Term
| Biologies Control Act of 1902 |
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Definition
| This act regulated the vaccines and sera sold via interstate commerce |
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Term
| National Institutes of Health (NIH) |
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Definition
| Federal agency of the Department of Health and Human Services comprising a number of institutes that carry out research and programs related to certain types of diseases, such as cancer. Played a vital role in recent clinical research on the treatment of the following diseases: heart disease and stroke, cancer, depression and schizophrenia, spinal cord injuries |
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Term
| Social Securities Act of 1935 |
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Definition
| Gave states funds on a matching basis for maternal and infant care, rehabilitation of crippled children, general public health work, and aid for dependent children under the age of 16. |
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Term
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Definition
| The federal legislation enacted in 1946 as the Hospital Survey and Construction Act to authorize grants for states to construct new hospitals and later, to modernize old ones. |
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Term
| Hospital Survey and Construction Act of 1946 |
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Definition
| The hospital system grew from 6,000 hospitals in 1946 to a high of approximately 7,200 acute care hospitals. |
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Term
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Definition
| Amendments were made the Social Security Act; Medicare and Medicaid were brought to existence. |
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Term
| Public Law 92-603 of 1972 |
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Definition
| Requires concurrent review for Medicare and Medicaid patients; and established the professional standards review organization (PSRO) program to implement concurrent review. |
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Term
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Definition
| A healthcare facility licensed by applicable state or local law to offer room and board, skilled nursing by a full-time registered nurse, intermediate care, or a combination of levels on a 24-hour basis over a long period of time. |
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Term
| Health Planning and Resources Development Act of 1974 |
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Definition
| Called for a new type of organization, the health systems agency (HSA), to have broad representation of healthcare providers and consumers on governing boards and committees. |
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Term
| Utilization Review Act of 1977 |
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Definition
| Made it a requirement that hospitals conduct continued-stay reviews for Medicare and Medicaid patients. Continued-stay reviews determine whether it's necessary for a patient to remain hospitalized. This legislation also included fraud and abuse regulations. |
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Term
| Peer Review Improvement Act of 1982 |
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Definition
| Redesigned the PSRO program and renamed the agencies peer review organizations (PROs). At this time, hospitals began to review the medical necessity and appropriateness of certain admissions even before patients were admitted. PROs were given a new name in 2002 and now are called quality improvement organizations (QIOs). |
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Term
| peer review organization (PRO) |
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Definition
| Until 2002, a medical organization that preforms a professional review of medical necessity, quality, and appropriateness of healthcare services provided to Medicare beneficiaries; now called quality improvement organization (QIO). |
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Term
| quality improvement organization (QIO) |
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Definition
| An organization that performs medical peer review of Medicare and Medicaid claims, including review of validity of hospital diagnosis and procedure coding information; completeness, adequacy, and quality of care; and appropriateness of prospective payments for outlier cases and non emergent use of the emergency room; until 2002, called peer review organization. |
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Term
| Tax Equity and Fiscal Responsibility Act of 1982 (TEFRA) |
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Definition
| Required extensive changes in the Medicare program; its purpose was to control the rising cost of providing healthcare services to Medicare beneficiaries. Required the gradual implementation of a prospective payment system (PPS) for Medicare reimbursement. |
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Term
| Prospective Payment Act (1982)/Public Law 98-21 of 1983 |
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Definition
| Reimbursement for hospital care provided to Medicare patients is based on diagnosis-related groups (DGRs). |
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Term
| Consolidated Omnibus Budget Reconciliation Act of 1985 |
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Definition
| Made it possible for the Centers for Medicare and Medicaid Services (CMS) to deny reimbursement for substandard healthcare services provided to Medicare and Medicaid beneficiaries. |
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Term
| Omnibus Budget Reconciliation Act of 1986 |
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Definition
| Requires PROs to report instances of substandard care to relevant licensing and certification agencies. |
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Term
| Healthcare Quality Improvement Act of 1986 |
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Definition
| Established the National Practitioner Data Bank (NPDB). |
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Term
| National Practitioner Data Bank (NPDB) |
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Definition
| A data bank established by the federal government through the 1986 Health Care Quality Improvement Act that contains information on the professional review actions taken against physicians and other licensed healthcare practitioners, which healthcare organizations are required to check as part of the credentialing process. |
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Term
| Omnibus Budget Reconciliation Act of 1989 |
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Definition
| Instituted the Agency for Healthcare Policy and Research; the mission of this agency is to develop outcome measures to evaluate the quality of healthcare services. |
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Term
| Omnibus Budget Reconciliation Act of 1990 |
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Definition
| Requires PROs to report actions taken against physicians to state medical boards and licensing agencies. |
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Term
| Mental Health Parity Act of 1996 (MHPA) |
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Definition
| A federal law that may apply to large group self-funded group plans or large group fully insured group health plans. The purpose of the law is to provide equality (parity) for mental health benefits with medical/surgical benefits when applying aggregate lifetime and annual dollar limits under a group health plan. |
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Term
| Health Insurance Portability and Accountability Act of 1996 (HIPPA) |
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Definition
| Addresses issues related to the portability of health insurance after leaving employment, establishment of national standards for electronic healthcare transactions, and national identifiers for providers, health plans, and employers. A portion addressed the security and privacy of health information by establishing privacy standards to protect health information and security standards for electronic healthcare information. |
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Term
| American Recovery and Reinvestment Act of 2009 (ARRA) |
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Definition
| One of the largest health information technology laws in recent history. It provided stimulus funds to the US economy in the midst of a major economic downturn. A substantial portion of the bill, Title XIII of the Act entitled the Health Information Technology for Economic and Clinical (HITECH) Act, allocated funds for implementation of a nationwide health information exchange and implementation of electronic health records. |
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Term
| Patient Protection and Affordable Care Act, 2010 |
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Definition
-Subsidized premiums for people with pre-existing conditions
-Eliminating lifetime limits on benefits
-The option of covering children on parents' insurance until the age of 26
-Development of state-based and state-administered health insurance exchanges
-Consumer Operated and Oriented Plan program
-Expansion of Medicaid to individuals under 65 with incomes up to 133% of federal poverty level
-Individual mendate to have acceptable coverage or pay a tax penalty
-Employers with 50+ employees must provide healthcare coverage
-Premium subsidies to individuals
-Small employer tax credits (AMA 2011) |
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Term
| Accountable Care Organizations (ACOs) |
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Definition
| An organization of healthcare providers accountable for the quality, cost, and overall care of Medicare beneficiaries who are assigned and enrolled in the traditional fee-for-service program. |
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Term
| American Medical Association (AMA) |
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Definition
Founded 1847 as a national voluntary service organization; key objectives are:
-to become the world leader in obtaining, synthesizing, integrating, and disseminating information on health and medical practice
-To remain the acknowledged leader in promoting professionalism in medicine and setting standards for medical ethics, practice, and education
-To continue to be an authoritative voice and influential advocate for patients and physicians
-To continue to be a sound organization that provides value to its members, related organizations, and employees |
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Term
| American Hospital Association (AHA) |
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Definition
| The national trade organization that provides education, conducts research, and represents the hospital industry's interests in national legislative matters; membership includes individual healthcare organizations as well as individual healthcare professionals working in specialized areas of hospitals, such as risk management |
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Term
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Definition
| A private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations on the basis of predefined performance standards; formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) |
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Term
| Blue Cross and Blue Shield Association |
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Definition
| The first prepaid healthcare plans in the US; Blue Shield plans traditionally cover hospital care and Blue Cross plans cover physicians' services |
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Term
| American College of Healthcare Executives (ACHE) |
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Definition
| The national professional organization of healthcare administrators that provides certification services for its members and promotes excellence in the field |
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Term
| American Nurses Association (ANA) |
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Definition
| The national professional membership association of nurses that works for the improvement of health standards and the availability of healthcare services, fosters high professional standards for the nursing profession, and advances the economic and general welfare of nurses |
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Term
| American Health Information Management Association (AHIMA) |
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Definition
| The professional membership organization for managers of health record services and healthcare information systems as well as coding services; provides accreditation, certification, and educational services |
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Term
| chief executive officer (CEO) |
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Definition
| The senior manager appointed by a governing board to direct an organization's overall management |
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Term
| medical staff classifications |
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Definition
| The organization of physicians in a healthcare facility; typical medical staff classifications include active, provisional, honorary, consulting, courtesy, and medical resident assignments |
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Term
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Definition
| A collection of guidelines adopted by a hospital's medical staff to govern its business conduct and the rights and responsibilities of its members |
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Term
| chief operating officer (COO) |
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Definition
| Individual who oversees the healthcare organization's internal operations, usually including direct patient care services, but not financial or information-related services |
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Term
| chief information officer (CIO) |
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Definition
| The senior manager responsible for the overall management of information resources in an organization |
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Term
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Definition
| 1. The ongoing, concurrent review performed by clinical professionals to ensure the necessity and effectiveness of the clinical services being provided to a patient 2. A process that integrates and coordinates patient care over time and across multiple sites and providers, especially in complex and high-cost cases 3. The process of developing a specific care plan for a patient that serves as a communication tool to improve quality of care and reduce cost |
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Term
| chief nursing officer (CNO) |
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Definition
| The senior manager (usually a registered nurse with advanced education and extensive experience) responsible for administering patient care services |
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Term
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Definition
| Health services provided to assist patients in achieving and maintaining their optimal level of function, self-care, and independence after some type of disability |
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Term
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Definition
| A type of step-down care provided after a patient is released from an acute care hospital (including nursing homes and other facilities that provide medical care, but not surgical or emergency care) |
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Term
| continuous quality improvement (CQI) |
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Definition
| 1. A management philosophy that emphasizes the importance of knowing and meeting customer expectations, reducing variation within processes, and relying on data to build knowledge for process improvement 2. A continuous cycle of planning, measuring, and monitoring performance and making knowledge-based improvements |
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Term
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Definition
| Fundamental rethinking and radical redesign of business processes to achieve significant performance improvements |
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Term
| skilled nursing facility (SNF) |
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Definition
| A long-term care facility with an organized professional staff and permanent facilities (including inpatient beds) that provides continuous nursing and other health-related, psychosocial, and personal services to patients who are not in an acute phase of illness but who primarily require continued care on an inpatient basis |
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Term
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Definition
| The medical care provided to persons with life expectancies of 6 months or less who elect to forgo standard treatment of their illness and to receive only palliative care |
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Term
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Definition
| Services concerned primarily with the health of entire communities and population groups |
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Term
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Definition
| The medical and/or personal care provided to individuals and families in their place of residence with the goal of promoting, maintaining, or restoring health or minimizing the effects of disabilities and illnesses, including terminal illnesses |
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Term
| investor-owned hospital chain |
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Definition
| Group of for-profit healthcare facilities owned by stockholders |
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Term
| health savings accounts (HSAs) |
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Definition
| Savings account designed to help people save for future medical and retiree health costs on a tax-free basis; part of the 2003 Medicare bill; also called medical savings accounts |
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