ESTIMATING MARKET-DRIVEN MEDICAL FACILITY RATES AND/OR CHARGES

• US 20140129237A1
• Filed: 11/02/2012
• Published: 05/08/2014
• Est. Priority Date: 11/02/2012
• Status: Abandoned Application

• Current Assignee: Mitchell International Incorporated (Mitchell International Holding, Inc.)
• Original Assignee: Qmedtrix Systems, Inc. (Mitchell International Holding, Inc.)
• Inventors: Quarum, Merrit Laird, Wornell, Benjamin Ryan, Stephens-Tiley, Frederick William, Nolke, Erik Richard, Parker, Michael Allen
• Application Number:
  US13/668,202
• Publication Number:
  US 20140129237A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 30/0206 Price or cost determination based on market factors

Abstract

Embodiments of methods or apparatus to estimate market-driven medical facility rates and/or charges are provided.

Claims

1. A method comprising:

executing machine-readable instructions by one or more processors to;

estimate, based at least in part on a plurality of historical reimbursement measurements for a base market, an associated market driven rate and/or charge for a group for a medical facility in said base market;

said base market to generate said estimate comprising a geographic region including said medical facility.

2. The method of claim 1, wherein said geographic region comprises a region roughly radially distributed relative to said medical facility.

3. The method of claim 2, wherein said historical reimbursement measurements comprise Medicare reimbursement measurements.

4. The method of claim 2, wherein said executing machine-readable instructions comprises executing machine-readable instructions by one or more processors to estimate said market-driven rate and/or charge for a medical procedure code included in said group for said medical facility in said base.

5. The method of claim 1, wherein said executing machine-readable instructions comprises executing machine-readable instructions by one or more processors to estimate said market-driven rate and/or charge for a group of medical codes pertaining to a similar ambulatory procedure code (APC).

6. The method of claim 1, wherein said executing machine-readable instructions comprises executing machine-readable instructions by one or more processors to estimate said market-driven rate and/or charge for said group by normalization using an average of historical reimbursement measurements for said medical procedures in said group divided by an average of a plurality of historical reimbursement measurements for a most frequently-occurring medical procedure within said group.

7. The method of claim 1, wherein said executing machine-readable instructions comprises executing machine-readable instructions to estimate a public insurer component distribution for use in estimating said market-driven rate and/or charge for said group for said medical facility in said base market.

8. The method of claim 1, wherein said historical reimbursement measurements are inflation adjusted.

9. The method of claim 8, wherein said inflation adjusted historical reimbursement measures are adjusted substantially in accordance with a healthcare producer price index or a healthcare consumer price index.

10. The method of claim 9, wherein said executing machine-readable instructions comprises executing machine-readable instructions to estimate a standard charge component for use in estimating said market-driven rate and/or charge for said group for said medical facility in said base market, said standard charge component estimate comprising a mean of said public insurer component distribution adjusted for inflation using a health care consumer price index.

11. The method of claim 9, wherein said executing machine-readable instructions comprises executing machine-readable instructions to estimate a private insurer component for use in estimating said market-driven rate and/or charge for said group for said medical facility in said base market, said private insurer component estimate comprising a mean of said public insurer component distribution adjusted for inflation using a health care producer price index and scaled up by 25 percent.

12. The method of claim 1, wherein said executing machine-readable instructions comprises executing machine-readable instructions by one or more processors to identify a sufficient number of medical facilities for said base market for said medical facility.

13. The method of claim 12, wherein said sufficient number of medical facilities comprises at least a target number of medical facilities for said base market for said medical facility.

14. The method of claim 1, wherein said executing machine-readable instructions comprises executing machine-readable instructions by one or more processors to expand said geographic region by an incremental amount so as to identify at least a target number of medical facilities for said base market for said medical facility if said geographic region does not include said target number of medical facilities.

15. The method of claim 1, wherein said executing machine-readable instructions comprises executing machine-readable instructions by one or more processors to count a statistically sufficient number of historical reimbursement measurements within a group in said base market for said medical facility.

16. The method of claim 1, wherein said executing machine-readable instructions comprises executing machine-readable instructions by one or more processors to count at least 11 historical reimbursement measurements within a group in said base market for said medical facility.

17. The method of claim 1, wherein said executing machine-readable instructions comprises executing machine-readable instructions by one or more processors to expand said geographic region to count a statistically sufficient number of historical reimbursement measurements within a group in said base market for said medical facility if said geographic region does not include a statistically sufficient number.

18. An article comprising:

a storage medium having stored thereon instructions executable by one or more processors to estimate, based at least in part on a plurality of historical reimbursement measurements for a base market, an associated market driven rate and/or charge for a group for a medical facility in said base market;

said base market to generate said estimate comprising a geographic region including said medical facility.

19. The article of claim 18, wherein said geographic region comprises a region roughly radially distributed relative to said medical facility.

20. The article of claim 18, wherein said historical reimbursement measurements comprise Medicare reimbursement measurements.

21. The article of claim 18, wherein said instructions being further executable to count a statistically sufficient number of historical reimbursement measurements within a group in said base market for said medical facility.

22. The article of claim 18, wherein said instructions being further executable to expand said geographic region to count a statistically sufficient number of historical reimbursement measurements within a group in said base market for said medical facility if said geographic region does not include a statistically sufficient number.

23. An apparatus comprising:

a computing platform to estimate, based at least in part on a plurality of historical reimbursement measurements for a base market, an associated market driven rate and/or charge for a group for a medical facility in said base market;

said base market to generate said estimate comprising a geographic region including said medical facility.

24. The apparatus of claim 23, wherein said geographic region comprises a region roughly radially distributed relative to said medical facility.

25. The apparatus of claim 23, wherein said historical reimbursement measurements comprise Medicare reimbursement measurements.

26. The apparatus of claim 23, wherein said computing platform further to count a statistically sufficient number of historical reimbursement measurements within a group in said base market for said medical facility.

27. The apparatus of claim 23, wherein said instructions being further executable to expand said geographic region to count a statistically sufficient number of historical reimbursement measurements within a group in said base market for said medical facility if said geographic region does not include a statistically sufficient number.