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.
"Provider service effectiveness." The effectiveness of
services rendered by a provider, determined by measurement of
the medical outcome of patients grouped by severity receiving
those services.
"Purchaser." Corporations, labor organizations or other
entities that purchase benefits which provide covered services
for their employees or members, either through a health care
insurer or by means of a self-funded program of benefits, and a
certified bargaining representative that represents a group or
groups of employees for whom employers purchase a program of
benefits which provide covered services, but excluding any
entity defined in this section as a "health care insurer ."
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