drg outliers

Summary

Summary: In health care reimbursement, especially in the prospective payment system, those patients who require an unusually long hospital stay or whose stay generates unusually high costs.

Top Publications

  1. ncbi Casemix reimbursement: a Singapore Children's Hospital perspective
    S L Yoong
    KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore 229899
    Ann Acad Med Singapore 30:36-40. 2001
  2. pmc The obligation of physicians to medical outliers: a Kantian and Hegelian synthesis
    Thomas J Papadimos
    Department of Anesthesiology, Medical College of Ohio, 3000 Arlington Avenue, Toledo, Ohio 43614, USA
    BMC Med Ethics 5:E3. 2004
  3. ncbi The clinician's role in Medicare prospective payment: part 4--Medicare adjustments
    Pamela Teenier
    Medicare Operations, Gentiva Health Services, Corpus Christi, TX, USA
    Home Healthc Nurse 23:331-4. 2005
  4. ncbi CMS investigates outlier payments
    Thomas H Brock
    Proskauer Rose LLP, Washington, D C, USA
    Healthc Financ Manage 57:70-4. 2003
  5. ncbi Outlier management. Influencing the highest resource-consuming areas in acute and critical care
    T Ahrens
    Department of Critical Care, Barnes Jewish Hospital, Washington University Medical Center, St Louis, Missouri, USA
    Crit Care Nurs Clin North Am 11:107-16. 1999
  6. ncbi The future of APCs: a look at Medicare's 2005 changes and industry trends
    Renee S Leary
    HSS, Inc, Hamden, Conn, USA
    Healthc Financ Manage 59:44-7. 2005
  7. ncbi Tough negotiations in store between plans and hospitals
    Ed Silverman
    Manag Care 12:42-5. 2003
  8. ncbi More fallout. CMS wants to 'fix' outlier payment formula
    Vince Galloro
    Mod Healthc 32:10-1. 2002
  9. ncbi Stormy weather. Echoes of Columbia/HCA heard as Tenet overhauls management amid scrutiny of outliner payments and investor protests
    Vince Galloro
    Mod Healthc 32:6-7, 1. 2002
  10. ncbi Tenet wades through legal mess. $215 million settlement reached; jury deliberates
    Vince Galloro
    Mod Healthc 36:10. 2006

Research Grants

Scientific Experts

Detail Information

Publications101 found, 100 shown here

  1. ncbi Casemix reimbursement: a Singapore Children's Hospital perspective
    S L Yoong
    KK Women's and Children's Hospital, 100 Bukit Timah Rd, Singapore 229899
    Ann Acad Med Singapore 30:36-40. 2001
    ....
  2. pmc The obligation of physicians to medical outliers: a Kantian and Hegelian synthesis
    Thomas J Papadimos
    Department of Anesthesiology, Medical College of Ohio, 3000 Arlington Avenue, Toledo, Ohio 43614, USA
    BMC Med Ethics 5:E3. 2004
    ..In fact, some providers may try to avoid caring for them altogether, or at least try to limit their institutional or practice exposure to them...
  3. ncbi The clinician's role in Medicare prospective payment: part 4--Medicare adjustments
    Pamela Teenier
    Medicare Operations, Gentiva Health Services, Corpus Christi, TX, USA
    Home Healthc Nurse 23:331-4. 2005
  4. ncbi CMS investigates outlier payments
    Thomas H Brock
    Proskauer Rose LLP, Washington, D C, USA
    Healthc Financ Manage 57:70-4. 2003
    ..Hospitals can expect CMS to implement changes to the outlier regulations...
  5. ncbi Outlier management. Influencing the highest resource-consuming areas in acute and critical care
    T Ahrens
    Department of Critical Care, Barnes Jewish Hospital, Washington University Medical Center, St Louis, Missouri, USA
    Crit Care Nurs Clin North Am 11:107-16. 1999
    ..The benefit to employing these methods leads to the best use of technology and the improved management of a difficult patient population...
  6. ncbi The future of APCs: a look at Medicare's 2005 changes and industry trends
    Renee S Leary
    HSS, Inc, Hamden, Conn, USA
    Healthc Financ Manage 59:44-7. 2005
    ....
  7. ncbi Tough negotiations in store between plans and hospitals
    Ed Silverman
    Manag Care 12:42-5. 2003
  8. ncbi More fallout. CMS wants to 'fix' outlier payment formula
    Vince Galloro
    Mod Healthc 32:10-1. 2002
  9. ncbi Stormy weather. Echoes of Columbia/HCA heard as Tenet overhauls management amid scrutiny of outliner payments and investor protests
    Vince Galloro
    Mod Healthc 32:6-7, 1. 2002
    ..Tenet's business strategy came under scrutiny because a large proportion of its Medicare revenue was generated by so-called outlier payments. Chairman and CEO Jeffrey Barbakow (left) says that's not how he wants to do business...
  10. ncbi Tenet wades through legal mess. $215 million settlement reached; jury deliberates
    Vince Galloro
    Mod Healthc 36:10. 2006
  11. ncbi Medicare intensive care unit use: analysis of incidence, cost, and payment
    Liesl M Cooper
    U S Outcomes Research, U S Medical Division, Eli Lilly and Company, Indianapolis, IN, USA
    Crit Care Med 32:2247-53. 2004
    ..To determine the incidence, cost, and payment for intensive care unit services among Medicare beneficiaries...
  12. pmc Identifying and accommodating statistical outliers when setting prospective payment rates for inpatient rehabilitation facilities
    Susan M Paddock
    RAND, Santa Monica, CA 90407, USA
    Health Serv Res 39:1859-79. 2004
    ..To demonstrate how a Bayesian outlier accommodation model identifies and accommodates statistical outlier hospitals when developing facility payment adjustments for Medicare's prospective payment system for inpatient rehabilitation care...
  13. ncbi Pay-for-performance: is medicare a good candidate?
    Michael F Cannon
    Cato Institute s, Health Policy Studies, USA
    Yale J Health Policy Law Ethics 7:1-38. 2007
  14. ncbi Evaluation of the performance of diagnosis-related groups and similar casemix systems: methodological issues
    G Palmer
    Centre for Hospital Management and Information Systems Research, School of Health Services Management, University of New South Wales, Sydney 2052
    Health Serv Manage Res 14:71-81. 2001
    ..Without the evidence provided by properly designed studies, policy-makers and managers may place undue reliance on subjective judgments and the views of the most influential, but not necessarily best informed, healthcare interest groups...
  15. pmc Differences in the implementation of diagnosis-related groups across clinical departments: a German hospital case study
    Hans Gerd Ridder
    Faculty of Economics and Management, Institute of Human Resource Management, Leibniz Universitat Hannover, Königsworther Platz 1, D 30167 Hannover, Germany
    Health Serv Res 42:2120-39; discussion 2294-323. 2007
    ..This article aims to examine the implementation process of diagnosis-related groups (DRGs) in the clinical departments of a German hospital group and to explain why some gain competitive advantage while others do not...
  16. ncbi Tenet cites St. Barnabas ruling. Fla. gaming lawsuit should be tossed as well: company
    Gregg Blesch
    Mod Healthc 37:12. 2007
  17. ncbi Development of a program to manage costly outliers
    N S Cisar
    Mayo Clinic Hospital in Phoenix, Arizona, USA
    Clin Nurse Spec 15:25-33. 2001
    ..The goals of this program were to identify who the outliers might be prior to becoming outliers and to manage their nursing care early in their hospital course, attempting to match resource requirements with resource availability...
  18. ncbi Estimation of the proportion of overweight individuals in small areas - a robust extension of the Fay-Herriot model
    Dawei Xie
    Department of Biostatistics and Epidemiology, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 617 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104, USA
    Stat Med 26:2699-715. 2007
    ..We also discuss two approaches for identifying outliers in the context of this application...
  19. ncbi Taking steps to discharge
    Craig Kenny
    Nurs Times 102:18-9. 2006
  20. ncbi A palliative medicine program in a community setting: 12 points from the first 12 months
    John D Cowan
    Advanced Illness Assistance Team, Blount Memorial Hospital, Maryville, Tennessee, USA
    Am J Hosp Palliat Care 20:415-33. 2003
    ..A median of eight recommendations was made for each consultation, with medication changes suggested for 84 percent. For those known to have died, the median survival from time of consultation to death was 11 days...
  21. ncbi Predicting "charge outliers" after spinal cord injury: a multicenter analysis of demographics, injury characteristics, outcomes, and rehabilitation charges
    D M Burnett
    Department of Physical Medicine and Rehabilitation, Medical College of Virginia Virginia Commonwealth University, Richmond, VA, USA
    Arch Phys Med Rehabil 82:114-9. 2001
    ....
  22. ncbi Holding out hope. CMS study to review payments to LTAC facilities
    Joseph Mantone
    Mod Healthc 35:28. 2005
  23. ncbi M-study; arguments for regional trauma databases
    P Joosse
    Trauma Unit, Dept of Surgery, Academical Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
    J Trauma 58:1272-6; discussion 1277. 2005
    ..Utilizing the M-statistic, different populations of trauma patients can be compared with the population originally enrolled in the MTOS...
  24. ncbi Age and laboratory costs for hospitalized medical patients
    Bradley B Brimhall
    Department of Pathology, University of Colorado School of Medicine, Denver, USA
    Arch Pathol Lab Med 127:169-77. 2003
    ..To examine the hypothesis that older hospitalized patients have higher laboratory costs than younger patients in the same severity-adjusted diagnosis-related group (DRG)...
  25. ncbi CMS proposed payment
    Cherilyn G Murer
    Murer Group, Joliet, IL, USA
    Rehab Manag 19:58-61. 2006
  26. ncbi Special characteristics of nursing staff scheduling in intensive care units
    A Ksykiewicz Dorota
    Department of Management in Nursing, Independent Laboratory of Nursing Skills, Faculty of Nursing and Health Sciences, Medical University of Lublin
    Ann Univ Mariae Curie Sklodowska Med 56:313-8. 2001
    ..Statistically significant differences were noted between the nursing time devoted to patients and the time they should be provided with according to their demand for care...
  27. ncbi Impact of the present-on-admission indicator on hospital quality measurement: experience with the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators
    Laurent G Glance
    University of Rochester School of Medicine, Rochester, New York, USA
    Med Care 46:112-9. 2008
    ..The extent to which the lack of a POA indicator biases quality assessment based on the AHRQ mortality measures is unknown...
  28. ncbi How DRGs hurt academic health systems
    P A Taheri
    Division of Trauma Burn and Emergency Surgery, University of Michigan Health System, Ann Arbor, USA
    J Am Coll Surg 193:1-8; discussion 8-11. 2001
    ..The application of our proposed reimbursement methodology better distributes risk between payers and providers, and reduces adverse selection and incentive problems ("moral hazard")...
  29. ncbi Analysis of cost outliers within APR-DRGs in a Belgian general hospital: two complementary approaches
    Magali Pirson
    Health Economics Department, School of Public Health, Universite Libre de Bruxelles, 806 Route de Lennik, B 1070 Bruxelles, Belgium
    Health Policy 76:13-25. 2006
    ..The objective of this study was to find factors that could explain high and low resource use outliers, by associating an explanatory analysis with a statistical analysis...
  30. ncbi Frequency of abnormal correlation between leptin and the body mass index during first and second generation antipsychotic drug treatment
    Rocío Peña
    Department of Physiology, Los Andes University Medical School, Merida, Venezuela
    Schizophr Res 106:315-9. 2008
    ..Leptin dysregulation has been implicated in the body weight gain and metabolic dysfunction observed with the second generation antipsychotic drugs (SGAD) olanzapine and clozapine...
  31. ncbi Techniques to monitor for endophthalmitis and other cataract surgery complications
    Jonathon Q Ng
    Eye and Vision Epidemiology Research Group, School of Public Health, Curtin University, Perth, Australia
    Ophthalmology 115:3-10. 2008
    ..To report complication incidence to identify outliers more reliably, to provide feedback on performance, and to generate more timely alerts...
  32. ncbi Putting it altogether: improving performance in heart failure outcomes, part 2
    Thomas R Clancy
    Mercy Hospital, Iowa City, IA 52240, USA
    J Nurs Adm 39:364-7. 2009
    ..As follow-up to the case study in this column's June 2009 article, this article highlights the interventions and outcomes of the study...
  33. ncbi Trialling diagnosis-related groups classification in the Iranian health system: a case study examining the feasibility of introducing casemix
    S Ghaffari
    School of Population Health, University of Queensland, Brisbane, Australia
    East Mediterr Health J 16:460-6. 2010
    ..R2 (variance in length of stay explained) was 44% for untrimmed cases, increasing to 63%, 57% and 58% after trimming by L3H3, IQR and 10th-95th percentile methods respectively...
  34. ncbi Tenet's conundrum. How can it increase volume without latest medical equipment, and vice versa?
    Vince Galloro
    Mod Healthc 37:10. 2007
  35. ncbi Complexities in transplant revenue management
    Barry Marshall
    Methodist University Hospital Transplant Institute, Memphis, TN, USA
    Prog Transplant 17:94-8. 2007
    ..A transplant program must have a thorough understanding of all available payment schemes and reimbursement optimizing strategies to facilitate the realization of a strong financial outlook...
  36. ncbi Nonparametric frontier model as a tool for exploratory analysis of hospital stays
    C Beguin
    Cliniques Universitaires Saint Luc, Universite Catholique de Louvain, Bruxelles, Belgium
    Methods Inf Med 40:241-7. 2001
    ..The analysis is done with the nonparametric Free Disposal Hull (FDH) model and the method developed by Wilson to detect extreme observations, when defining the frontier is adapted to analyze large databases...
  37. ncbi Outlier changes might shock you
    Alan L Broude
    Hosp Health Netw 76:10, 12. 2002
  38. ncbi Spinal cord injury "outliers": an analysis of etiology, outcomes, and length of stay
    D M Burnett
    Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Medical College of Virginia, Richmond 23298, USA
    J Neurotrauma 17:765-72. 2000
    ....
  39. ncbi New approaches to reimbursement schemes based on patient classification systems and their comparison
    Alfio Marazzi
    Institute for Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland
    Health Serv Manage Res 20:203-10. 2007
    ..However, the payment of a fixed amount per diem (not exceeding the marginal cost) and correcting the reimbursements for exceptional costs substantially reduces the average discrepancy between costs and reimbursements...
  40. ncbi Prospective rates for episodes of home health care
    Paul L Grimaldi
    State Healthcare Division of Affiliated Computer Services, Inc, Rockville, MD, USA
    J Health Care Finance 28:63-75. 2002
    ....
  41. ncbi The ethical health lawyer. Loopholes: opportunity, responsibility or liability?
    Elizabeth A Weeks
    Department of Law at the University of Kansas, USA
    J Law Med Ethics 35:320-4. 2007
  42. ncbi [Random sampling according to section 17 c KHG--report on the experience of maximal care hospitals in Hesse]
    J van Essen
    Hessen, Oberursel, Germany
    Gesundheitswesen 69:137-40. 2007
    ..Excluding these cases from the random sample introduces a bias in an avoidable way. The present rule is contrary to valid conclusions from the random sampling and should be abolished...
  43. ncbi Rating the quality of intensive care units: is it a function of the intensive care unit scoring system?
    Laurent G Glance
    Department of Anaesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
    Crit Care Med 30:1976-82. 2002
    ..The objective of this study was to determine whether the identity of ICU quality outliers depends on the ICU scoring system used to calculate the standardized mortality ratio...
  44. ncbi Identifying quality outliers in a large, multiple-institution database by using customized versions of the Simplified Acute Physiology Score II and the Mortality Probability Model II0
    Laurent G Glance
    Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
    Crit Care Med 30:1995-2002. 2002
    ..To assess whether customized versions of the Simplified Acute Physiology Score (SAPS) II and the Mortality Probability Model (MPM) II0 agree on the identity of intensive care unit quality outliers within a multiple-center database...
  45. ncbi Economic profiling of physician specialists: use of outlier treatment and episode attribution rules
    J William Thomas
    Institute for Health Policy, Edmund S Muskie School of Public Service, University of Southern Maine, Portland, ME 04101 9300, USA
    Inquiry 43:271-82. 2006
    ..No consistent combination of outlier methodology and episode attribution rule was found to be superior for identifying cost-inefficient physicians...
  46. ncbi Tenet's stock takes dive as profit outlook suffers. Analyst's questions about outlier payments add more uncertainty to system's earnings prospects
    Vince Galloro
    Mod Healthc 32:8-9. 2002
  47. ncbi Outlier probe may widen. Consultancies may be next to come under scrutiny
    Mark Taylor
    Mod Healthc 36:8-9. 2006
  48. ncbi N.J. system settles lawsuit
    Mark Taylor
    Mod Healthc 36:4. 2006
  49. ncbi Medicaid managed care payment methods and capitation rates in 2001
    John Holahan
    Health Policy Research Center, Urban Institute, Washington, DC, USA
    Health Aff (Millwood) 22:204-18. 2003
    ..The data also show that the growth in Medicaid capitation rates between 1998 and 2001 averaged 18 percent, considerably more than the increase in Medicare+Choice rates...
  50. ncbi Judge ends Tenet outlier suit. Ruling parallels decision in St. Barnabas case
    Gregg Blesch
    Mod Healthc 37:4. 2007
  51. pmc Excluded facility financial status and options for payment system modification
    J E Schneider
    Department of Health Services and Policy Analysis, University of California, Berkeley
    Health Care Financ Rev 15:7-30. 1993
    ..Cost sharing above the target amount could be increased to include more government sharing of losses...
  52. ncbi Determinants of maternity length of stay: a Gamma mixture risk-adjusted model
    A H Lee
    School of Public Health, Curtin University of Technology, Perth, WA, Australia
    Health Care Manag Sci 4:249-55. 2001
    ..The determination of pertinent factors would benefit hospital administrators and clinicians to manage LOS and expenditures efficiently...
  53. ncbi [Are extra costs generated by patients justifiable? Methodology and results from a study carried out in a Belgian general hospital]
    M Pirson
    Département d Economie de la Santé, Ecole de Santé Publique, ULB, Bruxelles
    Rev Med Brux 31:103-10. 2010
    ..An explanation is however not necessarily synonymous with medical justification...
  54. ncbi [Contribution of economic evaluation and budget impact analysis to public decision in health: the example of breast cancer]
    L Perrier
    Université de Lyon Centre régional de lutte contre le cancer Léon Bérard, Département cancer et environnement, GATE UMR 5824 CNRS axe économie de la santé, 28, rue Laennec, 69008 Lyon, France
    Bull Cancer 97:397-402. 2010
    ..Budget impact analysis, without consideration of efficacy, makes it possible to balance the financing needs arising from the adoption of a costly innovation with the paying capabilities of a given institution...
  55. pmc Effects of the Premier Hospital Quality Incentive Demonstration on Medicare patient mortality and cost
    Andrew M Ryan
    Brandeis University, Waltham, MA 02454, USA
    Health Serv Res 44:821-42. 2009
    ..and Centers for Medicare and Medicaid Services Hospital Quality Incentive Demonstration (PHQID), a public quality reporting and pay-for-performance (P4P) program, on Medicare patient mortality, cost, and outlier classification...
  56. ncbi [Outlier cases in surgical disciplines. Micro-economic and macro-economic problems]
    A Tecklenburg
    Medizinische Hochschule Hannover, OE 1110, Carl Neuberg Str 1, 30625, Hannover
    Chirurg 80:768-72. 2009
    ..To achieve this it is necessary to systematically analyze the extremely cost-intensive cases by experts of different medical disciplines to create a data basis for a proposal of a cost-covering payment...
  57. ncbi The variance of length of stay and the optimal DRG outlier payments
    Stefan Felder
    Health Economics, Duisburg Essen University, 45117, Essen, Germany
    Int J Health Care Finance Econ 9:279-89. 2009
    ..It then demonstrates for normally distributed truncated LOS that the optimal outlier threshold indeed decreases with an increase in the standard deviation...
  58. ncbi Adaptive designs for dose-finding in non-cancer phase II trials: influence of early unexpected outcomes
    Matthieu Resche-Rigon
    Biostatistical Department, U717 INSERM, AP HP, Paris 7 University, Saint Louis Hospital, 1 avenue Claude Vellefaux, 75475 Paris Cedex 10, France
    Clin Trials 5:595-606. 2008
    ..However, in certain vulnerable populations, such as neonates or infants, there is an heightened requirement for safety, precluding randomization...
  59. ncbi Acuity and case management: a healthy dose of outcomes, part III
    Diane L Huber
    Colleges of Nursing and Public Health, University of Iowa, Iowa City, IA 52242, USA
    Prof Case Manag 12:254-69; quiz 270-1. 2007
    ..Part II further explained dosage and 2 acuity instruments, the Acuity Tool and AccuDiff. Part III presents linkage to EBP and practical applications...
  60. ncbi Supply-side risk adjustment and outlier payment policy
    Michel Mougeot
    University of Franche Comte, CRESE, Besancon Cedex, France
    J Health Econ 27:1196-200. 2008
    ....
  61. ncbi African regional external quality assessment for CD4 T-cell enumeration: development, outcomes, and performance of laboratories
    Deborah K Glencross
    Department of Molecular Medicine and Haematology, University of the Witwatersrand, Faculty of Health Sciences and the South African National Health Laboratory Service, Johannesburg, South Africa
    Cytometry B Clin Cytom 74:S69-79. 2008
    ..The overall performance from 2002 to 2006 (Trials 1-20) is reported, together with cumulative longitudinal performance of the different CD4 methods used...
  62. ncbi Evaluation of a risk-adjustment model for pressure ulcer development using the Minimum Data Set
    D R Berlowitz
    Sections of General Internal Medicine and Geriatrics, Boston Medical Center, Boston, Massachusetts, USA
    J Am Geriatr Soc 49:872-6. 2001
    ..Nursing homes differ significantly in their expected rates of pressure ulcer development. Outlier identification also differs depending on whether unadjusted or risk-adjusted performance is evaluated...
  63. ncbi CMS rejiggers outlier rules
    Jeff Tieman
    Mod Healthc 34:10. 2004
  64. ncbi Final inpatient rehabilitation PPS rule improves on proposed rule
    M Reynolds
    Health Law Practice Group, ShawPittman LLP, Washington, DC, USA
    Healthc Financ Manage 55:68-70. 2001
    ....
  65. ncbi Describing Iranian hospital activity using Australian Refined DRGs: a case study of the Iranian Social Security Organisation
    Shahram Ghaffari
    School of Population Health, University of Queensland, Herston QLD 4006, Australia
    Health Policy 87:63-71. 2008
    ..To describe Iran's hospital activity with Australian Refined Diagnosis Related Groups (AR-DRGs)...
  66. ncbi Tenet settles outlier lawsuit. Fla. official's lawsuit yield dollar 7 million payment
    Vince Galloro
    Mod Healthc 36:8-9. 2006
  67. ncbi Lowered expectations. Proposed cuts in LTAC payments disturb hospitals
    Jessica Zigmond
    Mod Healthc 36:14. 2006
  68. ncbi On the lookout. CMS studies outlier billing practices
    Laura B Benko
    Mod Healthc 32:14. 2002
  69. ncbi Casemix in Singapore - 5 years on
    E K Lim
    Healthcare Finance Division, Minitry of Health, Singapore
    Ann Acad Med Singapore 33:660-1. 2004
  70. ncbi Long-term care hospital PPS creates opportunity for coders. Proposed rule addresses related coding issues
    Susan Hull
    J AHIMA 74:58-60. 2003
  71. ncbi Describing Chinese hospital activity with diagnosis related groups (DRGs). A case study in Chengdu
    Zhiping Gong
    School of Public Health, Faculty of Health Sciences, LaTrobe University, 29 Barwon Av Reservoir, Bundoora, VIC 3086, Australia
    Health Policy 69:93-100. 2004
    ..To examine the applicability of an Australian casemix classification system to the description of Chinese hospital activity...
  72. ncbi Change is not so bad. Host of outpatient PPS adjustments draws little reaction from hospital industry
    Tony Fong
    Mod Healthc 34:12. 2004
  73. ncbi Medicare implications of discounts to the uninsured
    Christopher L Keough
    Vinson and Elkins, LLP, Washington, DC, USA
    Healthc Financ Manage 58:40-3. 2004
    ..If you're considering making changes to your hospital's policy, you'll need to understand the current regulatory environment, recognize potential concerns, and develop a plan of action that complies with recent HHS guidance...
  74. ncbi Hospitals await final outlier rule
    Christopher L Keough
    Vinson and Elkins, LLP, Washington, D C, USA
    Healthc Financ Manage 57:30-4. 2003
  75. ncbi Analysis of the expenses linked to hospital stays: how to detect outliers
    C Beguin
    Centre d Informatique Médicale, Cliniques Universitaires Saint Luc, Universite Catholique de Louvain, Belgium
    Health Care Manag Sci 7:89-96. 2004
    ..The too-efficient stays are highlighted and described. The mean expenses are estimated after excluding too-efficient and inefficient stays. This mean is higher than the mean estimated by using classical trimming rules...
  76. ncbi Relationship between hospital structural level and length of stay outliers. Implications for hospital payment systems
    Francesc Cots
    Health Services Research Unit, Municipal Institute of Health, IMAS, Hospital del Mar, Passeig Marítim 25 29 E 08003, Barcelona, Spain
    Health Policy 68:159-68. 2004
    ..However, the relationship between hospital structural level and the presence of cases of extreme resource use (outliers) is not known. Some prospective payment systems pay these cases separately...
  77. ncbi Are your outlier charges likely to raise CMS scrutiny?
    Margaret Davino
    Kaufman Borgeest and Ryan, LLP, New York, USA
    Healthc Financ Manage 58:40-4. 2004
    ....
  78. ncbi Stability of risk-adjusted primary cesarean delivery rates over time
    Jennifer L Bailit
    Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio, USA
    Am J Obstet Gynecol 190:395-400. 2004
    ..The purpose of this study was to compare how hospital rankings, based on risk-adjusted primary cesarean rates, change over time...
  79. ncbi Judging trauma center quality: does it depend on the choice of outcomes?
    Laurent G Glance
    Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, New York 14642, USA
    J Trauma 56:165-72. 2004
    ..However, the use of survival as a measure of the effectiveness of trauma care may be too limited in scope because it fails to capture information regarding functional outcomes...
  80. ncbi The use of fixed- and random-effects models for classifying hospitals as mortality outliers: a Monte Carlo assessment
    Peter C Austin
    Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
    Med Decis Making 23:526-39. 2003
    ..There is an increasing movement towards the release of hospital "report-cards. "However, there is a paucity of research into the abilities of the different methods to correctly classify hospitals as performance outliers...
  81. ncbi Comparison of methods to identify outliers observed in health services small area variation studies
    Teresa To
    Population Health Sciences, Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
    Stat Methods Med Res 12:531-46. 2003
    ..The chi2 remains a useful tool in small area variation analysis to 'screen' or flag potential differences beyond chance alone...
  82. ncbi It's more than just Tenet. Analysis shows not-for-profit hospitals, including a cluster in New Jersey, also heavily rely on outlier payments
    Mary Chris Jaklevic
    Mod Healthc 33:4-5, 9, 1. 2003
    ..At left, Saint Barnabas Medical Center in Livingston, N.J., ranks among hospitals with a high reliance on outlier payments...
  83. ncbi CMS' inpatient surprise. Outlier threshold cut; transfer policy remains
    Jeff Tieman
    Mod Healthc 33:8-9. 2003
  84. ncbi Managing costly Medicare patients in the hospital
    Dee Tucker
    Sixty Plus Older Adult Services, Piedmont Hospital, Atlanta, Georgia, USA
    Geriatr Nurs 24:294-7. 2003
    ..Community follow up is provided by social workers to complete the continuum. Positive outcomes from this project suggest that nursing can identify and successfully intervene with high-cost Medicare patients...
  85. ncbi The other shoe drops. Barbakow, already set to lose chairman's seat, out as Tenet's CEO; shareholders, analyst call for outsider as his replacement
    Vince Galloro
    Mod Healthc 33:4-5, 16, 1. 2003
    ..stepped down last week from the company he headed during a period of glowing prosperity. But as he departs, Tenet is surrounded by a tempest similar to the one that led to his hiring...
  86. ncbi Prospective casemix-based funding, analysis and financial impact of cost outliers in all-patient refined diagnosis related groups in three Belgian general hospitals
    Magali Pirson
    School of Public Health, Universite Libre de Bruxelles, Brussels, Belgium
    Eur J Health Econ 7:55-65. 2006
    ..The billing generated by these patients largely compensates for costs generated. Length of stay and charges are not a good approximation to select cost outliers...
  87. ncbi Handling outliers in brain tumour MRS data analysis through robust topographic mapping
    Alfredo Vellido
    Universitat Politecnica de Catalunya UPC, Soft Computing Group, c Jordi Girona, 1 3, 08034, Barcelona, Spain
    Comput Biol Med 36:1049-63. 2006
    ..The effectiveness of this model on the MRS data is demonstrated empirically...
  88. ncbi Hospitals say it's not enough. Medicare payment update won't outpace inflation
    Tony Fong
    Mod Healthc 35:8-9. 2005
  89. ncbi Hospitals. Portrait of a failure
    Ken Terry
    Med Econ 82:26-30. 2005
  90. ncbi Evaluating trauma center quality: does the choice of the severity-adjustment model make a difference?
    Laurent G Glance
    Department of Anesthesiology, University of Rochester School of Medicine and Dentistry, NY 14642, USA
    J Trauma 58:1265-71. 2005
    ..The primary trauma outcome prediction models used for evaluating the quality of trauma care, TRISS and ASCOT (A Severity Characterization of Trauma), were developed using the MTOS database...
  91. ncbi A weak hand? Lawyer: filing shows holes in feds' outlier case against Tenet
    Vince Galloro
    Mod Healthc 35:18. 2005
  92. ncbi Analysis of cost outliers after gastric bypass surgery: what can we learn?
    Robert N Cooney
    Departments of Surgery, The Penn State College of Medicine, Penn State Milton S Hershey Medical Center, Hershey, PA 17033, USA
    Obes Surg 13:29-36. 2003
    ..However, a reanalysis of GBS hospital costs identified a 16% incidence of "cost outliers". We hypothesized that analysis of clinical variables would identify factors associated with increased hospital costs following GBS...
  93. ncbi Relevance of outlier cases in case mix systems and evaluation of trimming methods
    Francesc Cots
    Municipal Institute of Health, Health Service Research Unit, Hospital del Mar, Passeig Maritim 25 29, E 08003 Barcelona, Spain
    Health Care Manag Sci 6:27-35. 2003
    ..To determine the most appropriate outlier trimming method when the main source of information for case mix classification is length of stay (LOS) because cost information is unavailable...
  94. ncbi ROP in New York State
    Sandra M Brown
    Ophthalmology 112:738; author reply 738-9. 2005
  95. ncbi Tenet's new tangle. Other states could follow Fla. with racketeering charges
    Melanie Evans
    Mod Healthc 35:12. 2005
  96. ncbi Evidenced-based practice: priorities and implementation strategies
    Tom Ahrens
    Barnes Jewish Hospital, St Louis, MO 63110, USA
    AACN Clin Issues 16:36-42. 2005
    ..This article illustrates steps in making EBP a reality by highlighting the management of outliers and severe sepsis and the implementation strategies for these conditions...
  97. ncbi [DRG evaluation results--state comparisons: MDK Baden-Württemberg versus MDK Westfalen-Lippe]
    P Dirschedl
    MDK Baden Württemberg, Lahr, Germany
    Gesundheitswesen 69:141-5. 2007
    ..Result comparisons of this type can yield insights into streamlining of the review practice of Medical Review Boards, as well as increase the efficiency and effectiveness of the selection of cases...
  98. ncbi Defining excess resource utilization and identifying associated factors for trauma victims
    G E O'Keefe
    Department of Surgery, University of Texas, Southwestern Medical Center, Dallas 75235 9158, USA
    J Trauma 46:473-8. 1999
    ..The purpose of this study is to estimate expected hospital LOS after trauma and determine the consequences of excessive LOS...
  99. ncbi Analyzing hospital length of stay: mean or median regression?
    Andy H Lee
    School of Public Health, Curtin University of Technology, Perth, WA, Australia
    Med Care 41:681-6. 2003
    ..Length of stay (LOS) is an important measure of hospital activity and health care utilization, but its empirical distribution is often positively skewed...
  100. ncbi Influence of Japan's new Diagnosis Procedure Combination-based payment system on the surgical sector: does it really shorten the hospital stay?
    Hideo Yasunaga
    Department of Planning, Information, and Management, University of Tokyo Hospital, 7 3 1 Hongo, Tokyo, Japan
    Surg Today 36:577-85. 2006
    ..We analyzed the influence of this system on hospital revenue and expenditure, focusing on whether it reduces the length of stay in hospital (LOS), particularly in the surgical sector...
  101. ncbi Strong tenets. For the acting CEO at no. 2 hospital chain, three R's could be relationships, risk-taking and responsibility
    Vince Galloro
    Mod Healthc 33:32-3, 35. 2003

Research Grants1

  1. Are Volume Standards Accurate Measures of Quality?
    Laurent Glance; Fiscal Year: 2005
    ..abstract_text> ..