A patient's ability to obtain medical care. The ease of access is determined by components such as the availability of medical services and their acceptability to the patient, availability of insurance, the location of health care facilities, transportation, hours of operation, affordability and cost of care.
Approval by an authorizing agency for institutions and programs that meet or exceed a set of pre-determined standards.
- activities of daily living (ADLs)
Activities performed as part of a person's daily routine of self-care such as bathing, dressing, toileting and eating.
- acute care
Hospital care given to patients who generally require a stay of several days that focuses on a physical or mental condition requiring immediate intervention and constant medical attention, equipment and personnel.
- administrative costs
Costs related to activities such as utilization review, marketing, medical underwriting, commissions, premium collection, claims processing, insurer profit, quality assurance and risk management for purposes of insurance.
- advanced practice nurse (APN)
A registered nurse who is approved by the Board of Nursing to practice nursing in a specified area of advanced nursing practice. APN is an umbrella term given to a registered nurse who has met advanced educational and clinical practice requirements beyond the two to four years of basic nursing education required of all RNs. There are four types: 1) certified registered nurse anesthetist (CRNA); 2) clinical nurse specialist (CNS); 3) certified nurse practitioner (CNP); and 4) certified nurse midwife (CNM).
- adverse drug event (error)
Any incident in which the use of medication (drug or biologic) at any dose, a medical device, or a special nutritional product may have resulted in an adverse outcome in a patient.
- adverse event
An injury resulting from a medical intervention that is not due to the underlying condition of the patient.
- adverse selection
Among applicants for a given group or individual health insurance program, the tendency for those with an impaired health status, or those who are prone to higher-than-average utilization of benefits, to be enrolled in disproportionate numbers in lower deductible plans.
Services following hospitalization or rehabilitation, individualized for each patient's needs. Aftercare gradually phases the patient out of treatment while providing follow-up attention to prevent relapse.
- Agency for Healthcare Research and Quality (AHRQ)
A federal agency within the Public Health Service responsible for research on quality, appropriateness and cost of health care. AHRQ also centralizes access to state inpatient data. www.ahrq.gov
- allied health personnel
Specially trained and often licensed health workers other than physicians, dentists, optometrists, chiropractors, podiatrists and nurses. The term is sometimes used synonymously with paramedical personnel, which are all health workers who perform tasks that must otherwise be performed by a physician, or health workers who do not usually engage in independent practice.
One of two schools of medicine that treat disease by inducing effects opposite to those produced by the disease. The other school of medicine is. osteopathic
- allowable costs
Charges for services rendered or supplies furnished by a health provider that qualify as covered expenses for insurance purposes.
- alternative delivery
An alternative to traditional inpatient care system such as ambulatory care, home health care and same-day surgery.
- alternative medicine
Treatment procedures that are not supported by mainstream medicine, often due to lack of supporting experimental data.
Amended. A designation sometimes found before a House or Senate bill number showing that formal changes have been made to an introduced piece of legislation during the legislative process.
- ambulance restocking
The practice of a hospital replenishing certain drugs and supplies used by an ambulance service during transport of a patient to the hospital.
- ambulatory care
Care given to patients who do not require overnight hospitalization.
- ambulatory patient group (APG)
The Medicare program's prospective payment system for outpatient services and procedures. Each APG is a classified medical service or procedure. Unlike diagnosis related group reimbursement for inpatient care, where medical events are condensed into one diagnostic related group, an outpatient visit can combine several different APGs.
- ambulatory payment classification (APC)
Groups or groupings of medical procedures and services used as a basis for reimbursement under the Medicare outpatient prospective payment system.
- ambulatory setting
An institutional health setting in which organized health services are provided on an outpatient basis, such as a surgery center, clinic or other outpatient facility. Ambulatory care settings also may be mobile units of service (e.g., mobile mammography, MRI).
- ambulatory surgical facility
see freestanding outpatient surgical center
- American Accreditation Healthcare Commission (AAHC)
An independent not-for-profit corporation that develops national standards for utilization review and managed care organizations. www.urac.org
- American College of Healthcare Executives (ACHE)
An international professional society of nearly 30,000 health care executives based in Chicago. www.ache.org
- American Health Care Association (AHCA)
A trade association representing nursing homes and long-term care facilities in the U.S. based in Washington, D.C.www.acha.org
- American Hospital Association (AHA)
A national association that represents allopathic and osteopathic hospitals in the U.S. AHA is based in Washington, D.C., with operational offices in Chicago. www.aha.org
- American Medical Association (AMA)
A national association organized into local and regional societies that represents over 700,000 medical doctors in the United States. AMA is based in Chicago. www.ama-assn.org
- American Osteopathic Association (AOA)
A national association organized into local and regional societies that represents over 43,000 osteopathic physicians in the United States. AOA is based in Chicago and also provides accreditation for hospitals and colleges of osteopathic medicine. www.osteopathic.org
- American Society for Clinical Laboratory Science (ASCLS)
An organization for clinical laboratory science practitioners, providing leadership and promoting all aspects of clinical laboratory science practice, education and management to ensure cost-effective laboratory services for health care consumers. www.ascls.org
- American Society for Clinical Pathology (ASCP)
A national resource for the enhancement of the quality of the practice of pathology and laboratory medicine. www.ascp.org
- Americans with Disabilities Act (ADA)
A federal law that prohibits employers of more than 25 employees from discriminating against any individual with a disability who can perform the essential functions, with or without accommodations, of the job that the individual holds or wants. www.usdoj.gov/crt/ada/adahom1.htm
A term used to describe additional services performed related to care, such as lab work, X-ray and anesthesia.
- anti-kickback statute
A federal law that prohibits the paying or receiving of remuneration in exchange for the referral of patients or business paid by a federal health care program.
A situation in which a single entity, such as an integrated delivery system, controls enough of the practices in any one specialty in a relevant market to have monopoly power (e.g., the power to increase prices).
- any willing provider
A term used to describe legislation requiring a health plan to accept on its provider panels every physician, hospital or other practitioner that wants to participate in the health plan’s products.
- approved health care facility or program
A facility or program that is licensed, certified or otherwise authorized pursuant to the laws of the state to provide health care and that is approved by a health plan to provide the care described in a contract.
- associate degree in nursing (ADN)
A degree received after completing a two-year nursing education program at a college or university that qualifies a nurse to take a national licensing exam (NCLEX) to become a registered nurse.
- attorney general
Chief law enforcement officer of a state, responsible for advising the state or nation of legal matters.
- average adjusted per capita cost (AAPCC)
Payment rates used by the Centers for Medicare & Medicaid Services to reimburse managed care organizations for care delivered to Medicare enrollees.
- average length of stay (ALOS)
A standard hospital statistic used to determine the average amount of time between admission and departure for patients in a diagnosis related group, an age group, a specific hospital or other factors.
- avian (or bird) flu
Caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available. (see also seasonal flu and pandemic flu)