[Federal Register Volume 76, Number 228 (Monday, November 28, 2011)]
[Pages 72931-72934]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-30274]



Agency for Healthcare Research and Quality

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.


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 

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``Consumer Assessment of Healthcare Providers and Systems (CAHPS) 
Clinician and Group Survey Comparative Database.'' In accordance with 
the Paperwork Reduction Act, 44 U.S.C. 3501-3521, AHRQ invites the 
public to comment on this proposed information collection.

DATES: Comments on this notice must be received by January 27, 2012.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
    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.

Clearance Officer, (301) 427-1477, or by email at 


Proposed Project

Consumer Assessment of Healthcare Providers and Systems (CAHPS) 
Clinician and Group Survey Comparative Database
    The Agency for Healthcare Research and Quality (AHRQ) requests that 
the Office of Management and Budget (OMB) approve, under the Paperwork 
Reduction Act of 1995, AHRQ's collection of information for the AHRQ 
Consumer Assessment of Healthcare Providers and Systems (CAHPS) 
Database for Clinicians and Groups. The CAHPS Clinician and Group 
Database (CAHPS CG Database) consists of data from the AHRQ CAHPS 
Clinician and Group Survey (CAHPS CG Survey). Health systems 
administrators, medical groups and medical practitioners in the U.S. 
are asked to voluntarily submit data from the CAHPS CG Survey to AHRQ 
through its contractor.
    Dating back to the first phase of the CAHPS program (1996-2000), 
the CAHPS Consortium recognized the need for a standardized, evidence-
based instrument that would gather data on patients' experiences with 
physicians and staff in outpatient medical practices, enabling 
clinicians and administrators to assess and improve patients' 
experiences with medical care. In 1999, the Consortium began work on a 
survey that would assess patients' experiences with medical groups and 
clinicians. Working in collaboration with the Pacific Business Group on 
Health, whose Consumer Assessment Survey established a precedent for 
this type of instrument; the CAHPS Consortium developed a preliminary 
instrument known as the CAHPS Group Practices Survey (G-CAHPS).
    In August 2004, AHRQ issued a notice in the Federal Register 
inviting organizations to test this instrument. These field test 
organizations were crucial partners in the evolution and development of 
the instrument, and provided critical data illuminating key aspects of 
survey design and administration. In July 2007 the CAHPS CG Survey was 
endorsed by the National Quality Forum (NQF), an organization 
established to standardize health care quality measurement and 
reporting. The endorsement represents the consensus of many health care 
providers, consumer groups, professional associations, purchasers, 
federal agencies, and research and quality organizations. The CAHPS CG 
Survey and related toolkit materials are available on the CAHPS Web 
site at http://www.cahps.ahrq.gov/cahpskit/CG/CGChooseQX.asp. Since its 
release, the survey has been used by thousands of physicians and 
medical practices across the U.S.
    The current CAHPS Consortium includes AHRQ, the Centers for 
Medicare & Medicaid Services (CMS), RAND, Yale School of Public Health, 
and Westat.
    AHRQ has developed the database for CAHPS CG Survey data following 
the CAHPS Health Plan Database as a model. The CAHPS Health Plan 
Database was developed in 1998 in response to requests from health 
plans, purchasers, and CMS for comparative data to support public 
reporting of health plan ratings, health plan accreditation and quality 
improvement (OMB Control Number 0935-0165, Expiration Date 7/31/2013). 
Demand for comparative results from the CG Survey has grown as well, 
and therefore AHRQ has developed a dedicated CG Database to support 
benchmarking, quality improvement, and research.
    The CAHPS CG Database contains data from AHRQ's standardized CAHPS 
CG Survey, which provides comparative measures of quality to health 
care purchasers, consumers, regulators, and policy makers. The Database 
also provides data for AHRQ's annual National Healthcare Quality and 
National Healthcare Disparities Reports.
    Health systems, medical groups and practices that administer the 
CAHPS CG Survey according to CAHPS specifications can participate in 
this project. A health system is a complex of facilities, 
organizations, and providers of health care in a specified geographic 
area. A medical group is defined as a medical group, Accountable Care 
Organization (ACO), state organization or some other grouping of 
practices. A practice is an outpatient facility in a specific location 
whose physicians and other providers share administrative and clinical 
support staff Each practice located in a building containing multiple 
medical offices is considered a separate practice.
    The goal of this project is to continue to update the CAHPS CG 
Database, with the latest results of the CAHPS CG Survey. These results 
consist of 37 items that measure 5 areas or composites of patients' 
experiences with physicians and staff in outpatient medical practices. 
This database will 1) allow participating organizations to compare 
their survey results with those of other outpatient medical groups; 2) 
facilitate internal assessment and learning in the quality improvement 
process; and 3) provide information to help identify strengths and 
areas with potential for improvement in patient care. The five 
composite measures are:
Getting Timely Appointments, Care, and Information;
How Well Doctors Communicate With Patients;
Helpful, Courteous, and Respectful Office Staff;
Follow-up on Test Results;
Patients' Rating of the Doctor.

    This study is being conducted by AHRQ through its contractor, 
Westat, 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 quality, effectiveness, 
efficiency, appropriateness and value of healthcare services; quality 
measurement and improvement; and health surveys and database 
development. 42 U.S.C. 299a(a)(1), (2), and (8).

Method of Collection

    To achieve the goal of this project, the following activities and 
data collections will be implemented:
    (1) Registration Form--The purpose of this form is to determine the 
eligibility status and initiate the registration process for 
participating organizations seeking to voluntarily submit their CAHPS 
CG Survey data to the CAHPS CG Comparative Database. The point of 
contact (POC) at the participating organization (or parent 
organization) will complete the form. The POC is either a corporate-
level health care manager or a survey vendor who contracts with a 
participating organization to collect the CAHPS CG Survey data.
    (2) Data Use Agreement--The purpose of this form is to obtain 
authorization from participating organizations to use

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their voluntarily submitted CAHPS CG Survey data for analysis and 
reporting according to the terms specified in the Data Use Agreement 
(DUA). The POC will complete the form.
    (3) Data Submission--After the POC has completed the Registration 
Form and the Data Use Agreement, they will submit their patient-level 
data from the CAHPS CG Survey to the CAHPS CG Comparative Database. 
Data on the organizational characteristics such as ownership, number of 
patient visits per year and medical specialty, and information related 
to survey administration such as mode and dates of survey 
administration, sample size, and response rate, which are collected as 
part of CAHPS CG Survey operations, are also submitted. Each submission 
will consist of 3 data files: (1) A Group File that contains 
information about the group ownership and size of group, (2) a Practice 
File containing type of practice, the practice ownership and 
affiliation (i.e., commercial, hospital or integrated delivery system, 
insurance company, university or medical school, community health 
center, VA or military) and number of patient visits per year, and (3) 
a Sample File that contains one record for each patient surveyed, the 
date of visit, survey disposition code and information about survey 
    Survey data from the CAHPS CG Database is used to produce three 
types of products: (1) An online reporting of results available to the 
public on the CAHPS User Network web site; (2) comparative reports that 
are confidential and customized for each participating organization 
(e.g., health system, medical group or practice) that submits data; and 
(3) a database available to researchers for additional analyses.
    Information for the CAHPS CG Database is collected by AHRQ through 
its contractor Westat. Participating organizations are asked to 
voluntarily submit their data to the CARPS Database. The data is 
cleaned with standardized programs, then aggregated and used to produce 
comparative results. In addition, reports are produced that compare the 
participating organizations' results to the database in a password-
protected section of the CAHPS Database online reporting system. Trend 
data will be available to participants when enough data is collected 
across consecutive years.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for 
participating organizations. The burden hours and costs below are based 
on an estimated number of participants. It is estimated that about 30 
health systems, medical groups and practices will participate in the 
CAHPS CG Database. The number of data submissions per participating 
organization will vary because some participants may submit data for 
multiple practices, while others may only submit data for one.
    The total burden for completing the registration, DUA and data 
submission process is estimated to be 246 hours. The 30 participating 
organizations that complete the registration form and submit 
information to the CAHPS CG Database are a combination of an estimated 
20 health systems, medical groups and practices and 10 estimated 
vendors. Information about survey administration and the survey data 
files are submitted together for each participating organization.

                                  Exhibit 1--Estimated Annualized Burden Hours
                                                     Number of       Number of
                    Form name                      respondents/   responses  per     Hours per     Total burden
                                                       POCs             POC          response          hours
Registration Form...............................              30               1            6/60               3
Data Submission.................................              30               1      7 and 6/60             213
Data Use Agreement..............................              30               1               1              30
    Total.......................................              30              NA     8 and 12/60             246

    Exhibit 2 shows the estimated annualized cost burden based on the 
respondents' time to complete the submission process. The cost burden 
is estimated to be $10,485 annually.

                                   Exhibit 2--Estimated Annualized Cost Burden
                    Form name                        Number of     Total burden     hourly wage     Total cost
                                                    respondents        hours          rate *          burden
Registration Form...............................              30               3           42.62             128
Data Submission.................................              30             213           42.62           9,078
Data Use Agreement..............................              30              30           42.62           1,279
    Total.......................................              30             246              NA          10,485
* Mean hourly wage rate of $42.62 for Medical and Health Services Managers (SOC code 19111) was obtained from
  the May 2009 National Industry-Specific Occupational Employment and Wage Estimates, NAICS 621100--Offices of
  Physicians located at http://www.bls.gov/oes/2009/may/naics4_621100.htm.

Estimated Annual Cost to the Government

    Exhibit 3 shows the estimated annualized cost to the government for 
developing, maintaining and managing the CAHPS CG Database, analyzing 
the data and reporting results. The cost is estimated to be $220,000 
annually. Annualized costs for collecting and processing the CAHPS CG 
Database are based upon 10 years of historical CAHPS Health Plan 
Database project costs. AHRQ wishes to continue this data collection 
indefinitely and requests OMB approval for 3 years.

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                  Exhibit 3--Estimated Annualized Cost
             Cost component                 Total cost         cost
Database Maintenance....................        $120,000         $40,000
Data Submission.........................         240,000          80,000
Data Analysis and Reporting.............         300,000         100,000
    Total...............................         660,000         220,000

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: November 15, 2011.
Carolyn M. Clancy,
[FR Doc. 2011-30274 Filed 11-25-11; 8:45 am]