Upgrade to remove ads
Only $35.99/year

L & M

Terms in this set (22)

Acuity index
weighted statistical measurement that refers to severity of illness of patients for a given time. Patients are classified according to acuity of illness, usually in one of four categories. The acuity index is determined by taking a total of acuities and then dividing by the number of patients.
Case mix
Type of patients served by an institution. A hospital's case mix is usually defined in such patient-related variables as acuity levels, diagnosis, personal characteristics, and patterns of treatment.
Full time equivalent
Number of hours of work for which a full-time employee is scheduled for a weekly period. For example, 1.0 FTE = five eight hour days of staffing, which equals 40 hours of staffing per week. One FTE can be divided in different ways. For example, two part time employees, each working 20 hours per week, would equal 1 FTE. If a position requires coverage for more than 5 days or 40 hours per week, the FTE will be greater than 1 for that position.
Hours per patient-day
Hours of nursing care provided per patient per day by various levels of nursing personnel. HPPD are determined by dividing total production hours by the number of patients.
Patient Classification System
Method of classifying patients. Different criteria are used for different systems. In nursing, patients are usually classified according to acuity.
Staffing mmix
Ratio of registered nurses, LVNs/LPNs, and unlicensed workers.
Turnover Ratio
Rate at which employees leave their jobs for reasons other than death or retirement. The rate is calculated by dividing the number of employees leaving by the number of workers employed in the unit during the year and then multiplying by 100.
Medicaid
Federally assisted and state administered program to pay for medical services on behalf of certain groups of low income individuals. generally, these pop;le are not covered by social security.
Medicare
Nationwide health insurance program authorized under Title 18 of the social security act that provides benefits to pop;le aged 65 years or older. Coverage is also available to certain groups of people with catastrophic or chronic illness, such as patients with renal failure requiring hemodialysis.
Accountable Care Organizations (ACOs)
Groups of providers and suppliers of service who work together to better coordinate care for Medicare patients (not medicare advantage)
Bundled Payment
A payment structure in which different health-care providers who are treating a patient for the same or related conditions are paid an overall sum for taking care of that condition rather than being paid for each individual treatment test, or procedure. In doing so, providers are rewarded for coordinating care, preventing complications and errors, and reducing unnecessary or duplicative tests and treatments.
Value Based Purchasing
A payment methodology that rewards quality of care through payment incentives and transparency. In VBP, value can be broadly considered to be a function of quality, efficiency, safety, and cost.
Health Maintenance Organization (HMO)
Historically, a prepaid organization that provided health care to voluntarily enrolled members in return for a preset amount of money on a per-person, per-month basis. Often referred to as a managed care organization.
Types of managed care
Health Maintenance Organization
Preferred provider organization
Managed care
term used to describe a variety of health care plans designed to contain the cost of healthcare services delivered to members while maintaining the quality of care.
Preferred Provider Organization (PPO)
Health care financing and delivery program with a group of providers, such as physicians and hospitals who contract t to give services on an FFS basis. This provides financial incentives to consumers to use a select group of preferred providers and pay less for services. Insurance companies usually promise the PPO a certain volume of patients and prompt payment in exchange for fee discounts.
Third party payment system
a system of healthcare financing in which providers deliver services to patients, and a third party, or intermediary, usually an insurance company or a government agency pays the bill.
Capitation
A prospective payment system (PPS) that pays health plans or providers a fixed amount per enrollee per month for a defined set of health services, regardless of how many (if any) services are used.
Dx- related groups (DRGs)
Rate setting PPS used by Medicare to determine payment rates for an inpatient hospital stay based on admission diagnosis. Each DRG represents a particular case type for which Medicare provides a flat dollar amount of reimbursement. This set rate may, in actually, be higher or lower than the cost of treating the patient in a particular hospital.
Fee for Service
FFS system-- A reimbursement system under which insurance companies reimburse health-care providers after the needed services are delivered.
Pay for Performance Programs (P4P)
Incentives are paid to providers to achieve a targeted threshold of clinical performance, typically a process or outcome measure associated with a specified patient population.
Pay for Value Programs
Typically, these incentive payments are specific to a provider setting (e.g. hospital inpatient or outpatient, physical, home health, skilled nursing facility, and dialysis) and linked to both quality and efficiency improvements.
Sets with similar terms