Dictionary

The following terms are used throughout CompareMaine.

  • Agency for Healthcare Research and Quality (AHRQ)

    The Agency for Healthcare Research and Quality's (AHRQ) mission is to produce evidence to make healthcare safer, higher quality, more accessible, equitable, and affordable. AHRQ is a part of the U.S. Department of Health and Human Services. It is a source of data on health quality for CompareMaine. Learn more at AHRQ

  • Ambulatory Payment Classification (APC)

    The United States government's method for paying for facility outpatient services for the Medicare program.

  • Average Total Payment

    The average dollar amount the insurance company and the insured individual pay a facility and/or a provider for a healthcare procedure. The average is calculated using the median, which is the middle dollar amount in a range of numbers from lowest to highest. The average total payment does not represent actual payments, as that amount varies based on individual circumstances.

  • Bundled Service

    A service with an estimated payment that includes other related procedures. For example, a bloodwork procedure that includes the cost to draw and transport the sample.

  • Clostridium difficile (C. diff)

    Clostridium difficile, a bacteria that causes diarrhea, fever, loss of appetite, nausea and belly pain. It has become drug resistant and could be fatal. Older adults and people using antibiotics are more likely to get C. diff. People often take antibiotics while recovering from surgery, which puts them at a greater risk of getting this infection. CompareMaine uses this for the Preventing Healthcare-Associated Infections quality measure.

  • Clinician & Group-CAHPS (Consumer Assessment of Healthcare Providers and Systems)

    These surveys measure patient perceptions of care delivered by a provider (e.g., physician, nurse practitioner, physician assistant, etc.) in an office setting. These surveys are one source of data on patient experiences as reported on CompareMaine. The surveys were developed by AHRQ, and administered through certified local survey vendors. Learn more at CG CAHPS

  • Centers for Medicare & Medicaid Services (CMS)

    Centers for Medicare & Medicaid Services is a U.S. federal agency that administers Medicare, Medicaid, and the State Children's Health Insurance Program. It is a source of data on cost and quality for CompareMaine. Learn more at CMS

  • Confidence Interval

    Expresses the degree of uncertainty of an estimate and helps decide how precise the estimate is. The mean, plus and minus a margin of error in that estimate, is used to calculate the confidence interval. For example, CompareMaine uses a 95% confidence interval, meaning 95% of the time, the true value is represented in the estimate and 5% of the time, the value would not be represented.

  • Cost Breakdown

    The average total cost is broken out into costs paid by an insurance company and an insured individual to the healthcare facility and professional(s) providing services and procedures. When more than one facility provides care, all costs are attributed to the facility with the largest portion of the payment.

  • Common Procedural Terminology (CPT) Code

    A five-digit code used by healthcare providers and medical facilities to identify medical procedures. CPT codes distinguish procedures from one another, such as a CT of abdomen with dye (CPT 74160) and a CT of abdomen without dye (CPT 74150). To get an accurate average cost, you can ask your provider for the CPT code for your procedure. See the All Cost Procedures page for a list of procedures and their associated CPT codes.

  • Diagnosis Related Groups (DRG)

    System used to categorize inpatient hospital services to standardize payments.

  • Discount-Off Charges

    An agreed upon rate for service between the provider and insurance company that is usually less than the provider’s full charge. This may be a fixed amount per service, or a percentage discount.

  • Distance to Facility

    The estimated distance from the zip code you entered to the Lead Facility.

  • ETG Base

    The ETG Base class is a six-character code assigned to bundled episodes with Optum’s Symmetry® Episode Treatment Groups®. These codes have two components: a condition (indicated by the first four characters) and a body location (indicated by the last two).

  • Facility

    An organization that provides healthcare services and procedures. This includes hospitals, surgical centers, diagnostic imaging centers, health centers, laboratories, and clinics.

  • Facility Rating

    The rating indicates how well the facility performs on measures of quality.

  • Healthcare Transparency

    The availability of information to the public on the cost and quality of specific healthcare procedures. Transparency is essential for consumers to make informed decisions about their care, for providers to evaluate their performance compared to others, and for insurance companies and policymakers to identify and reward quality and efficiency.

  • Hospital-CAHPS (Consumer Assessment of Healthcare Providers and Systems)

    These are surveys that hospitals give out to adult patients after a hospital stay. The survey is given 48 hours to 6 weeks after the patient leaves the hospital. These surveys are one source of data on patient experiences as reported on CompareMaine. Learn more at Hospital CAHPS

  • Insurance Company

    Health insurance is a way to pay for care. "Show all insurance companies" shows the average costs across all insurance companies in Maine for the procedure at a facility. Average cost specific to one of Maine’s five major insurance companies is also available. All plans (e.g., HMO and PPO) are reported for each insurance company. Please contact your insurance company for exact prices.

  • Lead Facility

    The primary facility where a patient's healthcare procedures are received. For example, a patient might be seen at her doctor's office and have blood work done at another location. The lead facility would be the doctor's office. See the Find a Facility page for a list of all facilities that report cost data.

  • Location

    A city or zip code can be used to locate facilities. Search results are displayed alphabetically by the lead facility's name. If a facility has more than one location, the "Multiple locations" link under the facility's address may contain the matching search results.

  • Maine State Average (Cost)

    The average cost across all facilities in Maine for a procedure.

  • Maine State Average (Quality)

    The average rating across participating facilities in Maine for a quality measure.

  • Methicillin-resistant Staphylococcus aureus (MRSA)

    Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that can cause infection in people. "Regular" strains of staph bacteria can usually be treated by the antibiotic Methicillin. However, some strains of staph have developed that resist the effect of Methicillin and similar drugs. These bacteria are called MRSA. MRSA is hard to treat because it resists so many antibiotics.

  • National Average

    The average rating across participating facilities in the Nation for this quality measure.

  • Number of Procedures or Services

    The number of procedures or services used to calculate the payment estimate at a facility.

  • Patient Experience

    These are ratings that patients give their providers and healthcare facilities. These ratings tell you how satisfied patients are with the quality of their care overall. A five-bar scale is used, with each bar representative of a star in the CMS Five Star Summary Star Rating.

  • Patient-Centered Medical Homes CAHPS (Consumer Assessment of Healthcare Providers and Systems)

    The Patient-Centered Medical Homes (PCMH) model encourages health providers to organize around patients and to coordinate with other providers as a team. A medical home is not a physical location; it's a way of providing care where the primary care doctors and clinicians serve as advocates for their patients, making sure that patients have a say in their own care and that patients receive the right care across all the parts of the healthcare system. These surveys are one source of data on patient experiences as reported on CompareMaine. Learn more at PCMH CAHPS

  • Payer-Based Fee-Schedule

    A fee schedule that lists the maximum payment an insurance company will allow for specific services.

  • Preventing Healthcare-Associated Infections (HAIs)

    Infections that patients get during the course of treatment for other conditions in a healthcare setting. These can often be prevented if hospitals follow infection-prevention steps based on best practices and scientific evidence.

  • Preventing Serious Complications

    These are harmful but preventable outcomes of healthcare or surgery in a hospital setting. The measure shows how likely patients will suffer from complications while in the hospital or after having certain inpatient surgical procedures. It is a combination of ten Patient Safety Indicators from the Agency for Healthcare Research & Quality (AHRQ).

  • Professional

    An individual healthcare provider, such as a doctor, who provides direct services or procedures to a patient.

  • Revenue Code

    A three- or four-digit code used on hospital bills to identify different types of services and supplies used, and the department where the services were provided to the patient.