Systems and Methods for Evaluating Performance of a Health Care Provider

• US 20150073877A1
• Filed: 09/10/2014
• Published: 03/12/2015
• Est. Priority Date: 09/10/2013
• Status: Abandoned Application

• Current Assignee: Accolade, Inc.
• Original Assignee: MD Insider, Inc. (Accolade, Inc.)
• Inventors: Norris, David Lee, Goldstein, Susanne Beth, Calvert, Jay W., Conroy, Brian Patrick, Chatterjee, Kingshuk
• Application Number:
  US14/482,949
• Publication Number:
  US 20150073877A1
• Time in Patent Office: Days
• US Class Current: 705/7.39
• CPC Class Codes: G06F 16/24575 using context
• CPC Class Codes: G06Q 10/06393 Score-carding, benchmarking or key performance indicator [KPI] analysis
• CPC Class Codes: G06Q 30/0627 using item specifications
• CPC Class Codes: G06Q 50/22 Social work or social welfare, e.g. community support activities or counselling services
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• 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
• CPC Class Codes: G16H 80/00 ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring

Abstract

In one embodiment, a method comprises receiving an indication of one or more care-episodes from a client device. Each care-episode may include an identifier for one or more physicians, a base-concept corresponding to a medical condition or medical treatment, one or more sub-concepts associated with the base-concept, and an indication of the resources used during the care-episode. The method comprises calculates one or more cost-factors for a base-concept for a particular physician based on the care-episodes associated with the base-concept. The method further comprises determining a specialty and geographic region of the particular physician. A peer group of physicians in the same specialty and geographic region is selected. A performance score is calculated based on the cost-factor for the physician compared to the cost-factors for the peer group of physicians.

Claims

1. A method comprising:

receiving, by one or more computing devices of a performance-engine system, an indication of one or more care-episodes from a client device, wherein each care-episode comprises;

an identifier for one or more physicians;

a base-concept corresponding to a medical-condition or medical-treatment;

one or more sub-concepts associated with the base-concept; and

a resource-usage factor;

calculating, by one or more computing devices, one or more cost-factors, each cost-factor being calculated for a particular physician and based at least in part on;

a particular base-concept;

one or more particular sub-concepts associated with the base-concept; and

one or more care-episodes associated with the particular base-concept and particular sub-concepts;

determining, by the one or more computing devices, a specialty and geographic region of the particular physician;

selecting, by the one or more computing devices, a peer-group of physicians, the peer-group comprising a plurality of physicians having a common specialty and geographic region as the particular physician; and

calculating, by the one or more computing devices, a performance-score for the particular physician with respect to the particular base-concept based at least in part on the cost-factor of the particular physician and an average cost factor for the peer-group.

2. The method of claim 1, wherein the cost factor is based on the geographic location of the episode of care.

3. The method of claim 1, wherein the indication of a care-episode comprises one or more Current Procedural Terminology (CPT) codes and one or more International Classification of Diseases (ICD) codes associated with the care-episode.

4. The method of claim 3, wherein each of the one or more sub-concepts associated with the base-concept are based at least in part on one or more CPT codes or ICD codes received for the care-episode.

5. The method of claim 1, wherein the cost factors comprise a monetary cost for treating the base-concept.

6. The method of claim 1, wherein the cost factors comprise one or more relative value units (RVU) corresponding to one or more CPT codes associated with the base-concept.

7. The method of claim 6, wherein the RVU cost factor is compared with the monetary cost for treating the base-concept.

8. The method of claim 6, wherein the resource-usage factor comprises an RVU cost for the care-episode, wherein the RVU cost represents a total cost for each medical procedure performed by the physician in association with the care-episode.

9. The method of claim 1, wherein the one or more particular sub-concepts comprise a sub-concept group associated with one or more base-concepts.

10. The method of claim 9, wherein determining the one or more sub-concepts associated with the base concept comprises selecting a sub-concept group stored on a database of the performance-engine system.

11. The method of claim 9, further comprising:

determining that the one or more sub-concepts associated with the base-concept do not correspond to a sub-concept group stored on a database of the performance-engine system; and

selecting a new sub-concept group comprising the one or more sub-concepts and adding the new sub-concept group to the database.

15. The method of claim 1, wherein each care-episode has an associated period of time.

16. The method of claim 1, wherein the client device is associated with the one or more physicians.

17. The method of claim 1, wherein a performance-score for a particular sub-concept group is based on the difference between an RVU cost of the sub-concept group for one physician, compared to an RVU cost of the sub-concept group for the peer-group of physicians.

18. The method of claim 1, wherein the performance-score for a particular base-concept comprises an aggregate of one or more individual performance-scores for one or more associated sub-concept groups.

19. One or more non-transitory, computer-readable storage media embodying software that is operable when executed to:

receive an indication of one or more care-episodes from a client device, wherein each care-episode comprises;

an identifier for one or more physicians;

a base-concept;

one or more sub-concepts associated with the base-concept; and

a resource-usage factor;

calculate one or more cost-factors, each cost-factor being calculated for a particular physician and based at least in part on;

a particular base-concept;

one or more particular sub-concepts associated with the base-concept; and

one or more care-episodes associated with the particular base-concept and particular sub-concepts;

determine a specialty and geographic region of the particular physician;

select a peer-group of physicians, the peer-group comprising a plurality of physicians having a common specialty and geographic region as the particular physician; and

calculate a performance-score for the particular physician with respect to the particular base-concept based at least in part on the cost-factor of the particular physician and an average cost factor for the peer-group.

12. The method of claim 19, wherein each sub-concept group is associated with a patient-group comprising one or more patients, wherein each of the one or more patients correspond to care-episodes corresponding to the one or more sub-concepts comprising the sub-concept group.

13. The method of claim 12, wherein each patient-group is associated with an aggregate cost-factor, the aggregate cost-factor comprising one or more resource-usage factors associated with the care-episodes for each of the patients in the patient-group.

14. The method of claim 13, wherein the aggregate cost-factor comprises a weighted average of the resource-usage factors, each resource-usage factor being weighted by an age of the care-episode.

20. A system comprising:

one or more processors; and

a memory coupled to the processors comprising instructions executable by the processors, the processors being operable when executing the instructions to;

receive an indication of one or more care-episodes from a client device, wherein each care-episode comprises;

an identifier for one or more physicians;

a base-concept;

one or more sub-concepts associated with the base-concept; and

a resource-usage factor;

calculate one or more cost-factors, each cost-factor being calculated for a particular physician and based at least in part on;

a particular base-concept;

one or more particular sub-concepts associated with the base-concept; and

one or more care-episodes associated with the particular base-concept and particular sub-concepts;

determine a specialty and geographic region of the particular physician;

select a peer-group of physicians, the peer-group comprising a plurality of physicians having a common specialty and geographic region as the particular physician; and

calculate a performance-score for the particular physician with respect to the particular base-concept based at least in part on the cost-factor of the particular physician and an average cost factor for the peer-group.