I am not sure I quite understand the purpose of this entire methodology, but is this company trying to re-invent themselves are insurers do? Again, speaking from what is published and what I have read, are we trying to make use of data that has already been accumulated, queried in a different fashion to get, give physicians more overhead and red tape to deal with in having to look at pay for performance measures?
How more confusing and time consumer are the algorithms for payment going to get? Is the the same data base just queried differently or a new data base created from the old with some restructuring? Andrew Cuomo just came down on one division with fines, etc. so again, it boggles my mind as to why a new business intelligence grouping is needed so physicians can see that they are already drowning in the pay for performance areas, that is if they have time as right now 60% of their time is spent waiting for information and on red tape administrative tasks, 16% only for actual healthcare. Can we give the MDs a break and get the percentage up on the time they can spend on patients, 16% is a pretty bad. The other division that was was scrutinized by Andrew Cuomo made 1.3 billion dollars last year related to balance billing, and we have seen what the legal outcomes are with that issue with fines and reimbursements in the works. BD
Ingenix has made public and is seeking industry comment on the measurement methodology for its Episode Treatment Groups. They are used to compare provider treatment patterns and measure the quality and efficiency of care.
The methodology organizes related health services into a medically relevant and distinct measurement unit describing an episode of care. It primarily is used as a measuring tool for pay-for-performance and other performance evaluation initiatives. But it could at some point also be used for general reimbursement functions.
The Episode Treatment Groups are not related to a controversial Ingenix database used to determine out-of-network reimbursement rates for consumers across the nation, says Shelby Solomon, executive vice president for commercial and government health plans at Ingenix. Several insurers have stopped using the database as part of agreements with New York Attorney General Andrew Cuomo.