[ACS conditions] -Ambulatory care-sensitive (ACS) conditions – such as asthma, pneumonia, chronic pulmonary obstructive disease and congestive heart failure – refer to those for which hospitalization is often preventable when access to primary care is adequate.
[AHRQ] -Agency for Healthcare Research and Quality, part of the U.S. Department of Health and Human Services
[AMI] -Acute myocardial infarction, commonly referred to as heart attack.
[Arthroplasty] -Surgical replacement of a joint, such as a hip, knee or shoulder.
[BETOS codes] -Berenson-Eggers Type of Service codes. Used to classify Medicare claims according to type of service (such as evaluation & management, procedure, imaging, test, etc.).
[CABG] -Coronary artery bypass grafting, often referred to as coronary artery bypass surgery, heart bypass, or open heart surgery.
[Capitated] -Under capitation, the federal government pays providers or insurance companies a fixed annual amount per Medicare enrollee, in exchange for which they must provide all required services. If the total costs of care exceed the amount the government pays, then the organization must absorb the loss; if they are less, then the organization may retain the difference.
[CHF] -Congestive heart failure.
[CMG] -Canadian medical school graduate.
[CMHS file] -Continuous Medicare History Sample file. This file includes a record for each beneficiary in a 5% sample for each year, going back thirty years. It includes summary expenditure data and is used to estimate Medicare spending by program component.
[CMS] -The Centers for Medicare and Medicaid Services (CMS) is the U.S. federal agency that administers Medicare and Medicaid.
[Confidence interval] -A range of values within which a measurement falls corresponding to a given probability. A 95% confidence interval indicates that, if the same population was sampled on numerous occasions and interval estimates were made on each occasion, the resulting intervals would bracket the true population measure in approximately 95% of the cases.
[COPD] -Chronic obstructive pulmonary disease, including emphysema and chronic bronchitis.
[COTH] -The Council of Teaching Hospitals of the Association of American Medical Colleges (AAMC).
[CPT codes] -Current Procedural Terminology codes are used in medical claims to describe the services and procedures for which the bill was submitted.
[DME] -Durable medical equipment, such as wheelchairs, prosthetics and oxygen for home use
[DRG] -Diagnosis-related groups (DRGs) are used as part of Medicare’s prospective payment system to classify hospital claims with similar characteristics into groups that can be expected to have similar hospital resource use. DRGs are assigned based on diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities.
[E&M] -Evaluation & management (E&M) services include physician visits and consultations in all settings. Claims are classified as E&M by BETOS codes.
[EOL] -End of life.
[ESRD] -End stage renal disease. Medicare provides a national health insurance program for people with ESRD.
[FQHC] -Federally Qualified Health Center. FQHC services are similar to those provided in rural health clinics (RHCs). FQHC services also include preventive primary health services.
[FTE] -Full-time equivalent (FTE) is a standardized measure of work effort. An FTE of 1.0 means the equivalent of one full-time worker. Physician labor input measures use work relative value units (RVUs) to measure FTEs.
[HCAHPS] -Hospital Consumer Assessment of Healthcare Providers & Systems. A national survey to measure patients’ perspectives on hospital care.
[HCI index] -Hospital Care Intensity index. The HCI index is based on two variables: the number of days patients spent in the hospital and the number of physician encounters (visits) they experienced as inpatients. It is computed as the age-sex-race-illness standardized ratio of patient days and visits. For each variable, the ratio of a given hospital’s utilization rate to the national average was calculated, and these two ratios were averaged to create the index.
[HEDIS] -The Healthcare Effectiveness Data and Information Set (HEDIS) is a tool used by health plans to measure performance on important dimensions of care and service.
[HRR] -Hospital referral regions (HRRs) are regional market areas for tertiary medical care. Each HRR contains at least one hospital that performs major cardiovascular procedures and neurosurgery.
[HSA] -Hospital service areas (HSAs) are local health care markets for hospital care. An HSA is a collection of ZIP codes whose residents receive most of their hospitalizations from the hospitals in that area.
[ICD codes] -These are the International Classification of Disease codes used to identify diagnoses, symptoms and procedures in hospital and provider claims. The ICD-9 codes were discontinued on October 1, 2015, with the ICD-10 codes replacing them. This may require a transition in coding procedures for longitudinal analysis.
[IMG] -International medical school graduate (non-U.S. and Canada).
[L2Y] -Last two years of life.
[L6M] -Last six months of life.
[MedPAR file] -The Medicare Provider Analysis and Review (MedPAR) file includes one record for each hospital stay by Medicare beneficiaries. The record includes data on dates of admission/discharge, diagnoses, procedures and Medicare reimbursements to the hospital.
[NCQA] -The National Committee for Quality Assurance (NCQA) is a private, not-for-profit organization dedicated to improving health care quality.
[NPI] -National Provider Identifier issued by CMS to health care providers caring for Medicare enrollees.
[Part A] -Part A is Medicare’s hospital insurance program. It covers inpatient care in hospitals, nursing homes, skilled nursing facilities, and critical access hospitals.
[Part B] -The coverage provided by Medicare Part B includes medically necessary doctor’s services, outpatient care, and most other services that Part A does not cover (such as some physical or occupational therapies and some home health care services). Part B covers preventive services as well.
[Part D] -Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare.
[PCI] -Percutaneous coronary intervention, commonly known as coronary angioplasty.
[PCSA] -Primary Care Service Areas (PCSAs) reflect Medicare patient travel to primary care providers.
[Revascularization] -Surgical procedure to establish or improve blood supply to a body part or organ.
[RHC] -Rural Health Clinics (RHCs) are clinics that are located in areas designated by the Bureau of the Census as rural and by the Secretary of Department of Health and Human Services or the state as medically underserved.
[RVU] -Relative value units (RVUs) quantify the values of health care services. An RVU is a dollar amount assigned to each encounter, procedure, or surgery. They are calculated on the basis of the amount of work required, the expense to the practice, and the cost of malpractice insurance.
[SNF] -Skilled nursing facility.
[TURP for BPH] -Transurethral prostatectomy for benign prostatic hyperplasia.