초록 ▼

A method for providing a payment mechanism for out-patient diagnostic imaging services based upon an episode of care payment methodology. An episode of care is selected as a given time period during which all imaging studies performed for a given patient for one clinical indication. An episode of ca

A method for providing a payment mechanism for out-patient diagnostic imaging services based upon an episode of care payment methodology. An episode of care is selected as a given time period during which all imaging studies performed for a given patient for one clinical indication. An episode of care may include multiple diagnostic imaging procedures. All tests performed by a provider within the given time period comprise one episode of care. An intensity adjustment factor based upon the types of imaging studies performed is multiplied against the total episodes of care. This results in a total intensity adjusted episode of care. Each provider's percentage of the total intensity adjusted episode of care is calculated, and each provider is paid from the funds collected from the members. Provisions are also made for giving credit to providers based upon the complexity of the imaging studies. Furthermore, providers can be given credit for consulting with the referring physician to provide the best imaging studies based upon the identified clinical conditions.

대표청구항 ▼

[ What is claimed is:] [1.] A computer implemented method of providing payments to diagnostic imaging providers of a health care plan comprising the steps of:funding a diagnostic imaging provider account through a fixed per member per first-time period dollar amount;crediting a provider with an epis

[ What is claimed is:] [1.] A computer implemented method of providing payments to diagnostic imaging providers of a health care plan comprising the steps of:funding a diagnostic imaging provider account through a fixed per member per first-time period dollar amount;crediting a provider with an episode of care which includes all imaging studies performed on a given member within a second time period for one clinical indication;calculating an intensity adjustment factor for the provider based upon the types of imaging studies performed;totaling the provider's episodes of care during the first time period;calculating intensity adjusted episodes of care for the providers by indexing the totaled episodes of care by the intensity adjustment factor;totaling the intensity adjusted episodes of care for all providers during the first time period;calculating the provider's percentage of the total of all providers' intensity adjusted episodes of care for the first time period;storing an amount representing the provider's percentage of the total of all providers' intensity adjusted episodes of care times the amount funded in the diagnostic imaging account in the first time period andpaying the provider from the diagnostic imaging provider account the stored amount.