Download Glossary of Terms - Companion Connection Senior Care

Glossary of Terms
2010 Affordable Care Act: The Patient Protection and Affordable Care Act
(PPACA) informally referred to as Obamacare is a United States federal statute
signed into law by President Barack Obama on March 23, 2010 after nearly a
year of overall consideration by both chambers of Congress. It provides for a
movement towards universal coverage, as well as providing for measures that
are intended to curtail health care costs.
Acute Care: Short-term medical treatment, usually in a hospital, for patients
having an acute illness or injury or recovering from surgery.
Acute illness: Any illness characterized by signs and symptoms of rapid
onset and short duration
Acute myocardial function: An acute myocardial infarction (AMI), also
called a heart attack, happens when one of the heart’s arteries becomes blocked
and the supply of blood and oxygen to part of the heart muscle is slowed or
stopped. When the heart muscle doesn't get the oxygen and nutrients it needs,
the affected heart tissue may die.
Care Transition: The term "care transitions" refers to the movement patients
make between health care practitioners and settings as their condition and care
needs change during the course of a chronic or acute illness. For example, in the
course of an acute exacerbation of an illness, a patient might receive care from a
PCP or specialist in an outpatient setting, then transition to a hospital physician
and nursing team during an inpatient admission before moving on to yet another
care team at a skilled nursing facility. Finally, the patient might return home,
where he or she would receive care from a visiting nurse. Each of these shifts
from care providers and settings is defined as a care transition.
Chronic illness: Chronic is the opposite of acute - meaning a long term
condition, for example chronic bronchitis. Chronic may also be confused by the
general public to mean severe. Once again, this is a different definition
medically and something can be chronic but not severe.
HospitalistCMS Center for Medicare and Medicaid Services. The federal
agency that runs the Medicare program for the elderly aged and disabled. In
addition, CMS works with the states to run the Medicaid program for low-income
individuals. CMS works to make sure that the people in these programs are able
to get high quality health care.
Hospitalist: The term hospitalist was coined in 1996 and is applied to a
medical practitioner whose primary focus is care of patients in the hospital
setting. In most situations, hospitalists do not have an office practice. Although
there is some variability, most hospitalists are trained in general internal
medicine, meaning they are trained to diagnose and treat disease in adults.
Hospital Outcomes: Outcomes of care and patient experiences of hospital
stays are publicly reported on the medicare.gov site, allowing consumers and
health care providers compare performances of hospitals within their geographic
area.
Med Pac: The Medicare Payment Advisory Commission (MedPAC) is an
independent Congressional agency established by the Balanced Budget Act of
1997 (P.L. 105-33) to advise the U.S. Congress on issues affecting the Medicare
program. The Commission's statutory mandate is quite broad: In addition to
advising the Congress on payments to private health plans participating in
Medicare and providers in Medicare's traditional fee-for-service program,
MedPAC is also tasked with analyzing access to care, quality of care, and other
issues affecting Medicare
Post Acute Care (PAC): The type of care provided after a hospitalization. It
can include intense nursing and rehabilitation for individuals who have been
hospitalized and require further nursing care and rehabilitation services. Post
Acute care can occur in nursing, rehabilitation facilities and home health facilities.
Sometimes referred to as sub-acute care.
PCP: Primary Care Physician is a physician/medical doctor who provides
both the first contact for a person with an undiagnosed health concern as well as
continuing care of varied medical conditions, not limited by cause, organ system,
or diagnosis.
Prospective Pay: Hospitals that have contracted with Medicare to provide
acute inpatient care and accept a predetermined rate as payment in full.
Readmission: Readmission occurs when a patient is discharged from the
applicable hospital to a non acute setting and then is readmitted to the same or
another acute care within 30 days for any reason
Risk adjustment The statistical process of accounting for differences in
patients’ sickness before they were admitted to the hospital is called risk
adjustment. This statistical process aims to ‘level the playing field’ by accounting
for health risks that patients have before they enter the hospital.
Utilization Review: Hospital utilization review plans are the documentation
that determine how long a patient stays in a hospital for treatment or even if the
patient is admitted to a hospital for treatment. It a process aimed at providing
quality patient care in a cost-effective manner, reducing hospital admissions and
lengths of stay in medical facilities. It compares proposed treatment options to
national averages and standards, and is used to determine whether private
insurance companies or government-backed Medicaid covers hospital lengths of
stay
Value Based Reimbursement: Requires bundled payment of services
over a cycle of care. In its simplest form, healthcare providers are incentivized
for “good outcomes” and penalized for “bad outcomes”.