Glossary of Nephrology Terms
Your helpful guide to nephrology industry terms.
| Term | Definition |
| Adjusted Average Per Capita Cost (AAPCC) | The basis for HMO or CMP reimbursement under Medicare-risk contracts. |
| Accrual | Accounting method by which you match revenue with expense regardless of collections (cash). |
| Accountable Care Organization (ACO) | Groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to their Medicare patients. |
| Articles of Partnership | A voluntary contract between two or more to place their capital, labor, and skills, and corporation in business with the understanding that there will be a sharing of the profits and losses between/among partners. |
| American Society of Nephrology (ASN) | World’s largest professional society dedicated to the study of kidney disease. |
| Balance Sheet | Overview of all assets and liabilities to date. |
| Buy-In | Dollar amount needed to purchase into practice ownership (or shareholder). This amount varies accordingly and could include JV ownership, Medical Director income, real estate, profit sharing. |
| Capital | Funds and assets invested in a business by the owners. |
| Capitation | Capitation is a payment arrangement for health care service providers. It pays a provider a fixed amount for each of the patients for whom they agree to provide care, regardless of whether those patients seek care or not. |
| Centers for Disease Control and Prevention (CDC) | National Public Health Agency that collaborates to protect communities from disease. |
| Comprehensive ESRD Care Initiative (CEC) | An Accountable Care Organization (ACO) model developed under the authority of the Center for Medicare and Medicaid Innovation (Innovation Center) to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care. |
| Comprehensive Kidney Care Contracting (CKCC) | Three voluntary payment options under the Kidney Care Choices (KCC) Model designed to reduce Medicare expenditures while preserving or enhancing the quality of care furnished to beneficiaries with late-stage chronic kidney disease (CKD) and end-stage kidney disease (ESKD). |
| Clawback Cause | A provision in an employment contract under which money that’s already been paid out must be returned to the employer. A clawback is typically used for signing bonuses, relocation expenses, etc. should the employee leave the practice prior to the set contract timeframe, for example, three years. |
| Center for Medicare & Medicaid Innovation (CMMI) | Supports the development and testing of innovative health care payment and service delivery models. |
| Centers for Medicare & Medicaid Services (CMS) | Serves the public as a trusted partner and steward, dedicated to advancing health equity, expanding coverage, and improving health outcomes. |
| Certificate of Need (CON) | A legal document that is required in many states in order to construct a new healthcare facility. |
| Clinical Practice Guideline (CPG) | Systematically developed statements to assist practitioner and patient decisions about appropriate health care. |
| Clinical Practice Recommendation (CPR) | Recommendations on how to diagnose and treat a medical condition. |
| Current Procedural Terminology (CPT) | A uniform language for coding medical services and procedures to streamline reporting, increase accuracy and efficiency. These are used in calculating RVUs (see RVU). |
| Denovo | De novo, Latin for “from the beginning,” is a term used for a new dialysis unit that is built from the ground up. |
| Dialysis Outcome Quality Initiative (DOQI) | Evidence-based clinical practice guidelines for all stages of chronic kidney disease (CKD) and related complications. |
| EBITDA | Earnings before interest, taxes, depreciation, and amortization. One of the most widely used measures of a company’s financial health and ability to generate cash. |
| Electronic Health Record (EHR) | A digital version of a patient’s paper chart. |
| ESRD Seamless Care Organizations (ESCO) | An Accountable Care Organization (ACO) composed of providers and suppliers who voluntarily come together to form a legal entity that offers coordinated care to beneficiaries with ESRD through the Comprehensive ESRD Care model. |
| End-Stage Renal Disease (ESRD) | A medical condition in which a person’s kidneys cease functioning on a permanent basis leading to the need for a regular course of long-term dialysis or a kidney transplant to maintain life. |
| ESRD Treatment Choices (ETC) | An innovative payment model that aims to test whether greater use of home dialysis and kidney transplantation for Medicare beneficiaries with ESRD will reduce Medicare expenditures, while preserving or enhancing the quality of care furnished to the patient. |
| Equity | Ownership interest in a business. |
| Free Open Access Medical Education (FOAMed) | A collection of medical education available to anyone, anywhere, i.e. online sources, Twitter. |
| Fee for Service (FFS) | A method in which doctors and other health care providers are paid for each service performed. |
| Federally Qualified Health Center (FQHC) | An outpatient clinic that qualifies for specific reimbursement under Medicare and Medicaid. |
| Group Model HMO | A group of physicians representing various specialties or a single specialty which negotiates on behalf of its physician members to accept managed care or discounted fee-for-service contracts. |
| Group Practice | Defined as a practice with three or more practitioners. |
| Joinder Agreement | An agreement joining a person as party to another existing agreement. Joinder agreements are commonly used when new partners or shareholders receive equity and are made party to an existing shareholders’ agreement or LLC agreement. |
| Joint Operating Agreement (JOA) | A legal business arrangement of two or more parties agreeing to cooperatively manage their existing organizations |
| Joint Venture (JV) | A partnership between two or more companies to undertake a business venture together i.e. dialysis center. It forms its own corporation, limited liability company or partnership specifically for the joint venture. Parties share profits, losses, and control. |
| Large Dialysis Organization (LDO) | A dialysis organization with 200 or more dialysis clinics. |
| Liquidity | Money in the bank sufficient to bills and payroll. |
| Long Term Care/Long Term Acute Care (LTC/LTAC) | Involves a variety of services designed to meet a person’s health or personal care needs during a short or long period of time. |
| Medical Director Agreement (MDA) | An agreement outlining duties of the clinician who oversees and guides the care that is provided in a specific healthcare setting, such as a dialysis clinic. |
| National Kidney Foundation (NKF) | A non-profit organization that provides support for people living with kidney disease. |
| Nephrology Business Leadership (NBLU) | Nephrology Business Leadership is a unique week-long program tailored to second year nephrology fellows preparing to begin a career in nephrology. Learn more at nbluniv.org |
| Non-Compete | A clause in an employment contract which prohibits an employee from competing with the business directly or indirectly for a specific duration of time after their employment has ended. May be combined with a restrictive covenant. |
| Operating Expenses/Overhead Costs | A category of expenditures that a business such as a practice incurs as a result of performing its normal business operation. |
| Partnership Track | An opportunity which offers ownership in a practice after a specific period of time. This may or may not involve a buy-in or buy-out. Upon partnership, one may be provided a share in the practice profits and be responsible for a percentage of overhead expenses, for example. |
| Payer | An organization (such as the federal government for Medicare or a commercial insurance company) or an individual person who directly reimburses a healthcare provider for their services. |
| Physician Management Company (PMC) | Provides non-clinical business administrative services to physicians and physician groups/private practices. |
| Preferred Provider Organization (PPO) | A type of health plan that contracts with medical providers, such as hospitals and doctors, to create a network of participating providers. |
| Productivity Bonus | A bonus which is paid once a specified amount of billing and/or collections has been exceeded. This may be offered in addition to a guaranteed salary. |
| Profit and Loss Statement (P&L) | A financial statement that shows income and expenses and resulting profit or loss over a specific period of time. |
| Quality Incentive Program (QIP) | A program designed to improve patient outcomes, service provider performance, and the quality of services provided. |
| Restrictive Covenant | A restrictive covenant provides that upon termination of a professional contract, a physician may not work in a defined geographical location for a specific period of time. This may be combined with a non-compete clause. |
| Renal Physicians Association (RPA) | A national organization supporting nephrologists and nephrology administrators. |
| Renal Research Institute (RRI) | An internationally recognized organization fostering ideas, treatment processes, and technologies to improve the lives of kidney patients. |
| Relative Value Units (RVU) | Physician productivity and compensation may incorporate models based on Relative Value Units (RVUs). RVUs reflect the relative level of time, skill, training and intensity required of a physician to provide a given service (see CPT codes). |
| Secured Credit | Loans secured by the assets of your business, personal assets, or both. |
| Staff Assisted Home Hemodialysis (Staff Assist) | The patient and support person are trained to dialyze the patient during the daytime or overnight. The patient and caregivers are responsible for maintaining the dialysis equipment. |
| Value Based Care (VBC) | An alternative and potential replacement for fee-for-service reimbursement based on quality rather than quantity. For more information visit: https://kidneylink.com/ |
| Women in Nephrology (WIN) | An organization supporting women to develop exciting careers in the field of nephrology via mentorship and education. |
