Glossary

VA Medical Centers deliver inpatient hospital care and related services for surgery and short-term health conditions, as well as comprehensive primary, specialty and long-term care.

The Veterans Health Administration's (VA's) medical benefits package is available to Veterans (including Reservists and National Guard) who served on active duty and meet eligibility requirements. Other groups can also be eligible. For more information, visit www.va.gov/healtheligibility- Opens in a new window.

An episode of illness that is short and relatively severe.

The national organization that represents and serves all types of hospitals, health care networks, and their patients and communities. AHA takes part in national health policy development, legislative and regulatory debates, and legal matters. AHA provides education for health care leaders and is a source of information on health care issues and trends.

In angioplasty, a catheter is used to insert a balloon that is inflated to open a blocked blood vessel. Percutaneous transluminal coronary angioplasty (PTCA) is one of several procedures used to open a blocked blood vessel, known collectively as a percutaneous coronary intervention or PCI.

A drug used to treat patients with heart failure and a decreased function of the left heart. ARBs block the action of a hormone that can narrow blood vessels. This helps reduce the pressure in the heart and lower blood pressure.

Asthma is a chronic lung condition that causes problems getting air in and out of the lungs. Children with asthma may experience wheezing, coughing, chest tightness and trouble breathing.

A type of drug that is used to lower blood pressure, treat chest pain (angina) and heart failure, and to help prevent a heart attack. Beta blockers relieve the stress on the heart by slowing the heart rate and reducing the force with which the heart muscles contract to pump blood. They also help keep blood vessels from constricting in the heart, brain, and body.

A registry collects and analyzes information on certain medical topics, conditions, or procedures for hospitals or other providers. The registry then provides the hospitals or providers with information to help them improve the care they provide. A cardiac surgery registry is one example of a registry in which hospitals or providers that perform cardiac surgery can participate.

State government agencies inspect health care providers, including hospitals, nursing homes, dialysis facilities and home health agencies, as well as other health care providers. These providers are certified if they pass inspection. Being certified is not the same as being accredited. Medicare or Medicaid only pays for care provided by certified or accredited providers.

An illness that persists over a long period of time.

A provider or supplier that has been accredited by a CMS-approved national accreditation program and that such accreditation demonstrates compliance with the applicable conditions of participation, conditions for coverage, conditions for certification or requirements.

DNV Healthcare, established in 1864, is an independent, international foundation with a purpose to safe guard life, property and the environment. Increasing patient safety and reducing errors in healthcare is an important part of that purpose. DNV Healthcare obtained CMS-approval for their hospital accreditation program in September 2008. DNV Healthcare’s hospital accreditation program is unique in that it integrates the ISO 9001 standards (international quality standards that define minimum requirements for a quality management system) and the Medicare hospital conditions of participation.

Additional information regarding DNV Healthcare’s accreditation program can be found by clicking on the following link: http://www.dnv.com

Hospitals that treat sicker patients do not necessarily have worse rates of readmission or death. To compare hospitals fairly (and to avoid penalizing those that treat sicker patients) it is important to consider differences in patients’ health before they were admitted to the hospital. The hospital-specific 30-day rates used in this report have been adjusted to account for differences in patients’ health before their hospital admission. The statistical process of accounting for differences in patients’ sickness before they were admitted to the hospital is called risk adjustment. This statistical process aims to ‘level the playing field’ by accounting for health risks that patients have before they enter the hospital.

Fibrinolytic drugs are "clot-busting" drugs that can help dissolve blood clots in blood vessels and improve blood flow to your heart. They are important for treating heart attacks. If you have a heart attack, your doctor may give you a fibrinolytic drug, perform a percutaneous coronary intervention (PCI), or both.

Measures that tell what happened after patients with certain conditions received hospital care are called "Outcome Measures." The death rates focus on whether patients died within 30 days of their hospitalization. The rates of readmission focus on whether patients were hospitalized again within 30 days. Rates of readmission show whether a hospital is doing its best to prevent complications, teach patients at discharge, and ensure patients make a smooth transition to their home or another setting such as a nursing home.

In December 2002, the American Hospital Association (AHA), Federation of American Hospitals (FAH), and Association of American Medical Colleges (AAMC) launched the Hospital Quality Alliance (HQA), a national public-private collaboration to encourage hospitals to voluntarily collect and report hospital quality performance information. This effort is intended to make important information about hospital performance accessible to the public and to inform and invigorate efforts to improve quality. CMS and the Joint Commission participate in the HQA, along with the AHA, the FAH, the AAMC, the American Medical Association, the American Nurses Association, the National Association of Children’s Hospitals and Related Organizations, American Association of Retired People, American Federation of Labor and Council of Industrial Organizations, the Consumer-Purchaser Disclosure Project, the Agency for Healthcare Research and Quality, the National Quality Forum, the Blue Cross and Blue Shield Association, the National Business Coalition on Health, America’s Health Insurance Plans, National Association of Public Hospitals and Health Systems, Society for Critical Care Medicine, Wisconsin Collaborative for Healthcare Quality, and the U.S. Chamber of Commerce.

Influenza is a serious and sometimes deadly lung infection that can spread quickly in a community. Symptoms include fever—often a high temperature of more than 102° Fahrenheit (38.9° Celsius), headache, muscle aches and pains, chills, cough and chest pain when you take a breath ("pleuritic chest pain"). Although most people recover from the illness, the Centers for Disease Control and Prevention (the CDC) estimates that in the United States more than 200,000 people are hospitalized and about 36,000 people die from the flu and its complications every year.

Services provided to patients admitted to a hospital that include bed and board, nursing services, diagnostic or therapeutic services, and medical or surgical services.

For each hospital’s rate of readmission or death rate, the model also calculates an " interval estimate " (which is like a margin of error), which describes how much uncertainty there is around the rate—how much bigger or smaller the rate might really be. A hospital with many patients will have a rate that is more precise or certain; that is, the " interval estimate " will be relatively narrow. A hospital with fewer patients will have a rate that is less precise or certain; that is, it will have a wider " interval estimate." The " risk-adjusted " hospital rate with its " interval estimate " can be compared to the U.S. National Rate. If the interval estimate includes (overlaps with) the U.S. National Rate, the hospital’s performance is considered to " No Different Than the U.S. National Rate " and so is placed in that category. If the entire interval estimate is lower than (better than) the U.S. National Rate, then the hospital’s performance is " Better than the U.S. National Rate. " If the entire interval estimate is higher than (worse than) the U.S. National Rate, the hospital’s performance is " Worse than the U.S. National Rate. "

A facility, like a nursing home, that provides a variety of services that help people with health or personal needs and activities of daily living (like walking, eating, and going to the bathroom) over a period of time. Most long-term care is custodial care, for which Medicare does not pay.

The median payment refers to the midpoint of all payments to the hospital for a particular MS-DRG, that is, half the payments were lower and half the payments were higher than the median payment.

Median Medicare payments for the same MS-DRG can vary. A hospital can get a higher payment for any or all of the following reasons:

• It is classified as a teaching hospital
• It treats a high percentage of low-income patients (disproportionate share)
• It may treat unusually expensive cases (outlier payments)
• It pays it’s employees more compared to the national average because the hospital is in a high-cost area (wage index) Note: The hospital’s wage index is calculated using the hospitals’ payroll records, contracts and other wage related documentation

Tests that create images of various parts of the body to screen for or diagnose medical conditions. Examples of medical imaging include CT Scans, MRIs, and mammograms.

A Medicare health plan is offered by a private company that contracts with Medicare to provide Part A (Hospital Insurance) and Part B (Medical Insurance) benefits to people with Medicare who enroll in the plan. This term includes all Medicare Advantage Plans, Medicare Cost Plans, Demonstration/Pilot Programs, and Programs for All-inclusive Care for the Elderly (PACE).

The Medicare Severity - Diagnosis Related Groups (MS-DRGs) are payment groups designed for the Medicare population. Patients who have similar clinical characteristics and similar costs are assigned to a MS-DRG. The MS-DRG will be linked to a fixed payment amount based on the average cost of patients in the group. Patients can be assigned to a MS-DRG based on their diagnosis, surgical procedures, age and other information. Hospitals provide this information on their bills and Medicare uses this information to decide how much the hospitals should be paid. There may be some groups of MS-DRGs that are based on complications or comorbidities (CCs) or major complications or comorbidities (MCCs). Complications are new problems that are the result of a procedure, treatment, or illness. The term comorbidities means that two or more diseases are present at the same time.

Medicare supplement insurance policy sold by private insurance companies to fill "gaps" in Original Medicare coverage.

The "number of completed surveys" is the total number of patients who completed a survey. When at least 300 patients have completed the survey for a hospital, we can be more confident that the survey results are fully representative of patients' experiences at that hospital and are reliable for assessing the hospital's performance. However, smaller hospitals could sample all of their HCAHPS-eligible discharges but, because of their small size, still have fewer than 300 completed surveys.

Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for your Part A (Hospital Insurance) and/or your Part B (Medical Insurance) benefits. For more information, view the Medicare and You Handbook- Opens in a new window.

Test that measures the amount of oxygen in your blood to see if you need oxygen therapy.

The procedures called Percutaneous Coronary Interventions (PCI), such as angioplasty and atherectomy are among those that are the most effective for opening blocked blood vessels that cause heart attacks. Doctors may perform a PCI, or give certain drugs to open the blockage, and in some cases, may do both.

An inflammation of the lungs caused by a viral or bacterial infection. This fills your lungs with mucus and lowers the oxygen level in your blood. Symptoms can include fever, fatigue, difficulty breathing, chills, a "wet" cough, and chest pain.

A doctor, hospital, health care professional, or health care facility.

Quality health care is how well a doctor, hospital, health plan, or other provider of health care, keeps its members healthy or treats them when they are sick. Good quality health care means doing the right thing at the right time, in the right way, for the right person and getting the best possible results.

A group of practicing doctors and other health care experts who are paid by the Federal government to check and improve the care given to people with Medicare. They must review your complaints about the quality of care given by: inpatient hospitals, hospital outpatient departments, hospital emergency rooms, skilled nursing facilities, home health agencies, Private Fee-for-Service plans, and ambulatory surgical centers.

The amount of one thing compared to the amount of another. For example, the number of combination CT scans done compared to the number of all CT scans done.

Relievers are medications that relax the bands of muscle surrounding the airways and are used to quickly make breathing easier.

Hospital Compare will show two overall ratings for patient safety:

• Serious Complications (Complication/patient safety for selected indicators)
• Deaths for Certain Conditions (Mortality for selected medical conditions)

The overall score for serious complications will be based on how often adult patients had certain serious, but potentially preventable complications related to medical or surgical inpatient hospital care.

The overall score for deaths for certain conditions will be based on how many patients with these conditions died while they were in the hospital.

Data for these measures will come from Medicare Fee-for-Service claims data. These composite ratings will be based upon a number of individual measures including the following:

• Death among surgical patients with serious, treatable complications
• Collapsed lung that results from medical treatment (Iatrogenic pneumothorax, adult)
• Breathing failure after surgery (Post-operative respiratory failure)
• Blood clots, in the lung or a large vein, after surgery (Post-operative PE or DVT)
• A wound that splits open after surgery (Post-operative wound dehiscence)
• Accidental cuts and tears (Accidental puncture or laceration)
• Death after surgery to repair a weakness in the abdominal aorta (Abdominal aortic aneurysm mortality rate)
• Death from hip fractures (Hip fracture mortality rate)

Heart Attack

• Aspirin at arrival
• Aspirin at discharge
• ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction*
• Beta Blocker at arrival
• Beta Blocker at discharge

Heart Failure

• Evaluation of Left Ventricular Systolic (LVS) Function**
• ACE Inhibitor or ARB for Left Ventricular Systolic Dysfunction*

Pneumonia

• Oxygenation Assessment
• Initial Antibiotic Timing
• Pneumococcal Vaccination Status

*Modified, effective 1Q2005 discharges. For more information, see The Hospital Quality Alliance (HQA) Ten Measure Starter Set- Opens in a new window.

**Modified, effective 1Q2006 discharges.

A small wire tube inserted in a blood vessel by a catheter to hold open a blocked blood vessel. One of several procedures to open a blocked blood vessel called a percutaneous coronary intervention (PCI).

A structural measure reflects the environment in which providers care for patients. For example, whether or not a hospital uses an electronic health record is a structural measure.

A national, standardized survey of hospital patients about their experiences during a recent inpatient hospital stay.

This is also referred to as HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).

Systemic corticosteroids are inflammation-reducing, anti-allergic medications that affect the body as a whole.

The Joint Commission is an independent, not-for-profit organization that accredits and certifies a large number of health care organizations and programs in the United States. The Joint Commission’s hospital accreditation program has held deeming authority since the inception of the Medicare program in 1965. The Joint Commission’s mission is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

Additional information regarding accreditation with deemed status by the Joint Commission’s accreditation program can be found by clicking on the following link: http://www.jointcommission.org/AboutUs

Something done to help with a health problem. For example, giving certain drugs and performing surgery are treatments.

These categories show how hospitals' rates compare to the U.S. National rate.

Hospitals’ rates are "risk-adjusted." That is, they take into account how sick patients were before they were admitted to the hospital. The categories take into account differences that might be due to chance.

Hospitals are shown to be "Better" or "Worse Than U.S. National Rate" only if we can be 95% certain that the difference between the hospital’s rates and the U.S. National rate is not due to chance. All others are shown in the "No Different Than U.S. National Rate" category or as "Number of Cases too Small."

Better Than U.S. National Rate

Hospitals in the "Better Than U.S. National Rate" category have 30-day risk-adjusted rates that are lower than the U.S. National rate, and we can be 95% certain that this difference is not due to chance.

No Different than U.S. National Rate

Many hospitals in the "No Different Than U.S. National Rate" category have 30-day risk-adjusted rates that are about the same as the U.S. National rate. Other hospitals in this category have rates that are higher or lower than the U.S. National rate, but we cannot be 95% certain that these differences are not due to chance. One cannot be certain about differences when a hospital has very few patients who meet the requirements to be included in these rates.

Worse Than U.S. National Rate

Hospitals in the "Worse Than U.S. National Rate" category have 30-day risk-adjusted rates that are higher than the U.S. National rate, and we can be 95% certain that this difference is not due to chance.

Number of Cases Too Small

Hospitals that have very few eligible patients (fewer than 25 over the 3-year period), are not categorized, but are listed as "The number of cases is too small (fewer than 25) to reliably tell how well the hospital is performing."