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Method and system for evaluating a physician's economic performance and gainsharing of physician services

  • US 7,716,067 B2
  • Filed: 12/12/2007
  • Issued: 05/11/2010
  • Est. Priority Date: 01/17/2002
  • Status: Active Grant
First Claim
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1. A method of evaluating physician'"'"'s economic performance comprising the steps of:

  • (a) identifying a population comprising a plurality of patients;

    (b) for each patient, receiving by a computer one or more inpatient admission charges for medical services rendered to the respective patient;

    (c) for each inpatient admission charge, adjusting by a computer the inpatient admission charge by a severity of illness experienced by the respective patient during provision of the medical services;

    (d) defining a plurality of All Patient Refined Diagnostic Related Groups, wherein each All Patient Refined Diagnostic Related Group is statistically homogenous group of similar medical charges;

    (e) for each inpatient admission charge;

    (i) categorizing by a computer the inpatient admission charge into the All Patient Refined Diagnostic Related Groups based on the inpatient admission charge'"'"'s designated medical diagnosis;

    (ii) identifying the physician responsible therefore therefor;

    (f) for each All Patient Refined Diagnostic Related Group;

    (i) defining a numeric threshold;

    (ii) filtering by a computer from the All Patient Refined Diagnostic Related Group all inpatient admission charges not below the numeric threshold;

    (iii) averaging the billed amounts of the filtered inpatient admission charges below the threshold to determine a best practice norm;

    (g) for each physician;

    (i) assign one or more inpatient admission charges for which the physician is the responsible physician;

    (ii) grouping the physician'"'"'s one or more inpatient admission charges by the respective All Patient Refined Diagnostic Related Group;

    (iii) analyzing by a computer the physician'"'"'s inpatient admission charges in each All Patient Refined Diagnostic Related Group to determine a current performance profile for each respective All Patient Refined Diagnostic Related Group; and

    determining a physician'"'"'s economic performance by comparing by a computer each current performance profile with the best practice norm in the appropriate All Patient Refined Diagnostic Related Group.

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