Method and apparatus for objectively monitoring and assessing the performance of health-care providers based on the severity of sickness episodes treated by the providers

摘要

A method and apparatus for objectively monitoring the performance of a group of health-care providers. In-patient payment claim records representative of in-patient health-care services performed for patients by health-care providers within the group of health-care providers and out-patient payment claim records representative of out- patient health- care services performed for patients by health-care providers within group of health-care providers are stored in databases. A plurality of sickness episode data records are built from the in- patient payment claim records and the out-patient payment claim records, and an objective severity adjustment analysis is performed on the sickness episode data records to form a plurality of severity-adjusted sickness episode data records. A cost-efficiency performance level is determined for each individual health-care provider within the group of health-care providers from the plurality of severity-adjusted sickness episode data records, and a qualitative performance level is determined for the group of health- care providers as a whole.