Healthcare Flashcards
Academic health center
An institution that encompasses all of the health-related components of a university, including its health professions school, patient care operations, and research enterprise.
Acute care hospital
A hospital (typically a community hospital) that delivers services designed to meet the needs of patients who require short-term care for a period of less than 30 days.
Ambulatory care
Medical care provided on an outpatient basis.
Ancillary services
Services that relate to a patient’s care, such as lab work, X-rays, and anesthesia.
Average length of stay
The average number of days in a given period that a patient remains in the hospital; varies by type of admission, age, and sex and is calculated by dividing the total number of bed days by the number of discharges for a specified period.
Bundled pricing
The act of placing several products or services together in a single package and selling for a lower price than would be charged if the items were sold separately; in healthcare, usually means one price for all of the services provided for a given diagnosis or procedure, such as total joint replacement.
Centers for Medicare & Medicaid Services
The federal agency responsible for administering Medicare, Medicaid, and the State Children’s Health Insurance Program.
Community benefit
Charitable care, educational services, and other benefits that a healthcare organization provides to its community to qualify as a tax-exempt charity under section 501(c)(3) of the Internal Revenue Code.
Community-acquired infection rates
The measure of infections acquired from a community, in contrast to those acquired in a hospital.
Continuum of care
The full spectrum of healthcare, including preventive, ambulatory, acute, post-acute, long-term, palliative, and hospice.
Critical access hospital
A rural community hospital that receives cost-based reimbursement.
Disproportionate share hospital
A hospital that receives Medicare funding for treating a higher proportion of indigent patients (calculated by a formula); the Affordable Care Act would decrease this funding over time.
Epidemiologic planning model
A statistical analysis and forecast of the health needs of the community a healthcare organization serves.
Evidence-based management
A management approach that relies heavily on performance measurement, identification of best practices, and formal process specification.
Health maintenance organization
A health insurance organization licensed at the state level to which subscribers pay a predetermined fee in return for access to a panel of employed physicians and network of facilities.
Health savings account
An account created for individuals who are covered under high-deductible health plans to save for medical expenses that the plans do not cover.
Healthcare Effectiveness Data and Information Set
A comprehensive set of standardized performance measures designed to provide purchasers and consumers with the information they need for reliable comparison of health plan performance; HEDIS measures relate to significant public health issues such as cancer, heart disease, smoking, asthma, and diabetes.
Hospice
An organization that provides medical care and support services (e.g., pain and symptom management, counseling, bereavement services) to terminally ill patients and their families; it may be a freestanding facility, a unit of a hospital or other institution, or a separate program of a hospital, agency, or institution.
Hospital preauthorization
A managed care technique in which the insured obtains permission from a managed care organization before entering the hospital for nonemergency care.
Hospitalist
A physicians who manages broad categories of hospitalized patients.
Indemnity plans
Traditional fee-for-service health plans.
Independent practice association
A legal entity that contracts with a group of independent physicians to provide services to managed care organizations at a negotiated per capita rate; the arrangement is usually not exclusive, so the physicians may sign contracts with other managed care companies.
Interdisciplinary plan of care
A documented process that includes the patient, the family, and all clinical disciplines involved in planning and providing care to a patient from system point of entry, throughout the entire acute care episode, and to the next level of care.
Joint Commission
The independent, not-for-profit organization that evaluates and monitors the quality of care provided in hospitals.
Long-term care
A continuum of maintenance, custodial, and health services provided to the chronically ill, disabled, or mentally handicapped.
Magnet Recognition Program
A program developed by the American Nurses Credentialing Center that recognizes healthcare organizations for quality patient care, nursing excellence, and innovations in professional nursing practice; Magnet designation is the ultimate credential for high-quality nursing.
Medicare recovery audit program
A program to identify and correct improper payments from Medicare to providers, with the aim of preventing future improper payments by Medicare; a common improper payment is for surgical services provided in the wrong setting (inpatient instead of outpatient).
Medigap
Health insurance sold by private insurance companies to fill the “gaps” in original Medicare plan coverage.
Morbidity
The incidence and severity of illness and accidents in a population.
Mortality
The incidence of death in a population.
Occupational Safety and Health Administration
An agency of the US Department of Labor whose mission is to ensure safe and healthful working conditions.
Outcome
The end result of medical care, as indicated by recovery, disability, functional status, mortality, morbidity, or patient satisfaction.
Palliative care
Interdisciplinary care provided to a patient with a serious, life-threatening, or life-limiting illness that aims not to provide curative treatment but rather to manage symptoms; relieve pain and discomfort; improve quality of life; and meet the emotional, social, and spiritual needs of the patient and the patient’s family.
Patient autonomy
A patient’s self-determination, or the right to make decisions regarding his or her own healthcare.
Patient satisfaction score
The measure of a patient’s overall satisfaction with the level of care received from a healthcare professional, hospital, or other healthcare provider; the HAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national standardized survey of patient satisfaction.
Patient-centered care
Care that is respectful of and responsive to the Individual patient’s preferences, needs, and values.
Point-of-service plan
A type of managed care insurance plan that combines characteristics of a health maintenance organization and a preferred provider organization; enrollees choose a primary care physician in the healthcare network as their “point of service,” but the primary care physician can make referrals outside the network for lesser compensation from the insurance company.
Population health
The health outcomes of a defined group of individuals.
Preferred provider organization
A type of health plan that contracts directly with providers to create a network; enrollees pay less if they use providers in the network.
Safety-net provider
A hospital or health system that provides a significant level of care to low-income, uninsured, and vulnerable populations; may be publicly owned and operated by local or state governments, or may be not-for-profit.
Service excellence
Anticipating and meeting or exceeding customer needs and expectations on the basis of an organization’s mission and values.
Service lines
Patient care teams organized and coordinated around a set of similar diseases or patient needs.
Shared governance
A nursing model in which staff nurses share the authority and accountability for practice decisions and other activities that influence their work environment.
Supply chain management
Management of the flow of goods and services, including the movement and storage of raw materials, of work-in-progress inventory, and of finished goods from the point of origin to the point of consumption.
Triage
The evaluation of patient conditions for urgency and seriousness and the establishment of a priority list to direct care and ensure the efficient use of medical and nursing staff and facilities.
Urgent care
Care for injury, illness, or another type of condition (usually not life threatening) that should be treated within 24 hours; also refers to after-hours care and to a health plan’s classification of hospital admissions as urgent, semiurgent, or elective.
US Department of Health and Human Services
A department of the US federal government that aims to protect the health and well-being of all Americans.
Value-based purchasing
Linking financial incentives to the quality of care provided.
