Medical practice pattern tool

• US 7,818,181 B2
• Filed: 03/29/2006
• Issued: 10/19/2010
• Est. Priority Date: 10/31/2005
• Status: Active Grant

• Current Assignee: Focused Medical Analytics LLC
• Original Assignee: Focused Medical Analytics LLC
• Inventors: Green, Robert A.
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): Pauls; John A
• Application Number:
  US11/392,179
• Publication Number:
  US 20070106533A1
• Time in Patent Office: 1,665 Days
• Field of Search: 705/2, 705/3, 705/4, 364/401
• 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:

compiling a plurality of episodes of care, each episode including services performed for that episode by medical practitioners;

selecting for analysis the episodes of care from the plurality of the episodes of care that correspond to a given condition;

preserving, with a computer, those services having a service value above a service value threshold defined such that only services that have a predetermined level of impact on the selected episodes of care are preserved;

sorting, with the computer, the medical practitioners into the two or more cost strata according to a predefined cost criterion, the sorting occurring such that each stratum includes at least one medical practitioner who provided at least one service performed in the selected episodes of care, the strata including a lower-cost practitioner stratum and higher-cost practitioner stratum;

listing the services associated with the medical practitioners for the selected episodes of care in each stratum with a service value being included with each of the services;

comparing the service values of the preserved services within the lower-cost practitioner stratum to the service values of corresponding preserved services within the higher-cost practitioner stratum; and

identifying the services which are cost drivers associated with the selected episodes of care that are at least partially responsible for differences in cost of the selected episodes of care between the lower-cost and higher-cost practitioner strata, the identification being performed by the computer and based on the step of comparing the preserved selected service values.

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

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

b) setting a minimum threshold for the service value threshold; and

c) preserving the services having a service value above the minimum 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 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 listing services 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 claim 5, wherein the step of providing the medical practitioners with a description includes providing 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 lesser affect on a particular difference between the strata.

7. The method of claim 5, wherein the step of providing the medical practitioners with a description includes providing 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 the medical practice pattern analysis that revealed a service as a driver for a difference between a plurality of stratified medical practitioners.

8. The method of managing medical care of claim 1, the service value being selected from the group consisting of the service cost total and the service utilization total.

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

a) determining an expected service value for each of the services in each strata; and

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

c) setting a minimum threshold for the service value threshold; and

d) preserving the services having a service value above the minimum threshold in a potential cost drivers table.

10. The method of managing medical care of claim 9, further comprising the step of generating a report that compares service values for the services in the potential cost drivers table between the strata.

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

12. The method of managing medical care of claim 9, the expected service value determination step comprising the steps of:

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

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

c) multiplying the analysis average of the service value by the number of episodes in each stratum for each service to provide the expected 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 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 cost criterion for separating the medical practitioners into strata further includes a criterion selected from the group consisting of 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 compiled episodes being selected from the group consisting of a complete episode treatment group, a combination of episode treatment groups, a subset of an episode treatment group, and a combination of subsets of a plurality of episode treatment groups.

16. 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.

17. The method of managing medical care according to claim 16, wherein all the episodes related to a particular medical specialty are selected in the episode compiling step.

18. The method of managing medical care according to claim 1, wherein the medical practitioners having a particular service value are removed from the group.

19. The method of managing medical care according to claim 1, wherein the practitioners being attributed to the episodes are selected from the group consisting 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.

20. 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.

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 meta-drilldown analysis including data from a plurality of medical conditions.

22. 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 of a complete condition, a combination of conditions, a subset of a condition, and a combination of subsets of a plurality of conditions.

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

a) equating the service value threshold 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.

24. The method of managing medical care of claim 1, the service value being the service cost total.

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

a) determining the service value threshold 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 a minimum threshold for the service value threshold; and

c) storing the services having a service value above the minimum threshold in a potential cost drivers table.

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

a) determining an expected service value for each of the services; and

b) determining the service value threshold by subtracting the service values from the expected service value;

c) setting a minimum threshold for the service value threshold; and

d) preserving the services having a service value above the minimum threshold in a potential cost drivers table.

27. The method of managing medical care of claim 26, further comprising the steps of:

a) generating a report comparing the 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.

28. The method of managing medical care of claim 26, the service value being selected from the group consisting of the service cost total and the service utilization total.

29. The method of managing medical care of claim 26, the expected service value determination step comprising the steps of:

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

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

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

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

compiling a plurality of episodes of care, each episode including a plurality of services performed for that episode by medical practitioners;

selecting for analysis the episodes of care from the plurality of episodes of care that correspond to a given condition;

sorting, with a computer, the medical practitioners into two or more cost strata according to a predefined cost criterion, the sorting occurring such that each stratum includes at least one medical practitioner who provided at least one service performed in the selected episodes of care, the strata including a lower-cost practitioner stratum and a higher-cost practitioner stratum;

listing the services associated with the medical practitioners for the selected episodes of care in each stratum; and

comparing, with the computer, an actual service value for the each service within the lower-cost and higher-cost practitioner strata to an expected service value for the service;

identifying the services which are cost drivers associated with the selected episode of care that are at least partially responsible for differences in cost of the selected episodes of care between the lower-cost and higher-cost practitioner strata, the identification being performed by the computer and based on the step of comparing the actual service values within the lower-cost and higher-cost practitioner strata to the expected service value.

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

compiling a plurality of episodes of care, each episode including services performed for that episode by medical practitioners;

selecting for analysis the episodes of care from the plurality of episodes of care that correspond to a given condition;

sorting, with a computer, the medical practitioners into the two or more cost strata according to a predefined cost criterion, the sorting occurring such that each stratum includes multiple medical practitioners who provided at least one service performed in the selected episode of care, the strata including a lower-cost practitioner stratum and a higher-cost practitioner stratum;

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

listing the services associated with the medical practitioners in each stratum;

comparing the service values of the selected services within the lower-cost practitioner stratum to the service values of corresponding services within the higher-cost practitioner stratum;

identifying the services which are cost drivers associated with the selected episodes of care that are at least partially responsible for differences in cost of the selected episodes of care between the lower-cost and higher-cost practitioner strata, the identification being performed by the computer and based on the step of comparing the service values.