Software system reviews physicians' practice and billing methods - Health Payment Review, Inc.'s Patterns of Treatment - Product Announcement

Health Care Financing Review, Spring, 1993

Health Payment Review, Inc. (HPR), the Boston-based leader in the development of health care cost containment software systems, has introduced an automated version of the first ambulatory review product-patterns of Treatment.

Patterns of Treatment is a medically based software system designed to determine the appropriateness of ambulatory services-health care provided outside of a hospital. Ambulatory services are the major contributor to soaring health care costs, which now total about $838 billion or 14 percent of the gross national product.

"Patterns of Treatment combines medical expertise with advanced computer technology to provide insurers with a medical peer review' software system that can effectively and fairly manage the utilization of ambulatory services," says Marcia Radosevich, Ph.D., chief executive officer of HPR. "The clinically based system embodies the expertise of hundreds of board-certified physicians, surgeons, and subspecialists."

Using data from individual patient claims, Patterns of Treatment identifies cases of inappropriate or excessive utilization of physician services. For example, the system will recommend that a claim be adjusted if a physician consistently bills for a new patient visit each time the patient goes to the physician's off ice for a diabetic checkup. Each claim is evaluated using carefully researched guidelines set by HPR's Medical Advisory Board, which are constantly updated by physician peer panels.

For more information, contact Deirdre O'Connell, Schwartz Communications, Incorporated at (617) 431-0770.