1. Greater Nashville Healthcare Analytics Healthcare Statistics 101 Series: Outliers-What? Why? How?
Open Forum
Facilitator: Christine Lai
Date: April 12, 2016
Place: Vanderbilt University Medical Center

2. “An outlier is an observation that lies an abnormal distance from other values in a random sample from a population. In a sense, this definition leaves it up to the analyst (or a consensus process) to decide what will be considered abnormal. Before abnormal observations can be singled out, it is necessary to characterize normal observations.”
Definition of Outliers, Engineering Statistics Handbook, National Institute of Standard and Technology Section

3. Outlier in Healthcare:
There are outlier payments in CMS IPPS for hospital:
“The actual determination of whether a case qualifies for outlier payments takes into account both operating and capital costs and DRG payments. That is, the combined operating and capital costs of a case must exceed the fixed loss outlier threshold to qualify for an outlier payment. …”
CMS Acute Inpatient PPS - Outlier Payments

4. Focus areas: Why are they important in healthcare? What are outliers ?
Medical service utilization
Abnormality, Abuses, fraudulent
Population Differences
What are outliers ?
Definition
Detection tools
How to handle outliers?
Investigation on root causes
Diagnostics
Modeling
Risk Management

5. Detection tools:

6. Detection tools:

7. Detection tools: comparative

8. Your take? Experience? Insight?