AVOIDING THE LOSS OF OUTLIERS

What is an outlier? This term refers to a Medicare recipient who has remained in an acute care facility beyond the allotted days anticipated for a particular illness and who has charges in excess of the total DRG reimbursement. This is usually someone who is catastrophically ill, with many needs, such as ventilator respiratory support, dialysis, feeding issues, etc. Who pays for outlier services to an acute care hospital? These services are factored in to a cost...