Outlier

A patient who requires an unusually long stay or whose stay generates unusually great cost. The term is used in the prospective payment system (PPS). About five or six percent of the budgets for regional and national rates have been set aside for payments for outliers. Outliers provide an escape hatch for the hospital, because they allow the hospital to negotiate for a fee higher than the Diagnosis Related Group (DRG) price which would otherwise apply to the patient.


 


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