obstetrics/gynecology, oncology (medical, radiation and surgical), orthopedic surgery, otolaryngology, pathology, pediatrics, peripheral vascular disease and vascular surgery, physical medicine and rehabilitation, plastic surgery, preventive medicine, psychiatry, pulmonary disease, rheumatology, sports medicine, thoracic surgery, and urology.

An FAQ providing more information on the past and upcoming work of the clinical subcommittees and work groups can be found here. Additional information is on the CMS website.

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