Author: Glossary

A proposed mechanism for helping an individual provide funds for health care. It would be a savings account set up for an individual under regulations and tax treatment similar to an individual retirement account (IRA). The cash in the account would be available to pay for deductibles, copayments, and services not provided by the holder’s…

An agency established under the prospective payment system (PPS) to carry out certain surveillance functions with respect to hospital and physician performance and detection of fraud.  

An independent organization promoting electronic health records as a part of a seamless, patient-centered information system. Provides educational programs and publications in the field.  

A physician who contracts with or is employed by a health care plan (or other managed care organization) to provide medical direction. Responsibilities will include review of authorizations for referrals and admissions, review of cases for quality and utilization issues, formulation of clinical policies, criteria, and standards, and so forth. A physician, usually employed by…

An essentially undefined term which may refer to a single institution, but is usually taken to mean that there is more to the institution than merely a single hospital—perhaps several hospitals in a complex, or perhaps a wider range of facilities and services than an ordinary hospital is likely to offer. The term does not…

A hotel for patients who need certain hospital services, but who can live in hotel surroundings, that is, without round-the-clock nursing. This is not a hotel for the families of patients.  

Usually refers to the patient care audit (medical audit), which is a retrospective review of the quality of care of a group of patients, ordinarily a group with the same diagnosis or therapy.  

Traditionally, care which was under the direction of a physician. For a time, “medical care” came to refer only to those portions of the care provided directly or personally by a physician, with the care given by other professionals (such as nursing care, rehabilitation, and the like) excluded, or at least semi-independent, from the definition…

The tools, equipment, and supplies necessary to do any given work, as contrasted with the personnel needed to do the work.  

A federal antitrust case in which the appellate opinion suggests that providers can freely deal with (or even refuse to deal with) insurance companies even where the providers have a “natural monopoly” (the market is just too small to support additional providers). At trial it was argued that a provider (Marshfield Clinic and its wholly-owned…