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

摘要

A method for measuring physician efficiency and patient health risk stratification is disclosed. Episodes of care are formed from medical claims data and an output process is performed. Physicians are assigned to report groups, and eligible physicians and episode assignments are determined. Condition-specific episode statistics and weighted episode statistics are calculated, from which physician efficiency scores are determined.

主权项

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.