Methods for improving the clinical outcome of patient care and for reducing overall health care costs

• US 20050251416A1
• Filed: 05/06/2004
• Published: 11/10/2005
• Est. Priority Date: 05/06/2004
• Status: Abandoned Application

• Current Assignee: Medencentive LLC
• Original Assignee: Medencentive LLC
• Inventors: Greene, Jeffrey C.
• Application Number:
  US10/841,240
• Publication Number:
  US 20050251416A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/00 ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

The current invention is directed to improved methods for providing health care and for reducing the costs of health care. Additionally, the methods of the current invention are designed to improve the clinical outcome for the patient. The methods of the current invention provide financial incentives to both the patient and the medical service provider is an integrated manner that encourages patient empowerment, patient and physician accountability and appropriate checks and balances by incorporating evidence-based medicine treatment guidelines and content and other similar types of content through an Internet application or by other means to improve the clinical outcome of the health care treatment and to reduce the overall costs of health care.

Claims

1. A method for delivering health care services comprising the steps of:

receiving a claim for compensation for medical services from a medical practitioner for medical treatment of a patient, said claim including at least one diagnosis code corresponding to at least one medical treatment received by said patient;

determining if said diagnosis code corresponds to a medical diagnosis found in a data base of medical diagnoses;

sending a notice to the medical practitioner when said diagnosis code corresponds to a medical diagnosis found in said data base;

providing the medical practitioner access to a website, said website provides the medical practitioner with access to EBM treatment guidelines for said medical diagnosis;

said website requests the medical practitioner to confirm medical treatment within the scope of said EBM treatment guidelines;

monitoring the medical practitioner'"'"'s access of said EBM treatment guidelines;

selecting a compensation pay scale in response to said medical practitioner'"'"'s input received on said website;

said website providing said medical practitioner with the option of prescribing information therapy for said patient; and

,

said website automatically generating a notice for transmission to a patient when said medical practitioner prescribes information therapy.

2. The method of claim 1, wherein said website receives the claim for compensation for medical services from a medical practitioner and said website automatically compares said medical diagnosis code to said data base of medical diagnoses.

3. The method of claim 1, wherein said website providing the means for monitoring the medical practitioner'"'"'s access of said EBM treatment guidelines.

4. The method of claim 1, wherein said website automatically selects between at least two pay scales in response to input received from said practitioner.

5. The method of claim 1, wherein said website automatically selects between at least three pay scales in response to input received from said practitioner.

6. The method of claim 1, wherein said website automatically selects the lowest available pay scale when said medical practitioner does not prescribe information therapy for said patient.

7. The method of claim 1, wherein said website automatically selects an intermediate pay scale if the diagnosis code is not found within said data base of medical diagnoses.

8. The method of claim 1, wherein said website automatically selects the highest pay scale when said diagnosis code has a corresponding EBM treatment guideline and said medical practitioner indicates compliance with the said EBM treatment guideline.

9. The method of claim 1, wherein said website automatically selects the highest pay scale when said diagnosis code has a corresponding EBM treatment guideline and said medical practitioner indicates compliance with the said EBM treatment guideline and said medical practitioner prescribes information therapy for said patient.

10. The method of claim 1, wherein said website automatically selects the highest pay scale when said diagnosis code has a corresponding EBM treatment guideline and said medical practitioner indicates non-compliance with the said EBM treatment guideline while providing an explanation of the reason for non-compliance with the EBM treatment guidelines.

11. The method of claim 1, wherein said website automatically selects the highest pay scale when said diagnosis code has a corresponding EBM treatment guideline and said medical practitioner indicates non-compliance with the said EBM treatment guideline while providing an explanation of the reason for non-compliance with the EBM treatment guidelines and said medical practitioner prescribes information therapy for said patient.

32. The method of claim 1, further comprising the steps of:

said website providing said patient with access to medical information relating to said medical diagnosis;

monitoring said patient'"'"'s access of said medical information;

providing said patient with a knowledge exam to determine said patient'"'"'s understanding of the medical diagnosis;

scoring said knowledge exam; and

,

providing said patient the option of forwarding the patient'"'"'s knowledge exam results to patient'"'"'s health care network.

33. The method of claim 1, wherein an intermediate pay scale is selected when said medical practitioner does not prescribe information therapy for said patient.

34. The method of claim 1, wherein the highest pay scale is selected when said medical practitioner does not prescribe information therapy for said patient.

35. The method of claim 1, further comprising the step of monitoring the frequency of treatments by said medical practitioner which do not comply with said EBM treatment guidelines.

36. The method of claim 1, further comprising the step of said medical practitioner informing said health care network of patient'"'"'s non-compliance with said information therapy.

12. A method for delivering health care services comprising the steps of:

receiving a claim for medical services from a medical practitioner, said claim including at least one code corresponding to at least one medical diagnosis;

comparing said code to a data base of medical diagnoses;

sending a notice to the medical practitioner when said code corresponds to a medical diagnosis found in said data base;

providing the medical practitioner access to an website, said website provides the medical practitioner with access to guidelines for EBM treatment of said medical diagnosis;

said website provides the means for the medical practitioner to confirm medical treatment within the scope of the EBM treatment guidelines;

said website providing said medical practitioner with the option of prescribing information therapy;

said website automatically generating a notice for transmission to a patient when said medical practitioner prescribes information therapy;

said website providing said patient with access to medical information relating to said medical diagnosis;

monitoring the access of said medical information by said patient;

providing said patient with a knowledge exam to determine said patient'"'"'s understanding of the medical diagnosis;

automatically scoring said knowledge exam; and

,

forwarding the knowledge exam results to patient'"'"'s health care network.

37. The method of claim 12, further comprising the step of monitoring the medical practitioner'"'"'s access of said EBM treatment guidelines.

38. The method of claim 12, further comprising the step of selecting a compensation rate from between at least two pay scales, the selected pay scale being based on said medical practitioner'"'"'s indication of compliance or non-compliance with treatment within the scope of said EBM treatment guidelines.

39. The method of claim 12, further comprising the step of selecting a compensation rate between at least three pay scales, the selected pay scale being based on said medical practitioner'"'"'s indication of compliance or non-compliance with treatment within the scope of said EBM treatment guidelines.

40. The method of claim 39, wherein an intermediate pay scale is selected if the diagnosis code does not have a corresponding EMB treatment guideline.

41. The method of claim 39, further comprising the step of selecting the highest pay scale when said diagnosis code has a corresponding EMB treatment guideline and said medical practitioner indicates compliance with said EBM treatment guidelines.

42. The method of claim 39, further comprising the step of selecting the highest pay scale when said diagnosis code has a corresponding EMB treatment guideline and said medical practitioner indicates non-compliance with said EBM treatment guidelines while providing an explanation of the reason for non-compliance with said EBM treatment guidelines.

43. The method of claim 12, further comprising the step of said medical practitioner informing said health care network of patient'"'"'s non-compliance with said information therapy.

13. A method for delivering health care services comprising the steps of:

receiving a claim for medical services from a medical practitioner, said claim including at least one code corresponding to at least one medical diagnosis;

comparing said code to a data base of medical diagnoses;

sending a notice to the medical practitioner when said code corresponds to a medical diagnosis found in said data base;

providing the medical practitioner access to an website, said website provides the medical practitioner with access to guidelines for EBM treatment of said medical diagnosis;

said website provides the means for the medical practitioner to confirm medical treatment within the scope of the EBM treatment guidelines;

said website providing the means for monitoring the medical practitioner'"'"'s access of said EBM treatment guidelines;

said website selecting a compensation pay scale based on said medical practitioner'"'"'s response to said request for confirmation of medical treatment within the scope of said EBM treatment guidelines;

said website selecting between at least two pay scales;

said website providing said medical practitioner with the option of prescribing information therapy;

said website automatically generating a notice for transmission to a patient when said medical practitioner prescribes information therapy;

said website providing said patient with access to medical information relating to said medical diagnosis;

monitoring the access of said medical information by said patient;

providing said patient with a knowledge exam to determine said patient'"'"'s understanding of the medical diagnosis;

automatically scoring said knowledge exam; and

,

forwarding the knowledge exam results to patient'"'"'s health care network.

44. The method of claim 13, further comprising the step of selecting a compensation rate between at least three pay scales, the selected pay scale being based on said medical practitioner'"'"'s response to request for confirmation of treatment within the scope of said EBM treatment guidelines.

45. The method of claim 13, wherein said website selects the lowest available pay scale when said medical practitioner does not prescribe information therapy for said patient.

46. The method of claim 13, wherein said website selects an intermediate pay scale when said medical practitioner does not prescribe information therapy for said patient.

47. The method of claim 13, wherein said website selects the highest pay scale when said medical practitioner does not prescribe information therapy for said patient.

48. The method of claim 13, wherein said website selects an intermediate pay scale if the diagnosis code does not have a corresponding EMB treatment guideline.

49. The method of claim 13, wherein said website selects the highest pay scale when said diagnosis code has a corresponding EMB treatment guideline and said medical practitioner indicates compliance with said EBM treatment guidelines.

50. The method of claim 13, wherein said website selects the highest pay scale when said diagnosis code has a corresponding EMB treatment guideline and said medical practitioner indicates compliance with said EBM treatment guidelines and said medical practitioner prescribes information therapy for said patient.

51. The method of claim 13, wherein said website selects the highest pay scale when said diagnosis code has a corresponding EMB treatment guideline and said medical practitioner indicates non-compliance with said EBM treatment guidelines while providing an explanation of the reason for non-compliance with the EBM treatment guidelines.

52. The method of claim 13, wherein said website selects the highest pay scale when said diagnosis code has a corresponding EMB treatment guideline and said medical practitioner indicates non-compliance with said EBM treatment guidelines while providing an explanation of the reason for non-compliance with the EBM treatment guidelines and said medical practitioner prescribes information therapy for said patient.

53. The method of claim 13, wherein said website selects the highest pay scale when said diagnosis code has a corresponding EMB treatment guideline and said medical practitioner indicates non-compliance with said EBM treatment guidelines while providing an explanation of the reason for non-compliance with said EBM treatment guidelines and wherein said website monitors the frequency of non-compliant treatments by said medical practitioner.

54. The method of claim 13, further comprising the step of monitoring the frequency of treatments by said medical practitioner which do not comply with said EBM treatment guidelines.

55. The method of claim 13, further comprising the step of said medical practitioner informing said health care network of patient'"'"'s non-compliance with said information therapy.

14. A method for delivering health care services comprising the steps of:

receiving a claim for compensation for medical services from a medical practitioner for medical treatment of a patient, said claim including at least one diagnosis code corresponding to at least one medical treatment received by said patient;

determining if said diagnosis code corresponds to a medical diagnosis found in a data base of medical diagnoses;

providing the medical practitioner access to a website, said website provides the medical practitioner with access to treatment guidelines for said medical diagnoses;

said website requests the medical practitioner to confirm medical treatment within the scope of said treatment guidelines;

monitoring the medical practitioner'"'"'s access of said treatment guidelines;

selecting a compensation pay scale based on said medical practitioner'"'"'s response to request for confirmation of treatment within the scope of said treatment guidelines.

15. The method of claim 14, further comprising the steps of:

said website providing said medical practitioner with the option of prescribing information therapy for said patient; and

,

said website generating a notice for transmission to said patient when said medical practitioner prescribes information therapy.

16. The method of claim 14, wherein following receipt of the claim for compensation for medical services from a medical practitioner, further comprising the step of comparing said medical diagnosis code to said data base containing said treatment guidelines.

17. The method of claim 14, further comprising the step of monitoring the medical practitioner'"'"'s access of said treatment guidelines.

18. The method of claim 14, further comprising the step of selecting a compensation rate from between at least two pay scales, the selected pay scale being based on said medical practitioner'"'"'s response to request for confirmation of treatment within the scope of said treatment guidelines.

19. The method of claim 14, further comprising the step of selecting a compensation rate between at least three pay scales, the selected pay scale being based on said medical practitioner'"'"'s response to request for confirmation of treatment within the scope of said treatment guidelines.

20. The method of claim 14, wherein the lowest available pay scale is selected when said medical practitioner does not prescribe information therapy for said patient.

21. The method of claim 14, wherein an intermediate pay scale is selected when said medical practitioner does not prescribe information therapy for said patient.

22. The method of claim 14, wherein the highest pay scale is selected when said medical practitioner does not prescribe information therapy for said patient.

23. The method of claim 16, wherein an intermediate pay scale is selected if the diagnosis code is not found within said data base of treatment guidelines.

24. The method of claim 16, further comprising the step of selecting the highest pay scale when said diagnosis code is found in said data base of treatment guidelines and said medical practitioner indicates compliance with said treatment guidelines.

25. The method of claim 16, further comprising the step of selecting the highest pay scale when said diagnosis code is found in said data base of treatment guidelines and said medical practitioner indicates compliance with said treatment guidelines and prescribes information therapy for said patient.

26. The method of claim 16, further comprising the step of selecting the highest pay scale when said diagnosis code is found in said data base of treatment guidelines and said medical practitioner indicates non-compliance with said treatment guidelines while providing an explanation of the reason for non-compliance with said treatment guidelines.

27. The method of claim 16, further comprising the step of selecting the highest pay scale when said diagnosis code is found in said data base of treatment guidelines and said medical practitioner indicates non-compliance with said treatment guidelines while providing an explanation of the reason for non-compliance with the treatment guidelines and said medical practitioner prescribes information therapy for said patient.

28. The method of claim 16, further comprising the steps of:

selecting the highest pay scale when said diagnosis code is found in said data base of treatment guidelines and said medical practitioner indicates non-compliance with said treatment guidelines while providing an explanation of the reason for non-compliance with the treatment guidelines; and

,

monitoring the frequency of non-compliant treatments by said medical practitioner.

29. The method of claim 15, further comprising the steps of:

said website providing said patient access to medical information relating to said medical diagnosis;

monitoring said patient'"'"'s access of said medical information;

providing said patient with a knowledge exam to determine said patient'"'"'s understanding of the medical diagnosis;

scoring said knowledge exam; and

,

providing said patient with the means for forwarding the patient'"'"'s knowledge exam results to patient'"'"'s health care network.

30. The method of claim 14, further comprising the step of monitoring the frequency of treatments by said medical practitioner which do not comply with said treatment guidelines.

31. The method of claim 15, further comprising the step of said medical practitioner informing said health care network of patient'"'"'s non-compliance with said information therapy.