Association between one or more hospitals and one or more physicians to assist in negotiation, contract development, administrative services, financial management services, and marketing of managed care plans for its members. The PHO may also undertake utilization review, credentialing, and quality assurance. Physicians have their own practices and continue their traditional business outside the PHO. Also called medical staff-hospital organization.

Any compensation arrangement at any contracting level between a managed care organization (MCO) and a physician or physician group that may directly or indirectly have the effect of reducing or limiting services furnished to Medicare or Medicaid enrollees in the MCO. MCOs must disclose physician incentive plans between groups or intermediate entities (e.g., certain individual practice associations [IPAs], physician-hospital organizations [PHOs]) and individual physicians and groups.

State organization responsible for issuing licenses, accreditation, or certification for a health care provider to practice. Also called Board of Healing Arts, Board of Medical Examiners, Board of Medical Practice, Department of Business and Professional Regulation, and medical licensing board.

Association of physicians who contract with managed care plans as an entity or represent the physician part in a physician hospital organization (PHO). Physician practice financials are linked to assist physicians in managing risk and capitation.

Business that is investor owned and purchases, partners, or manages physician practices and gives investment capital for development or expansion of a practice.

A physician-owned business that has the flexibility to deal with all forms of contract medicine and still offer its own packages to business groups, unions, and the general public.

Voluntary program that provided a financial incentive to physicians and other eligible professionals who successfully reported quality information related to services provided under the Medicare Physician Fee Schedule between July 1 and December 31, 2007. It was established when President Bush signed the Tax Relief and Health Care Act of 2006 (TRHCA), Section 101 Title I.

Medical services rendered by a physician to a patient. This may include surgery, consultation, home visit, office visit, hospital visits, and institutional visits. Physician services given while in the hospital that appear on the hospital bill are not included.