Author: Glossary

A patient who requires an unusually long stay or whose stay generates unusually great cost. The term is used in the prospective payment system (PPS). About five or six percent of the budgets for regional and national rates have been set aside for payments for outliers. Outliers provide an escape hatch for the hospital, because…

Research attempting to evaluate the relative benefits of various kinds of treatment and medical care by measuring the outcomes of the care. The basic question asked is “Does Treatment A or Treatment B give the better outcome?” This is, of course, followed by “How much better is the one than the other?” and “How costly…

An agency set up to keep records of persons needing organ transplants and donor organs available, and to match the two with such speed that the surgery can be performed. Also, an organization designated by the Health Care Financing Administration (HCFA) as qualified to obtain and supply organs for transplantation in the Medicare program.  

In 1989 Oregon passed the Oregon Basic Health Services Act designed to insure that all citizens would receive at least basic health care. One part would expand Medicaid coverage to all residents below the federal poverty level. This would be done by prioritizing services to be offered on the basis of cost-effectiveness, and only offering…

Submission of a patient’s bill with diagnosis and operation coding which will qualify for the highest reimbursement possible, yet avoid any suggestion to the payer’s audit system that an attempt is being made to obtain unjustified reimbursement, i.e., to avoid interpretation of the bill as “over-coded”. Computer systems which are intended to achieve optimal coding…

Short for On Lok Senior Health Services, a program in San Francisco’s Chinatown which enables severely disabled and frail older persons to remain at home rather than be placed in nursing homes.  

Electronically available from a local or remote location; can be accessed by computer with a modem or through a network. Often written as “on-line”. Online information is generally thought to be easier to distribute widely and keep up to date. Some types of information which can be made available online, such as pictures and sounds,…

A market in which there are only a few buyers who exert great influence on the market. A special case of oligopsony is a monopsony, in which there is only one buyer.  

A technique reported from Canada in which a review team goes into the offices of physicians whose practice is outside the hospital, and examines patient records (medical records) for the purpose of determining the quality of care.