Glossary of Terms: Health Care Reform
The Heart Rhythm 2010 Opening Plenary Session will focus on health care reform, the shift toward quality outcomes-based payment systems and their impact on the practice of medicine. The following terms may be used during health care reform discussions:
Bundled payments
Reimbursement of health care providers (such as hospitals and physicians) on the basis of expected costs for clinically-defined episodes of care. Rather than paying health care providers for each service provided, a bundled payment would be a single, fixed compensation for a patient's stay and, potentially, follow-up care. This flat payment would cover all expenses related to a treatment or a condition.
Comparative effectiveness research
Comparative effectiveness research (CER) is the conduct and synthesis of systematic research comparing different interventions and strategies to prevent, diagnose, treat and monitor health conditions. For example, CER can compare competing drugs or can compare a procedure vs. drug therapy.
Early offers
Early offers is a proposed medical litigation reform scheme which provides a structured process for resolving medical malpractice cases shortly after they have been filed. Generally it does not compensate for non-economic damages while ensuring that patients receive payment very quickly after filing suit.
Episode of care
Episode of care is an interval of care by a health care facility or provider for a specific medical problem or condition. It may be continuous or it may consist of a series of intervals marked by one or more brief separations from care, and can also identify the sequence of care (e.g., emergency, inpatient, outpatient).
Evidence-based medicine
The conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
Fee for service
Reimbursement of health care providers in which providers are paid for each service rendered to a patient.
Health courts
The health courts are specialized administrative tribunals with expert judges and neutral expert witnesses in lieu of judges and juries to address medical liability claims.
Non-economic damages caps
Limit on damages (i.e. caps) for intangible harms such as pain, suffering, emotional distress, loss of companionship, consortium. (Economic damages include loss of wages, medical bills, damage to property, etc.)
Quality outcomes-based payment
Payment model that rewards physicians, hospitals, medical groups, and other healthcare providers for meeting certain performance measures for quality and efficiency.
Safe harbors for practice of evidence-based medicine
Provision of a statute or a regulation that reduces or eliminates a party's liability under the law, on the condition that the party performed its actions according to evidence-based medicine.
Sustainable Growth Rate (SGR) Formula
A component of the formula CMS uses to calculate physician payments for providing services to Medicare patients. The SGR is an expenditure target formula. If utilization of physician services increased above this arbitrary target growth rate, the reimbursement per service performed drops.
The SGR is based on the following factors:
- Estimated change in fees for physician's services
- Estimated change in beneficiaries enrolled in Medicare's fee-for-service program
- Estimated growth in real gross domestic product (GDP) per capita
- Estimated change in expenditures due to law and regulation.
Value-based purchasing
Value based purchasing is defined as Quality divided by Cost. The concept of value-based health care purchasing is that buyers should hold providers of health care accountable for both cost and quality of care. Value-based purchasing brings together information on the quality of health care, including patient outcomes and health status, with data on the dollar outlays going towards health. It focuses on managing the use of the health care system to reduce inappropriate care and to identify and reward the best-performing providers.
