Patent ID: 8639528
Filing Date: 2014-01-28
Classification: A61B,G06Q,G16H,G16Z

Abstract:
1. A method implemented on a computer system of determining physician efficiency, the method comprising: obtaining medical claims data stored in a 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 wherein a valid and accurate diagnosis code is assigned to each claim line item with a non-specific diagnosis code before assigning the claim line item to an episode of care; assigning episodes of care to physicians utilizing an assignment rule that allows assignment of an episode of care to more than one physician; applying a first maximum duration rule that utilizes at least one of a set consisting of static window periods and variable window periods to identify episodes of care; determining eligible physicians and episode of care assignments for use in calculating episode of care statistics utilizing the computer system; calculating condition-specific episode of care statistics utilizing the computer system; calculating episode of care statistics across medical conditions utilizing the computer system; and determining efficiency scores for physicians from said calculated condition-specific episode of care statistics and said episode of care statistics calculated across medical conditions utilizing the computer system.