SYSTEM FOR ESTABLISHING HEALTH CARE REIMBURSEMENTS

摘要

A third party scoring entity establishes a market-based scoring system which can be used to generate a supply efficiency score to be assigned to a service provider seeking to begin providing a service in a territory. The supply efficiency score is indicative of the need for additional capacity to supply the service. The supply efficiency score is supplied to payers designated by the service provider and the payers will use the score to determine a reimbursement rate for the professional services provided based upon existing market saturation.

主权项

1. A process for establishing a healthcare reimbursement rate for providing a selected procedure by a prospective service provider comprising:
a) having the prospective service provider apply for a supply efficiency score for the selected procedure by accessing a programmed computer that determines and assigns said supply efficiency score and inputting criteria for establishing said supply efficiency score into the programmed computer; the steps for determining and assigning said supply efficiency score include:
i) having the prospective service provider input into the programmed computer a location where the selected procedure will be performed;ii) determining a total number of times the selected procedure has been performed on patients residing within an established geographic range from the location during a set period and inputting said total number of times the selected procedure has been performed into the programmed computer;iii) determining a procedure capacity comprising an estimate of the number of times the selected procedure can be performed within the established geographic range during the set period and inputting said procedure capacity into the programmed computer;iv) determining a current procedure utilization as a ratio of the total number of times the selected procedure has been performed on patients in the established geographic range during the set period versus the estimated maximum number of procedures that can be performed in the established geographic range during the period and inputting said procedure utilization into the programmed computer; andv) applying said procedure utilization to a scoring range indicative of the need for additional capacity for providing the selected procedure to produce a supply efficiency score; b) sending said supply efficiency score to at least one payer selected by the prospective service provider; and c) instructing the at least one payer on using said supply efficiency score to determine a reimbursement rate for performance of the selected procedure by the prospective service provider.