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Glossary beginning with P

Click one of the letters above to go to the page of all terms beginning with that letter.

P

Paratransit

Types of passenger transportation that are more flexible than conventional Fixed-Route transit but more structured than the use of private automobiles. Paratransit includes Demand-Response transportation services, subscription bus services, shared-ride taxis, car pooling and vanpooling, jitney services, and so on. Most often refers to wheelchair-accessible, demand-response van service.

Participation

Compliance with standards a facility or supplier of services is required to meet in order to Participate or be Certified in the Medicare or Medicaid programs. These conditions include meeting a statutory definition of the particular institution or facility, conforming with state and local laws and having an acceptable utilization review plan. Surveys to determine whether facilities meet conditions of participation are made by the appropriate state health agency.

Patient

Terminology used by hospitals, physicians, and home health agencies to identify their customers. Long term care facilities prefer the term resident.

Patient Days

A measurement of the utilization of institutional care programs, such as nursing homes and assisted living facilities. Patient days are calculated by multiplying each person cared for by the number of days they were cared for in the month, and combining the totals. Licensed patient days would be the total of each licensed bed times the number of days in the month. Actual patient days would be the total of each resident cared for times the number of days of care each received.

Payor

The source of payment for a healthcare product or service. Payors include Medicare, Medicaid, insurance, private pay or self pay, and other miscellaneous entities and pro

Payor Mix

The composition of payors for the residents or patients of a healthcare organization. A favorable payor mix includes a high percentage of payors with attractive reimbursement rates. In nursing homes, private payors are often the most desirable, and Medicaid is generally the least desirable, so a nursing home with a high percentage of private pay residents would have a favorable payor mix, and a home with a high percentage of Medicaid residents would have an unfavorable payor mix.

Per Capita

A measurement based on the number of persons cared for. Per capita reimbursement rates may be paid on a per member, per month (PMPM) basis, under “capitation,” as compared to per diem rates or fee-for-service payments.

Per Diem

A measurement based on the days a person is cared for. Per diem reimbursement pays a set amount for each day the person is under care. Contrast per diem reimbursement rates to per capita reimbursement rates where payment is a flat amount per person cared for, whether or not they received services, and to fee schedule reimbursement where standard amounts are charges based on the units of service provided.

Per Member Per Month

A monthly fee paid to a provider or plan for each member under care, also called capitation.

Per Patient Day

A measurement of revenue and expenses on a per diem basis, calculating the revenue and cost per patient day. Revenue and expenses are divided by patient days to calculate PPD revenue and costs, to calculate an average of the daily revenue and expense of caring for a resident. PPDs may be calculated on a facility-wide basis, by unit, or by level of care.

Personal Care

A level of care which is mainly for the purpose of addressing deficits in the Activities of Daily Living and Independent Activities of Daily Living. It may be provided by persons without professional skills or training. Such care is intended to maintain and support an existing level of health, rather than to cure or rehabilitate.

Power of Attorney

Authorization for one person to act in the place of another, which may be triggered by loss of competency of the elderly person, or may be valid even if the other person is still competent. Used to make decisions or sign documents related to property or financial affairs.

Private Pay

Residents or patients responsible for payment of their own care, as opposed to residents whose care will be paid for by a third party, such as Medicare

Program of All-Inclusive Care for the Elderly

Programs which combine Medicare and Medicaid benefits into a single managed care program. PACE programs are created for dual-eligibles who need a nursing home level of care, and are designed to reduce or prevent nursing home utilization by the extensive use of adult day care, and home and community based services.

Prospective Payment System

Program for reimbursing Skilled Nursing Facilities based on the expected, or prospective, cost of providing care, using an assessment of the residentÂ’s condition as scored on the Minimum Data Set. This program is being phased in to replace the Cost-Based Reimbursement System used prior to 1999. Under PPS, each resident gets a per diem rate based on the geographical area in which they are receiving care and their MDS scores. MDS scores are grouped into 44 distinct categories, each of which has its own reimbursement rate.

Prospective Rates

Rates paid based an expectation of what costs will be. Sometimes prospective rates are coupled with “settlements,” where actual costs are compared to the prospective reimbursement, and the difference is due to/from the program.

Provider Tax

Taxes imposed by the state on health care providers, generally based on the number of licensed beds or on gross revenues. Provider taxes are usually imposed to increase funding for state Medicaid programs.

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