You are on page 1of 48

OF HEALTHCARE TERMS & ABBREVIATIONS

JULY 2002
OF H EALTHCARE T ERMS & A BBREVIATIONS

All rights reserved. No part of this publication may be reproduced in


any form without the prior written permission of the publisher, the
New Jersey Hospital Association (NJHA). NJHA is not responsible for
any misprints, typographical or other errors, or any consequences
caused as a result of the use of this publication. This publication is
provided with the understanding that NJHA is not engaged in render-
ing any legal, accounting or other professional services and NJHA
shall not be held liable for any circumstances arising out of its use. JULY 2002
If legal advice or other expert assistance is required, the services of
a competent professional should be sought.
PREFACE

H ospitals rely greatly on the talents and expertise of groups of individuals who
donate their time to the hospital. These individuals, serving as hospital trustee,
auxiliary leader, or other volunteer, while usually not professionally educated in
the field of healthcare, are often called on to discuss healthcare issues. The Glossary of
Healthcare Terms and Abbreviations, a project of the NJHA Council on Hospital Governance,
is designed to help these individuals understand the everyday language of healthcare.

This Glossary, while primarily intended to familiarize members of hospital governance


boards with the language of healthcare, will be of value to anyone involved in healthcare.
It serves as a quick read of commonly used healthcare terms and abbreviations. The NJHA
Council on Hospital Governance encourages reference to the Glossary as a way to better
understand the meaning of today’s most pressing healthcare issues.

Gary S. Carter, FACHE


President and CEO
New Jersey Hospital Association

Glossary of Healthcare Terms & Abbreviations I


CONTENTS
TS

Introduction ............................................................................................ iii

Glossary of Healthcare Terms.................................................................. 1

Frequently Used Abbreviations/Acronyms ............................................ 31

Glossary of Healthcare Terms & Abbreviations II


INTRODUCTION

T he language of healthcare has changed drastically over the past two decades. The
NJHA Council on Governance’s first glossary, for example, was called Glossary of
HOSPITAL Terms and Abbreviations. Now, titled the Glossary of HEALTHCARE Terms
and Abbreviations, it reflects hospitals’ movement beyond their own four walls. At one time,
the language of healthcare was almost exclusively within the medical domain. Now, one must
also be fluent in the language of business, finance and computer technology.

The Glossary is designed as an easy-to-use reference. Users of the Glossary will find words
and terms dealing with medicine, finance, insurance and the computer world. It is not an all-
inclusive healthcare dictionary, but rather a glossary of words, terms and abbreviations
commonly used by professionals involved in New Jersey’s hospital and healthcare industry.

The first section of the Glossary includes definitions of words and terms, defined within the
context of the healthcare world. Any commonly used abbreviations or acronyms for the
words and terms are provided. A list of frequently used general healthcare abbreviations and
or acronyms comprise the second section.

Future revisions of the Glossary will be published as needed. It is through such revisions that
the Council on Hospital Governance will continue to help non-healthcare professionals
participate in meaningful healthcare dialogue.

The Council on Hospital Governance gratefully acknowledges the expertise and assistance of
NJHA staff in the development of the original and revised edition of the Glossary.

Glossary of Healthcare Terms & Abbreviations III


Glossary of Healthcare Terms
APD Adjusted patient day. An accounting method for modifying
the definition of inpatient days to include outpatient revenues.

Access Potential and actual entry of a population into the healthcare


delivery system.

Accounts Receivable Assets arising from services provided or the sales of goods to
patients on credit

Accreditation A process of evaluating an institution to see if it meets stan-


dards set by the accrediting body. Generally refers to the
evaluation by the Joint Commission on Accreditation of
Health Care Organizations. (see JCAHO)

Accreditation Manual A JCAHO publication published annually, consisting of policies


For Hospitals and procedures relating to hospital accreditation surveys,
hospital standards and scoring guidelines used to determine
levels of compliance with the standards. (see JCAHO)

Activities Of Basic self-care activities, including eating, bathing, dressing,


Daily Living (ADL) transferring from bed to chair, bowel and bladder control and
independent ambulation. ADLs are widely used as a measure
of evaluating independent functional status.

Acute Care Generally refers to inpatient hospital care of a short duration


as opposed to ambulatory care or long-term care for the
chronically ill.

Adult Day Care A program that provides a combination of health, recreational


and social services to older adults during the day. Services
may include comprehensive assessment, health monitoring,
occupational therapy, personal care, a noon meal and trans-
portation. Some programs also provide primary healthcare
and rehabilitation services.

Glossary of Healthcare Terms & Abbreviations Page 1


Advanced Directive see Living Will

AIDS Acquired Immune Deficiency Syndrome is an incurable,


usually fatal dieseace caused by a virus hat destroys the body’s
ability to fight off illness. AIDS causes recurrent infections or
secondary diseases affecting multiple body systems.

All-Payer System A plan to impose uniform prices of medical services, regard-


less of who is paying.

Allied Health Professionally educated and certified non-physician healthcare


Professionals providers, including nurse practitioners, certified registered
nurse anesthetists, respiratory therapists, physicians= assistants
and others.

Alternative Delivery Refers to alternatives to fee-for-service systems for delivering


healthcare. Examples include health maintenance organiza-
tions (HMOs), independent practice associations (IPAs) and
preferred provider organizations (PPOs). (see HMOs, IPAs,
PHOs, PPOs and PSOs)

Ambulatory Care Care delivered on an outpatient basis, including primary care,


same- day surgery and outpatient diagnostic services.

Ancillary Services Services provided to hospital patients in the course of care,


other than room, board, medical and nursing services, such as
laboratory, radiology, pharmacy and rehabilitation therapy
services.

Assignment An agreement by a physician to bill Medicare or other third-


party payers directly and accept “reasonable charge” as full
payment for his or her services. If the physician does not
accept assignment, the patient is billed for the difference
between the Medicare charge and his or her usual charge.

Auxilian Member of a hospital auxiliary who may or may not be an in-


service volunteer within the affiliated hospital.

Average Adjusted Per The formula used for determining Medicare reimbursement
Capita Cost (AAPCC) for managed care. The formula is 95 percent of Medicare Part
A and B costs per person by county.

Glossary of Healthcare Terms & Abbreviations Page 2


Balance Sheet Statement of assets and liabilities.

Bed Conversion Allocation of beds from one level of care to another, as in


converting acute-care beds to long-term care beds.

Bench Marking The process of continually measuring products, services and


practices against major competitors or industry leaders.

Biohazard A biological or chemical agent or a condition that is harmful


to humans or other living things. A term often used in
biohazardous materials like used needles, bandages and other
contaminated materials.

Biomedical Ethics A term used to describe philosophical questions involving


morals, values and ethics in the provision of healthcare.

Board Certified A physician or other health professional who has passed an


examination given by a specialty board and has been certified
by that board as a specialist in that subject.

Bundled Billing The practice of charging an all-inclusive package price for all
medical services associated with selected procedures.

CD-ROM Compact Disc-Read Only Memory; these are discs inscribed


with non-erasable data. They are about the same size and
appearance as audio compact discs; one disc can hold 300,000
printed pages.

CHIN Community Health Information Network; also known as a


Community Health Management Information System
(CHMIS). An electronic information system that transmits
healthcare data among hospitals, physicians, employers and
third-party payers within a community. The system also
contains a data repository for purchasing and quality reports.

CT or CAT Scan Computerized axial tomography. An advanced, noninvasive


method of radiological diagnosis that creates “images” of the
body in a computerized display.

Capital Asset Depreciable property of fixed or permanent nature, such as


buildings or equipment, that is not held for sale in the regular
course of business.

Glossary of Healthcare Terms & Abbreviations Page 3


Capital Cost Hospital’s costs for major fixed or durable assets, such as plant
and property, movable equipment, and working capital. (see
depreciation)

Capital Formation Methods for obtaining and accumulating funds for capital
needs.

Capitation A method of paying for health services on a per-person basis


as opposed to fee-for-services basis. For example, HMOs
charge subscribers a fixed fee per person or family for compre-
hensive coverage. (see alternative delivery systems, HMOs,
IPAs, PPOs)

Caps Maximum allowable limits placed on revenue or rates by the


federal or state government.

Captive Insurance Typically a captive is a wholly owned subsidiary of a group of


hospitals that Companies have organized to insure their risk.
A captive is like a self-insurance company program that has
assumed the formalities of an insurance company.

Cardiac Catheterization A minimally invasive procedure used to diagnose disorders of


the heart, lungs and great vessels.

Carve-Out Services not included in a health plan, but available from


another supplier or agent at a different, usually higher, fee.

Case Management A system of assessment, treatment planning, referral and


follow-up that ensures the provision of services, according to
client needs, and the coordination of payment and reimburse-
ment for care. A case manager acts as a client advocate,
monitoring the individual’s progress through the system.

Case Mix A measure of patient acuity reflecting different patients’ needs


for hospital resources. There are many ways of measuring case
mix; some are based on patients’ diagnoses or the severity of
their illnesses, and some on their utilization of services. A
high case mix index refers to a patient population more ill
than average..

Glossary of Healthcare Terms & Abbreviations Page 4


Computerized Axial Diagnostic equipment that produces a cross section image of
Tomography (CAT) the body.

Catastrophic Illness Any acute or prolonged illness that is usually considered to be


life-threatening or with the threat of serious residual disability
and that entails large expense over an extended period.

Catchment Area Geographic area defined and served by a hospital and delin-
eated on the basis of such factors as population distribution,
natural geographic boundaries or transportation accessibility.

Census Average number of inpatients, excluding newborn, receiving


care each day during a reported period.

Centers for Medicaid Formerly known as HCFA (Health Care Financing


and Medicare Administration) this is the governmental department that
Services (CMS) administrates Medicaid, Medicare and State Children’s Health
Insurance Program (SCHIP).

Certificate Of Need A certificate issued by the N.J. Department of Health and


(CN) Senior Services, to a hospital seeking permission to modify its
facility, acquire major medical equipment or offer a new or
different health service.

Charges The amount billed by a hospital for services provided. A charge


generally includes the cost plus an operating margin. Many
payers pay a discounted rate, negotiated rate or government-set
rate (e.g., PPS).

Charity Care Free medical care rendered to individuals who do not have the
ability to pay for such care.

Chat Bulletin Board Methods used on the Internet for groups of like-minded
ListServ and/or individuals to talk to each other.

Chief Of Staff The elected or appointed leader of the hospital medical staff
organization.

Glossary of Healthcare Terms & Abbreviations Page 5


Children’s Health A state administered program funded equally by state and federal
Insurance Plan (CHIP) for dollars that allows states to provide health coverage to uninsured
State Children’s Health low-income or children not previously eligible for Medicaid. In
Insurance Plan (SCHIP) New Jersey the program is NJ KidCare.

Claims Made Coverage A liability policy form that covers claims made against the
insured during the policy period irrespective of when the
event occurred that caused the claim to be made.

Claims-Made Policy Coverage extends to claims-made (reported or filed) during


the year the policy is in force or during a previous period in
which the policyholder was insured under a claims-made
contract, provided the coverage is continuous with the insurer.

Clinical Department In a departmentalized hospital, the medical staff organization


is subdivided into major divisions such as medicine, surgery,
obstetrics-gynecology, pediatrics and family medicine. Each
clinical department has a chief or chairman and is responsible
for setting and monitoring standards of professional and
personal conduct of physicians within those departments.

Clinical Pathway see critical pathway

Clinical Privileges The right to provide medical or surgical care services in the
hospital, within well-defined limits, according to an individ-
ual’s professional license, education, training, experience and
current clinical competence. Hospital privileges must be
delineated individually for each practitioner by the hospital
board, based on medical staff recommendations.

Closed Staff As applied to the medical staff as a whole, an arrangement


wherein no new applicants are accepted.

Code of Federal A codified collection of regulations issued by various departments,


Regulations bureaus and agencies of the federal government that is
promoted in the Federal Register.

Co-Insurance Requirement of an insurance policy or prepayment plan that


the beneficiary pay a predetermined portion or percentage of
the provider’s charges.

Glossary of Healthcare Terms & Abbreviations Page 6


Commercial Carriers For-profit, private insurance carriers (i.e. Aetna, Prudential)
offering health and other types of coverage.

Community Benefits Activities initiated by not-for-profit hospitals to benefit the


hospital’s community. Community benefits are evolving stan-
dards defined by the Internal Revenue Service (IRS) to
determine the tax-exempt status of not-for-profit healthcare
organizations.

Community Health Dynamic process undertaken to identify the health, problems


Assessment and goals of the community, enabling a community-wide
establishment of health priorities and facilitating collaborative
actionplanning directed toward improving the community’s
health status. The community health assessment process
involves multiple sectors of the community.

Community Health A local, community-based ambulatory healthcare program


Center organized and funded by the U.S. Public Health Service that
provides primary and preventive health services, often called
neighborhood health centers. They are usually located in an
area with scarce health services or with a population with
special health needs. There are also similar non-federally
funded community health programs, sponsored by local
hospitals and/or community foundations.

Community Rating A method used to determine a health insurance premium in


which a premium is based on the average cost of the actual or
anticipated health services used by all subscribers in a specific
geographic area or industry. This method spreads the cost of
illness evenly over all subscribers rather than charging the sick
more than the healthy.

Comorbidity A secondary illness.

Comprehensive Services that meet the total healthcare needs of a patient.


Healthcare

Congregate Housing Housing for older adults that includes access to a variety of
support services such as laundry or linen service, meal service,
a security system, socialization opportunities or transporta-
tion. Individual apartments usually include kitchen facilities.

Glossary of Healthcare Terms & Abbreviations Page 7


Consortium Formal voluntary alliance of institutions, usually from the
same geographic area, for a specific purpose, that functions
under a set of bylaws.

Continuous Quality Used by JCAHO to describe its “Agenda for Change.” The
Improvement concept at heart of the Total Quality Management philosophy
is that quality is never static, but is a constantly moving target,
constantly open to improvement.

Continuum Of Care A comprehensive system of long-term care services and


support system in the community, as well as in institutions.
Continuum includes:
1) community services such as senior centers;
2) in-home care such as home-delivered meals, homemaker
services, home health services, shopping assistance,
personal care, chore services and friendly visiting;
3) community-based services such as adult day care;
4) non-institutional housing arrangements such as congre-
gate housing, shared housing, and board and care homes;
5) nursing homes; and
6) acute care services.

Contractual Negotiated discounts from hospital-established charges.


Allowances

Conversion A major change that a hospital undertakes, such as the conver-


sion from not-for-profit status to for-profit, or the conversion
of an acute care facility to ambulatory care. This usually
entails a complete change of mission after a new line of busi-
ness or service displaces a core activity.

Corporate The formation and use of one or more corporations in addition


Restructuring to the hospital corporation for the purpose of holding assets
or carrying out other business activities. Restructuring gener-
ally involves either the formation of corporations legally
independent of the hospital, or the hospital becoming a
subsidiary of a new parent corporate structure.

Cost Accounting An accounting system arriving at charges by healthcare


providers based on actual costs for services rendered.

Glossary of Healthcare Terms & Abbreviations Page 8


Cost Finding Determining how it much it actually costs to provide a given
service. Usually requires a cost accounting system or a retro-
spective cost study.

Cost Sharing Having consumers pay a portion of the cost of their healthcare
bills or insurance premiums.

Cost Shifting Increasing the charges to one group of hospital patients to


cover or subsidize losses on other groups of patients.

Credentialing The process of checking a practitioner’s references and docu-


menting his/her credentials, including training and education,
experience, demonstrated ability, licensure verification and
malpractice insurance. The hospital governing board has ulti-
mate accountability for physician credentialing but usually
delegates the process to the medical staff committee.

Critical Pathway Treatment regimen agreed on by a consensus of clinicians. It


includes only those few vital elements proven to affect patient
outcomes. Only critical components - items that directly affect
care - are part of the critical pathway.

DRG(s) Diagnosis-related group(s). A system for classifying hospital


patients based on their clinical condition (diagnosis or surgi-
cal procedure), age, and whether they had any other illnesses
(complications or comorbidities); a predetermined price is set
for each of over 500 DRGs. DRGs are the used by the federal
government for Medicare’ prospective pricing system, and
until 1993, were the basis for New Jersey’s payment system.

Dashboard A variety of indicators displayed visually, much like a car’s dash-


board. This is key information easy to read to indicate areas of
success and those that need improvement. Dashboards often
cover clinical quality, revenue, full time employees, patient satis-
faction, etc.

Deductible Amount of loss or expense that the insured must incur before
the insurance company will assume any liability for all or part
of the remaining cost of covered services.

Glossary of Healthcare Terms & Abbreviations Page 9


Deemed Status A hospital is “deemed qualified” to participate in the Medicare
program if it is accredited by the JCAHO, thus obviating the
need for a duplicative Medicare accreditation survey.

Denial The refusal by a third-party payer to reimburse a provider for


services or a refusal to authorize payment for services
prospectively. Denials are generally issued on the basis that a
hospital admission, diagnostic test, treatment or continued
stay is inappropriate according to a set of guidelines.

Depreciation The amortization of the cost of a physical asset (plant, prop-


erty and equipment) over its useful life. Annual depreciation
is the amount charged each year as expense for such assets as
building, equipment and vehicles. Accumulated depreciation
is the total amount of depreciation of the hospital’s financial
books. Funded depreciation refers to setting aside and invest-
ing the accumulated depreciation so that these monies can be
used for replacement and renovation of assets (see capital
costs).

Directors and Officers Protection for directors and officers of corporations against
Liability Insurance suits or Legal claims brought by stockholders or others alleg-
ing that the directors and/or officers acted improperly in some
manner in the conduct of their duties. This coverage does not
extend to dishonest acts.

Discharge Planning Discharge planning assists patients and their families in arrang-
ing services they will need after discharge from a hospital.

Discoverable Information that may be legally obtained by a party to a


lawsuit. In New Jersey there are no laws protecting a hospital
from discovery even from a morbidity and mortality meeting
or from a sentinel event investigation.

Disproportionate A hospital that provides care to a large number of patients


Share Hospital (DSH) who cannot afford to pay or do not have insurance.
Reimbursement is at a higher rate under the prospective
payment system for inpatient services to cover the higher cost
of caring for these patients. Inner city and rural hospitals typi-
cally fall into this category.

Glossary of Healthcare Terms & Abbreviations Page 10


Do-Not-Resuscitate Order placed on a patient’s chart by the attending physician,
(DNR) with a patient or surrogate consent that directs hospital
personnel not to revive the patient if respiratory or cardiac
activity ceases.

Drug Formulary A listing of prescription medications approved for use by and


in a hospital; also used to identify those prescription medica-
tions approved for use and/or coverage by health insurance
plans.

Durable Medical The sale or rental of products and/or equipment designed to


Equipment Services assist individuals needing medical care at home. It can
include, but is not limited to, wheelchairs, canes, walkers and
respirators.

EMTALA Emergency Medical Treatment and Active Labor Act, also known
as COBRA Aanti-dumping” law. EMTALA requires that all
patients who come to the Emergency Department must receive
an appropriate medical screening examination regardless of
their ability to pay and must be stabilized if they are to be trans-
ferred to another facility.

EPSDT Early Periodic Screening, Diagnosis and Treatment Program


for children through maternal and child health programs
designed to determine illnesses that handicap children.

Emergency Medical Emergency Medical Systems. Refers to a systematic, community


System (EMS) linkage among hospital trauma centers, ambulance emergency
units and other emergency vehicles, personnel trained in emer-
gency medicine, and communications systems so that severely
ill or injured persons are transported and treated promptly and
appropriately.

Emergency Response An emergency alarm and response system designed for functionally
System impaired persons (particularly the elderly) living in the
community. The system includes an electronic communica-
tion unit that is easily activated (in the home) when there is
an emergency, a central emergency station located in a hospi-
tal or similar facility that is responsible for receiving incoming
alarms, a process of client identification and a quick response
team or mechanism.

Glossary of Healthcare Terms & Abbreviations Page 11


Endowment Funds intended to be invested in perpetuity, providing income
for the continued support of a not-for-profit organization.

ERISA Employee Retirement Income Security Act of 1974; self-


insured companies are usually organized under ERISA and are
exempt from state laws governing insurance.

Ethics Committee Hospital Committee concerned with biomedical ethics issues.


Its purpose may be to direct educational programs or provide
forums for discussion of these issues among hospital medical
professionals and others, to serve in an advisory capacity and/or
as a resource to healthcare professionals involved in biomedical
ethical implications.

Exclusive Provider A healthcare plan in which subscribers are eligible to receive


Organization (EPO) benefits when they use the services of a limited network of
providers.

Extended Care Unit Unit for treatment of inpatients who require convalescent,
rehabilitative or long-term skilled nursing care.

Fee For Service Method of charging patients for services or treatment in which a
provider bills for each patient encounter or treatment or service
rendered.

Financial Statement Detailed report of the financial conditions of an entity includ-


ing profits, losses, assets and liabilities.

Fiscal Intermediary (FI) Blue Cross Plan, private insurance company, or other public or
private agency selected by healthcare providers to pay claims
under Medicare. Currently Riverbend in Tennessee is the FI for
New Jersey.

501(c)(3) The section of the tax code that defines nonprofit, charitable,
tax-exempt organizations.

Glossary of Healthcare Terms & Abbreviations Page 12


Fraud and Abuse The federal body of law applying to Medicare and Medical
providers. This law prohibits three things: filing false claims,
paying or receiving bribes or kickbacks for referrals and self-
referral schemes. Violations can result in criminal and/or civil
punishment. Enforcement comes under several umbrellas of
the government. Civil action in enforced by The Office of the
Inspector General (OIG) and Department of Health and
Human Services (DHHS). The Department of Justice (DOJ)
enforces criminal penalties.

Free-Standing Facilities Healthcare facilities that are not physically, administratively or


financially connected to a hospital. An example is a freestand-
ing ambulatory surgery center.

Gainsharing A common description of a compensation agreement between


hospitals and physicians. Under the current system of
payments for Medicare, this has been deemed illegal by the
OIG and DHSS. New Jersey is in discussions with CMS to
pilot a program of gainsharing to improve length of stay and
other factors to improve Medicare delivery and savings.

Gatekeeper A term that is generally used to refer to the primary care physi-
cian who controls referrals of patients to a hospital or for
specialty care.

Geriatric Acute Provides acute care to elderly patients in a separate unit or


Care Unit wing that may include specifically designed units with archi-
tectural adaptations designed to accommodate the decreased
sensory perception of older adults. Geriatric assessment/reha-
bilitation units utilize a multidisciplinary team of therapists.
Staff are usually trained in geriatrics.

Geriatric Assessment An interdisciplinary service providing a comprehensive assessment


Service of the physical and mental health, and the functional, social
and financial status of an older adult, resulting in a plan for
comprehensive treatment and referral to appropriate providers
reflecting individual and family preferences and financial
status. An assessment service can be part of an inpatient or
ambulatory care setting. (see geriatric acute unit)

Glossary of Healthcare Terms & Abbreviations Page 13


Geriatric Assessment Disciplinary team of professionals that may have the following
Team members: physicians, nurses, social workers and therapists.
The team assesses the medical and psychosocial needs and
functional status of elderly patients to determine the services
they require.

Geriatrician Physician who specializes in the diagnosis and treatment and


overall healthcare needs of older adults and is cognizant of the
special problems related to aging.

Going Bare The colloquial term used to describe the choice of a provider
not to be protected by malpractice or professional liability
insurance. Many hospitals prohibit this practice by requiring
medical staff members to carry insurance.

Governing Body The legal entity ultimately responsible for hospital policy,
organization, management, and quality of care. Also called
the governing board, board of trustees, commissioners or
directors. The governing body is accountable to the owner(s)
of the hospital, which may be a corporation, the community,
local government or stockholders.

Hazardous materials Materials that are harmful to humans and other living things
(HAZMAT) like radioactive, biological or chemical materials or agents.
Within a disaster preparedness plan there is often a hazardous
material plan incorporated to deal specifically with this type
of emergency. In the event of this type of emergency a hospi-
tal is required to control patient admissions through a special
entrance, decontamination, special equipment for staff,
airflow control, etc.

Health Maintenance A prepaid health plan that acts as both an insurer and a provider
Organization (HMO) of comprehensive health services. HMO subscribers pay a capi-
tated fee and are limited to the hospitals and physicians affiliated
with the HMO. (see capitation, IPA, staff model HMO and group
model HMO)

Glossary of Healthcare Terms & Abbreviations Page 14


HealthPAC A political action committee (P.A.C.) formed to educate New
Jersey legislators and political candidates regarding issues
affecting New Jersey’s hospitals. It is an independent, bi-parti-
san organization, not affiliated with any political party.
HealthPAC pools contributions from individuals to financially
help support the campaigns of those who demonstrate their
commitment to hospitals.

Health Promotion Education and/or other supportive services that are hospital -
Services planned and coordinated to help people to adopt healthy
behaviors, reduce health risks, increase self - care skills, use
health care services effectively and increase understanding of
medical procedures and therapeutic regimens.

Hill-Burton A federal program established in the 1960’s that created finan-


cial assistance for the construction and renovation of hospitals
and other healthcare facilities. Named for its two principal
congressional proponents, Hill and Burton.

Holding Company Separate entity used to hold a variety of subsidiary groups that
often perform related functions but have a distinct corporate
identity.

Home Healthcare A program for providing nursing, therapy and health-related


homemaker or social services to individuals in their homes.

Home Page A document on the Internet’s World Wide Web (WWW); the
home page is usually the first screen presented and contains
information and Alinks” to the rest of the document (as well
as other home pages). The NJHA home page, for example,
links the Avisitor” to HRET educational programs, NJHA meet-
ings and other important information, as well as to NJHA
member hospitals that have their own WWW home page.

Homemaker/Home Programs designed to prevent institutionalization and/or


Health Aide deterioration of an older adult by providing in-home suppor
services such as light housekeeping, meal preparation and
grocery shopping, as well as personal care services.

Glossary of Healthcare Terms & Abbreviations Page 15


Horizontal Integration A linkage or network of the same types of providers i.e., a
multi-organizational system composed of acute care hospitals.
A competitive strategy used by some hospitals to control the
geographical distribution of healthcare services. (see hospital
alliance and vertical integration)

Hospice Care Care that addresses the physical, spiritual, emotional, psycho-
logical, social, financial and legal needs of the person who is
terminally ill and his or her family. Hospice care is provided
by an interdisciplinary team of professionals and volunteers in
a variety of settings, both inpatient and at home and includes
bereavement care for the family.

Hospital Alliance A group of not-for-profit hospitals that join together to share


common services and pursue business opportunities that could
not be supported by the hospitals individually. Typically, the
hospitals in an alliance retain their individual autonomy, but
may share information and services and do joint planning and
group purchasing.

Hospitalist A physician who specializes in inpatient medicine. In the


hospital setting, the hospitalist functions as a primary care
physician does outside of the hospital coordinating care.

House Staff Aggregate body of physicians and dentists who have completed
medical or dental school and who participate in an accredited
program of post-graduate medical education sponsored by a
hospital.

Indigent Care Medical care for those who cannot afford it. (see medically
indigent, charity care, uncompensated care)

Individual Practice In an IPA, independent doctors and/or small group practices


Association Model contract with an HMO to provide services to an enrolled
population. The physiHMO (IPA) cians may own the HMO
and are usually reimbursed on a fee-for-service basis, with a
percentage withheld. This Apool” of funds held by the IPA=s
administration can be redistributed to the doctors in a prof-
itable year.

Glossary of Healthcare Terms & Abbreviations Page 16


Infection, Nosocomial Infection acquired during hospitalization that is neither pres-
ent nor incubating at the time of hospital admission, that may
become clinically manifest after discharge from the hospital.

Inpatient A patient receiving acute care through admission to the hospi-


tal for a stay of longer than 24 hours.

Insurance, Catastrophic Insurance that protects the insured against all or a percentage
of loss that is not covered by another insurance or pre-
payment plan or that is incurred under specified
circumstances, or insurance in excess of specified amounts or
other dollar or benefit limits.

Insurance, Catastrophic insurance that protects the insured against all or a


Major Medical percentage of loss incurred as the result of severe or prolonged
illness or disability in which costs exceed a specified dollar
amount.

Integrated Delivery A local or regional healthcare network that provides a full


(IDS) range of System services for all aspects of healthcare in a
specific geographic area. Also called community care network.

Intern A term used to identify physicians in their first year or two of


post- medical school clinical training. They are now more
commonly called Post Graduate Year, or PGY I, II, III, IV or V.

Intermediate Care A facility that provides nursing, supervisory and supportive services
Facility to elderly or chronically ill patients who do not require the
degree of care or treatment that a skilled nursing unit is
designed to provide.

Investor-Owned A hospital operated by a for-profit corporation in which the


Hospital profits go to shareholders who own the corporation. Also
referred to as a Aproprietary” hospital.

Joint Commission on An independent, voluntary, not-for-profit accreditation body


Accreditation of sponsored by the American College of Physicians, the
Healthcare American College of Surgeons, the American Hospital
Organizations (JCAHO) Association, the American Medical Association and the
American Dental Association. The JCAHO conducts accredita-
tion surveys for hospitals and other healthcare organizations.

Glossary of Healthcare Terms & Abbreviations Page 17


Joint Venture A cooperative financial relationship between two parties (i.e.,
hospital and physician group, two hospitals, hospital and
HMO) in which each party shares risks and benefits.

Length of Stay (LOS) Number of calendar days that elapse between an inpatient’s
admission and discharge.

Licensure Formal process by which a government agency grants an indi-


vidual the legal right to practice an occupation; grants an
organization the legal right to engage in an activity, such as
operation of a hospital; and prohibits all other individuals
and organizations from legally doing so, to ensure that the
public health, safety and welfare are reasonably well protected.

Lifecare/Continuing A program through which older adults commit to reside in a


Care community for the remainder of their lives. The community
has the physical facilities and services to provide care ranging
from freestanding apartments to nursing home care. The
concept has insurance features in that an initial payment
(entry fee) is required. The fee guarantees residents a specified
package of health and long-term care benefits (in addition to
Medicare cover services), co-payment and deductibles.

Life Safety Code Standard developed and updated regularly by the National
Fire Protection Association that specifies construction and
operational conditions to minimize fire hazards and provide a
system of safety in case of fire.

Living Will A statement of a person’s preferences for medical treatment if


he or she becomes incapable of making healthcare decisions.
Most living wills specify that the person does not want respira-
tors, cardiopulmonary resuscitation or other measures used if
there is no hope of recovery. Persons who sign living wills
also should make their wishes known to their family and
physician. Operation of some living wills is restricted until
the patient is terminal. Also known as an Advanced Directive.

Glossary of Healthcare Terms & Abbreviations Page 18


Long-Term Care Those services designed to provide diagnostic, preventive, ther-
apeutic, rehabilitative, supportive and maintenance services
for individuals (and their care givers) who have chronic physi-
cal and/or mental impairments; this care is provided in a
variety of settings, including the home. The goal of a compre-
hensive long-term care system is to promote the optimal level
of physical, social and psychological functioning.

Long Term Care Acute Either free standing or hospitals-within-hospitals, LTACs


Care Hospital (LTAC) provide acute care services for patients requiring and average
length of stay of at least 25 days.

Magnetic Resonance Using a scanner, this is a high-technology diagnostic procedure


Imaging (MRI) used to create cross-sectional images of the body through the
use of magnetic fields and radio frequency fields. Previously
known as nuclear magnetic resonance (NMR).

Malpractice Failure in providing healthcare services to exercise the degree


of skill and care generally exercised by like professionals under
similar circumstances.

Market Basket Components of the overall cost of health care used to deter-
mine the Consumer Price Index (CPI).

Marketing A systematic process for researching the needs and desires of


consumers and customers and designing responsive programs,
services and promotional strategies to reach these markets.

Meals on Wheels A program that provides meals on a daily basis (usually


Monday through Friday) to homebound older adults who are
not able to provide or prepare meals for themselves.

Medicaid A joint federal-state program which since 1966 has paid much
of the healthcare costs of certain (but not all) low-income
persons. The federal government sets certain minimum rules
and payment levels and provides some of the funding, and each
state administers the program, contributes additional funds and
may establish additional eligibility rules and benefits.

Medical Director Physician who serves as a salaried chief of staff, generally


reporting to the CEO, and responsible for medico-administra-
tive affairs.

Glossary of Healthcare Terms & Abbreviations Page 19


Medical Education, Member of the medical staff of a hospital or an educator who
Director of coordinates programs of graduate and continuing medical
education.

Medical Savings An insurance concept designed to give individuals greater control


Account (MSA) in the use of their healthcare dollars. MSAs combine a high-
deductible major medical insurance policy (which usually costs
less than a low-deductible policy) with an employer-funded
healthcare savings account. Employers can draw from the account
to cover their first dollar healthcare expenses. The funds used to
create the account come from the savings realized by purchasing
the high-deductible insurance plan.

Medical Staff That body which, according to the medical staff standard of the
Organization JCAHO, “includes fully licensed physicians, and may include other
licensed individuals permitted by law and by the hospital to
provide inpatient care services independently in the hospital.”
These individuals together make up the “organized medical staff.”

Medically Indigent A person who, by current income standards, is not poor but lacks
the financial resources to afford necessary medical services.

Medically Underserved Geographic location that has insufficient health resources to meet
Area the medical needs of the resident population.

Medicare The federal health insurance program for people age 65 and over and
those with certain chronic disabilities. Medicare has two parts. Part A
(hospital insurance) pays for most inpatient hospital care and some
follow-up care. Part B (medical insurance) pays for most physicians’
services. Patients are responsible for deductibles and co-payments.
Medicare pays hospitals for patient care using a prospective pricing
system (PPS) based on diagnosis-related groups (DRGs).

Medicare Geographic Established in 1990 by Congress, this five-person board reviews


Classification Review hospital requests for geographic reclassification for Medicare
Board prospective payment system purposes. Reclassification occurs
when hospitals are located in adjacent county and pay wages equal
to at least 85% of those paid by hospitals in the area for which
classification is being represented.

Glossary of Healthcare Terms & Abbreviations Page 20


Medicare Supplemental Private insurance policies that pay some or all of Medicare’s
Income deductibles and copayments.

Medicare Payment In 1997 Congress approved the merger of The Physician


Advisory Commission Payment Review Commission and the Prospective Payment
(MedPAC) Assessment Commission to form MedPAC. This body provides
policy advice and technical assistance concerning Medicare
and other parts of the healthcare system. It conducts inde-
pendent research, analyzes legislation and makes
recommendations to Congress.

Midwife, Certified A registered professional nurse with post-graduate education


Nurse in pre-natal care and the delivery of babies. In New Jersey,
certified nurse midwives must have a masters degree in nurs-
ing and be certified by the N.J. Board of Medical Examiners.

Morbidity Extent of illness, injury or disability in a defined population.

Multi-Hospital System An organizational affiliation among two or more healthcare


organizations. Multi-hospital systems may be vertically or
horizontally integrated. The tie among the institutions can be
through ownership, lease, contract management or vertical
integration.

Multi-Disciplinary An approach to caring for the elderly that involves a


Team multidisciplinary team of professionals having the goal of
providing comprehensive, integrated care. The team often
includes a physician, nurse and social worker working closely
together and, depending on the patient’s needs, may also
include an occupational, physical or other therapist, psychia-
trist or psychologist. (see Geriatric Assessment Team)

National Health Federal health insurance program designed to provide


Insurance comprehensive benefits to the majority of the population.

National Practitioner An alert or flagging system created to facilitate a more


Data Bank comprehensive review of professional credentials. It assists
state licensing boards, hospitals and other healthcare entities
in conducting intensive independent reviews of the qualifica-
tions of the healthcare practitioner they seek to license or
grant clinical privileges. Information reported to the bank is
confidential except to those legally allowed to access it.

Glossary of Healthcare Terms & Abbreviations Page 21


Neonatal An infant’s life from the hour of birth through the first 27
days, 23 hours and 59 minutes (this constitutes the definition
of newborn).

Nuclear Medicine The use of radioisotopes to diagnose and treat patients.


Applications can provide images (pictures) for diagnostics and
others provide diagnostic tests and treatments for disease.

Nurse Practitioner (NP) A registered professional nurse with graduate level education
in a nursing specialty (i.e., family health, pediatrics, gerontol-
ogy). In N.J., NPs are licensed by the State Board of Nursing
and are qualified to carry out expanded healthcare evaluations
and treatment plans. Also known as advanced practice nurse.

Occupancy The inpatient census, generally expressed as a percentage of


total beds that are occupied at any given time.

Occurrence Coverage This was once the most common type of commercial malprac-
tice insurance. It provides coverage for liability arising from
malpractice that occurred while the policy was in effect,
regardless of when the claim or potential loss is reported. For
example, if a claim is filed after an occurrence policy has
expired, but the claim alleges an act of malpractice that
occurred when the policy was in force, the occurrence policy
will cover the management and payment of the claim.

Occurrence Policy Insurance coverage is provided for all events that occur while
the policy is in force, regardless of when the claim is filed/
reported/ made.

Operating Budget A financial plan for the expected revenues and expenditures of
the day-to-day operations of the hospital.

ORYX Introduced in 1997, ORYX is an initiative of the Joint


Commission on Accreditation of Healthcare Organizations
(JCAHO). It seeks to integrate outcome and other measure-
ment data into the accreditation process.

Glossary of Healthcare Terms & Abbreviations Page 22


Outcome and CMS developed a data set for use in monitoring outcomes of
Assessment Information adult home health care patients. Providers who use and pass
Set (OASIS) OASIS measurements are Medicare-certified home health
agencies.

Outlier A patient that generates unusually high costs or requires an


unusually long stay.

Outpatient A person who receives care without being admitted to the


hospital for overnight or longer stay.

PGY I, II, III, IV, V Post Graduate Year I, II, III, IV and V; a term used to identify a
medical school graduate’s year of post-graduate clinical training.
(Previously known as interns and residents.) (see interns, residents)

Paramedic A technician with 18 months training in emergency medicine.


Paramedics administer emergency care out of the hospital.

Patient Dumping The refusal to examine, treat and stabilize any person irrespec-
tive of payer/class who has an emergency medical condition, or
is in active labor or contractions once that person has been
presented at a hospital emergency room or emergency depart-
ment. (see EMTALA)

Patient Satisfaction A questionnaire use to solicit the perceptions of patients


Survey regarding their stay and/or service in a healthcare facility, i.e.,
waiting time, access to treatment, food, staff, etc.

Payment Error A CMS mandated program that is carried out by the Peer Review
Prevention (PEPP) Organization (PRO) for each state. The objective of PEPP is to
reduce payment errors made under the prospective payment
system (PPS).

Peer Review PRO is comprised of physicians operating independently of


Organization (PRO) the hospital and under contract with the federal government
to review the hospital care of Medicare patients. The PRO in
New Jersey is operated by The Peer Review Organization of
New Jersey, Inc.

Glossary of Healthcare Terms & Abbreviations Page 23


Performance A clinical outcome measurement model developed in 1993 by
Measurement System NJHA and QuadraMed Corp. The system provides hard-copy
reports providing comparisons to peer groups and risk-
adjusted predicted rates based on actual patient data. Also
available in an electronic version that can target specific results
down to individual physician practice patterns or patient
profile analysis.

Personal Care Room, board and the provision of some assistance with activi-
ties of daily living (i.e., grooming, bathing, eating).

Physician Assistant (PA) Person who provides healthcare services (customarily


performed by a physician) under responsible supervision of a
qualified licensed physician. Physician Assistants must
complete an accredited education program and be licensed by
a recognized agency or commission. In New Jersey PAs are
licensed by the N.J. Board of Medical Examiners.

Physician-Hospital A legal entity formed by a hospital and a group of physicians,


Organization (PHO) usually for the purpose of obtaining managed care contracts
directly with employers. The PHO serves as a collective nego-
tiating and contracting unit.

Point Of Service (POS) A type of managed care plan in which beneficiaries have the
option of choosing to obtain medical services from the
provider of their choice, or a primary physician from the
plan’s panel of physicians. There is a financial incentive to
select a primary physician from the plan’s panel.

Positron Emission An imaging technique that tracks metabolism and responses to


Tomography (PET) therapy used in oncology, neurology and cardiology. This
system is especially effective in evaluating brain and nervous
system disorders.

Post Retirement Health A major component of general retirement benefits that cover
Benefits (PRHBs) healthcare cost not paid by Medicare (in part or fully). They
are provided to retirees through the employer’s group health
plan and the set of benefits varies according to eligibility, serv-
ices covered and payment.

Glossary of Healthcare Terms & Abbreviations Page 24


Point-Of-Service Plan A type of health plan allowing the covered person to choose a
service from a participating or non-participating provider;
there is a financial incentive to use participating providers.

Population Profile A statistical summary of population-specific healthcare data


used to assess healthcare delivery.

Portability The state of being able to continue health insurance coverage


when changing job or residence, without a waiting period or
having to meet additional deductible requirements.

Preferred Provider PPOs are organizational entities that have a contractual


Organization (PPO) arrangement between healthcare providers (including institu-
tions and professionals) and employers, insurance carriers or
third-party payers to provide healthcare services to a defined
population.

Primary Care Physician In managed care the term refers to the physician responsible
for coordinating and managing the healthcare needs of
members, including hospitalization and specialist referrals.

Private Not-For-Profit A not-for-profit hospital is owned and operated by a private


corporation whose excess of income over expenses is used for
hospital purposes rather than return to stockholders or
investors as dividends. They are sometimes referred to as
“voluntary” hospitals.

Process Management Assuring the organizational processes meet quality, cost and
productivity processes means they can be defined, measures
and systematically proved.

Product Line Groupings of related business activities. A hospital’s product


line might be as broad as cardiac care or surgical care, or as
specific as care by DRG or product code.

Productivity The relationship between service input and output. Typical


productivity measures for labor cost include full-time equiva-
lent positions (FTE) per patient day, FTEs per admission and
FTEs per bed.

Glossary of Healthcare Terms & Abbreviations Page 25


Professional Liability Protection for real or alleged errors committed in the practice
Insurance of a profession (i.e., Hospital Professional Liability).

Prospective Payment A method of payment for healthcare services in which the


amount of payment for services is set prior to the delivery of
those services and the hospital (or other provider) is at least
partially at risk for losses or stands to gain from surpluses that
accrue in the payment period. Prospective payment rates may
be per service, per capita, per diem or per case rates.

Prospective Payment An independent commission established by the Social Security


Assessment Commission Amendments of 1983 (Public Law 98-21), the law that created
(ProPAC) Medicare’s DRG-based prospective payment system (PPS), to
advise the Secretary of Health and Human Services on the
annual update factor and on adjustments of DRG classifica-
tions and weights.

Prospective Payment Medicare’s system, adopted in the Social Security Amendments


Pricing) System (PPS) of 1983, or by which hospitals are paid a fixed, prospectively set
price for each Medicare beneficiary treated as an inpatient
according to the patient’s DRG.

Provider A hospital or healthcare professional who provides healthcare


services to patients. May be an entity (hospital, nursing home
or other) or a person, such as a physician or nurse.

Provider - Sponsored Healthcare systems owned and operated by providers that integrate
Organization (PSO) a wide spectrum of services and contract with various entities
on a managed care basis. Also known as a Provider Sponsored
Network (PSN).

Quality Assurance The process used to determine the quality of care, to develop
and maintain programs to keep it at an acceptable level and to
correct patterns of care that fall below that level.

Quality Improvement System that strives to prevent crises rather than manage them.
System

Quality Improvement Usually an ad hoc team from multiple departments, typically


Team managerial or professional members, whose purpose is to
improve quality in a specific area.

Glossary of Healthcare Terms & Abbreviations Page 26


Quality of Care The degree to which patient care meets accepted principles
and standards of practice.

RFP Request for Proposal. An RFP lists project specifications and


application procedures for contracts or grant programs. Used
most frequently by local, state and federal agencies, RFPs are sent
to organizations that might be qualified to participate in the
grant program.

Rate Review Prospective review by a government or private agency of a


hospital’s budget and financial data, performed for the purpose
of determining the reasonableness of the hospital rates and
evaluating proposed
rate increases.

Reasonable Charges Physicians’ fee limitations determined on the basis of the


lowest of actual charge, customary charge or prevailing charge
and other profiles added under the Tax Equity and Fiscal
Responsibility Act of 1982 (Public Law 97-248) and Medicare
provider-based physician regulations.

Regulated Medical The seven classes of waste usually derived from direct patient
Waste care or research as defined by the federal Waste Tracking Act
WASTE (RMW) and the New Jersey Waste Tracking Act (NJAC
7:26-3A.6). It does not include ordinary business and kitchen
waste nor medical waste that does not transmit disease or raise
serious aesthetic concerns if disposed of improperly.

Rehabilitation Facility A facility that provides medical, health-related, social, and/or


vocational services to disabled persons to help them attain
their maximum functional capacity.

Reinsurance A type of insurance purchased by primary insurers (insurers


that provide healthcare coverage directly to policy holders)
from other secondary insurers, called Areinsurers,” to protect
against part of all losses the primary insurer might assume in
honoring claims of its policyholders.

Glossary of Healthcare Terms & Abbreviations Page 27


Relative Value Unit Unit of measure designed to permit comparison of the
amounts of resources required to perform various services
within a single department or between similar departments in
various hospitals by assigning weight to such factors as
personnel time, level of skill and sophistication of equipment
required to render service.

Resident A resident is a graduate physician in post-graduate hospital


clinical training. Formerly, the first year after graduation was
referred to as an “internship” and thereafter, as “residency.”
The years are now referred to as post-graduate years (PGY) I -
V. (see PGY I, II, III, IV and V)

Respite Care Patient care provided intermittently in the home or institution in


order to provide temporary relief to the family home care giver.

Restricted Funds Funds that have been designated to be spent for a specific
purpose.

Risk Management An insurance and quality control-related discipline responsible


for identification and assessment of loss potential, control and
funding, and also includes the management of workers compen-
sation and claims professionals.

Safe Harbor Regulations A set of federal regulations which clarify and ease the restric-
tions of the Medicare/Medicaid Fraud & Abuse Statutes. The
regulations specify certain types of provider payment arrange-
ments that are not subject to criminal prosecution or civil
sanctions.

Same Day Surgery A hospital-based program that provides intensive medical, nurs-
ing and rehabilitation services to individuals who spend the day
at the hospital and return home in the evening and who would
need to be in the hospital where the day program is not avail-
able. Services provided are more intensive in nature than those
commonly provided by adult day care programs.

Glossary of Healthcare Terms & Abbreviations Page 28


Self Insurance This method retains the risk within a hospital or group of
hospitals while providing a funding mechanism (similar to a
trust fund) to cover the cost of litigation and malpractice
liability losses. Another form of self-insurance is non-funded
self-insurance, or “going bare.” Under this method the hospi-
tal makes no prearrangement whatsoever to cover the payment
of malpractice liability losses or litigation or claims manage-
ment costs. Rather, the hospital pays its malpractice losses
and related expenses from its operating capital.

Senior Volunteer A volunteer program making particular efforts to recruit and involve
Program older adults.

Shared Services Administrative, clinical or service functions that are common


to two or more healthcare institutions, which are used jointly
or cooperatively by them in some manner for the purpose of
improving service, containing cost and/or effecting economies
of scale.

Skilled Nursing Care Nursing or other rehabilitative services provided under the
direction of a physician or an approved professional. To be
reimbursed by Medicare, this care must meet Medicare stan-
dards and be delivered in a Medicare-approved facility.

Skilled Nursing A facility that provides acute medical care and continuous
Facility (SNF) nursing care services and various other health and social serv-
ices to patients who are not in the acute phase of illness but
who require primarily convalescent, rehabilitative and/or
restorative services. The care may be delivered in a freestand-
ing facility or in a unit of a hospital.

Smart Card Credit-card-sized, they contain a small semiconductor chip,


capable of holding an individual’s complete medical history
and other healthcare information.

Staff Model HMO Physicians are employed to provide services to subscribers at


the HMO’s corporate location or its multiple satellite loca-
tions. Subscribers choose a primary care physician from the
physicians employed by the HMO.

Glossary of Healthcare Terms & Abbreviations Page 29


Staffing Ratio The total number of hospital employees (full-time equiva-
lents, or FTEs) divided by the average daily census.

State Health Plan Required by the Health Care Cost Reduction Act of 1991, the
State Health Plan is a document, prepared by the State Health
Planning Board and the Department of Health, that is intended
to identify unmet health needs in an area by service and loca-
tion, and to serve as the basis on which all certificate of need
applications will be reviewed and approved. Although the State
Health Plan was originally given the force and effect of law, the
Legislature revised the statutes in 1992 to make the State Health
Plan only an advisory document.

State Health Established by the Health Care Cost Reduction Act of 1991,
Planning Board the State Health Planning Board serves as the planning advi-
sory board to the Department of Health. The Board is
responsible for annually preparing and revising the State
Health Plan.

Statement of Change Financial report showing liquid assets increasing and decreasing
in Fund Balance (balance of cash accounts).

Stop Loss Insurance Also known as excess risk insurance. An insurance policy
designed to reimburse a self-funded arrangement of one or
more small employers for catastrophic, excess or unexpected
expenses; neither the employees nor other individuals are
third-party beneficiaries under the policy.

Subacute Care Medical and skilled nursing services provided to patients who
are not in an acute phase of illness but require a level of care
higher than that provided in a long term care setting.

Surgicenter A health care facility separated physically from a hospital that


provides prescheduled outpatient surgical services.

Swing Beds Unused acute care beds that can be “swung” to long-term care
beds within the same hospital.

Teaching Hospital A hospital that has an accredited medical residency training


programs and is often affiliated with a medical school.

Glossary of Healthcare Terms & Abbreviations Page 30


TEFRA In 1982, Congress passed P.L. 97-248, Tax Equity and Fiscal
Responsibility Act. This law limited the amount of all hospital
inpatient costs per discharge and mandated the development of
a prospective pricing system (PPS). The PPS reimbursement
diagnosis - related groups, or DRG. There are 467 DRGs and the
government reimburses the hospital a flat rate for each DRG
and considers that rate as payment in full. The rate for each
DRG is established before the patient is treated, hence the term
prospective pricing.

Teleconference A meeting held at two or more different locations where partici-


pants are able to communicate with each other in real time using
telecommunications. A video teleconference allows visual
communication between participants while an audio teleconfer-
ence is limited to voice communications.

Tertiary Care Medical care of a highly technological and specialized nature


provided in a medical center or teaching and research institution
for patients with severe, complicated or unusual medical problems.

Third-Party Payer A payer that neither gives nor receives the care (the patient
and the provider are the first two parties). Usually an insur-
ance company or government agency.

Tort A civil remedy to a negligent or intentional civil wrong exclud-


ing a breach of contract. The injured person may sue the
wrongdoer for damages.

Total Quality A long-term corporate strategy focusing on the continuous


Management (TQM) improvement of key work processes that ultimately improves
products and services and satisfies the needs and expectations
of customers.

Traditional Insurance A fixed premium for a year through which the subscribers
receive medical care from their chosen provider. The health-
care provider is paid for services rendered at essentially a rate
equivalent to usual and customary fees.

Glossary of Healthcare Terms & Abbreviations Page 31


Trauma Center A hospital, specifically designated within a region, that is
equipped and staffed to receive critically ill or injured patients.

Triage A system of assigning priorities of medical treatment on the


basis of urgency, chance for survival or other indicators.

Ultrasound A high frequency (pitch above human hearing) imaging tech-


nique also called sonography.

Uncompensated Care Care for which the provider is not compensated. Generally,
uncompensated care includes charity care and bad debts
(uncollectible charges to patients who have the ability to pay).
(see charity care)

Uniform Bill - UB-92 Uniform billing form submitted to the N.J. Department of
Health and Senior Services. Every acute care hospital in the
state submits this data for all inpatients and all same-day
surgery patients.

Uniform Clinical A HCFA initiative that involves collection of approximately


Data Set (UCDS) 1,800 data elements that describe patient demographic charac-
teristics, clinical history, clinical findings and therapeutic
intervention. The data is obtained from the medical records
of Medicare beneficiaries

Unlicensed Assistive Trained, unlicensed staff who assist professional staff in the
Personnel (UAP) delivery of patient care.

Unrestricted Funds Any funds not designated for a specific purpose.

Urgent Care Center Sometimes referred to as a “minor emergency facility” or


“urgicenter,” it is a free-standing emergency care facility. A
hospital, a physician or a corporate entity may sponsor it.

Usual, Customary The traditional method of determining the prevailing physician


& Reasonable Charges fees in a given area.
(UCR)

Glossary of Healthcare Terms & Abbreviations Page 32


Utilization Review A systematic program of reviewing and managing patient care
in pursuit of cost-effective use of hospital services including
patient days, diagnostic tests, medications and surgical proce-
dures. JCAHO, Medicare and other external bodies require
hospital utilization management programs. Some third-party
payers have external utilization review organizations to review
services.

Vertical Integration A healthcare system that provides a range of continuum of


care such as outpatient, acute hospital, long-term, home and
hospice care, usually through partnerships, joint ventures and
contractual arrangements. (see multi-institutional system,
horizontal organization and integrated delivery system)

Glossary of Healthcare Terms & Abbreviations Page 33


FREQUENTLY USED ABBREVIATIONS
ently Used Abbreviations/Acronyms
AAHP American Association of Health Plans

AARP American Association of Retired Persons

ACHE American College of Healthcare Executives

ADC Average daily census

ADL Activities of daily living

ADSPN Association of Diploma Schools for Professional Nursing

AGMEC Advisory Graduate Medical Education Council

AHA American Hospital Association

AIDS Acquired immune deficiency syndrome

ALJ Administrative law judge

ALOS Average length of stay

AMA Against medical advice

AMA American Medical Association

ANA American Nurses Association

AOA American Osteopathic Association

AOHA American Osteopathic Hospital Association

AONE American Organization of Nurse Executives

Glossary of Healthcare Terms & Abbreviations Page 34


APD Adjusted patient day

ASAE American Society of Association Executives

BC/BS Blue Cross and Blue Shield

BME Board of Medical Examiners

CDC Centers for Disease Control

CE Continuing education

CEO Chief Executive Officer

CFO Chief Financial Officer

CHIN Community health information network

CICU Coronary intensive care unit

CMS Centers of Medicaid and Medicare Services (formerly HCFA)

CN or CON Certificate of Need

CNS Clinical Nurse Specialist

COB Coordination of benefits

COBRA Consolidated Omnibus Reconciliation Act of 1985

COHE College of Osteopathic Healthcare Executives

COO Chief Operating Officer

CPA Certified Public Accountant

CPR Cardiopulmonary resuscitation or customary, prevailing and


reasonable (charges)

CRNA Certified Registered Nurse Anesthetist

Glossary of Healthcare Terms & Abbreviations Page 35


CT Computed tomography

CY Calendar year

D&O Directors and officers

DHSS Department of Health and Human Services

DME Director of Medical Education or durable medical equipment

DNR Do not resuscitate

DOH Department of Health and Senior Services

DOJ Department of Justice

DOL Department of Labor

DOT Department of Transportation

DRG Diagnosis Related Group

DSH Disproportionate share hospital

EAB Engineering Advisory Board

EBT Employee Benefit Trust

ECF Extended care facility

ED Emergency Department

EMS Emergency medical system

EMT Emergency Medical Technologist

EMTALA Emergency Medical Treatment and Active Labor Act

EPA Environmental Protection Agency

Glossary of Healthcare Terms & Abbreviations Page 36


ER Emergency room (now referred to as the Emergency
Department - see ED)

ERISA Employee Retirement Income Security Act

ESRD End stage renal disease

FACHE Fellow of American College of Healthcare Executives

FDA Food and Drug Administration

FMG Foreign medical graduate

FTC Federal Trade Commission

FTE Full-time equivalent

FY Fiscal year

GAO General Accounting Office

GME Graduate medical education

GNP Gross national product

HCAB Health Care Administration Board

HCFA Health Care Financing Administration (renamed CMS in


2001)

HCFFA Health Care Facilities Financing Authority

HCIC Health Care Insurance Company

HEFCU Healthcare Employees Federal Credit Union

HFMA Healthcare Financial Management Association

HHAA Home Health Agency Assembly of NJ

HHS Health and Human Services (Dept. of)

Glossary of Healthcare Terms & Abbreviations Page 37


HHS Home health services

HIAA Health Insurance Association of America

HIP Health insurance plan

HIPAA Health Insurance Portability and Accountability Act of 1996

HMO Health Maintenance Organization

HRET Health Research and Educational Trust

HRSC Hospital Rate Setting Commission

ICD-9-CM International Classification of Diseases, 9th revision

ICF Intermediate care facility

ICU Intensive care unit

IDS Integrated delivery system

IMG International Medical Graduate

IPA Independent Practice Association

IPA Individual practice arrangement/association

IRA Individual retirement account

IV Intravenous

JCAHO Joint Commission on Accreditation of Healthcare


Organizations

JNESO New Jersey Nurses Economic Security Organization

LAB Local Advisory Board (no longer applicable in New Jersey)

LOS Length of stay

Glossary of Healthcare Terms & Abbreviations Page 38


LPN Licensed Practical Nurse

LTC Long-term care

LTAC Long term acute care hospital

MAHC Middle Atlantic Health Congress

MD Medical Doctor

MHA Master of Healthcare Administration

MICU Mobile intensive care unit

MONOC Monmouth Ocean Hospital Shared Services Association

MPH Master of Public Health

MRI Magnetic resonance imaging

MSA Medical savings account

MSNJ Medical Society of New Jersey

NA Nursing assistant

NJAC New Jersey Administrative Code

NJANPHA New Jersey Association of Non-Profit Homes for the Aging

NJHA New Jersey Hospital Association

NJHC New Jersey Healthcare Congress

NJHO New Jersey Hospice Organization

NJSA New Jersey Statutes Annotated

NJSNA New Jersey State Nurses Association

NP Nurse Practitioner

Glossary of Healthcare Terms & Abbreviations Page 39


OBRA Omnibus Budget Reconciliation Act

OMB Office of Management and Budget

OP Outpatient

OR Operating room

OSHA Occupational Safety and Hazard Agency

OT Occupational therapy

P&L Profit and loss

PA Physician assistant

PAC Political Action Committee

PAT Preadmission testing

PBM Pharmacy benefit management company

PDR Physicians’ Desk Reference

PGY Post graduate year

PHO Physician-hospital organization

PIC Princeton Insurance Company

PIP Periodic interim payments

PPO Preferred provider organization

PPS Prospective payment system

PRHB Post retirement health benefit

PRO Professional Review Organization (see QIO)

ProPAC Prospective Payment Assessment Commission

Glossary of Healthcare Terms & Abbreviations Page 40


PSN Provider sponsored network

PSO Provider-sponsored organization

PSRO Professional Standards Review Organization

PT Physical therapy

QA Quality assurance

QIO Quality Improvement Organizations

R&D Research and development

RN Registered Nurse

RPh Registered Pharmacist

RPT Registered Physical Therapist

RRA Registered Record Administrator

RRT Registered Respiratory Therapist

RT Respiratory Therapist/Therapy

SCHIP State Children’s Health Insurance Program

SIDS Sudden infant death syndrome

SNF Skilled nursing facility (pronounced “sniff”)

SNJHC Southern New Jersey Hospital Council

TEFRA Tax Equity and Fiscal Responsibility Act

TQM Total Quality Management

TRO Temporary restraining order

TSA Tax-sheltered annuity

Glossary of Healthcare Terms & Abbreviations Page 41


UAP Unlicensed assistive personnel

UP-92 Uniform Billing form, modified in 1992

UBPS Uniform bill patient summary

UCR Usual, customary and reasonable charges

UMDNJ University of Medicine and Dentistry of New Jersey

UR Utilization review

URL Uniform Resouce Locator

VA Veterans Administration

VHA Voluntary Hospitals of America

WC Worker’s compensation

WWW World Wide Web

YTD Year-to-date

Glossary of Healthcare Terms & Abbreviations Page 42


760 Alexander Road
PO Box 1
Princeton, NJ 08543-0001
609-275-4044
www.njha.com