Author: Glossary

Those services required to take care of the activities of daily living (ADL).  

Refers to the cost (or charge) for a health care premium for an individual for one month. At this writing, the cost PMPM is in the range of $100-150.  

A payment arrangement which allows money due to be paid in installments, over time, instead of in a lump sum. The term is used in regard to settlements (or judgments) in malpractice cases, which allow the defendant to pay for the patient’s health care and other needs as those expenses accrue, or to pay a…

A system of providing Medicare funds to providers on a regular basis. Periodic payments may be made monthly or semi-monthly to a hospital, home health agency, or skilled nursing facility in the Medicare program, based on the institution’s estimated annual Medicare revenue. Adjustments are made later when actual revenue figures become available. Such a system…

Data which are developed from the activities of an individual or institution. Traditional hospital statistics such as admissions and discharges, lengths of stay, and mortality are performance data. More sophisticated performance data can be developed from ongoing information systems, such as those for billing and medical records. These can describe patterns of medical and surgical…

An advisory body which in 1990 made recommendations as to universal health insurance coverage for both acute care and long term care, and recommended the play or pay method of financing. Most of the members of the Commission were congressional leaders. The official name of the Commission was the U.S. Bipartisan Commission on Comprehensive Health…

A committee of physicians, charged with review of the performance of other physicians. The committee may be that of a medical society, hospital department, medical staff, or other entity.  

The act of paying or the amount paid for health care services.  

An organization or person who furnishes the money to pay for the provision of health care services. A payer may be the government (for example, Medicare), a nonprofit organization (such as Blue Cross/Blue Shield (BC/BS)), commercial insurance , or some other entity. In common usage, “payer” most often means “third party payer”.  

Enabling individuals to control their own health and health care decisions. “Empowerment” means granting power or authority; it also means enablement. Granting authority may mean simply giving permission, but enablement may also require the provision of information not ordinarily available and/or additional education. “Patient empowerment” requires using empowerment in both senses. At a personal level,…