PAI Issue Brief: The Need for Complete and Transparent Claims Remittance Data in State All Payer Claims Databases

PAI Physician Tip Sheet: Reviewing and Disputing Physician Rating and Tiering by Health Plans

Understanding Episodes of Care

In June 2007, the PAI held a workshop for Federation staff entitled "Understanding Episodes of Care." The purpose of this workshop was to educate the federation about how health insurers use Episode of Treatment Groupers, known as ETGs, to rate physicians on cost of care measures. This workshop brought together national experts to highlight the methodology underlying how ETGs are derived and what physicians need to know in order to combat unfair and inaccurate ratings of physicians by health plans using ETGs. This video is intended to reach the widest possible audience of physicians in order to educate physicians about the intricacies of this latest methodology that rates physicians' "efficiency," most commonly known as "cost of care." This video defines pertinent terminology and explains how the ETG methodology works. After completing this course, it is anticipated that physicians will be armed with the information they need to engage health plans in meaningful dialogue about the quality of care decisions and advocacy that physicians undertake on behalf of their patients. All practicing physicians and their practice staff will benefit from the technical and practical information contained on this video. Any questions about this video should be directed to Mary Jo Malone, Executive Vice President and CEO of the PAI by e-mail: maryjomalone@sbcglobal.netPLEASE NOTE: CME CREDIT IS NO LONGER AVAILABLE FOR THIS PRODUCT

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