Systems and Methods for Evaluating Health Care Provider Referrals
In one embodiment, a method comprises accessing a physician-referral-network, which comprises a number of nodes and a number of edges connecting the nodes, each of the edges representing a single degree of separation between the nodes. Each node represents a physician, and each edge represents a patient-referral between two physicians corresponding to the connected nodes. One or more references indicating a patient-referral from a first physician to a second physician is received. The physician-referral-network is updated based on the received reference. One or more performance-scores from the second physicians may be received, each performance-score corresponding to a patient-referral. A referral-score is calculated for the first physician based on the performance-scores. The method further comprises determining if a referral-score for a first physician is below a threshold referral-score.
1 . A method comprising:
accessing, by one or more computing devices, a physician-referral-network, the physician-referral-network comprising a plurality of nodes and a plurality of edges connecting the nodes, each of the edges between two of the nodes representing a single degree of separation between them, wherein:
each node corresponds to a physician; and
each edge corresponds to one or more patient-referrals made from one of the connected nodes to the other;
receiving, by one or more computing devices, one or more references, each of the one or more references indicating a patient-referral from a first physician to one or more second physicians;
updating, by one or more computing devices, one or more edges connecting the node corresponding to the first physician and one or more nodes corresponding to the second physicians;
receiving, by one or more computing devices, one or more performance-scores from the second physicians, each of the performance-scores corresponding to the patient-referral;
calculating, by one or more computing devices, a referral-score for the first physician based at least in part on the performance-scores from the second physicians;
determining, by one or more computing devices, if a referral-score for the first physician is below a threshold referral-score.
2 . The method of claim 1 , wherein an edge of the physician-referral-network indicates one or more patient-referrals in one direction from a first physician to a second physician.
3 . The method of claim 1 , wherein an edge of the physician-referral-network indicates patient-referrals from the first physician to the second physician, and from the second physician to the first physician.
4 . The method of claim 1 , wherein the patient-referral is associated with one or more base-concepts, wherein each base-concept corresponds to a type of medical treatments or medical services.
5 . The method of claim 4 , wherein a referral-score for the first physician below the threshold referral-score indicates that the one or more patient-referrals are unnecessary.
6 . The method of claim 5 , further comprising notifying the first physician or the second physician that the patient-referrals are unnecessary.
7 . The method of claim 5 , further comprising removing the first physician or the second physician from recommendation to users of a matching-engine system associated with the physician-referral-network.
8 . The method of claim 7 , wherein the first physician or second physician is removed from recommendation for one or more base-concepts associated with the unnecessary patient-referrals.
9 . The method of claim 1 , wherein the performance-score is based on one or more cost factors associated with the second physician and a care-episode corresponding to the patient-referral.
10 . The method of claim 9 , wherein the care-episode comprises:
a base-concept;
one or more sub-concepts associated with the base-concept; and
a resource-usage factor for one or more medical treatments associated with the care-episode.
11 . The method of claim 10 , wherein the one or more medical treatments correspond to one or more Current Procedural Terminology (CPT) codes.
12 . The method of claim 10 , wherein the resource-usage factor comprises one or more relative value units (RVU) corresponding to the one or more CPT codes.
13 . The method of claim 1 , wherein the reference to a patient-referral further comprises a reference to a second patient-referral from the second physician to one or more third physicians.
14 . The method of claim 13 , wherein the performance-score for a second physician is based at least in part on a performance-score for a third physician with respect to the second patient-referral.
15 . The method of claim 13 , further comprising:
determining that the second patient-referral is unnecessary; and
notifying the first physician of the unnecessary second patient-referral.
16 . The method of claim 13 , further comprising:
determining that the second patient-referral is unnecessary; and
removing the first physician from recommendation to users of a matching-engine system associated with the physician-referral-network.
17 . The method of claim 1 , further comprising determining an experience-score for the second physician with respect to one or more conditions corresponding to the patient-referral.
18 . The method of claim 17 , wherein the second physician is determined to be unqualified if the experience-score is below a threshold experience-score.
19 . One or more non-transitory, computer-readable storage media embodying software that is operable when executed to:
access a physician-referral-network, the physician-referral-network comprising a plurality of nodes and a plurality of edges connecting the nodes, each of the edges between two of the nodes representing a single degree of separation between them, wherein:
each node corresponds to a physician; and
each edge corresponds to one or more patient-referrals made from one of the connected nodes to the other;
receive one or more references, each of the one or more references indicating a patient-referral from a first physician to one or more second physicians;
update one or more edges connecting the node corresponding to the first physician and one or more nodes corresponding to the second physicians;
receive one or more performance-scores from the second physicians, each of the performance-scores corresponding to the patient-referral;
calculate a referral-score for the first physician based at least in part on the performance-scores from the second physicians;
determine if a referral-score for the first physician is below a threshold referral-score.
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:
access a physician-referral-network, the physician-referral-network comprising a plurality of nodes and a plurality of edges connecting the nodes, each of the edges between two of the nodes representing a single degree of separation between them, wherein:
each node corresponds to a physician; and
each edge corresponds to one or more patient-referrals made from one of the connected nodes to the other;
receive one or more references, each of the one or more references indicating a patient-referral from a first physician to one or more second physicians;
update one or more edges connecting the node corresponding to the first physician and one or more nodes corresponding to the second physicians;
receive one or more performance-scores from the second physicians, each of the performance-scores corresponding to the patient-referral;
calculate a referral-score for the first physician based at least in part on the performance-scores from the second physicians;
determine if a referral-score for the first physician is below a threshold referral-score.