physician

(9) Reports on utilization (A) Development of episode grouper (i) In general The Secretary shall develop an episode grouper that combines separate but clinically related items and services into an episode of care for an individual, as appropriate. (ii) Timeline for development The episode grouper described in subparagraph (A) shall be developed by not later than January 1, 2012 . (iii) Public availability The Secretary shall make the details of the episode grouper described in subparagraph (A) 9 available to the public. (iv) Endorsement The Secretary shall seek endorsement of the episode grouper described in subparagraph (A) 9 by the entity with a contract under section 1395aaa(a) of this title . (B) Reports on utilization Effective beginning with 2012, the Secretary shall provide reports to physicians that compare, as determined appropriate by the Secretary, patterns of resource use of the individual physician to such patterns of other physicians. (C) Analysis of data The Secretary shall, for purposes of preparing reports under this paragraph, establish methodologies as appropriate, such as to— (i) attribute episodes of care, in whole or in part, to physicians; (ii) identify appropriate physicians for purposes of comparison under subparagraph (B); and (iii) aggregate episodes of care attributed to a physician under clause (i) into a composite measure per individual. (D) Data adjustment In preparing reports under this paragraph, the Secretary shall make appropriate adjustments, including adjustments— (i) to account for differences in socioeconomic and demographic characteristics, ethnicity, and health status of individuals (such as to recognize that less healthy individuals may require more intensive interventions); and (ii) to eliminate the effect of geographic adjustments in payment rates (as described in subsection (e)). (E) Public availability of methodology The Secretary shall make available to the public— (i) the methodologies established under subparagraph (C); (ii) information regarding any adjustments made to data under subparagraph (D); and (iii) aggregate reports with respect to physicians. (F) Definition of physician In this paragraph: (i) In general The term “physician” has the meaning given that term in section 1395x(r)(1) of this title . (ii) Treatment of groups Such term includes, as the Secretary determines appropriate, a group of physicians. (G) Limitations on review There shall be no administrative or judicial review under section 1395ff of this title , section 1395oo of this title, or otherwise of the establishment of the methodology under subparagraph (C), including the determination of an episode of care under such methodology.

Source

42 USC § 1395w-4(n)(9)


Scoping language

In this paragraph
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