Appendix_F_Definitions.doc

APPENDIX F

DEFINITIONS

ACCREDITATION ASSOCIATION FOR AMBULATORY HEALTH CARE (AAAHC): Is the accrediting agency for outpatient ambulatory care facilities.

ADVANCED CARDIAC LIFE SUPPORT (ACLS): Required every 2 years for contracted physicians working at the MTF

AIR FORCE COMPLETE IMMUNIZATION TRACKING APPLICATION (AFCITA): Database used to track patient immunizations.

Armed Forces Healthcare Longitudinal Technical Application (AHLTA): is the military medical and dental clinical information system that generates and maintains a comprehensive, life-long, computer-based patient record for each Military Health System (MHS) beneficiary.

BASIC LIFE SUPPORT (BLS) CERTIFICATION: Required every 2 years for all personnel, including contract personnel, working at the MTF; includes cardiopulmonary resuscitation training.

CLINICAL PRIVILEGES: Those ambulatory clinical activities permitted to the provider in the granting medical treatment facility (MTF) after evaluation by the credentials function and approved by the medical center commander.

Composite Healthcare System (CHCS): Department of Defense computer system that includes laboratory/pharmacy and scheduling modules. Works in conjunction with AHLTA as the electronic medical record.

CONTINUING MEDICAL EDUCATION (CME): Advanced training/education for professional medical staff

CONTRACT PROVIDER. Any healthcare personnel providing medical services at this MTF who are either directly employed by, or who provide services pursuant to a contract with the Contractor.

CONTRACT SPECIALIST (CS): Government employees who administer and manage contracts and solicitations.

CONTRACTING OFFICER (CO): Government representative with the authority and warrant to enter into contractual agreements that legally bind the government.

CONTRACTOR: Refers to the company or vendor awarded the contract, not its employees.

CREDENTIALING: the process of securing/verifying all documents regarding education, training, licensure, experience, board certification and expertise of a health care provider. Process must be completed before a provider can see patients.

CREDENTIALS. Documents providing evidence of education, training, licensure, experience, board certification and expertise of a health care provider.

CREDENTIALS COMMITTEE: The professional body set up to review credentials, make recommendations on clinical privileges for providers, and to promote quality control in professional practice.

DEFECTIVE SERVICE. A service output that does not meet the standard of performance specified in the contract for that service. The method of surveillance for each performance objective is listed in the Service Delivery Summary. Defective services will be determined by either customer complaint or periodic inspection. A defect may be either an unsatisfactory inspection report or a customer complaint, which addresses unacceptable turnaround times or errors in reports.

DRUG ENFORCEMENT AGENCY (DEA) number: A certificate required that allows provider to prescribe scheduled narcotic medications

EXPOSURE-PRONE PROCEDURE. A certain invasive surgical or dental procedure that has been implicated in the transmission of the hepatitis-B virus from an infected health care worker to a patient. Characteristics of exposure-prone procedures include digital palpation of a needle tip in a body cavity or the simultaneous presence of the health care worker’s fingers and a needle or other sharp instrument or object in a poorly visualized or highly confined anatomic site.

FREEDOM OF INFORMATION ACT (FOIA) REQUEST. A written request for DoD records made by any person, including a member of the public, an organization, or a business that either explicitly or implicitly involves the FOIA, DoD Directive 5400.7.

FULL REIMBURSEMENT RATE. A rate, which is set annually by Congress, for reimbursement by non-eligible personnel who receive medical services at the MTF. This is a flat rate set for outpatient and inpatient care.

FULL TIME EQUIVALENT (FTE). One (1) FTE represents 2000 hours (e.g.; (40 Hrs x 52 Wks) — 10 Federal Holidays x 8 Hrs). All 2000 hours are production; production is measured in relative value units (RVUs). Each family practice physician is expected to perform on average a minimum of 300 RVUs per month. The Government does not reimburse physicians as independent contractors for Federal Holidays and vacation/sick time.

FUNCTIONAL AREA CHIEF (FAC). A generic term used interchangeably to refer to the Functional Commander, the Chief of Service, designated Quality Assurance personnel or technical representatives of the Contracting Officer.

FUNCTIONAL COMMANDER. The Chief/Director of the MTF medical service for whom the contracted providers are acquired, or his designated representative. Also referred to as the FAC.

FUNCTIONAL REQUEST. A written request for DoD records made by any person, including a member of the public, an organization, or a business that either does not cite the FOIA or Privacy Act. This does not include requests from Government employees with a need to know to perform official Government business.

GOVERNMENT QUALITY ASSURANCE. Those actions taken by the Government to assure services meet the requirements of the contract. A planned and systematic pattern of all actions necessary to provide confidence that adequate technical requirements are established, products and services conform to established technical requirements, and satisfactory performance is achieved. For purposes of this contract, quality assurance refers to actions by the government.

HEALTH CARE PROVIDER. Any contract healthcare professional that, under regulations of a Military Department, is granted clinical practice privileges in a military MTF who is licensed or certified to perform healthcare services by a Governmental board or Agency or professional health care society or organization.

INVASIVE MEDICAL PROCEDURE. Any procedure that involves a puncture or incision of the skin, the insertion of an instrument or foreign material into the body, or breaking of the mucosal lining of the body.

MEDICAL GROUP (MDG). Place where care is provided

MEDICAL TREATMENT FACILITY (MTF): Air Force hospitals or clinics, including all activities providing outpatient healthcare services for authorized personnel.

MULTI-FUNCTIONAL TEAM (MFT): Responsible for execution of the service acquisition throughout the life of the contract requirement. This team includes representatives of the technical and procurement communities, stakeholders of the service acquisition and the contractor who provides the services. Primary MFT members for this contract are the Functional Commander, Contracting Officer, Program Manager, Senior Quality Assurance Evaluator, Quality Assurance Evaluator and Quality Assurance Specialist. This team may consist of various sub-group(s) responsible for routine contract actions. Member participation is contingent upon business requirements.

NATIONAL PRACTITIONERS DATA BANK (NPDB): The NPDB is primarily an alert or flagging system intended to facilitate a comprehensive review of health care practitioners' professional credentials.

NATIONAL PROVIDER IDENTIFICATION (NPI) NUMBER: A provider identification number used for tracking for billing and credentialing purposes.

Pediatric Advanced Life Support (PALS):: Required for all providers credentialed to see patients under the age of 12.

Personal Individual Medical Readiness (PIMR): Database used to track active duty military medical readiness requirements.

PERFORMANCE OBJECTIVES (PO): The POs listed in the Service Summary table identify the minimum performance assessment requirements that must be accomplished on a periodic basis.

PERFORMANCE WORK STATEMENT (PWS): A document that becomes part of the contract that accurately describes a service in terms of the output requirements.

PHYSICIAN PRECEPTOR: Teach students "real-world" knowledge that can't be learned at medical school. Helps students ranging from newcomers learning basic history-taking and exam skills, to senior students planning to enter family practice residencies and needing more hands-on clinical experience.

PREPRIVILEGING: The application of a screening process whereby prospective DoD healthcare providers, required to be privileged to provide patient care within MTFs, have their education, training, and past performance evaluated preliminary to their being considered for an active contractual relationship.

PRIVILEGING: Frequently referred to as credentialing; the process whereby the medical center commander, or the major command surgeon general, upon recommendations from the MTF credentials function, grants to individual health care providers the privileges and responsibility of providing specified medical care within the MTF.

PRIMARY SOURCE VERIFICATION. The verification in writing or by documented telephone conversation from the original medical or nursing school, training or residency program, licensing or certifying boards, etc. The training and credentials claimed by a health care provider and used in the privileging process.

PRIVACY ACT REQUEST. A written request from the subject of the records or a request with the subject’s written consent.

QUALITY ASSURANCE PERSONNEL (QAP): Government personnel responsible for quality issues regarding the contract.

QUALITY ASSURANCE EVALUATOR (QAE): A government employee assigned as an evaluator of contract performance.

RELATIVE VALUE UNITS (RVUs). RVUs are derived from the establishment of the Relative Value-Based Resource System which was developed in 1992 by Medicare. This system significantly changed the way Medicare would pay for physicians’ services. Instead of basing payments on charges, the federal government established a standardized physician payment schedule based on a resource-based relative value scale (RBRVS). In the RBRVS system, payments for services are determined by the resource costs needed to provide them (i.e., relative value units). The cost of providing each service is divided into three components:

physician work, practice expense and professional liability insurance. Payments are calculated by multiplying the combined costs of a service by a conversion factor (a monetary amount that is determined by the Centers for Medicare and Medicaid Services). Payments are also adjusted for geographical differences in resource costs).]

SERVICE SUMMARY (SS): Each PO has a corresponding performance threshold which is the minimum acceptable performance level and the PWS reference paragraph. Each PO also contains a method of assessment for the QAP to use, the minimum frequency at which to accomplish the assessments and the QAP responsible to perform the assessment.

SHIFT: A normal duty day.

TEAM MEMBER: Refers to contractor’s employees working at the clinic.

VALID LICENSE. A grant of permission by an official agency of the District of Columbia, a state, or territory of the United States, to provide care independently as a health care professional. Licenses must be current to be valid. Some jurisdictions issue no-fee licenses to Federal employees or military personnel. These are acceptable if the issuing authority will exercise professional regulating control over individuals with these licenses.

APPX F