[Federal Register Volume 77, Number 183 (Thursday, September 20, 2012)]
[Notices]
[Pages 58386-58389]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2012-23163]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Notice.
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SUMMARY: This notice announces the intention of the Agency for
Healthcare Research and Quality (AHRQ) to request that the Office of
Management and Budget (OMB) approve the proposed information collection
project: ``Medical Expenditure Panel Survey (MEPS) Household Component
and the MEPS Medical Provider Component.'' In accordance with the
Paperwork Reduction Act, 44 U.S.C. 3501-3521, AHRQ invites the public
to comment on this proposed information collection.
This proposed information collection was previously published in
the Federal Register on June 13th, 2012 and allowed 60 days for public
comment. One comment was received. The purpose of this notice is to
allow an additional 30 days for public comment.
DATES: Comments on this notice must be received by October 22, 2012.
ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by
email at [email protected] (attention: AHRQ's desk officer).
Copies of the proposed collection plans, data collection
instruments, and specific details on the estimated burden can be
obtained from the AHRQ Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by email at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Medical Expenditure Panel Survey (MEPS) Household Component and the
MEPS Medical Provider Component
For over thirty years, results from the MEPS and its predecessor
surveys (the 1977 National Medical Care Expenditure Survey, the 1980
National Medical Care Utilization and Expenditure Survey and the 1987
National Medical Expenditure Survey) have been used by OMB, DHHS,
Congress and a wide number of health services researchers to analyze
health care use, expenses, and health policy.
Major changes continue to take place in the health care delivery
system. The MEPS is needed to provide information about the current
state of the health care system as well as to track changes over time.
The MEPS permits annual estimates of use of health care and
expenditures and sources of payment for that health care. It also
permits tracking individual change in employment, income, health
insurance and health status over two years. The use of the National
Health Interview Survey (NHIS) as a sampling frame expands the MEPS
analytic capacity by providing another data point for comparisons over
time.
Households selected for participation in the MEPS Household
Component (MEPS-HC) are interviewed five times in person. These rounds
of interviewing are spaced about 5 months apart. The interview will
take place with a family respondent who will report for him/herself and
for other family members.
The MEPS-HC has the following goal:
To provide nationally representative estimates for the
U.S. civilian noninstitutionalized population for health care use,
expenditures, sources of payment and health insurance coverage.
The MEPS Medical Provider Component (MEPS-MPC) will contact medical
providers (hospitals, physicians, home health agencies and
institutions) identified by household respondents in the MEPS-HC as
sources of medical care for the time period covered by the interview,
and all pharmacies providing prescription drugs to household members
during the covered time period. The MEPS-MPC is not designed to yield
national estimates. The sample is designed to target the types of
individuals and providers for whom household reported expenditure data
was expected to be insufficient. For example, households with one or
more Medicaid enrollees are targeted for inclusion in the MEPSMPC
because this group is expected to have limited information about
payments for their medical care.
The MEPS-MPC has the following goal:
To serve as an imputation source for and to supplement/
replace household reported expenditure and source of payment
information. This data will supplement, replace and verify information
provided by household respondents about the charges, payments, and
sources of payment associated with specific health care encounters.
This study is being conducted by AHRQ through its contractors,
Westat and RTI International, pursuant to AHRQ's statutory authority to
conduct and support research on healthcare and on systems for the
delivery of such care, including activities with respect to the cost
and use of health care services and with respect to health statistics
and surveys. 42 U.S.C. 299a(a)(3) and (8); 42 U.S.C. 299b-2.
Method of Collection
To achieve the goals of the MEPS-HC the following data collections
are implemented:
1. Household Component Core Instrument. The core instrument
collects data about persons in sample households. Topical areas asked
in each round of interviewing include condition enumeration, health
status, health care utilization including prescribed medicines, expense
and payment, employment, and health insurance. Other topical areas that
are asked only once a year include access to care, income, assets,
satisfaction with health plans and providers, children's health, and
adult preventive care. While many of the questions are asked about the
entire reporting unit (RU), which is
[[Page 58387]]
typically a family, only one person normally provides this information.
2. Adult Self Administered Questionnaire. A brief self-administered
questionnaire (SAQ) will be used to collect self-reported (rather than
through household proxy) information on health status, health opinions
and satisfaction with health care for adults 18 and older. The
satisfaction with health care items are a subset of items from the
Consumer Assessment of Healthcare Providers and Systems
(CAHPS[supreg]). The health status items are from the Short Form 12
Version 2 (SF-12 version 2), which has been widely used as a measure of
self-reported health status in the United States, the Kessler Index
(K6) of non-specific psychological distress, and the Patient Health
Questionnaire (PHQ-2).
3. Diabetes Care SAQ. A brief self administered paper-and-pencil
questionnaire on the quality of diabetes care is administered once a
year (during rounds 3 and 5) to persons identified as having diabetes.
Included are questions about the number of times the respondent
reported having a hemoglobin A1c blood test, whether the respondent
reported having his or her feet checked for sores or irritations,
whether the respondent reported having an eye exam in which the pupils
were dilated, the last time the respondent had his or her blood
cholesterol checked and whether the diabetes has caused kidney or eye
problems. Respondents are also asked if their diabetes is being treated
with diet, oral medications or insulin.
4. Authorization forms for the MEPS-MPC Provider and Pharmacy
Survey. As in previous panels of the MEPS, we will ask respondents for
authorization to obtain supplemental information from their medical
providers (hospitals, physicians, home health agencies and
institutions) and pharmacies.
5. MEPS Validation Interview. Each interviewer is required to have
at least 15 percent of his/her caseload validated to insure that CAPI
questionnaire content was asked appropriately and procedures followed,
for example the use of show cards. Validation flags are set
programmatically for cases pre-selected by data processing staff before
each round of interviewing. Home office and field management may also
request that other cases be validated throughout the field period. When
an interviewer fails a validation all their work is subject to 100
percent validation. Additionally, any case completed in less than 30
minutes is validated. A validation abstract form containing selected
data collected in the CAPI interview is generated and used by the
validator to guide the validation interview.
To achieve the goal of the MEPS-MPC the following data collections
are implemented:
1. MPC Contact Guide/Screening Call. An initial screening call is
placed to determine the type of facility, whether the practice or
facility is in scope for the MEPS-MPC, the appropriate MEPS-MPC
respondent and some details about the organization and availability of
medical records and billing at the practice/facility. All hospitals,
physician offices, home health agencies, institutions and pharmacies
are screened by telephone. A unique screening instrument is used for
each of the seven provider types in the MEPS-MPC.
2. Home Care Provider Questionnaire for Health Care Providers. This
questionnaire is used to collect data from home health care agencies
which provide medical care services to household respondents.
Information collected includes type of personnel providing care, hours
or visits provided per month, and the charges and payments for services
received.
3. Home Care Provider Questionnaire for Non-Health Care Providers.
This questionnaire is used to collect information about services
provided in the home by non-health care workers to household
respondents because of a medical condition; for example, cleaning or
yard work, transportation, shopping, or child care.
4. Medical Event Questionnaire for Office-Based Providers. This
questionnaire is for office-based physicians, including doctors of
medicine (MDs) and osteopathy (DOs), as well as providers practicing
under the direction or supervision of an MD or DO (e.g., physician
assistants and nurse practitioners working in clinics). Providers of
care in private offices as well as staff model HMOs are included.
5. Medical Event Questionnaire for Separately Billing Doctors. This
questionnaire collects information from physicians identified by
hospitals (during the Hospital Event data collection) as providing care
to sampled persons during the course of inpatient, outpatient
department or emergency room care, but who bill separately from the
hospital.
6. Hospital Event Questionnaire. This questionnaire is used to
collect information about hospital events, including inpatient stays,
outpatient department, and emergency room visits. Hospital data are
collected not only from the billing department, but from medical
records and administrative records departments as well. Medical records
departments are contacted to determine the names of all the doctors who
treated the patient during a stay or visit. In many cases, the hospital
administrative office also has to be contacted to determine whether the
doctors identified by medical records billed separately from the
hospital itself; the doctors that do bill separately from the hospital
will be contacted as part of the Medical Event Questionnaire for
Separately Billing Doctors. HMOs are included in this provider type.
7. Institutions Event Questionnaire. This questionnaire is used to
collect information about institution events, including nursing homes,
rehabilitation facilities and skilled nursing facilities. Institution
data are collected not only from the billing department, but from
medical records and administrative records departments as well. Medical
records departments are contacted to determine the names of all the
doctors who treated the patient during a stay. In many cases, the
institution administrative office also has to be contacted to determine
whether the doctors identified by medical records billed separately
from the institution itself.
8. Pharmacy Data Collection Questionnaire. This questionnaire
requests the national drug code (NDC) and when that is not available
the prescription name, date prescription was filled, payments by
source, prescription strength and form (when the NDC is not available),
quantity, and person for whom the prescription was filled. When the NDC
is available, we do not ask for prescription name, strength or form
because that information is embedded in the NDC; this reduces burden on
the respondent. Most pharmacies have the requested information
available in electronic format and respond by providing a computer
generated printout of the patient's prescription information. If the
computerized form is unavailable, the pharmacy can report their data to
a telephone interviewer. Pharmacies are also able to provide a CD-ROM
with the requested information if that is preferred. HMOs are included
in this provider type.
The MEPS is a multi-purpose survey. In addition to collecting data
to yield annual estimates for a variety of measures related to health
care use and expenditures, the MEPS also provides estimates of measures
related to health status, consumer assessment of health care, health
insurance coverage, demographic characteristics, employment and access
to health care indicators. Estimates can be provided for individuals,
families and population
[[Page 58388]]
subgroups of interest. Data from the MEPS, both the HC and MPC, are
intended for a number of annual reports required to be produced by
AHRQ, including the National Health Care Quality Report and the
National Health Care Disparities Report.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in the MEPS-HC and the MEPS-MPC. The
MEPS-HC Core Interview will be completed by 15,093* (see note below
Exhibit 1) ``family level'' respondents, also referred to as RU
respondents. Since the MEPS-HC consists of 5 rounds of interviewing
covering a full two years of data, the annual average number of
responses per respondent is 2.5 responses per year. The MEPS-HC core
requires an average response time of 86 minutes to administer. The
Adult SAQ will be completed once a year by each person in the RU that
is 18 years old and older, an estimated 28,254 persons. The Adult SAQ
requires an average of 7 minutes to complete. The Diabetes care SAQ
will be completed once a year by each person in the RU identified as
having diabetes, an estimated 2,345 persons, and takes about 3 minutes
to complete. The authorization form for the MEPS-MPC Provider Survey
will be completed once for each medical provider seen by any RU member.
The 14,489* RUs in the MEPS-HC will complete an average of 5.2 forms,
which require about 3 minutes each to complete. The authorization form
for the MEPS-MPC Pharmacy Survey will be completed once for each
pharmacy for any RU member who has obtained a prescription medication.
RUs will complete an average of 3.1 forms, which take about 3 minutes
to complete. About one third of all interviewed RUs will complete a
validation interview as part of the MEPS-HC quality control, which
takes an average of 5 minutes to complete. The total annual burden
hours for the MEPS-HC are estimated to be 63,907 hours.
All 34,000 medical providers and pharmacies included in the MEPS-
MPC will receive a screening call which will take 3 minutes on average.
The MEPS-MPC uses 7 different questionnaires--6 for medical providers
and 1 for pharmacies. Each questionnaire is relatively short and
requires 3 to 5 minutes to complete. The total annual burden hours for
the MEPS-MPC are estimated to be 18,914 hours. The total annual burden
for the MEPS-HC and MPC is estimated to be 82,821 hours.
Exhibit 2 shows the estimated annual cost burden associated with
the respondents' time to participate in this information collection.
The annual cost burden for the MEPS-HC is estimated to be $1,389,339;
the annual cost burden for the MEPS-MPC is estimated to be $285,680.
The total annual cost burden for the MEPS-HC and MPC is estimated to be
$1,675,019.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
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MEPS-HC
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MEPS-HC Core Interview........................... *15,093 2.5 86/60 54,083
Adult SAQ........................................ 28,254 1 7/60 3,296
Diabetes care SAQ................................ 2,345 1 3/60 117
Authorization form for the MEPS-MPC Provider 14,489 5.2 3/60 3,767
Survey..........................................
Authorization form for the MEPS-MPC Pharmacy 14,489 3.1 3/60 2,246
Survey..........................................
MEPS-HC Validation Interview..................... 4,781 1 5/60 398
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Subtotal for the MEPS-HC..................... 79,451 na na 63,907
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MEPS-MPC
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MPC Contact Guide/Screening Call**............... 34,000 1 3/60 1,700
Home care for health care providers questionnaire 465 6.5 5/60 252
Home care for non-health care providers 35 6.6 5/60 19
questionnaire...................................
Office-based providers questionnaire............. 10,800 5.8 5/60 5,220
Separately billing doctors questionnaire......... 10,800 2 3/60 1,080
Hospitals questionnaire.......................... 5,000 6.5 5/60 2,708
Institutions (non-hospital) questionnaire........ 100 1.5 5/60 13
Pharmacies questionnaire......................... 6,800 23.3 3/60 7,922
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Subtotal for the MEPS-MPC.................... 68,000 na na 18,914
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Grand Total.............................. 147,451 na na 82,821
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* While the expected number of responding units for the annual estimates is 14,489, it is necessary to adjust
for survey attrition of initial respondents by a factor of 0.96 (15,093 = 14,489/0.96).
** There are 6 different contact guides; one for each provider type, except for the two home care provider types
which use the same contact guide.
Exhibit 2--Estimated Annualized Cost Burden
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Number of Total burden Average hourly Total cost
Form name respondents hours wage rate burden
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MEPS-HC
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MEPS-HC Core Interview.......................... 15,093 54,083 * $21.74 $1,175,764
Adult SAQ....................................... 28,254 3,296 21.74 71,655
[[Page 58389]]
Diabetes care SAQ............................... 2,345 117 21.74 2,544
Authorization forms for the MEPS-MPC Provider 14,489 3,767 21.74 81,895
Survey.........................................
Authorization form for the MEPS-MPC Pharmacy 14,489 2,246 21.74 48,828
Survey.........................................
MEPS-HC Validation Interview.................... 4,781 398 21.74 8,653
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Subtotal for the MEPS-HC.................... 79,451 63,907 na 1,389,339
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MEPS-MPC
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MPC Contact Guide/Screening Call................ 34,000 1,700 ** 15.59 26,503
Home care for health care providers 465 252 15.59 3,929
questionnaire..................................
Home care for non-health care providers 35 19 15.59 296
questionnaire..................................
Office-based providers questionnaire............ 10,800 5,220 15.59 81,380
Separately billing doctors questionnaire........ 10,800 1,080 15.59 16,837
Hospitals questionnaire......................... 5,000 2,708 15.59 42,218
Institutions (non-hospital) questionnaire....... 100 13 15.59 203
Pharmacies questionnaire........................ 6,800 7,922 *** 14.43 114,314
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Subtotal for the MEPS-MPC................... 68,000 18,347 na 285,680
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Grand Total............................. 147,451 82,254 na 1,675,019
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* Mean hourly wage for All Occupations (00-0000).
** Mean hourly wage for Medical Secretaries (43-6013)
*** Mean hourly wage for Pharmacy Technicians (29-2052)
Occupational Employment Statistics, May 2011 National Occupational Employment and Wage Estimates United States,
U.S. Department of Labor, Bureau of Labor Statistics. http://www.bls.gov/oes/current/oes_nat.htm#b29-0000.
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the total and annualized cost of this information
collection. The cost associated with the design and data collection of
the MEPS-HC and MEPS-MPC is estimated to be $51,401,596 in each of the
three years covered by this information collection request.
Exhibit 3--Estimated Total and Annualized Cost
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Annualized
Cost component Total cost cost
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Sampling Activities..................... $3,002,731 $1,000,910
Interviewer Recruitment and Training.... 9,190,168 3,063,389
Data Collection Activities.............. 93,611,428 31,203,809
Data Processing......................... 23,087,605 7,695,868
Production of Public Use Data Files..... 21,079,118 7,026,373
Project Management...................... 4,233,739 1,411,246
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Total............................... 154,204,789 51,401,596
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Request for Comments
In accordance with the Paperwork Reduction Act, comments on AHRQ's
information collection are requested with regard to any of the
following: (a) Whether the proposed collection of information is
necessary for the proper performance of AHRQ healthcare research and
healthcare information dissemination functions, including whether the
information will have practical utility; (b) the accuracy of AHRQ's
estimate of burden (including hours and costs) of the proposed
collection(s) of information; (c) ways to enhance the quality, utility,
and clarity of the information to be collected; and (d) ways to
minimize the burden of the collection of information upon the
respondents, including the use of automated collection techniques or
other forms of information technology.
Comments submitted in response to this notice will be summarized
and included in the Agency's subsequent request for OMB approval of the
proposed information collection. All comments will become a matter of
public record.
Dated: September 6, 2012.
Carolyn M. Clancy,
Director.
[FR Doc. 2012-23163 Filed 9-19-12; 8:45 am]
BILLING CODE 4160-90-M