|
Glossary
of Health Care Terms
Glossary
Acronyms
The Ohio Hospital Association's
Glossary of Health Care Terms provides a brief,
easy-to-use and easy-to-understand list of health care and legislative
terms that can help those in health care, as well as the community at
large, better comprehend the evolving health care delivery system.
The glossary is organized alphabetically with an
emphasis on those terms that impact OHA members the most. Terms and
organizations that are often referred to by acronyms are listed by full
name, followed by acronym. Web sites are provided for several agencies and
organizations following the terms’ citations. The OHA Web site may be an
additional resource for more information for certain terms.
A
comprehensive list of acronyms is also available to help sort
through the health care alphabet soup.
If you would like to recommend additions to the OHA
Glossary, send them to Katie Taybus
in the Public Affairs Department for
consideration in future editions. For additional copies of the glossary,
please contact Paula King in the
Mailing Services Department. Suggestions and requests may also be mailed
to:
Ohio Hospital Association
155 E. Broad St., Floor 15
Columbus, OH 43215-3620
614.221.7614
AA
B
C D E
F G
H
I J K
L M
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P Q R
S T U
V W
Y Z
| access |
A patient's ability to obtain medical care. The ease of access is
determined by components such as the availability of medical
services and their acceptability to the patient, availability of
insurance, the location of health care facilities, transportation,
hours of operation, affordability and cost of care.
|
|
accreditation
|
Approval
by an authorizing agency for institutions and programs that meet
or exceed a set of pre-determined standards.
|
| activities of daily
living (ADLs)
|
Activities performed as
part of a person's daily routine of self-care such as bathing,
dressing, toileting and eating.
|
| acute
care
|
Hospital care given to
patients who generally require a stay of several days that
focuses on a physical or mental condition requiring immediate
intervention and constant medical attention, equipment and
personnel.
|
| AdminaStar
Federal
|
Ohio's
Medicare Part A
fiscal intermediary.
www.astar-federal.com
|
| administrative
costs
|
Costs related to
activities such as utilization review, marketing, medical
underwriting, commissions, premium collection, claims processing,
insurer profit, quality assurance and risk management for
purposes of insurance. |
| advance
directive
|
A document that patients
complete to direct their medical care when they are unable to
communicate their own wishes due to a medical condition. In Ohio,
do not resuscitate orders, living wills and durable powers of
attorney are advance directives that are authorized by state law.
(see do not resuscitate,
durable power
of attorney and living will)
www.ohanet.org |
|
advanced practice
nurse (APN)
|
A registered nurse who
is approved by the Board of Nursing
to practice nursing in a specified area of advanced nursing
practice. APN is an umbrella term given to a registered nurse who
has met advanced educational and clinical practice requirements
beyond the two to four years of basic nursing education required
of all RNs. There are four types: 1) certified registered nurse
anesthetist (CRNA); 2) clinical nurse specialist (CNS); 3)
certified nurse practitioner (CNP); and 4) certified nurse midwife
(CNM).
|
| adverse
drug event (error)
|
Any incident in which
the use of medication (drug or biologic) at any dose, a medical
device, or a special nutritional product may have resulted in an
adverse outcome in a patient.
|
| adverse
event
|
An injury resulting from
a medical intervention that is not due to the underlying condition
of the patient.
|
| adverse
selection
|
Among applicants for a
given group or individual health insurance program, the tendency
for those with an impaired health status, or those who are prone to
higher-than-average utilization of benefits, to be enrolled in
disproportionate numbers in lower deductible plans. |
| aftercare
|
Services following
hospitalization or rehabilitation, individualized for each
patient's needs. Aftercare
gradually phases the patient out of treatment while providing
follow-up attention to prevent relapse. |
| Agency
for Healthcare Research and Quality
(AHRQ)
|
A federal agency within
the Public Health Service responsible for research on quality,
appropriateness and cost of health care. AHRQ also
centralizes access to state inpatient data.
www.ahrq.gov |
|
Akron Regional Hospital Association (ARHA) |
A regional allied association representing hospitals
and health systems in the Akron, Ohio, region.
www.arha.org |
| allied
health personnel
|
Specially trained and
often licensed health workers other than physicians, dentists,
optometrists, chiropractors, podiatrists and nurses. The term is
sometimes used synonymously with paramedical personnel, which are all health
workers who perform tasks that must otherwise be performed by a
physician, or health workers who do not usually engage in
independent practice. |
| allopathic
|
One of two schools of
medicine that treat disease by inducing effects opposite to those
produced by the disease. The other school of medicine is osteopathic. |
| allowable
costs
|
Charges for services
rendered or supplies furnished by a health provider that qualify
as covered expenses for insurance purposes.
|
| alternative
delivery
|
An alternative to
traditional inpatient care system such as ambulatory care, home
health care and same-day surgery. |
| alternative
medicine
|
Treatment procedures
that are not supported by mainstream medicine, often due to
lack of supporting experimental data. |
|
am.
|
Amended. A designation
sometimes found before a House or Senate bill number showing that
formal changes have been made to an introduced piece of
legislation during the legislative process. |
| ambulance
restocking
|
The practice of a
hospital replenishing certain drugs and supplies used by an
ambulance service during transport of a patient to the hospital.
|
| ambulatory
care
|
Care given to patients who do not
require overnight hospitalization. |
|
ambulatory patient group (APG) |
The Medicare program's prospective payment system for
outpatient services and procedures. Each APG is a classified
medical service or procedure. Unlike diagnosis related group
reimbursement for inpatient care, where medical events are condensed
into one diagnostic related group, an outpatient visit can combine
several different APGs. |
| ambulatory
payment classification (APC)
|
Groups or groupings of medical procedures and services used as a
basis for reimbursement under the Medicare outpatient prospective
payment system. |
| ambulatory
setting
|
An
institutional health setting in which organized health services
are provided on an outpatient basis, such as a surgery center,
clinic or other outpatient facility. Ambulatory care settings also
may be mobile units of service (e.g., mobile mammography, MRI). |
| ambulatory
surgical facility
|
see
freestanding outpatient surgical center
|
| American
Accreditation Healthcare Commission (AAHC)
|
An independent not-for-profit corporation that develops national
standards for utilization review and managed care organizations. www.urac.org
|
| American
College of Healthcare Executives
(ACHE)
|
An
international professional society of nearly 30,000 health care
executives based in Chicago. www.ache.org
|
| American
Health Care Association (AHCA)
|
A
trade association representing nursing homes and long-term care
facilities in the U.S. based in Washington, D.C. www.ahca.org
|
| American
Hospital Association (AHA)
|
A national association that represents allopathic and osteopathic
hospitals in the U.S. AHA is based in Washington, D.C., with
operational offices in Chicago. www.aha.org
|
| American Medical
Association (AMA)
|
A national association
organized into local and regional societies that represents over
700,000 medical doctors in the United States. AMA is based in Chicago.
www.ama-assn.org
|
| American
Osteopathic Association (AOA)
|
A national association
organized into local and regional societies that represents over
43,000 osteopathic physicians in the United States. AOA is based in
Chicago and also provides accreditation for hospitals and colleges of
osteopathic medicine.
www.osteopathic.org
|
|
American Society for Clinical Laboratory Science (ASCLS) |
An organization
for clinical laboratory science practitioners, providing leadership
and promoting all aspects of clinical laboratory science practice,
education and management to ensure cost-effective laboratory
services for health care consumers.
www.ascls.org |
|
American Society for Clinical Pathology (ASCP) |
A national resource for the
enhancement of the quality of the practice of pathology and
laboratory medicine.
www.ascp.org |
| Americans with
Disabilities Act (ADA)
|
A federal law
that
prohibits employers of more than 25 employees from discriminating
against any individual with a disability who can perform the
essential functions, with or without accommodations, of the job
that the individual holds or wants. www.usdoj.gov/crt/ada/adahom1.htm
|
| ancillary
|
A term used to describe additional
services performed related to care, such as lab work, X-ray and
anesthesia. |
| Annual
Hospital Registration and Planning Report
|
An annual report of health care statistics that hospitals are
required by law to file with the Ohio Department of Health.
|
| anti-kickback
statute
|
A
federal law that prohibits the paying or receiving of remuneration
in exchange for the referral of patients or business paid by a
federal health care program.
|
| antitrust
|
A
situation in which a single entity, such as an integrated delivery
system, controls enough of the practices in any one specialty in a
relevant market to have monopoly power (e.g., the power to
increase prices).
|
| any willing
provider
|
A term used to
describe legislation requiring a health plan to accept on its
provider panels every physician, hospital or other practitioner
that wants to participate in the health plan’s products.
|
| approved
health care facility or program
|
A
facility or program that is licensed, certified or otherwise
authorized pursuant to the laws of the state to provide health
care and that is approved by a health plan to provide the care
described in a contract. |
|
associate degree in
nursing (ADN)
|
A degree received
after completing a two-year nursing education program at a college
or university that qualifies a nurse to take a national licensing
exam (NCLEX) to become a registered nurse.
|
|
attorney
general |
Chief law enforcement officer of a
state, responsible for advising the state or nation of legal
matters. |
|
average adjusted
per capita cost (AAPCC)
|
Payment rates used by
the Centers for Medicare & Medicaid Services to reimburse
managed care organizations for care delivered to Medicare
enrollees.
|
| average length of
stay (ALOS)
|
A standard hospital statistic used to determine the average amount
of time between admission and departure for patients in a diagnosis
related group, an age group, a specific hospital or other factors.
|
|
avian (or bird) flu |
Caused by
influenza viruses that occur naturally among wild birds. The H5N1
variant is deadly to domestic fowl and can be transmitted from birds
to humans. There is no human immunity and no vaccine is available.
(see also seasonal flu and
pandemic flu) |
|
bachelor
of science in nursing (BSN)
|
A
degree received after completing a four-year college or
university program that qualifies a graduate nurse to take a
national licensing exam (NCLEX) to become a registered nurse.
|
|
bad debt |
Results when patients do not pay
bills for which payment was expected. It occurs for a variety of
reasons, such as when uninsured patients have incomes above the
guidelines for charity care, but still cannot afford the cost of
their care. |
| balance
billing
|
A
provider's billing of a covered person directly for charges above
the amount reimbursed by the health plan. This may or may not be
allowed, depending upon the contractual arrangements between the
parties.
|
| Balanced
Budget Act of 1997 (BBA)
|
A federal law enacted by
U.S. Congress that makes
numerous changes to various titles of the Social Security Act,
contains significant changes to the Medicare and Medicaid
programs, and creates a new Title XXI, the State Children's Health
Insurance Program (SCHIP). Payment reductions and other changes
enacted under the BBA likely will continue to be the focus of
advocacy efforts for hospitals and other providers throughout the
early 21st century. |
| Balanced
Budget Refinement Act of 1999 (BBRA)
|
A
federal law enacted by U.S. Congress that restores an estimated $17
billion to the Medicare program. The law provides relief for
hospitals, and includes special packages for rural and teaching
hospitals, nursing homes and home health agencies.
|
| behavioral
health care
|
Mental
health services, including services for alcohol and substance
abuse.
|
| benchmarking
|
A
method of comparing the procedures and results of a process,
system or operation under study with a similar process, system or
operation under study that is generally recognized as outstanding.
|
beneficiary
|
A
person designated by an insuring organization as
eligible to receive insurance benefits.
|
| Benefits
Improvement and Protection Act of 2000 (BIPA)
|
A
federal law enacted by U.S. Congress that, among other provisions,
restores an estimated $11.5 billion over five years to hospitals
under Medicare, Medicaid and other federal and state health care
programs.
|
|
bioterrorism planning regions |
Ohio is divided into seven regions to promote
regional bioterrorism planning between hospitals, public health and
all responding agencies to a terrorist event. |
| Blue
Cross and Blue Shield Association (BC/BS)
|
An
organization that offers information, consultation, representation
and operational services for the Blue Cross and Blue Shield plan
members across the country for purposes of providing insurance
benefits. www.bluecares.com
|
| board
certified
|
A
clinician who has passed the national examination in a particular
field. Board certification is available for most physician
specialties, as well as for many allied medical professions.
|
|
Bureau
of Workers' Compensation (BWC)
|
The
state-operated insurance system that pays medical and lost wage
benefits to workers who are injured on the job. www.ohiobwc.com
|
| capitation
(CAP)
|
A
stipulated dollar amount established to cover the cost of health
care delivered for a person or group of persons. The term usually
refers to a negotiated per capita rate to be paid periodically,
usually monthly, to a health care provider. The provider is
responsible for delivering or arranging for the delivery of all
health services required by the covered person(s) under the
conditions of the contract.
|
|
captive insurance |
A wholly owned subsidiary of a business or other
legal entity, including a group of hospitals or trade associations,
that is formed to insure risk. A captive is a form of
self-insurance that has assumed the formalities of an insurance
company. |
|
careLearning
|
An
online education service of more than 40 state hospital associations along
with the American Hospital Association (AHA) for the purpose of
delivering more cost-effective education to hospitals.
www.carelearning.com
|
| CARE
System
|
The Core Analysis Research Evolution (CARE) System is a set of
process measures used for quality improvement. The
system meets Joint Commission and CMS core measurement requirements.
|
|
carrier |
The Medicare Part B claims processing contractor. |
| case
manager
|
A
health care professional who monitors the allocation and
coordination of a patient's overall care.
|
| case
mix index
|
A
measure of relative severity of medical conditions of a hospital's
patients.
|
|
Center for Health Affairs (CHA) |
A regional allied association representing hospitals
and health systems in Northeast Ohio.
www.chanet.org |
| Centers
for Disease Control and Prevention (CDC)
|
An agency within the U.S. Department of Health and Human Services
that serves as the central point for consolidation of disease
control data, health promotion and public health programs. www.cdc.gov
|
|
Centers for Medicare & Medicaid Services (CMS)
|
An agency within the U.S. Department of Health and Human Services
responsible for the administration of the Medicare and Medicaid
programs. Formerly called the Health Care Financing Administration. www.cms.gov
|
|
Central Ohio Hospital Council (COHC) |
A regional allied association representing hospitals
and health systems in Central Ohio.
www.centralohiohospitals.org |
| certificate
of need (CON)
|
A designation that hospitals had to obtain from the Ohio Department
of Health to authorize an activity such as constructing or
modifying hospitals, purchasing certain medical equipment or
providing new health care services. This process was gradually
phased out for most acute care hospital activities from 1995
through 1998 and replaced with quality standards.
|
|
charity
care
|
Health care
provided at a substantial discount to those unable to pay. Hospitals
either do not attempt to collect a portion of charges or agree to
write off charges. Eligibility is sometimes determined from a
sliding scale based on a percentage of the patient's income above
the federal poverty level. |
| Children’s
Health Insurance Program (CHIP)
|
A
state-administered program funded partly by the federal government
that allows states to expand health coverage to uninsured,
low-income children not eligible for Medicaid. Also called State Children’s Health Insurance Program (SCHIP). www.hcfa.gov/INIT/CHILDREN.HTM
|
| Civilian
Health and Medical Program of the Uniformed Services (CHAMPUS)
|
A
program that provides funds to pay for the treatment
in private institutions for members of
the uniformed services and their families.
(see Tricare)
|
|
claims-made insurance policy |
A liability insurance policy under which coverage applies
to claims filed during the policy period. Medical professional liability
insurance is typically written on a claims-made basis. |
|
Clinical
Laboratory Improvement Amendments (CLIA) |
Federal law designed to
set national quality standards for laboratory testing. The law
covers all laboratories that engage in testing for assessment,
diagnosis, prevention or treatment purposes. |
|
clinical nurse specialist (CNS) |
A registered nurse with a
graduate degree in nursing who may provide and manage the care of
individuals and groups with complex health problems and provide
health care services that promote, improve and manage health care
within the nurse’s nursing specialty.
|
| closed
panel
|
Medical
services delivered in the health insuring corporation (HIC)-owned
health center or satellite clinic by physicians who belong to a
specially formed, but legally separate, medical group that only
serves the HIC.
|
|
Consolidated Omnibus Budget Reconciliation Act
|
see
Omnibus Budget Reconciliation Act |
| Code
of Federal
Regulations (CFR)
|
A
publication of the federal government that consists of all
regulations of federal departments and agencies.
www.gpoaccess.gov/cfr/index.html |
|
co-insurance
|
A specified dollar amount
or percentage of covered expenses that an insurance policy or
Medicare requires a beneficiary to pay toward eligible medical
bills. |
|
community
benefit
|
Hospital community benefit includes programs or
activities that provide treatment and/or promote health and healing
as a response to identified community needs. A community benefit
must meet at least one of the following criteria: generates a low or
negative margin, responds to needs of special populations, supplies
services that would likely be discontinued if considered on a purely
financial basis, responds to public health needs, and/or involves
education or research that improves overall community health.
www.caringforcommunities.org/caringforcommunities/
and www.ohanet.org |
|
Community
Health Information Network (CHIN)
|
A
community-based activity that focuses on the development of a
shared information database and retrieval system of patients,
their medical histories and clinical and diagnostic tests.
|
| community
rating
|
Setting
insurance rates based on the average cost of providing health
services to all people in a geographic area without adjusting for
each individual’s medical history or likelihood of using medical
services.
|
|
computerized
physician order entry (CPOE) |
A system that allows
physicians to write medical orders for their hospitalized patients
using a clinical software application. |
| conference committee
|
A
bi-partisan committee made up of three members from each chamber
of the Ohio General Assembly or U.S. Congress that is responsible
for working out differences between House- and Senate-passed
versions of a piece of legislation.
|
|
Congressional Budget Office |
A non-partisan office that provides U.S. Congress
with cost estimates of legislative proposals and calculates
estimates related to the federal budget. |
|
Consolidated Omnibus Budget Reconciliation Act
(COBRA) |
Health benefit provisions passed by Congress in
1986 amending the Employee Retirement Income Security Act, the
Internal Revenue Code and the Public Health Service Act to
provide continuation of group health coverage that otherwise
might be terminated. |
|
continuing
education unit (CEU)
|
A uniform unit of measurement
used to assess all levels of noncredit continuing education. One
CEU is equivalent to 10 contact hours of participation in an
organized continuing education experience. |
|
continuing
medical education (CME)
|
The
continuing education of practicing physicians and nurses through
refresher courses, journals and texts, educational programs and
self-study courses. In some states, including Ohio, continuing
education is required for continued licensure.
|
Continuous Survey Readiness
Program (CSR)
|
A joint
effort of OHA and the Joint Commission Resources to help
hospitals attain a level of
continuous survey readiness for accreditation surveys.
www.ohanet.org
|
Controlling Board
|
A seven-member board consisting of six legislators and one
appointee of the Ohio Office of Budget and Management that, under
certain conditions, has authority to increase spending levels and
authorize expenditures for state agencies and programs.
|
| coordination
of benefits
|
Provisions
and procedures used by third-party payers to determine the amount
payable when a claimant is covered under two or more health plans.
|
| copayment
|
A
type of cost-sharing that requires the insured or subscriber to
pay a specified flat dollar amount, usually on a
per-unit-of-service basis, with the third-party payer reimbursing
some portion of the remaining charges.
|
|
corporate campaign |
A strategy whereby a labor union aggressively
attacks the public reputation of a target employer with a goal
of forcing management to yield to the union's demands or risk
the company's financial well-being. |
|
Corporate
Partner
|
An
organization doing business with Ohio hospitals that is a member
in good standing with OHA. www.ohanet.org/partners |
| corporate
practice of medicine
|
A
state law doctrine that prohibits any person or entity other than
a licensed physician from holding itself out as a provider of
professional medical services, from billing in its name for such
professional medical services, or from owning or controlling a
professional medical delivery system.
|
|
cost |
The price a hospital must pay to provide a service,
including the price of providing facilities, technology and
workforce. |
| credentialing
|
The
process of reviewing a practitioner’s academic, clinical and
professional ability as demonstrated in the past to determine if
criteria for clinical privileges are met.
|
| critical
access hospital (CAH)
|
A
federal designation under which hospitals receive cost- based
reimbursement for Medicare services. Hospitals must meet certain
criteria, such as size, length of stay and proximity to other
facilities.
|
| critical
pathway
|
Standardized
specifications for care developed by a formal process that
incorporates the best scientific evidence of effectiveness with
expert opinion.
|
| deductible
|
An amount which a policyholder agrees to pay, per
claim or per accident, toward the total amount of an insured loss.
Under a health insurance policy, the out-of-pocket expenses paid by
the health insurance subscriber before the insurer will begin
reimbursing the subscriber for additional medical expenses. |
| diagnostic
related group (DRG)
|
A
classification system that groups patients by common
characteristics requiring treatment.
|
Disability Medical Assistance
|
A state
administered program that provides limited medical assistance to
persons who are medication-dependent and ineligible for any
category of Medicaid. There is no federal funding or federal
regulation of this program. |
|
disaster codes |
see Ohio Emergency Codes |
| discharge
planning
|
The
evaluation of patients' health needs for appropriate care after
discharge from an inpatient setting.
|
| disproportionate
share hospital (DSH)
|
A
hospital that provides care to a high number of patients who
cannot afford to pay and/or do not have insurance.
|
| diversion
|
The
routing of patients to other hospitals because an emergency room
is at maximum capacity.
|
|
doctor of
osteopathy (DO)
|
A
licensed physician who is a graduate from an accredited school of
osteopathic medicine.
|
|
do
not resuscitate (DNR)
|
An advance
directive that patients may make to forego cardiopulmonary
resuscitation or other resuscitative efforts. (see advance
directive) |
| durable
medical
equipment (DME)
|
Equipment
that can stand repeated use, is primarily and customarily used to
serve a medical purpose, generally is not useful to a person in
the absence of illness or injury, and is appropriate for use at
home, such as hospital beds, wheelchairs and oxygen equipment.
|
|
durable
power of attorney
|
A
document in which individuals select another person to act on
their behalf in the event they become incapacitated. The document
may identify specific activities, such as managing the
incapacitated person's financial affairs. If the document allows
the agent to make health care decisions, it must be drafted in a
manner that meets statutory requirements for a "health care
durable power of attorney." (see advance
directive) |
|
electronic health record (EHR) |
A
patient’s computerized health information as recorded and maintained
by a provider system. An EHR is distinguished from a physician
health record (PHR) by control: an EHR is controlled by the
provider’s system while a PHR is owned and controlled by the
patient. |
| emergency
medical services (EMS)
|
A
system of health care professionals, facilities and equipment
providing emergency care.
|
| emergency
medical technician (EMT)
|
A
person certified to provide pre-hospital emergency medical
treatment.
|
| Employee
Retirement Income Security Act (ERISA)
|
A
federal law that exempts self-insured health plans from state laws
governing health insurance, including contribution to risk pools,
prohibitions against disease discrimination and other state health
reforms.
|
| Environmental
Protection Agency (EPA)
|
A
federal and state agency responsible for programs to control air,
water and noise pollution, solid waste disposal and other
environmental concerns. www.epa.gov
|
| exclusions
|
Specific conditions or circumstances listed in an
insurance contract for which the policy will not provide benefit
payments. Exclusions can eliminate coverage for select individuals,
groups, locations, properties or risks. |
| experience
rating
|
A
system where an insurance company evaluates the risk of an
individual or group by considering the applicant's loss history.
For health insurance this would include evaluation of the
applicant's health history. |
|
Extended Reporting Period |
An additional period of time after policy
expiration during which valid claims will be paid under a
claims-made policy of liability insurance. |
failure
mode
effect analysis
|
A systematic
method of identifying and preventing problems (errors) before they
occur.
|
False Claims Act
|
A federal law
that imposes liability for treble damages and fines of $5,000 to
$10,000 for knowingly submitting to the federal government a false
or fraudulent claim for payment.
|
| Farmers
Home Administration (FHA)
|
A
division of the U.S. Department of Agriculture that guarantees
hospital mortgages. www.citation.com/hpage/fha.html
|
| federal
financial
participation (FFP)
|
The
portion paid by the federal government to states for their share
of expenditures for providing Medicaid services and for
administering the Medicaid program and certain other human service
programs. Also called federal medical assistance percentage (FMAP).
|
| federal
fiscal year (FFY) |
The
federal government's accounting year, which begins Oct. 1
and ends Sept. 30 (e.g., FFY 2009 begins Oct. 1, 2008, and ends
Sept. 30, 2009).
|
|
federal medical assistance percentage (FMAP) |
The
share of each state's Medicaid program paid by the federal
government, based on the state's per capita income. By law, the FMAP
cannot be lower than 50 percent nor higher than 83 percent, with the
average FMAP about 57 percent. Ohio's 2000 FMAP is 62 percent. Also
called federal financial participation. |
federal poverty guidelines
|
The official
annual income level for poverty as defined by the federal
government. Under the 2008 guidelines, the federal poverty level
for a family of four is $21,200.
|
Federal Register
|
An official
publication of the federal government that provides final and
proposed regulations of federal legislation.
www.gpoaccess.gov/fr/index.html
|
| Federation
of American Hospitals (FAH)
|
A
trade association composed of proprietary or investor-owned
hospitals.
www.fah.org |
| fee
for service
|
A
method in which physicians and other health care providers receive
a fee for services performed.
|
| fee
schedule
|
A
comprehensive listing of fees used by either a health care plan or
the government to reimburse providers on a fee-for-service basis.
|
| Fellow
of American College of Healthcare Executives
(FACHE)
|
A
credential awarded by the American College of Healthcare
Executives.
|
| fiscal
intermediary
|
see
Medicare
Administrative Contractor |
| fiscal
note
|
An
analysis by the Legislative Budget Office of the financial impact
of proposed state legislation.
|
| fiscal
year (FY)
|
Any
entity's accounting year.
|
525 Account
|
The specific line item in the state budget that represents the
Medicaid budget under the Ohio Department of Job and Family
Services.
|
| Food
and Drug Administration (FDA)
|
An
agency within the federal government that is responsible
for regulations pertaining to food and drugs sold in the United
States. www.fda.gov
|
| Foundation
for Healthy Communities
|
The
nonprofit foundation of OHA that promotes and supports healthy
communities and lifestyles through partnerships with Ohio hospitals
and health systems.
www.healthycommunitiesohio.org
|
| freestanding
emergency medical service center
|
A
health care facility that is physically separate from a hospital
and whose primary purpose is the provision of immediate,
short-term medical care for minor but urgent medical conditions.
(see "urgent care")
|
| freestanding
outpatient surgical center
|
A
health care facility, physically separate from a hospital, that
provides pre-scheduled, outpatient surgical services. (see
surgicenter or
ambulatory surgical
facility) |
Friends of Ohio Hospitals
|
A corporate
political action committee supported by Ohio hospital employees
and board members to protect and promote the needs of their
patients and of their health care delivery through political
action.
www.friendsofohiohospitals.org
|
| full-time
equivalent (FTE)
|
A
standardized accounting of the numbers of full-time and part-time
employees.
|
|
FutureThink |
An initiative created by the Ohio Organization for
Nurse Executives and OHA to design the future of clinical
health care in response to the current health care workforce
shortage.
www.futurethink.org |
| gatekeeper
|
A
primary care physician responsible for overseeing and coordinating
all aspects of a patient’s medical care and pre-authorizing
specialty care.
|
| general
practitioner
|
A
physician whose practice is based on a broad understanding of all
illnesses and who does not restrict his/her practice to any
particular field of medicine.
|
|
going bare |
The colloquial term describing the choice of an
individual, provider or other legal entity not to purchase liability
insurance such as medical liability insurance or have a
self-insurance mechanism such as a trust fund, or captive insurance
company. |
|
Government Accountability Office (GAO) |
A non-partisan investigative arm of U.S. Congress
that evaluates federal programs as an oversight of federal spending,
efficiency and performance.
www.gao.gov |
| graduate
medical education (GME)
|
Medical
education as an intern, resident or fellow after graduating from a
medical school.
|
|
Greater Cincinnati Health Council (GCHC) |
A regional allied association representing hospitals
and health systems in the Cincinnati region.
www.gchc.org |
|
Greater Dayton Area Hospital Association (GDAHA) |
A regional allied association representing hospitals
and health systems in the Dayton region.
www.gdaha.org |
| group
insurance
|
Any
insurance policy or health services contract by which groups of
employees (and often their dependents) are covered under a single
policy or contract, issued by their employer or other group
entity.
|
| group
model HMO
|
An
HMO that contracts with a multi-specialty medical group to provide
care for HMO members. Members are required to receive medical care
from a physician within the group unless a referral is made
outside the network.
|
| group
practice association
|
A
formal arrangement of three or more physicians or other health
professionals providing health services. Income is pooled and
redistributed to the members of the group according to a
prearranged plan.
|
|
health care-acquired condition |
see
hospital-acquired condition |
|
health
care durable power of attorney
|
A
document in which individuals select another individual to make
health care decisions for them in the event they become
incapacitated. A health care durable power of attorney should be
distinguished from a living will, a document drafted by an
individual that provides direction regarding medical care if the
individual becomes incapacitated by terminal illness or permanent
unconsciousness. (see advance
directive)
|
|
Health Employer Data and Information Set (HEDIS) |
A set of performance
measures designed to standardize the way health plans report data to
employers. HEDIS measures five major areas of health plan
performance: quality, access and patient satisfaction, membership
and utilization, finance, and descriptive information on health plan
management. |
| Health
Insurance Association of America (HIAA)
|
A
corporate member association of health and accident insurance
companies. www.hiaa.org
|
| Health
Insurance Portability and Accountability Act (HIPAA)
|
Federal legislation, enacted in 1996, mandating
regulations governing privacy, security and administrative
simplification standards for health care information. HIPAA governs
how health care organizations handle all facets of information
management, including patient records. |
| health
insuring corporation (HIC)
|
A term for managed care insurers in Ohio which
includes all Ohio HMOs and other companies that offer pre-paid
managed care. |
| health
maintenance organization (HMO)
|
An
entity that offers prepaid, comprehensive health coverage for both
hospital and physician services with specific health care
providers using a fixed fee structure or capitated rates.
|
| Health
Partnership Program (HPP)
|
One
of two systems for managing workers' compensation health care in
Ohio. Primarily designed for state-fund employers, the HPP uses
private managed-care organizations (MCOs) certified by the state
Bureau of Workers’ Compensation to provide medical
services.
|
|
health savings account |
Formerly called
medical savings accounts (MSAs), a method of financing health care
by giving tax advantages to individuals who establish and maintain
personal accounts for health care purposes; similar to an Individual
Retirement Account for retirement purposes. The health savings
account legislation was signed into law in 2003, making the HSA the
next generation of MSA plans. |
| health
service agency (HSA)
|
A
local agency that engages in voluntary health planning. Ohio
has 10 regions of the state previously designated as health
service regions for planning purposes.
|
Healthy Start/Healthy Families
|
A Medicaid
program that provides health care for pregnant women, children and
parents who are at or below a specified level of income and
age.
|
Help Me Grow
|
A program
intended to reduce
infant deaths and illnesses in Ohio by promoting preventive health
care and educating parents as to the care and early development of
their children.
www.helpmegrow.org
|
Hill-Burton Act
|
Federal
legislation enacted in 1947 to support the construction and
modernization of health care institutions.
No funds have been appropriated since the late 1960s.
|
| home
health agency
|
An
organization that provides medical, therapeutic or other health
services in patients' homes.
|
| hospice
|
A
facility or program that is licensed, certified or otherwise
authorized by law that provides supportive care of the
terminally ill.
|
|
hospital-acquired
condition (HAC) |
Conditions that could reasonably have been
prevented through the application of evidence based guidelines. |
|
hospital-acquired infection (HAI) |
An infection acquired by an individual while
receiving care or services in a health care organization. |
| hospital
affiliation
|
A
contractual relationship between a health insurance plan and one
or more hospitals whereby the hospital provides the inpatient
benefits offered by the plan.
|
| Hospital
Care Assurance Program (HCAP)
|
Ohio’s
Medicaid disproportionate share hospital (DSH) program in which
hospitals are assessed to attract federal matching funds to help
hospitals provide health care for the indigent and uninsured.
www.ohanet.org/hcap/ |
|
