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Common Terms in Health Care

Editor’s note: I thought this compendium of terms used in the health care bills and debate might be helpful to my readers. This comes from MCOL Free Online.

Accountable Care Organization (ACO)
A provider organization responsible for the full continuum of care for its patients.

American Recovery and Reinvestment Act

Bundled Payment
A fixed bulk compensation for a patient’s episode of treatment.

Comparative Effectiveness Research

Comparative Effectiveness
A type of health care research that compares the results of one approach for managing a disease to the results of other approaches. Comparative effectiveness usually compares two or more types of treatment, such as different drugs, for the same disease. Comparative effectiveness also can compare types of surgery or other kinds of medical procedures and tests. The results often are summarized in a systematic review. The kinds of results that are studied to compare drugs or procedures include relief of symptoms, length of life, or whether people need to go to the hospital. These results are called outcomes. Many other kinds of outcomes can also be compared.

Whether a drug or other treatment works under the best possible conditions. In a research study about efficacy, the study participants are carefully selected, and the researchers can make sure the drug is taken properly and stored properly. The study participants may differ from other people in the general public who have the disease. A treatment that has efficacy under the best conditions may not work as well in a different group of people with the same disease.

Employee Retirement Income Security Act of 1974 (ERISA)
Federal law 93-406 that governs purchasers who qualify to provide self-insurance.  ERISA (Employment Retirement Income Security Act of 1974) regulations govern self-insured organizations, and exempts them from applicable state laws. This way a group operating in many states keeps its plan the same in every state.

The clinical exchange of information between a provider and patient used in assisting the diagnosis or treatment of the patient that is conducted via the Internet.

Federal employees health benefit plan.

Guaranteed Issue
An insurance policy that must accept all applicants regardless of their health status, provided they meet the other written qualifying conditions to be accepted for coverage.

Health Care Cooperative
Member owned non-profit organizations that provide or arrange for for the delivery of health care services and benefits to the member population.

Health Insurance Exchange
A government-administered marketplace in which qualifying health plans are offered and sold to qualifying groups or individuals, within set parameters for covered benefits and plan features.

The current version of the standardized International Classification of Diseases (ICD) codes in the billing and payment process for health care services, and for the medical records, data collection and analysis of these services,  published by the World Health Organization (WHO). The ICD-10 consists of: Tabular lists containing cause-of-death titles and codes.

International Classification of Diseases (ICD)
A medical code set maintained by the World Health Organization (WHO). The primary purpose of this code set is to classify causes of death. A US extension of this coding system, maintained by the NCHS within the CDC, is used to identify morbidity factors, or diagnoses.

Medical Home
A model of delivering primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. The goal of the medical home is to provide a patient with a broad spectrum of care, both preventive and curative, over a period of time and to coordinate all of the care the patient receives.

Medicare Recovery Audit Contractors

Remote Patient Management
Use of transformative technologies in chronic care management for purposes of supporting patient self-management, shifting responsibilities to non-clinical providers, and reducing the use of more intensive health care services, with remote monitoring of patients by applicable care providers enabled via applicable devices and systems.

Retail Clinics
Relatively small, limited-service medical clinics located inside grocery stores, pharmacies, and other retail locations, providing a limited menu of basic medical services delivered in a consumer-friendly environment typically by appropriately trained mid-level practitioners rather than physicians.


December 1, 2009 - Posted by | healthcare | ,

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