Method and system for producing statistical analysis of medical care information

• US 10,319,474 B1
• Filed: 05/01/2014
• Issued: 06/11/2019
• Est. Priority Date: 07/18/2008
• Status: Active Grant

• Current Assignee: Cave Consulting Group LLC
• Original Assignee: Cave Consulting Group LLC
• Inventors: Cave, Douglas G, Alexandrian, Yuri, Calvin, John T, Lara, Jenine A
• Primary Examiner(s): Burgess, Joseph D
• Application Number:
  US14/266,842
• Time in Patent Office: 1,867 Days
• CPC Class Codes: G06Q 10/06393 Score-carding, benchmarking or key performance indicator [KPI] analysis
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 50/22 Social work or social welfare, e.g. community support activities or counselling services
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

A method and system for producing statistical analysis of medical care information comprises: aggregating medical care providers to a peer group level; aggregating medical care information at the peer group level and at the medical care provider level; computing a statistical analysis, such as performing Pearson'"'"'s correlation analysis; and generating peer group level and medical care provider level results utilizing the computed statistical analysis. Also, a method for producing statistical analysis of medical care information for a medical care provider efficiency measurement comprises: applying minimum unit of analysis criteria for medical care providers to be used in statistical analysis; calculating an overall weighted average medical care information measure for each medical care provider; calculating a medical condition-specific medical care information measure for each medical care provider; removing outlier medical care providers from statistical analysis at medical care information level; calculating a statistical analysis to medical care provider efficiency measurement at each medical care information level using a statistical calculation; and selecting statistically related medical care information to identify medical care providers meeting a desired practice pattern.

Claims

1. A computer-implemented method of identifying a practice pattern associated with an efficiency of medical care providers, said method comprising:

providing, at a computer system, a plurality of episodes of care records, wherein each of the plurality of episodes of care records is identified by one of a plurality of episode-of-care identifiers, and includes one of a plurality of provider identifiers identifying one of a plurality of medical care providers, wherein an episode metric is defined as at least one of an average utilization per episode of care and an average cost per episode of care;

providing, at the computer system, a plurality of patient treatment claim records, wherein each of the plurality of patient treatment claim records includes (i) an associated one of the episode-of-care identifiers, and (ii) at least one of a plurality of codes, each of the plurality of codes associated with at least one of a procedure and service in a medical care field associated with the plurality of medical care providers, each of the plurality of codes being assigned to one of a plurality of service categories;

providing, at the computer system for each of the plurality of medical care providers, a provider service category episode metric for each of the service categories, the provider service category episode metric being the episode metric for the respective provider across the codes in the respective service category;

providing, at the computer system, a group service category episode metric for each of the service categories, the group service category episode metric being the episode metric across the codes in the respective service category across all of the providers;

providing, at the computer system, a plurality of medical care provider overall efficiency measurements each associated with one of the plurality of provider identifiers;

displaying, to a user, a practitioner efficiency report associated with a first one of the plurality of medical care providers, wherein the practitioner efficiency report includes (i) the overall efficiency measurement associated with the first medical care provider, (ii) the provider service category episode metric of the first medical care provider for each of the service categories, (iii) the group service category episode metric for each of the service categories, and (iv) a graphical indication for at least one of the service categories that the indicated provider service category episode metric exceeds the corresponding group service category episode metric by a first threshold amount;

receiving, from the user, a designation of one of the at least one graphically indicated service categories for a drill-down analysis;

providing, at the computer system, for each of the plurality of medical care providers, a provider code episode metric for each of the codes associated with the designated service category, the provider code episode metric being the episode metric for the respective provider for the respective code;

providing, at the computer system a group code episode metric for each of the codes associated with the designated service category, the group code episode metric being the episode metric across all providers for the respective code;

associating, by the computer system, with each of the plurality of medical care providers, a code score for each of the codes associated with the designated service category, wherein the code score is based on (i) the provider code episode metric for the respective code and the respective provider relative to (ii) the group code episode metric for the respective code;

calculating, for each of the codes associated with the designated service category, a correlation value based on a plurality of pairs of values, each pair of values corresponding to a respective one of the plurality of medical providers and comprising;

the overall efficiency measurement associated with the respective medical care provider, and

the code score associated with the respective code for the respective medical care provider;

displaying, to the user, a code report for the designated service category, wherein the code report includes (i) an identifier of at least a portion of the codes in the designated service category, (ii) the correlation value corresponding to each included code, and (iii) a graphical indication of at least one of the included codes as having an associated correlation value exceeding a second threshold amount;

receiving, from the user, a designation of a set of the included codes as the practice pattern associated with efficiency; and

displaying, to the user, a practitioner target report, wherein the practitioner target report includes (i) a respective identifier of each of a subset of the plurality of medical providers, (ii) an identifier of a number of the designated codes in the practice pattern for which the provider code episode metric of the respective identified provider exceeds the group code episode metric by a third threshold amount, and (iii) for each identified provider, a link to a detail display of the provider code episode metrics of the respective identified provider for the included codes in the practice pattern.

2. The method in claim 1 further comprising:

calculating the correlation value at a plurality of levels of aggregation of medical care information from the patient treatment claim records.

3. The method in claim 2 wherein:

the plurality of levels includes aggregation by specific medical conditions, and the code score for each of the codes associated with the designated service category is based on the provider code episode metric for the respective medical care provider for episode-of-care identifiers associated with each specific medical condition relative to the group code episode metric for episode-of-care identifiers associated with the specific medical condition.

4. The method in claim 1 which further comprises:

computing a second statistical analysis from aggregated medical care information on the computer system;

generating peer group level results utilizing the second computed statistical analysis on the computer system; and

generating medical care provider level results utilizing the second computed statistical analysis on the computer system; and

calculating the medical care provider overall efficiency measurement through a comparison of medical care provider level results to peer group level results on the computer system.

5. The method in claim 1 wherein the code score associated with each of the codes associated with the designated service category is based on the utilization for each of the codes.

6. The method in claim 5 wherein the utilization is a utilization frequency rate.

7. The method in claim 1, wherein displaying the practitioner target report comprises displaying the subset of providers each having an overall efficiency score exceeding a fourth threshold amount.

8. The method in claim 1 which further comprises:

removing medical care providers failing to meet a minimum unit of analysis criteria before calculating the correlation value.

9. The method in claim 8 wherein:

the minimum unit of analysis is determined by a configuration parameter.

10. The method in claim 1 wherein the correlation calculation includes a Pearson'"'"'s correlation.

11. The method in claim 1 which further comprises:

selecting statistically related medical care information to identify medical care providers meeting the identified practice pattern based on the selected indicators on the computer system.

14. The method in claim 1 wherein providing the plurality of medical care provider overall efficiency measurements includes providing the plurality of medical care provider overall efficiency measurements wherein each overall efficiency measurement represents an average usage of resources per episode of care for the associated medical care provider relative to the average usage of resources per episode of care for the plurality of medical care providers, and wherein the average usage of resources per episode of care is weighted according to a predetermined relevance of an associated medical condition in a practice area associated with the plurality of medical care providers.

12. A computer system for identifying a practice pattern associated with an efficiency of medical care providers, said computer system comprising:

a processor capable of executing computer instructions;

a memory coupled to the processor containing computer instructions for;

accessing a plurality of episodes of care records, wherein each of the plurality of episodes of care records is identified by one of a plurality of episode-of-care identifiers, and includes one of a plurality of provider identifiers identifying one of a plurality of medical care providers, wherein an episode metric is defined as at least one of an average utilization per episode of care and an average cost per episode of care;

accessing a plurality of patient treatment claim records, wherein each of the plurality of patient treatment claim records includes (i) an associated one of the episode-of-care identifiers, and (ii) at least one of a plurality of codes, each of the plurality of codes associated with at least one of a procedure and service in a medical care field associated with the plurality of medical care providers, each of the plurality of codes being assigned to one of a plurality of service categories;

accessing, for each of the plurality of medical care providers, a provider service category episode metric for each of the service categories, the provider service category episode metric being the episode metric for the respective provider across the codes in the respective service category;

accessing a group service category episode metric for each of the service categories, the group service category episode metric being the episode metric across the codes in the respective service category across all of the providers;

accessing a plurality of medical care provider overall efficiency measurements each associated with one of the plurality of provider identifiers;

displaying, to a user, a practitioner efficiency report associated with a first one of the plurality of medical care providers, wherein the practitioner efficiency report includes (i) the overall efficiency measurement associated with the first medical care provider, (ii) the provider service category episode metric of the first medical care provider for each of the service categories, (iii) the group service category episode metric for each of the service categories, and (iv) a graphical indication for at least one of the service categories that the indicated provider service category episode metric exceeds the corresponding group service category episode metric by a first threshold amount;

receiving, from the user, a designation of one of the at least one graphically indicated service categories for a drill-down analysis;

accessing, for each of the plurality of medical care providers, a provider code episode metric for each of the codes associated with the designated service category, the provider code episode metric being the episode metric for the respective provider for the respective code;

accessing a group code episode metric for each of the codes associated with the designated service category, the group code episode metric being the episode metric across all providers for the respective code;

associating, with each of the medical care providers, a code score for each of the codes associated with the designated service category, wherein the code score is based on (i) the provider code episode metric for the respective code and the respective provider relative to (ii) the group code episode metric for the respective code;

calculating, for each of the codes associated with the designated service category, a correlation value based on a plurality of pairs of values, each pair of values corresponding to a respective one of the plurality of medical providers and comprising;

the overall efficiency measurement associated with the respective medical care provider, and

the code score associated with the respective code for the respective medical care provider;

displaying, to the user, a code report for the designated service category, wherein the code report includes (i) an identifier of at least a portion of the codes in the designated service category, (ii) the correlation value corresponding to each included code, and (iii) a graphical indication of at least one of the included codes as having an associated correlation value exceeding a second threshold amount;

receiving, from the user, a designation of a set of the included codes as the practice pattern associated with efficiency; and

displaying, to the user, a practitioner target report, wherein the practitioner target report includes (i) a respective identifier of each of a subset of the plurality of medical providers, (ii) an identifier of a number of the designated codes in the practice pattern for which the provider code episode metric of the respective identified provider exceeds the group code episode metric by a third threshold amount, and (iii) for each identified provider, a link to a detail display of the provider code episode metrics of the respective identified provider for the included codes in the practice pattern.

13. A non-transitory recordable medium containing computer instructions for identifying a practice pattern associated with an efficiency of medical care providers, said computer instructions when executed by at least one processor cause the at least one processor to:

access a plurality of episodes of care records, wherein each of the plurality of episodes of care records is identified by one of a plurality of episode-of-care identifiers, and includes one of a plurality of provider identifiers identifying one of a plurality of medical care providers, wherein an episode metric is defined as at least one of an average utilization per episode of care and an average cost per episode of care;

access a plurality of patient treatment claim records, wherein each of the plurality of patient treatment claim records includes (i) an associated one of the episode-of-care identifiers, and (ii) at least one of a plurality of codes, each of the plurality of codes associated with at least one of a procedure and service in a medical care field associated with the plurality of medical care providers, each of the plurality of codes being assigned to one of a plurality of service categories;

access, for each of the plurality of medical care providers, a provider service category episode metric for each of the service categories, the provider service category episode metric being the episode metric for the respective provider across the codes in the respective service category;

access a group service category episode metric for each of the service categories, the group service category episode metric being the episode metric across the codes in the respective service category across all of the providers;

access a plurality of medical care provider overall efficiency measurements each associated with one of the plurality of provider identifiers;

display, to a user, a practitioner efficiency report associated with a first one of the plurality of medical care providers, wherein the practitioner efficiency report includes (i) the overall efficiency measurement associated with the first medical care provider, (ii) the provider service category episode metric of the first medical care provider for each of the service categories, (iii) the group service category episode metric for each of the service categories, and (iv) a graphical indication for at least one of the service categories that the indicated provider service category episode metric exceeds the corresponding group service category episode metric by a first threshold amount;

receiving, from the user, a designation of one of the at least one graphically indicated service categories for a drill-down analysis;

access, for each of the plurality of medical care providers, a provider code episode metric for each of the sets of related codes associated with the designated service category, the provider code episode metric being the episode metric for the respective provider for the respective code;

accessing a group code episode metric for each of the codes associated with the designated service category, the group code episode metric being the episode metric across all providers for the respective code;

associate, with each of the plurality of medical care providers, a code score for each of the codes associated with the designated service category, wherein the code score is based on (i) the provider code episode metric for the respective code and the respective provider relative to (ii) the group code episode metric for the respective code;

calculate, for each of the codes associated with the designated service category, a correlation value based on a plurality of pairs of values, each pair of values corresponding to a respective one of the plurality of medical providers and comprising;

the overall efficiency measurement associated with the respective medical care provider, and

the codes score associated with the respective code for the respective medical care provider;

display, to the user, a code report for the designated service category, wherein the code report includes (i) an identifier of at least a portion of the codes in the designated service category, (ii) the correlation value corresponding to each included code, and (iii) a graphical indication of at least one of the included codes as having an associated correlation value exceeding a second threshold amount;

receive, from the user, a designation of a set of the included codes as the practice pattern associated with efficiency- and

display, to the user, a practitioner target report, wherein the practitioner target report includes (i) a respective identifier of each of a subset of the plurality of medical providers, (ii) an identifier of a number of the designated codes in the practice pattern for which the provider code episode metric of the respective identified provider exceeds the group code episode metric by a third threshold amount, and (iii) for each identified provider, a link to a detail display of the provider code episode metrics of the respective identified provider for the included codes in the practice pattern.