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Method, system, and computer program product for physician efficiency measurement and patient health risk stratification utilizing variable windows for episode creation

DC CAFC
  • US 8,768,726 B1
  • Filed: 03/11/2013
  • Issued: 07/01/2014
  • Est. Priority Date: 03/02/2004
  • Status: Expired due to Term
First Claim
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1. A method implemented on a computer system of determining physician efficiency, the method comprising:

  • obtaining medical claims data stored in a non-transitory computer readable medium on the computer system;

    performing patient analysis using said obtained medical claims data to form episodes of care utilizing the computer system;

    assigning complete (non-partial) episodes of care to physicians utilizing an assignment rule that allows assignment of an episode of care to more than one physician;

    assigning at least one physician to a report group based on geographic area designation utilizing the computer system, each physician assigned to no more than one report group;

    determining eligible physicians and episode of care assignments utilizing the computer system;

    calculating condition-specific episode of care statistics utilizing the computer system;

    calculating weighted episode of care statistics across medical conditions utilizing a predefined set of medical conditions for a specific specialty type utilizing the computer system; and

    determining efficiency scores for physicians from said calculated condition-specific episode of care statistics and said weighted episode of care statistics calculated across medical conditions utilizing the computer system.

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