Health Information Management

News: Outlier payments prove costly at some facilities

CDI Strategies, December 5, 2013

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Cedars-Sinai Medical Center in Los Angeles receives nearly $300 million in Medicare “outlier” payments—more than any other hospital in the country, according to a Modern Healthcare analysis of data provided under a Freedom of Information Act request published in its November 23 article “High outlier payments at large not-for-profits, small for-profits lead OIG to push for increased scrutiny.”

The hospitals with the highest outlier payments received an average of 13% of their total Medicare revenue from outliers as opposed to an average of 2% in outlier payments from typical facilities, according to the report.

Tracheostomy with mechanical ventilation lasting longer than four days following a major surgical procedure accounted for $1.3 billion of all outlier spending over a four-year period, between 2008 and 2011. Also listed among the highest outlier payments were:

  • bowel surgery
  • infectious diseases with major complications
  • severe sepsis with mechanical ventilation
  • major cardiovascular procedures with complications



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