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Occupancy Rate - A measure of inpatient health facility use, resolute by dividing available bed days by patient days. It measures the regular percentage of a hospital's beds occupied and may be institution-wide or specific for one department or service.

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Occupational Health - OSHA, county health departments and dictatorial bodies oversee occupational health hazards in workplaces, including hospitals. Many health providers present occupational health consultations as well as occupational health screenings, treatments and case-management. Employers and health providers frequently enter agreements whereby health providers will provide these services as well as managed the associated workers compensation case management and rehabilitation programs.

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Office for Civil Rights - This office is part of the HHS. Its HIPPA responsibilities comprise oversight of the privacy requirements.

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Office of Inspector General (OIG) - The office liable for auditing, evaluating and criminal and civil investigating for HHS, as well as imposing sanctions, when needed, against health care providers.

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Ombudsperson or Ombudsman - A person within a managed care organization or a person outside of the health care system who is selected to receive and investigate complaints from beneficiaries about quality of care, inability to access care, discrimination, and other problems that beneficiaries may experience with their managed care organization. This individual frequently functions as the beneficiary's advocate in pursuing grievances or complaints about denials of care or inappropriate care.

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Open Access - A term describing a member's capacity to self-refer for specialty care. Open access arrangements permit a member to see a participating provider without a referral from another doctor. Health plan members' abilities, rights or request to self refer for specialty care.

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Open Enrollment Period - A period during which subscribers in a health profit program have an opportunity to select among health plans being offered to them, typically without evidence of insurability or waiting periods. A period of time which qualified subscribers may elect to enroll in, or transfer between, available programs providing health care coverage. Under an open enrollment requirement, a plan must recognize all who apply during a specific period each year.

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Open Formulary - The provision that drugs on the favored list and those not on the preferred list will both be covered by a PBM or MCO.

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Open Panel - An HMO in which any physician who meets the HMO's standards of care may indenture with the HMO as a provider. These physicians typically function out of their own offices and see other patients as well as HMO members.

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Open PHO - A type of physician-hospital organization that is available to all of a hospital's appropriate medical staff.

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Organized Care System - Often used to discuss a more to evolve form of IDSs and CCNs, this relatively new term describes the outcome of mergers and alliances between and among physicians, health systems, and managed care organizations. These systems frequently have the same performance imperatives as IDSs and CCNs are improve health status, incorporate delivery, demonstrate value, improve efficiency of care delivery and prevention, and meet patient and community needs.

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Original Medicare Plan - A fee-for-service health plan that lets enrollees go to any doctor, hospital, or other health care dealer who accepts Medicare and they can also accept new Medicare patients. Medicare pays its divide of the Medicare-approved amount, and the enrollee pays a share .In some cases the enrollee may be charge more than the Medicare-approved amount. The Original Medicare Plan has two parts as Part A and Part B.

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Outcome or Outcome Measures - Healthcare quality indicators that measure the extent to which healthcare services succeed in improving or maintaining approval and patient health. A clinical product is the result of medical or surgical intervention or nonintervention, or the results of a specific health care service or benefit package. The valued results of care as qualified primarily by the patient but also by physicians and all other participants in the processes contributing to the outcomes.

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Outcomes Management - Providers and payers alike want to find a method of managing care in a way that would produce the best outcomes. Managed care organizations are progressively more interested in learning to manage the outcome of care rather than just managing the cost of care. It is thought that through a database of outcomes knowledge, caregivers will know better which treatment modalities result in consistently better outcomes for patients. Outcomes management may guide to the development of clinical protocols.

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Outcomes Research - Research on measures of changes in patient outcomes, that is, patient health position and satisfaction, resulting from specific medical and health interventions. Attributing changes in outcomes to medical care requires distinctive the effects of care from the effects of the many other factors that influence patients' health and satisfaction.

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Outlier- A patient whose length of stay or treatment cost differs considerably from the stays or costs of most other patients in a diagnosis related group. Under DRG reimbursement, outliers are given exceptional treatment subject to examine review and organization review.

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Outlier thresholds - The day and cost cutoff points that divide inlier patients from outlier patients.

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National Accounts - Benefits complete to a patient by a payer or managed care organization when the patient needs services while outside the geographic area of the network. MCOs often attempt to discuss a case-by-case discount with providers when patients utilize their services while "out of area".

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Out of Network Benefits - With most HMOs, a patient cannot have any services reimburse if provided by a hospital or doctor who is not in the network. With PPOs and other managed care organizations, there may subsist a provision for reimbursement of "out of network" providers.

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Out-of-Network Provider - A health care provider with whom a managed care organization does not have an agreement to provide health care services. Because the beneficiary must pay either all of the costs of care from an out-of-network provider or their cost-sharing requirements are significantly increased, depending on the particular plan a beneficiary is in, out-of-network providers are generally not economically accessible to Medicaid beneficiaries.

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Out of Pocket Expenses, Out of Pocket Costs - Dollar amounts set by MCOs that limit the amount a member has to give out of his or her own pocket for particular healthcare services during a particular time period. Costs bear by the members that are not covered by health care plan. In the age of managed care, out of pocket expenses can also refer to the payment of services not covered by or accepted for reimbursement by the health plan.

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National Accounts - A cap placed on out of pocket costs, after which benefits amplify to provide full coverage for the rest of the year. It is a stated dollar amount set by the insurance company, in addition to normal premiums.

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Outpatient Care - Care given a person who is not confined to bed. Many surgeries and treatments are now provided on an outpatient basis, while previously they had been measured reason for inpatient hospitalization.

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Outpatient Hospital Care - Medical or surgical care to furnish by a hospital to a patient if that patient has not been admitted as an inpatient but is registered on hospital records as an outpatient. If a doctor orders that a patient be placed under surveillance, it may be considered outpatient care, even if the patient stays under observation overnight.

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