| Term |
Definition |
| Early Periodic Screening, Diagnosis and Treatment Program (EPSDT) |
One of the services that states are required to include in their basic benefits package for all Medicaid-eligible children under age 21. The services include maternal and child health programs designed to determine illnesses that handicap children. |
| Emergency Medical Treatment and Active Labor Act (EMTALA) |
Also known as the COBRA “anti-dumping” law. EMTALA is a federal law which requires that all patients who come to the Emergency Department receive an appropriate medical screening examination regardless of their ability to pay and must be stabilized if they are to be transferred to another facility. |
| Electronic Health Record (EHR) |
An electronic version of a patient’s medical record, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. Also known as an Electronic Medical Record (EMR). |
| Elements of Performance |
The steps providers must take to achieve the goals of The Joint Commission standards. |
| Emergency Medical System (EMS) |
A systematic, community linkage among hospital trauma centers, ambulance emergency units and other emergency vehicles, personnel trained in emergency medicine and communications systems so that severely ill or injured persons are transported and treated promptly and appropriately. |
| Employee Retirement Income Security Act of 1974 (ERISA) |
A federal law mandating reporting and disclosure requirements for self-funded group health and life insurance plans. |
| Endowment |
Funds intended to be invested in perpetuity, providing income for the continued support of a nonprofit organization. |
| Ethics Committee |
A hospital or other healthcare organization’s committee concerned with biomedical ethics issues. |
| Exclusive Provider Organization (EPO) |
A health insurance plan in which subscribers are eligible to receive benefits only when they use the services of a limited network of providers. |
| Explanation of Benefits (EOB) |
A primary communication between health insurance carriers and their customers that details recent care charges and benefit plan payments. Whenever healthcare services are received, the carrier sends an EOB to the primary account holder. It shows what claim was submitted, what has been paid and what is owed by the customer. |
| Extended Care Unit |
Unit for treatment of inpatients who require convalescent, rehabilitative or long-term skilled nursing care. |
| Family and Medical Leave Act (FMLA) |
A federal law that guarantees up to 12 weeks of job-protected leave for certain employees when they need to take time off due to serious illness or disability, to have or adopt a child, or to care for another family member. The New Jersey Family Leave Act (NJFLA) also provides time off from work in connection with the birth or adoption of a child or the serious illness of a parent, child or spouse. |
| Federal Medical Assistance Percentage (FMAP) |
The statutory term for the federal Medicaid matching rate, or the share of total Medicaid costs that the federal government bears. The FMAP varies depending on a state’s per capita income compared to the national average. The federal share of Medicaid spending varies by state, ranging from 50 percent (the minimum level by statute; also, the rate for New Jersey) to 77 percent. |
| Federal Poverty Level (FPL) |
The federal Department of Health and Human Services (HHS) issues two versions of the federal poverty measure: the poverty thresholds and the poverty guidelines. The poverty thresholds are the original version of the federal poverty measure and are updated annually by the Census Bureau. These are calculated based on family size, income and the Consumer Price Index for all Urban Consumers (CPI-U) and are used mainly for statistical purposes. The poverty guidelines are a simplification of the poverty thresholds for use for administrative purposes — for instance, determining financial eligibility for certain federal programs. |
| Federally Facilitated Marketplace (FFM) |
Marketplaces operated by the federal Department of Health and Human Services (HHS) in states that have elected not to establish state-run healthcare marketplaces pursuant to the Affordable Care Act. New Jersey has a federally-facilitated marketplace which is designed to streamline the process of renewing and selecting health insurance. |
| Federally Qualified Health Centers (FQHC) |
FQHCs provide primary care services to medically underserved areas and populations. They are federally funded and provide services on a sliding scale fee to consumers. |
| Fee-For-Service |
Method of charging patients for services provided, in which the healthcare provider bills for each patient encounter or service rendered on a retrospective basis. |
| Financial Statement |
Detailed report of the financial conditions of an entity including profits, losses, assets and liabilities. The four major components of a financial statement are the income statement, the statement of owner’s equity, the balance sheet and the statement of cash flow. |
| Fiscal Intermediary (FI) |
An organization that contracts with the federal government to administer claims processing for the Medicare program. |
| Flexible Spending Account (FSA) |
A flexible spending account is a special account used to pay for certain out-of-pocket healthcare costs or for dependent day care expenses. By using FSAs, individuals save an amount equal to the taxes that otherwise would have been paid on the money saved in the account. Also known as a flexible spending arrangement. |
| Fraud and Abuse |
The federal body of law applying to Medicare and Medicaid providers. This law prohibits three things: filing false claims, paying or receiving bribes or kickbacks for referrals and self-referral schemes. Violations can result in criminal and/or civil punishment. |
| Freestanding Facilities |
Healthcare facilities that are not physically, administratively or financially connected to a hospital. An example is a freestanding ambulatory surgery center. |
| Gainsharing |
A compensation agreement between hospitals and physicians, designed to align payment incentives and make physicians and hospitals perform more efficiently. If the physicians and hospital meet specific performance goals of improving quality, streamlining care and achieve cost savings, the physician will receive a payment as a share of the hospital savings from the cost reduction. Although this type of arrangement was previously impermissible under Medicare, CMS and OMB allowed New Jersey to conduct a gainsharing pilot program beginning in 2009 with 12 acute care hospitals which was replaced in April 2013 with a similar program and expanded to include additional acute care hospitals. |
| Gatekeeper |
Generally, a primary care physician who controls referrals of patients to a hospital or for specialty care. |
| Geriatric Acute Care Unit (ACE) |
A unit that provides acute care to elderly patients in a separate area or wing that may include specifically designed units with architectural adaptations designed to accommodate the decreased sensory perception of older adults. |
| Geriatric Assessment Service |
An interdisciplinary service providing a comprehensive assessment of the physical and mental health, and the functional, social and financial status of an older adult, resulting in a plan for comprehensive treatment and referral to appropriate providers reflecting individual and family preferences and financial status. |
| Geriatric Assessment Team |
Disciplinary team of professionals that may have the following members: physicians, nurses, social workers and therapists. The team assesses the medical and psychosocial needs and functional status of elderly patients to determine the services they require. |
| Graduate Medical Education (GME) |
Medical education after receiving the medical doctorate or equivalent degrees, including education received as an intern, resident or fellow. For hospital reimbursement purposes, GME payments are broken into two categories: direct GME payments for the direct cost of residency programs and indirect medical education (IME) payments to reflect the higher indirect costs of patient care in teaching versus non-teaching facilities. |
| Governing Body |
The legal entity ultimately responsible for hospital policy, organization, management and quality of care. Also called the governing board, board of trustees, commissioners or directors. The governing body is accountable to the owner(s) of the hospital, which may be a corporation, the community, local government or stockholders. |
| Hazardous materials (HAZMAT) |
Materials that are harmful to humans and other living things such as radioactive, biological or chemical materials or agents. |
| Healthcare Consumerism |
Targeted efforts that encourage consumers to be active participants in the procurement of healthcare services. |
| Healthcare Proxy |
A legal document giving a trusted advisor, also called an agent, the responsibility for making medical decisions for an individual who has become incapacitated. |
| Health Information Exchange (HIE) |
A technology solution that allows provider electronic health record (EHR) systems to connect across a region with other provider EHR systems through a private or secured network. This technology makes it possible for clinicians to access in real time the complete or parts of their patients’ EHR that is stored by other healthcare organizations and clinicians. |
| Health Information Organization (HIO) |
The organization that operates an HIE and governs the policies and all other operational aspects associated with running an HIE. |
| Health Insurance Portability and Accountability Act of 1996 (HIPAA) |
A federal law that established national standards for electronic healthcare transactions and code sets, unique health identifiers and security. Additionally, the law mandates privacy protections for individually identifiable health information. Two other federal laws add requirements to HIPAA: the Health Information Technology for Economic and Clinical Health Act (HITECH), enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA), and the Patient Protection and Affordable Care Act of 2010 (ACA). |
| Health Maintenance Organization (HMO) |
A healthcare system that assumes both the financial risks associated with providing comprehensive medical services (insurance and service risk) and the responsibility for healthcare delivery in a particular geographic area to HMO members, usually in return for a fixed, prepaid fee. Financial risk may be shared with the providers participating in the HMO. (see Capitation, IPA, Staff model HMO) |
| HealthPAC |
A political action committee formed to educate New Jersey legislators and political candidates regarding issues affecting New Jersey’s hospitals. It is an independent, bi-partisan organization, not affiliated with any political party. |
| Health Promotion Services |
Education and/or other supportive services that are hospital-planned and coordinated to help people to adopt healthy behaviors, reduce health risks, increase self-care skills, use healthcare services effectively and increase understanding of medical procedures and therapeutic regimens. |
| Health Spending Account (HSA) |
Accounts created in 2003 so that individuals covered by high-deductible health plans could receive tax-preferred treatment of money saved for medical expenses. Health savings accounts (HSAs) are similar to personal savings accounts, but the money in them is used to pay for healthcare expenses. The individual owns and controls the money in an HSA. The money deposited into the account is not taxed. To be eligible to open an HSA, an individual must have a high-deductible plan. |
| Health Reimbursement Account (HRA) |
Employer-funded group health plans from which employees are reimbursed tax-free for qualified medical expenses up to a fixed dollar amount per year. Unused amounts may be rolled over to be used in subsequent years. The employer funds and owns the account. Health Reimbursement Accounts are sometimes called Health Reimbursement Arrangements. |
| Healthcare-Acquired Condition (HAC) |
A “reasonably preventable” condition or event during an inpatient hospital stay. |
| High Deductible Health Plan |
A plan design that offsets lower premiums with a higher deductible. Also known as Consumer Directed Health Plans because they are often one of the mechanisms utilized to engage consumers. |
| Hill-Burton |
A federal program established in the 1960s that created financial assistance for the construction and renovation of hospitals and other healthcare facilities. The program was named for its two principal congressional proponents, Hill and Burton. |
| Holding Company |
Separate entity used to hold a variety of subsidiary groups that often perform related functions but have a distinct corporate identity. |
| Home Health Care |
A program that provides nursing, rehabilitative and home health aide care to individuals in their place of residence to promote, maintain or restore health or for minimizing the effects of disability or illness. |
| Horizontal Integration |
A linkage or network of the same types of providers, i.e., a multi-organizational system composed of acute care hospitals. A competitive strategy used by some hospitals to control the geographical distribution of healthcare services. (see Hospital Alliance and Vertical Integration) |
| Hospice Care |
Care that addresses the physical, spiritual, emotional, psychological, social, financial and legal needs of the person who is terminally ill and his or her family. Hospice care is provided by an interdisciplinary team of professionals and volunteers in a variety of settings, both inpatient and at home, and includes bereavement care for the family. |
| Hospital Alliance |
A group of nonprofit hospitals that join together to share common services and pursue business opportunities that could not be supported by the hospitals individually. Typically, the hospitals in an alliance retain their individual autonomy, but may share information and services and do joint planning and group purchasing. |
| Hospital Consumer Assessment of Healthcare Providers and Services (HCAHPS) |
A national, standardized, publicly reported survey of patients’ perspectives of hospital care. It is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. |
| Hospital Engagement Network (HEN) |
A network of hospitals participating in the Partnership for Patients quality initiative. Partnership for Patients is a national initiative developed by the Centers for Medicare and Medicaid Services (CMS) to improve the quality, safety and affordability of healthcare. NJHA’s Health Research and Educational Trust was selected by CMS to lead this effort in New Jersey as a HEN. Beginning in 2017, HENs will be known as HIINs or Hospital Improvement and Innovation Networks. |
| Hospital Improvement and Innovation Networks (HIIN) |
see Hospital Engagement Network (HEN) |
| Hospitalist |
A physician who specializes in inpatient medicine. In the hospital setting, the hospitalist functions much like a primary care physician does outside of the hospital coordinating care. They do not have private practices and typically do not follow patients after discharge except if they are treated in a hospital-based clinic. |
