What Is the Purpose of this Site?
This site contains documents related to Medicare’s Physician Resource Use Measurement and Reporting Program. During Phase I of this project, the Centers for Medicare & Medicaid Services, in partnership with Mathematica Policy Research, Inc., began developing and testing physician resource use measures and confidential feedback reports that compare physicians on their relative resource use.
The feedback reports are disseminated only to physicians with either per capita costs that are statistically reliable for at least one calendar year and/or per episode costs that are statistically reliable for at least one health condition. Within the reports, “per episode cost” data are presented for selected conditions. For the Round 1 feedback reports, “episodes” were created using the Medical Episode Grouper® (MEG). For Round 2, “episodes" were created using Episode Treatment Groups® (ETG). The names and definitions of the conditions varied slightly between Round 1 and Round 2 due to differences in the groupers. For Round 1, the potential chronic conditions for a physician’s report were congestive heart failure, chronic obstructive pulmonary disease, coronary artery disease, and prostate cancer. The potential acute conditions for a physician’s report were cholecystitis, acute myocardial infarction, hip fracture, community acquired pneumonia, and urinary tract infection. Conditions are included in the report only if there were a sufficient number of episodes attributed to the physician to determine a statistically reliable cost estimate. Due to the broad range of potentially reportable conditions, it is rare for a physician’s report to include all of the conditions listed above.
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Resource Use Report Prototype (format:PDF 1.1Mb)–The prototype is an example of the reports that were sent to physicians in Phase I of the project. (The data used in the prototype are based on real data, but are for demonstration purposes only.)
The following examples of “per episode costs” for acute myocardial infarction (AMI), cholecystitis, and prostate cancer were not included in the Round 1 Resource Use Report prototype above because the physician was not assigned enough episodes of care for these conditions to generate a reliable cost estimate. However, physicians for each of the RUR samples below did have enough assigned episodes for the given condition to generate a reliable cost estimate.
• Sample Per Episode Costs: Acute Myocardial Infarction (AMI)
• Sample Per Episode Costs: Cholecystitis
• Sample Per Episode Costs: Prostate Cancer
For Round 2, the potential chronic conditions for a physician’s report were congestive heart failure, chronic obstructive pulmonary disease, ischemic heart disease, and malignant neoplasm of the prostate. The potential acute conditions for a physician’s report were bacterial lung infections, cholelithiasis, hip fracture, and infection of lower or upper GU system. The following examples of “per episode costs” are samples from the Round 2 Resource Use Reports.
• Sample Per Episode Costs: Infection of Lower or Upper GU System
• Sample Per Episode Costs: Bacterial Lung Infections
• Sample Per Episode Costs: Chronic Obstructive Pulmonary Disease (COPD)
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