Education in our data driven world will become increasingly important as we try to understand the effect on healthcare and how care is provided to humanity. We find the information difficult for the average person and are sharing a version to help you prepare if you are attending the public information sharing scheduled in August 2026.
On Wednesday, August 5th from 1:00 to 4:30 PM (EST), a national expert panel will meet to discuss how Medicare updates the way it measures healthcare costs, and you’re invited to listen in.
Medicare is working hard to make healthcare better, more affordable, and more fair for everyone. One of the ways they do this is by creating episode‑based cost measures. These measures help Medicare understand how much care costs for specific health conditions, and whether patients are getting good value for the money spent.
If you’ve ever wondered how Medicare decides what “good care” looks like, here’s a simple explanation of how these measures are built.
Step 1: Choosing the Health Condition
Medicare starts by looking at conditions that:
- Affect a lot of people
- Cost a lot of money
- Have big differences in how care is delivered
- Can be improved with better coordination
Examples include diabetes, COPD, heart disease, joint replacement, and certain types of cancer.
Step 2: Asking Clinicians for Help
Medicare brings together doctors, nurses, specialists, and other experts to answer important questions like:
- What starts an episode of care?
- What services should be included?
- What complications matter?
- How long should the episode last?
This ensures the measure reflects real medical practice, not just numbers on a spreadsheet.
Step 3: Reviewing With a Technical Expert Panel (TEP)
This is where national experts including the Physician Cost Measures and Patient Relationship Codes (PCMP) TEP step in.
They help Medicare make sure the measure is:
- Fair
- Clinically accurate
- Easy to understand
- Safe for patients
- Useful for improving care
They also check for unintended consequences, like whether the measure might accidentally disadvantage rural communities, older adults, or people with complex health needs.
Step 4: Testing the Measure Behind the Scenes
Medicare runs the measure using real claims data to see:
- Does it work?
- Does it make sense?
- Does it treat different types of patients fairly?
- Does it reflect the care clinicians actually provide?
If something looks off, they fix it before sharing it publicly.
Step 5: Field Testing With Real Clinicians
This is one of the most important steps.
Doctors, hospitals, and clinics receive confidential reports showing:
- How they performed
- What their costs looked like
- How patients were attributed to them
- Whether the measure seems fair
They give feedback on what works and what doesn’t. Medicare uses this feedback to make improvements.
Step 6: Public Comment
Medicare then shares the measure publicly and invites comments from:
- Patients
- Caregivers
- Clinicians
- Health systems
- Community organizations
- Advocacy groups
Anyone can speak up and Medicare is required to consider all comments.
Step 7: Finalizing the Measure
Medicare updates the measure based on:
- Expert recommendations
- Field testing
- Public comments
- Data analysis
- Equity reviews
This is where the measure becomes polished, fair, and ready for use.
Step 8: Official Rulemaking
Finally, Medicare publishes the measure in the Medicare Physician Fee Schedule. After one more round of public review, the measure becomes official and is used in programs like the Quality Payment Program (QPP).
This affects:
- How clinicians are evaluated
- How healthcare organizations are paid
- How care is coordinated
- How prevention and equity are prioritized
Why This Matters to You
Episode‑based cost measures help ensure:
- Patients get the right care at the right time
- Healthcare dollars are spent wisely
- Preventive care is encouraged
- Chronic disease is managed better
- Older adults and long‑term care residents receive safer, more coordinated care
- Communities with greater needs are recognized
Better measures mean better care for families, seniors, caregivers, and communities.
Want to Learn More? Join the National Webinar
PCMP Technical Expert Panel Webinar Wednesday, August 5 @1:00 PM – 4:30 PM (EST) Virtual meeting (open to the public)
This webinar explains how Medicare builds these measures and how they shape the future of healthcare.
Understanding how Medicare measures cost is one of the most important steps toward building a healthier, more equitable Rochester.
