Glossary
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- RAND Assessing Care of Vulnerable Elders
- Generated the first set of quality measures for the vulnerable elderly (those most likely to die or become severely disabled in the next two years). The measures were used to assess the care being provided to the elderly by primary care physicians. In phase 2, the measures were used to evaluate practical interventions aimed at improving performance of underperformed health care procedures.
- RAND Community Quality Index (CQI) Study
- An assessment of the extent to which recommended care was provided to a representative sample of the U.S. population for a broad range of conditions. The research team used random telephone surveys to interview more than 13,000 adults in 12 metropolitan areas regarding their health care experiences.
- RAND Future Elderly Model
- A demographic-economic model framework of health spending projections developed by the RAND Corporation that enables the user to answer "what-if" questions about the effects of changes in health status and disease treatment on future health care costs. What distinguishes the FEM from other models is its inclusion of a multidimensional characterization of health status, which allows the user to include a richer set of demographic controls, comorbid conditions and functional status.
- RAND Health Insurance Experiment
- A randomized controlled experiment, performed in the 1970s and early '80, that examined the effects of cost sharing. RAND recruited 2,750 families (7,700 individuals) under the age of 65 from six sites (to provide regional and urban/rural balance). Participants were randomly assigned to one of five types of health plans. HIE remains the only long-term, experimental study of cost sharing and its effect on health care utilization and spending, quality of care, and health.
- RAND Quality Assessment Tools (QA Tools)
- A comprehensive, clinically based system for assessing quality of care for children and adults. QA Tools contains indicators for general medical conditions; oncology and HIV; cardiopulmonary conditions; children and adolescent health care; and women's health. Each indicator is based on scientific literature and the ratings of a panel of experts.
- RAND/UCLA Appropriateness Method
- A widely accepted clinically based method to judge whether the expected health benefits of a medical procedure substantially exceed the health risks. Given that randomized clinical trials (RCT) are often unavailable or insufficient to apply to the wide range of patients seen in everyday clinical practice, a method was developed that combined the best available scientific evidence with the collective judgment of experts.
- Randomization
- A technique for selecting or assigning cases, or individuals, so that each case or individual has an equal probability of being selected or assigned. It is used to change distribution, reduce the effects of confounding factors, and produce unbiased statistical data.
- Randomized Controlled Trial/Randomized Clinical Trial
- An experimental clinical study to test the safety, efficacy, or effectiveness of a health care treatment or intervention, in which the subjects are randomly assigned to treatment or control conditions and the outcomes are compared. Such allocation eliminates bias and establishes the basis for statistical analysis.
- Rationing
- Allocating the available supply of an item is allocated to users in an equitable manner. May be used as a policy tool when the government wants to distribute a scarce resource equitably or prevent the price of the item from skyrocketing.
- Readmission
- A second or subsequent admission of a patient to a treatment facility. The term is sometimes used to imply a quality problem - either because of a recurrence of the problem that occasioned the prior admission, a failure of the prior treatment, or a failure of outpatient follow-up.
- Reference pricing
- A reimbursement rule used by a payer or regulator that determines the maximum price at which it will reimburse the supplier - often set at the price of the lowest-priced product in the market or the weighted average of the lowest prices in the market. The consumer may choose a higher-priced product but pays the difference between the reference price and the market price.
- Regional Health Information Organization
- A collaborative, nongovernmental, multi-stakeholder organization, which operates to support the electronic exchange of health information across local institutional systems, and which seeks to ensure that such communications are both secure and in compliance with law. Current federal policy is that RHIOs will be the building blocks of the National Health Information Network. (See also NHIN).
- Registered nurse
- A health care professional who has graduated from an accredited nursing program, has passed the state examination for licensure, and has been registered and licensed to practice by a state authority.
- Regression analysis
- A set of procedures that are used to model or estimate the relationship between a dependent variable and one or more independent variables.
- Regression to the mean
- The phenomenon of an extreme value for a given variable followed by a much less extreme value when remeasurement takes place. For example, apparent hypertension in a subject who records a very high blood pressure reading. Remeasurement is very likely to result in a lower blood pressure reading, even without treatment. The blood pressure has "regressed" (gone back) toward the true underlying mean.
- Reinsurance
- A type of insurance that self-insured employers and insurance companies may buy for their own protection; such organizations frequently reinsure themselves to protect against certain unanticipated and potentially crippling losses incurred on covered services for employees/members.
- Relative Risk
- In epidemiology, the likelihood of developing the disease among persons who are exposed relative to those who are not.
- Relative weights
- The method used by the Centers for Medicare & Medicaid Services (CMS) to determine how billing-related codes (such as DRGs and APCs) are linked to cost, in order to compute the appropriate reimbursement for health services.
- Reliability
- The consistency with which the health care system delivers evidence-based care to everyone in the population. A reliable health care entity is one that provides the right care, to the right patient, at the right time, every time. The concept of reliability falls within the broader, more commonly used concept of health care "quality" but is a more operational, narrowly focused definition of the attribute.
- Reminder
- A manual or computerized tool to send timely notices about specific clinical events to practitioners and/or patients.
- Reporting Hospital Quality Data Annual Payment Update
- Centers for Medicare & Medicaid Services (CMS) pay for reporting program for the 3,500 Inpatient Prospective Payment System (IPPS) hospitals in the U.S. It requires hospitals to submit data on a specified set of quality measures in order to obtain their full annual payment update to the DRG payment. The data are reported on the Hospital Compare web site.
- Resource Utilization Group
- A case-mix classification system used to determine Medicare payment for Skilled Nursing Facilities (SNF).
- Resource-Based Relative Value Scale
- A method for determining physicians' fees based on the time, training, skill, and other factors required to deliver various services. It was developed to compensate for Medicare's tendency to overpay for procedural services (such as surgery and diagnostic tests) while underpaying for primary care services involving examination and discussion/education with patients. The scale is adjusted for regional deviations, related charges, and overhead.
- Retail clinic
- Health care facilities operating out of retail-store locations (such as drugstores), often staffed by nurse practitioners and physician assistants, and which provide non-emergent, routine medical care (such as strep cultures and flu shots).
- Retiree Health Insurance
- Employer-sponsored private insurance coverage provided for retirees. Particularly for employers with a large number of retirees, it may be a key cost in providing health insurance benefits. Some employers have responded by declining to offer coverage to new retirees and increasing contribution requirements for existing retirees.
- Retrospective payment system
- Paying health care providers fees on a per-service basis, based on the actual cost of delivering services (or an agreed upon discounted fee schedule) with the payment provided after the health care provider has delivered the service. Sometimes called cost-based reimbursement, such payment is thought to incentivize providers to over-treat.
- Risk
- Any measurable or predictable chance of loss, injury, disadvantage, hazard, danger, peril, or destruction.
- Risk adjustment
- A statistical process for reducing, removing, or clarifying the influences of confounding factors that differ among groups being compared. For example, when comparing health care interventions, it is important to adjust for the fact that groups of patients may differ on preexisting health factors (that is, prior to the intervention, some patients may be sicker or have more complicated conditions).
- Risk factor
- Health factors related to disease; these may be immutable characteristics (such as sex or race) or factors that are influenced by behavior (such as smoking or inactivity).
- Risk pool
- See purchasing pool
- Risk segmentation
- Refers to creating groups that have comparable levels of health risk, that is, expected spending on health care.
- Risk selection
- A method that an insurer uses to choose among applicants for insurance. It may include either intentional or unintentional efforts to enroll members to achieve a distribution of risk that is higher or lower than that of the population as a whole; also called biased selection.
- Risk-sharing
- The distribution of financial risk among parties - as through a contract or insurance policy. Common methods used to share risk between insurers and health care providers include capitation and diagnosis related groups.
- Rochester Independent Physician Association
- IPA based out of Rochester, N.Y. that led a pay for performance initiative reporting short-term returns on investment in diabetes care and hospitalization.