Systems and Methods for Evaluating Performance of a Health Care Provider
In one embodiment, a method comprises receiving an indication of one or more care-episodes from a client device. Each care-episode may include an identifier for one or more physicians, a base-concept corresponding to a medical condition or medical treatment, one or more sub-concepts associated with the base-concept, and an indication of the resources used during the care-episode. The method comprises calculates one or more cost-factors for a base-concept for a particular physician based on the care-episodes associated with the base-concept. The method further comprises determining a specialty and geographic region of the particular physician. A peer group of physicians in the same specialty and geographic region is selected. A performance score is calculated based on the cost-factor for the physician compared to the cost-factors for the peer group of physicians.
1 . A method comprising:
receiving, by one or more computing devices of a performance-engine system, an indication of one or more care-episodes from a client device, wherein each care-episode comprises:
an identifier for one or more physicians;
a base-concept corresponding to a medical-condition or medical-treatment;
one or more sub-concepts associated with the base-concept; and
a resource-usage factor;
calculating, by one or more computing devices, one or more cost-factors, each cost-factor being calculated for a particular physician and based at least in part on:
a particular base-concept;
one or more particular sub-concepts associated with the base-concept; and
one or more care-episodes associated with the particular base-concept and particular sub-concepts;
determining, by the one or more computing devices, a specialty and geographic region of the particular physician;
selecting, by the one or more computing devices, a peer-group of physicians, the peer-group comprising a plurality of physicians having a common specialty and geographic region as the particular physician; and
calculating, by the one or more computing devices, a performance-score for the particular physician with respect to the particular base-concept based at least in part on the cost-factor of the particular physician and an average cost factor for the peer-group.
2 . The method of claim 1 , wherein the cost factor is based on the geographic location of the episode of care.
3 . The method of claim 1 , wherein the indication of a care-episode comprises one or more Current Procedural Terminology (CPT) codes and one or more International Classification of Diseases (ICD) codes associated with the care-episode.
4 . The method of claim 3 , wherein each of the one or more sub-concepts associated with the base-concept are based at least in part on one or more CPT codes or ICD codes received for the care-episode.
5 . The method of claim 1 , wherein the cost factors comprise a monetary cost for treating the base-concept.
6 . The method of claim 1 , wherein the cost factors comprise one or more relative value units (RVU) corresponding to one or more CPT codes associated with the base-concept.
7 . The method of claim 6 , wherein the RVU cost factor is compared with the monetary cost for treating the base-concept.
8 . The method of claim 6 , wherein the resource-usage factor comprises an RVU cost for the care-episode, wherein the RVU cost represents a total cost for each medical procedure performed by the physician in association with the care-episode.
9 . The method of claim 1 , wherein the one or more particular sub-concepts comprise a sub-concept group associated with one or more base-concepts.
10 . The method of claim 9 , wherein determining the one or more sub-concepts associated with the base concept comprises selecting a sub-concept group stored on a database of the performance-engine system.
11 . The method of claim 9 , further comprising:
determining that the one or more sub-concepts associated with the base-concept do not correspond to a sub-concept group stored on a database of the performance-engine system; and
selecting a new sub-concept group comprising the one or more sub-concepts and adding the new sub-concept group to the database.
12 . The method of claim 19 , wherein each sub-concept group is associated with a patient-group comprising one or more patients, wherein each of the one or more patients correspond to care-episodes corresponding to the one or more sub-concepts comprising the sub-concept group.
13 . The method of claim 12 , wherein each patient-group is associated with an aggregate cost-factor, the aggregate cost-factor comprising one or more resource-usage factors associated with the care-episodes for each of the patients in the patient-group.
14 . The method of claim 13 , wherein the aggregate cost-factor comprises a weighted average of the resource-usage factors, each resource-usage factor being weighted by an age of the care-episode.
15 . The method of claim 1 , wherein each care-episode has an associated period of time.
16 . The method of claim 1 , wherein the client device is associated with the one or more physicians.
17 . The method of claim 1 , wherein a performance-score for a particular sub-concept group is based on the difference between an RVU cost of the sub-concept group for one physician, compared to an RVU cost of the sub-concept group for the peer-group of physicians.
18 . The method of claim 1 , wherein the performance-score for a particular base-concept comprises an aggregate of one or more individual performance-scores for one or more associated sub-concept groups.
19 . One or more non-transitory, computer-readable storage media embodying software that is operable when executed to:
receive an indication of one or more care-episodes from a client device, wherein each care-episode comprises:
an identifier for one or more physicians;
a base-concept;
one or more sub-concepts associated with the base-concept; and
a resource-usage factor;
calculate one or more cost-factors, each cost-factor being calculated for a particular physician and based at least in part on:
a particular base-concept;
one or more particular sub-concepts associated with the base-concept; and
one or more care-episodes associated with the particular base-concept and particular sub-concepts;
determine a specialty and geographic region of the particular physician;
select a peer-group of physicians, the peer-group comprising a plurality of physicians having a common specialty and geographic region as the particular physician; and
calculate a performance-score for the particular physician with respect to the particular base-concept based at least in part on the cost-factor of the particular physician and an average cost factor for the peer-group.
20 . A system comprising: one or more processors; and a memory coupled to the processors comprising instructions executable by the processors, the processors being operable when executing the instructions to:
receive an indication of one or more care-episodes from a client device, wherein each care-episode comprises:
an identifier for one or more physicians;
a base-concept;
one or more sub-concepts associated with the base-concept; and
a resource-usage factor;
calculate one or more cost-factors, each cost-factor being calculated for a particular physician and based at least in part on:
a particular base-concept;
one or more particular sub-concepts associated with the base-concept; and
one or more care-episodes associated with the particular base-concept and particular sub-concepts;
determine a specialty and geographic region of the particular physician;
select a peer-group of physicians, the peer-group comprising a plurality of physicians having a common specialty and geographic region as the particular physician; and
calculate a performance-score for the particular physician with respect to the particular base-concept based at least in part on the cost-factor of the particular physician and an average cost factor for the peer-group.