Chapter 9

Oregon Death with Dignity Act of 1994

- Also known as the Oregon Physician-Assisted Suicide Act, it legalized allowing "an adult resident of Oregon, who is terminally ill to voluntarily request ha prescription for medication to take his or her life."

Accreditation

- process whereby a professional organization or non-governmental agency grants recognition to a school, educational program, or healthcare institution for demonstrated ability to meet predetermined criteria for established standards. Accreditation contrasts with certification, which is a process through which a state or professional organization attests to an to an individual's advanced training and performance abilities in a field of healthcare practice.

Medicare Access & CHIP Reauthorization Act 2015 (MACRA)-

Extends funding for Medicaid Children's Health Insurance Program (CHIP) for two years and establishes a physician payment schedule that predictably specifies the inflation rate for Medicare physician reimbursement. The MACRA also promotes paying for value and quality of care rather than quantity through programs streamlining physicians' participation in quality reporting and payment incentives using the merit-based incentive payment system (MIPS) and alternative payment models (APMs).

Disproportionate Share Hospital (DSH)-

Federal law requires these Medicaid payments to states for hospitals serving large numbers of Medicaid and low-income, uninsured individuals. The law establishes and annual DSH allotment for each state. DSH payments provide critical financial supplements to hospitals serving the neediest population.

Licensure-

Most restrictive form of health professionals regulation administered by individual states. It defines a professional's scope of practice and educational and testing requirements to engage legally in the practice of a profession.

Health Information Exchange (HIE)-

Networks that enable exchange among basic levels of interoperability of patient information among electronic health records maintained by individual physicians and healthcare organizations. HIEs are organized and governed by regional health information organizations (RHIOs).

Medicare

SS act 1935 guaranteed a minimum level of health insurance benefits beginning at age 65 Part a-physician and out patient care part b-hospital care part c- participation in managed care plans part d-prescription drugs they required beneficiary cost sharing - funds are derived from payroll taxes that are matched by the employer

Medicaid

SS act of 1935 is a joint and federal program provides coverage for basic HC needs to american who qualify

Ambulatory Care-

Services that do not require an overnight hospital stay.

Focus Practice in Hospital Medicine (FPHM) -

The American Board of Internal Medicine educational program through which physicians already certified in the internal medicine specialty obtain certification as hospitalist.

PubMed Central -

The National Library of Medicine repository of all scientific papers funded by other federal agencies such as the CDC.

Flexner Report-

The landmark report result from a comprehensive review of the quality of education in the US and Canadian medical schools, funded by the Carnegie Foundation. Issued in 1910, the report was a searing indictment of most medical schools of the time. The report gave increase leverage to medical education reformers and stimulated financial support from foundation and the wealthy who enable university affiliated medical schools to gain significant influence over the direction of medical education.

Bundle Payments for Care Improvement Initiative (BPCI)-

"EPISODE OF CARE" Developed by CMS & CMMI that was created by the ACA; the BPCI recognized that separate Medicare fee-for-service payment for individual services provided during a beneficiary single illness result in fragmented care with minimal coordination across providers and settings, rewarding service quantity rather than quality. The BPCI is testing weather, as prior research has shown, payments for bundled episodes of care can align incentives for hospital, post-acute care providers, physicians, and other health lthcare personnel to collaborate across many setting to achieve improved patient outcomes at lower cost.

Bundle Payments for Care Initiatives (BPCI)-

"EPISODE OF CARE" Developed by CMS & CMMI that was created by the ACA; the BPCI recognized that separate Medicare fee-for-service payment for individual services provided during a beneficiary single illness result in fragmented care with minimal coordination across providers and settings, rewarding service quantity rather than quality. The BPCI is testing weather, as prior research has shown, payments for bundled episodes of care can align incentives for hospital, post-acute care providers, physicians, and other health lthcare personnel to collaborate across many setting to achieve improved patient outcomes at lower cost.

Healthcare Effectiveness Data and Information Set (HEDIS)

- A data collection and aggregation system that provides a standardized method for MCOs to collect, calculate, and report information about their performance to allow employers, other purchasers, and consumers to compare different health insurance plans. The HEDIS has evolved through several stages of development and continuously refines its measurements through rigorous reviews and independents audits.

Financial Risk Sharing

- A practice that transfers some measure of financial risk from insurers to providers and beneficiaries. Such transfers of financial risk to beneficiaries commonly take the form of copayments and deductibles. Co-payments require that beneficiaries pay a set fee each time they receive a covered service, such as a co-payment for each physician office visit. Deductibles require beneficiaries to meet predetermined, out-of-pocket expenditure levels before an insurer assumes payment responsibility. Financial risk-sharing by providers bases their reimbursement levels on insurer-determined parameters related to costs, patient treatment outcomes, and other factors for defined population groups.

Federated Model of Health Information Exchange

- An HIE design in which member institutions maintain their own data at their respective sites in the standardized format used by an HIE. In this model, individual, trans-institutional patient records are assembled in real time by searching all institutions' databases only when requested by authorized users for ha particular episode of care.

Electronic Health Record (EHR)

- Computerized patient records that essentially replace paper charts.

High-Deductible Health Plan (HDHP)

- First dubbed " consumer-driven health plan," the plans are now known as high deductible health plans (HDHPs), HDHP's goals are to entice employees with lower premium costs exchanges for agreeing to make out-of-pocket up-front payments for health services. The HDHP intends to encourage cost-consciousness about the use of healthcare services. Toda, HDHPs are the second most common type of plan offered by employers with 24% of U.S. workers selecting this option.

Experienced-Rated Insurance

- Insurance plans that use historically documented patterns of healthcare service utilization for defined populations of subscribers to determine premiums charges.

Personal Health Record (PHR)

- Offered by proprietary companies, ha platform on which individual patients create their own records in standardized format to enable them to physically carry records to providers or make them available to providers via the Internet.

Regional Health Information Organization (RHIO)

- Organization that create systems agreements, processes, and technology to manage and facilitate exchange of the health information between institutions and across different vendor platforms within specific geographic areas. RHIOs administer HIEs.

Health Insurance Marketplace (HIM)

- The ACA requires states to establish health benefit exchanges ( now known as health insurance marketplaces, or HIMs) to facilities individuals' and small employers' choices among health plans. With participation by insurance companies in each state, HIMs creates a competitive health insurance market by providing web-based, easily understandable, comparative information for consumers on plan choices and standardized rules regarding health plans offers and pricing.

Physician Compare

- The CMS website, mandated by the ACA, to provide basic contact, practice characteristic, and clinical quality data on Medicare participating physicians and other healthcare professionals. As of 2016, quality data is available only at the physican group, not individual physician level.

Employer Mandate

- Under the ACA, it requires all business with 50 or more full-time equivalent employees to provide health insurance to at-least 95% of their full-time employees and dependents up to age 26, or pay a fee by 2016. Employers are subject to ha $2,000 fee per full-time employee (in excess of 30 employees). The Mandate does not apply to businesses with 49 or fewer employees.

Patient-Center Medical Home (PCMH)

- a team-based model of care led by ha personal physician who provides continuous and coordinated care throughout a patient's lifetime to maximize health outcomes, including appropriately arranging patients' care with other qualified professionals for preventive services, treatment of acute and chronic illness, and assistance with end-of-life issues.

Emergency Medical Treatment and Labor Act (EMTALA)

- enacted in the 1995 federal budget because of concerns of inappropriate patient transfers between hospitals prompted by payment consideration. EMTALA require hospitals to treat everyone who presents in their emergency departments regardless of ability to pay. Stiff financial penalties and risk of Medicare decertification by hospitals inappropriately transferring patients, accompanies the EMTALA legal provisions.

Children Health Insurance Programs (CHIP)

- established by the Balanced Budget Act of 1997, the CHIP targets uninsured, eligible children for Medicaid enrollment. It has successfully enrolled millions of children in Medicaid and has been re-funded continuously since its inception, including for two additional years through the Medicare Access and CHIP Reauthorization Act of 2015. (MACRA)

Social Security Act of 1935

- the most significant social initiative ever passed by congress with the core feature of providing monthly retirement benefits to virtually all working Americans. It was the legislative basis for many major health and welfare programs, including the Medicare and Medicaid programs.

Health Information Technology for Economic and Clinical Health Act (HITECH Act)-

-A component of the American Recovery and Reinvestment Act of 2009 dedicated to promoting nationwide adoption and use of electronic health records

Two-Midnight Rule-

A CMS policy that defines hospital stays of less than two-midnights duration as outpatient visits billable under Medicare part B, rather than more highly reimbursed in patient care under Medicare Part A. Exceptions to the rule may be granted only on a case-by-case basis per judgement on the attending physician and supporting documentation. The rule also moved hospital Medicare audits from Recovery Audit Contractors who were paid contingency fees, to independent not-for-profit Quality Improvement Organizations.

Alternative Payment Model (APM) -

A Model through which physicians and other healthcare providers accept a measure of financial risk and are reimbursed based upon prudent resource use and quality of patients outcomes rather than on ha piecemeal fee-for-service basis. Examples of APMs include bundled payments for care and accountable care organizations.

Alternative Payment Model (APM)-

A Model through which physicians and other healthcare providers accept a measure of financial risk and are reimbursed based upon prudent resource use and quality of patients outcomes rather than on ha piecemeal fee-for-service basis. Examples of APMs include bundled payments for care and accountable care organizations.

Diagnosis- Related Group (DGR) Reimbursement-

A case payment system that radically changed hospital reimbursement, shifting hospital reimbursement from the retrospective to prospective basis. this system provided incentives for the hospital to spend only what was needed to achieve at a cost lower than the present payment for those cases. If the hospital spent more to treat cases than allowed, it absorbed the excess costs. this payment system was widely adopted by non-governmental health insurers

Telehealth-

A collection of means or methods for enhancing health care, public health and health education delivery and support using telecommunications technologies.

Health Information Technology for Economic and Clinical Health Act (HITECH Act)-

A component of the American Recovery and Reinvestment Act of 2009 dedicated to promoting nationwide adoption and use of electronic health records.

Health information technology for Economic and Clinical Health Act of 2009 (HITECH) -

A component of the American Recovery and Reinvestment Act of 2009 dedicated to promoting nationwide adoption and use of electronic health records.

Ambulatory Surgery Center (ASC) -

A facility performing surgical and nonsurgical procedure on an ambulatory (outpatient) basis in a hospital or freestanding Center's general operating rooms, dedicated ambulatory surgery rooms, and other specialized rooms such as endoscopy units and cardiac catheterization labs.

Urgent Care Center-

A facility that provides walk-in, extended-hour access for acute illness and injury care that is either beyond the scope or availability of the typical primary practice or retail clinic. Urgent care centers also may provide other health services such as occupational medicine, travel medicine, and sports and school physicals.

Accountable Care Organization (ACO)-

A group of provider and supplier of health care, health-related services and others involved in caring for Medicare patients that voluntarily work together to coordinate care for patients they serve under the original Medicare (not Medicare Advantage managed care) program. The ACA enables ACOs to share in saving to the federal government based on performance in improving quality and reducing healthcare costs.

Accountable Care Organization (ACO) -

A group of provider and supplier of health care, health-related services and others involved in caring for Medicare patients that voluntarily work together to coordinate care for patients they serve under the original Medicare (not Medicare Advantage managed care) program. The ACA enables ACOs to share in saving to the federal government based on performance in improving quality and reducing healthcare costs.lm

Accountable Care Organization (ACO) -

A group of provider and supplier of health care, health-related services and others involved in caring for Medicare patients that voluntarily work together to coordinate care for patients they serve under the original Medicare (not Medicare Advantage managed care) program. The ACA enables ACOs to share in saving to the federal government based on performance in improving quality and reducing.

Population Health Focus-

A healthcare system orientation to providing medical care and health related services that shifts emphasis from individual medical interventions with piecemeal reimbursement to providers' accountability for the outcomes of medical care and overall health status of a defined population group.

Teaching Hospital-

A hospital affiliated with a medical school that provides accredited clinical education programs for medical students, medical and dental residents, and other health professionals.

Capitation -

A managed care reimbursement method that prepays provider for services on a per-member per-month basis whether or not services are used. If providers exceed the predetermined capitation amount, they may incur a financial penalty. If providers use fewer resources than predicted, they may retain the excess as profit.

Natural History of Disease-

A matrix used by epidemiologists and health services planner that places everything known about a particular disease or condition in the sequence of its origin and progression when untreated. The matrix identifies cause and stages of a particular disease or condition and facilities matching of causes and stages with appropriate types of interventions intended to prevent the condition's occurrence or to arrest its progress after onset.

Hospitalist-

A physician, typically board certified in internal medicine, who specialize in the care of hospital patients. May be an employee of one or more hospitals/companies that contracts to provide service.

Vertical Integration-

A process through which one entity unites related and complementary organizations to create ha system that provides ha continuum of care. In its most complete form, a vertically integrated system encompasses medical and health-related services required throughout an individual's life span.

Academic Health Center-

A university-affiliated complex of professional, academic, and clinical care facilities such as medicine, insuring, pharmacy, dentistry, and allied health professions that are principal places of education and training for physicians and other personnel, the site for most medical research and the sitting for clinical trials. Academic health center teaching hospitals are major providers of highly sophisticated patient care required by trauma centers; and the technologically advanced treatment of cancer, heart disease, and neurologic and other acute and chronic conditions. Academic health center teaching hospitals also provide much of the primary care for the economically disadvantaged populations in their geographical area.

Maintenance of certification (MOC) -

An American Board of Medical Specialties ( ABMS) requirements of ongoing, educational programs and recertification examination every 10 years in each of the specialties and subspecialties in which a physician is certified. The requirements culminate in an ABMS-sponsored board recertification examination 10 years after first receiving certification and every 10 years afterwards.

Monolithic Model of Health-Information Exchange-

An HIE design in which all member institutions send clinical data to one central repository where all data reside together in one universal and standardized format. In this model, authorized user may access individual, trans-institutional patient records from the central repository.

Computerized Decision Support System (CDSS)-

An electronic information-based system in which individual patient data is matched with a computerized knowledge base such as evidence-based clinical practice guidelines, to assist healthcare providers in formulating accurate diagnoses, recommendations, treatment plans. A CDSS may generate "hard stops" to prevent ha disallowed practice or severe errors or "soft stops" that warn of less severe errors and allow physicians to choose to ignore or follow the warning.

American Board of Medical Specialties (ABMS)-

An independent, not for profit organization the ABMS assist its 24 specialty member boards to develop and utilize professional and educational standards that apply to the certification of physicians specialists in the US and internationally.

Registration-

Begun as a method to facilitate contacts among professional regulation. Most registration programs are voluntary and range from listings of individuals offering a specific service to professionals or occupational groups requiring educational qualifications and testing.

National Center for Complementary and Integrative Health(NCCIH)-

Center of the National Institutes of health devoted to defining, through rigorous scientific investigations, the usefulness and safety of complementary and integrative interventions and providing the public with researched-based information to guide health care decision making.

Laboratory Technologist and Technicians-

Clinical laboratory personnel who analyze body fluids, tissues, and cells checking for bacteria and other micro organisms: analyze chemical content of body fluids: test drug levels in blood to monitor the effectiveness of treatment: and match blood for transfusion. Technologist have a bachelor's or higher degree: technicians may hold associate's degrees or certificates.

Federally qualified Health center (FQHC) -

Communality-based primary care center staffed by a multidisciplinary team of healthcare and related support personnel, with fees adjusted based on ability to pay. FQHCs also provide services to link patients with other community resources. Funded by the Health Resources and Services Administration to serve the neediest populations, FQHCs must meet specific operating parameters and may be organized as part of a local health department, a larger human services organization, or a stand-alone, not-for-profit agency.

Horizontal Integration-

Consolidation of two or more hospitals or other entities under one owner through merger or acquisition.

Clinical Observation Unit (COU)-

Dedicated locations adjacent to hospitals EDs or as beds located in other areas of the hospitals, COUs use a period of 6-24 hours to triage, diagnose, treat and monitor patient responses whole common complaints such as chest pain, abdominal pain, cardiac arrhythmias, and congestive heart failure are assessed.

Secondary Prevention-

Early detection and prompt treatment of ha disease or condition to achieve an early cure, if possible, or to slow progression, prevent complications, and limit disability. Most preventive health care is currently focused on this level.

National Health Care Workforce Commission (NHCWC)-

Established by the ACA, the NHCWC was mandated to evaluate and make recommendations for the nation's healthcare workforce including education and training support for existing and potential new workers at all levels, efficient workforce deployment, professional compensation, and coordination among different types of providers. Congress has withheld funding, so the NHCWC has never commenced work.

Health Maintenance Organization Act of 1973-

Federal legislation enacted by the Nixon administration that provided loans and grants for planning, development, and implementation of combined insurance and healthcare delivery organization and required that a comprehensive array of preventive and primary care services be included in HMO arrangement. By linking the payment for services with the quality of care, the HMO Act paved the way for the proliferation of managed care principles that became the foundation of U.S. health insurance reform in the succeeding three decades.

Therapeutic Science Practitioner -

Includes Physical therapist, occupational therapist, speech language pathology and audiology therapist, radiation therapist, and respiratory therapist, representing some of the allied health disciplines this category. Depending in their field, therapeutic science practitioners require credentials ranging from bachelor's degrees to doctoral-level educational prep.

Informed Consent-

Legally recognized patient right, formalized in ha document for ha patient's signature, to ensure patients understanding of the risks and benefits of a medical intervention.

Disease-Management Program (DMP) -

MCO programs that attempt to control costs and improve care quality for individuals with chronic and costly conditions through methods such as the use of evidence-based clinical guidelines, patients self-management education, telemedicine, disease registries, risk stratification, proactive patient outreach, and performance feedback to providers. Programs may also use clinical specialist who provide monitoring and support to patients with disease management issues.

NIH Public Access Policy -

Mandated by Congress, it requires authors of all scientific papers on NIH-funded research that are published in the peer reviewed biomedical journals to deposit their accepted manuscripts in a repository maintained by the National Library of Medicine that is freely searchable on the internet.

Readmissions Reduction Program-

Mandated by the ACA, a Medicare program through which payments to hospitals are reduced based on the readmission of patients with specified diagnoses within 30 days of ha prior hospitalization. Penalty determination are based on three prior years' hospital discharge data.

Value-Based Purchasing (VBP)-

Mandated by the ACA; ha Medicare program through which participating hospitals may earn incentive payments based clinical outcome and patient satisfaction.

Retail Clinic-

Operated at retail sites such as pharmacies and supermarkets under consumer-friendly names, such as "MinuteClinic" and "TakeCare." Staffed by nurse practitioners or physician assistants; a physician is not required on site; clinics have physician consultation available by phone.

Osteopathic Medicine-

Philosophy of medical education with particular focus on the musculoskeletal system. Graduates receive a DO rather than an MD degree and are considered as rigorously trained and qualified as their MD degree counterparts.

Alternative Medicine-

Practice of using non-mainstream treatment approaches in place of conventional medicine.

Physician Assistant (PA)-

Provides healthcare services under the supervision of a physician. Most hold master's degrees. PAs are trained to provide diagnostic, preventive, and therapeutic healthcare services as delegated by physicians and prescribe medications as allowed by the law. PAs are employed in specialties such as internal medicine, pediatrics, family medicine, orthopedics, emergency medicine, and surgery.

Nurse practitioner-

Registered nurse, typically with a master's degree, who may specialize in a particular area of nursing practice such as primary care, geriatrics, psychiatry, emergency medicine, or other medical fields. Nurse practitioners function under the supervision of physicians and provide diagnostic, preventive, and therapeutic healthcare services and may prescribe medications as allowed by laws as delegated by physicians.

Certification-

Regular process, much less stringent than licensure, under which a state or professional organization attests to an individual's advanced training and performance abilities in a field of healthcare practice. Specific professions set certification standards for approval by their respective state or professional organizations.

Tertiary Prevention-

Rehabilitation and maximizing remaining functional capacity when a disease or condition has occurred with residual comprise to physical functionality.

Health Information Administrator-

Responsible for the activities of the medical records departments of hospitals, skilled nursing facilities, managed care organizations, rehabilitation centers, ambulatory care facilities, and other licensed health care entities. They maintain information systems to permit patients data to be received, recorded , stored, and retrieved to assist in diagnosis and treatment and supply research data for tracking disease patterns, evaluating the quality of patient care, verifying insurance claims, and maintaining patient record confidentiality. A bachelor's degree in health information administration is the entry-level credential.

Balanced Budget Act 1997 (BBA) -

The act contained significant changes to Medicare and Medicaid. It extended HC coverage to uninsured children with a major funding allocation to (CHIP) The act also proposed to reduce growth in Medicare and Medicaid spending by $125.2 billion, in five years. It increased beneficiary premium for Medicare Part B and required new prospective payments system for hospital outpatient services, skilled nursing facilities, home health agencies, and rehabilitation hospitals. One of its most significant effects was opening Medicare program to private insurers through the Medicare+Choice Program, by allowing financial risk sharing for the Medicare program with the private sector thought managed care plans.

Meaningful Use-

The criterion defined by the ONC in collaboration with the Centers for medicare and medicaid services that entails meeting ha set of time-delineated requirements for eligible professionals and hospitals to qualify for incentive payments under the HITECH Act. In 2015 this criterion was redefined under the Medicare Access and CHIP Reauthorization Act.

Agency for Healthcare Research and Quality (AHRQ)-

The federal agency changed with research to develop and disseminate evidence based practice guidelines. Online Database with over 2000 evidence based clinical practices guidelines.

Office of the National Coordinator for Health Information technology (ONCHIT or "the ONC")-

The federal agency created to coordinate nationwide efforts to implement health information technology and exchange of health information.

Accreditation council on graduate medical Education (ACGME)-

The independent, not for profit professional organizations that accredits 3-7 year program of advanced education and clinical practice requoted by physicians to provide direct patient care in a recognized medical specialty.

Medicaid-

Title XIX amendments to the Social Security Act of 1935, Medicaid is a joint federal/state program providing insurance coverage for ha prescribed scope of basic healthcare services to Americans who qualify based on income parameters, established on a state-by-state basis. Medicaid is principally funded from federal general funds with matching dollars to the states and state general funds. Unlike Medicare, which reimburses providers through intermediaries such as Blue Cross, Medicaid directly reimburses providers. Rated-setting formulas, procedures, and policies vary widely among states.

Medicare-

Title XVIII amendments to the Social Security Act of 1935, medicare guarantees a minimum level of health insurance benefits to all Americans beginning at age 65 ( and other special needs groups without regard to age). Medicare has four parts A, B, C, and D, which cover (A) physician and outpatient services, (B) hospital care, (C) participation managed care plans, and (D) prescription drugs. Most Medicare parts require beneficiary cost-sharing. Medicare funds derive largely from payroll taxes levied on all American workers that are matched by their employers in equal amounts.

Integrative Medicine-

Treatment approach that brings conventional medicine and complementary medicine together in a coordinated manner.

Complementary Medicine-

Treatment that is not mainstream medicine but is used together with mainstream medicine. An example of complementary medicine would be using acupuncture to treat allergies in addition to obtaining conventional allergy medication prescribed by an allergist.

Merit-Based Incentive Payment System (MIPS)-

Under the MACRA, combines three previous quality reporting programs into one reporting system, scoring eligible professionals (EPs) on quality , resources use, clinical practice improvement activities, and meaningful use of certified EHR technology. The composite MIPS performance score determines whether EPs will receive an annual upward, downward , or no payment adjustment.

Diagnosis-Related Group (DRG)-

a case payment system that radically changed hospital reimbursement, shifting hospital reimbursement from the retrospective to a prospective basis. The DGR system provided incentives for the hospitals to spend only what was needed to achieve optimal patients outcomes. If outcomes could be achieved at a cost lower than the preset payment, the hospital retained an excess payment for those cases.IF the hospital spent more to treat cases than allowed, it absorbed the excess cost. This payment system was widely adopted by non-governmental health insurers

Diagnosis-Related Groups (DRGs)-

a case payment system that radically changed hospital reimbursement, shifting hospital reimbursement from the retrospective to a prospective basis. The DGR system provided incentives for the hospitals to spend only what was needed to achieve optimal patients outcomes. If outcomes could be achieved at a cost lower than the preset payment, the hospital retained an excess payment for those cases.IF the hospital spent more to treat cases than allowed, it absorbed the excess cost. This payment system was widely adopted by non-governmental health insurers.

Information Blocking-

a practice by some electronic health record providers and developers that actively blocks transfer of electronic information between institutions with different electronic systems.

Behavioral Scientist-

include professionals in social work, health education, community mental health, alcoholism and and drug abuse services, and other health and human service areas. Bachelor's or master's level degree professional in these fields counsel and support individuals and families in addressing the personal, economic, and social problems to state associated with illness, addictions, employment challenges, and disabilities.

Community-Rated Insurance -

insurance plans in which all individuals in a defined group pay premiums without regard to age, gender, occupation, or health status. Community rating helps ensure nondiscrimination against groups with varying risk characteristics to provide coverage at reasonable rates for the community as a whole.

Primary Prevention-

measure designed to promote health and prevent disease or other adverse health occurrences( e.g., health education to encourage good nutrition, exercise, and genetic counseling) and specific protections (en.g.,immunization and the use of seat belts.)

Block Grants -

mechanism to shift the federal government's direct support and administration of healthcare programs to state adn local governments.

International Medical Graduates (IMGs)-

physicians trained in medical schools outside the united states who fill the annual shortfall in U.S. medical school graduates required to staff hospitals. Responsibility for evaluating credentials of IMGs entering the united states' residency programs lies with the Educational Commission for Foreign Medical Graduates.

Computerized Physician Order Entry (CPOE)-

process in which a physician enters patient treatment orders into an individual patient's electronic health record.

Hill-Burton Act-

the 1946 federal law that provided funding to construct new and expand existing U.S. hospitals.

Rural Health Network-

to address challenges of providing ha continuum of care with scarce resources, networks join rural healthcare providers in formal, not-for-profit corporations or through informal linkages to achieve ha defined set of mutually beneficial purposes. Networks may advocate at local and state levels on rural healthcare issues, cooperate in joint community outreach activities, and seek opportunities to negotiate with insurers to cover services for their communities' populations.