Patent Issued for Identification of employment relationships between healthcare practitioners and healthcare facilities (USPTO 11488109): Milliman Solutions LLC

2022 NOV 22 (NewsRx) -- By a News Reporter-Staff News Editor at Hospital & Nursing Home Daily -- Milliman Solutions LLC (Seattle, Washington, United States) has been issued patent number 11488109, according to news reporting originating out of Alexandria, Virginia, by NewsRx editors.

The patent’s inventors are Muhlestein, David (Salt Lake City, UT, US), Richards, Robert (Salt Lake City, UT, US).

This patent was filed on February 5, 2020 and was published online on November 1, 2022.

From the background information supplied by the inventors, news correspondents obtained the following quote: “The healthcare industry is extraordinarily complex. Specifically, in the United States, relationships between healthcare practitioners, clinics, facilities, groups, and systems are complex and interwoven such that it can be challenging to identify relationships between different entities. One practitioner may see patients that are part of different systems, health insurance networks, or groups. Further, the practitioner may be associated with more than one facility or clinic. The interwoven relationships between healthcare entities makes it challenging to determine if a certain practitioner is associated with or employed by a certain facility, clinic, group, or system. Additionally, other relationships between practitioners, facilities, clinics, groups, and systems throughout the healthcare industry are difficult to identify and quantify.

“In some instances, it is necessary or beneficial to understand the relationships between healthcare entities. For example, a health insurance provider seeking to create an in-network selection of providers may need to know which practitioners are associated with which facilities, clinics, groups, or systems. Further for example, a manufacturer or seller of medical devices or pharmaceuticals may benefit from understanding the business relationships between practitioners, facilities, clinics, groups, and systems. In some instances, for example, the manufacturer or seller may sell a medical device or pharmaceutical to a single group, and this would in turn lead to distribution of that medical device or pharmaceutical to hundreds of practitioners associated with the group. These relationships between healthcare entities are nearly impossible to identify or quantify.

“In light of the foregoing, disclosed herein are systems, methods, and devices for identifying relationships between healthcare entities.”

Supplementing the background information on this patent, NewsRx reporters also obtained the inventors’ summary information for this patent: “Disclosed herein are systems, methods, and devices for identifying and quantifying relationships between healthcare entities. In an embodiment, an employment relationship between a facility and a healthcare practitioner is identified and quantified based on the practitioner’s procedures and facility claims.

“Current understanding of the healthcare industry in the United States is extremely fragmented. In some instances, it is difficult or impossible to identify systems of care including financial, employment, and enrollment relationships between healthcare entities. The healthcare industry uses multiple data sources for storing billing, procedure, and facility records. There is no one data source that is ideal or reliable for identifying the numerous relationships between healthcare entities.

“Embodiments of the disclosure begin at the level of individual practitioner billing and procedure codes and builds from there to identify and quantify relationships between other healthcare entities. By tracking the relationships of individual practitioners to higher level entities, the connections between practitioners and multiple other entities can be identified. This is an improved and more streamlined method when compared with viewing all organizations as discrete, mutually exclusive sets of practitioners.

“Embodiments of the disclosure leverage multiple data sources to precisely and completely describe relationships between healthcare entities. Relationships between practitioners and other healthcare entities cannot be viewed as binary. There are multiple types of affiliations between healthcare entities, and each affiliation may be characterized in terms of its strength. An affiliation reported as merely binary (i.e. yes/no, exists/does not exist, and so forth) masks important information.

“Embodiments of the disclosure interpret affiliation metrics based on an individualized perspective. For example, a physician’s affiliation with a hospital has two perspectives: the physician’s perspective and the hospital’s perspective. The physician may view the hospital as a necessary portion of the practice that enables the physician to perform certain procedures. The hospital may view the physician as one of many, and the physician’s procedures performed at the hospital may represent a very small portion of all procedures performed at the hospital. Understanding affiliations from both perspectives is more informative than viewing the affiliations from only one perspective.”

The claims supplied by the inventors are:

“1. A method comprising: aggregating data from a plurality of different data sources, wherein the data comprises raw claims data ingested from an external data source, wherein at least a portion of the raw claims data is encrypted, and wherein the raw claims data comprises carrier claims, wherein the carrier claims comprise data metrics that include calendar year, entity, practitioner identifier (ID), or facility identifier; executing an electronic data security measure by de-encrypting the encrypted portion of the raw claims data; generating an intermediary file from the de-encrypted raw claims data comprising a modeled version of the raw claims data, wherein the modeled version of the raw claims data is cleaned to eliminate superfluous data; storing the intermediary file in a database; partitioning the intermediary file based on one or more of the data metrics; identifying a plurality of carrier claims processed by a practitioner for procedures performed at a facility, wherein the plurality of carrier claims is identified from within the partitioned version of the intermediary file that is stored in the database; executing a database merge process to match the plurality of carrier claims to the facility to generate matched claims; calculating a percentage of outpatient claims based on a percentage of office claims performed by the practitioner that did not occur at the facility; and calculating a level of confidence that the practitioner is employed by the facility based on the matched claims and the percentage of outpatient claims; wherein the database merge process comprises a plurality of steps, and wherein each of the plurality of steps comprises matching the plurality of carrier claims to the facility based on an identified data metric; wherein calculating the level of confidence that the practitioner is employed by the facility reflects real-world associations between the practitioner and the facility based on real-world claims data; and wherein the intermediary file decreases the amount of disc storage and/or Random Access Memory (RAM) needed to calculate the level of confidence that the practitioner is employed by the facility based on the real-world claims data.

“2. The method of claim 1, wherein the raw claims data further comprises facility claims and the method further comprising identifying a plurality of facility claims within the partitioned version of the intermediary file that is stored on the database, wherein the plurality of facility claims is associated with the facility, and wherein matching the plurality of carrier claims to the facility comprises matching the plurality of carrier claims to the plurality of facility claims to generate the matched claims.

“3. The method of claim 1, wherein calculating the percentage of outpatient claims comprises collapsing the matched claims on a practitioner ID associated with the practitioner.

“4. The method of claim 1, further comprising collapsing the matched claims to group level, wherein the facility is a healthcare facility associated with a group.

“5. The method of claim 4, further comprising calculating a percentage of employment by calculating a percentage of practitioners associated with the group that are employed by a facility associated with the group.

“6. The method of claim 1, wherein the carrier claims further comprise patient identification, procedure, date of service, procedural code, inpatient facility, clinic identifier (ID), and wherein matching the plurality of carrier claims with the facility comprises matching based on: in a first matching iteration, a patient identification for a patient that received a procedure from the practitioner, a date of service for the procedure performed, and a procedure code for the procedure; in a second matching iteration, the patient identification, the date of service, and a practitioner ID (National Provider Identifier) associated with the practitioner; in a third matching iteration, an inpatient facility associated with a carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility; in a fourth matching iteration, the date of service and a most common facility associated with the practitioner; and in a fifth matching iteration, the most common facility associated with the practitioner as determined based on a clinic ID (National Provider Identifier) in a carrier claim.

“7. The method of claim 6, wherein matching the plurality of carrier claims with the facility further comprises matching based on: in a sixth matching iteration, the date of service and the most common facility associated with the practitioner; in a seventh matching iteration, the date of service and recent most common facility associated with the practitioner based on claims processed by the practitioner in a recent time period; in an eighth matching iteration, the date of service and the most common facility associated with the practitioner; in a ninth matching iteration, a most common facility associated with the practitioner using previously joined facilities; and in a tenth matching iteration, a facility most closely link to the clinic ID based on the carrier claim.

“8. The method of claim 1, further comprising calculating a level of confidence that the practitioner is employed by the facility for each year there are available carrier claims and aggregating the level of confidence for each year to calculate an aggregated level of confidence that the practitioner is employed by the facility.

“9. The method of claim 1, wherein the carrier claims further comprise patient identification, procedure, date of service, procedural code, inpatient facility, clinic identifier (ID), and wherein the plurality of steps for the database merge process comprises matching based on one or more of: a patient identification for a patient that received a procedure from the practitioner; a date of service for the procedure; a procedure code for the procedure; a practitioner ID (National Provider Identifier) associated with the practitioner; an inpatient facility associated with a carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility; a most common facility that is most commonly associated with the practitioner; a clinic ID (National Provider Identifier) associated with the facility; or a facility most commonly linked to the clinic ID based on the carrier claims.

“10. The method of claim 1, wherein the carrier claims further comprise patient identification, procedure, date of service, procedural code, inpatient facility, clinic identifier (ID), and wherein the database merge process for matching the plurality of carrier claims with the facility comprises matching based on each of: a patient identification for a patient that received a procedure from the practitioner; a date of service for the procedure; a procedure code for the procedure; a practitioner ID (National Provider Identifier) associated with the practitioner; an inpatient facility associated with a carrier claim if the carrier claim occurred during a hospitalization at the inpatient facility; a most common facility that is most commonly associated with the practitioner; a clinic ID (National Provider Identifier) associated with the facility; and a facility most commonly linked to the clinic ID based on the carrier claims.

“11. The method of claim 1, further comprising determining that the practitioner is employed by the facility in response to determining that all carrier claims billed by the practitioner are matched to the facility.

“12. A system comprising one or more processors configured to execute instructions stored in non-transitory computer readable storage media, the instructions comprising: aggregating data from a plurality of different data sources, wherein the data comprises raw claims data ingested from an external data source, wherein at least a portion of the raw claims data is encrypted, and wherein the raw claims data comprises carrier claims, wherein the carrier claims comprise data metrics that include calendar year, entity, practitioner identifier (ID), or facility identifier; executing an electronic data security measure by de-encrypting the encrypted portion of the raw claims data; generating an intermediary file from the de-encrypted raw claims data comprising a modeled version of the raw claims data, wherein the modeled version of the raw claims data is cleaned to eliminate superfluous data; storing the intermediary file in a database; partitioning the intermediary file based on one or more of the data metrics; identifying a plurality of carrier claims processed by a practitioner for procedures performed at a facility, wherein the plurality of carrier claims is identified from within the partitioned version of the intermediary file that is stored in the database; executing a database merge process to match the plurality of carrier claims to the facility to generate matched claims; calculating a percentage of outpatient claims based on a percentage of office claims performed by the practitioner that did not occur at the facility; and calculating a level of confidence that the practitioner is employed by the facility based on the matched claims and the percentage of outpatient claims; wherein the database merge process comprises a plurality of steps, and wherein each of the plurality of steps comprises matching the plurality of carrier claims to the facility based on an identified data metric; wherein calculating the level of confidence that the practitioner is employed by the facility reflects real-world associations between the practitioner and the facility based on real-world claims data; and wherein the intermediary file decreases the amount of disc storage and/or Random Access Memory (RAM) needed to calculate the level of confidence that the practitioner is employed by the facility based on the real-world claims data.”

There are additional claims. Please visit full patent to read further.

For the URL and additional information on this patent, see: Muhlestein, David. Identification of employment relationships between healthcare practitioners and healthcare facilities. U.S. Patent Number 11488109, filed February 5, 2020, and published online on November 1, 2022. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=11488109.PN.&OS=PN/11488109RS=PN/11488109

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