Medical practice pattern tool

• US 20070106533A1
• Filed: 03/29/2006
• Published: 05/10/2007
• Est. Priority Date: 10/31/2005
• Status: Active Grant

• Current Assignee: Focused Medical Analytics LLC
• Original Assignee: Focused Medical Analytics LLC
• Inventors: Greene, Robert
• Granted Patent: US 7,818,181 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• 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 invention is a business process embodied in a software algorithm that determines difference in practice patterns among physicians for the main cost components of given conditions.

Claims

1. A method of managing medical care performed by a group of medical practitioners, comprising the steps of:

a) compiling a plurality of episodes of care comprising a plurality of services provided by each practitioner in the group of practitioners;

b) sorting the medical practitioners into strata according to a predefined criterion;

c) listing the services associated with the medical practitioners in each stratum with a selected service value being included with each of the services; and

d) assembling a list of services having a threshold parameter above a threshold defined such that only services that have a significant impact on the selected service value are preserved.

2. The method of managing medical care of claim 1, the step of assembling services comprising the steps of:

a) determining the threshold parameter for each service by dividing the selected service value in each stratum by the number of episodes in that stratum;

b) setting the minimum threshold for the threshold parameter; and

c) storing the services having a threshold parameter above the threshold in a potential cost drivers table.

3. The method of managing medical care of claim 2, further comprising the step of generating a report comparing the selected service values for the services in the potential cost drivers table between the strata.

4. The method of managing medical care of claim 3, further comprising the step of identifying the service that differentiates the strata.

5. The method of managing medical care of claim 4, further comprising the step of providing the medical practitioners with a description of how to reduce the difference between the strata.

6. The method of managing medical care of claim 1, the selected service value being selected from the group consisting essentially of the service cost total for all the episodes in each stratum and the service utilization total for all the episodes in each stratum.

7. The method of managing medical care of claim 1, the step of assembling services comprising the steps of:

a) determining an expected selected service value for each of the services in each of the episodes of care; and

b) evaluating the threshold parameter by subtracting the selected service values in each stratum from the expected selected service value and dividing the difference by the number of episodes in that stratum;

c) setting the minimum threshold for the threshold parameter; and

d) storing the services having a threshold parameter above the threshold in a potential cost drivers table.

8. The method of managing medical care of claim 7, further comprising the step of generating a report comparing the selected service values for the services in the potential cost drivers table between the strata.

9. The method of managing medical care of claim 8, further comprising the step of identifying the services that differentiate the strata.

10. The method of managing medical care of claim 9, further comprising the step of providing the medical practitioners with a description of how to reduce the difference between the strata.

11. The method of managing medical care of claim 7, the selected service value being selected from the group consisting essentially of the service cost total for all the episodes in each stratum and the service utilization total for all the episodes in each stratum.

12. The method of managing medical care of claim 7, the expected selected service value determination step comprising the steps of:

a) totaling the selected service value for each service for all the episodes in the analysis to provide an analysis total of the selected service value;

b) determining an analysis average for the selected service value of each service by dividing the analysis total of the selected service value by the sum of the episodes in the analysis; and

c) multiplying the analysis average of the selected service value by the number of episodes in each stratum for each service to provide the expected selected service value.

13. The method of managing medical care of claim 1, wherein said step of compiling a plurality of episodes comprises:

a) tracking each service by episodes of care performed by a group of medical practitioners;

b) aggregating the medical services according to given characteristics; and

c) sorting the episodes of care into predefined conditions.

14. The method of managing medical care according to claim 13, wherein the criterion for separating the medical practitioners into strata is selected from the group consisting essentially of cost, the number of services performed, geographic region, specialty, type of practice, size of practice, and performance in another condition.

15. The method of managing medical care according to claim 1, the episodes of care being formed using the Symmetry ETG grouper software.

16. The method of managing medical care according to claim 15, the compiled episodes being selected from the group consisting essentially of a complete ETG, a combination of ETGs, a subset of an ETG, and a combination of subsets of a plurality of ETGs.

17. The method of managing medical care according to claim 1, each of the medical practitioners being sorted into a separate stratum to provide an analysis comparing individual practitioners.

18. The method of managing medical care according to claim 17, wherein all the episodes related to a particular medical specialty are selected in the episode compiling step.

19. The method of managing medical care according to claim 1, wherein the medical practitioners having an anomalous selected service value are removed from the group.

20. The method of managing medical care according to claim 1, wherein the practitioners being attributed to the episodes are selected from the group consisting essentially of the practitioner with the highest percentage cost of the episode, all practitioners in the episode responsible for costs that, in total, contributed more than a preset percentage of the total cost to the episode, all practitioners in the episode having professional fees that contributed more than a preset percentage of the total cost to the episode, a primary care physician associated with the episode, all practitioners with any involvement in the episode, the practitioner that performed a significant procedure in the episode, the practitioner that had the most face-to-face encounters with a patient associated with the episode, and combinations thereof.

21. The method of managing medical care according to claim 1, further comprising the step of analyzing the practice pattern of an individual practitioner in a total role drilldown analysis of a single medical condition.

22. The method of managing medical care according to claim 1, further comprising the step of analyzing the practice pattern of an individual practitioner in a total role meta-drilldown analysis including data from a plurality of medical conditions.

23. The method of managing medical care according to claim 1, the episodes being grouped into conditions by a grouper program and the compiled episodes being selected from the group consisting essentially of a complete condition, a combination of conditions, a subset of a condition, and a combination of subsets of a plurality of conditions.

24. The method of managing medical care of claim 1, the step of assembling services comprising the steps of:

a) equating the threshold parameter for each service in each stratum to the selected service value in that stratum;

b) setting the minimum threshold for the threshold parameter; and

c) storing the services having a threshold parameter above the threshold in a potential cost drivers table.

25. The method of managing medical care of claim 1, the selected service value being the service cost total for all the episodes in each stratum.

26. The method of managing medical care of claim 25, the step of assembling services comprising the steps of:

a) determining the threshold parameter for each service in each stratum by dividing the service cost total for all the episodes in that stratum by the service utilization total for all the episodes in that stratum;

b) setting the minimum threshold for the threshold parameter; and

c) storing the services having a threshold parameter above the threshold in a potential cost drivers table.

27. The method of managing medical care of claim 1, the step of assembling services comprising the steps of:

a) determining an expected selected service value for each of the services in each of the episodes of care; and

b) evaluating the threshold parameter by subtracting the selected service values in each stratum from the expected selected service value;

c) setting the minimum threshold for the threshold parameter; and

d) storing the services having a threshold parameter above the threshold in a potential cost drivers table.

28. The method of managing medical care of claim 27, further comprising the steps of:

a) generating a report comparing the selected service values for the services in the potential cost drivers table between the strata;

b) identifying the services that differentiate the strata; and

c) providing the medical practitioners with a description of how to reduce the difference between the strata.

29. The method of managing medical care of claim 27, the selected service value being selected from the group consisting essentially of the service cost total for all the episodes in each stratum and the service utilization total for all the episodes in each stratum.

30. The method of managing medical care of claim 27, the expected selected service value determination step comprising the steps of:

a) totaling the selected service value for each service for all the episodes in the analysis to provide an analysis total of the selected service value;

b) determining an analysis average for the selected service value of each service by dividing the analysis total of the selected service value by the sum of the episodes in the analysis; and

c) multiplying the analysis average of the selected service value by the number of episodes in each stratum for each service to provide the expected selected service value.

31. A method of managing medical care performed by a group of medical practitioners, comprising the steps of:

a) compiling a plurality of episodes of care comprising a plurality of services provided by each practitioner in the group of practitioners;

b) sorting the medical practitioners into strata according to a predefined criterion;

c) listing the services associated with the medical practitioners in each stratum; and

d) comparing an actual selected service value to an expected selected service value for each of the services in each stratum.

32. A method of managing medical care performed by a group of medical practitioners, comprising the steps of:

a) compiling a plurality of episodes of care comprising a plurality of services provided by each practitioner in the group of practitioners;

b) sorting the medical practitioners into strata according to a predefined criterion;

c) associating each of the medical practitioners with all the services in the episodes that the medical practitioner had a role; and

d) listing the services associated with the medical practitioners in each stratum.

33. A method of providing a group of medical providers with guidelines for decreasing undesirable use and increasing desirable use of medical services, comprising the steps of:

a) identifying a number of medical conditions treated by the group of medical providers;

b) performing a medical practice pattern analysis to produce an analysis;

c) analyzing the results of the medical practice pattern analysis to identify a number of cost drivers that differentiate the strata in each condition; and

d) providing the medical practitioners with a description of how to reduce the difference in the cost drivers between the strata in each condition.

34. A medical practice pattern analysis report, comprising a table of a selected service value for a service for a plurality of strata, wherein the selected service value is greater than a threshold set to remove a plurality of other services having a less significant affect on a particular difference between the strata.

35. A medical method blueprint, comprising a plurality of cells, wherein each cell describes a treatment recommendation for a particular type of episode of care, wherein the recommendation is based on a medical practice pattern analysis that revealed a service as a driver for a difference between a plurality of stratified medical practitioners.