1. Portion of the monthly capitation payment to physicians retained by the health maintenance organization (HMO) until the end of the year to create an incentive for efficient care. If the physician exceeds utilization norms, he or she will not receive it. Also called withhold incentive . 2. Percentage of payment or set dollar amounts that are deducted from the payment to the physician group/physician that may or may not be returned depending on specific predetermined factors.

Account established to cover use of medical services that exceed the managed care plan budget. The funds are given to participating providers when medical services do not exceed the budget.

Total amount that a health maintenance organization (HMO) retains from the providers’ payments until the end of the year. Cost of referrals and medical services that are considered excessive are held back by the HMO.

Program that focuses on the restoration of musculoskeletal, cardiovascular, and safe work demand performance for individuals who have suffered an industrial injury. Circuit training and work simulation are included in the program.

Under the Health Insurance Portability and Accountability Act (HIPAA), this means employees, volunteers, trainees, and other persons under the direct control of a covered entity, whether or not they are paid by the covered entity.

1. Individualized program of therapy using simulated or real job duties to build up strength and improve the worker’s endurance to be able to work up to 8 hours per day. Sometimes work site modifications are instituted to get the employee back to gainful employment. 2. In a workers’ compensation case, program that uses conditioning tasks with real or simulated work activities that are graded to progressively improve the biomechanical, neuromuscular, cardiovascular, metabolic, and psychosocial functioning of the injured worker to maximize the ability to return to work (e.g, in vocational rehabilitation). It incorporates psychomedical counseling, ergonomics, job coaching, and transitional work development.

Policies and procedures that reduce the possibility of employee exposure to hazards by changing the manner in which a task is done (e.g., to handwash after removal of gloves, to prohibit mouth pipetting for a laboratory test, to recap needles using the two-handed method).

Structured and supervised program of physical conditioning, exercise, strengthening, and functional task performance with real and simulated job activities for workers recovering from industrial injuries. Its purpose is to return people back to work and prevent future injury risk.

In a workers’ compensation case, temporary or permanent prohibitions of certain activities, body positions, motions, exposure and time limitations that have been placed on the injured worker by the treating or consulting physician to expedite recovery from the injury or on a permanent basis because of the effects of the injury. Restrictions can be actual because of inability to perform the activity or prophylactic to prevent further injury. Permanent work restrictions are rated disabilities.