Accountable Care Organization (ACO)
A group of coordinated health care providers who form a healthcare organization characterized by a payment and care delivery model that seeks to tie provider reimbursements to quality metrics and reductions in the total cost of care for their population of patients. The ACO is accountable to patients and the third-party payer for the quality, appropriateness, and efficiency of the care provided.
Ancillary/Supplementary Services
Ancillary services are those services that supplement the routine (professional) services personally performed by the practice’s provider staff. Such services are billed under separate CPT codes and reimbursed separately, either by third-party payers and/or patients. Examples of ancillary services include: Advanced Radiology, Aesthetics and Cosmetic Services, Allergy/ Asthma/Immunology, Ambulatory Surgery Center, Audiology/Hearing Aid(S)/Center, Clinical Laboratory Services, Complementary Alternative Medicine, Drug Administration, Durable Medical Equipment (DME), General Radiology, Health Education/Counseling Services, Optical Shop, PT/ OT/Cardiac Rehabilitation, Radiation Therapy, and Sleeping Lab/Center.
Care Team Model
According to the American Society of Anesthesiologists, the care team model consists of anesthesiologists supervising qualified advanced practice anesthesia providers and/or resident physicians who are training in the provision of anesthesia care. The anesthesiologist may delegate patient monitoring and appropriate tasks to these advanced practice providers while retaining overall responsibility for the patient.
Members of the Anesthesia Care Team work together to provide the optimal anesthesia experience for all patients. Core members of the anesthesia care team include both physicians (anesthesiologist, anesthesiology fellow, anesthesiology resident) and advanced practice (anesthesiologist assistant, nurse anesthetist, anesthesiologist assistant student, student nurse anesthetist). Other healthcare professionals also make important contributions to the perianesthetic care of the patient.
To provide optimum patient safety, the anesthesiologist directing the Anesthesia Care Team is responsible for management of team personnel, patient pre-anesthetic evaluation, prescribing theanesthetic plan, management of the anesthetic, post-anesthesia care and anesthesia consultation.
Demographic Classification
Metropolitan Area (50,000 or More): The county in which the practice is located is defined as a metropolitan (metro) county by the Office of Management and Budget (OMB), based on recent Census Bureau data.
Nonmetropolitan Area (49,999 or Fewer): The county in which the practice is located is defined as a nonmetropolitan (nonmetro) county by the Office of Management and Budget (OMB), based on recent Census Bureau data.
Demographic Classification (Expanded)
Metro - Counties in metro areas of fewer than 250,000 population: The county in which the practice is located is Census Bureau defined urbanized area with a population less than 250,000. Metro - Counties in metro areas of 250,000 to 1 million population: The county in which the practice is located is Census Bureau defined urbanized area with a population of 250,001 to 1,000,000.
Metro - Counties in metro areas of 1 million population or more: The county in which the practice is located has a population of 1,000,001 or more.
Nonmetro - Completely rural or less than 2,500 urban population: The county in which the practice is located is referred to as “rural.” It may or may not be adjacent to a metro area and has a population less than 2,500.
Nonmetro - Urban population of 2,500 to 19,999: The county in which the practice is located is referred to as “rural.” It may or may not be adjacent to a metro area and has a population between 2,500 and 19,999.
Nonmetro - Urban population of 20,000 or more: The county in which the practice is located is referred to as “rural.” It may or may not be adjacent to a metro area and has a population of 20,000 or more.
Federally Qualified Health Center (FQHC)
A reimbursement designation that refers to several health programs funded under Section 330 of the Public Health Service Act of the US Federal Government. These 330 grantees in the Health Center Program include:
- Community Health Centers which serve a variety of underserved populations and areas;
- Migrant Health Centers which serve migrant and seasonal agricultural workers;
- Health Care for the Homeless Programs which reach out to homeless individuals and families and provide primary and preventive care and substance abuse services; and
- Public Housing Primary Care Programs that serve residents of public housing and are located in or adjacent to the communities they serve.
FQHCs are community-based organizations that provide comprehensive primary and preventive health, oral, and mental health/substance abuse services to persons in all stages of the life cycle, regardless of their ability to pay.
Fiscal Year
The corporate year established by the practice for business purposes. For many practices, this is January through December of the same year. The data reported is representative of the completed fiscal year.
Full Time Equivalent (FTE)
A measure based upon the number of actual hours worked regardless of whether it’s spent in clinical or nonclinical activities. A 1.0 FTE provider works the number of hours the practice considers to be the minimum for a normal workweek, which could be 37.5, 40, 50 hours, or some other standard.
| Western Section: | Midwest Section: | Eastern Section: | Southern Section: |
|---|---|---|---|
| Alaska | Illinois | Connecticut | Alabama |
| Arizona | Indiana | Delaware | Arkansas |
| California | Iowa | District of Columbia | Florida |
| Colorado | Michigan | Maine | Georgia |
| Hawaii | Minnesota | Maryland | Kansas |
| Idaho | Nebraska | Massachusetts | Kentucky |
| Montana | North Dakota | New Hampshire | Louisiana |
| Nevada | Ohio | New Jersey | Mississippi |
| New Mexico | South Dakota | New York | Missouri |
| Oregon | Wisconsin | North Carolina | Oklahoma |
| Utah | Pennsylvania | South Carolina | |
| Washington | Rhode Island | Tennessee | |
| Wyoming | Vermont | Texas | |
| Virginia | |||
| Virginia |
Health and Human Services (HHS) Regions
| HHS Region 1: | HHS Region 2: | HHS Region 3: | HHS Region 4: | HHS Region 5: |
|---|---|---|---|---|
| Connecticut | New Jersey | Delaware | Alabama | Illinois |
| Maine | New York | District of Columbia | Florida | Indiana |
| Massachusetts | Maryland | Georgia | Michigan | |
| New Hampshire | Pennsylvania | Kentucky | Minnesota | |
| Rhode Island | Virginia | Mississippi | Ohio | |
| Vermont | West Virginia | North Carolina | Wisconsin | |
| South Carolina | ||||
| Tennessee | ||||
| HHS Region 6: | HHS Region 7: | HHS Region 8: | HHS Region 9: | HHS Region 10: |
| Arkansas | Iowa | Colorado | Arizona | Alaska |
| Louisiana | Kansas | Montana | California | Idaho |
| New Mexico | Missouri | North Dakota | Hawaii | Oregon |
| Texas | Utah | |||
| Wyoming |
Legal Organization
Business Corporation: A for-profit organization recognized by law as a business entity separate and distinct from its shareholders. Shareholders need not be licensed in the profession practiced by the corporation.
Limited Liability Company (LLC): A legal entity that is a hybrid between a corporation and a partnership, because it provides limited liability to owners like a corporation while passing profits and losses through to owners like a partnership.
Not-for-profit Corporation/Foundation: An organization that has obtained special exemption under Section 501(c) of the Internal Revenue Service code that qualifies the organization to be exempt from federal income taxes. To qualify as a tax exempt organization, a practice or faculty practice plan would have to provide evidence of a charitable, educational, or research purpose.
Partnership: An unincorporated organization where two or more individuals have agreed that they will share profits, losses, assets, and liabilities, although not necessarily on an equal basis. The partnership agreement may or may not be formalized in writing.
Professional Corporation/Association: A for-profit organization recognized by law as a business entity separate and distinct from its shareholders. Shareholders must be licensed in the profession practiced by the organization.
Sole Proprietorship: An organization with a single owner who is responsible for all profit, losses, assets, and liabilities.
Minor Geographic Region
| Northeast: | Southeast: | Lower Midwest: |
|---|---|---|
| Connecticut | Alabama | Arkansas |
| Maine | Florida | Kansas |
| Massachusetts | Georgia | Louisiana |
| New Hampshire | Mississippi | Missouri |
| Rhode Island | North Carolina | Oklahoma |
| Vermont | South Carolina | Texas |
| Tennessee | ||
| North Atlantic | Eastern Midwest | Rocky Mountain |
| New Jersey | Illinois | Arizona |
| New York | Indiana | Colorado |
| Pennsylvania | Kentucky | Montana |
| Michigan | Nevada | |
| Ohio | New Mexico | |
| Utah | ||
| Northwest | Upper Midwest | Pacific |
| Idaho | Iowa | Alaska |
| Oregon | Minnesota | California |
| Washington | Nebraska | Hawaii |
| North Dakota | ||
| South Dakota | ||
| Wisconsin | ||
| Mid Atlantic | ||
| Delaware | ||
| District of Columbia | ||
| Maryland | ||
| Virginia | ||
| West Virginia |
Number of Branch Clinics
The primary clinic location is the clinic with the most FTE physicians out of all the practice branches. A branch or satellite clinic is a smaller clinical facility for which the practice incurs occupancy costs such as lease, depreciation and utilities. A branch is in a separate location from the practice’s principal facility. Merely having a physician practice in another location does not qualify that location as a branch or satellite clinic. For example, if a physician sees patients in a hospital, this would not normally be counted as a branch or satellite clinic unless the practice pays rent for the space.
Organization Ownership
Hospital/IDS Owned:
- Hospital: A hospital is an inpatient facility that admits patients for overnight stays, incurs nursing care costs, and generates bed-day revenues.
- Integrated Health System or Integrated Delivery System (IDS): A network of organizations that provide or coordinate and arrange for the provision of a continuum of health care services to consumers and is willing to be held clinically and fiscally responsible for the outcomes and the health status of the populations served. Generally consisting of hospitals, physician groups, health plans, home health agencies, hospices, skilled nursing facilities, or other provider entities, these networks may be built through “virtual” integration processes encompassing contractual arrangements and strategic alliances as well as through direct ownership.
- Management Services Organization (MSO): An entity organized to provide various forms of practice management and administrative support services to health care providers. These services may include centralized billing and collections services, management information services, and other components of the managed care infrastructure. MSOs do not actually deliver health care services. MSOs may be jointly or solely owned and sponsored by physicians, hospitals, or other parties. Some MSOs also purchase assets of affiliated physicians and enter into long-term management service arrangements with a provider network. Some expand their ownership base by involving outside investors to help capitalize the development of such practice infrastructure.
- Physician Practice Management Company (PPMC): Publicly held or entrepreneurial directed enterprises that acquire total or partial ownership interests in physician organizations. PPMCs are a type of MSO, however their motivations, goals, strategies, and structures arising from their unequivocal ownership character – development of growth and profits for their investors, not for participating providers – differentiate them from other MSO models.
Physician Owned:
- Advanced Practice Providers: Any advanced practice provider (e.g. nurse practitioners, physical therapists, etc.) duly licensed and qualified under the law of jurisdiction in which treatment is received.
- Physicians: Any Doctor of Medicine (MD) or Doctor of Osteopathy (DO) who is duly licensed and qualified under the law of jurisdiction in which treatment is received.
Other Majority Owner:
- Insurance Company (Including HMO and PPO): An insurance company is an organization that indemnifies an insured party against a specified loss in return for premiums paid, as stipulated by a contract. An HMO is an insurance company that accepts responsibility for providing and delivering a predetermined set of comprehensive health maintenance and treatment services to a voluntarily enrolled population for a negotiated and fixed periodic premium.
- Government: A governmental organization at the federal, state, or local level. Government funding is not enough criterion. Government ownership is the key factor. An example would be a medical clinic at a federal, state, or county correctional facility.
- Privately Operated: A company or individual that takes their own money and uses it to fund another organization. Some investors have the option to invest passively, which means they give their funding and play no further role, while others have a more significant role in the organization. Includes non-clinical investors or owners.
- University or Medical School: An institution of higher learning with teaching and research facilities comprising undergraduate, graduate and professional schools. A medical school is an institution that trains physicians and awards medical and osteopathic degrees.
- Foundation: Foundations are very similar to nonprofit legal entities to allow physicians, organizations or other healthcare providers a mechanism to provide medical services or perform research. Foundations are generally organizations that do not qualify as a public charity, but are often set up via an endowment to support charitable purposes or as a memorial or similar healthcare related purpose. They are usually non-stock corporations and are eligible for federal tax exempt status.
Patient Centered Medical Home (PCMH)
A care delivery model where patient treatment and care is coordinated through their primary care provider to ensure they receive high quality care when care is necessary. The objective is collaboration between the patient and physicians with care delivered in a way the patient can understand. PCMHs seek to improve the quality, effectiveness, and efficiency of the care delivered while focusing on meeting patient needs first.
Practice Type
Multispecialty: A medical practice that consists of physicians practicing in different specialties.
- Multispecialty with Primary and Specialty Care: Medical practices that consist of physicians practicing in different specialties, including at least one primary care specialty listed below:
- Family Medicine: General
- Family Medicine: Sports Medicine
- Family Medicine: Urgent Care
- Family Medicine: With Obstetrics
- Family Medicine: Without Obstetrics
- Geriatrics
- Internal Medicine: General
- Pediatrics: Adolescent Medicine
- Pediatrics: General
- Pediatrics: Sports Medicine
- Urgent Care
- Multispecialty with Primary Care Only: A medical practice that consists of physicians practicing in more than one of the primary care specialties listed above or one of the specialties below:
- Obstetrics/gynecology
- Gynecology (only)
- Obstetrics(only)
- Multispecialty with Specialty Care Only: A medical practice that consists of physicians practicing in different specialties, none of which are the primary care specialties listed above.
- Single Specialty: A medical practice that focuses its clinical work in one specialty. The determining factor for classifying the type of specialty is the focus of clinical work and not necessarily the specialties of the physicians in the practice.
Rent vs. Own Practice Space
Whether a practice rents or owns their medical practice space.
Rural Health Clinic (RHC)
A clinic certified to receive special Medicare and Medicaid reimbursement. The purpose of the RHC program is to improve access to primary care in underserved rural areas. RHCs are required to use a team approach of physicians and advanced practice providers (nurse practitioners, physician assistants, and certified nurse midwives) to provide services. The clinic must be staffed at least 50% of the time with an advanced practice provider. RHCs may also provide other healthcare services such as mental health or vision services, but reimbursement for those services may not be based on their allowable cost.
Staffing Model for Anesthesiology Practices
Designation for various Anesthesiology practice staffing models.
- Physician Only
- Fewer than 1 CRNA/Anesthesia Assistant (AA) per Physician
- 1 CRNA/Anesthesia Assistant (AA) per Physician or more