Healthcare Glossary

updated July 2017
 
Abuse Abuse is the improper usage or treatment of an entity, often to unfairly or improperly gain benefit.
Advance Directive State and federal laws that prohibit health care and other providers from price-fixing or developing monopolies that would prevent consumers from having choices in terms of costs and service.
Advanced Practice Nurse (APN) Advanced practice registered nurses who hold a master's or doctoral degree in a specialized area of nursing practice.
Affirmative Action Affirmation Action employment programs are designed to remedy (as required by federal regulations/statutes) discriminatory practices in hiring minority group members, eliminate existing/continuing discrimination, remedy lingering effects of past discrimination, and to create procedures/systems to prevent future discrimination. Factored considered are race, color, sex, creed and age.
Affordable Care Act (ACA) Also known as the Patient Protection and Affordable Care Act, this federal legislation was passed in March of 2010 and contains new health reform provisions.
AHRQ (Agency for Healthcare Research and Quality) A federal agency within the Public Health Service responsible for research on quality, appropriateness, and cost of health care. AHRQ also centralizes access to state inpatient data.
American Hospital Association (AHA) National organization that represents and serves all types of hospitals, health care networks, and their patients and communities.
American Nurses Association (ANA) Professional organization to advance and protect the profession of nursing.
American Nurses Credentialing Center (ANCC) A Subsidiary of American Nurses Association (ANA), the organization promotes excellence in nursing and health care globally through credentialing programs.
American Organization of Nurse Executives (ADNE) A subsidiary of the American Hospital Association, ADNE provides leadership, professional development, advocacy and research to advance nursing practice and patient care, promote nursing leadership excellence, and shape public policy for health care nationwide. 
Anti-Kickback Statute A federal law passed in 1972 that provides for criminal and civil penalties on individuals or entities that offer payment or solicit or receive remunerations in exchange for Medicare, Medicaid or other federally financed health care program referrals.
Anti-Trust Laws State and federal laws that prohibit health care and other providers from price-fixing or developing monopolies that would prevent consumers from having choices in terms of costs and service.
CDC Centers for Disease Control and Prevention
Civil Rights Act The Civil Rights Act of 1964 (Pub.L. 88-352, 78 Stat. 241, enacted July 2, 1964) is a landmark piece of civil rights legislation in the United States that outlawed discrimination based on race, color, religion, sex, or national origin.
Clinical Nurse Specialist (CNS) Advanced practice registered nurses who hold a master's or doctorial degree in a specialized area of nursing practice.
CMS Centers for Medicare and Medicaid Services
Comorbidity A preexisting patient condition that, linked to a principal diagnosis, causes an increase in length of stay by at least one day in approximately 75 percent of cases.
CoP (Conditions of Participation) The federal regulations hospitals must comply with in order to qualify for Medicare reimbursement.
Corporate Responsibility A form of corporate self-regulation integrated into a business model.
Data Use Agreement The written assurance required by HIPAA that the "limited data set recipient will only use or disclose the protected health information for limited purposes."
DOJ Department of Justice
DRG (Diagnostic Related Group) A system of classifying patients on the basis of diagnoses for the purpose of payment to hospitals; for payment under Medicare’s PPS and by some other payers. The ERG system classifies patients into groups based on the principal diagnosis, type of surgical procedure, presence or absence of significant comorbidities or complications and other relevant criteria. DRGs are intended to categorize patients into groups that are clinically meaningful and homogeneous with respect to resource use.
DRP Disaster Recovery Plan
Durable Power of Attorney A legal document in which individuals select another person to act on their behalf in the event they become incapacitated.
EMTALA (Emergency Medical Treatment and Active Labor Act) EMTALA requires hospitals to provide emergency treatment to individuals, regardless of insurance status and ability to pay. If they are transferred to another facility, they must be stabilized first.
EQRO (External quality review organization) States are required to contract with an entity that is external to and independent of the state and its health maintenance organization (HMO) and health insurance organization (HIO) contractors to perform an annual review of the quality of services furnished by each HMO or HIO contractor.
Equal Employment Opportunity Commission (EEOC) The federal agency responsible for publishing guidelines, enforcing EEO laws and investigating complaints of job discrimination based on race, color, religion, sex (including pregnancy), national origin, age or disability.
Evidenced Based Practice (EBP) Conscientious, explicit and judicious use of current best evidence in decision making as it relates to the care of the patient.
Exclusivity Clause A part of a contract which prohibits a health care provider from contracting with more than one managed care organization.
False Claims Act A federal law sometimes used to charge hospitals with fraud and abuse.
Fraud In criminal law, fraud is intentional deception made for personal gain or to damage another individual; the related adjective is fraudulent, and verb is defraud. Fraud is a crime and a civil tort at common law, though the specific criminal law definition varies by legal jurisdiction. Defrauding people or entities of money or valuables is a common purpose of fraud.
Good Samaritan Law A legal doctrine that protects a person from penalty for aiding another person in an emergency situation.
Health Insurance Portability and Accountability Act (HIPAA) Protection for patients from medical decisions done by third parties. It regulates patient identity theft and insurance fraud.
Healthcare Facilities Accreditation Program (HFAP) Authorized by the Centers for Medicare and Medicaid Services (CMS) to survey all hospitals for compliance with the Medicare Conditions of Participation and Coverage.
High Reliability Organization (HRO) An organization that has succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity.
Hours Per Patient Day (HPPD) Amount of man-hours required to care for patients in hospitals tracking the total number of direct nursing care hours (RNs, LPNs and PCTs), compared to number of patients in the hospital. A higher number may indicate that a hospital provides a higher level of patient care.
Human Resource Management The formal structure within an organization responsible for all decisions, strategies, factors, principles, operations, practices, functions, activities and methods related to the management of people.
Human Resource Management System A software application (Human Resource Information System - HRIS) combining various human resource functions, such as benefits, payroll, recruiting, training, etc., into one package.
Informed Consent A legal concept requiring a patient or a patient's guardian to be advised of and to understand the risks associated with a proposed procedure or treatment prior to approving such procedure and treatment, usually indicated by a signed written agreement.
Institute for Healthcare Improvement (IHI) Independent not-for-profit organization is a leading innovator, convener, partner, and driver of results in health and health care improvement.
Job pricing for job classification The process of determining pay rates for jobs within the organization by analyzing industry or regional salary survey data in order to establish appropriate pay rates that allow for classification by pay grades, incorporating pay ranges and class descriptions for each.
The Joint Commission The Joint Commission accredits and certifies nearly 21,000 health care organizations and programs in the United States. JC accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards.
Knowledge, skills and abilities (KSAs) Attributes required to perform a job; generally demonstrated through qualifying experience, education, and training.
Living Will A legal document generated by an individual to guide providers on the desired medical care in cases when the individual is unable to articulate his or her own wishes. Medical care and the degree of medical intervention and life sustaining support is typically expressed in this document.
Magnet Designation American Nurses Credentialing Center (ANCC's) program to recognize healthcare organizations that provide nursing excellence.
Medical Terminology Click on link to access medical dictionary, common abbreviations and tutorial regarding understanding medical terminology.
Mentoring A career development method whereby less experienced employees are matched with more experienced colleagues for guidance either through formal or informal programs.
National Database of Nursing Quality Indicators (NDNQI) ANA established database to gather unit level nursing sensitive indicator information / supply hospitals with performance reports that allow administrators to compare their data with national averages, percentile rankings, and other pertinent information.
National Healthcare Safety Network (NHSN) CDC's National Healthcare Safety Network is the nation's most widely used healthcare association infection tracking system. NHSN provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections.
National Labor Relations Act (NLRA) of 1947 The National Labor Relations Act (NLRA), passed in 1935, provides that all employees have the right to form, join, and assist labor organizations, and to bargain collectively with their employers.
National League of Nursing (NLN) NLN is the premier organization for nurse faculty and leaders in nursing education / offers professional development, networking opportunities, testing services, nursing research grants, and public policy initiatives.
Nursing Sensitive Indicators (NSI) ANA identified critical nursing sensitive indicators for acute care settings, e.g., pressure ulcers, patient falls, staffing mix, nurse satisfaction, and patient satisfaction in various areas.
Occupational Safety and Health Administration (OSHA) Law (enforced by the Department of Labor office - OSHA) setting forth standards that employers must comply with in order to provide working conditions that are safe and free from any health hazards for all employees. The law requires employers provide employees with protection against workplace hazards that could result in illness, injury, or death to an individual, as well as communicate information on hazardous materials they may be required to handle.
OCR Office of Civil Rights
OIG Office of Inspector General
ONCHIT Office of the National Coordinator for Healthcare Information Technology
Patient Safety Organization Group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection and analysis, reporting, education, funding, and advocacy.
Pay Range Associated with pay grades, the range sets the upper and lower compensation boundaries for jobs within that range.
Peer Review The process by which health care professionals evaluate each other's clinical performance. This may be done by a committee which examines the work of a peer and determines whether the individual under review has met accepted standards of care in rendering medical services. A peer review may be initiated at the request of a patient, physician, or an insurance carrier..
Performance-based Pay A variable pay strategy that pays employees based on their individual performance and contributions, rather than the value of the job they are performing.
Performance Improvement Plan Plan implemented by a manager or supervisor that is designed to provide employees with constructive feedback, facilitate discussions between an employee and their supervisor regarding performance-related issues, and outline areas requiring improvement.
Position Control A workforce planning tool that imposes certain rules or restrictions on the creation, and filing of positions as a means to manage and control the costs associated with any given position within the organization.
Privacy An individual's interest in limiting who has access to personal health care information (as related to the HIPAA privacy act).
Probationary Period Period of time (typically 30-90 days) where a newly hired, promoted, or transferred employee's job performance is evaluated. Primarily used by supervisors to closely observe an employee's work, help the employee adjust to the position, and reject any employee whose performance does not meet required standards.
Qui Tam (Whistleblower) Action A lawsuit brought by a private citizen (popularly called a "whistle blower") against a person or company who is believed to have violated the law in the performance of a contract with the government or in violation of a government regulation, when there is a statute which provides for a penalty for such violations.
Root Cause Analysis (RCA) Method of problem solving used for identifying the root causes of faults or problems.
Safe Harbor Laws A set of federal regulations providing safe refuge for certain health care business arrangements (primarily physician-hospital arrangements) from the criminal and civil sanction provision of the Medicare Anti-Kickback Statute prohibiting illegal remunerations.
Sarbanes Oxley (SOX) Federal legislation passed by the U.S. Congress to protect shareholders and the general public from accounting errors and fraudulent practices in the enterprise, as well as improve the accuracy of corporate disclosures.
Seniority Status determined by the length of time an employee has worked for a specific employer, department, or position within the organization.
Sexual Harassment Expressed or implied demands for sexual favors in exchange for some benefit (a promotion, pay increase, etc.) or to avoid some detriment (termination, demotion, etc.) in the workplace. By definition, it can only be perpetrated by someone in a position of power or authority over another person (i.e., manager or supervisor over a subordinate).
Situation, Background, Assessment, Recommendation Technique that can be used to facilitate prompt and appropriate communication. This model has gained popularity in healthcare settings, especially amongst professions such as nursing.
Span of Control Management principle expressing that a limit exists to the number of people an individual can effectively and successfully manage.
Staffing Metrics Measures used to determine costs associated with recruitment and hiring, time to fill/start for open positions, and recruiter workload/activity.
Standardized and Structured Interviews The standardized interview utilizes the same subject matter and identically sequenced questions for response evaluation to determine candidate differences while the structured format asks the same questions (typically in four job-related forms: situational, observational, personal, and behavioral) to allow for valid response comparisons.
Stark Law Prohibits a physician or immediate family member who has a financial relationship with an entity from referring a Medicare or Medicaid patient to the entity for health services.
Succession Planning Process of identifying long-range needs and cultivating a supply of internal talent to meet those needs.
Telemedicine/Telehealth The use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology.  (American Telemedicine Association).
Turnover Rate Number of separations during a month, including both voluntary and involuntary terminations (excluding layoffs). Turnover  rate is calculated by taking the number of separations during a month divided by the average number of employees on the payroll multiplied by 100.
Value-Based Purchasing (VBP)  Hospital Value-Based Purchasing (VBP) is part of CMS’ effort to link a value-based system to Medicare’s payment system in an effort to improve healthcare quality.  Participating hospitals are paid for acute care inpatient services based not only on quantity of services, but quality of care provided.  The program uses the hospital quality reporting structure developed for the Hospital Inpatient Quality Reporting (IQR) Program authorized by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
Wage and Hour Laws Group of laws in the United States that protect worker' rights with respect to pay and hours worked, e.g., setting a minimum amount someone may earn per hour worked. Each state has its own set of wage and hour laws. Many also make provisions for how many hours someone can work per day, and set different minimums for weekend and overtime pay.
Work/Life Balance Having a measure of control over when, where, and how individuals work, leading to their being able to enjoy an optimal quality of life. Balance is achieved when an individual's right to a fulfilled life inside and outside of paid work is accepted and respected as the norm, to the mutual benefit of the individual, business, and society.