the incidence in the population of specific medical, surgical
and radiological procedures in any given year, expressed as a
deviation from the norm, as these terms are defined in the
classical statistical definition of "variation," "incidence,"
"deviation" and "norm."
"Payment." The payments that providers actually accept for
their services, exclusive of charity care, rather than the
charges they bill.
"Payor." Any person or entity, including, but not limited
to, health care insurers and purchasers, that make direct
payments to providers for covered services.
"Physician." An individual licensed under the laws of this
Commonwealth to practice medicine and surgery within the scope
of the act of October 5, 1978 (P.L.1109, No.261), known as the
Osteopathic Medical Practice Act, or the act of December 20,
1985 (P.L.457, No.112), known as the Medical Practice Act of
1985.
"Preferred provider organization." Any arrangement between a
health care insurer and providers of health care services which
specifies rates of payment to such providers which differ from
their usual and customary charges to the general public and
which encourages enrollees to receive health services from such
providers.
"Provider." A hospital, a health care facility, an
ambulatory service facility or a physician.
"Provider quality." The extent to which a provider renders
care that, within the capabilities of modern medicine, obtains
for patients medically acceptable health outcomes and prognoses,
adjusted for patient severity, and treats patients
compassionately and responsively.
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