GLOSSARY OF HEALTHCARE TERMS AS USED BY OSHPD`s

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GLOSSARY OF HEALTHCARE TERMS USED BY
OSHPD HOSPITAL AND HEALTHCARE DATA
PROGRAMS
Average Daily Census (ADC): The average number of patients in the facility per day.
Derived by dividing the number of patient days for the year by the number of days the
facility was open during the year.
Adjusted Average Charge per Day: The average charge billed by hospitals for one day of
care, which is Adjusted Total Charges divided by total days of care. (See Adjusted Total
Charges).
Adjusted Average Charge per Discharge: The average charge billed by hospitals for an
inpatient stay (from the day of admission to the day of discharge), which is Adjusted
Total Charges divided by number of discharges. (See Adjusted Total Charges).
Adjusted Total Charges: Since OSHPD regulations require that hospitals report charges
for the last 365 days of a stay only, total charges for a patient who stays more than one
year must be adjusted upward (increased) to reflect the entire stay. Thus, for patients
staying longer than one year, the average daily charge for the last year of the stay is
calculated and applied to the entire stay. The formula is:
(Total Charges divided by 365 = Charge per Day) x Length of Stay = Adjusted Total
Charges
Admission Source: The physical site from which the patient was admitted: Home,
Residential Care Facility, Ambulatory Surgery Facility, Skilled Nursing/Intermediate
Care Facility, Acute Hospital Care, Other Hospital Care, Newborn, Prison/Jail or Other;
the licensure of the site: This Hospital, Another Hospital, Note a Hospital; and the route
of admission: This Hospital's Emergency Room, Another Emergency Room.
Admissions, Hospital: The number of patients formally admitted to a type of care in the
facility. Includes the discharge from acute and formal admission to non-acute, and vice
versa. (Hosp)
Admissions, LTC Facility: The number of patients formally admitted to the facility, or
transferred from a residential care unit of the facility. Does not include patients returning
to the facility under a bed hold or leave, where a bed has been held specifically for
patient's return. (LTC)
Age: The age of a patient is based on age at discharge date. A patient does not reach a
particular age until his/her actual birth date.
Available Beds (Average for Report Period): The average complement of beds
(excluding bassinets) physically existing and actually available for overnight use,
regardless of staffing levels. Beds in suspense and beds in nursing units converted to uses
other than inpatient overnight accommodations (which cannot be placed back into service
within 24 hours) are not included.
Average Length of Stay (ALOS) (Using Census Days): The average period of
hospitalization of inpatients discharged over the reporting period. This average is the
result of dividing the patient (census) days by hospital discharges (excluding nursery) for
each facility.
Average Length of Stay (ALOS) (Using Discharge Days): The average number of days
of service rendered (discharge days) to all inpatients discharged (including deaths) during
the reporting period. This average is calculated by dividing total discharge days by total
discharges.
Bad Debts: Accounts receivable which, although the patients have the ability to pay, are
regarded as uncollectible and are charged as a credit loss against gross patient revenue.
Bad debts are not included in Total Operating Expenses.
Census Days: See Patient (Census) Days.
CHAMPUS (TRICARE): Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS). The name of this program was changed to TRICARE. TRICARE
is a health care program overseen by the Department of Defense in cooperation with
regional civilian contractors. TRICARE began in March 1995 in Washington and Oregon
and has expanded into all areas of the country. TRICARE provides three options to
eligible beneficiaries: TRICARE Prime, similar to a health maintenance organization;
TRICARE Extra, a preferred provider option that saves money for patients; and
TRICARE Standard, a fee-for-service option, which is the same as the former
CHAMPUS.
Charges: (See Adjusted Total Charges).
Charity Care: The difference between full-established charges for services rendered to
patients who are not able to pay for all or part of the services provided and the amount
paid by or on behalf of the patient, if any. Previously included care provided to medically
indigent for which counties are responsible.(See County Indigent Programs.)
Charity - Hill-Burton: The amount of charity care rendered by the hospital to satisfy, or
partially satisfy, its obligations to uncompensated services as required under the federal
Hill-Burton Program.
Charity - Other: The amount of charity care rendered exclusive of charity care related to
the Hill-Burton Program obligation. Previously included care provided to medically
indigent patients for which counties are responsible. (See County Indigent Programs)
Chemical Dependency Recovery Hospital Beds: Beds in a chemical dependency
recovery hospital or a general acute care hospital classified by the Division of Licensing
and Certification, as chemical dependency recovery beds and used for the same services
as those in a chemical dependency recovery hospital.
Consolidated License: A general acute care hospital with more than one physical plant
on a single license, under specified circumstances. The second physical plant may be
another hospital or a long-term care facility.
Contractual Adjustments: The difference between billings at full-established rates and
amounts received or receivable from third-party payors under formal contract
agreements.
Cost Center: An organizational division, department, or unit performing functional
activities within a facility; for each such center, cost accountability is maintained for
revenues produced and for controllable expenses incurred.
Cost-To-Charge Ratio: The quotient of cost (total operating expenses minus other
operating revenue) divided by charges (gross patient revenue) expressed as a decimal.
County Indigent Programs: This payor category includes indigent patients covered
under Welfare and Institution Code Section 17000. Also included are patients paid for in
whole or part by Realignment funds, the County Medical Services Program (CMSP),
California Health Care for Indigent Program (CHIP), specified tobacco tax funds, and
other funding sources for which the hospital renders a bill or other claim for payment to a
county. This category also includes indigent patients who are provided care in county
hospitals or in certain non-county hospitals whether or not a bill is rendered.
County Indigent Programs Net Patient Revenue: County Indigent Programs gross
patient revenue minus County Indigent Programs deductions from revenue.
Deductions From Revenue: The difference between gross patient revenue (charges based
on full established rates) and amounts received from patients and third-party payors for
services performed. Deductions from revenue include contractual adjustments, provision
for bad debts, charity care, and other adjustments and allowances, which reduce gross
patient revenue. (See also Donations/Subsidies for Indigent Care).
Diagnosis Related Groups (DRGs): A classification scheme with which to categorize
patients according to clinical coherence and expected resource intensity, as indicated by
their diagnoses, procedures, age, sex, and disposition, and was established and is revised
annually by the U.S. Health Care Financing Administration.
Direct Expense: The cost of any good or service that contributes to (and is readily
attributable to) the facility’s product or service output.
Discharge: A person who was formally admitted to a hospital as an inpatient for
observation, diagnosis, or treatment, with the expectation of remaining overnight or
longer, and who is discharged under one of the following circumstances:
(a) is formally discharged from care of the hospital and leaves the hospital,
(b) transfers within the hospital from one type of care to another type of care, or
(c) has died.
Discharge Days: The total number of days between the admission and discharge dates for
each patient (length of stay). The day of admission but not the day of discharge is counted
as a discharge day (except for admission and discharge on the same day, which is counted
as one discharge day). Discharge Days include any days from previous years for those
patients admitted prior to the year of discharge, and excludes days in the current year for
patients not discharged by December 31.
The two Patient Days statistics are Discharge Days, defined above, and Census Days,
which is the cumulative census for a specific time period. Census days are necessary to
calculate occupancy rates, while discharge days are more appropriate to calculate average
lengths of stay.
Disposition: The consequent arrangement or event ending a patient's stay in the hospital.
The following 13 dispositions are reported: Routine Discharge, Acute Care Within This
Hospital, Other Type of Hospital Care Within This Hospital, Skilled Nursing/Intermediate
Care Within This Hospital, Acute Care at Another Hospital, Another Type of Hospital
Care at Another Hospital, Skilled Nursing/Intermediate Care Elsewhere, Residential Care
Facility, Prison/Jail, Against Medical Advise, Died, Home Health Service, Other.
Disproportionate Share Payments, Medi-Cal: Supplemental payments paid to
disproportionate share hospitals for each paid Medi-Cal patient day. The payments are
made to hospitals serving a high percentage of Medi-Cal and other low-income patients.
Authorized under Senate Bill 855 (Chapter 279, 1991) these payments are funded from
intergovernmental transfers from public agencies (counties, hospital districts, and the
University of California system) to the State and from federal matching funds.
Donations/Subsidies for Indigent Care: Donations, grants, or subsidies voluntarily
provided for the care of medically indigent patients. Includes discretionary tobacco tax
funds provided by a county to a non-county hospital.
Emergency Room: The ambulatory services cost center in a hospital which provides
emergency treatment to the ill and injured who require immediate medical or surgical
care on an unscheduled basis, including occasional care for conditions which would not
be considered emergencies.
EMS Level: The Emergency Medical Services (EMS) level, if any, at which the facility is
licensed by the Division of Licensing and Certification, Department of Health Services.
Only a general acute care hospital (GAC) can be licensed for emergency medical
services. Licensed levels are:
Standby - the provision of emergency medical care in a specifically designated area of
the hospital that is equipped and maintained at all times to receive patients with
urgent medical problems, and capable of providing physician services within a
reasonable time. (See Title 22, Division 5, Sections 70651-70657, California Code of
Regulations, for details)
Basic - the provision of emergency medical care in a specifically designated area of
the hospital that is staffed and equipped at all times to provide prompt care for any
patient presenting urgent medical problems. (See Title 22, Division 5, Sections
70413-70419, California Code of Regulations, for details)
Comprehensive - the provision of diagnostic and therapeutic services for unforeseen
physical and mental disorders that, if not properly treated, would lead to marked
suffering, disability, or death. The scope of services is comprehensive, with in-house
capability for managing all medical situations on a definitive and continuing basis.
(See Title 22, Division 5, Sections 70453-70459, California Code of Regulations, for
details)
EMS Station: An Emergency Medical Services (EMS) treatment station. This is a
specific place within the EMS Department adequate to treat one patient at a time.
Holding or observation beds are not included.
EMS Visits: Visits made during the year to the Emergency Medical Service (EMS)
Department. These visists are classified in the following three categories:
a. Non-Urgent - a patient with a non-emergent injury, illness, or condition; sometimes
chronic; that can be treated in a non-emergency setting and not necessarily on the same
day they are seen in the EMS department (e.g., pregnancy tests, toothache, minor cold,
ingrown toenail).
b. Urgent - a patient with an acute injury or illness where loss of life or limb is not an
immediate threat to their well-being, or a patient who needs a timely evaluation (fracture
or laceration).
c. Critical - a patient presents an acute injury or illness that could result in permanent
damage, injury or death (head injury, vehicular accident, a shooting).
EMS Visits Resulting in Admissions: Emergency Medical Services visits that result in
hospital admissions.
Expected Source of Payment: Effective with discharges on or after January 1, 1999, the
following payer categories are to be used to indicate the type of entity or organization
which is expected to pay or did pay the greatest share of the patient's bill.
a. Medicare - A federally administered third party reimbursement program
authorized by Title XVIII of the Social Security Act. Includes crossovers to
secondary payers.
b. Medi-Cal - A state administered third party reimbursement program authorized by
Title XIX of the Social Security Act.
c. Private Coverage - Payment covered by private, nonprofit, or commercial health
plans, whether insurance or other coverage, or organizations. Included are
payments by local or organized charities, such as the Cerebral Palsy Foundation,
Easter Seals, March of Dimes, Shriners.
d. Workers' Compensation - Payment from workers' compensation insurance,
government or privately sponsored.
e. County Indigent Programs - Patients covered under Welfare and Institutions Code
Section 17000. Includes programs funded in whole or in part by County Medical
Services Program (CMSP), California Health Care for Indigent Program (CHIP),
and/or Realignment Funds whether or not a bill is rendered.
f. Other Government - Any form of payment from American government agencies,
whether local, state, federal, or foreign, except those included in the Medicare,
Medi-Cal, Workers' Compensation, or County Indigent Programs categories listed
above. Includes California Children Services (CCS), the Civilian Health and
Medical Program of the Uniformed Services (TRICARE), and the Veterans
Administration.
g. Other Indigent - Patients receiving care pursuant to Hill-Burton obligations or
who meet the standards for charity care pursuant to the hospital's established
charity care policy. Includes indigent patients, except those described in the
County Indigent Programs above.
h. Self Pay - Payment directly by the patient, personal guarantor, relatives, or
friends. The greatest share of the patient's bill is not expected to be paid by any
form of insurance or health plan.
i. Other Payer - Any third party payment not included in the above categories.
Included are cases where no payment will be required by the facility, such as
special research or courtesy patients.
Facility Name: The name under which the health facility is doing business.
Fiscal Year End: The date of last day of the health facility’s fiscal year. (See Report
Period)
General Acute Care: Services provided to patients (on the basis of physicians’ orders and
approved nursing care plans) who are in an acute phase of illness but not to the degree
which requires the concentrated and continuous observation and care provided in the
intensive care centers.
Governmental: An ownership group of health facilities that are owned by a city, county,
district, or the state.
Gross Inpatient Expenses: Operating expenses related to providing inpatient services.
Excludes non-operating expenses and income taxes but includes Physician Professional
Component Expenses. Gross inpatient expenses are determined by allocating total
operating expenses using the ratio of gross inpatient revenue to the total gross patient
revenue.
Gross Inpatient Revenue: Total inpatient charges at the hospital’s full established rates
for services rendered and goods sold, including revenue from daily hospital services,
inpatient ambulatory services, and inpatient ancillary services. Also includes charges
related to hospital-based physician professional services. Other operating revenue and
nonoperating revenue are excluded.
Gross Operating Expenses: (See Operating Expenses.)
Gross Outpatient Expenses: Total operating expenses relating to outpatient services.
Excludes nonoperating expenses and income taxes, but includes Physician Professional
Component Expenses. Gross outpatient expenses are determined by allocating total
operating expenses using the ratio of gross outpatient revenue to total gross revenue.
Gross Outpatient Revenue: Total outpatient charges at the hospital’s full established rates
for outpatient ambulatory and outpatient ancillary services rendered and goods sold. Also
includes charges related to hospital-based physician professional services. Other
operating revenue and nonoperating revenue are excluded.
Gross Patient Revenue: The total charges at the hospital’s full established rates for the
provision of patient care services before deductions from revenue are applied. Includes
charges related to hospital-based physician professional services. Other operating revenue
and non-operating revenue are excluded.
a. Gross Inpatient Revenue - Gross revenue for daily hospital services and inpatient
ancillary services before deductions from revenue are applied.
b. Gross Outpatient Revenue - Gross revenue for outpatient ancillary services before
deductions from revenue are applied.
Gross Patient Service Revenue: The total charges at the facility’s full established rates
for the provision of patient care before deductions from revenue are applied.
Grouper Program: The program (software) which groups discharges to Major Diagnostic
Catagories (MDCs) and Diagnostic Related Groups (DRGs) based on the logic of DRGs:
Diagnostic Related Groups Definitions Manual, 3M Health Information Systems, New
Haven CT 06511. (See DRG and MDC.)
Health Facility Planning Area (HFPA): A geographic area which is a subdivision of a
Health Service Area. These areas are defined by Office of Statewide Health Planning and
Development (OSHPD).
Health Service Area (HSA): A geographic area consisting of one or more contiguous
counties designated by the United States Department of Health and Human Services for
health planning on a regional basis. There are 14 HSAs in California.
Hill-Burton Program: A federal assistance program in which hospitals received grants,
low interest loans, and loan guarantees for capital expansion projects. In return, hospitals
are obligated to provide a specified amount of charity care.
Hospital DBA Name: The name under which the hospital is doing business as, which
may be different from its legal name.
ICD-9-CM: International Classification of Diseases, 9th Revision, Clinical Modification
consists of two sections; diseases and procedures. Each diagnosis and each procedure is
represented by a code. This coding classification system is established to be used in the
United States, and is used as a basis for determining DRGs. Section 128735, Health and
Safety Code, requires that hospitals use ICD-9-CM to report diagnoses and procedures to
OSHPD.
ICF: Intermediate Care Facility (ICF) is the lower of two levels of Long-term Care.
ICU/CCU: Intensive Care Unit/Coronary Care Unit - The daily hospital services cost
centers, which provide nursing care of the most concentrated and exhaustive nature. This
unit is staffed with specially trained nursing personnel and contains monitoring and
specialized support equipment for patients who (because of shock, trauma, or threatening
conditions) require intensified, comprehensive observation, and care.
Income (Loss) from Health Care Operations: Gross patient service revenue plus other
operating revenue minus deductions from revenue and total health care expenses.
Indirect Expenses: Functional costs not identified directly with the production of a
specified product or service but with an activity associated with production generally.
Indirect expenses are the overhead expenses allocated to each revenue producing center,
e.g., administration, housekeeping, laundry and linen, and dietary.
Intensive Care for Newborn Nursery (ICNN): An ICNN service is a critical care unit for
newborn infants (neonates). It is licensed as ICNN rather than as ICU, and has different
standard of care. These units are for the provision of comprehensive and intensive care
for all contingencies of the newborn infant including infant transport service.
ICNN beds are certified for two levels of care: NICU (Neonatal Intensive Care Unit), the
higher level, which meets all ICNN standards and is sometimes referred to as the tertiary
level, and INICU (Intermediate Newborn Intensive Care Unit) which is the lower level
which meets all ICNN licensing standards except for the provision of neonatal
cardiovascular surgery and transport service.
Intermediate Care: Intermediate Care (IC) is a level of nursing care service that provides
long-term care for patients who are ambulatory or semi-ambulatory and have a recurring
need for skilled nursing supervision and supportive care but who do not require
continuous skilled nursing care.
Intra-Hospital Transfer: An in-house discharge from one level of care to another level of
care, usually from intensive care to medical/surgical acute care. The patient is moved to
another care unit, but not discharged from the hospital. These are also called Service
Discharges.
Investor-Owned: An ownership group which includes all health facilities that are
partnerships, sole proprietorships, and corporations, or divisions of corporations that
issue stock.
Labor Cost: The sum of salaries and wages and employee benefits.
Length of Stay (LOS): The total number of calendar days between an inpatient's
admission and discharge dates, but not including the day of discharge. Patients admitted
and discharged on the same day have a calculated LOS of one day. (See Discharge Days
and Average Length of Stay).
Licensee: The holder of a health facility license issued under Chapter 2 (commencing
with Section 1250) of the Health and Safety Code or Chapter 8.6 (commencing with
Section 1760) of the Health and Safety Code for a long-term health care facility.
Licensed Beds: a. Average: The average number of beds licensed by the Licensing and
Certification Division of the Department of Health Services, less those beds in suspense,
during the reporting period.
b. End of Period: The number of beds licensed by the Department of Health Services, less
those beds in suspense, as of the last day of the reporting period.
Licensed Bed Days: The sum of the number of days each bed was licensed during the
calendar year. Takes into account any changes in the licensed number of beds which
occurred during the year. If there were no license changes, licensed beds days would
equal the number of licensed beds times the number of days in the year.
Licensed Beds (End of the Report Period): The number of beds stated on the facility
license as of the last day of the reporting period. Excludes beds placed in suspense and
nursery bassinets.
Major Diagnostic Categories (MDCs): A broad classification system of related diseases
and disorders. Fourteen of the 25 MDCs refer to specific body systems, two refer to
delivery and neonates, and the remaining nine refer to diseases and disorders which affect
any or all body systems.
MDC: Major Diagnostic Catagories. (See above)
Medi-Cal: A federally aided, state operated and administered program which provides
medical benefits for certain low-income persons. This is California's version of the
federal Medicaid program.
Medi-Cal Net Patient Revenue: Medi-Cal gross patient revenue minus Medi-Cal
deductions from revenue. For hospitals, it includes Disproportionate Share payments
received from SB 855 (Chapter 279, Statutes of 1991).
Medical/Surgical: Also referred to as Unspecified General Acute Care (GAC); i.e., beds
not designated as perinatal, pediatric, ICU, CCU, acute respiratory, burn center, ICNN, or
acute rehabilitation.
Medicare: A federal third-party reimbursement program administered by the Social
Security Administration that underwrites the medical costs of persons 65 and over and
some qualified persons under 65.
Medicare Net Patient Revenue: Medicare gross patient revenue minus Medicare
deductions from revenue.
Net Income (Loss): Total patient service revenue less deductions from revenue, plus
other operating revenue, less total operating expenses, plus non-health care revenue, less
non-health care expenses, income taxes, and extraordinary items.
Net Income From Operations: Total Operating Revenue minus Total Operating
Expenses.
Net Patient Revenue: Gross inpatient revenue plus gross outpatient revenue minus
related deductions from revenue.
Net Revenue: (See Net Patient Revenue.)
Newborn: An infant, born alive in the hospital.
Nonhealth Care Revenue and Expenses: Revenues and expenses not directly related to
patient services. This includes residential care revenues and expense.
Nonoperating Revenue, Net of Nonoperating Expenses: Revenue and expenses of a
hospital that are not directly related to the provision of health care services. Examples
include gains and losses on the disposal of assets; income, gains and losses from
unrestricted investments; revenue and expenses associated with medical office buildings;
revenue and expenses of retail operations; and various governmental assessments, taxes,
and appropriations.
Not-for-Profit: Ownership group which includes all church-related and other facilities
that are corporations organized and operated under a policy by which no trustee or other
person shares in the profits or losses of the enterprise.
Nursery: A hospital perinatal unit for normal newborns, and includes incubators for nondistressed, low birth weight babies.
Occupancy Rate: A measure of the usage of the licensed beds during the reporting period
that is derived by dividing the patient days in the reporting period by the licensed bed
days in the reporting period.
Occupancy Rate: A measure of health facility inpatient use, showing the percentage of
beds (excluding beds in suspense) occupied during the reporting period. It is determined
by dividing patient (census) days by licensed or available bed days (the number of beds
multiplied by number of calendar days in reporting period).
Occupancy Rate: The percentage of facility beds occupied during the reporting period. It
is determined by dividing patient days by the quantity: average number of licensed beds,
excluding those beds in suspense, multiplied by number of calendar days in the reporting
period, with that result multiplied by 100 to convert it to a percentage. [Patient days
divided by (number of beds x number of days in reporting period) x 100].
Operating Margin: Income (loss) from health care operations plus mortgage interest
expenses plus other interest expenses divided by net patient service revenue. This ratio
indicates the percentage of net patient service revenue which remains as income after
operating expenses, except interest expense, have been deducted.
Other Operating Revenue: Revenue related to health care operations, but not from
patient care services. Examples include non-patient food sales, rebates and refunds,
purchase discounts, supplies and drugs sold to non-patients, and medical records abstract
sales.
Other Operating Revenue: Cost recoveries and other non-patient revenue related to
health care operations.
Other Payer (LTC): All payers other than Medicare, Medi-Cal, and self-pay. Medi-Cal
patients enrolled in health maintenance organizations, however, are included in this
category.
Other Payers (hospital): This category represents all patients not sponsored by any form
of health care coverage. This includes patients designated as self-pay and those
determined to be eligible for charity care. University of California teaching hospital
patients who are provided care with Clinical Teaching Support funds are also included in
this category.
Other Payers Net Patient Revenue: Other payers' gross patient revenue after deducting
deductions from revenue.
Other Third Party Payers: This payer category includes patients covered by a variety of
third-party contractual purchasers of health care as well as indemnity plans. Examples
include health maintenance organizations (HMOs), preferred provider organizations
(PPOs), Short-Doyle, TRICARE (formerly CHAMPUS), IRCA/SLIAG, California
Children's Services, other commercial insurance, Blue Cross and Blue Shield, and
Workers' Compensation. Prior to 2000, it also included Medicare and Medi-Cal managed
care.
Other Third Party Payers Net Patient Revenue: Other Third Party Payers' Gross Patient
Revenue minus Other Third Party Payers' deductions from revenue.
Outpatient Visits: Included are emergency room visits, outpatient clinic visits, referred
ancillary service visits, home health care contacts, and day care days, where the
outpatient is treated and released the same day. Also included are outpatient ambulatory
surgery visits, renal dialysis visits, observation care visits, psychiatric visits, chemical
dependency visits, hospice outpatient visits, and adult day health care visits.
Ownership Type: (See Type of Ownership)
Patient Days: (See Discharge Days which includes a discussion of Discharge Days
versus Census Days).
Patient (Census) Days: The number of days that inpatients (excluding newborns in the
nursery) are hospitalized. The day of admission, but not the day of discharge, is counted
as a patient day. If both admission and discharge occur the same day, the day is counted
as one patient day.
Payor: A person or organization which pays the hospital for services rendered to patients.
This can be the patient and/or third parties such as Medicare, Medi-Cal, Blue Cross,
managed care organizations, or other private insurance plans. (Also see Principal
Payment Source).
Perinatal Unit: A maternity and newborn service for the provision of care during
pregnancy, labor, delivery, postpartum, and neonatal periods with appropriate staff, space,
equipment, and supplies. Commonly called maternity or obstetrical beds.
Principal Diagnosis: That condition established after study to be chiefly responsible for
occasioning the admission of the patient to the hospital for care. This definition may not
apply to patients receiving long-term care (skilled nursing/intermediate care) or physical
rehabilitation care, due to issues concerning reimbursement.
Principal Diagnostic Group: The major group of diseases, disorders and conditions as
listed in, and roughly corresponding to, the chapters of the International Classification of
Diseases, 9th Revision, Clinical Modification (ICD-9-CM).
Race/Ethnicity: For the Patient Discharge Data Program, the patient's ethnic and racial
background is reported as one alternative under the following ethnicity choices and one
alternative under the following race choices:
a. Ethnicity:
1. Hispanic. A person who identifies with or is of Mexican, Puerto Rican, Cuban,
Central or South American, or other Spanish culture or origin.
2. Non-Hispanic.
3. Unknown.
b. Race:
1. White - A person having origins in or who identifies with any of the original
Caucasian peoples of Europe, North Africa, or the Middle East.
2. Black - A person having origins in or who identifies with any of the black racial
groups of Africa.
3. Native American/Eskimo/Aleut - A person having origins in or who identifies with
any of the original peoples of North America, and who maintains cultural
identification through tribal affiliation or community recognition.
4. Asian/Pacific Islander - A person having origins in or who identifies with any of the
original oriental peoples of the Far East, Southeast Asia, the Indian subcontinent,
or the Pacific Islands. Includes, Hawaii, Laos, Vietnam, Cambodia, Hong Kong,
Taiwan, China, India, Japan, Korea, the Philippine Islands, and Samoa.
5. Other - Any possible options not covered in the above categories.
6. Unknown.
Reporting Period: The period of time covered by a report encompasses. For financial
data, this period normally consists of 12 consecutive calendar months (or 13 four-week
periods) that begin on the first day of a month and end on the last day of a month. Other
reporting periods may coincide with a calendar quarter, a semi-annual period, or any
consecutive calendar period of time.
Sub-Acute Care: A level of nursing and supportive care services for patients who have a
fragile medical condition. Such care is more intensive than skilled nursing care but less
intensive than the usual medical, surgical, and pediatric acute care requirements. Staffing
requires specially trained licensed nursing personnel.
Suspense: Occurs when a licensee requests that their license, or some licensed beds, be
temporarily taken out of service, or when the Department of Health Services does so on
its own.
Swing Beds: Beds licensed for general acute care which may be used, with the approval
of Licensing and Certification, Department of Health Services, as skilled nursing beds.
Total Charges: All charges reported by the hospital for services rendered during an
inpatient stay (up through 365 days). Total charges include charges for: daily hospital
services, ambulatory services, ancillary services, and any other service which is defined
as patient care. OSHPD regulations require that the physician professional component be
excluded from total charges. Total charges are adjusted upward (increased) for stays
longer than one year. (See Adjusted Total Charges). It should be noted that charges
frequently have little relationship to actual monies collected.
Total Net Patient Revenue: Gross Patient Revenue from all payers minus all deductions
from revenue.
Total Operating Expenses: Total cost incurred to maintain and develop the operation of
the facility during the reporting period. Includes Daily Hospital Services, Ambulatory
Services, Ancillary Services, Purchased Inpatient and Outpatient Services, Research,
Education, General Services, Fiscal Services, Administrative Services, Physician
Professional Component Expenses, and other unassigned costs. Excludes Non-operating
Expenses and Income Taxes. It is not reduced by Other Operating Revenue.
TRICARE: TRICARE is a health care program for military dependents and retired
military overseen by the Department of Defense in cooperation with regional civilian
contractors. TRICARE began in March 1995 in Washington and Oregon and has
expanded into all areas of the country. TRICARE provides three options to eligible
beneficiaries: TRICARE Prime, similar to a health maintenance organization; TRICARE
Extra, a preferred provider option that saves money for patients; and TRICARE Standard,
a fee-for-service option, which is the same as the former CHAMPUS, the Civilian Health
and Medical Program of the Uniformed Services.
Type of Control: The following categories indicate ownership and legal organization of a
hospital:
a. County/City
b. District
c. Investor-owned
d. Nonprofit
Well-Baby Days: Non-acute, newborn nursery days; refers to condition of baby, not
location.
Zip Code: A code applied to geographic areas by the U.S. Postal Service for efficiency in
delivering mail. Thus, a zip code may cut across civil boundaries (such as counties), and
are likely to observe natural geographic features, such as rivers and mountain ranges.
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