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“THE LANGUAGE OF THE HOSPITAL”. KEY CONCEPTS. CAPACITY THE SIZE OR CAPACITY OF A HOSPITAL IS DETERMINED BY THE NUMBER OF BEDS SET UP AND STAFFED FOR INPATIENT USE. INPATIENT DAYS
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“THE LANGUAGE OF THE HOSPITAL” • KEY CONCEPTS
CAPACITY • THE SIZE OR CAPACITY OF A HOSPITAL IS DETERMINED BY THE NUMBER OF BEDS SET UP AND STAFFED FOR INPATIENT USE.
INPATIENT DAYS • INPATIENT DAY (ALSO REFERRED TO AS A PATIENT DAY OR A HOSPITAL DAY) IS A NIGHT SPENT IN THE HOSPITAL BY A PERSON ADMITTED AS AN INPATIENT.
DAYS OF CARE • THE CUMULATIVE NUMBER OF PATIENT DAYS OVER A CERTAIN PERIOD OF TIME.
DAYS OF CARE PER 1,000 POPULATION OVER A PERIOD OF ONE YEAR GENERALLY REFLECT ACCESS TO INPATIENT SERVICES AS WELL AS THEIR UTILIZATION.
WHEN LOOKING DAYS OF UTILIZATION THESE TRENDS ARE OBSERVABLE. • THE ELDERLY SPEND MORE TIME IN HOSPITALS THAN YOUNGER PEOPLE.
MORE FEMALES ARE ADMITTED THAN MALES. • MEN GENERALLY INCUR LONGER PERIODS OF HOSPITALIZATION.
HOSPITAL UTILIZATION IS HIGHER AMONG BLACKS THAN WHITES AND AMONG PEOPLE OF LOWER SOCIOECONOMIC STATUS THAN THE MORE AFFLUENT.
IN THE WESTERN UNITED STATES, HOSPITALIZATION IS MUCH LOWER THAN IT IS IN OTHER PARTS OF THE COUNTRY. • LEVELS OR UTILIZATION AMONG RURAL AND URBAN POPULATIONS IS ABOUT THE SAME.
AS MIGHT BE EXPECTED, LEVELS OF UTILIZATION ARE HIGHER AMONG MEDICARE AND MEDICAID PATIENTS.
AVERAGE DAILY CENSUS • AVERAGE DAILY CENSUS IS THE AVERAGE NUMBER OF HOSPITAL BEDS OCCUPIED PER DAY.
DISCHARGES • DISCHARGES REFERS TO THE TOTAL NUMBER OF PATIENTS DISCHARGED FROM A HOSPITAL’S ACUTE CARE BEDS DURING A GIVEN PERIOD OF TIME.
AVERAGE LENGTH OF STAY • AVERAGE LENGTH OF STAY IS CALCULATED BY DIVIDING THE TOTAL NUMBER OF INPATIENT DAYS BY THE TOTAL DISCHARGES (OR TOTAL ADMISSIONS).
IT PROVIDES A MEASURE OF HOW MANY DAYS A PATIENT, ON AVERAGE, SPENDS IN THIS HOSPITAL. • IT IS AN INDICATOR OF SEVERITY OF ILLNESS.
IT INDICATES THE AVERAGE INPATIENT RESOURCES USED FOR SPECIFIC CATEGORIES OF PATIENTS.
OCCUPANCY RATE • OCCUPANCY RATE IS DERIVED BY DIVIDING THE AVERAGE DAILY CENSUS BY THE AVERAGE NUMBER OF BEDS (CAPACITY) DURING A GIVEN PERIOD OF TIME. IT IS EXPRESSED AS A PERCENTAGE.
ADMISSION: A patient who is provided with room, board, continuous nursing service, and other institutional services for at least one overnight stay.
ADULT LIVING FACILITY: A facility offering housing, food service and personal services such as assistance with eating, bathing, grooming, dressing, and supervision of self-administered medication.
ANCILLARY CARE SERVICES: Diagnostic or therapeutic services performed by non-nursing departments. These include, but are not limited to, surgery, laboratory, radiology, pharmacy, and physical therapy.
AVAILABLE BEDS: Beds staffed and ready for use. Does not include beds in labor rooms, bassinets, postoperative recovery rooms, outpatient residences and other areas utilized for only a portion of a patient’s stay.
CAPITATION: A method of payment for health services in which a provider is paid a fixed amount per month for each person served, regardless of the number or type of actual services provided to each person.
ABUSE: Any incident or practice of a provider, physician, or supplier which, although not usually considered fraudulent, is inconsistent with accepted and sound medical, business, or fiscal practices and directly or indirectly results in unnecessary costs to the Medicare program, improper reimbursement, or program reimbursement for services that fail to meet professionally recognized standards of care or, in some cases, may be medically unnecessary.
AMBULATORY SURGICAL CENTER (ASC): A facility that operates exclusively for the purpose of providing outpatient surgery services to patients
ASSIGNMENT: A process in which a Medicare beneficiary agrees to have Medicare’s share of the cost of a service paid directly to the provider. The provider agrees to accept the Medicare approved charges as payment in full.
DEDUCTIBLE: Amount that must be paid by an insured person before an insurance plan pays any portion of the associated costs.
ENTITLEMENT: Refers to a Medicare beneficiary who can receive benefits under the Medicare program (e.g., the date of entitlement begins at age 65 for most beneficiaries).
ACCESS: A person’s ability to obtain affordable medical care on a timely basis.
AMBULATORY CARE FACILITY (ACF): A medical care center tht provides a wide range of healthcare services, including preventive care, acute care, surgery, and outpatient care, in a centralized facility. Also known as a medical clinic or medical center.
AT-RISK: Term used to describe a provider organization that bears the insurance risk associated with the healthcare it provides.
CASE MANAGEMENT: A process of identifying plan members with special healthcare needs, developing a health-care strategy that meets those needs, and coordinating and monitoring the care, with the ultimate goal of achieving the optimum healthcare outcome in an efficient and cost-effective manner. Also known as large case management (LCM).
BALANCED BUDGET ACT: The Balanced Budget Act of 1997 makes numerous changes to the various titles of the Social Security Act and includes several anti-fraud and abuse provisions and improvements in protecting program integrity.
ACUTE CARE: NON-FEDERAL SHORT-TERM MEDICAL/SURGICAL HOSPITAL. ALSO CALLED “COMMUNITY” HOSPITAL OR “GENERAL MEDICAL/SURGICAL HOSPITAL.”
FEDERAL: CONTROLLED BY A DEPARTMENT OF THE FEDERAL GOVERNMENT, SUCH AS, VETERAN'S ADMINISTRATION, U.S. NAVY, U.S. ARMY, AND OTHERS.
INVESTOR-OWNED: OWNED AND OPERATED BYA CORPORATION OR AN INDIVIDUAL AND THAT OPERATES ON A FOR-PROFIT BASIS.
LONG-TERM: A HOSPITAL IN WHICH THE AVERAGE LENGTH OF STAY EXCEEDS 30 DAYS.
NOT-FOR-PROFIT: A GENERAL ACUTE CARE, NON-TAXABLE HOSPITAL THAT OPERATES ON A NOT-FOR-PROFIT BASIS UNDER THE OWNERSHIP AND CONTROL OF A PRIVATE CORPORATION.
PSYCHIATRIC: PROVIDES DIAGNOSTIC AND TREATMENT SERVICES TO PATIENTS WITH EMOTIONAL, MENTAL, OR SUBSTANCE ABUSE DISORDERS.
REHABILITATION: SPECIALIZES IN PROVIDING RESTORATIVE SERVICES TO REHABILITATE THE CHRONICALLY ILL AND DISABLED INDIVIDUALS TO A MAXIMUM LEVEL OF FUNCTIONING
RURAL: MEDICARE DEFINES “RURAL” AS A HOSPITAL LOCATED IN A NON-METROPOLITAN AREA. FOR ALL PURPOSES OTHER THAN MEDICARE, “RURAL” IS DEFINED BY STATE STATUTE.
SHORT-TERM: A HOSPITAL IN WHICH THE AVERAGE LENGTH OF STAY IS LESS THAN 30 DAYS.
SPECIALTY: PROVIDES MEDICAL SERVICES TO A DESIGNATED GROUP OF INDIVIDUALS WITHIN 23 RECOGNIZED AREAS OF EXPERTISE. SOME SPECIALITY HOSPITALS CAN BE CLASSIFIED AS “ACUTE CARE” IF SURGICAL SERVICES ARE PROVIDED.
TEACHING: VARIES FROM STATE TO STATE BUT IN FLORIDA, MUST BE AFFILIATED WITH AN ACCREDITED MEDICAL SCHOOL, AND MUST HAVE AT LEAST SEVEN DIFFERENT RESIDENT PHYSICIAN SPECIALITIES AND 100 OR MORE RESIDENTS.
BAD DEBT: PATIENT CHARGES THAT ARE UNCOLLECTIBLE. A HEALTH CARE PROVIDER MAY ABSORB THE COST OF BAD DEBT BY INCREASING CHARGES FOR OTHER PATIENTS. (COST SHIFTING)
BASSINET: CRIB FOR NEWBORNS NOT INCLUDED IN THE BED COUNT. COUNTED AS BED IF NEWBORN ADMITTED WITH A DIAGNOSIS.
CERTIFICATE OF NEED (CON): APPROVAL GRANTED BY THE STATE TO ADD NEW FACILITIES, TERTIARY SERVICES, OR TO BUY MAJOR EQUIPMENT. HOSPITALS, NURSING HOMES, AMBULATORY SURGICAL CENTERS AND HOME CARE AGENCIES MUST COMPLY WITH CON REGULATIONS.
COST SHIFTING: THE PRACTICE OF CHARGING HIGHER PRICES TO CERTAIN GROUPS OF HEALTH CARE PURCHASERS TO COVER THE COST OF UNCOMPENSATED CARE AND SHORTFALLS IN PAYMENT FROM GOVERNMENT PAYERS.
DIAGNOSIS RELATED GROUP (DRG): PATIENTS WITH THE SAME DIAGNOSIS, THE SAME PROCEDURES, AND WITH SIMILAR CHARACTERISTICS, SUCH AS AGE AND PRESENCE OF OTHER SICKNESSES AND COMPLICATIONS. MEDICARE REIMBURSES ACUTE CARE HOSPITALS BY ASSIGNING SPECIFIC PAYMENTS TO EACH “DRG.”
