Patent Document ID: 7546245
Application ID: 10346308
Patent Flag: 1

Claim One:
1. A method capable of providing gainsharing of physician services for a plurality of physicians comprising the steps of: (a) identifying a population comprising a plurality of patients; (b) for each patient, receiving by a computer one or more inpatient admission charges for medical services rendered to the respective patient; (c) for each inpatient admission charge, adjusting by a computer the inpatient admission charge by a severity of illness experienced by the respective patient during provision of the medical services; (d) defining a plurality of All Patient Refined Diagnostic Related Groups, wherein each All Patient Refined Diagnostic Related Group is statistically homogenous group of similar medical charges; (e) for each inpatient admission charge: (i) categorizing by a computer the inpatient admission charge into the All Patient Refined Diagnostic Related Groups based on the inpatient admission charge's designated medical diagnosis; (ii) identifying the physician responsible therefor; (f) for each All Patient Refined Diagnostic Related Group: (i) defining a numeric threshold; (ii) filtering by a computer from the All Patient Refined Diagnostic Related Group all inpatient admission charges not below the numeric threshold; (iii) averaging the billed amounts of the filtered inpatient admission charges below the threshold to determine a best practice norm; (g) identifying a plurality of physicians participating in the gainsharing program; (h) for each physician; (i) assign one or more inpatient admission charges for which the physician is the responsible physician; (ii) grouping the physician's one or more inpatient admission charges by the respective All Patient Refined Diagnostic Related Group; (iii) analyzing by a computer the physician's inpatient admission charges in each All Patient Refined Diagnostic Related Group to determine a current performance profile and a historical performance profile for each respective All Patient Refined Diagnostic Related Group; (iv) comparing by a computer each current performance profile with the best practice norm in the appropriate All Patient Refined Diagnostic Related Group to determine the physician's performance; (v) comparing by a computer each current performance profile against the physician's historical profile in the respective All Patient Refined Diagnostic Related Group to determine the physician's improvement; (vi) assigning by a computer a first weight to the physician's performance; (vii) assigning by a computer a second weight to the physician's improvement; (viii) determining by a computer physician's gainsharing amount based on the physician's performance weighted by the first weight and the physician's improvement weighted by the second weight, wherein the physician's gainsharing amount is capped by a maximum amount; (i) repeating the method for a future period and adjusting the first weight and the second weight.