Author: Glossary

Setting (or agreeing upon) prices in advance for the furnishing of a product or service. This is in direct contrast with the concept of reimbursement, in which the service or product is provided first, and then the provider is paid whatever it cost. The prospective payment system (PPS) adopted for Medicare, and applied also for…

The name given the system currently in use for paying for services for Medicare patients (payment for patients “by Diagnosis Related Groups (DRGs)”). The idea is that patients are classified into categories (in this case, DRGs) for which prices are negotiated or imposed on the hospital in advance; thus it is actually “prospective pricing” rather…

A term often used as a misnomer for prospective pricing. “Prospective pricing” is the term which more accurately denotes the intent of the payment system currently being used for Medicare, which is discussed under prospective payment system (PPS).  

A short-term (from one to ten year) loan from a foundation or other philanthropic organization to a nonprofit organization which is eligible for grants or charitable contributions. Nonprofit organizations often have difficulty in obtaining loans through normal channels because such organizations typically do not show profit margins, which the usual lending institutions see as essential…

A term now being used in health care to denote the kinds of services offered by a health care institution, including, for example, the kinds of patients (defined by their diagnoses, procedures required, and age limitations accepted for care). For example, a hospital’s product line might include three “products”—acute care, hospice care, and home health…

The mechanisms by which one given health care facility (a hospital, laboratory, or imaging service, for example) or specialist physician is selected in preference to another. Since such “procedure services” are the results of referral, primarily from physicians, “procedure capture” really is the sum of the efforts to persuade the referring person to make the…

A physician in whose specialty the performance of procedures, diagnostic or therapeutic, such as endoscopies and surgical operations, are a significant element. Physicians who are not proceduralists have no specific label, but their services are often described as “cognitive”. Despite advent of the resource-based relative value scale (RBRVS) system in physician payment reform (PPR), the…

Interactive computer software for common PC computers which elicits (profiles) the significant attributes of a patient’s problem and then matches (couples) this profile of the patient with the existing literature which has a bearing on the understanding of or solution to that problem.  

A special right, benefit, or advantage granted to one person or a group or entity, but not to everyone. Rights granted by the governing body of the hospital to physicians and other health care professionals, who are members of the medical staff, giving them permission to carry out specified diagnostic and therapeutic procedures within the…

A group of primary care physicians who have formed a network in order to share the risk of providing services to enrollees in a prepaid plan.