The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to establish care episode groups and patient condition groups, which will be used to measure resource use under the new Merit-Based Incentive Payment System (MIPS) and alternative payment models (APMs). Care episode groups describe the patient's clinical problems at the time items and services are furnished during an episode of care, such as clinical conditions or diagnoses, whether hospitalization occurs, and the principal services furnished. Patient condition groups describe the patient's clinical history at the time of an encounter, such as chronic conditions, health status, and recent significant medical history. CMS is inviting comments on options for episode groups, along with the specific clinical criteria and patient characteristics used to classify patients into care episode and patient condition groups, and classification codes to identify patient/physician relationship categories. The comment deadline is February 15, 2016. Supplemental materials are available here.
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