Home Cost Performance Ratings: What You Need to Know About Episode Treatment Groups (ETGs)

The Massachusetts Medical Society

Cost Performance Ratings:

What You Need to Know About Episode Treatment Groups (ETGs)

presented by J. William Thomas, PhD, MBA and Arnold Milstein, MD, MPH

Sponsored by the Massachusetts Medical Society

Introduction and Discussion with Kenneth R. Peelle, MD, Immediate Past President MMS

This course was developed from a presentation and discussion held on November 3, 2006 at the MMS Headquarters in Waltham, MA.  Utilizing slides and audio you will experience the presentations and panel discussions on Cost Performance Ratings: What You Need to Know About Episode Treatment Groups (ETGs).

DESCRIPTION

Episode Treatment Groups (ETGs) is an illness classification system that spans the full range of care. It includes the initial physician visit through hospitalization if needed, and all tests, labs and drugs until there is a "clean" bill of health. This information is aggregated, calculated and reported back to the insurance carriers who then provide a report on the efficiency of the provider. This information is shared with the public and the question remains as to the validity of the data, and the impact ETGs have on improving patient care and physician performance.

AUDIENCE

This program is intended for practicing physicians.

FACULTY

J. William Thomas, PhD, MBA

Bill Thomas is Professor Emeritus of Health Management and Policy, as well as Professor of Health Policy and Management at the University of Southern Maine in Portland. His research has focused primarily on measuring performance of health care providers in terms of efficiency and quality of care.

During the 1980s and early 1990s, his work focused on hospital inpatient care. More recently, Dr. Thomas has examined methodologies used in the economic profiling of physicians. In 2002, he completed an evaluation of risk adjustment methods used in the economic profiling of primary care physicians. In 2004, he finished a study that focused on methodological issues associated with economic profiling of specialist physicians, including minimum sample sizes needed for reliable profiles, rules for attributing responsibility for episodes of care to individual physicians, and methods for dealing with cost outlier episodes.

Currently, Dr. Thomas is working with the RAND Corporation on a study investigating relationships between measures of physicians' quality of care performance and practice efficiency performance. He also is working with colleagues at the University of Southern Maine on a Robert Wood Johnson Foundation grant examining issues associated with use of tiered provider networks by health plans.

Dr. Thomas earned a PhD in Managerial Science and Applied Economics and a Master of Business Administration from the Wharton School, University of Pennsylvania. He received a Bachelor of Mechanical Engineering from the Georgia Institute of Technology.

Arnold Milstein, MD, MPH

Dr. Arnold Milstein is the Medical Director of the Pacific Business Group on Health (PBGH) and the U.S. Health Care Thought Leader at Mercer Health & Benefits. PBGH is the largest employer health care purchasing coalition in the U.S.

His work and publications focus on private and public sector health care purchasing strategy, clinical performance measurement, and the psychology of clinical performance improvement.

He co-founded both the Leapfrog Group and the Consumer-Purchaser Disclosure Project. He heads performance measurement activities for both initiatives and is a MedPAC Commissioner. Previously a Rosenthal Lecturer at the Institute of Medicine, the New England Journal of Medicine’s series on employer sponsored health insurance described him as a "pioneer" in efforts to advance quality of care. In 2004 and 2005, he was selected for the highest annual award of World-at-Work, the largest global organization of human resource managers, and of the National Business Group on Health (NBGH). The NBGH award cited nationally recognized innovation and implementation success in health care cost reduction and quality gains.

Dr. Milstein earned degrees at Harvard (BA-Economics), Tufts University School of Medicine (MD) and UC-Berkeley (MPH-Health Services Evaluation and Planning).

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